15 research outputs found
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
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
Outcome quality standards in advanced ovarian cancer surgery
Advanced ovarian cancer surgery (AOCS) frequently results in serious postoperative complications.
Because managing AOCS is difficult, some standards need to be established that allow surgeons to assess the quality of treatment provided and consider what aspects should improve. This study aimed to identify quality indicators (QIs) of clinical relevance and to establish their acceptable quality limits (i.e., standard) in AOCS
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
Step by step Indiana puch construction in a previously irradiated patient with a cervical cancer relapse
Introduction
Radiation therapy and radical pelvic surgery, either radical cystectomy or pelvic exenteration, is the golden standard treatment for infiltrating bladder carcinoma, as well as advanced or recurrent cervical, vulvar, vaginal and endometrial cancer. However, due to the poor radiation sensitivity of the cervix and vagina, a high-radiation dose is required, leading to early and/or late onset urogenital complications in approximately 50% of the patients.
Case presentation
The following case report describes a 64-year-old native Russian woman presenting a relapse of a vaginal cuff squamous cell carcinoma, who underwent a laterally extended endopelvic resection (LEER) followed by a neobladder reconstruction based on the Indiana pouch (IP) technique. The process is described here step by step.
Discussion
Indiana pouch urinary diversion was based on thorough research, the reproducibility of the technique, our urologist’s experience with the Indiana Pouch, as well the lower rate of complications published in various separate series.
Conclusion
Indiana pouch is a successful continence urinary reservoir with a reproductible technique, however long-term observation is needed
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