Accuracy of intraoperative frozen section during laparoscopic management of early endometrial cancer.

OBJECTIVE: The aim of our retrospective study was to correlate the intraoperative frozen section (FS) and permanent section (PS) diagnosis among patients with early-stage endometrial cancer (FIGO Stage I). METHODS: Retrospective analysis of clinical data. A set of 63 women were operated by the technique of laparoscopic assisted vaginal hysterectomy with bilateral salpingo-oophorectomy (LAVH with BSO). All probands had intraoperative FS biopsy performed with grading and myometrial invasion assessment. These data were then compared with PS diagnosis. Statistical evaluation was used to detect diagnostic accuracy of FS (sensitivity, specificity and positive vs negative predictive value, and accuracy rate). RESULTS: The average age was 61 years, BMI 32.4 kg/m2 and operation time including lymphadenectomy (LAE) was 108.7 minutes. Sensitivity of FS was 77.8%, specificity 98.1%, positive predictive value (PPV) 87.5%, negative predictive value (NPV) 96.4% and accuracy rate 95.2%. Suboptimal surgical management due to underevaluation of FS biopsy compared to PS diagnosis occurred in 2 patients (3.2%). CONCLUSION: Combination of LAVH with BSO and use of intraoperative FS enables the surgeon to individualize surgical treatment for every patient to the extent of either performing complete operation together with LAE or not.

[Reproductive outcome after laparoscopic myomectomy--retrospective analysis 1994-2007]. / Reprodukcní výsledky po laparoskopické myomektomii--retrospektivní analýza 1994-2007.

The aim of the study was to analyse the reproductive outcome after laparoscopic myomectomy (LM) in infertile patients. Between the years 1994-2007 were 351 infertile women operated in our department. The average age of the patients was 33.5. The total number of extirpated fibroids was 643, with the average of 1.7 per patient and the average size of 3.3 cm. 171 women (48.7%) became pregnant after LM. There were 119 deliveries, 16 spontaneous abortions and 6 ectopic pregnancies in this group. The caesarean section (CS) rate was 46.2% . Intramural localisation of the fibroid significantly correlated with the termination of pregnancy by CS. I. and II. trimester pregnancy loss correlated significantly with deep coagulation when conception occurred during 12 months after surgery. No uterine rupture was observed during pregnancy.

Bilateral avulsion of the puborectal muscle: magnetic resonance imaging-based three-dimensional reconstruction and comparison with a model of a healthy nulliparous woman.

OBJECTIVES: Obstetric trauma to the puborectal muscle seems to be an important cause of pelvic floor dysfunction in women. Due to the complicated three-dimensional (3D) arrangement of the pelvic structures, two-dimensional images are not sufficient to demonstrate its relationships in a complex fashion. Thus, we aimed to create a 3D computer model to visualize the normal female pelvic floor anatomy and to compare this with the anatomy after bilateral avulsion of the puborectal muscle following delivery. METHODS: We created two 3D computer models of the female pelvic floor, one of a healthy nulliparous woman and the other of a woman with bilateral puborectal muscle avulsion after vaginal delivery. The data for the models were obtained from magnetic resonance imaging examinations and the following structures were depicted: pelvic bones, puborectal muscle, internal obturator muscle, urethra, urinary bladder, vagina and rectum. The models were compared. RESULTS: The models allowed us to demonstrate in three dimensions changes in the puborectal muscle after avulsion. Its relations to the bone, internal obturator muscle, perineal membrane and the deep part of the external anal sphincter were modeled and differences from the normal non-injured anatomy were demonstrated. Avulsion altered the support to the whole endopelvic fascia and destabilized both the anterior and the posterior vaginal walls. CONCLUSIONS: The use of 3D technology including modeling allows for the acquisition of new knowledge and aids in the understanding of both normal and pathological pelvic anatomy.

[Clinical comparison of laparoscopy-assisted vaginal hysterectomy (LAVH) and total laparoscopy hysterectomy (TLH) in women with benign disease of uterus--a prospective randomized study]. / Klinické srovnání laparoskopicky asistované vaginální hysterektomie (LAVH) a totální laparoskopické hysterektomie (TLH) u zen s benigním onemocnením delohy--prospektivní randomizovaná studie.

OBJECTIVE: To compare two techniques of hysterectomy. DESIGN: Prospective, randomised study. SETTING: Institute for the Mother and Child Care, Prague. METHODS: 85 patients randomized into two groups--laparoscopically assisted vaginal hysterectomy (LAVH) and total laparoscopic hysterectomy (TLH). The criteria studied were length of the procedure, blood loss, complication rate, uterus weight, rate of conversions, consumption of analgesics, inflammatory response. RESULTS: Mean length of the procedure for LAVH, TLH was 85 and 111 min, respectivelly, the mean blood loss 306 and 184 ml. There was no difference in inflammatory response and use of antibiotics. Consumption of analgesics was higher in the TLH group. Conversions to laparotomy occurred only in the LAVH group. Only in the TLH group we noticed serious postoperative complications. CONCLUSION: LAVH seems to be the preferable technique of hysterectomy for benign diseases of the uterus.

Left-sided suprarenal retrocrural para-aortic lymphadenectomy in advanced cervical cancer by laparoscopy.

OBJECTIVE: Conventional open suprarenal retrocrural lymphadenectomy is done via a thoraco-abdominal approach including partial rib resection. We developed a less invasive technique. METHODS: Through a laparoscopic transperitoneal approach the left paracolic peritoneum and the left phrenicocolic ligament are transected. The colonic flexure, left kidney with adrenal, tail of the pancreas, and spleen are mobilized and retracted medially. The suprarenal aorta with superior mesenteric artery and coeliac trunk are exposed. The crus of the diaphragm and the right inferior phrenic artery are transected. This allows lymphadenectomy from the level of the left renal vessels to the crus of the diaphragm. RESULTS: In October 1997 three women with cervical cancer stage IIIB underwent laparoscopic suprarenal retrocrural lymphadenectomy. A mean of 10 lymph nodes was removed (range 8-12). Duration of operation was on average 218 min (range 196-258 min). Intraoperative blood loss was estimated between 100 and 400 ml and hospital stay was 4 days on average. There were no intra- or postoperative complications. CONCLUSION: This laparoscopic technique may prove useful for staging and treatment of women with advanced gynecologic cancer.