Iatrogenic orifice transluminal endoscopic surgery (IOTES): managing uterine perforations at operative hysteroscopy.

OBJECTIVE: To prove safety and feasibility of an intra-abdominal endoscopic evaluation via an iatrogenic uterine perforation that occurred during operative hysteroscopy. DESIGN: Clinical case report. SETTING: University Hospital. PATIENT(S): A multimorbid woman with postmenopausal bleeding with iatrogenic uterine perforation during hysteroscopic resection of an endometrial polyp. INTERVENTION(S): Intra-abdominal endoscopic evaluation via the iatrogenic uterine perforation site with use of a standard diagnostic hysteroscope. MAIN OUTCOME MEASURE(S): Visibility, technical feasibility, clinical course, and hematologic follow-up of the patient. RESULT(S): A sufficient assessment of the intra-abdominal cavity and the uterine defect was possible with use of a small-diameter diagnostic hysteroscope during the workup of an iatrogenic uterine perforation. No additional intervention-related side effects occurred. CONCLUSION(S): This technique was safe and feasible to gain operative access to the abdominal cavity, allowing a complete diagnostic intra-abdominal inspection for lesions of the adjacent organs. IOTES bears the potential to become a time-saving low-risk alternative to diagnostic standard laparoscopy.

Comparative study of the neuropeptide-Y sympathetic nerves in endometriotic involved and noninvolved sacrouterine ligaments in women with pelvic endometriosis.

STUDY OBJECTIVE: To show the relationship between the neuropeptide-Y pelvic sympathetic nerves and neoangiogenesis in the development of endometriosis DESIGN: Prospective study. SETTING: Academic community teaching hospital. PATIENTS: Fifteen consecutive women with unilateral endometriotic infiltration of the sacrouterine ligaments. INTERVENTIONS: A laparoscopic excision/biopsy of involved and noninvolved parts of the sacrouterine ligaments were taken. The sections were incubated with the neuronal marker rabbit polyclonal anti-protein gene product 9.5 and rabbit polyclonal anti-neuropeptide-Y. We made a comparative study on the distribution of nerve fibers and their relationship to the vessels on intact and endometriotic involved tissue. MEASUREMENTS AND MAIN RESULTS: The results show that a large amount of nerves are present around the blood vessels in the endometriosis samples, and a large number of these nerves are neuropeptide-Y sympathetic nerves. Adrenergic fibers are also present in the intact control subjects, however, in significantly smaller amounts. CONCLUSION: This finding shows a strong relationship between the neuropeptide-Y sympathetic pelvic nerves and the neoangiogenesis required for the development of endometriosis.