Journal of Gynecological Endoscopy and Surgery

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...

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...

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...

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...

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...

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...

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...

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...

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.

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...

Two cases of true broad ligament fibroids and thirty cases of false broad ligament fibroids were operated. All were removed through the laparoscopic route, with very minimal blood loss and without a need for blood transfusion. We traced the course of the ureters in all cases. No complications were met with.

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.

A 43-year-old, who underwent a subtotal hysterectomy for postpartum hemorrhage following a normal delivery, 10 years ago, presented with a history of persistent vaginal discharge and post-coital bleeding. A pap smear reported moderate dysplasia, and a subsequent colposcopic biopsy reported severe dysplasia with crypt extension. The patient underwent a laparoscopic trachelectomy, and histology of the stump reported cervical squamous carcinoma in situ, with no microinvasion.

Although there are many studies the ongoing debate on the management of posthysterectomy vault prolapse whether it should be abdominal, vaginal, or laparoscopic still continues. However there is no clear consensus. Though the incidence of vaginal vault prolapse is said to range from 0.2 to 45%, the choice of the optimal treatment depends on the surgeon's experience, suitability for surgery, age, symptoms, quality of life impairment, and prolapse grade. Abdominal sacrocopopexy (ASCP) with mesh interposition is the traditional surgical procedure for treating pelvic organ prolapse and has been shown to have one of the highest long-term success rates for vaginal vault prolapse...

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)...

OBJECTIVE: To assess the feasibility and outcome of laparoscopic myomectomy and multiple layer closure of the myoma bed, for management of myomas, at a tertiary care hospital. MATERIALS AND METHODS: From September 2005 to September 2010, 417 patients, with large and moderate size myomas, were managed by laparoscopic myomectomy. Indications were subfertility, menorrhagia, and abdominal mass. Preoperative evaluation included history, clinical examination, and sonographic mapping...

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...

Most of the surgeons find it difficult to perform myomectomy when it bleeds during the procedure as it becomes difficult to get into the correct plane of dissection. If this bleeding or blood staining of tissues is prevented it will be easier to get into the correct plane of dissection. In several studies, it is found that bilateral uterine artery ligation, at origin, does not interfere with future fertility as the end vessels and collaterals of the uterus are not interfered with. As no energy source is used to incise the myoma once Vasopressin has been used, the myomectomy scar integrity is better, as noted by various surgeons...

Compared to myomas that occur in the uterine corpus, cervical myomas are closer to other organs such as the bladder, ureter, and rectum, and the approach needs to be modified, as the organs that have to be considered differ depending on the location of the myoma. Surgical difficulties associated with these cases are, poor access to the operative field, difficulty in suturing the repairs, increased blood loss, and distortion of the anatomy of the vital neighboring structures in the pelvic cavity.

Services provided by healthcare providers have been the subject matter of judicial review time and again. The Consumer Disputes Redressal Commissions have laid down decisively what is and what is not 'deficiency' in the services provided by a healthcare provider. 'Deficiency' means, any fault, imperfection, shortcoming or inadequacy in the quality, nature, and manner of performance that is required to be maintained by or under any law for the time being in force or has been undertaken to be performed by a person in pursuance of a contract or otherwise, in relation to any service...