Immediate laparoscopic nontransvesical repair without omental interposition for vesicovaginal fistula developing after total abdominal hysterectomy.

BACKGROUND AND OBJECTIVE: We conducted this study to evaluate the feasibility and efficacy of immediate laparoscopic nontransvesical repair without omental interposition for vesicovaginal fistula (VVF) developing after total abdominal hysterectomy (TAH), which causes not only social and economic misery for the patient but also considerable stress to the physicians who perform the surgery. METHODS: We performed a retrospective review of 5 women who underwent immediate laparoscopic nontransvesical repair without omental interposition for VVFs, developing after TAH from October 2007 to March 2009. In terms of laparoscopic procedure, cystoscopy was performed to confirm the location of fistula and ureteral openings, initially. Without opening the bladder, the fistula tract was identified, and the bladder was dissected from the vagina. The bladder defect was closed by using intracorporeal, continuous, and double-layer suturing, laparoscopically. The vaginal defect was closed using interrupted and single-layer suturing, vaginally. A Foley catheter was inserted for 2 weeks and removed after bladder integrity was confirmed with a retrograde cystogram. RESULTS: The median age and body mass index of the patients were 47 years and 22.3 kg/m², respectively. Operating time, hemoglobin change, and hospital stay were 95 minutes, 1.1 g/dL, and 5 days, respectively. There were no complications or laparoconversions. During follow-up (median 56.1 weeks; range 26.6 to 74.0), there was no evidence of recurrence. CONCLUSIONS: Immediate laparoscopic nontransvesical repair without omental interposition might be an effective, feasible alternative to the traditional methods in select patients with small sized (<1 cm) VVF developing after TAH.

Repeat laparoscopic paraaortic lymphadenectomy for an isolated lymph node recurrence in a patient with stage IB2 cervical cancer.

We report a case of repeat laparoscopic paraaortic lymphadenectomy (LPAL) after surgery and concurrent chemoradiation of cervical cancer, FIGO stage IB2. Twelve months after the initial treatment, F-18 fluoro-deoxyglucose-positron emission tomography-computed tomography showed an isolated paraaortic lymph node recurrence in a 49-year-old woman. The lymph nodes were successfully removed in a repeat LPAL. The patient received 3 cycles of combination chemotherapy and showed a complete clinical recovery. Repeat LPAL is thus a feasible and effective procedure to remove and confirm of an isolated paraaortic lymph node recurrence after previous surgery and chemoradiation for treating cervical cancer.

Distal urethral polypropylene sling surgical management for urodynamic stress incontinence in Korean women.

INTRODUCTION: The purpose of the present study was to assess the objective and subjective efficacy of the distal urethral polypropylene sling (DUPS) for urodynamic stress incontinence (USI) in Korean women. PATIENTS AND METHODS: We performed DUPS in 89 consecutive patients with USI. The Incontinence Impact Questionnaire (IIQ-7) and the Urogenital Distress Inventory (UDI-6) were used to evaluate the surgical outcomes. RESULTS: The mean operative time was 29.4 min (range 25-40). Concomitant procedures were performed including rectocele repair (n = 48), laparoscopically assisted vaginal hysterectomy (n = 12) and laparoscopic myomectomy (n = 1). There were no intraoperative complications or major postoperative complications. The average follow-up was 15 months (range 12-18). Both mean IIQ-7 and UDI-6 scores decreased significantly after DUPS. In addition, 87% of the patients reported no symptoms of USI under any circumstances and 95% of the patients reported never or rarely being bothered by USI. CONCLUSIONS: DUPS is a safe, inexpensive, simple, and effective surgical method for USI. The procedure provides a high cure rate in Korean women.

The four-trocar method for performing laparoscopically-assisted vaginal hysterectomy on large uteri.

STUDY OBJECTIVE: To assess the feasibility and efficacy of laparoscopically-assisted-vaginal hysterectomy (LAVH) for a large uterus with the new trocar technique. DESIGN: Retrospective clinical study (Canadian Task Force classification III). SETTING: University teaching hospital. PATIENTS: Thirty-four women with a large uterus (>500 g). INTERVENTION: LAVH with Choi's 4-trocar method. MEASUREMENTS AND MAIN RESULTS: We reviewed the medical records of 34 patients for age, parity, history of previous abdominal surgery, operative indications, histopathologic diagnosis, mean operative time, weight of the removed uterus, change in the hemoglobin level, hospital stay, and occurrence of any complications. The patient's median age was 45 years (range 36-51 years), median parity was 2 (range 0-3), and 18 patients (52.9%) had a previous operative history. The most common operative indication was a palpable abdominal mass, and the most common histopathologic diagnosis was leiomyoma. The median operative time was 62.5 minutes (range 35-245 minutes), and the median weight of the removed uterus was 615.0 g (range 500-1200 g). The median change in hemoglobin level was 1.4 g/dL (range 0-5 g/dL). The median hospital stay was 4.0 days (range 2-6 days). The only complication was superficial port site bleeding (1 patient). None of the operations were switched to total abdominal hysterectomy. CONCLUSION: Choi's 4-trocar method provided an excellent operative field during LAVH for a large uterus.