[Show abstract][Hide abstract] ABSTRACT: Five consecutive cases of cervical pregnancy (CP) are presented. In four cases, the diagnosis was made at routine check-ups and these were all treated conservatively. In the fifth case, an erroneous diagnosis of inevitable abortion was made, in a patient presenting with profuse vaginal bleeding. Persistent bleeding following curettage required an emergency hysterectomy, after failure of compressive methods. From the four cases treated conservatively, three received standard methotrexate i.m. (MTX) in combination with bilateral uterine artery embolization (UAE). In one case MTX was followed by intraamniotic puncture and instillation of KCl due to persistent embryonic heartbeat. A spontaneous evacuation of the cervical pregnancy occurred in all patients treated conservatively. We postulate that the preventive use of uterine artery embolization in combination with standard MTX treatment could contribute to reduce the risk of excessive bleeding and facilitate spontaneous expulsion. Possible detrimental effects of the treatment on subsequent reproductive capacities and obstetrical outcome are also pointed out. The diagnostic methods and therapeutic approaches are discussed and the literature is reviewed. With referral to the first case of our series, which required an emergency hysterectomy, we want to stress the importance of an early diagnosis for a correct management of this condition.
No preview · Article · Oct 2008 · The European Journal of Contraception and Reproductive Health Care
[Show abstract][Hide abstract] ABSTRACT: The aim of the paper is to discuss possible urological complications related to laparoscopic hysterectomy and to focus on the most effective strategies to get their occurrence reduced. A review of the literature concerning the safety of the procedure was conducted, comparing laparoscopic hysterectomy (LH) with abdominal hysterectomy (AH) and vaginal hysterectomy (VH) in terms of urological complications during surgery. The possible effect of the "learning curve" on the frequency of this kind of complications was evaluated. The effect of the "learning curve" has been shown by large observational studies where the number of urological complications occurring during LH seems to diminish as the ability in performing this surgical procedure increases. Also the great variability existing between different centres was highlighted showing that the spreading in case of urological complications varies between 0.4% and 4%. The lesions of the bladder roof are not specific for LH while they are commonly associated with AH, although their rate of occurrence is far higher in the LH group when compared with AH (2% vs 0.8%). Little difference seems to exist between VH and LH regarding this specific lesion (1.6 vs 1.2). Ureteral lesions occur with a frequency of 1.2% in the LH and 0.2% in case of an hysterectomy performed by the abdominal route whereas current data show that these lesions are very rare in those women undergoing VH. The present study stresses the importance of intraoperative diagnosis of urological lesions and gives some practical tips to avoid them providing also a brief description of some procedural aspects of LH as performed at our institution.
No preview · Article · Sep 2008 · Minerva ginecologica
[Show abstract][Hide abstract] ABSTRACT: Two methods for the laparoscopic dissection of dermoid ovarian cysts, less than 10 cm, in 55 fertile women, are compared. Water dissection was performed in 23 patients and bipolar scissors were used in 32 patients, creating a rhomb on the surface of the ovary, just to obtain a good traction for atraumatic dissection. The mean surgical time, complications and hospital stay have been compared. Operative laparoscopy is the technique of choice to remove most, if not all, ovarian dermoid cysts. It is suggested to use particular strategies in order to safely and easily dissect in toto the cysts.
No preview · Article · Jul 2003 · Minerva ginecologica
[Show abstract][Hide abstract] ABSTRACT: The purpose of our study is to identify the ureteral and vesical lesions that may occur in the course of total laparoscopic hysterectomy using intraoperative cystoscopy. After the patient has been placed in dorsolithotomic position, we used a Hourcabie manipulator, a 10 mm umbilical trochar and two 5-mm suprapubics. Total hysterectomy is carried out and after closing the vagina 5 ml of stain in a physiological solution are injected into the vein to carry out cystoscopy. Analysis refers to the first 120 patients from 1998 to 1999 treated with laparoscopic hysterectomy. No material or vesical intraoperative lesions were found in any of the patients with the exception of a vesical lesion which was sutured during laparoscopy. Even with the cystoscopic finding normal, 2 fistulas were observed 20 and 25 days after the operation, so the negativity of the cystoscopy excludes certainly immediate complications but not late ones. Furthermore, not all surgeons carry out intraoperative cystoscopy, so the data available are scanty.
No preview · Article · Nov 2002 · Minerva ginecologica
[Show abstract][Hide abstract] ABSTRACT: Palmer s point must be considered a safe alternative site to insert the Verres needle and the primary trocar. It s possible, also, to perform adhesiolysis by this way before to insert the bigger trocar in umbilical site. Our experience shows that this technique can avoid intestinal, omental, injury if the trocar was inserted directly using the umbilical site: that in patients with previous surgery.
No preview · Article · Sep 2001 · Minerva ginecologica