Parasitic myomas after laparoscopic surgery: an emerging complication in the use of morcellator? Description of four cases

Objective: To report the development of parasitic myomas after the use of a morcellator. Design: Retrospective study. Setting: Tertiary care referral center for the treatment of benign gynecologic pathologies. Patient(s): Women undergoing surgery for uterine fibroids. Intervention(s): Chart review. Main Outcome Measure(s): Presence of parasitic leiomyomas. Result(s): We identified four cases of parasitic myomas over the 3-year study period. Two out of the four were symptomatic. The prevalence of this complication, considering all women with whom the electric morcellator was used (n 1⁄4 423) was 0.9% (95% CI, 0.3–2.2%). Considering exclusively the women who underwent myomectomy (n 1⁄4 321), it was 1.2% (95% CI, 0.4–2.9%). Conclusion(s): Laparoscopic myomectomy with the use of a morcellator is associated with an increased risk of developing of parasitic myomas. A thorough inspection and washing of the abdominopelvic cavity at the end of the surgery should be performed to prevent this rare complication

Spontaneous bilateral tubal pregnancy in a nulliparous woman. Laparoscopic diagnosis and treatment

A 34 year-old nulliparous woman was referred to our Department, complaining of vaginal bleeding and intermittent lower abdominal cramping. serum level of β-hCG was 4954 IU/L. Transvaginal ultrasound examination revealed no gestational sac in the uterine cavity and a right adnexal mass, suggestive of ectopic pregnancy; left adnexal area appeared regular. At laparoscopy, the presence of an ectopic pregnancy was confirmed in the right tube; on the left side, surprisingly, there was an intact infundibular ectopic pregnancy. Right tuba was removed; considering the condition of nulliparous of the patient, we decided to perform a linear salpingostomy. Histologic exam confirmed the diagnosis of spontaneous bilateral tubal ectopic pregnancies

Appendiceal mucinous neoplasms: An uncertain nosological entity. Report of a case

Introduction: Appendiceal mucocele is a relatively rare condition characterized by progressive dilation of the appendix caused by intraluminal accumulation of mucoid substance. Its incidence is 0.07 - 0,63% of all appendectomies performed. Case report: We report the case of a 70-year-old man who came to our observation with gravative pain in right lower abdominal region. A computed tomography abdominal scan revealed a cystic/tubular structure like an appendicular mass with wall enhancement but without calcifications suggestive of a mucocele. Into peritoneal cavity we found profuse mucinous material with a 1,5 cm size parietal nodule. We also identified a free perforation of the cecum with consensual spillage of gelatinous material mimicking a pseudomyxoma peritonei. We decided to perform a right hemicolectomy with excision of peritoneal lesion. Discussion: The controversy in the pathologic terminology can give rise to a clinical dilemma in terms of the management and follow-up plans. For mucosal hyperplasia and cystadenoma simple appendectomy is curative. Only in case of large base of implantation it may be necessary the resection of the ileum and caecum or right hemicolectomy. In case of mucinous cystoadenocarcinoma authors perform a right hemicolectomy. Conclusion: Appendiceal mucinous neoplasms are different pathological entities. The correct surgical management depends on size and location of lesion. A preoperative diagnosis is obviously needed in order to perform the correct treatment. CT abdominal scan is the better diagnostic tool, but different authors show their inability to reach a preoperative diagnosis in the larger majority of cases

Adenomyotic Cyst in a 25-Year-Old Woman: Case Report

Adenomyotic cysts are uncommon findings, usually in the context of diffuse adenomyosis and <5 mm in diameter. Herein we report a 4.5-cm adenomyotic cyst in a 25-year-old nulliparous woman with severe dysmenorrhea and pelvic pain. Transvaginal ultrasonography and magnetic resonance imaging revealed a well-circumscribed hypoechogenic mass in the posterior uterine wall, well separated from the uterine cavity. Pathologic analysis demonstrated that the cyst was lined with endometrial epithelium and stroma and was surrounded by smooth muscle hyperplasia. In the literature, we found 30 reports of cysts with similar characteristics. Because this cyst has not been clearly defined, it has been called by various names including adenomyotic cyst, cystic adenomyosis, and cystic adenomyoma. We believe this lesion should not be called an adenomyoma, but is more correctly called an adenomyotic cyst or, depending on age at onset, a juvenile adenomyotic cyst

Factors Associated with Anti-SARS-CoV-2 Vaccine Acceptance among Pregnant Women: Data from Outpatient Women Experiencing High-Risk Pregnancy

Pregnant women are at higher risk of severe Coronavirus disease 2019 (COVID-19) complications than non-pregnant women. The initial exclusion of pregnant women from anti-SARS-CoV-2 vaccines clinical trials has caused a lack of conclusive data about safety and efficacy for this vulnerable population. This cross-sectional study aims to define the factors related to vaccination adherence in a sample of women experiencing high-risk pregnancies. The recruited women completed a questionnaire based on the Health Belief Model. Data were analyzed to evaluate the associations between socio-demographic variables and vaccination acceptance through descriptive, univariate and multivariate logistic analyses. Among the 233 women enrolled, 65.2% (n = 152) declared that they would accept the anti-SARS-CoV-2 vaccine. Multivariate analysis showed that vaccination acceptance was associated with a high educational level (aOR = 4.52, p = 0.001), a low perception of barriers to vaccination (aOR = 1.58, p = 0.005) and the gynecologist's advice (aOR = 3.18, p = 0.01). About a third of pregnant women are still hesitant about the anti-SARS-CoV-2 vaccine, probably because of the conflicting information received from media, friends, acquaintances and health institutions. Determining factors linked to vaccine hesitancy among pregnant women is useful for creating vaccination strategies that increase vaccination uptake

Endometrial cancer: Robotic versus Laparoscopic treatment. Preliminary report

Laparoscopic approach is today the standard treatment for benign and malignant gynecological pathologies. To traditional laparoscopic surgery in the last 10 years we can add the possibility to use a robotic platform. The adoption of this system allows undoubted advantages as the three-dimensional vision, the absence of the physiological tremor with enhanced ergonomics and possibility of using articulable tools. In this study we analyzed the results of 18 patients with endometrial cancer (Stage I) treated with robotic approach. The results were compared with a selected sample of 26 patients, with the same characteristics, treated with traditional laparoscopic approach in the same period by the same surgical team. The mean total operative time was significantly longer for robotic than laparoscopic group (125.6 min vs 102.3 min). However, if to this operative time we remove the time of preparation (docking time) we obtain the following results: 102.5 min for robotic group and 95.7 min for the laparoscopic control group. Intra-operative blood loss are significantly lower in the robotic group than in laparoscopic group. The robotic treatment of gynecological cancer is a safe and feasible technique. The oncological results are also equivalent to those of traditional laparoscopic surgery with advantages in terms of precision and reduction of intraoperative bleeding. Additional clinical studies on larger samples and heterogeneous patients are necessary in order to clarify the real advantages of robotic treatment

Data comparison between pharmacological induction of labour and spontaneous delivery. A single centre experience

Objectives: To assess the differences in the maternal and fetal outcomes between pharmacological induced and sponta­neous labour in nulliparous women. Material and methods: Observational cohort study carried out over a period of 2 years. Inclusion criteria: nulliparous sin­gleton pregnancies, with cephalic fetal presentation, elective labour induction with intra-vaginal prostaglandin E2 (PGE2) gel (Prepidil® 2 mg) at a gestational age of 41 weeks. Control group: patients who entered labour spontaneously at a gestational age of ≥ 40 weeks. The main demographic maternal characteristics and intra- and postpartum data were extracted from computer records and obstetrics diaries and were used for the analysis. Results: One hundred and three patients with induction of labour and 97 with spontaneous labour were enrolled. Cesarean delivery was performed in 18 cases (17.5%), all in the induction group. There were no differences in newborn weights between the 2 groups while both the 1-minute and 5-minute Apgar scores were significantly higher in the spontaneous group (p = 0.014 and p = 0.0003, respectively). Women in the induction group had a significantly longer duration of I stage labour in comparison with spontaneous group (p &lt; 0.0001). Conclusions: Primiparous women whose labour was induced spent a longer time in labour than women who presented in spontaneous labour. Clinicians should keep in mind that a slow rate of dilation in a woman being induced may be normal. For this reason, an arrest diagnosis needs to be carefully considered

Primary umbilical endometrioma: Analyzing the pathogenesis of endometriosis from an unusual localization

Objective: This report presents a rare case of symptomatic primary umbilical endometriosis and reviews the literature on the topic with the aim to clarify some questions on the origin of endometriosis. Case Report: A 33-year-old woman with cyclic umbilical bleeding was found to have umbilical endometriosis. She had no history of pelvic or abdominal surgery. There was no past history of endometriosis or endometriosis-associated symptoms. An omphalectomy was performed after explorative laparoscopy to carefully inspect the abdominopelvic cavity and assess any coexisting pelvic endometriotic lesions. Histological examination confirmed the diagnosis of umbilical endometriosis. Conclusion: Umbilical endometriosis is a rare but under-recognized phenomenon. Primary lesions are difficult to recognize, but probably represent an independent nosological entity. The possibility of endometriosis must be considered during the evaluation of an umbilical mass despite the absence of previous surgery. Complete excision and successive histology are highly recommended

Impact of monopolar and bipolar endometrial resection on abnormal uterine bleeding

Study Objective. To compare two procedures for endometrial resection: resectoscopy with monopolar knife versus resectoscopy with bipolar knife. Patients and methods. 76 perimenopausal patients affected by DUB (Dysfunctional Uterine Bleeding), no longer wishing to remain pregnant and having failed to respond to pharmacological treatment, underwent endometrial ablation with monopolar loop (group A: 38 women) or bipolar loop (group B: 38 women). Operative parameters, complication rate, menstrual outcome were considered. Results. Operative time was no different between groups. The amount of distention fluid adsorbed was significantly higher in group A than in group B, and late cumulative complication rate was 44% in group A and 24% in group B. Menstrual cycle was, overall, controlled in both groups. Conclusions. Bipolar electrode is as effective as monopolar electrode for endometrial resection, but was safer than monopolar knif

Gonadotrophin-releasing hormone analogue or dienogest plus estradiol valerate to prevent pain recurrence after laparoscopic surgery for endometriosis: a multi-center randomized trial.

Abstract Objectives To evaluate the efficacy of dienogest + estradiol valerate (E2V) and gonadotrophin-releasing hormone analogue (GnRH-a) in reducing recurrence of pain in patients with chronic pelvic pain due to laparoscopically diagnosed and treated endometriosis. Design Multi-center, prospective, randomized study. Setting Three university departments of obstetrics and gynecology in Italy. Population Seventy-eight women who underwent laparoscopic surgery for endometriosis combined with chronic pelvic pain. Methods Post-operative administration of dienogest + E2V for 9 months (group 1) or GnRH-a monthly for 6 months (group 2). Main outcome measures A visual analogue scale was used to test intensity of pain before laparoscopic surgery at 3, 6 and 9 months of follow up. A questionnaire to investigate quality of life was administered before surgery and at 9 months of follow up. Results The visual analogue scale score did not show any significant differences between the two groups (p = 0.417). The questionnaire showed an increase of scores for all women compared with pre-surgery values, demonstrating a marked improvement in quality of life and health-related satisfaction with both treatments. No significant differences were found between the groups. The rate of apparent endometriosis recurrence was 10.8% in group 1 and 13.7% in group 2 (p = 0.962). Conclusion Both therapies seemed equally efficacious in preventing endometriosis-related chronic pelvic pain recurrence in the first 9 months of follow-up