Unsuspected Diagnosis of Uterine Leiomyosarcoma after Laparoscopic Myomectomy in an Isolated Bag

Minimally invasive techniques are generally applied for patients suspected of having benign fibroids if medical treatment is insufficient. On the other hand, sometimes some occult carcinomas of uterus like leiomyosarcomas may be reported for the patients’ applied morcellation. This condition is rare but outcomes are clinically significant. Fragmentation of occult sarcoma in the abdominal cavity without isolation bag results in widespread and poor survival. In this article, we report a case of 37-year-old woman suffering from pain due to unexpected leiomyosarcoma. Laparoscopic myomectomy was performed with power morcellation in an isolated bag. Although isolation bag is generally reported to be preventive, recurrence of sarcoma was seen at 5th month of follow-up. Even though morcellation within a bag seems to block wide spreading, dispersion of tumor cannot be stopped and more investigations have to be done.

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Buschke-Löwenstein Tumour: Successful Treatment with Minimally Invasive Techniques

Case Reports in Dermatological Medicine ◽

10.1155/2015/651703 ◽

2015 ◽

Vol 2015 ◽

pp. 1-4

Author(s):

Estefânia Correia ◽

António Santos

Keyword(s):

Minimally Invasive ◽

Cost Effective ◽

Functional Results ◽

Moderate Degree ◽

Minimally Invasive Techniques ◽

Secondary Intention ◽

History Of ◽

Full Thickness Excision ◽

Invasive Techniques

We report a case of an 80-year-old female who presented with a four-year history of a growing mass in the perianal area with pain and bleeding during defaecation. Clinical examination revealed a locally destructive, cauliflower-like, verrucous mass measuring 10×12 cm in diameter. Histologic findings revealed a moderate degree of dysplasia of the epithelium with koilocytosis atypia, acanthosis, and parakeratosis, features that are consistent with Buschke-Löwenstein tumour. Polymerase-chain-reaction assay for human papillomavirus (HPV) showed an infection with HPV type 11. Full-thickness excision of involved skin was undertaken by cryotherapy and electrocautery over five months. The entire wound was left open to heal by secondary intention. After 3 years of follow-up, the patient has not experienced a recurrence, with excellent functional results, but the cosmetic results were satisfactory. These minimally invasive techniques can be safer and more cost-effective than surgery and the General Practitioner can play a key role in diagnosis.

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PS01.096: CHOOSING THE TREATMENT OPTION OF END-STAGE CARDIAC ACHALASIA

Diseases of the Esophagus ◽

10.1093/dote/doy089.ps01.096 ◽

2018 ◽

Vol 31 (Supplement_1) ◽

pp. 77-77

Author(s):

Mikhail Koshkin ◽

Oleg Vasnev ◽

Magomet Baychorov ◽

Roman Izrailov ◽

Kirill Shishin ◽

...

Keyword(s):

Minimally Invasive ◽

Conflicts Of Interest ◽

Treatment Options ◽

Laparoscopic Heller Myotomy ◽

Minimally Invasive Techniques ◽

Laparoscopic Esophagectomy ◽

Endoscopic Myotomy ◽

Clinically Significant ◽

End Stage ◽

Invasive Techniques

Abstract Background Until recently the esophagectomy was the only choice in treatment of patients with end-stage achalasia. Developing of minimally invasive techniques such as a laparoscopic Heller miotomy and peroral endoscopic myotomy (POEM) allowed to use them as a treatment options. Aim: to present an experience of treatment of patents with end-stage cardiac achalasia. Methods Since 07.2013 till the 12.2017 eleven patients with end-stage cardiac achalasia were operated on. Among them 2 (18%) were males and 9 (82%) were females. Mean age was 54 years (26–81). Results POEM was performed in 6 patients, laparoscopic Heller myotomy was performed in 2, and esophagectomies were performed in 3 patients with failed previously myotomy made in other clinics. Gastric tube was used to replace the esophagus in patients underwent esophagectomy. Mean operative time was 90 min for POEM, 172 minutes for laparoscopic Heller procedure and 422 minutes for laparoscopic esophagectomy. Blood loss was insignificant in all patients. There were no clinically significant complications during the postoperative course of all patients. Mean postoperative hospital stay was 2 days after POEM, 4 days after laparoscopic Heller procedure and 11 days after esophagectomy. To asses the dysphagia after POEM and Heller procedure Eckardt scale was used. In all cases it was rated as grade 0. Conclusion Minimally invasive techniques such as POEM and laparoscopic Heller procedure should be the first options in surgical treatment of patients with end-stage cardiac achalasia. In case of ineffectiveness of these options esophagectomy should be performed. Disclosure All authors have declared no conflicts of interest.

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Correcting Reflux Laparoscopically

Canadian Journal of Gastroenterology ◽

10.1155/1998/274016 ◽

1998 ◽

Vol 12 (5) ◽

pp. 327-332 ◽

Cited By ~ 1

Author(s):

Eric C Poulin ◽

Christopher M Schlachta ◽

Joseph Mamazza

Keyword(s):

Minimally Invasive ◽

Antireflux Surgery ◽

Abdominal Cavity ◽

Learning Curves ◽

Barium Swallow ◽

Short Esophagus ◽

Minimally Invasive Techniques ◽

Laparoscopic Procedures ◽

Surgical Methods ◽

Invasive Techniques

Most operations in the abdominal cavity and chest can be performed using minimally invasive techniques. As yet it has not been determined which laparoscopic procedures are preferable to the same operations done through conventional laparotomy. However, most surgeons who have completed the learning curves of these procedures believe that most minimally invasive techniques will be scientifically recognized soon. The evolution, validation and justification of advanced laparoscopic surgical methods seem inevitable. Most believe that the trend towards procedures that minimize or eliminate the trauma of surgery while adhering to accepted surgical principles is irreversible. The functional results of laparoscopic antireflux surgery in the seven years since its inception have been virtually identical to the success curves generated with open fundoplication in past years. Furthermore, overall patient outcomes with laparoscopic procedures have been superior to outcomes with the traditional approach. Success is determined by patient selection and operative technique. Patient evaluation should include esophagogastroduodenoscopy, barium swallow, 24 h pH study and esophageal motility study. Gastric emptying also should be evaluated. Patients who have abnormal propulsion in the esophagus should not receive a complete fundoplication (Nissen) because it adds a factor of obstruction. Dor or Toupet procedures are adequate alternatives. Prokinetic agents, dilation or pyloroplasty are used for pyloric obstruction ranging from little to more severe. Correcting reflux laparoscopically is more difficult in patients with obesity, peptic strictures, paraesophageal hernias, short esophagus, or a history of previous upper abdominal or antireflux surgery.

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Surgical Treatment of Brainstem Cavernous Malformations with Three Basic Skull Base Approaches and Minimally Invasive Techniques: Observations in 20 Patients

Translational Neuroscience and Clinics ◽

10.18679/cn11-6030_r.2017.019 ◽

2017 ◽

Vol 3 (2) ◽

pp. 74-83

Author(s):

Wen Yin ◽

Jianrong Ma ◽

Yiwei Liao

Keyword(s):

Minimally Invasive ◽

Skull Base ◽

Surgical Approach ◽

Cavernous Malformation ◽

Minimally Invasive Techniques ◽

Cavernous Malformations ◽

Bleeding Episodes ◽

Surgical Treatments ◽

Invasive Techniques

Objective Brainstem cavernous malformation (BSCM) is extremely challenging for neurosurgeons in terms of surgical approach choices. In this article, we summarized our experience in skull base approaches of BSCM, and elucidated the advance of surgical treatments of brain stem cavernous malformation through reviewing recent relevant articles. Methods We retrospectively reviewed 20 consecutive patients who underwent resection between May 1, 2014 and April 30, 2016. Only midline suboccipital, subtemporal approach and retrosigmoid approach were used in this series. The diagnoses of all patients were confirmed by radiological and histological examination. Results All 20 patients were completely extirpated without surgical-related mortality. The mean follow-up period was 9.5 months (range, 2-20 months). Of the 20 patients, 80% symptomatic patients underwent surgery after first bleeding episode within 3 months, 20% after two or more bleeding episodes by magnetic resonance imaging. After resection and during follow-up, 75% of patients had an improvement in their modified Rankin scale (mRS) scores, whereas 10% were worse compared with their preoperative presentation; 15% were unchanged. Conclusion Appropriate basic surgical approach and minimally invasive techniques are necessary in preventing impairment of neurologic function. The three common basic skull base approaches, combined with minimally invasive techniques can handle most of BSCMs with good surgical results.

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Fetal chylous ascites may redevelop only after birth

Case Reports in Perinatal Medicine ◽

10.1515/crpm-2013-0026 ◽

2014 ◽

Vol 3 (2) ◽

Author(s):

Ivan Peychl ◽

Karel Harvanek ◽

Petra Krasnicanova

Keyword(s):

Abdominal Cavity ◽

Chylous Ascites ◽

Rare Condition ◽

Good Health ◽

Minimal Amount ◽

Medium Chain Triglycerides ◽

Hernia Sac ◽

Clinically Significant ◽

Long Chain

AbstractCongenital chylous ascites is a rare condition. We describe a case in which fetal ascites was found on a routine antenatal ultrasound, with all abnormalities resolving by 36 weeks’ gestation. No investigations or treatment for the ascites was undertaken after the baby´s birth. At the age of 3 months, when the baby underwent surgery for bilateral inguinal hernias and hydrocele, milky fluid was drained from the hernia sac. Laboratory and ultrasound investigations confirmed the presence of a significant amount of chyle in the peritoneal cavity. Congenital chylous ascites was treated by means of a diet based on medium chain triglycerides. By the age of 6 months, the fluid in the abdomen had resolved. However, it partly reappeared once a normal mixed diet was allowed. A minimal amount of fluid in the lower abdominal cavity was consistently found up to the age of 22 months. The fluid had finally disappeared by the age of 30 months when the child was generally in good health and developing normally. We conclude that congenital chylous ascites may be diagnosed prior to birth but may become more clinically significant only after birth, when its severity is enhanced by feedings of milk containing long chain fats. We recommend a thorough postnatal evaluation and follow-up in all infants diagnosed with fetal ascites, so that appropriate and timely management decisions can be made, if the chylous origin of the ascites is confirmed.

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Surgery and endovenous techniques for the treatment of small saphenous varicose veins: a review of the literature

Phlebology The Journal of Venous Disease ◽

10.1258/phleb.2010.009095 ◽

2011 ◽

Vol 26 (5) ◽

pp. 179-184 ◽

Cited By ~ 19

Author(s):

S S Tellings ◽

R P M Ceulen ◽

A Sommer

Keyword(s):

Minimally Invasive ◽

Saphenous Vein ◽

Minimally Invasive Techniques ◽

Success Rates ◽

Review Of The Literature ◽

Treatment Techniques ◽

Significant Difference ◽

Invasive Techniques ◽

All Treatment

In 15% of all patients, varicosis is caused by insufficiency of the small saphenous vein (SSV). In the past it was common to entirely remove the SSV by surgical procedure; however, recently minimally invasive techniques have taken over a significant number of varicose vein treatments. The aim of this paper is a review of the literature of all treatment modalities of the insufficient SSV. The search aimed to identify all papers published describing one or more treatments for SSV insufficiency. International literature databases were searched through for articles eligible for this review. Articles describing one or more treatment techniques for SSV insufficiency were eligible for this review. Also studies describing SSV as well as greater saphenous vein were included as long as they made a clear distinction in their results between the two groups. Studies were excluded if they did not use ultrasound examination to qualify outcome, as this is the golden standard to evaluate venous insufficiency. Seventeen articles were included in this review. Five articles on surgical treatment showed success rates varying from 24% to 100% (follow-up 1.5–60 months). Ten articles on endovenous laser ablation (EVLA) showed success rates varying from 91% to 100% (follow-up 1.5–36 months). Two articles on ultrasound-guided foam sclerotherapy (UGFS) showed success rates varying from 82% to 100% (follow-up 1.5–11 months). Statistical analysis showed a significant difference ( P < 0.05) in success rate of 47.8% versus 94.9% for surgery and EVLA/UGFS, respectively. Most complications for all treatment techniques were mild and self-limiting. Rates of deep venous thrombosis were not described often and in the articles that mentioned it, varied from 1.8% to 3.5% (surgery) and 2.5–5.7% for EVLA. In the absence of large, comparative randomized clinical trials, minimally invasive techniques appear to have a tendency towards better results than surgery, in the treatment of the insufficient SSV.

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Local Fibrinolysis in Spontaneous Supratentorial Hematomas: Comparison with Surgical and Medical Treatment

Interventional Neurology ◽

10.1159/000447310 ◽

2016 ◽

Vol 5 (3-4) ◽

pp. 165-173 ◽

Cited By ~ 1

Author(s):

Eugeniu Condrea ◽

Valeriu Timirgaz ◽

Stanislav Groppa ◽

Ion Codreanu ◽

Natalia Rotaru

Keyword(s):

Mortality Rate ◽

Minimally Invasive ◽

Assisted Ventilation ◽

The Other ◽

Minimally Invasive Techniques ◽

Spontaneous Intracerebral Hemorrhage ◽

Surgical Interventions ◽

Local Fibrinolysis ◽

Invasive Techniques ◽

Overall Mortality

Objective: To evaluate the effectiveness of minimally invasive craniopuncture with local fibrinolysis in the management of supratentorial spontaneous intracerebral hemorrhage (SICH). Methods: The study included 218 consecutive patients with supratentorial SICH who were assigned to one of three groups: treated with minimally invasive craniopuncture with local fibrinolysis, treated with craniotomy or other minimally invasive techniques without local fibrinolysis, or receiving conservative management alone. Results: Minimally invasive craniopuncture with local fibrinolysis was associated with a lower rate of assisted ventilation, a shorter period of in-hospital stay, a more frequent initiation of early rehabilitation, and a lower mortality rate at all periods of assessment. The overall mortality at 12 months was 19.4% (vs. 50.0 and 33.3% in the two other therapy groups). Lobar (subcortical and cortical) SICHs treated with local fibrinolysis had an overall mortality of 4.8% (vs. 43.5 and 41.7% in the two other therapy groups). On the other hand, SICHs having mixed (basal ganglia and lobar) locations treated with medical therapy alone had an overall mortality of 28.6%, while associated surgery with or without local fibrinolysis increased the overall mortality to over 65%. Conclusions: The study demonstrated the applicability of minimally invasive craniopuncture with local fibrinolysis for the management of supratentorial SICHs and the advantages it may have in certain categories of patients. The method proved particularly useful in lobar SICHs, being associated with the lowest mortality. Mixed SICHs do not represent a predilection for surgical interventions; however, the results related to mixed supratentorial locations need confirmation in larger cohorts.

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Single-stage minimally invasive nephroureterectomy for upper tract urothelial carcinoma: Perioperative and early oncological outcomes

Journal of Clinical Urology ◽

10.1177/2051415820913449 ◽

2020 ◽

Vol 13 (5) ◽

pp. 332-338

Author(s):

PC Ryan ◽

UM Haroon ◽

RA Keenan ◽

PJ O’Donoghue ◽

M Hegazy ◽

...

Keyword(s):

Minimally Invasive ◽

Urothelial Carcinoma ◽

Single Stage ◽

Upper Tract Urothelial Carcinoma ◽

Perioperative Outcomes ◽

Minimally Invasive Techniques ◽

Upper Tract ◽

Oncological Outcomes ◽

Invasive Techniques

Objective: The purpose of this article is to present our minimally-invasive techniques for upper tract urothelial carcinoma and review the perioperative and early oncological outcomes at our centre. Materials and methods: A retrospective review of all patients undergoing minimally-invasive surgery for upper tract urothelial carcinoma over a 3-year period following institutional approval was performed. Perioperative and early oncological outcomes were assessed. Results: Twenty-three cases of minimally-invasive single-stage nephroureterectomy were performed with a mean patient age of 69.45 years. Twelve (52%) of these cases were for high-grade disease and six (27%) had received neo-adjuvant chemotherapy. There were no intraoperative complications, no positive surgical margins and four (17.4%) of patients had a post-operative complication. Mean length of stay was 5.5 days and there was one readmission within 30 days of surgery. Seven patients (30%) experienced either local or distant recurrences with a median time to recurrence of 6 months. Recurrence free survival was 69.6%. Two patients died during the follow-up period. Conclusion: Our minimally-invasive techniques provides a safe and reproducible approach for upper tract urothelial carcinoma. Our perioperative outcomes and oncological are comparable to similar studies, but more long-term follow-up and larger patient numbers are required to validate oncological efficacy. Level of evidence: 4.

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VP028 TAPP REPAIR FOR INCISIONAL LUMBAR HERNIA

British Journal of Surgery ◽

10.1093/bjs/znab395.159 ◽

2021 ◽

Vol 108 (Supplement_8) ◽

Author(s):

Sónia Ribas ◽

Ana Peixoto Pereira ◽

Conceição Antunes

Keyword(s):

Minimally Invasive ◽

Abdominal Cavity ◽

Lumbar Hernia ◽

Barbed Suture ◽

Invasive Approach ◽

Incisional Hernias ◽

Tapp Repair ◽

Duration Of Surgery ◽

Invasive Techniques

Abstract Aim “Incisional hernias are very common and can present even after minimally invasive surgery for other pathologies. Laparoscopic ventral hernia repair first described by LeBlanc in 1992, gained great popularity, because of its known advantages over the open techniques. In the last decade because of increasing concerns about the future risks of using an intra-peritoneal mesh, several minimally invasive techniques using a mesh outside abdominal cavity have been described. We report the use of a TAPP technique.” Material and Methods “48 yo female patient, that underwent a laparoscopic right adrenalectomy, for myelolipoma, in 2015, with subsequent incisional lumbar hernia (L4W1) in the extraction incision.” Results “The patient was submitted to a laparoscopic TAPP repair in ambulatory surgery with extended recovery. The hernia defect was closed with a barbed suture and it was used a 15x15cm medium weight polypropylene mesh without traumatic fixation. For pain control it was done a TAP block guided by laparoscopy. The duration of surgery was 90 minutes. The patient had no complications. No recurrence on follow-up (4 months).” Conclusions “New minimally invasive procedures for the repair of incisional hernias avoid the intraperitoneal mesh position and maintain all the advantages of the minimally invasive approach. Some of these techniques may be complex and have a long learning curve. TAPP seems reproducible and a good option if a good extra-peritoneal dissection is possible. Larger series are needed, to accurately compare these new techniques with IPOM, open sublay and to select the best technique for each patient.”

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

Case Reports in Obstetrics and Gynecology ◽

10.1155/2016/4705790 ◽

2016 ◽

Vol 2016 ◽

pp. 1-4

Author(s):

Jaime Alfaro-Alfaro ◽

María de los Ángeles Flores-Manzur ◽

Roberto Nevarez-Bernal ◽

Rodrigo Ayala-Yáñez

Keyword(s):

Transvaginal Ultrasound ◽

Abdominal Cavity ◽

Adhesion Formation ◽

Uterine Fibroids ◽

Malignant Cell ◽

The United States ◽

Laparoscopic Myomectomy ◽

Peritoneal Adhesions ◽

Bicornuate Uterus ◽

Power Morcellation

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.

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