Robotic-assisted gynecologic surgery associated tympanic membrane perforation: A report of two cases and review of the literature

Robotic gynecologic surgery is associated with the use of steep Trendelenburg positioning. Steep Trendelenburg is necessary to provide optimal exposure to the pelvis but is associated with an increased risk of non-surgical complications such as suboptimal ventilation, facial and laryngeal edema, increased intraocular and intracranial pressure as well as neurologic injury. Several case reports have described otorrhagia after robotic assisted surgery; however, there are limited reports on the risk of tympanic membrane perforation. To our knowledge, there are no published reports on tympanic membrane perforation in gynecologic nor gynecologic oncology surgery. We report two cases of perioperative tympanic membrane rupture and bloody otorrhagia associated with robot-assisted gynecologic surgery. In both cases otolaryngology/Ear Nose and Throat (ENT) was consulted, and the perforations resolved with conservative management

Antenatal diagnosis of a large immature abdominal wall teratoma by 2d-3d ultrasound using hdlive and magnetic resonance imaging

We describe the first case of prenatally detected teratoma of the fetal abdomen wall using ultrasound and fetal magnetic resonance imaging (MRI). A heterogeneous mass, partly solid and cystic, originating from the anterior abdominal wall of the fetus close to an omphalocele sac was detected by means of 2D/3D ultrasound and MRI. Amniodrainage was performed and due to sign of impending fetal risk, an emergency Cesarean section was performed. A bulky, crumbly and bleeding tumoral mass was confirmed at delivery. Ligation of the supplying artery to the tumor was complicated by uncontrollable hemorrhage and early neonatal death. Pathology identified the tumor as an immature teratoma of the anterior fetal abdominal wall. 2D/3D ultrasound, especially using HDlive application and MRI demonstrated accurate detection and characterization of this congenital tumor.CDPI, Radiol, Rio De Janeiro, BrazilHosp Fed Servidores Estado Rio de Janeiro, Obstet, Rio De Janeiro, BrazilClin Perinatal Laranjeiras, Obstet & Gynecol, Rio De Janeiro, BrazilGuastalla Civil Hosp, Obstet & Gynecol, Reggio Emilia, ItalyUniv Fed Sao Paulo, Obstet, Paulista Sch Med, Rua Belchior Azevedo,156 Apto 111 Torre Vitoria, BR-05089030 Sao Paulo, BrazilFundacao Oswaldo Cruz, Pathol, Inst Fernandes Figueira, Rio De Janeiro, BrazilArcispedale S Maria Nuova, Pathol, Reggio Emilia, ItalyUniversidade Federal de Sao Paulo, Obstet, Paulista Sch Med, Rua Belchior Azevedo,156 Apto 111 Torre Vitoria, BR-05089030 Sao Paulo, Brazil.Web of Scienc