Intra operative lesion of the pelvic ureter solved in a minimally invasive manner.

Ureteral lesions during open hysterectomy, vaginal hysterectomy or laparoscopic hysterectomy have a rate of 0.2% up to 6%. Multiple complications may occur if the lesion is not recognised intra operatively: hydronephrosis, anuria (bilateral lesion), ureterovaginal fistula, ileus, peritonitis. The rate of recognition of an intra operative ureter lesion is 30% and it could rise up to 90% when cystoscopy with ureteroscopy is used at the end of the intervention. The article presents the case of a 46-year-old patient with uterine fibromatosis, whose pelvic ureter was sectioned during surgery. The lesion was recognised during surgery because, at the end of each intervention, the diuresis was stimulated by injecting Furosemide in order to detect the lesions of the ureters and urinary bladder.

Laparoscopic myomectomy.

Uterine leiomyoma is the most common benign tumour occurring in women in the reproductive age. It is typically found during the middle and later reproductive years. The prevalence quoted in literature ranges from 20-50% based on post mortem studies. The symptoms usually reported by women with fibroids are the following: abnormal gynaecologic haemorrhage, chronic pelvic pain, dyspareunia, as well as urinary and bowel symptoms, urinary frequency or retention and, in some cases, infertility. During pregnancy, premature labor might be caused, interfering with the position of the fetus or abortion could be induced. However, only 30% of the women develop symptoms, most of them being asymptomatic. It was proved that the factors that can cause fibroids are the following: genetic, hormonal, and growth factors, especially transforming the growth factor beta (TGFb)-related cellular changes. As diagnosis tools, studies are revealing that ultrasound has been shown to be an insufficient method of myoma mapping, and magnetic resonance imaging should be preferred for surgical therapy planning. The contour of the endometrial cavity is delineated by using trans vaginal ultrasound and saline infusion hysterosonography, but hysteroscopy is the gold standard to evaluate the uterine cavity.

Single incision laparoscopic surgery (SILS) cholecystectomy. A novel technique.

INTRODUCTION: Since early nineties, laparoscopic cholecystectomy has become gold standard for cholecystectomy. Also, a high tendency of minimizing surgical trauma encourages the use of new approaches in laparoscopic surgery. A novel approach such as Single incision laparoscopic surgery (SILS) cholecystectomy has been describes. CASE REPORT: We report on a case of a 33-year-old female patient scheduled for elective laparoscopic cholecystectomy due to symptomatic ultrasonography verified cholelithiasis. A single 2.5-cm long semicircular infraumbilical skin incision was used. Pneumoperitoneum was established alter introduction of the predesigned trocar. Antegrade cholecystectomy was performed without stay suture placement. Postoperative course was uneventful. DISCUSSION: This article reports the authors' method of performing SILS cholecystectomy. SILS approach is feasible with new standard devices from the industry that offers slightly modified instruments for standard laparoscopic cholecystectomy. CONCLUSION: Single-incision laparoscopic surgery is a feasible way to perform cholecystectomy. A learning-curve is required and further work in the form of randomized controlled trials is needed to investigate the advantages of this new technique.