Single-port access laparoscopy-assisted vaginal hysterectomy: our initial experiences with 100 cases.

Objectives. To present our initial experiences with laparoscopically assisted vaginal hysterectomy performed using homemade transumbilical single-port system. Materials and Methods. We reviewed the medical records of one hundred patients who underwent single-port access laparoscopically assisted vaginal hysterectomy (SPA-LAVH). SPA-LAVH was performed with homemade single port system and conventional rigid laparoscopic instruments. Results. All procedures were successfully completed through the single-port system and vagina without need for extraumbilical puncture or conversion to laparotomy. The median patient age was 48.2 ± 6.5 years. Thirty-three patients had history of past abdominopelvic surgery. The median total operative time, largest dimension of the uterus, and weight of the uterus were 73.1 ± 24.6 min, 10.5 ± 2.1 cm, and 300.8 ± 192.5 gram, respectively. The median decline in the hemoglobin from before surgery to postoperative day 1 was 1.8 ± 0.9 g/dL. Bladder injury in occurred one patient who was repaired through intraoperative laparoscopic suture. The postoperative course was uneventful in most patients except for three who had a transient paralytic ileus, five who had pelvic hematoma, but they were recovered following conservative managements. No port-related complications were noted, and the cosmetic results were excellent. Conclusions. SPA-LAVH is technically safe procedure, and the homemade single-port system offers reliable access for single-port surgery.

Human papillomavirus L1 capsid protein and human papillomavirus type 16 as prognostic markers in cervical intraepithelial neoplasia 1.

INTRODUCTION: The aim of the study was to determine whether human papillomavirus (HPV) L1 capsid protein and the HPV genotype can predict the disease course as prognostic markers for cervical intraepithelial neoplasia 1 (CIN1). METHODS: Immunohistochemical staining was performed for HPV L1 capsid protein in 101 women who had been confirmed to have CIN1 by histologic examination and HPV high-risk infection by HPV genotyping. The disease course was analyzed by follow-up histologic examination according to the HPV L1 capsid protein and HPV genotype over a minimum of 12 months. RESULTS: The CIN1 regressed spontaneously in 60.4% of the women; most cases of regression occurred within 1 year (90.9% of regression cases). The HPV L1 capsid protein-positive patients had a spontaneous regression rate of 72.7% (48/66) and a rate of persistent disease or progression to higher grade disease of 27.3% (18/66). The HPV L1 capsid protein-negative women had a regression rate of 37.1% (13/35) and a rate of persistent disease or progression of 62.9% (22/35; P < 0.001). The HPV-16-infected patients had a regression rate of 38.6% (17/44) and a rate of persistent disease or progression of 61.4% (27/44), whereas the non-HPV-16-infected patients had a regression rate of 77.2% (44/57) and a rate of persistent disease or progression of 22.8% (13/57; P < 0.001). CONCLUSIONS: The HPV L1 protein expression is closely related to spontaneous disease regression, but HPV-16 infection is related to persistent disease or progression to high-grade lesions in patients with CIN1.

Laparoscopic cornuotomy using a temporary tourniquet suture and diluted vasopressin injection in interstitial pregnancy.

OBJECTIVE: To evaluate the efficiency of laparoscopic cornuotomy. DESIGN: Retrospective case review. SETTING: An urban medical center. PATIENT(S): Eight patients with interstitial pregnancy who have undergone laparoscopic cornuotomy. INTERVENTION(S): Laparoscopic cornuotomy was performed using a temporary tourniquet suture and the injection of diluted vasopressin around the cornual mass. The tourniquet suture was removed completely after repairing the cornu. MAIN OUTCOME MEASURE(S): Operating time, hemorrhage, beta-hCG levels. RESULT(S): The estimated blood loss was 50 +/- 22 mL (mean +/- SD), and the operating time was 58 +/- 16 minutes. The serum beta-hCG level returned to within the normal range approximately 4 weeks postoperatively in all patients. There were no major postoperative complications, such as hemorrhage, and no postoperative adjuvant therapy was required. CONCLUSION(S): Laparoscopic cornuotomy is a safe and effective method in interstitial pregnancy, and we believe that it has the advantage of preserving reproductive capacity over cornual resection.