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Splenogonadal fusion (SGF) is a rare developmental anomaly in which an abnormal connection between the splenic tissue and gonads or mesonephric derivatives is present. This entity often presents with scrotal mass, inguinal hernia, or cryptorchidism. Less than 200 cases have been reported since it was first described in 1883. It can be of continuous and discontinuous type based on the presence of a band of connecting splenic tissue. Report a rare case of discontinuous type of SGF in an adolescent male presenting as nonpalpable testis. On evaluation, ultrasonography (USG) and magnetic resonance imaging of abdomen and pelvis, his left scrotal testis was atrophied and right intra-abdominal undescended testis. This is the first reported case of SGF from Bosnia and Herzegovina. Laparoscopy was demonstrated to be the only accurate exploratory procedure for the diagnosis and surgical treatment of SGF with non‑palpable testis.
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Objective To study the initial experience and outcomes of laparoscopic enucleation with preoperative selective arterial embolization ( PSAE) for the treatment of renal angiomyolipomas. Methods A total of 43 patients with sporadic renal angiomyolipomas from July 2013 to November 2014 underwent laparoscopic nephron-sparing surgery ( NSS) .The patients were divided into either PSAE group ( n =19 ) or non-PSAE group ( n =24 ) .The data of patient demographics, success rate of surgery, perioperative complications rate, operating time ( OT ) , warm ischemia time ( WIT ) , estimated blood loss ( EBL ) , length of hospitalization, kidney estimated glomerular filtration rate (eGFR) and serum creatinine (Scr) level over 3 months, and ipsilateral recurrence were collected and compared between the two groups. Results Enucleation was successful in 100%patients (19/19) of the PSAE group and in 62.5%patients (15/24) of the non-PSAE group,with no significant difference ( Fisher' s test, P=0.105) The EBL was (46.4 ±20.6) ml in the PSAE group, which was significantly less than the non-PSAE group [(89.5 ±30.4) ml, t=-5.287, P=0.000].The OT and WIT were significantly shorter in the PSAE group than those in the non-PSAE group [(90.3 ± 21.1) min vs.(131.7 ±18.6) min, t=-6.831,P=0.000;(9.5 ±5.7) min vs.(24.2 ±4.8) min, t=-9.181, P=0.000]. The length of hospitalization was significantly longer in the PSAE group than that in the non-PSAE group [(7.7 ±1.1) d vs.(6.3 ± 1.3) d, t=3.748, P=0.000].No severe complications occurred in the PSAE group, whereas the non-PSAE group had 1 case of urinary leakage and 1 case of hematoma.The Scr level over 3 months after surgery was more ideal in the PSAE group [(70.1 ±13.7)μmol/L vs.(84.2 ±9.1) μmol/L, t=-4.045, P=0.000].No statistically significant difference was found in the eGFR between the PSAE group and the non-PSAE group [(72.6 ±12.8) ml· min-1· 1.73 m-2 vs.(68.0 ±10.7) ml· min-1· 1.73 m-2, t=1.284, P=0.206].No evidence of recurrence was found during follow-up period in both groups. Conclusions Laparoscopic enucleation with PSAE is a safe and effective minimally invasive procedure for the treatment of renal angiomyolipomas.As compared to traditional laparoscopic partial nephrectomy, it has advantages of less WIT, less EBL, and better protection of renal functions.It can be recommended in well-selected patients.
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Se comunica la experiencia y los resultados obtenidos de 110 casos de histerectomía total laparoscópica asistida por robot entre junio de 2010 y abril de 2013 en Clínica Indisa. Parámetros evaluados: diagnóstico, edad, índice de masa corporal (IMC), tiempo de instalación de trócares (TT), tiempo operatorio (TO), conversión a laparotomía, sangrado, dolor postoperatorio, estadía hospitalaria y complicaciones postoperatorias. Los diagnósticos preoperatorios más frecuentes fueron: miomatosis y adenomiosis. El promedio de edad fue de 45 años y de IMC 25,8 kg/m2, 7 por ciento de las pacientes con IMC mayor de 35. TT promedio de 14 min y TO fue de 81 min. No hubo conversión a laparotomía. Sangrado promedio de 17 ml. A las 48 horas pos intervención el 100 por ciento de las pacientes presentó un test de EVA de 0-2. Promedio de estadía hospitalaria fue 1,6 días. Hubo tres complicaciones postoperatorias: una neumonía, un desgarro vulvar y una dehiscencia de la cúpula vaginal. Conclusión: La histerectomía total laparoscópica asistida por robot es una técnica segura y ofrece ventajas al paciente y cirujano...
We reports the experience and results obtained after 110 total robot assisted laparoscopic hysterectomy from June 2010 to April 2013 at Indisa Clinic. Parameters evaluated: diagnostic, age, body mass index (BMI), trocars installation time (TT), intervention time (TO), conversion to laparotomy, bleeding, post operatory pain, hospital stay, and post operatory complications. The most frequent preoperatory diagnostic were uterine fibroid and adenomyosis. The age average was 45 years and BMI 25.8 Kg/m2 and 7 percent was over 35. TT average 14 min and TO 81 min. There were no conversions to laparotomy. Bleeding average was 17 ml. At 48 hours, 100 percent of patients had an EVA test of 0-2. The average of hospital stay was 1.6 days. Only three complications occurred: one pneumonia, one vulvar tear and one vaginal cuff dehiscence. Conclusion: robot assisted laparoscopy hysterectomy appears to be a safe surgical technique that offers benefits to the patient and also to the surgeon...
Subject(s)
Humans , Adult , Female , Middle Aged , Aged, 80 and over , Hysterectomy/methods , Laparoscopy , Robotics , Hysterectomy/instrumentation , Length of Stay , Postoperative Complications , Treatment OutcomeABSTRACT
Effective therapy preserving reproductive function in adenomyosis is warranted. From June 2003 to June 2004, patients diagnosed as having adenomyosis by transvaginal ultrasound and had symptoms of menorrhagia, dysmenorrhea, and pelvic pain were randomly allocated to either receive laparoscopic resection or myolysis. GnRH analog was given for 3 cycles after surgery. Within 6 months, symptoms were evaluated using questionnaires and at the end of follow up, adenomyosis volume was assessed by transvaginal ultra-sound. There were 20 patients included, 10 patients had resection and the rest underwent myolysis. Both procedures did not yield sig-nificant complications. Subjective evaluation by questionnaires was done in all patients. Three patients could not be evaluated objec-tively by transvaginal ultrasound, 2 patients resigned and 1 was pregnant. There was no significant difference in menorrhagia and dysmenorrhea reduction score between the 2 groups (p=0.399 and 0.213, respectively). In both groups, dysmenorrhea was reduced significantly after treatment. No significant statistical difference was found in median adenomyosis volume increment (p=0.630) be-tween the resection (median=+15.35% (-100-159)} and myolysis groups (median=+48.43% (-100-553)). Five patients were pregnant, 3 from the resection group and 2 from the myolysis group. Uterine rupture was found in 1 patient (from the myolysis group) at the age of 8 months of pregnancy. The effectiveness of laparoscopic adenomyosis resection was not significantly different compared with lapa-rascopic myolysis as an alternative conservative surgery in treating symptomatic adenomyosis. Myolysis was not recommended for women who wish to be pregnant.
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AdenomyosisABSTRACT
Objective To investigate the clinical efficacy of total laparoscopic hysterectomy(TLH) with separating and blocking uterine arteries.Methods From January 2004 to June 2006,68 cases of uterine benign diseases underwent TLH by blocking uterine arteries after separating and clipping uterine arteries with Titanic clip.Results All operations were performed successfully without conversion to open surgery and complications.1 patient,who had twice gastrohysterectomy histories,underwent bipolar coagulating uterine arteries as to the failure of separating bilateral uterine arteries.Pelvic adhesion release was performed in 18 cases,unilateral or bilateral adnexectomy in 14 cases,oophorocystectomy in 8 cases,appendectomy in 1 case,and cholecystectomy in 1 case simultaneously.The operation time was 90-185 min,(112.6?27.5)min.The time of separating uterine artery in one side was 3-15 min,(5.2?3.4)min.The intraoperative blood loss was 50-150 ml,(86.5?39.6)ml.The time to first bowel movement was 18-48 h,(27.3?4.8)h.The rate of postoperative pyrexia was 4.4%(3/68),and the hospital stay was 4-7 d,(5.1?1.8) d.A follow-up period of 2-6 months,(3.5?1.6) months,showed 3 cases of vaginal dropping hemorrhage 1-2 months after operation,which was cured with the use of antibiotics and hemostatics for 5-7 d.Conclusions TLH with separating and blocking uterine arteries is a safe,effective and feasible procedure with less complication,so it is worthy of being recommended.
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Objective To investigate the clinical value of classic intrafascial supracervical hysterectomy(CISH) by including the clipping of the uterine artery.Methods A total of 60 cases of benign uterine diseases were included in the study.After the uterine artery had been dissected and clipped on both sides under laparoscope,classic intrafascial supracervical hysterectomy was performed.Results All the operations were performed successfully under laparoscope.No conversions to open surgery were needed.Operating complications happened in no case.The operating time was 72~186 min(91.4?26.3 min),the amount of blood loss was 50~150 ml(76.5?20.6 ml),the time to postoperative gastrointestinal function recovery was 18~30 h(22.7?5.8 h),and the volume of pelvic drainage within 24 hours,50~160 ml(80.5?31.8) ml.Postoperative body temperature was elevated to 38.5 ℃ in 2 cases,the postoperative pyrexia rate being 3.3%.The length of postoperative hospital stay was 4~7 d.Follow-up for 6~18 months(10.6?4.2 months) in the 60 cases showed 3 cases of small amount of vaginal bleeding at 1~3 months,which were cured with the use of antibiotics and hemostatics for 5~7 d.Conclusions Classic intrafascial supracervical hysterectomy by including the clipping of the uterine artery is a safe and effective improvement to CISH technique.
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OBJECTIVE: Hepatic dysfunction frequently occurs in patients with hematologic malignancies and aplastic anemia who receive intensive chemotherapy or bone marrow transplantation (BMT). The role of laparoscopic liver biopsy in patients with hematologic disorders is very important to determine the etiological factors and to make treatment decisions. The aim of the present study was to evaluate the possible causes of liver disease in patients with abnormal liver function tests. METHODS: Laparoscopy guided liver biopsy was performed in 38 subjects who were receiving intensive cytotoxic therapy with BMT or without BMT. Two to three pieces of liver tissues were obtained in each patients using Vim-Silverman needle with electrocoagulation on biopsy site. Platelet transfusions were given if platelet count was less than 50,000/mm3. 39 biopsies were obtained in 38 patients. RESULTS: At the time of liver biopsy, platelet count was 170,000+/-138000/mm3 (range: 42,000 - 798,000/mm3). No procedure-related complications were observed. Biopsy findings after BMT (n=16) revealed graft versus host disease (GVHD) (n=9), drug induced hepatitis (n=6), veno-occlusive disease (n=2), viral hepatitis (n=1), and nonspecific reactive hepatitis (n=1). 3 patients of GVHD associated with other liver diseases such as drug-induced hepatitis, veno-occlusive disease and chronic active hepatitis B. The authors compared histologic diagnosis with laparoscopic findings. Laparoscopic findings of the liver surface were classified by Shimada's code number system. 5 patients who were biopsed before BMT showed cholestasis and fatty changes and it was possible to be treated with allogenic BMT. Histologic diagnosis in patients without BMT (n=18) showed viral hepatitis (n=6), drug induced hepatitis (n=5), non-specific reactive hepatitis (n=1), and others (n=6). In 12 cases (31%) laparoscopic liver biopsy led to a change in medical management. CONCLUSION: Laparascopic liver biopsy has been proven to be an effective means of assessing the cause of liver dysfunction in patients with hematologic disorders. The diagnosis obtained at laparoscopic liver biopsy could be changed the therapeutic plan in 12 of 39 (31%) patients.
Subject(s)
Humans , Anemia, Aplastic , Biopsy , Bone Marrow Transplantation , Cholestasis , Diagnosis , Drug Therapy , Chemical and Drug Induced Liver Injury , Electrocoagulation , Graft vs Host Disease , Hematologic Neoplasms , Hepatitis , Hepatitis, Chronic , Laparoscopy , Liver Diseases , Liver Function Tests , Liver , Needles , Platelet Count , Platelet TransfusionABSTRACT
The clinical syndrome of venoocclusive disease of the liver is one of several manifestations of regimen-related toxicity that can occur after high-dose cytoreductive therapy. Hepatic dysfunction after bone marrow transplantation may result from a number of causes such as pretransplant chemoradiation, graft-versus host disease, drugs for prophylaxis of graft-versus host disease, venoocclusive disease, various infections, and infiltration of recurrent malignancy. The clinical distinction of these causes may be difficult and the treatment of each cause is also quite different. Therefore the diagnosis of veno-occlusive disease is important. Veno-occlusive disease affects zone 3 of the liver acinus and produces a syndrome of jaundice, painful hepatomegaly, and fluid retention. Veno-occlusive disease occurs in up to 50% of the patients who undergo BMT and is usually associated with a high mortality rate. In Korea, there are a few case reports on venoocclusive disease after BMT which were only confirmed by clinical symptoms. This is a first report of two cases of hepatic veno-occlusive disease after allogenic BMT, which were proven by laparoscopic liver biopsy in our country.
Subject(s)
Humans , Biopsy , Bone Marrow Transplantation , Bone Marrow , Diagnosis , Hepatic Veno-Occlusive Disease , Hepatomegaly , Jaundice , Korea , Leukemia , Liver , MortalityABSTRACT
The clinical syndrome of venoocclusive disease of the liver is one of several manifestations of regimen-related toxicity that can occur after high-dose cytoreductive therapy. Hepatic dysfunction after bone marrow transplantation may result from a number of causes such as pretransplant chemoradiation, graft-versus host disease, drugs for prophylaxis of graft-versus host disease, venoocclusive disease, various infections, and infiltration of recurrent malignancy. The clinical distinction of these causes may be difficult and the treatment of each cause is also quite different. Therefore the diagnosis of veno-occlusive disease is important. Veno-occlusive disease affects zone 3 of the liver acinus and produces a syndrome of jaundice, painful hepatomegaly, and fluid retention. Veno-occlusive disease occurs in up to 50% of the patients who undergo BMT and is usually associated with a high mortality rate. In Korea, there are a few case reports on venoocclusive disease after BMT which were only confirmed by clinical symptoms. This is a first report of two cases of hepatic veno-occlusive disease after allogenic BMT, which were proven by laparoscopic liver biopsy in our country.
Subject(s)
Humans , Biopsy , Bone Marrow Transplantation , Bone Marrow , Diagnosis , Hepatic Veno-Occlusive Disease , Hepatomegaly , Jaundice , Korea , Leukemia , Liver , MortalityABSTRACT
Trendelenburg position has been used for the low abdominal and pelvic surgery or for the management of the hypotensive patients. But, various adverse effects can also occur in steep Trendelenburg position, of which brachial plexus injury has been known as the most common nerve injury during this position under the general anesthesia especiaUy when the shoulder braces are used. We experienced a case of brachial plexus palsy in a 53 year old woman who had a laparas-copy assisted vaginal hysterectomy(LAVH) under the general anesthesia for myoma uteri for four and a half hours. During the operation she was in a 30 degree-tilting Trendelenburg and combined lithotomy position with her arms tucked at her side with drawsheet and shoulder braces were placed over the acromioclavicular joints bilaterally. In the morning of the postoperative 1st day, she complained the right shouder pain and the right arm tingling sensation and weakness. After needle electromyography and nerve conduction study, it was decided that she got an intraoperative brachial plexus injury mainly involving the lateral cord of the brachial plexus, resulting from the nerve compression caused by shoulder braces in Trendelenburg position. The symptoms were improved after the physical therapy and she was recommended to take more physical therapy after discharge.