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   2018| April-June  | Volume 7 | Issue 2  
    Online since May 2, 2018

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Outcome and management of uterine leiomyosarcoma treated following surgery for presumed benign disease: Review of literature
Tanitra Tantitamit, Kuan-Gen Huang, Manatsawee Manopunya, Chih-Feng Yen
April-June 2018, 7(2):47-55
DOI:10.4103/GMIT.GMIT_10_18  PMID:30254937
Uterine leiomyosarcoma (uLMS) is a rare and aggressive cancer, usually diagnosed incidentally at the time of myomectomy or hysterectomy. There have been concerns for several years about the fact that the inadvertent disruption of occult uLMS may have a negative impact on patient outcome. This study reviews the outcome and management of patients with a diagnosis of uLMS after surgery for presumed benign disease. We conducted a literature search in which 47 published English-language articles were obtained for evaluation. A total of 23 studies with outcomes data were included. It is evidenced that patients who underwent surgery with tumor disruption resulted in poorer outcomes compared with en bloc tumor, especially by power morcellation. The power morcellation was associated with an increased risk of recurrence, shorten time to recurrence, and upstage after re-exploration. Early re-exploration and surgical staging are appreciated for better prognosis and may alter postoperative treatment. We also updated on the incidence and preoperative evaluation to assess the risk of patient and give an effective counseling.
  1,192 250 -
Size, type, and location of myoma as predictors for successful laparoscopic myomectomy: A Tertiary Government Hospital experience
Mikaela Erlinda G. Martinez, Madonna Victoria C. Domingo
April-June 2018, 7(2):61-65
DOI:10.4103/GMIT.GMIT_12_18  PMID:30254939
Background: Laparoscopic myomectomy (LM) is a preferred alternative to abdominal myomectomy due to shorter hospitalization, faster recovery, and decreased intraoperative adhesions. The criteria, however, which constitute proper selection of patients for LM, are still a matter of debate. Since conversion to either laparoscopic-assisted myomectomy (LAM) or laparotomy (EL) entails longer time and increased costs compared to performing an open procedure from the outset, this research aims to evaluate size, location, and type of myoma as predictors for LM. Methodology: Inpatient medical records of all women who underwent LM from January 2014 to August 2016 were retrieved and reviewed. Demographic data, intraoperative records, and postoperative course were obtained. The association of size, type, and location of myomas to the procedure performed was analyzed. Results: There was no significant association between the size of the myoma or its location to the procedure performed. However, intramural and subserous myomas were associated with successful LM, while submucous myomas were associated with conversion to either LAM or EL (P = 0.010). Conclusion: LM is a difficult procedure that challenges even the most skilled laparoscopic surgeon. Proper patient selection lessens complications and decreases the risk of conversion. In this study, type of myoma may be a good predictor for successful LM; however, this conclusion may be limited by the small sample size. A large-scale multicentric prospective study is necessary to validate the role of the proposed predictors to prevent unplanned conversion to an open procedure and reduce cost and increase safety of LM.
  1,170 225 -
Hysteroscopic-guided removal of retained intrauterine device: Experience at an Academic Tertiary Hospital
Ma. Rosielyn D. Asto, Maria Antonia E. Habana
April-June 2018, 7(2):56-60
DOI:10.4103/GMIT.GMIT_11_18  PMID:30254938
Background: Removal of an intrauterine device can be easily done when the string is visible during speculum exam. The task becomes challenging when the string is no longer visible. Methodology: The in-patient and out-patient medical records of all patients admitted for hysteroscopic-guided intrauterine device removal from January 2013 to December 2015 from a tertiary academic government hospital were retrieved and reviewed. Demographic data, intraoperative record, and post-operative course and outcome were obtained. Prior attempts on removal were also noted. Total operative time, type of IUD removed, operative findings and any complications encountered were recorded. The size and model of the hysteroscope were also noted. Results: Nineteen patients were included, twelve were of reproductive age and seven were already in their menopausal years. Majority were multigravida. Reasons for IUD removal for most patients were spotting, desire for pregnancy, and expired date of use. All patients had prior attempts of ultrasound guided IUD removal. Majority of patients had unremarkable post-operative course and no readmissions were noted. Conclusion: Hysteroscopic-guided removal of IUD is a superior option for management when ultrasound guided removal fails. Unnecessary major operation and complications were avoided. In the three – year experience, there has been no major complications and re-admissions related to the procedure. Hysteroscopic removal of IUD was shown to be an effective option after failed ultrasound-guided removal with low risk of complications.
  1,163 227 1
Laparoscopy and computed tomography imaging in advanced ovarian tumors: A roadmap for prediction of optimal cytoreductive surgery
Ahmed Samy El-Agwany
April-June 2018, 7(2):66-69
DOI:10.4103/GMIT.GMIT_1_17  PMID:30254940
Introduction: Comprehensive staging laparotomy and cytoreductive surgery followed by chemotherapy has been the standard of care in advanced ovarian cancer. Neoadjuvant chemotherapy is an alternative in inoperable advanced cases. To select patients amenable for successful cytoreduction, major determinants including CT imaging and laparoscopy could be of value. There is no general accepted model for selection and reproducibility of techniques are a major challenge due to different clinical practice and complexity of scoring systems. Some lesions as small size (<5 mm) peritoneal deposits and mesenteric affection are hard to see on CT so, complementary laparoscopy may play a role in the preoperative assessment. The aim of this study was evaluation of the role of laparoscopy in advanced ovarian tumors for prediction of optimal cytoreductive surgery in relation to CT and surgical peritoneal carcinomatosis index (PCI). Aim: Was to evaluate laparoscopic assessment in advanced ovarian tumors for prediction of optimal cytoreductive surgery in relation to CT and surgical peritoneal carcinomatosis index (PCI). Setting: Gyne-oncology specialized center, El-Shatby maternity university hospital, Alexandria Egypt. Methods: From January 2016 to December 2016, 15 patients were recruited from gyne-oncology specialized center, Alexandria, Egypt. Patients underwent a special design described later then laparoscopy using palmar point entry was done for assessing small lesions and the extent of affection in surface peritoneal, mesentery, serosa of the gut especially small intestine (terminal ileum affection, more or less than 50% affection) mainly with evaluating other sites as liver surface and diaphragm peritoneal surface affection after removal of ascites by aspiration. Findings were correlated with laparotomy and CT scan findings. Surgery was performed in the same setting which is better or with in two weeks. Results: There were two cases with upper abdominal surgeries (cholecystectomy and splenectomy) where no visualization of liver and stomach on laparoscopy but were free on CT scan and surgical evaluation. Douglas pouch was not assessed in two patients with large fixed bilateral ovarian masses on laparoscopy. Two cases with diaphragmatic affection on CT scan related to the posterior surface were not detected on laparoscopy. These findings were correlated with surgical findings as the gold standard. The pathology was ranging from low grade to high grade serous cyst adenocarcinoma. Conclusions: Laparoscopic evaluation is a useful adjunct with CT prior to performing ovarian cancer cytoreductive surgery for assessment of operability. Laparoscopy is better for evaluating extent of serosal affection in advanced tumors in cases with omental cakes on CT. A roadmap for prediction of operability in advanced ovarian cancer can be used by combing CT PCI and laparoscopic assessment.
  1,177 194 3
Laparoscopic management of maldescended ovary presenting with recurrent acute abdomen
Eghoihunu Ireo, Muhammad Haruna, Preeti Gandhi
April-June 2018, 7(2):74-77
DOI:10.4103/GMIT.GMIT_16_18  PMID:30254942
Ovarian maldescent is an extremely rare gynecological phenomenon, usually associated with Müllerian abnormalities. We report a 27-year-old woman, presenting with acute, right-sided abdominal pain. She has a history of subfertility and repeated admissions with chronic pelvic pain. Previous hysterosalpingogram and laparoscopy demonstrated unicornuate uterus with absent right fallopian tube and ovary. A right-sided, ectopic ovary was identified on later imaging and suspected as the cause of her symptoms. She underwent laparoscopic excision of the maldescended ovary with remnant fimbrial end and gubernaculum. She was discharged the following day as she was pain-free and remains so 11 months later. This case report prompts a gynecologist to consider diagnosis of maldescended ovary in the women with uterine abnormalities and repeated episodes of abdominal pain. This is the first case report to the best of our knowledge where surgical management of ovarian maldescent was performed via minimal access approach, thus avoiding laparotomy in this acute setting.
  1,077 126 -
Endometriosis involving the sciatic nerve: A case report of isolated endometriosis of the sciatic nerve and review of the literature
Tal D Saar, Stefaan Pacquée, Dean Helmar Conrad, Mikhail Sarofim, Philippe De Rosnay, David Rosen, Greg Cario, Danny Chou
April-June 2018, 7(2):81-85
DOI:10.4103/GMIT.GMIT_24_18  PMID:30254944
Endometriosis is a common gynecological condition which affects 5–10% of women of reproductive age and up to 50% of women with pelvic pain and infertility. The most commonly affected areas are the pelvic peritoneum, ovaries and rectovaginal septum. Isolated endometriosis of the sciatic nerve is very rare. Our patient suffered from worsening right hip and buttock pain with severe exacerbation during menstruation. Several different imaging modalities (ultrasound of her pelvis and right hip, as well as X-rays and computed tomography scans of her right hip and lumbosacral spine) failed to identify any pathology. Magnetic resonance imaging scans of her pelvis revealed a 3.5 cm endometriotic lesion over the pelvic segment of her right sciatic nerve. Following a multidisciplinary discussion, the patient underwent laparoscopic excision of endometriosis. The patient recovered well from her surgery. She successfully conceived with in vitro fertilization 3 years after her surgery, following a failed course of Clomid (Clomiphene citrate) for ovulatory dysfunction.
  1,000 174 -
Polypoid endometriosis of urinary bladder
Srisupa Laopakorn, Kuan-Gen Huang
April-June 2018, 7(2):86-87
DOI:10.4103/GMIT.GMIT_18_18  PMID:30254945
  917 159 -
Transvaginal natural orifice transluminal endoscopic surgery hysterectomy in a woman with uterine adenomyosis and multiple severe abdominal adhesions
Pei-Chen Li, Dah-Ching Ding
April-June 2018, 7(2):70-73
DOI:10.4103/GMIT.GMIT_6_18  PMID:30254941
Natural orifice transluminal endoscopic surgery (NOTES) had been used for many gynecologic surgeries without pelvic adhesions. We report a 30-year-old female with multiple abdominal adhesions underwent NOTES hysterectomy successfully. A 30-year-old female (para 2, gravida 3, abortus 1) presented with menorrhagia and dysmenorrhea. She had multiple abdominal surgical histories. Computed tomography scan revealed multiple adhesions between the abdominal wall and small intestine. On pelvic ultrasonography, an enlarged uterus 8.3 cm × 3.5 cm with adenomyosis was visualized. Because of the extensive intra-abdominal adhesions, we decided to use a transvaginal NOTES approach to perform hysterectomy. We performed the surgery successfully without complication. Pathological examination confirmed adenomyosis of uterus. NOTES hysterectomy may be feasibly and safely performed in gynecologic patients with extensive abdominal adhesions.
  881 165 1
Hysteroscopy as a tool for identification of uterine endocervical lesion
Maria Crizelda Valino, Chih-Feng Yen, Kuan-Gen Huang, Ala Uwais
April-June 2018, 7(2):88-89
DOI:10.4103/GMIT.GMIT_15_18  PMID:30254946
  784 112 -
An elongated endometrial polyp prolapsing through the introitus in a Virgin
Teerayut Temtanakitpaisan, Hsin-Hong Kuo, Kuan-Gen Huang
April-June 2018, 7(2):78-80
DOI:10.4103/GMIT.GMIT_21_18  PMID:30254943
The objective of the study is to report on the unusual case of an elongated endometrial polyp prolapsing through the introitus. A nulliparous 38-year-old woman presented to the gynecology department with an abnormal mass prolapsing at the vulva area without any abnormal uterine bleeding. Because she had no history of having engaged in sexual intercourse, a pelvic examination was not performed. Ultrasonography revealed an intrauterine hyperechoic lesion 1.5 cm × 0.8 cm in diameter suspected to be endometrial polyp. A hysteroscopy revealed an elongated endometrial polyp 12 cm × 0.5 cm in length, which originated from the midanterior corpus and extended out of the cervix and introitus. Then, the base of the polyp was cut and removed. The pathological report was consistent with an endometrial polyp. This was an unusual case of an elongated endometrial polyp prolapsing through the introitus in a nulliparous woman. Hysteroscopy is the best tool for diagnosis and management in this case.
  768 118 -
Laparoscopic resection of cesarean scar pregnancy with bilateral uterine artery ligation
Ali Emre Tahaoglu, Mehmet Sait Bakir, Yasemin Dogan, Zelal Tahaoglu
April-June 2018, 7(2):90-91
DOI:10.4103/GMIT.GMIT_7_18  PMID:30254947
  703 109 -
Erratum: The role of hysteroscopy in evaluating postmenopausal asymptomatic women with thickened endometrium

April-June 2018, 7(2):92-92
DOI:10.4103/2213-3070.231753  PMID:30254948
  677 96 -