Laparoscopic treatment of a vesico-vaginal fistula: A new approach

Vesicovaginal fistulas (VVF) are among the most distressing complications of gynecologic and obstetric procedures. Management of these fistulas has been better defined and standardized over the last decade. VVF repair is most commonly repared with transvaginal approach. We report a case of VVF which was repaired using a laparoscopic approach. The fistula was a complication of a benign laparoscopic hysterectomy. We describe a novel technique for the treatment of VVF of supratrigonal location by intraperitoneal laparoscopic approach

The Use of Barbed Suture for Vaginal Cuff Closure in Total Laparoscopic Hysterectomy

Objective: The aim of this work is to evaluate the safety and efficacy of the barbed unidirectional suture in a total laparoscopic hysterectomy. Materials and Methods: A retrospective and descriptive study was conducted, which included all of the patients that have undergone laparoscopic hysterectomy and closure of the vaginal cuff, using barbed sutures (V-loc™90 Device, CovidienTM), during the period between May 2011 and December 2014. We have analyzed the general characteristics, indications, history of previous surgery and the presence of fever or surgical re-intervention due to pelvic abscesses. The appearance of a vaginal cuff hematoma, active bleeding and vaginal cuff dehiscence were also taken into account. Results: A hundred and twenty-one laparoscopic hysterectomies with vaginal cuff closure, using barbed sutures, were performed. There was a report of one case of bladder lesion and another case of ureter lesion. Of all patients, four (3.3%) of them presented fever while one (0.8%) presented paralytic ileus. Three (2.4%) patients suffered active vaginal bleeding, and one presented a partial dehiscence of the vaginal cuff. And finally, two (1.6%) cases of vaginal cuff hematomas were observed and in one (0.8%) of the cases, a pelvic abscess was detected. Conclusion: The use of a unidirectional barbed suture is a safe technique for vaginal cuff closure in laparoscopic total hysterectomies

Clear Cell Adenocarcinoma of Cervix: Radical Trachelectomy to Preserve the Fertility

Carcinoma of the uterine cervix is a common gynecologic malignant neoplasm all over the world. The most common histological type of malignant cervical neoplasms is squamous cell carcinoma [1,2]. Clear cell adenocarcinomas (CCAC) of the uterine cervix is a rare disease accounting for only 4% of all adenocarcinomas of the uterine cervix [3]. Primary CCAC of the uterine cervix is a rare neoplastic entity which occurs in young women exposed to DES in utero; primary CCAC without DES exposure in utero is extremely rare. Here we report a 23- years-old Spanish female with primary CCA of the uterine cervix with no maternal history of DES ingestion during pregnancy

Surgical technique for video endoscopic inguinal lymphadenectomy in vulvar cancer

Introduction: Inguinal lymph node involvement is an important prognostic factor in patients with vulvar cancer. Inguinal lymph node dissection allows for staging and treatment of inguinal node disease but causes morbidity and is associated with complications such as lymphocele formation, wound dehiscence, and infection. Video endoscopic inguinal lymphadenectomy (VEIL) seems to be a new and attractive approach with lower morbidity than the standard open procedure. The objective of this study was to report our surgical technique for VEIL for the treatment of vulvar cancer. Methods: We retrospectively evaluated a case involving a 78-year-old woman with vulvar cancer who underwent bilateral VEIL. Findings: The operative time was 140 min, and there were no complications. After 3 months of follow-up, there were no signs of vulvar oedema, lymphedema, or lymphocele. Conclusions: In patients with vulvar cancer, VEIL is feasible in clinical practice. Additional studies with a larger number of patients and longer-term follow-up are needed to confirm the oncological efficacy and the possible reduction in morbidity of this new approach.Introduccio´n: La afectacio´n de los no´dulos linfa´ticos inguinales es un factor prono´stico importante en pacientes con ca´ncer de vulva. La diseccio´n de los no´dulos linfa´ticos inguinales nos permite la estadificacio´n y el tratamiento de la afectacio´n ganglionar inguinal. Por otra parte, causa morbilidad y esta´ asociada a complicaciones como linfocele, dehiscencia de la herida e infeccio´n. La linfadenectomı´a inguinal videoendosco´pica parece ser una nueva y atractiva te´cnica con menor morbilidad que el abordaje abierto. El objetivo de este trabajo es reportar nuestra te´cnica de linfadenectomı´a inguinal videoendosco´pica para el tratamiento del ca´ncer de vulva. Me´todos: Se evaluo´ de manera retrospectiva el caso de una paciente de 78 an˜os de edad con ca´ncer de vulva a la que se realizo´ una linfadenectomı´a inguinal videoendosco´pica bilateral. Hallazgos: El tiempo operatorio fue de 140 min y no hubo complicaciones. Tras 3 meses de seguimiento no se observaron signos de edema vulvar, linfedema o linfocele. Conclusiones: La linfadenectomı´a inguinal videoendosco´pica en pacientes con ca´ncer de vulva es factible en la pra´ctica clı´nica. Estudios adicionales con un mayor nu´mero de pacientes y a ma´s largo plazo de seguimiento son necesarios para confirmar la eficacia oncolo´gica y la posible menor morbilidad de este nuevo enfoque

Surgical treatment of Paget’s disease of the vulva using Mohs micrographic surgery, followed by vulvar reconstruction using the “lotus petal” suprafascial flap

Vulvar Paget’s disease is an extramammary manifestation of Paget’s disease, a cutaneous neoplasm that clin-ically appears as sharply defined erythematous plaques with irregular borders that usually affect apocrine gland-bearing skin. Extramammary Paget’s disease (EMPD) of the vulva can remain undiagnosed for years and could be associated with multifocal neoplasms. The current gold standard for the treatment of vulvar EMPD is surgical excision and the Mohs micrographic surgery is the preferred technique used in evaluating the margins of the specimen. The reconstruc-tion of the vulva using suprafascial flaps reduces hospitalization time and complications rate

Complications of laparoscopic lymphadenectomy for gynecologic malignancies. Experience of 372 patients

Evaluation of lymph nodes is an integral part in the management of women with gynecologic cancers, which is why the pelvic and aortic lymphadenectomy is widely used as a staging and/ or prognostic procedure in such malignancies. The purpose of this study was to describe our experience with pelvic and aortic laparoscopic lymphadenectomy and evaluate the safety and feasibility of this procedure for gynecologic malignancies. From January 2004 to December 2015, a laparoscopic pelvic and/or aortic lymphadenectomy was performed in 372 women at the Department of Gynecology Oncology of the University General Hospital of Castellon and at the Department of Obstetrics and Gynecology of Sant Pau and Santa Tecla Tarragona Hospitals. Out of the 372 cases, 240 combined pelvic and paraaortic lymphadenectomies were performed, while 108 and 24 patients underwent pelvic and aortic lymphadenectomy respectively. The mean operative times were 40 min (20-89) in order to perform a complete pelvic lymphadenectomy, 62 min (21-151) for transperitoneal aortic lymphadenectomy and 45 min (35-65) for a retroperitoneal approach. A conversion to laparotomy was needed in 1.6% of patients. Twenty-three (6.1%) complications were encountered in 372 patients undergoing laparoscopic lymphadenectomy. Nine (2.4%) major complications occurred intraoperatively while fourteen (3.7%) appeared postoperatively. The most frequent intraoperatory complication was vascular injury (1.3%). Laparoscopic lymphadenectomy can be considered a safe and achievable procedure, and could be considered the golden standard procedure for staging gynecologic malignancies

A Case of Urethrocutaneous Fistula Following a Transobturator Tape Procedure for Stress Urinary Incontinence

The transobturator tape procedure (TOT) is a highly effective technique used to resolve cases of female stress urinary incontinence and is a safe procedure with relatively few per-operative and early post-operative complications compared to the tension free vaginal tape (TVT). Recent studies, however, have demonstrated that the late surgical sequelae following a TOT procedure are relatively common. Urethrocutaneous fistula is an unusual complication in the female population that is defined as an abnormal connection between the urethra and the skin, usually affecting the perineum. It may also develop secondary to urethral strictures, repair of hypospadias, prostate surgery, chronic untreated periurethral abscesses, trauma etc. It is usually diagnosed using retrograde urethrography and fistulography. We present a case of a 53 year old woman who developed a urethrocutaneous fistula after a TOT procedure four years ago as a surgical treatment of female stress urinary incontinence which was diagnosed recently after presenting various episodes of vulvar abscesse

Laterally Extended Endopelvic Resection (Leer) and Reconstructive Techniques for Treatment of Locally Advanced Cervix Cancer: A Case Report

The aim of this report is to describe the surgical procedure done in a 24-year-old woman who presents a locally advanced squamous cervix carcinoma and is proposed to laterally extended endopelvic resection (LEER), intraoperative radiation therapy with electrons (IORT) and urinary and colon diversion with vaginal reconstruction. A year after surgery the patient is alive, without disease and with and acceptable quality of life

Hepatic epithelioid hemangioendothelioma: A great mimicker

INTRODUCTION: Epithelioid hemangioendothelioma is a malignant mesenchymal tumor of unknown etiology. They tend to be asymptomatic or with non-specific symptoms. The lesion is usually multiple and variable size. PRESENTATION OF CASE: We describe a clinical case of a 23-years-old patient diagnosed with a pelvic mass, a possible uterine fibroid or adnexal mass, and multiple liver lesions that seemed an advanced ovarian cancer presentation and after liver biopsy turned out to be a hepatic epithelioid hemangioendothelioma. DISCUSSION: It may be confused with a metastatic process in diagnostic imaging. There have been described some possible risk factors but the etiology remains unknown. The prognosis is usually lethal in 50% of cases. The surgical removal of the lesion and liver transplant appear to be the only hope for these patients. CONCLUSION: Epithelioid hemangioendothelioma must be part of our differential diagnosis when we find a liver tumour, especially in young women. Treatment is excision of the tumour in limited disease. In the case of unresectable disease are candidates for liver transplantation

Intravesical mini-laparoscopic repair of vesicovaginal fistulas

Vesicovaginal fistulas (VVF) constitute the most common type of genitourinary fistulas. In developed countries, VVF are almost always iatrogenic and frequently a secondary result of gynecological surgery. Some minimally invasive techniques have been introduced to decrease the morbidity related to standard open procedures for the treatment of VVF. One such procedure is the intravesical minilaparoscopic approach. The aim of this study was to present our initial clinical experience using this technique for transvesical VVF repair. In 2013 and 2014, we carried out mini-laparoscopic repair of VVF in two women who did not respond to conservative treatment with a Foley catheter. The procedure was performed transvesically with a 3-mm instrument and a 5-mm, 30° scope. The fistulous tract was dissected and partially excised. The bladder and vaginal wall defects were closed in two layers with two separated continuous barbed, resorbable 3-0 sutures (V-Loc 90 Absorbable Wound Closure Device; Covidien, Norwalk, CT, USA). The median operative time for the two patients was approximately 100 min, and the blood loss was not clinically significant. The patients were released from the hospital 24 h after surgery. A Foley catheter was left in place for 14 days. Imaging examinations performed 6 weeks postoperatively revealed no VVF. In patients with simple fistulas, this technique provides a minimally invasive, easily reproducible approach with few associated complications. Nevertheless, further experience and observations are necessary