Laparoscopic surgery for early endometrial cancer.

INTRODUCTION: The purpose of the present study was to evaluate learning curves and short-term outcomes following laparoscopic surgery for early endometrial cancer in women of different body mass index (BMI) classes. MATERIAL AND METHODS: Data from 227 women planned for laparoscopic surgery for presumed stage I endometrial cancer were collected retrospectively from a Danish gynecologic oncology unit. Surgery included laparoscopic hysterectomy and bilateral salpingo-oophorectomy with or without pelvic lymphadenectomy (PLA). RESULTS: Median length of operations was 60 min (range, 30-197) and 120 min (range, 60-230), depending on whether PLA was included. The median pelvic lymph node yield was 18 (range, 7-42). For staging with PLA there was a learning curve when measured as operative time as well as lymph node yield, and a level of proficiency was not reached after 40 operations. The women had a perioperative complication rate of 4.5% and a median hospital stay of one night. Postoperative complication rate was 12%, comprising vaginal cuff hematoma (3.1%), vaginal cuff rupture (0.9%), trocar hernia (1.3%), ureter lesion (0.4%), bowel lesion (0.4%), reoperation (0.9%) and other complications (4.5%). All peri- and postoperative outcomes were independent of BMI classes. CONCLUSIONS: Our data suggest that laparoscopic surgery for early endometrial cancer is feasible and safe. With increasing surgeon's experience there is a significant decrease in operative time and increase in the number of lymph nodes harvested. In experienced hands, either operative time, complications or length of stay are not affected by increasing BMI, even when women are morbidly obese.

Fetal goiter and bilateral ovarian cysts.

A unique case of fetal goiter accompanied by bilateral ovarian cysts in a mother treated with methimazole for Graves'disease is reported. The abnormal findings were detected by ultrasound at 31 weeks of gestation. Umbilical fetal blood sampling revealed elevated serum TSH, normal concentrations of free T 4 , normal FSH and LH and high concentrations of E 2 . A series of weekly amniocenteses and intra-amniotic injections of levothyroxine was initiated, along with a reduction of the mother's methimazole dosage. The level of TSH in amniotic fluid was initially high, but was considerably reduced by each injection and followed by a gradual reduction of fetal goiter as well as the left ovarian cyst. The right cyst ruptured spontaneously. At 36 weeks + 4 days, the patient underwent elective caesarean section and gave birth to a female, weighing 2,880 g with 1- and 5-min Apgar scores of 10. The thyroid gland appeared normal in size, and cord blood TSH and free T 4 were both within normal limits. At ultrasound control 6 days later, the right ovarian cyst was not visible, while the left cyst was still present. Thus, our report supports previous findings that fetal goiter can be treated successfully with intra-amniotic injection of levothyroxine.More importantly, it shows that fetal hypothyroidism with elevated levels of TSH can be accompanied by ovarian cysts,suggesting interference between thyreotropic and gonadotropic hormones.