[Hysteroscopic myomectomy. Surgical management. Presentation of a case]. / Miomectomía histeroscópica. Manejo médico quirúrgico. Presentación de un caso.

A case of a 34 years old woman with primary sterility secondary to multiple myomatosis, is presented. Any other sterility factor was ruled out. First, she went on laparotomy for multiple myoma resection but two of these were left. The cornual myoma couldn't be removed because the high risk of salpinx damage. The other one was a 3 cm. intracavitary tumor. After four months on leuprolide acetate therapy an hysteroscopic myomectomy was performed. The next menstrual cycle pregnancy was achieved.

[Laparoscopic hysterectomy. Initial experience]. / Histerectomía laparoscópica (HVAL). Experiencia inicial.

The results of the first twelve cases of Laparoscopic Assisted Vaginal Hysterectomy, are presented. The indications for hysterectomy were myomatosis, suspicion of adenomyosis and endometriosis. The surgical technique is described in detail in which a combination of bipolar Kleppinger forceps and reusable scissors were employed. There were two intraoperative accidents. One subcutaneous emphysema of the left half of the abdominal wall, thorax, neck, face and upper limb. The second case was a damage to a branch of the left epigastric artery. The average time was 4 hours 31 minutes which includes 9 patients to which another surgical procedure was practiced. There was no significant bleeding in any of the patients. The postoperative complications were 1 hyponatremia that needed the use of an Intensive Care Unit and the other was periumbilical hematoma of 3 cm. of diameter. The patient was discharged on the one to three postoperative day with an average of two days. The average hospital fee was 35% higher than an abdominal hysterectomy. All the surgery were videotaped and later viewed by the patients. It was concluded that the laparoscopic assistance that is offered to the vaginal hysterectomy is particularly advantageous for hysterectomy especially in the cases where absence of genital prolapse, when uni or bilateral Adnexectomy is required, previous past history of abdomino-pelvic surgery, endometriosis and adhesions. This procedure should be included in the armamentarium of the Gynecological Surgeons but only after and appropriate training.