The objective of this study was to review the body of literature in reference to ureteral injury during laparoscopic surgeries and to determine: 1) the reported rates of ureteral injury; 2) the initial laparoscopic surgeries during which ureteral injury occurred; 3) the time of injury recognition (intra- versus postoperative); 4) the type, 5) the location, and 6) the mode of injury repair; and 7) the surgical laparoscopic instruments involved in ureteral injury. The appropriate medical subject heading (MSH) terms were selected and used in a search of the Medline computerized database and the online American College of Obstetricians and Gynecologists database. World literature published in the English language on ureteral injury during laparoscopic surgery between 1966 and 2003 was reviewed.A total of 70 reported instances of ureteral injury during laparoscopic surgery were identified among 2491 reported cases in which ureteral laparoscopic complications were discussed. Incidences of injury ranged from <1% to 2%. These 2491 cases of laparoscopy were presented as a mixed group, which included case reports, small series of studies, as well as longer, consecutive studies. In 18 of the 70 (25.7%) cases, the initial laparoscopic procedures during which ureteral injury occurred were not described or specified. In cases in which the type of laparoscopic surgery was specified, 14 of the 70 (20.0%) total cases of ureteral injury occurred during laparoscopically assisted vaginal hysterectomy (LAVH). Ureteral injury was identified intraoperatively in 6 of 70 (8.6%) cases, postoperatively in 49 of 70 (70.0%) cases, and, in 15 of 70 (21.4%) cases, the time of diagnosis was not specified. In 36 of the 70 (51.4%) reported injuries, the type of injury was not specified or described. In instances in which the types of injury were described, transection occurred most commonly, accounting for 14 of 70 (20.0%) injuries. The location of ureteral injury was not specified in 46 of the 70 (65.7%) cases. When location was specified, injuries most often occurred at or above the pelvic brim, accounting for 10 of the total 70 (14.3%). Electrocautery was involved in 17 of the 70 (24.3%) cases of ureteral injury, but in 34 of the 70 (48.6%) cases, the surgical laparoscopic instrument involved was not reported. A laparotomy was used to repair the ureteral injury in 43 of 70 (61.4%) cases.Ureteral injuries reported in peer-reviewed journals often lack detailed presentation of the initial laparoscopic surgeries during which ureteral injury occurred, or of the type, the location, and the instrumentation involved in ureteral injury. A high incidence of ureteral injury was found among the laparoscopic procedures analyzed in this review. Laparoscopically-assisted vaginal hysterectomy was the leading procedure in which injury occurred, and instruments involved in electrocoagulation were associated with the most injuries incurred during laparoscopic surgery.

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In the differential diagnosis of a progressively increasing incisional mass and pain after laparoscopic myomectomy, inadvertent implantation and growing particles of uterine leiomyomas should be considered when fragmented tumors are removed through a trocar sleeve.

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Objectives To expand the anatomical investigations of the G‐spot and to assess the G‐spot's characteristic histological and immunohistochemical features. Design An observational study. Setting International multicentre. Population Eight consecutive fresh human female cadavers. Methods Anterior vaginal wall dissections were executed and G‐spot microdissections were performed. All specimens were stained with haematoxylin and eosin (H&E). The tissues of two women were selected at random for immunohistochemical staining. Main outcome measures The primary outcome measure was to document the anatomy of the G‐spot. The secondary outcome measures were to identify the histology of the G‐spot and to determine whether histological samples stained with H&E are sufficient to identify the G‐spot. Results The anatomical existence of the G‐spot was identified in all women and was in a diagonal plane. In seven (87.5%) and one (12.5%) of the women the G‐spot complex was found on the left or right side, respectively. The G‐spot was intimately fused with vessels, creating a complex. A large tangled vein‐like vascular structure resembled an arteriovenous malformation and there were a few smaller feeding arteries. A band‐like structure protruded from the tail of the G‐spot. The size of the G‐spot varied. Histologically, the G‐spot was determined as a neurovascular complex structure. The neural component contained abundant peripheral nerve bundles and a nerve ganglion. The vascular component comprised large vein‐like vessels and smaller feeding arteries. Circular and longitudinal muscles covered the G‐complex. Conclusion The anatomy of the G‐spot complex was confirmed. The histology of the G‐spot presents as neurovascular tissues with a nerve ganglion. H&E staining is sufficient for the identification of the G‐spot complex.

The objective of this review is to present the incidence of latrogenic bladder injury associated with diagnostic and/or operative laparoscopic surgery; to determine the type of primary laparoscopic operation, the time at which the reported injuries occurred, the location of injuries, and the method(s) used to repair those injuries; to decide which laparoscopic procedure carries the highest risk for bladder injury; and to establish the most frequent surgical instruments with which injuries happened. World literature published between 1970 and 1996 was reviewed. The appropriate Medical Subject Heading (MeSH) terms were selected and used in a search of the MEDLINE, ACOGNET, OVID Compact Disk Version database. A total of 1372 articles on laparoscopic surgery complications were reviewed. Of that number, a total of 77 articles identified bladder injuries, and these were analyzed for the objectives of this study. There are a wide range of bladder injuries during laparoscopic procedures. In the studied articles, the incidence of bladder injury during laparoscopic procedures ranged from 0.02 to 8.3 percent of cases. Most frequently, these injuries occurred during laparoscopic-assisted vaginal hysterectomy. Sharp electrosurgical dissection was the leading instrument causing injury. An intraoperative diagnosis of bladder injury was made in 53.24 percent of all bladder injury cases. The bladder dome was the most commonly injured structure. Less than half (29.87 percent) of the bladder injuries were corrected laparoscopically.

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Background: No paper on vaginal columnar rugation rejuvenation has been published so far. Objectives: To evaluate a new surgical technique of vaginal rugae restoration for the management of an acquired sensation of wide/smooth vagina (ASWSV). Methods: A prospective observational study was conducted. Ten women with ASWSV (group I) were compared to 10 healthy women (control group II). The vaginal rugation rejuvenation (VRR) technique was developed and appraised. The primary outcome measure was to assess VRR applicability. A secondary outcome measure was to evaluate the surgical resolution of symptoms and signs associated with ASWSV and the impact of VRR on female sexual function. Results: In group I, VRR was executed without complications and the surgical resolution of symptoms and signs associated with ASWSV was observed in all subjects. Improved feelings of penile strokes during coitus were also reported by all subjects of study group I. Conclusions:VRR (restoration) was accomplished without increasing the risks of complications. Surgical resolution of symptoms and signs was observed and sexual function improved by 18.75% following VRR in group I. This nonrandomized study precluded us from drawing the conclusion that VRR is a safe and effective operation.