JOURNAL SPOTLIGHT: Laparoscopic Management of Sacral Nerve Root Schwannoma With Intractable Vulvococcygodynia: Report of Three Cases and Review of Literature June 17, 2013

Authors: Marc Possover, Plamen Kostov
Citation: The Journal of Minimally Invasive Gynecology, Volume 20, Issue 3, Page 394-397
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Abstract: Herein we report the feasibility of laparoscopic resection of schwannomas of the sacral nerves roots in 3 women with intractable vulvodynia and coccygodynia. Laparoscopic en bloc resection of the sacral schwannomas was performed, with primary control of the tumor blood supply and with exposure and sparing of the sacral nerve roots. In all 3 patients, laparoscopy was successful, with minimal blood loss and without complications. Histologic examination confirmed the diagnosis of schwannoma without malignant transformation in all 3 women. At mean follow-up of 27.66 months, no patient reported recurrence or worsening of symptoms. All patients are able to walk normally without gait aids. Primary control of the tumor blood supply during laparoscopic surgery to resect deep sacral masses reduces considerably the risk of operative hemorrhage. Compared with classic neurosurgical approaches, laparoscopic exposure of the rectum, ureters, and sacral nerve roots renders the procedure safer and easier, with less risk of postoperative functional morbidity.

JOURNAL SPOTLIGHT: Robotic-Assisted Laparoscopic vs Abdominal and Laparoscopic Myomectomy: Systematic Review and Meta-Analysis June 14, 2013

Authors: Jyotsna Pundir, Vishal Pundir, Rajalaxmi Walavalkar, Kireki Omanwa, Gillian Lancaster, Salma Kayani
Citation: The Journal of Minimally Invasive Gynecology, Volume 20, Issue 3, Page 335-345
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Abstract: Herein is presented a systematic review and meta-analysis of evidence related to operative outcomes associated with robotic-assisted laparoscopic myomectomy (RLM) compared with abdominal myomectomy (AM) and laparoscopic myomectomy (LM). Outcome measures included estimated blood loss (EBL), blood transfusion, operating time, complications, length of hospital stay (LOHS), and costs. Meta-analysis 1 compared RLM vs AM, and meta-analysis 2 compared RLM vs LM. Studies scored moderately well on the Newcastle-Ottawa Quality Assessment Scale. No significant differences were found in age, body mass index, or number, diameter, and weight of myomas. In meta-analysis 1, EBL, blood transfusion, and LOHS were significantly lower; risk of complications was similar; and operating time and costs were significantly higher with RLM. In meta-analysis 2, no significant differences were noted in EBL, operating time, complications, and LOHS with RLM; however, blood transfusion risk and costs were higher. It was concluded that insofar as operative outcomes, RLM has significant short-term benefits compared with AM and no benefits compared with LM. Long-term benefits such as recurrence, fertility, and obstetric outcomes remain uncertain.

JOURNAL SPOTLIGHT: Laparoscopic Transvesical Approach for Vesicovaginal Fistula Repair June 12, 2013

Authors: Shailesh P. Puntambekar, Riddhi Desai, Amit Galagali, Geetanjali Agarwal Joshi, Saurabh Joshi, Rahul Kenawadekar, Archit Pandit, Anup Aitwade, Seema S. Puntambekar
Citation: The Journal of Minimally Invasive Gynecology, Volume 20, Issue 3, Page 334-334
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Abstract: Study Objective: To access the technical feasibility of performing laparoscopic repair of vesicovaginal fistula.Material and Methods: We attempted a laparoscopic repair of vesicovaginal fistula in five women with a history of urinary leakage via the vagina after vaginal hysterectomy. Five pelvic ports were used. The surgical procedure was performed using the same principles as for open surgery, i.e., separation of the vaginal wall from the bladder wall, repair of the fistula, and interposition of the omentum.Results: There was early recovery of the patients in terms of continence, with less chance of recurrence. Results were comparable to those with the vaginal approach.Conclusion: The use of minimally invasive surgery for vesicovaginal fistula repair helps to ease the suturing deep in the pelvis, and the magnification facilitates good identification of tissues planes and thus better mobilization of the vaginal and bladder walls and decreases postoperative morbidity.

JOURNAL SPOTLIGHT: CO2 Laser Treatment for Bartholin Gland Abscess: Ultrasound Evaluation of Risk Recurrence June 10, 2013

Authors: Violante Di Donato, Filippo Bellati, Assunta Casorelli, Margherita Giorgini, Giorgia Perniola, Claudia Marchetti, Innocenza Palaia, Pierluigi Benedetti Panici
Citation: The Journal of Minimally Invasive Gynecology, Volume 20, Issue 3, Page 346-352>
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Abstract: Study Objective: To evaluate the efficacy of CO2 laser treatment and parameters correlated with recurrence in patients with Bartholin gland abscesses treated using this approach.Design: Prospective study (Canadian Task Force classification II-2).Setting: University hospital.Patients: One hundred forty-seven patients who met eligibility criteria.Intervention: Preoperative ultrasound evaluation of Bartholin gland lesions and CO2 laser treatment.Measurements and Main Results: All patients received CO2 laser therapy, with median operative time 15 minutes (range, 12

JOURNAL SPOTLIGHT: Prospective Evaluation of the Incidence of Uterine Vascular Malformations Developing After Abortion or Delivery June 7, 2013

Authors: Hiroyuki Yazawa, Syu Soeda, Tsuyoshi Hiraiwa, Masayo Takaiwa, Sumiko Hasegawa-Endo, Manabu Kojima, Keiya Fujimori
Citation: The Journal of Minimally Invasive Gynecology, Volume 20, Issue 3, Page 360-367
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Abstract: Study Objective: To describe the incidence of uterine vascular malformations (UVMs) including uterine arteriovenous malformations (AVMs) in patients after abortion or delivery and in outpatients.Design: Prospective study (Canadian Task Force classification II-3).Setting: Fukushima Red Cross Hospital.Patients: Six patients with a UVM including 1 with an AVM.Interventions: Clinical screening of patients using transvaginal color Doppler ultrasonography between April 2010 and March 2012.Measurements and Main Results: The incidence of UVM developing after abortion or delivery or in outpatients was prospectively evaluated using transvaginal color Doppler ultrasonography. From 959 patients, we identified 6 (0.63%) with UVMs, including 1 (0.10%) with a uterine AVM. Specifically, we detected UVMs in 4 of 77 patients (5.2%) after abortion, 1 of 458 patients (0.22%) after delivery, and 1 of 424 outpatients (0.24%). Four patients after abortion and 1 after delivery reported mild symptoms, which were treated conservatively; however, the outpatient had a severe uterine AVM, which was confirmed via 3-dimensional computed tomography angiography.Conclusion: The incidence of UVMs was relatively higher, in particular in the patients after abortion, and was significantly higher than that in postpartum or outpatient groups. Therefore, it is important to consider the possibility of UVMs in any patient with episodes of unexplained uterine bleeding and to perform follow-up analysis using color Doppler ultrasonography. Such an approach will facilitate accurate diagnosis and lead to appropriate clinical management to prevent unnecessary dangerous repeat curettage, which might induce profuse uterine bleeding.