Introduction The ability to offer less invasive surgery for leiomyomas to women often requires the removal of large tissue specimens through small incisions, which is facilitated by morcellation. Electromechanical morcellation may lead to dissemination of occult uterine malignancy throughout the intraperitoneal cavity and may worsen the prognosis. Objectives To assess the safety of morcellation for removing uterine specimen during laparoscopic and vaginal hysterectomies for leiomyoma and to find incidence of leiomyosarcoma (LMS)
Background: The objective of the current study was to assess the need of vault suspension after completion of hysterectomy in all cases of procedentia to prevent vault prolapse and to reduce the operating time for sacrocolpopexy using combined vaginal and laparoscopic approach by two surgeons.Methods: A total of 25 women undergoing surgery for procedentia were included. After completion of hysterectomy the need for vault suspension was assessed intraoperatively. In all cases polypropelene mesh was fixed vaginally to the uterosacral and cardinal ligaments. Vaginal vault was closed vaginally. Laparoscopic surgeon did laparoscopic sacrocolpopexy (LSC). Intraoperative and post-operative complications were then evaluated.Results: Our average operating time was 35 minutes for vaginal hysterectomy and 15 minutes for LSC. The shorter duration of surgery was because mesh was fixed vaginally and trackers were used to fix the mesh to sacral promontory. Intraoperative complications like bladder, ureteric, bowel injuries and hemorrhage were nil in our series. Postoperative stay in hospital was uneventful and all cases were discharged on second postoperative day. Conversion rate to laparotomy was nil. All cases have completed follow up for 5 years with 100% subjective and objective improvement.Conclusions: Restoration of vagina to its normal anatomic position remains the most important fact to prevent vault prolapse. Our technique is very easy, less time taking with negligible complication rates.
Background: During laparoscopic ventral hernia repair (LVHR) mesh is used and so this procedure is not combined with any other major surgery, due to the risk of mesh infection. We did laparoscopic hysterectomy (LH) with LVHR in our study group and found it to be safe procedure with excellent patient recovery and satisfaction rates. Aims and objectives of the study was to assess the short- and long-term clinical outcomes of doing LH and LVHR simultaneously. The primary objectives were to evaluate the intraoperative and post-operative complications, mesh infection rates, hernia recurrence rates and patient satisfaction rates for at least 4 years.Methods: This prospective study was conducted at Aarogya Hospital and test tube centre from 1st January 2007 to 31st December 2016 and follow up completed by 31st December 2020. Total 100 women were included, willing for LH and LVHR simultaneously irrespective of the size of uterus and hernia defect size up to 7cms.Results: Maximum number of patients 65% were in the age group of 45-55 years. 70% patients had previous surgeries commonest being LSCS in 46% cases. Hernia defect size was between 3-5 cm in length and width in 70% cases, requiring dual mesh fixation in 68% cases of size 15x15cms. Our recurrence rate for hernia was nil, 98% cases were highly satisfied with the surgical outcomes by the end of 4 years follow-up.Conclusions: We emphasize that LH can be easily done with LVHR in combination reducing operative morbidity.
Primary lipomatous tumors of the uterus are very unusual benign neoplasms with an incidence of 0.03% to 0.2%. Most commonly described in the uterine corpus, lipoleiomyomas (LLM) have been reported in cervix, broad ligament and retro peritoneum. Here we report a case of perimenopausal women with cervical LLM which was highly friable simulating cervical malignancy, creating an intraoperative dilemma. A 45 year old perimenopausal woman presented with severe abdominal pain with difficulty in passing urine and motion, excessive bleeding per vaginum with increased frequency of menses, since 6 months. Ultrasonography revealed a well-defined rounded to oval heterogeneous hyperechoic lesion with minimal vascularity measuring 10.4×11.0×7.7 cm, volume-469 cc, probably arising from anterior lip of cervix. Patient was taken for laparotomy. Intraoperative friability and vascularity of the mass was suggestive of malignancy. LLM, if asymptomatic, requires no treatment. But symptomatic cases require surgical management.
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