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   2020| January-March  | Volume 9 | Issue 1  
    Online since January 23, 2020

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Laparoscopic removal of a 40-cm paratubal cyst in a morbidly obese patient
Luay Ibrahim Abu Atileh, Duaa Dahbour, Hasan Hammo, Mai Abdullattif
January-March 2020, 9(1):39-41
Paratubal cysts (PTCs) are remnants of the paramesonephric or the mesonephric ducts that are present during embryogenesis. They are mostly benign; however, malignancy has been described. The incidence of PTCs is estimated to be 5%–20% of all adnexal masses. They can present in any age group but most commonly the third or fourth decades. Huge PTCs exceeding 10–15 cm in diameter are considered rare and challenging, as only a few cases have been reported that describe complete laparoscopic excision. A simple asymptomatic PTC can be managed expectantly; however, surgery is mandatory if the cyst is huge, complicated, or causes severe symptoms. In this article, we describe a laparoscopic removal of a 40-cm PTC in a 32-year- old woman, as the largest PTC in literature that was removed by laparoscopy.
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The significant risk factors of intra-operative hemorrhage during laparoscopic myomectomy: A systematic review
Zaki Sleiman, Rania El Baba, Simone Garzon, Aline Khazaka
January-March 2020, 9(1):6-12
Laparoscopic myomectomy (LM) is becoming increasingly common in the management of uterine myomas and is usually offered regardless of the number, location, and size of the myomas. It has a generally low rate of periprocedural complications and is preferred to laparotomy for several reasons that are not limited to decreased length of hospital stay, number of sutures, smaller incisions, and decreased pain. However, blood loss during LM remains a challenge. To be able to stratify patients and provide better management after LM, it is crucial to identify these predictors of blood loss. Therefore, the aim of this review was to identify the risk factors for periprocedural blood loss after laparoscopic uterine myomectomy. According to our data synthesis, age, body mass index, and phase of the menstrual cycle do not seem to affect the blood loss during LM. Conversely, size and number of myomas, as well as operative time, was directly related to the increase of blood loss.
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A high-intensity focused ultrasound surgery theater design in a private clinic
Lian Zhang, Felix Wu Shun Wong
January-March 2020, 9(1):1-5
Noninvasive high-intensity focused ultrasound (HIFU) surgery has become a popular surgical treatment for fibroids, adenomyosis, and various gynecological diseases in China and many countries. While traditional theater designs in hospitals are standardized and easily available for reference, an outpatient HIFU theater design is not yet available in the literature or is nonexistent. The authors presented the design and setup of an ultrasound-guided HIFU center in Hong Kong and listed the space and safety requirements and special features of their HIFU theater. Despite its limited space, the HIFU surgery center has made available a nursing station, a changing room, and an observation/recovery room. A room for learning HIFU treatment and viewing is also available without any intrusion of patient's privacy during treatment. The article concluded that because the space requirements for a HIFU theater were much reduced, the cost of the HIFU theater setup would be much cost-effective. Finally, its relaxing lighting environment was totally different and impossible to be installed in a traditional operating theater in a hospital.
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Role of frozen section in surgical management of ovarian neoplasm
Saphina Palakkan, Tony Augestine, MK Valsan, K P Abdul Vahab, Lekha K Nair
January-March 2020, 9(1):13-17
Objective: Cancers of the adnexae, including ovarian and fallopian tube, constitute the eighth most common cancers among women worldwide. Surgery remains the cornerstone in the management of ovarian cancer. Intraoperative frozen section diagnosis of ovarian tumors is widely used in making this distinction and to decide the course of surgery. Therefore, the accuracy of this technique is very important. The aim was to determine the overall accuracy, sensitivity, specificity, and predictive values of frozen section for ovarian tumors and to evaluate the role of frozen section in the surgical management of ovarian tumors. Materials and Methods: This was a descriptive longitudinal study conducted in the gynecology department of a tertiary care hospital. During the 1 ½ year period of data collection, frozen section was performed among 60 cases of ovarian neoplasms. The overall accuracy, sensitivity, specificity and predictive values of frozen section for benign, borderline and malignant categories of ovarian tumors were studied. Results: Out of the 60 patients of ovarian tumors, frozen section diagnosis showed that 43 (71.7%) tumors were benign, 11 (18.3%) were malignant and 6 (10%) were of borderline nature. Final histopathological diagnosis showed that 45 (75%) tumors were benign, 11 (18.3%) were malignant and 4 (6.7%) were borderline. Frozen section for benign tumors had 95% sensitivity, 100% specificity, 100% positive predictive value (PPV) and 88% negative predictive value (NPV). Malignant tumors had 90% sensitivity, 97% specificity, 90% PPV and 97% NPV with frozen section. However, frozen section had low sensitivity (75%) and PPV (50%) for borderline tumors. Specificity was 94% and NPV 98% in this group of tumors. Conclusion: Frozen section was found to be an accurate and useful modality in the intraoperative evaluation of patients with ovarian neoplasm. The results can help to decide the type and extent of surgery.
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Laparoscopic pectopexy and paravaginal repair after failed recurrent pelvic organ prolapse surgery
Mehmet Sait Bakir, Ihsan Bagli, Yunus Cavus, Ali Emre Tahaoglu
January-March 2020, 9(1):42-44
Laparoscopic pectopexy has been described recently for pelvic organ prolapse (POP) and it could be an alternative surgery to sacrohysteropexy. A 36-year-old parity 3 women was operated cause of POP, and on her history, she had performed one sacrospinous ligament fixation with colporrhaphy anterior and one abdominal sacrohysteropexy because of POP. After 6-month follow-up, anatomic and functional cures were provided. Laparoscopic pectopexy could be an alternative procedure for recurrent POP surgery with promising results.
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Endometrial polyp removed by a manual hysteroscopic tissue removal device
Menelik Man Hin Lee
January-March 2020, 9(1):34-35
We report one of the first cases where an endometrial polyp was removed using a manual hysteroscopic tissue removal (HTR) device. The case showed its feasibility with potential reduction in the required setup time and tubing required compared to routine HTR device. This technique is ideal in the removal of endometrial polyps, particularly within the outpatient settings.
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Ovarian fibroma commonly misdiagnosed as uterine leiomyoma
Ibrahim A Abdelazim, Mohannad Abu-Faza, Khaled Abdelrazek, Osama O Amer, Svetlana Shikanova, Gulmira Zhurabekova
January-March 2020, 9(1):36-38
Ovarian fibroma usually misdiagnosed preoperatively as uterine leiomyoma. A 36-year-old woman, presented with abdominal pain and vomiting, provisionally diagnosed as complicated ovarian cyst. The transvaginal ultrasound and Doppler showed left solid adnexal mass with preserved ovarian blood flow. Magnetic resonance imaging showed a well-defined solid mass in the left side of the pelvis, measuring 8 cm × 10 cm most probably subserous uterine leiomyoma. At laparotomy, the solid ovarian mass was originating from the left ovary, and the microscopic examination confirmed the diagnosis of the ovarian fibroma. This report represents the preoperative misdiagnosis of the ovarian fibromas and the conservative ovarian surgery for the ovarian fibromas and the importance of the follow-up for future fertility and/or recurrence of the fibromas in young women.
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Establishing a low-budget hysteroscopy unit in a resource-poor setting
Jude Ehiabhi Okohue, Joy Ose Okohue
January-March 2020, 9(1):18-23
Objective: To report our experience in establishing a low-budget hysteroscopy unit in the Niger Delta Region of Nigeria over a 7-year period. Materials and Methods: A retrospective descriptive study carried out between April 1, 2010, and March 31, 2017. Transaction receipts for the hysteroscopic equipment were retrieved. Situations where we had to improvise were documented. Patients' case files were retrieved, and relevant data were extracted. Results: A cart was made by a technician; home television sets served as monitors. A back-up, handheld LED light source was used. The hysteroscopic forceps and scissors were detachable versions. Sterile urine bags were improvised for providing larger saline infusions for bipolar resections. A total of 1002 hysteroscopic procedures were performed. Majority of the patients (979 or 97.70%) presented with infertility. The most common indication for hysteroscopy was intrauterine adhesions (401 or 40.01%). While 765 (76.35%) operative hysteroscopies were performed, 237 (23.65%) were diagnostic. The most common surgical procedure performed was intrauterine adhesiolysis (483 or 63.14%). There were 4 (0.40%) cases of inadvertent uterine perforation and one case (0.10%) of glycine distension fluid overload. Conclusion: Hysteroscopy with acceptable results is possible in a resource-poor setting using numerous innovative ways to circumvent the need for some of the expensive equipment.
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Laparoscopic detorsion and fertility preservation in twisted ischemic adnexa – A single-center prospective study
Devi Balasubramaniam, Kavitha Yogini Duraisamy, Malathi Ezhilmani
January-March 2020, 9(1):24-28
Objective: This study aimed to analyze our experience about the salvageability of ovary in cases of adnexal torsion by laparoscopy, irrespective of the grade of necrosis and number of twists, and to assess the subsequent ovarian viability. Materials and Methods: This is a prospective study conducted in a tertiary care laparoscopic institute. All the cohorts of intraoperative diagnosis of adnexal torsion were included irrespective of the age group from January 2015 to January 2018 over the period of 3 years after obtaining approval from the institute's human ethics committee. Their demographic details and clinical and operative findings were entered after obtaining an informed written consent. All patients underwent laparoscopy except those with a suspicious diagnosis of malignancy. Postoperatively, ovarian viability was assessed by ultrasound Doppler in terms of vascularity and follicular development at 1, 6, and 12 months. Results: A total of 84 patients were included in the study. Acute abdominal pain (71.4%) was the main presenting symptom in all age groups. The total number of cases of adnexal torsion was 69. Adnexal torsion was mainly diagnosed in young and adolescent girls. Out of 46 attempted detorsion, 45 ovaries were preserved (97.8%). Most of the pathologies were benign. All the preserved ovaries were showing follicles and vascularity during ultrasound follow-up. Conclusion: Laparoscopic detorsion of the ovary is the best treatment modality irrespective of the grade of ischemia. Ovarian structure and follicles were preserved following detorsion in all the cases, even in gravely ischemic ovaries.
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Comparative study of laparoscopic versus conventional open surgical staging procedure for endometrial cancer: Our institutional experience
Subbiah Shanmugam, Rajkiran Thanikachalam, Arul Murugan
January-March 2020, 9(1):29-33
Objective: The aim of this study was to compare laparoscopic surgical staging of endometrial cancer with conventional open methods. Materials and Methods: The retrospective data were collected from 90 endometrial cancer patients who were operated between 2013 and 2018 in our government institution. The safety and morbidity of the two groups were compared based on mean operative time, blood loss, intraoperative complications, postoperative complication, etc., and the results were analyzed. Statistical analysis was performed using IBM SPSS statistics version 20. Clinical and pathologic factors were compared between two groups with Fisher's exact test and Student's t-test for data analysis. The survival data were analyzed using Kaplan–Meier survival curves. P < 0.05 was considered statistically significant. Results: Thirty-two patients underwent laparoscopic staging, 45 underwent laparotomy, and 13 cases lap converted to open surgery. The mean operative time for the laparoscopic procedure was lower than the open procedure (P = 0.001). The mean hospital stay of patients who underwent laparoscopic staging was around 7.1 days significantly less compared to the laparotomy group. Intraoperative blood loss of patients undergoing laparoscopic surgery was significantly less than that of the laparotomy group (P = 0.015). There was no statistically significant difference in nodal retrieval between laparotomy and laparoscopy group (P = 0.172). The mean duration of hospitalization was statistically significantly greater in the laparotomy group than the laparoscopic group (13 and 7 days, P < 0.001). Based on the Kaplan–Meier survival curve, there was no difference in survival rates between the groups. Median follow-up duration was 32 months. Conclusion: Laparoscopic surgical staging is oncologically safe for the management of endometrial cancer with acceptable morbidity compared to the open approach with far less blood loss and shorter postoperative stay.
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Magnetic resonance imaging-guided high-intensity focused ultrasound ablation for endometriosis of the abdominal wall
Minh Duc Nguyen
January-March 2020, 9(1):45-46
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A rare case of utero-ovarian ligamental leiomyoma
Gayatri Rao, Sharda Arvind, Shweta Raje, Latika J Chawla
January-March 2020, 9(1):47-48
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A rare presentation of cervical lipoleiomyoma with hematometra
Reddy Ravikanth, Kanagasabai Kamalasekar
January-March 2020, 9(1):49-50
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