Journal of Gynecological Endoscopy and Surgery
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A comparative evaluation of suburethral and transobturator sling in 209 cases with stress urinary incontinence in 8 years
Prakash Trivedi, Sylvia D'Costa, Preeti Shirkande, Shilpi Kumar, Mangala Patil
July-December 2009, 1(2):105-112
DOI:10.4103/0974-1216.71615  PMID:22442522
Aims and Objectives: To evaluate the outcome of suburethral and transobturator sling in treatment of female stress urinary incontinence in 209 cases from 2002 to 2010. The criteria evaluated were success, failure, complications, operating time, ease of the procedure, availability and cost effectivity of the sling. Design and Setting: A retrospective comparative study was carried out at a tertiary referral centre for female urinary incontinence. Material and Methods: A total of 209 patients (females from 27 to 79 years of age) with proven stress urinary incontinence were treated by suburethral transvaginal tape (TVT) type of slings in 101 cases and transobturator Monarc type of sling in 108 cases at the National Institute of Endoscopic Surgery and Urinary Incontinence Center, Mumbai, India, from March 2002 to June 2010. The maximum follow up was for 8 years. Results: The TVT type of slings had higher complication rate like needle entering the bladder, retention of urine necessitating to cut the tape in the center and had a success rate of 94.5% compared to Monarc/Trivedi obturator tape (TrOT) type of sling with outside-in technique, which had a negligible complication (less than 1%), pain in groin or leg movement that reduced in 6 weeks and a success rate of 95%. Specially, the Indian design Trivedi's stress urinary incontinence tape (TSUIT) and TrOT with reusable needles, the cost was only 15-20% of the international brands.
  14,537 191 1
Entry complications in laparoscopic surgery
S Krishnakumar, P Tambe
January-June 2009, 1(1):4-11
DOI:10.4103/0974-1216.51902  PMID:22442503
Objective: To review the complications associated with laparoscopic surgery and provide clinical direction regarding the best practice based on the best available evidence. Options: The laparoscopic entry techniques and technologies reviewed include the classic pneumoperitoneum (Veress/trocar), the open (Hasson), the direct trocar insertion, the use of disposable shielded trocars, radially expanding trocars and visual entry systems. Evidence: Medline, Pubmed and Cochrane Databases were searched for English language articles published before December 2008. Conclusions: It is an evidence based fact that minimal access surgery is superior to conventional open surgery since this is beneficial to the women, community and the healthcare system.Over the past 50 years, many techniques, technologies and guidelines have been introduced to eliminate the risks associated with laparoscopic entry. No single technique or instrument has been proved to eliminate laparoscopic entry associated injury. Proper evaluation of the women, supported by surgical skills and good knowledge of the technology and instrumentation is the keystone to safe access and prevention of complications during laparoscopic surgery.
  13,076 1,506 8
Laparoscopic myomectomy with uterine artery ligation: Review article and comparative analysis
Rakesh Sinha, Meenakshi Sundaram, Chaitali Mahajan, Shweta Raje, Pratima Kadam, Gayatri Rao
January-June 2011, 2(1):3-10
DOI:10.4103/0974-1216.85272  PMID:22442527
Uterine leiomyomas are one of the most common benign smooth muscle tumors in women, with a prevalence of 20 to 40% in women over the age of 35 years. Although many women are asymptomatic, problems such as bleeding, pelvic pain, and infertility may necessitate treatment. Laparoscopic myomectomy is one of the treatment options for myomas. The major concern of myomectomy either by open method or by laparoscopy is the bleeding encountered during the procedure. Most studies have aimed at ways of reducing blood loss during myomectomy. There are various ways in which bleeding during laparoscopic myomectomy can be reduced, the most reliable of which is ligation of the uterine vessels bilaterally. In this review we propose to discuss the benefits and possible disadvantages of ligating the uterine arteries bilaterally before performing laparoscopic myomectomy.
  13,364 737 2
Hysteroscopy in postmenopausal bleeding
Sunita Tandulwadkar, Prashant Deshmukh, Pooja Lodha, Bhavana Agarwal
July-December 2009, 1(2):89-93
DOI:10.4103/0974-1216.71614  PMID:22442519
Objectives : 1) To study the etiology of postmenopausal bleeding (PMB). 2) To study the significance of hysteroscopy in evaluation of the etiopathogenic factors. 3) Correlating the diagnosis after transvaginal sonography (TVS), hysteroscopy and histopathologic diagnosis. 4) Feasibility of conservative management with hysteroscopy in PMB. Design : Prospective study from January 2008 to June 2009. Setting : Department of Obstetrics and Gynecology of Ruby Hall Clinic, Pune. Patients: Sixty postmenopausal women with complaint of bleeding per vaginum. Interventions: Clinical and sonographic evaluation, followed by diagnostic and/or therapeutic hysteroscopy and guided biopsy. Hysteroscopic images were analyzed and compared with histopathologic results. Measurements and Main Results : On hysteroscopy, endometrium was classified as suggestive of normal, atrophic, endometrial hyperplasia or endometrial carcinoma. Histopathologic diagnosis is taken as a gold standard to determine the efficacy of hysteroscopy in diagnosing endometrial pathologies. The sensitivity and specificity of hysteroscopy in diagnosing endometrial pathologies was assessed. Conclusions : In women with PMB, hysteroscopy is the basic tool that allows precise diagnosis of various endouterine pathologies. The average sensitivity of hysteroscopy was 97% in our study and the specificity was 98.66%. Hence, we can conclude that it is highly accurate for evaluating endometrial pathologies. For obvious benign lesions, it also provides treatment in the same sitting, therefore avoiding an extensive, morbid, and expensive procedure like hysterectomy.
  13,595 472 2
Role of hysteroscopy prior to assisted reproductive techniques
Nandita Palshetkar, Hrishikesh Pai, Suchita Pisat
January-June 2009, 1(1):27-30
DOI:10.4103/0974-1216.51906  PMID:22442507
Background: There have been numerous advances in the area of assisted reproduction. Among the various reasons of implantation failure, intrauterine lesions play an important role. Objective: The aim of the present study is to evaluate the role of hysteroscopy prior to any assisted reproductive technique. Materials and Methods: It is a retrospective study of 292 women who attended our infertility clinic over a period of 18 months, who had a variable number of failed IVF cycles previously. Results: Out of the 292 women studied, in 74 women, that is 25%, intrauterine pathology was detected, which when rectified by hysteroscopy, gave a considerable increase in pregnancy rate. Conclusion: According to this study it can be concluded that evaluating the uterine cavity is an important step before any assisted reproductive procedures.
  13,149 806 -
Laparoscopic management of large myomas
Rakesh Sinha, Meenakshi Sundaram
July-December 2009, 1(2):73-82
DOI:10.4103/0974-1216.71611  PMID:22442517
The objective of this article is to review the different techniques that have been adopted for removal of large myomas laparoscopically. We have also quoted literature about the impact of myomas on Pregnancy and obstetrical outcome and the effect of laparoscopic myomectomy on the same. Technical modifications to remove large myomas have been described along with methods to reduce intraoperative bleeding. This comprehensive review describes all possibilities of laparoscopic myomectomy irrespective of size, site and number.
  12,663 353 1
Reproductive performance after hysteroscopic metroplasty in women with primary infertility and septate uterus
Hrishikesh D Pai, Manisha T Kundnani, Nandita P Palshetkar, Rishma D Pai, Nidhi Saxena
January-June 2009, 1(1):17-20
DOI:10.4103/0974-1216.51904  PMID:22442505
Background: There is enough evidence in the literature to support that removal of septum improves pregnancy rates in women with bad obstetric history. However, its role in patients with otherwise unexplained infertility is still not clear due to paucity of enough evidence. Objective: To assess reproductive performance in women with septate uterus and otherwise unexplained infertility after hysteroscopic metroplasty. Materials and Methods: 72 women with septate uterus and otherwise unexplained primary infertility were included in the study. All these women underwent hysteroscopic septal resection. Reproductive performance of these women within one year of surgery was studied and analysed. Result: 33 women (45.83%) conceived within one year of surgery. Only 4 women (12%) had spontaneous abortions and only 5 (15%) had preterm delivery. Conclusion: Hysteroscopic metroplasty in women with septate uterus significantly improves the reproductive performance.
  12,457 550 3
Total laparoscopic hysterectomy for large uterus
Rakesh Sinha, Meenakshi Sundaram, Smita Lakhotia, Chaitali Mahajan, Gayatri Manaktala, Parul Shah
January-June 2009, 1(1):34-39
DOI:10.4103/0974-1216.51908  PMID:22442509
Aim: In this review, we assessed the feasibility of total laparoscopic hysterectomy (TLH) in cases of very large uteri weighing more than 500 grams. We have analyzed whether it is possible for an experienced laparoscopic surgeon to perform efficient total laparoscopic hysterectomy for large myomatous uteri regardless of the size, number and location of the myomas. Design: Retrospective review (Canadian Task Force Classification II-1) Setting: Dedicated high volume Gynecological laparoscopy centre. Patients: 173 women with symptomatic myomas who underwent total laparoscopic hysterectomy at our center. There were no exclusion criteria based on the size number or location of myomas. Intervention: Total laparoscopic hysterectomy and modifications of performing the surgery by ligating the uterine arteries prior, myomectomy followed by hysterectomy, direct morcellation after uterine artery ligation. Results: 72% of patients had previous normal vaginal delivery and 28% had previous cesarean section. Average clinical size of the uterus was 18 weeks (10, 32). The average weight of the specimen was 700 grams (500, 2240). The average duration of surgery was 107 min (40, 300) and the average blood loss was 228 ml (10, 3200). Conclusion: Total laparoscopic hysterectomy is a technically feasible procedure. It can be performed by experienced surgeons for large uteri regardless of the size, number or location of the myomas.
  11,845 789 5
Predisposing factors for fibroids and outcome of laparoscopic myomectomy in infertility
Prakash Trivedi, Mohini Abreo
January-June 2009, 1(1):47-56
DOI:10.4103/0974-1216.51910  PMID:22442511
Introduction: Fibroids are very common tumors affecting women for centuries, however surprising that no significant data is still available as to what could be the cause of fibroid? What could be the predisposing or risk factors? Does it has any impact on fertility? Outcomes of Laparoscopic myomectomy in infertility? Setting: Advanced Tertiary Gynecologic endoscopic unit. Aims and Objectives: 1) What are the predisposing factors to develop fibroids? 2) Do fibroids lead to infertility? 3) What are the indications for removal of fibroids in infertility? 4) Is laparoscopic surgery better than open surgery? 5) Is the risk of rupture uterus more after laparoscopic myomectomy? 6) What is the success in terms of pregnancy rate after myomectomy? 7) What are the chances of abortions with or without myomectomy? Materials and Methods: A retrospective research study was carried out on 2540 women at the National Institute of Laser and Endoscopic Surgery and Aakar IVF Centre, Mumbai, a referral centre in India. This study was done over a period of 14 years. Women varied in age from 23 to 51 years and infertility of at least more than three years. The woman had fibroids from one to seventeen in number and two centimeters to eighteen centimeters in size which were either submucous, intramural, serosal, cervical or broad ligament. The women requiring hysteroscopic myoma resection were excluded in this study and Laparoscopic myomectomy done in woman other than infertility are also excluded from the study. Results: During the course of our study we found that the diet, weight, hypertension, habits had a bearing on incidence of fibroid. In one of the most promising research fact we found that fibroids itself produce prolactin and due to three times high level of aromatase had higher level of estradiol locally compared to normal myometrium. This was detrimental to fertility. A mild elevation of blood levels of prolactin usually in the range of 40 - 60 ng/ml was noticed in nearly 42% of the cases. Fibroids with infertility as a major complaint along with excessive vaginal bleeding in 33%, pain abdomen and dysmenorhea 10%, pressure symptoms in 3%, accidental finding of a large mass in 5% were the major indications for laparoscopic myomectomy. The pregnancy rate after removal of fibroids with active fertility treatment was 42 % and in donor oocyte IVF was 50%, abortion rate was 5%, 64% LSCS, 31% vaginal deliveries. There was no scar rupture in all pregnancies post laparoscopic myomectomy. Conclusion: Presence of fibroids in first degree female relative, predominantly red meat eating women, excess weight and high Blood pressure increased incidence of fibroids. Pregnancies & oral contraceptives decreased chances of fibroids. In infertile patient fibroids of significant size, multiple, had high local prolactin & aromatase level affecting fertility. Laparoscopic removal of fibroids increased pregnancy rate to 37.2% & 50% in donor oocyte IVF.
  11,859 641 1
Laparoscopic myomectomy with aquadissection and barbed sutures
Rajesh Modi
January-June 2011, 2(1):47-52
DOI:10.4103/0974-1216.85283  PMID:22442536
The objective of this study was to evaluate the efficacy of aquadissection technique to reduce the blood loss in myomectomy and to assess the benefits and feasibility of the use of barbed suture for myometrial defect closure. Vasopressin is diluted with saline as 10 units of vasopressin for every 100 ml of saline. For a fibroid of about 8 cm size, 40 units of vasopressin is diluted in 400 ml of normal saline. The whole of 400 ml of this saline is injected in the myometrium. Incision is made on the uterus with just simple scissors (no energy source is required). As the uterus is cut, instead of bleeding, saline leakage takes place. This helps to keep the field clear and it is easier to get the correct plane between the fibroid and the myometrium. The separation of the fibroid is helped due to the dissection of the correct plane by the saline injection.
  11,397 490 -
Anesthetic implications of robotic gynecologic surgery
J Thomas McLarney, Gregory L Rose
July-December 2011, 2(2):75-78
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.
  10,170 619 -
Hydrosalpinx functional surgery or salpingectomy? The importance of hydrosalpinx fluid in assisted reproductive technologies
Mandakini Parihar, Aparna Mirge, Reshma Hasabe
January-June 2009, 1(1):12-16
DOI:10.4103/0974-1216.51903  PMID:22442504
The first IVF baby, Louise Brown, was born in a natural cycle IVF of a woman who had bilateral tubal block making IVF the only option for having a child. The last 3 decades has seen astounding progress in the field of ART. Today thanks to ART, tubal disease and tubal factor infertility is easily overcome. The accepted theory today is that the hydrosalpinx fluid plays a causative role in the reduced pregnancy rate with ART. It is well known that the success of ART for patients with tubal disease with hydrosalpinx is reduced by half compared with patients without hydrosalpinx. Ideal would be removal of a hydrosalpinx by laparoscopic salpingectomy to improve pregnancy rates. However in some cases this is not feasible due to dense pelvic adhesions making access difficult. In such cases it is recommended that even de-linking the tube from the uterus would help in improving the ART outcome. There is suggestion that sonographically visible hydrosalpinges and those affected bilaterally have a poorer prognosis than those seen incidentally at laparoscopy. While there is clinical evidence supporting the causative role of the fluid itself, there is a lack of knowledge as to how the fluid exerts its negative effects. It is generally believed that the fluid holds a key position in impairing implantation potential. The aim of this review is to highlight the importance of identifying hydrosalpinges and its association with reduced fertility outcome using assisted reproductive technologies. Here we have discussed the different options available for the same, and highlighted the current modes of treatment.
  9,975 641 -
A comparative study between laparoscopically assisted vaginal hysterectomy and vaginal hysterectomy: Experience in a tertiary diabetes care hospital in Bangladesh
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
July-December 2011, 2(2):79-84
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.
  9,597 553 -
Role of diagnostic hysteroscopy in abnormal uterine bleeding and its histopathologic correlation
Sheetal G Patil, SB Bhute, SA Inamdar, Neema S Acharya, Deepti S Shrivastava
July-December 2009, 1(2):98-104
DOI:10.4103/0974-1216.71617  PMID:22442521
Aims and Objectives: To study the accuracy of hysteroscopy in evaluation of abnormal uterine bleeding and to correlate hysteroscopic findings with histopathologic findings. Materials and Methods : A prospective study was carried out in the Department of Obstetrics and Gynecology at AVBRH and JNMC, Sawangi (M), Wardha, from May 2006 to September 2008. One hundred cases were selected for this study from patients of age group 18 and above, who were admitted with the history of abnormal uterine bleeding. Hysteroscopic examination was done in all patients post-menstrually, whenever possible, except in those cases where menstrual cycles were grossly irregular or patients came with continuous bleeding per vaginum. The patients then underwent dilatation and curettage and endometrium was sent for histopathologic examination. The correlation between findings on hysteroscopy and histopathologic examination was tabulated. Results : Following were the findings on hysteroscopy: proliferative 34%, secretary 16%, hyperplasia 18%, atrophic 8%, endometrial polyp 9%, submucous myoma 11%, carcinoma of endometrium 03%, misplaced Cu-T 1%. Conclusion: In patients with abnormal uterine bleeding, hyster­oscopy provides more accurate dia­gnosis than dilatation and curettage.
  9,392 554 -
Multiple layer closure of myoma bed in laparoscopic myomectomy
Nutan Jain, Priyanka Sahni
July-December 2011, 2(2):85-90
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.
  9,361 500 -
Thermal balloon endometrial ablation in dysfunctional uterine bleeding
Rishma Dhillon Pai
January-June 2009, 1(1):31-33
DOI:10.4103/0974-1216.51907  PMID:22442508
Introduction: Dysfunctional uterine bleeding (DUB) affects a large number of women in the reproductive and perimenopausal age group. It significantly impairs the quality of life in otherwise healthy women. There are many different techniques for the conservative management of DUB. Medical management, LNG-IUD, hysteroscopic resection and various global ablation techniques. Materials and Methods: We did a retrospective analysis of 156 women with dysfunctional uterine bleeding who had completed childbearing and who underwent uterine balloon ablation therapy using the Thermachoice device. Majority of the women (72%) were done using short general anesthesia while in the others sedation or local anesthesia was used. Results: 49% women had amenorrhea while 41 % had oligomenorhoea or eumenorrhoea. 90% were satisfied with the procedure. There were no major complications during this study. Conclusions: Thermal balloon endometrial ablation is a simple, safe and effective technique for the permanent treatment of DUB in well selected cases.
  9,037 609 2
Single-port access laparoscopic hysterectomy: A new dimension of minimally invasive surgery
Mereu Liliana, Pontis Alessandro, Carri Giada, Mencaglia Luca
January-June 2011, 2(1):11-17
DOI:10.4103/0974-1216.85273  PMID:22442528
The fundamental idea is to have all of the laparoscopic working ports entering the abdominal wall through the same incision. Single-incision laparoscopic surgery is an alternative to conventional multiport laparoscopy. Single-access laparoscopy using a transumbilical port affords maximum cosmetic benefits because the surgical incision is hidden in the umbilicus and reduces morbidity of minimally invasive surgery. The advantages of single-access laparoscopic surgery may include less bleeding, infection, and hernia formation and better cosmetic outcome and less pain. The disadvantages and limitations include longer surgery time, difficulty in learning the technique, and the need for specialized instruments. This review summarizes the history of SPAL hysterectomy (single-port access laparoscopy), and emphasizes nomenclature, surgical technique, instrumentation, and perioperative outcomes. Specific gynecological applications of single-port hysterectomy to date are summarized. Using the PubMed database, the English-language literature was reviewed for the past 40 years. Keyword searches included scarless, scar free, single-port/trocar/incision, single-port access laparoscopic hysterectomy. Within the bibliography of selected references, additional sources were retrieved. The purpose of the present article was to review the development and current status of SPAL hysterectomy and highlight important advances associated with this innovative approach.
  8,492 260 8
Do new vessel sealing devices and harmonic ace increase ureteric injury in total laparoscopic hysterectomy?
Prakash Trivedi, Sylvia D'Costa, Preeti Shirkande, Meenu Wahi, Shilpi Kumar
July-December 2009, 1(2):83-88
Objectives: To compare the risk of ureteric injury in total laparoscopic hysterectomy (TLH) using new vessel sealing devices (VSDs) and harmonic scalpel with simple scissors, bipolar and suturing. This was an evaluation of 1209 cases, carried out from May 1999 to April 2010. Design and Setting: A retrospective comparative study was carried out at a tertiary gynecological endoscopic unit. Materials and Methods: Out of 1209 patients, who had hysterectomies for various indications, TLH was done in 892 patients, 273 had vaginal hysterectomy and 44 had abdominal hysterectomy. We evaluated the incidence of ureteric injury in these cases. Results: There was no mortality. In the group of vaginal and abdominal hysterectomy, there were no ureteric injuries. In the TLH group, we had 390 cases with simple scissors, bipolar and suturing with no ureteric injury. In 502 cases, new VSDs, e.g., plasma kinetic gyrus, Martin Maxim with Robi grasper, with or without harmonic 5 mm scalpel/ace were used. There were five ureteric injuries, all on the right side (one double ureter): first case was with Martin Maxim and Robi grasper, two with plasma kinetic gyrus 10 mm trissector, one with harmonic scalpel and the last one with scissors. We evaluated the reasons for such ureteric injuries, with experienced laparoscopic surgeons and the best possible set up. There were seven conversions to open surgery out of 892 cases of TLH, more due to poor case selection.
  7,778 233 -
Fibroids, infertility and laparoscopic myomectomy
Pankaj Desai, Purvi Patel
January-June 2011, 2(1):36-42
DOI:10.4103/0974-1216.85280  PMID:22442534
Objective: To review the literature and summarize the available evidence about the relationship of fibroids with infertility and to review the role of laparoscopic myomectomy in infertility. Materials and Methods: Medline, PubMed, and Cochrane Databases were searched for articles published between 1980 and 2010. Results: Fertility outcomes are decreased in women with submucosal fibroids, and myomectomy is of value. Subserosal fibroids do not affect fertility outcomes, and removal may not confer benefit. Intramural fibroids appear to decrease fertility, but the results of therapy are unclear. Although pregnancy rates for women with leiomyomata, managed endoscopically, are similar to those after laparotomy, there is a risk of uterine rupture. The risk is essentially unknown. Finally, the risk of recurrence seems higher after laparoscopic myomectomy compared to laparotomy. Conclusions: Laparoscopic myomectomy, when performed by an experienced surgeon, can be considered a safe technique, with an extremely low failure rate and good results in terms of the outcome of pregnancy.
  7,013 421 3
Laparoscopic management of large ovarian cysts at a rural hospital
Vishwanath V Shindholimath, SG Jyoti, KV Patil, AS Ammanagi
July-December 2009, 1(2):94-97
DOI:10.4103/0974-1216.71616  PMID:22442520
Objective: To assess the feasibility and outcome of laparoscopic surgery for the management of large ovarian cysts at a rural hospital. Materials and Methods: Fifteen patients from March 2004 to February 2007, with large ovarian cysts, with diameter >10 cm, were managed laparoscopically. The masses were cystic and were not associated with ascites or enlarged lymph nodes on ultrasound. Serum CA-125 levels were within the normal range (35 U/ml). Preoperative evaluation included history, clinical examination, sonographic images and serum markers. The management of these ovarian cysts included aspiration, cystectomy or salphingo-oophorectomy, depending on the patient's age, obstetric history and desire of future fertility. In large, solid, fixed or irregular adnexal masses, suspicious of malignancy, laparotomy was done. Results: Five patients presented with pain in the abdomen and 10 patients with abdominal distension and discomfort. The average maximum diameter of the ovarian cysts was 16.75 cm (range 10-24 cm). The mean duration of the operation was 80 min. The postoperative hospital stay was from 4 to 6 days. No intraoperative complications occurred and the hospital course of all patients was uncomplicated. In one case, laparoscopy was converted to laparotomy. One patient had minor wound infection at umbilical port site. The patients did not report any complaints during follow up and the clinical examination findings were normal in all, up to 9 months after discharge. Conclusion: With proper patient selection, the size of an ovarian cyst is not necessarily a contraindication for laparoscopic surgery.
  7,144 249 4
Large bowel injury during total laparoscopic hysterectomy
Malvika Sabharwal
January-June 2009, 1(1):57-58
DOI:10.4103/0974-1216.51911  PMID:22442512
Large bowel injuries are unfortunate complications of laparoscopic surgery, with an incidence of 0.62 to 1.6 per 1000 laparoscopies. One-third of these injuries can be diagnosed intraoperatively, with the rest going unnoticed and revealed later. Rectal injury, a very rare complication, may be caused during pelvic dissection of dense adhesions. Injury at the rectosigmoid junction due to traction with a rectal probe is extremely rare and highly underreported. We report a case of rectal injury during total laparoscopic hysterectomy in a case with dense pelvic adhesions.
  6,867 420 2
Parasitic myoma after morcellation
Rakesh Sinha, Meenakshi Sundaram, Smita Lakhotia, Pratima Kadam, Gayatri Rao, Chaitali Mahajan
July-December 2009, 1(2):113-115
DOI:10.4103/0974-1216.71612  PMID:22442523
We report an interesting case of parasitic fibroid which developed from a morcellation remnant following laparoscopic myomectomy. The patient presented with incidental finding of pelvic mass in 2005. She underwent laparoscopic myomectomy for a myoma extending from the Pouch of Douglas to both sides of broad ligament. She subsequently presented with abdominal pain 3 years later in 2008. She underwent total laparoscopic hysterectomy with removal of broad ligament fibroids. During her hysterectomy, a right lumbar mass attached to the omentum was detected, which was excised laparoscopically. Histopathology of the mass confirmed it to be consistent with leiomyoma. This mass could probably be a morcellation remnant that has grown to this size taking blood supply from the omentum. We report this case to emphasize that all tissue pieces that are morcellated should be diligently removed. Even small bits displaced into the upper abdomen can result in parasitic fibroids. Thus, it can be concluded that parasitic myomas can arise from morcellated remnants and grow depending on the blood supply.
  6,778 186 3
Safety of laparoscopy in ventriculoperitoneal shunt patients
Rajendra Sankpal, Abhishek Chandavarkar, Madhura Chandavarkar
July-December 2011, 2(2):91-93
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.
  6,778 177 -
Single incision laparoscopic myomectomy
B Ramesh, Madhuri Vidyashankar, BV Bharathi
January-June 2011, 2(1):61-63
DOI:10.4103/0974-1216.85288  PMID:22442539
Single port laparoscopic surgery (SPLS), also called SILS is the natural extension of multi-incisional laparoscopic surgery, in the quest for reduction of traumatic insult and residual scarring to the patient. Today with the evolution of newer instruments, bidirectional self-retaining sutures, and surgical experience we are able to perform many surgeries in gynecology.
  6,516 212 4
Detorsion and conservative therapy for twisted adnexa: Our experience
Sunita Tandulwadkar, Amit Shah, Bhavana Agarwal
January-June 2009, 1(1):21-26
DOI:10.4103/0974-1216.51905  PMID:22442506
Objective: 1) To determine if detorsion of the twisted adnexa is better than traditional adnexectomy to conserve the adnexa and preserve its function. 2) To determine the feasibility of detorsion in conservation of adnexa. Design: Prospective Study from September 2004 to September 2008 . Setting: Private IVF and Endoscopy Centre. Patients: 22 patients with twisted adnexa (15 non-pregnant and 7 pregnant) . Intervention: Surgical intervention and either detorsion of adnexa or adnexectomy . Main Outcome Measures: Ovarian preservation and conservation of ovarian function in 77.2% cases determined by: a) Follicular development on sonography (performed for one year after adnexectomy). b) Subsequent surgery for unrelated cause showing healthy ovaries. c) controlled ovarian hyperstimulation and successful oocyte retrieval subsequently. Results: We could conserve the adenexa in 77.2% cases. Laparoscopic detorsion was performed in 11/15(73.33 %) of non-pregnant women and adnexectomy done in four women 26.66%. Among the seven pregnant women, adnexa could be preserved in 6/7(85.7%) and only one woman required adnexectomy. Laparotomy was required in 2/22(9%) women both of which were in late second trimester of pregnancy. In one case (4.54%) we had recurrence of torsion. 88.23% of the women with conserved adnexa showed preservation of ovarian function. Conclusion: Our study showed that timely diagnosis and intervention could make the difference between ovarian loss and salvage- an outcome of great importance in population of reproductive age females. Laparoscopy with its many benefits proves to be superior to laparotomy.
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