Complex Laparoscopic Myomectomy with Severe Adhesions Performed with Proper Preventive Measures and Power Morcellation Provides a Safe Choice in Certain Infertility Cases.

Laparoscopic myomectomy offers a real benefit to infertile patients with uterine fibroids and peritoneal adhesions. The procedure requires a skilled surgeon and laparoscopy technique to minimize adhesion formation and other proven benefits. Restrictions arise since this procedure requires power morcellation for fibroid tissue extraction. Two years ago, the Food and Drug Administration in the United States of America (FDA) issued the alert on power morcellation for uterine leiomyomas, addressing the risk of malignant cell spreading within the abdominal cavity (actual risk assessment from 1 in 360 to 1 in 7400 cases). We review a 30-year-old female, without previous gestations, hypermenorrhea, intermenstrual bleeding, and chronic pelvic pain. Transvaginal ultrasound reports multiple fibroids in the right portion of a bicornuate uterus. Relevant history includes open myomectomy 6 years before and a complicated appendectomy, developing peritonitis within a year. Laparoscopy revealed multiple adhesions blocking uterine access, a bicornuate uterus, and myomas in the expected site. Myomectomy was performed utilizing power morcellation with good results. FDA recommendations have diminished this procedure's selection, converting many to open variants. This particular case was technically challenging, requiring morcellation, and safety device deployment was impossible, yet the infertility issue was properly addressed. Patient evaluation, safety measures, and laparoscopy benefits may outweigh the risks in particular cases as this one.

Forceps, Actual Use, and Potential Cesarean Section Prevention: Study in a Selected Mexican Population.

OBJECTIVE: Assessment of the frequency of complications observed with various forceps and operative vaginal delivery (OVD) techniques performed at the ABC Medical Center (Mexico City) to evaluate their safety, bearing in mind the importance of decreasing our country's high cesarean section incidence. METHODS: We reviewed 5,375 deliveries performed between the years 2007 and 2012, only 146 were delivered by OVD. RESULTS: Only 1.0% of the cases had a serious, life-threatening situation (uterine rupture). The Simpson forceps was the most favored instrument (46%) due to its simplicity of use, effectiveness, and familiarity. Prophylactic use was the most common indication (30.8%) and significant complications observed were vaginal lacerations (p = 0.016), relative risk (RR) of 3.4 (95% confidence interval [CI]: 1.15-10.04), and fourth degree perineal tear (p = 0.016), RR of 3.4 (95% CI: 1.15-10.04). CONCLUSIONS: Forceps use and other OVD techniques are a safe alternative to be considered, diminishing C-section incidence and its complications.

[A technique for total laparoscopic hysterectomy with vaginal morcellation on large uteri in order to maintain minimal invasion]. / Técnica para histerectomía laparoscópica de útero grande con morcelación vaginal para mantener la invasión mínima.

The advancement and increasing popularity of laparoscopic hysterectomy and the patient's foremost cosmetic concern has made the need for performing laparoscopic hysterectomy in a less morbile and time-consuming manner, we present a technique for large uteri using only three 5 mm entry ports, with tissue morcellation and removal vaginally using the Koh colpo-pneumo occluder.

[Latzko surgery in recidivant vesicovaginal fistulae. Two case reports and literature review]. / Operación de Latzko en fistula vesicovaginal recidivante. Reporte de dos casos y revisión del tema.

Recurrent vesicovaginal fistulae represent a clinical problem of the utmost importance due to the impact on the patients' quality of life. The current standard of treatment for this problem is surgical, with an abdominal approach, notwithstanding, may authors state that this repair should be done with the technique and approach that the surgeon feels most comfortable. We have successfully treated two patients with recurrent vesicovaginal fistulae using a vaginal approach, therefore we suggest it as a viable alternative in the treatment of this condition. We present two case reports an literature review, with the necessary modifications of the Latzko technique.

[Fusion of the labia minora as a cause of urinary incontinence in a postmenopausal woman. A case report and literature review]. / Fusión de los labios menores como causa de incontinencia urinaria en una mujer posmenopáusica. Reporte de un caso y revisión bibliográfica.

Labial fusion is rarely presented in the postmenopausal age group, its predisposing factors are hipoestrogenism and a inflamation/repair process in the vaginal epithelium. Our case report involves a 73 years old woman that presents with urinary incontinence. On physical exploration, complete labial fusion was noted, a surgical approach was undertaken with liberation of the labia and fixation, postoperatory local estrogen ointment was indicated with complete recovery. The literature review confirmed that this was the ideal treatment and also confirms the role of local estrogen ointment as profilactic and therapeutic.

[Endometrial ossification: a report of four cases and literature review]. / Osificación endometrial: comunicación de cuatro casos y revisión bibliográfica.

Endometrial ossification is a rare endometrial pathology. Its predisposing factors include history of uterine curettage to metabolic abnormalities. It usually presents in patients with secondary infertility and history of first trimester pregnancy loss, accompanied by severe dysmenorrhea and dyspareunia. The diagnosis is suspected by OB-GYN history and USG findings, therapeutic strategies range from D&C to hysterectomy, we propose diagnosis and management by hysteroscopy in order to preserve future fertility and minimize uterine damage. A review of four cases during 1985-2004 from a large assisted reproduction center in Mexico City is presented.

[Uterine and jejunum perforation due to intrauterine device. A report of a case and literature review]. / Perforación uterina y del yeyuno causada por un dispositivo intrauterino. Presentación de un caso con revisión de la literatura.

The application of a copper IUD can perforate completely the uterus and involve adjacent organs such as the bladder, small bowel, colon, rectum or appendix. Once the diagnosis is established, complete extraction must follow. We present a case report of a 33 year-old patient in which a copper IUD was placed in a medical office, three months after a third cesarean, without history of sepsis. Ninety days after placement, the patient complained of menstrual irregularities (opsomenhorrea) without any other symptoms. On physical examination with speculum, the IUD's guide strings were not visible; a transvaginal USG was performed without visualization of the IUD in the uterine cavity. An abdominal CAT scan showed the presence of the IUD outside the uterus. Hysteroscopy-laparoscopy was performed with transoperatory fluoroscopy, which revealed the copper IUD inside the yeyunum, a complete extraction followed with entero-entero anastomosis. This case will show that IUD placement is not innocuous and that adjacent organ damage must always be considered and resolved immediately.