[Laparoscopic conservative treatment of ovarian dermoid cysts]. / Trattamento laparoscopico conservativo delle cisti dermoidi ovariche.

Two methods for the laparoscopic dissection of dermoid ovarian cysts, less than 10 cm, in 55 fertile women, are compared. Water dissection was performed in 23 patients and bipolar scissors were used in 32 patients, creating a rhomb on the surface of the ovary, just to obtain a good traction for atraumatic dissection. The mean surgical time, complications and hospital stay have been compared. Operative laparoscopy is the technique of choice to remove most, if not all, ovarian dermoid cysts. It is suggested to use particular strategies in order to safely and easily dissect in toto the cysts.

[Value and significance of cystoscopy during laparoscopic hysterectomy]. / Valore e significato della citoscopia durante l'isterectomia laparoscopica.

The purpose of our study is to identify the ureteral and vesical lesions that may occur in the course of total laparoscopic hysterectomy using intraoperative cystoscopy. After the patient has been placed in dorsolithotomic position, we used a Hourcabie manipulator, a 10 mm umbilical trochar and two 5-mm suprapubics. Total hysterectomy is carried out and after closing the vagina 5 ml of stain in a physiological solution are injected into the vein to carry out cystoscopy. Analysis refers to the first 120 patients from 1998 to 1999 treated with laparoscopic hysterectomy. No material or vesical intraoperative lesions were found in any of the patients with the exception of a vesical lesion which was sutured during laparoscopy. Even with the cystoscopic finding normal, 2 fistulas were observed 20 and 25 days after the operation, so the negativity of the cystoscopy excludes certainly immediate complications but not late ones. Furthermore, not all surgeons carry out intraoperative cystoscopy, so the data available are scanty.

[The use of Foley's catheter and suturing to control abdominal wall haemorrhage provoked by the trochar. Comparative study]. / L'impiego del catetere di Foley e delle suture per il controllo dell'emorragia della parete addominale, provocata dal trocar. Studio comparativo.

Lesions of the abdominal vessels are becoming more frequent owing to the increase in the number of laparoscopies carried out with trochars: they occur in fact in 2% of cases. A study has been carried out to compare the effectiveness of 2 methods for stopping haemorrhage: the use of a Foley catheter and suturing with a Reverdin needle. Abdominal haemorrhages take place as a result of lesions during introduction of accessory trochars in the superficial, circumflex and deep epigastric vessels. Six patients were treated with Foley's catheter while 13 were treated with Reverdin's needle under visual control, maintaining the same operative route, something that is not possible with the Foley catheter. Patients treated with suturing were discharged within 24 hours without irritation or pain.

[Extraumbilical insertion of the laparoscope in abdominal adhesion]. / Inserzione extraombelicale del laparoscopio in caso di aderenze intraddominali.

Palmer s point must be considered a safe alternative site to insert the Verres needle and the primary trocar. It s possible, also, to perform adhesiolysis by this way before to insert the bigger trocar in umbilical site. Our experience shows that this technique can avoid intestinal, omental, injury if the trocar was inserted directly using the umbilical site: that in patients with previous surgery.

[Evaluation of oocyte maturity in patients undergoing ICSI and R-FSH treatment]. / La valutazione della maturazione ovacitaria in pazienti sottoposte ad ICSI e trattate con R-FSH.

BACKGROUND: This study compares embryo quality, fertilisation rate and pregnancy rates after ICSI related with the quality of oocytes achieved after r-FSH stimulation. METHODS: We evaluated 955 oocytes from patients following r-FSH and 643 oocytes from patients stimulated with ultrapure urinary FSH. The oocytes were divided into: a) normal oocytes; b) ooctyes with extra cytoplasmatic abnormalities (dark zona pellucida, wide perivitelline space); c) oocytes with cytoplasmatic abnormalities (dark cytoplasm, granular cytoplasm, retractile body), d) oocytes with shape abnormalities; e) oocytes with double abnormalities; f) oocytes with triple abnormalities. The embryos were divided into: A) even and homogeneous blastomeres without fragmentation; B) even and homogeneous blastomeres with <20% fragmentation; C) uneven and non-homogeneous blastomeres with 20-50% fragmentation; D) uneven and non homogeneous blastomere with >50% fragmentation. RESULTS: 40.9% of oocytes from patients treated with r-FSH have a normal morphology vs 35.2% of control groups (p<0.04). Abnormalities have a similar frequency in the two groups, except for the presence of three combined abnormalities (7.7 vs 5.4%; p<0.04). Fertilisation rate, cleavage rate, oocyte quality and pregnancy rate do not appear to be influenced by oocyte morphology and the type of FSH used for stimulation. CONCLUSIONS: The administration of r-FSH allows a large number of oocytes to be rescued, with a high incidence of normal morphology. The fertilisation rate and the quality of embryos obtained from oocytes with structural abnormalities are similar to those observed in morphologically normal oocytes. Even the probability of pregnancy is similar in the two groups.