Background: Same-day discharge has been suggested to safe and acceptable following minimally invasive hysterectomy. Objectives:To evaluate the feasibility of same-day discharge following minimally invasive hysterectomy and to identify associated factors. Search strategy: Medline, Embase and the Cochrane Central Register of ControlledTrials were systematically searched using the terms "same day discharge", "minimally invasive surgery", and "hysterectomy" between October 1 and October 31, 2015. No language or publication date restrictions were included.Selection criteria: Randomized controlled trials and observational studies evaluating same-day discharge before midnight on the day of minimally invasive hysterectomy were included.Data collection and analysis: Study characteristics, pre-operative selection criteria, and predictive factors for same-day discharge were analyzed.Main results: There were 15 observational studies with 11 992 patients included.Significant heterogeneity was observed in the studies, and publication and selection bias could have potentially affected the results. All the studies concluded that sameday discharge was feasible. However, some factors were associated with a decreased possibility of same-day discharge; these were older age, beginning surgery later than 1:00 pm and completing surgery later than 6:00 pm, longer duration of operation, and high estimated blood loss.Conclusions: Same-day discharge appears feasible for a majority of patients who undergo minimally invasive hysterectomies if adequate emphasis is placed on presurgical planning and careful patient selection.

Endodermal sinus tumors (EST) of the lower female genital tract are uncommon malignancies. Most of these tumors are found in the vagina or in the cervix. Only seven cases of EST involving the vulva are reported. We report an eighth case of vulvar EST. The patient recurred and was successfully treated with high-dose chemotherapy and peripheral blood cell transplantation. Because of their location, an early diagnosis of vulvar EST should be possible. Resection of the lesion by using a modified radical vulvectomy followed by cisplatin-based chemotherapy seems the best treatment for these tumors today. Our patient was initially treated with the help of local surgery and adjuvant chemotherapy consisting of three courses of etoposide and cisplatin. Sixteen months after the first diagnosis, pleural and lung metastases were diagnosed. Second-line chemotherapy followed by high-dose chemotherapy with autologous peripheral blood stem cell support was administered after resection of the lung metastases and biopsy of the pleural metastases. There is no evidence of disease 40 months after the diagnosis of the lung and pleural metastases, and 56 months after the primary diagnosis.

Our data suggest that preoperative tumor grade and intraoperative gross examination of the uterus provide useful information for pre-and intraoperative planning of pelvic lymphadenectomy. However, wrong decisions were made in 11% of the patients, and more reliable evaluation methods are needed.

The Essure™ Permanent Birth Control System, used for hysteroscopic female sterilization, is a transcervical technique that may be done in an outpatient setting with no need for anesthesia. When compared to conventional transabdominal methods, the Essure™ has proved to be feasible, effective, and safe. This prospective study sought patient attitudes toward the Essure™ system in 112 consecutive women having outpatient hysteroscopic sterilization without sedation or general anesthesia. Hysterosalpingography (HSG) was carried out 3 months after the procedure to confirm bilateral tubal occlusion. Postal questionnaires sent at this time inquired about patients' satisfaction and their experience of the procedure.The Essure™ microinserts were successfully placed in both tubes in 92% of women. Multivariate modeling showed that the nonsecretory phase of the menstrual cycle and a normal-sized uterus independently predicted a successful outcome. No major procedure-related complications were noted, but 5% of women had transient vasovagal reactions. Most patients had postoperative pain, but only 8% experienced severe pain and it seldom lasted longer than 8 hours. Vaginal bleeding or discharge was reported by 41% of women; its median duration was 3 days. Two women reported having received antibiotics for urinary tract infection after the procedure. Bilateral tubal occlusion was confirmed by HSG 3 months after the procedure in all but 1 of the 84 women evaluated. At 6 months, the success rate was 100%. Of 76 women who returned the questionnaires, 96% expressed satisfaction with their overall experience of the procedure including radiological follow-up, and nearly 90% reported being "very satisfied." Approximately 90% of women would recommend the procedure to a relative or friend.A very substantial proportion of women in this study were satisfied with the outcome of hysteroscopic sterilization, carried out using the Essure™ system without anesthesia. This outpatient procedure is a convenient and potentially cost-effective alternative to transabdominal methods. GYNECOLOGYVolume 62, Number 9 OBSTETRICAL AND GYNECOLOGICAL SURVEY ABSTRACTUpwards of 50 million women in the United States are screened each year in order to identify the relatively few who have significant preinvasive cervical disease, grade 2 or 3 cervical intraepithelial neoplasia (CIN), or cancer. The Bethesda 2001 System distinguishes between atypical squamous cells of undetermined significance (ASC-US) and atypical squamous cells that cannot exclude a high-grade squamous intraepithelial lesion (ASC-H). Colposcopy is recommended for women having ASC-H. This retrospective study attempted to determine the cumulative risk of CIN 2 or 3 in patients with ASC-H. The study population consisted of 229 patients with ASC-H whose mean age was 33 years. Initial assessment included colposcopy, endocervical curettage, and ectocervical biopsy as indicated.At the time of initial colposcopy, 10% of women had histological evidence of CIN 2 or 3. More than 80% of lesions were identified...