Malignant melanoma of the uterus: a rare cause of postmenopausal bleeding

Background: Malignant melanoma of the uterus is a very rare disease entity bearing potentially serious consequences with an unpredictable and poor prognosis. Case: A 64-year-old woman who had a longstanding, slow-growing blackish mass of the right big toe for more than a decade, presented with postmenopausal bleeding. Histopathologic examination confirmed the diagnosis of a likely secondary malignant melanoma of the uterus. Results: She was treated successfully without any complications via total laparoscopic hysterectomy and bilateral salpingo-oophorectomy (TLHBSO). Even though malignant melanoma of the uterus has a poor prognosis, the patient was alive and disease-free at a 1-year regular follow-up. Conclusions: A malignant melanoma of the uterus is very rare and has a poor prognosis. However, laparoscopic excision of the uterus and adjacent organs in selected patients could be a superior option, especially in terms of rapid recovery and minimal tumor spillage. A combined multidisciplinary approach is highly recommended for dealing with malignant melanoma–related diseases for optimal care and a better clinical outcome

Laparoscopic versus laparotomy: Staging surgery for endometrial cancer – Malaysia's early experience

Objective: The objective of the study is to assess the efficacy of laparoscopy compared with laparotomy in extrafascial hysterectomy and lymphadenectomy for endometrial cancer. Design: This was a retrospective study of small cases over a 5-year period. Setting: This study was conducted in Putrajaya Hospital, a district hospital with consultant care level in obstetrics and gynecology. Sample: Forty women presented with confirmed cases of endometrial cancer based on histopathology result and underwent extrafascial hysterectomy with or without lymphadenectomy between January 2010 and December 2014. Materials and Methods: Patient outcomes were compared between 26 women who underwent laparoscopic total hysterectomy with or without lymphadenectomy and 14 women who underwent open laparotomy extrafascial hysterectomy with or without lymphadenectomy. Data were collected using electronic medical records. Main Outcome Measures: Postoperative outcomes, operative time, total intraoperative blood loss, number of lymph nodes harvested, and total days of postoperative stay were obtained. Results: There was a significant reduction in operative blood loss in the laparoscopic group with mean 262.50 ± 47.87 and laparotomy group with mean 381.82 ± 138.33, 95% confidence interval, P < 0.05. Postoperative hospital stay was also significantly reduced in the laparoscopic group, where the mean postoperative stay in laparoscopic group was 2.5 ± 2.0 days and laparotomy 5.0 ± 3.6 days. There was no significant difference in mean operative time (the mean operative time: 256 ± 76.40 for laparotomy and 288.75 ± 43.66 for the laparoscopic approach). More number of lymph nodes were harvested laparoscopically (29.75 ± 16.59) than laparotomy (23.0 ± 12.62); however, this was not significant. Conclusions: Laparoscopic surgery had significant lesser blood loss and it is comparable to laparotomy in the surgical management of endometrial cancer. Experienced surgeon will be able to perform hysterectomy and lymphadenectomy as equally good to laparotomy with adequate tumor excision and complete staging

Laparoscopic cystectomy in pregnancy, a viable solution â A 14 years series

Study objective: To evaluate the safety and maternal fetal outcome of laparoscopic surgery in the management of ovarian mass in pregnant women and the usage of analgesia in postoperative period. Materials and methods: This is a retrospective cross-sectional study which was carried out at department of O&G, Putrajaya Hospital. A total of 120 cases of ovarian mass in pregnancy between Jan 2000âDecember 2014 were evaluated. 115 patients had undergone laparoscopy cystectomy/salpingo-oophorectomy. Women's age, parity, gestational age, surgical technique, operative findings and time, estimated blood loss, postoperative hospital stay, post operative pain score, usage of analgesia, complications of surgery, outcome of the pregnancy and histopathology reports were evaluated. Measurement and main results: Outcome of the pregnancy and post operative pain score and usage of analgesic were evaluated. The mean gestational week at the time of surgery was 14 weeks 1 day (±2 weeks 1 day). The duration of surgery was 87.4 mins (±34.8 mins) with average blood loss of 110.3 ml (±32.0). Median size of ovarian cyst was 6 cm (IQR 2 cm). 2 cases converted to laparotomy. Only 2 cases were reported with second trimester loss which was diagnosed after 4 weeks and 10 weeks respectively. 5 women received tocolytic agent post operatively, all of them delivered at term.The mean length of hospitalization was 1.51 day (±0.597). The average gestational age of delivery was 37.78 (±3.42) mean birth weight 2.97 kg (±0.65 kg). There was one intrauterine growth restriction baby with birth weight of 1.89 kg at 35 weeks of gestation and another baby with bladder exstrophy with ambiguous genitalia which was not related to surgery. The mean of pain score was 1.5 (±1.6) over 10. 87.9% of the women had mild pain which only 64.6% require paracetamol or no analgesia. Conclusion: Majority of women with ovarian masses in pregnancy can be treated with ensured safety and reduced morbidity using the endoscopic approach. Keywords: laparoscopic cystectomy, maternal fetal outcome, ovarian cyst in pregnancy, safety, usage of analgesi

Five-year lapsed: Review of laparoscopic myomectomy versus open myomectomy in Putrajaya Hospital

Study Objective: This study aimed to investigate the morbidity of laparoscopic myomectomy (LM) versus open myomectomy (OM), including intraoperative blood loss, duration of surgery, hospital stay, and complications and to evaluate the criteria for selection of cases suitable for LM. Design: This was a retrospective study. Setting: This study was conducted at tertiary hospital. Participants: The records of 67 women who underwent LM, 22 women who underwent OM, and 14 women who had laparo-conversion from January 2010 to November 2014 were reviewed. Measurement and Main Results: Fibroids up to 10 cm were removed by LM, while most fibroids more than 10 cm were managed through OM. The number and weight of myomas are significantly associated with laparo-conversion, with a rate of 17%. Mean blood loss was significantly reduced in LM group than the OM and laparo-conversion groups. Duration of hospital stay was also significantly less in LM (2 ± 1 days) compared to both OM and laparo-conversion groups (3 ± 1 days). Most women underwent LM (88%) had no postoperative complications compared to OM (50%) and laparo-conversion (57.1%). The number of fibroids removed and duration of surgery was positively correlated with blood loss in the women who underwent myomectomy. Conclusion: LM is an ideal surgical approach for removal of fibroids which are up to 10 cm diameter and 10 cm), and deeply located fibroids. Preoperative evaluation of the size and number of myomas is necessary to avoid laparo-conversion and to reduce intraoperative and postoperative complications

Laparoscopic cystectomy in pregnancy: an 8 year series

Objective: To evaluate the maternal and fetal outcome of laparoscopic ovarian cystectomy in pregnancy Method: A cross sectional study with descriptive analysis of the retrospective data collected from the electronic medical records, of 249 women with ovarian cystectomy from January 2000 until June 2007. We then focused on 37 out of 41 pregnant cases who had laparoscopic cystectomy performed. Results: The mean age was 28.3 years old. The gestational age ranges from 5 weeks to 20 weeks. The mean gestation in which the surgery was performed was 14 weeks. The duration of surgery was 86.3 minutes and average blood loss was 170 mls. Only one case was converted to laparotomy. There were no visceral injuries in this series. There was no miscarriage, contractions or per vaginal bleeding post operatively. Two patients had wound infection and were treated as outpatient. One had preterm contraction at 28 weeks but the pregnancy progressed till term. The duration of hospital stay was 3.9 days. The average gestation age of delivery was 37.5 weeks and mean birth weight was 2.9 kg. There was no admission to the neonatal intensive care and the AS were 9/10. However there was 1 fresh still birth but it was due to abruptio placenta. The commonest tumours were mature teratoma, cystadenoma and endometrioma. Conclusion: Laparoscopic ovarian cystectomy in pregnant women is safe and feasible. However further randomized controlled trials with a large sample size should be performed

Comparative study on surgical outcomes between laparoscopic and open cornuotomy in urban tertiary center of Malaysia

Study Objective: The objective of the study was to evaluate the prevalence of interstitial ectopic pregnancy and to compare the surgical outcomes of laparoscopic cornuotomy (LC) and laparotomy (open) cornuotomy (OC) of cornual ectopic pregnancy and to analyze its associated factors. Materials and Methods: A cross-sectional study was conducted involving cases of interstitial ectopic in Hospital Putrajaya, Putrajaya, Malaysia, over a 10-year period (2005–2014). Data on sociodemographic, clinical profile, perioperative, and postoperative were obtained from the electronic medical records. Measurement and Main Results: The prevalence of cornual pregnancy was 4.0% (n = 14) out of total 347 cases of all ectopic pregnancies in Putrajaya Hospital. The mean ± standard deviation age of patient in the LC group and OC group was 29.3 ± 5.9 years and 31.4 ± 7.3 years, respectively. The duration of hospitalization and mean operating time were both significantly shorter in the LC group than in the OC group (1.43 ± 0.54 versus 2.57 ± 0.79 and 61.4 ± 15.7 min versus 97.1 ± 38.2 min, respectively, P < 0.05).There were no statistically significant differences between both groups for the estimated blood loss, requirement of blood transfusion, complications, and future fertility. Conclusion: Laparoscopic cornual resection (cornuotomy) is a safe and less invasive procedure with a comparable complication rate. It has shown that it is feasibility and should be considered as initial treatment in managing those cases in trained hand surgeons