Robotic-Assisted Thoracic Surgery Approach to Thoracic Endometriosis Syndrome with Unilateral Diaphragmatic Palsy.

Endometriosis is characterized by endometrial-like glands and stroma outside the uterine cavity, affecting women of reproductive age. Thoracic endometriosis syndrome (TES) is an entity producing a range of clinical and radiological manifestations, including catamenial pneumothorax, haemothorax, haemoptysis, and pulmonary nodules within the thoracic cavity or on the diaphragm. TES symptoms are nonspecific, warranting a high degree of clinical suspicion. Management includes hormone replacement therapy, surgical management, or a combination of both. We present a case of a 37-year-old woman who presented with TES and unilateral diaphragmatic palsy, managed with robotic-assisted thoracoscopic surgery and hormone replacement.

The early benefits of Laparoscopic Sacrocolpopexy.

BACKGROUND: Prospective evaluation of the 6 months functional and clinical outcome of 27 patients treated with Laparoscopic Sacrocolpopexy (LSC). METHODS: Pelvic organ prolapse was assessed by Baden-Walker system along with a validated quality of life questionnaire preoperatively and at 6 months postoperatively to assess vaginal, urinary, bowel and sexual symptoms. RESULTS: At a mean 6 months follow-up, 96% of the symptomatic women had successful vaginal vault support with no recurrence of prolapse symptoms. Successful anatomical outcome (any prolapse ≤ stage 1) was found in 89%. Regarding the urinary functional symptoms, significant improvement was reported in the voiding function, painful symptoms and the relevant quality of life. Stress urinary incontinence resolved in 67% without concomitant continence surgery; 4% from the stress incontinence was de novo. Bowel symptoms were common, both pre- and postoperatively; 40% from the postoperative bowel symptoms was de novo. Sexually active women reported significant improvement in sexual function; there was one case of de novo dyspareunia. CONCLUSION: LSC is an effective treatment for vault prolapse as soon as in the 6-months follow-up. The outcome for anterior and posterior support is less predictable. The pelvic organ vaginal, urinary and sexual functional symptoms improve. The effects on bowel function are less clear. Long-term prospective studies are required to establish the duration of the benefits.

Association between chronic pelvic pain symptoms and the presence of endometriosis.

PURPOSE: The link between endometriosis and the presence or intensity of pain is controversial. The aim of the present study was to assess the relationship between chronic pelvic pain (CPP) and severity of endometriosis and the effectiveness of laparoscopic treatment in a 6-month follow-up. METHODS: Prospective observational study in a referral unit. 144 women had laparoscopy to investigate CPP. Symptoms were assessed by a 10-point visual analog scale. The main outcome measure was the frequency and intensity of CPP. RESULTS: No difference in pain was found between women with and without endometriosis. Advanced endometriosis was associated with dysmenorrhea, deep endometriosis with dyspareunia and rectovaginal disease with dyschezia. Laparoscopic treatment improves symptoms. CONCLUSIONS: Women with severe endometriosis are more likely to report severe dysmenorrhoea. Furthermore location of endometriosis in the rectovaginal space is associated with dyschezia and deep endometriosis with dyspareunia. However, the association between presence and stage of endometriosis and severity of symptoms is marginal.

Laparoscopically assisted retrieval of lost IUCD/foreign bodies: a novel locating technique with fluoroscopic image intensifier.

Migration of therapeutically implanted intrauterine contraceptive devices and foreign bodies pose challenges in accurate localization and removal through the least invasive method. Laparoscopic removal is the desired method of treatment due to the lessened surgical and anesthetic morbidity and accurate and rapid localization of the devices are imperative in aiding an endoscopic removal. Difficulties in locating the device leads to prolonged intraoperative times and at times culminate in a laparotomy with its attendant increased morbidity. We present a case series where rapid and accurate localization of the devices was achieved by intraoperative usage of the fluoroscopic image intensifier. The image intensifier can view images in real time and can be used intraoperatively, increasing the diagnostic accuracy. We propose that intraoperative imaging by the fluoroscopic image intensifier is a cost effective, rapid, and accurate method of localizing a migrated contraceptive device, thus enabling optimal endoscopic treatment.

Laparoscopic approach to an endometriotic vault fistula causing posthysterectomy "menstruation".

Endometriosis is a commonly prevalent disease but can include rare complaints posing a challenge to surgical treatment. We describe an unreported cause of menstruation after hysterectomy, which was revealed as an endometriotic tubo-ovarian mass that fistulated into the vaginal vault. A 37-year-old woman experienced monthly vaginal bleeding after hysterectomy. At laparoscopy a tubo-ovarian endometriotic mass was revealed with a fistula into the vaginal vault. The mass was adherent to the left ureter and the sigmoid colon. Laparoscopic excision of the mass and fistula after ureterolysis and bowel dissection was performed. This case describes an unreported cause of posthysterectomy menstruation. The management outlines the optimal surgical management of laparoscopic techniques combined with vaginal access to achieve complete excision with minimal patient morbidity.