Surgical Neuropelviology: Combined Sacral Plexus Neurolysis and Laparoscopic Laterally Extended Endopelvic Resection in Deep Lateral Pelvic Endometriosis

ABSTRACT Objective Surgical demonstration of combined sacral plexus neurolysis and laparoscopic laterally extended endopelvic resection for deep lateral infiltrating endometriosis. Design Video showing principles of neurolysis and laparoscopic laterally extended endopelvic resection applied to endometriotic surgery. Setting University tertiary referral center. Deep infiltrating endometriosis is an underestimated disease with real medical and clinical issues, recently classified as central pelvic endometriosis and lateral pelvic endometriosis further divided into superficial and deep according to the structures’ involvement [1] . The surgical removal of endometriotic foci remains the standar…

Appendiceal mucinous neoplasms: An uncertain nosological entity. Report of a case

Introduction: Appendiceal mucocele is a relatively rare condition characterized by progressive dilation of the appendix caused by intraluminal accumulation of mucoid substance. Its incidence is 0.07 - 0,63% of all appendectomies performed. Case report: We report the case of a 70-year-old man who came to our observation with gravative pain in right lower abdominal region. A computed tomography abdominal scan revealed a cystic/tubular structure like an appendicular mass with wall enhancement but without calcifications suggestive of a mucocele. Into peritoneal cavity we found profuse mucinous material with a 1,5 cm size parietal nodule. We also identified a free perforation of the cecum with c…

Laparoscopic aortic lymphadenectomy in left-sided inferior vena cava

Transposition of the inferior vena cava (IVC), also known as left-sided IVC (LS-IVC), is a rare congenital variant which results from regression of the right supracardinal vein and persistence of the left supracardinal vein in embryonic development.[1 2][1] LS-IVC occurs in 0.2–0.5% of the general

Nonhormonal management of postmenopausal women: Effects of a red clover based isoflavones supplementation on climacteric syndrome and cardiovascular risk serum profile

The aim of this prospective randomized study was to evaluate a red clover based isoflavones supplementation in the treatment of climacteric syndrome and its effects on cardiovascular risk serum profile. Materials and Methods: The study included 150 healthy postmenopausal women that were randomly assigned to receive phytoestrogens tablets, amounting in a total daily intake of 60.8 mg red clover isoflavones plus 19.2 mg soy isoflavones (n = 75), or placebo (n = 75). The authors evaluated teh following: daily number of hot flushes and Kupperman Index at baseline and after one and three months; serum total, high-density lipoprotein (HDL) and low-density lipoprotein (LDL) cholesterol, triglyceri…

EP755 Laparoscopically modified laterally extended endopelvic resection for gynecological malignancies involving pelvic side wall: a feasibility analysis

Introduction/Background Lateral pelvic side wall involvement by gynecological malignancies has been considered for a long time an absolute contraindication to curative resection. Recently the surgical paradigm is challenged with the development of the Laterally Extended Endopelvic Resection, LEER. Although the LEER is perfectly standardized in open surgery, just one small experience has been published about its endoscopic feasibility.The objective of this study is to analyze the feasibility of Laparoscopically Modified Laterally Extended Endopelvic Resection, LM-LEER, in patients with gynecological malignancies involving the lateral pelvic side wall. Methodology We retrospectively evaluated…

Histological Analysis of Specimens from Endometrioma Excision Performed by Different Surgeons: Does the Surgeon Matter?

Cervical intraepithelial neoplasia (CIN) in pregnancy: The state of the art

Cervical cancer is the most commonly diagnosed malignancy in pregnancy and cervical screening should be accordingly performed in this particular situation. Occurrence of a preneoplastic cervical disease in pregnancy has for a long time represented a challenge for the clinician, both in terms of diagnostic accuracy, treatment options and risk of obstetrical complications. For these reasons, lack of uniformity in diagnosis and management is still commonly observed and the need for evidence-based clarifications is strongly required. Consistently with the literature evidences and accordingly with international guidelines, this review aim to overview the most significant aspects of the issue and…

EP756 Laterally extended endopelvic resection: a comparative analysis between laparotomic and laparoscopically modified approach

Introduction/Background Laterally Extended Endopelvic Resection (LEER) has been identified as a valid therapeutic option for women with gynecological malignancies involving the pelvic side wall. The historical approach to LEER is laparotomic, recently we have proposed the so called Laparoscopically Modified Laterally Extended Endopelvic Resection (LM-LEER).The objective of this study is to compare surgical and oncological outcomes between LEER and LM-LEER in a consecutive series of patients with gynecological malignancies infiltrating the pelvic side wall. Methodology We retrospectively evaluated women submitted to LEER between October 2012 and January 2019. Inclusion criteria for LM-LEER w…

Long and fluctuating bone fragments in uterine isthmus: a curious feature of true osseous metaplasia.

Osseous metaplasia in the uterine cavity is a rare phenomenon arising from an unusual transformation of non-osseous connective tissue into mature bone. It is unclear how this alteration occurs and it has no single clinical manifestation. We report a case of asymptomatic endometrial osseous metaplasia of the isthmus with a singular picture: numerous long, floating bone-like structures in the cavity. The lesion was treated by operative hysteroscopy. Histological findings described a rare picture of true osseous metaplasia with the extraordinary presence of cells referable to areas of hematopoietic tissue in the cavities of trabecular bone. Physicians should be more informed and alert regardin…

New treatment for stress urinary incontinence

Objective: The aim of this study is to evaluate the safety and efficacy of the Zuidex implacement for the treatment of type III incontinence. Methods: We evaluated 36 women (median age 51) with type III ( MUCP<20 cm H2O and VLPP<60 cm H2O), with fixed urethra demonstrated (Delta Value<30 at Q-tip test). 21 (58.3%) had undergone previous continence surgery .They were recluted by a complete urogynaecological work-up( Vaginal profile, Q- tip test, Endoscopy and Urodynamic study, one hour Pad test, Ultrasonography). We defined as cured patients that were dry after the implant was performed, and as improved those who decreased in number of pads and symptoms.We underwent all patients an intrauret…

Surgical Neuropelveology: Lateral Femoral Cutaneous Nerve Endometriosis. Laparoscopic Resection and Nerve Transplantation

ABSTRACT Study Objective To demonstrate the application of surgical neuroanatomic principles for the diagnosis and treatment of deep infiltrating endometriosis involving the lateral femoral cutaneous nerve. Design Video demonstration of laparoscopic lateral femoral cutaneous endometriosis resection with nerve transplant. Setting Endometriosis infiltrating somatic nerves is a poorly known condition, which can cause severe neuropathic symptoms [1] and is often unrecognized with a subsequent treatment delay [1] . Intimate knowledge of pelvic neuroanatomy and expertise in minimally invasive surgery are essential to manage this challenging surgical scenario 2 , 3 , 4 . Interventions Thirty-six y…

Peritoneal tuberculosis in the differential diagnosis with peritoneal carcinomatosis: Case report and literature review

Tuberculosis is a severe public health problem in developing countries, but it is taking on the characteristics of a global epidemic. By virtue of migration flows, in fact, we are observing a resurgence of this disease in western countries, in all its forms including the genital one. The problem became more serious with the emergence of multidrug-resistant mutant (MDR) strains of Mycobacterium Tuberculosis. In this paper we describe a case of peritoneal tuberculosis, whose diagnosis was histologically made after laparoscopic examination. Laparoscopy proved crucial for the differential diagnosis with peritoneal carcinomatosis, particularly following the discrepancy in the results provided by…