No abstract

Even more experienced laparoscopic surgeons in this report became better prepared to perform a surgical procedure doing simple exercises on a virtual reality simulator before the actual procedure.

Ascites was present in all but one case. Other common findings were weight loss (12 cases), weakness (5 cases), abdominal pain (16 cases), anorexia (6 cases) and night sweat (3 cases). Abdominal ultrasound has been used to demonstrate ascites in 16 cases. Only two patients had chest radiography suggestive for active tuberculosis. Laparotomy was performed in four cases, laparoscopy in 14 cases (two conversions). Intraoperative findings included multiple diffuse involvements of the visceral and parietal peritoneum, white "miliary nodules" or plaques, enlarged lymph nodes, ascites, "violin string" fibrinous strands, and omental thickening. Biopsy specimens showed granulomas, while ascitic fluid showed numerous lymphocytes. We conclude that the symptoms of abdominal tuberculosis vary greatly, and laparoscopy can be essential for diagnosis and management. The operation is safe, reliable with few complications and permits a prompt diagnosis, necessary to cure the patient.

Gossypibomas, among abdominal foreign bodies, represent a certain reality with significant legal implications. Prevention should prevail and all efforts should be made in such respect. Laparoscopic approach is possible in selected cases (small swabs, encapsulated, no complications).

The ovarian fibroma is a rare benign tumor originating from the connective tissue of the ovarian cortex. On occasion, the general surgeon may encounter ovarian fibroma while operating an acute abdomen. We present a series of 15 ovarian fibromas encountered in 13 patients over 11 years experience in our general surgical ward. Only four cases required emergency operations due to either tumors or adnexal torsion. High-resolution ultrasound scan with color Doppler suggested an ovarian fibroma in only ten cases, while CT and MRI were suggestive for the diagnosis in three other cases. Surgical treatment consisted of five ovarectomies, three adnexal resections and five total hysterectomies with bilateral salpingo-oophorectomy. Seven patients underwent laparoscopic surgery, four of them for an ovarian resection and in three for an adnexectomy. Laparoscopic approach has significant advantages by limiting parietal aggression with better cosmetic results, short hospital admission, lower costs, few postoperative adhesions and rapid recovery.