Role of Laparoscopic Transillumination Guidance During Hysteroscopic Metroplasty in Simplifying Surgical Management of Type II Robert's Uterus.

Robert's uterus is a rare variant of septate uterus with an asymmetrical septum which divides the uterine cavity into a noncommunicating hemiuterus causing hematometra and other communicating hemiuterus with a single cervix and a normal fundal contour (U2bC3V4 ESHRE classification). It is a cause of severe dysmenorrhea in young girls. However, there is a type of Robert uterus (Type II) which does not have collection in the blind cavity and causes symptoms later, similar to our case. We describe a case of hysteroscopic septum resection (metroplasty) with laparoscopic guidance by transillumination in a case of Type II Robert's uterus in a 25-year-old nulliparous woman. Thick muscular septum posed a surgical challenge which was supplemented by astutely utilizing laparoscopic transillumination.

Intraoperative Dislodgment and Retrieval of Broken Parts of Laparoscopic Instruments: Arduous Exercise and Lessons Gleaned.

BACKGROUND: Dislodgement and breakage of instruments in laparoscopy is a rare event which not only surmounts the anxiety of the team, but also imposes an exceedingly onerous situation for the patient. Frequently a broken fragment of an instrument is confined to an area remote from the primary operative site and gets entrapped in the bowel loops or in the omentum. METHOD: We present the intraoperative loss of the distal tip of three 5-mm laparoscopy instruments (monopolar L-hook, myoma screw and tenaculum) in the abdominal cavity during endoscopy. RESULT: Various retrieval methods for laparoscopy instruments have been described. CONCLUSION: The distal working tips of laparoscopic instruments have delicate functioning and tend to fall off or break during usage. Maintenance of instruments used in endoscopy requires special care and should be done as outlined by the manufacturer. Reporting of such incidents should be encouraged and published despite the discomposure accompanying it as it aids in better understanding and learning to handle these situations.

Laparoscopic Excision of Cesarean Scar Ectopic Pregnancy.

BACKGROUND: Cesarean scar ectopic pregnancies are increasing in frequency, due to rise in cesarean deliveries. They should be managed early in pregnancy, preferably by surgical excision, failing which they may rupture, or later develop into morbidly adherent placenta. METHODS: This is a series of five cases described to explain the instrumentations and techniques in the laparoscopic excision of cesarean scar ectopic pregnancies. Written consent was taken from the patients. RESULTS: All five patients underwent successful laparoscopic excision. Follow-up period was uneventful. CONCLUSION: Laparoscopic excision of cesarean scar ectopic is a technically demanding procedure, but with excellent results. All gynecologists should be familiar with this technique due to the increasing incidence of cesarean scar ectopic gestations.

Unexpected rupture of an expectantly managed tubal ectopic pregnancy: a reminder for enhanced diligence.

Expectant management of tubal ectopic pregnancies is a feasible and possibly preferable method of management in asymptomatic women with low serum ß-human chorionic gonadotropin (hCG). This involves serial monitoring of ß-hCG until negative, after which it is deemed as spontaneously resolved ectopic pregnancy. We describe a case of tubal ectopic pregnancy which was expectantly managed with an initial ß-hCG of 585 mIU/mL until undetectable. This patient presented with ruptured ectopic pregnancy 8 weeks after the original diagnosis, at the level of 5 mIU/mL. This highlights the importance of close monitoring in the expectant management of tubal ectopic pregnancies, with the incorporation of imaging, even when serial ß-hCG shows a persistently reducing trend.