Journal of Gynecological Endoscopy and Surgery
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   Table of Contents - Current issue
July-December 2011
Volume 2 | Issue 2
Page Nos. 75-114

Online since Saturday, June 29, 2013

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Anesthetic implications of robotic gynecologic surgery p. 75
J Thomas McLarney, Gregory L Rose
Surgery using robotic techniques is becoming more and more common. One of the specialties at the fore-front of robotic surgery has been gynecology, much like it was at the fore-front a generation ago in bringing laparoscopy into the operating room. New considerations have been noted and new techniques have been learned on both sides of the drape in order to ensure a successful outcome for the patient undergoing robotic gynecologic surgery. The purpose of this article is to bring, to light the concerns facing the anesthesiologist in regards to robotic procedures. We discuss the problems facing anesthesiologists, when a patient is experiencing both intraabdominal insufflation and steep Trendelenburg position, and also the intraoperative management of such a patient.
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A comparative study between laparoscopically assisted vaginal hysterectomy and vaginal hysterectomy: Experience in a tertiary diabetes care hospital in Bangladesh p. 79
Samsad Jahan, Tripti Das, Nusrat Mahmud, Masuda Islam Khan, Latifa Akter, Samiron Kumar Mondol, Sharmin Yasmin, Nurun Nahar, Samira Humaira Habib, Soma Saha, Debashish Paul, Mahjabin Joarder
Objective: The study was undertaken to compare the efficiency and outcome of Laparoscopic Assisted Vaginal Hysterectomy (LAVH) and Vaginal Hysterectomy (VH) in terms of operative time, cost, estimated blood loss, hospital stay, quantity of analgesia use, intra- and postoperative complication rates and patients recovery. Materials and Methods: A total of 500 diabetic patients were prospectively collected in the study period from January 2005 through January 2009. The performance of LAVH was compared with that of VH, in a tertiary care hospital. The procedures were performed by the same surgeon. Results: There was no significant difference in terms of age, parity, body weight or uterine weight. The mean estimated blood loss in LAVH was significantly lower when compared with the VH group (126.5±39.8 ml and 100±32.8 ml), respectively. As to postoperative pain, less diclofenac was required in the LAVH group compared to the VH group (70.38±13.45 mg and 75.18±16.45 mg), respectively. Conclusions: LAVH, is clinically and economically comparable to VH, with patient benefits of less estimated blood loss, lower quantity of analgesia use, lower rate of intra- and postoperative complications, less postoperative pain, rapid patient recovery, and shorter hospital stay.
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Multiple layer closure of myoma bed in laparoscopic myomectomy p. 85
Nutan Jain, Priyanka Sahni
Objective: To assess the feasibility and outcome of laparoscopic Myomectomy and multiple layer closure of myoma bed for management of myomas at a tertiary care hospital. Materials and Methods: Four hundred and seventeen patients from September 2005 to September 2010 with large and moderate size myomas were managed by laparoscopic Myomectomy. Indications were subfertility, menorrhagia and abdominal mass. Pre-operative evaluation included history, clinical examination and sonographic mapping. Myomas were enucleated and retrieved laparoscopically. Myoma beds were sutured in multiple layers by endoscopic intracorporeal suturing. Results: Three hundred and fifteen patients presented with subfertility, 45 with menorrhagia and 57 with abdominal mass. The average maximum diameter of myoma was 9 cm. The mean duration of surgery was 120 min. The mean post-operative stay was 24 h. No intra-operative complication occurred and hospital course was uncomplicated. In one case, minilap incision was given for retrieval of myoma and suturing of the bed. Two patients had minor delayed wound healing of the morcellator port site. The patients did not report any complaints during follow-up except one patient who developed omental hernia at morcellator port site. There was no rupture of scar and very low adhesion scores in subsequent caesarian sections or second look scopies. Conclusion: With proper multilayer closure of the myoma bed, laparoscopic Myomectomy is feasible for moderate and even large myomas and has excellent outcomes.
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Safety of laparoscopy in ventriculoperitoneal shunt patients p. 91
Rajendra Sankpal, Abhishek Chandavarkar, Madhura Chandavarkar
There has been an increasing trend in Laparoscopic surgeries. There is also a higher incidence of patients with ventriculoperitoneal (VP) shunts due to the advances in the techniques of cerebral shunts. Surgeons may come across patients of VP shunts presenting with an indication for laparoscopic surgery. Although there is no absolute contraindication for laparoscopy in VP shunts, there is always a risk of raised intracranial pressure. We describe a case of VP shunt presenting with an ectopic pregnancy and undergoing laparoscopic salpingectomy. Patient withstood the procedure well and had an uneventful recovery. Reviewing the literature, we found that laparoscopy is safe in VP shunts. However, there should always be accompanied by good monitoring facilities.
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Laparoscopic management of congenital cervico-vaginal agenesis p. 94
Nutan Jain, Reema Sircar
We report a case of cervical agenesis or lack of uterine cervix. It is a rare mullerian anomaly and occurs in 1 in 80,000-100,000 births. The patient presented to us with primary amenorrhea and cyclical left lower abdominal pain. She was diagnosed to have cervical agenesis associated with vaginal agenesis and left endometriotic cyst. Neovagina was created laparoscopically. Utero-vaginal anastomosis was tried but it was not technically feasible. Subsequently, laparoscopic hysterectomy was done due to recurrent endometriotic cyst formation.
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Rare case of ovarian cystic lymphangioma managed at laparoscopy p. 97
Sejal Arunbhai Naik
Lymphangiomas are rare, usually benign tumors of the lymphatic system. Lymphangiomas may arise in any part of the body. Lymphangioma of the ovary is very rare tumor, which is usually slow-growing, remains asymptomatic for a long time, and identified incidentally at histopathological examination after excision. It is advisable to excise the lesion with microscopically clear margins. Many times, diagnosis becomes difficult because of confusion with malignant ovarian mass, especially in post-menopausal woman. A 72-year-old post-menopausal woman had a symptomatic pelvic mass. Imaging studies demonstrated a complex right ovarian cyst. Laparoscopic total hysterectomy with bilateral salpingo-oophorectomy was performed successfully. Cystic Lymphangioma should be included in the differential diagnosis of an ovarian cystic mass, and laparoscopic excision may be the method of treatment.
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Laparoscopic resection of unruptured rudimentary horn pregnancy p. 101
Deepti Sharma, MG Usha, Ramesh Gaikwad, S Sudha
A non-communicating rudimentary horn is an uncommon site for ectopic pregnancy. Rudimentary horn pregnancy (RHP) is a rare entity but associated with grave clinical consequences. Majority of these cases if not detected timely end up in uterine rupture and present as an obstetrical emergency. We present this case of a 32-year-old, third gravida with a 12 weeks live gestation in the right rudimentary horn, which was successfully managed with laparoscopic resection. Early diagnosis is the key stone in the management of such cases. Laparoscopic resection is a safe and viable option in the surgical management of unruptured RHP.
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Herlyn-Werner-Wunderlich syndrome complicated with pyocolpos: An unusual cause of postabortal sepsis p. 105
Deepti Sharma, MK Janu, Ramesh Gaikwad, MG Usha
Obstructive mullerian anomalies give rise to a spectrum of clinical presentations and are uncommon in routine gynecologic practice. The patient usually becomes symptomatic in early reproductive years. Recurrent pelvic pain, dysmenorrhea, enlarging abdominopelvic mass, and abnormal vaginal discharge are the common presenting symptoms. We describe a rare case of a mullerian anomaly getting diagnosed 13 years after attaining menarche during the evaluation of postabortal sepsis. Patient presented 2 weeks following evacuation carried out for missed abortion, with acute abdominal pain, fever and foul smelling discharge per vaginum. The anomaly was identified as uterus didelphys with obstructed left hemivagina and ipsilateral renal agenesis (Herlyn-Werner-Wunderlich syndrome) complicated by pyocolpos. She was successfully managed by single-stage transvaginal septum resection under laparoscopic control.
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Laparoscopic management of a rare case of spontaneous adnexal torsion in an adolescent p. 109
PN Shakuntala, Gowri Shankar
The occurrence of spontaneous torsion of normal ovary and fallopian tube in an adolescent is very rare. We report a case of a 14-year-old post-menarche teenager who presented as acute abdomen. Here, we discuss the differential diagnosis of acute pain abdomen, importance of immediate diagnostic laparoscopy and prompt decision for de torsion of the ovarian pedicle and mesoalphinx to salvage the fallopian tube and ovary, which has a bearing on future reproduction. The teenager is on follow-up for 4 years and has regular cycles and no recurrence of the symptoms.
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Laparoscopic management of tubo-ovarian stitch abscess after tubal sterilization p. 112
Jyoti S Ghongdemath, Vishwanath V Shindholimath, L Krishna
Tubo-ovarian abscess usually results from ascending infection of the lower genital tract. In few cases, it can occur as a result of direct contamination at the time of tubal sterilization. We describe two rare cases of "tubo-ovarian stitch abscess" after post-partum tubal sterilization and managed successfully by laparoscopy at a tertiary care teaching hospital.
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