Total laparoscopic ovarian cystectomy (TLC) is a common gynecological laparoscopic procedure and is often performed by a novice to this technique. We report a case of reoperation due to abdominal bleeding the day after TLC.A 26-year-old woman, gravida 2 para 2, presented with a 5 cm left ovarian cyst, presumed to be benign. TLC was performed. The next day, the patient's hemoglobin level decreased to 7.7 g/dL, and transabdominal ultrasonography revealed abdominal bleeding from the pelvic cavity to the Morrison's pouch. Laparoscopy was repeated, and suturing was performed to stop bleeding from the left ovary. Abdominal blood loss was 1300 mL. The postoperative course was uneventful, and the patient was discharged after 4 days without extra blood transfusion. Pathological diagnosis was mucinous cystadenoma.Excluding cases of endometrial cyst, the probability of postoperative bleeding and hematoma after TLC was reported to be 0.15% in the 2014-2015 adverse events research of the Japan Society of Gynecologic and Obstetric Endoscopy and Minimally Invasive Therapy. We considered the reason for this reoperation from two viewpoints: the technique of ovarian cystectomy and the property of laparoscopic surgery.
Interstitial ectopic pregnancy is rare but the frequency is increasing. It is important to diagnose and treat at an early stage to avoid massive hemorrhage due to rupture. We report a diagnostically challenging case of interstitial ectopic pregnancy associated with multiple myomas. A 34-year-old woman (gravida 0) was referred to our hospital because of possible ectopic pregnancy. She was pregnant by artificial insemination on the 36th day of her last menstrual period; however, a gestational sac (GS) was not seen in the uterine cavity and the serum human chorionic gonadotropin (hCG) level was 2,993 mIU/ml. Laparoscopic surgery was performed the same day. Intraoperative examination revealed that the uterus was enlarged by multiple myomas; the bilateral adnexa were normal in appearance. Villi were not observed intraperitoneally. Intrauterine curettage was performed, but only decidual tissue was histopathologically confirmed. Serum hCG increased to 2,555 mIU/ml 10 days after surgery, but a GS was still not observed. Enhanced computed tomography was performed because the pregnancy status was uncertain. An enhanced cystic mass was observed, suggesting a right interstitial ectopic pregnancy. Repeat laparoscopic surgery was performed. After local injection of vasopressin into the right fundus, the uterine wall was incised and villus-like tissue was confirmed in the interstitial portion of the right tube. We removed villi as much as possible and sutured the myometrium. Villi were confirmed histopathologically. Serum hCG promptly decreased and the postoperative course was uneventful.
We report 2 patients with history of prior renal transplantation who underwent laparoscopic myomectomy or hysterectomy. Case 1: A 43-year-old woman (gravida 0) underwent living related renal transplantation when she was 38 years old to treat chronic renal failure secondary to IgA nephropathy. She reported history of a uterine myoma, which had gradually enlarged to measure greater than the size of a newborn's head when she presented at the age of 43 years. Because of a sensation of lower abdominal fullness, she underwent laparoscopic myomectomy after receiving gonadotrophin releasing hormone (GnRH)-agonist therapy. A 3-port laparoscopic myomectomy was performed (an umbilical trocar and 2 parallel trocars on the patient's left side). The estimated blood loss was 500 mL, and the operation time was 224 min. Case 2: A 45-year-old woman (gravida1 para 0) underwent living related renal transplantation when she was 43 years
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