Vaginal hysterectomy presents superior results in terms of operative time and inflammatory response when compared with total abdominal and laparoscopic hysterectomy and it should be the first option for hysterectomy. Laparoscopic hysterectomy should be considered when the vaginal approach is unfeasible, showing clear advantages over abdominal hysterectomy.

The objective of this study is to report the current status on single-port laparoscopic surgery in gynecology. A systematic MEDLINE review of the English language literature from 2007 to 2011 was performed using the search term "single-port surgery," which contained information on single-port laparoscopic surgery in gynecology. Overall, 1,152 patients (26 studies) were included in the analysis. The operative time varied according to the type of procedure. The conversion rate to conventional laparoscopy was 1.99 %, and the conversion rate to laparotomy was 0.35 %. Postoperative complications were encountered in 1.48 % of cases. Different gynecologic procedures have been effectively performed by means of single-port laparoscopic surgery. The procedure seems to be feasible, reproducible, and safe. Reduced pain and improved cosmesis are supposed to be the potential advantages of these procedures, but it was not completely confirmed yet! Further studies are still necessary to establish the real benefits of this new surgical approach over the traditional multi-port laparoscopy.

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Objective: To demonstrate the surgical technique of Rendez-vous isthmoplasty for the treatment of symptomatic cesarean scar defect. In this video, the authors show the complete procedure in a step-by-step manner to standardize and facilitate the comprehension and performance of the procedure in a simple and safe way. Design:Step-by-step video demonstration of the surgical technique. Setting: Private hospital in Curitiba, Paran a, Brazil. Interventions: The patient is a 36-year-old woman without any comorbidities, G3 C3, and with radiologic transvaginal ultrasound diagnosis of isthmocele grade 3 (over 25 mm) identified in the superior third of the cervical canal. The main steps of combined laparoscopic-hysteroscopic isthmoplasty using the Rendez-vous technique are described in detail. A combined laparoscopic-hysteroscopic approach was performed. Under general anesthesia, the patient was placed in 0˚supine decubitus, with her arms alongside her body. Operative setup included 15 mm Hg pneumoperitoneum, created using the closed Veress technique, and 4 trocars: a 10-mm trocar at the umbilicus for a 0˚laparoscope, a 5-mm trocar in the right iliac fossa, a 5-mm trocar in the left iliac fossa, and a 5-mm trocar in the suprapubic area. The procedure begins after a systematic exploration of the pelvic and abdominal cavities.Step 1: Identification of key anatomic landmarks and exposure of the operation field.Step 2: By carrying out blunt and sharp dissection with cold scissors or a harmonic scalpel, the visceral peritoneal layer over the isthmus area is opened, a vesicouterine space is developed, and the bladder is pushed down at least 2 cm from the lower edge of the isthmocele.Step 3: Final Phrase: By hysteroscopic exploration of the cervical canal using the vaginoscopic approach, identification and delimitation of the isthmocele its performed by recognizing the diverticular mucosal hyperplasia, and then the hysteroscopic light is pointed directly toward the cephalic limit of the scar defect.Step 4: Laparoscopic lights are decreased in intensity and the "Halloween sign" is identified (hysteroscopic transillumination). The light of the hysteroscope is pointed to the top of the cesarean scar defect allowing the laparoscopist to identify the upper and lower edges of the scar.Step 5: Laparoscopic resection of all scar tissue, excision of all the edges of the pseudo cavity.Step 6: Adequate intracorporeal suturing technique, with a 2-layer myometrial repair using intracorporeal running and interrupted stitches of polydioxanone 2-0, is done, while ensuring preservation of the cavity by not including the endometrial tissue in the myometrial suture [1−3].Step 7: Installation of the methylene blue dye to locate any leakage. The surgery ended without any intraoperative complications and within 60 minutes. The patient was discharged on the first day postoperatively and became pregnant 6 months after surgery, with a final C-section delivery of a healthy term newborn at 39-weeks gestational age. Conclusion: Combined Rendez-vous isthmopl...

Interventions: Study population was split into two different groups: patients who underwent ureterolysis only (Group 1) and patients needing a stent positioning due to surgical procedure (Group2). Measurements/Results: 128 women underwent surgery with ureterolysis only (GP1), 61 women needed a ureteral stent due to more invasive surgery (GP2), used stent positioning as a marker for aggressive surgery on the ureter. We observed that more invasive surgery on the ureter occurred in older patients (41.2 yrs ± 5.54; p = 0.0001), with concomitant involvement of the ipsilateral ovary (p = 0.043), retrocervix (p = 0.008), ipsilateral parametrium (p = 0.0001), sigmoid (p = 0.003), rectovaginal septum (p = 0.013) and bladder (p = 0.0003). Additional bladder surgery was performed in 19.7% GP2 vs 3.12% GP1 (p = 0.0003). Additional bowel surgery was peformed in a high percentage of patients (GP1 68.75%; GP2 73.8% p = 0.05) but bowel resection was performed more often in GP1 (89.8%) than GP2 (62.2%) (p = 0.0003). Conversely bowel nodule shaving was performed more in GP2 (37.8% vs 10.2; p = 0.0003). We calculated the mean sonographic distance of the major nodule from the anal verge to be 12 ± 2.86 cm in GP1 and 9 ± 3 cm in GP2 (p = 0.0001). Conclusions: We found a significant association between parametrial endometriosis (p = 0.0001), sigmoid (0.003), retrocervix (0.008) and the need of intensive surgery on the ureter. Caudal rectal nodule was related to an higher risk of parametrial involvement and major ureteral surgery. However in this case, predominant asymmetrical parametrial disease did not require aggressive bowel surgery.

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