[TORSION OF FALLOPIAN TUBE LEIOMYOMA TREATED BY LAPAROSCOPY].

Leiomyomas of the Fallopian tubes are rare and their correct diagnosis is extremely difficult. Usually they are incidental findings seen at autopsy or unrelated surgical procedures: A 34-year-old woman presented with lower abdominal pain. Transvaginal ultrasound revealed a solid 7 cm extrauterine mass. Both ovaries are normal. Our preoperative diagnosis was torsion of the fallopian tube due intratubal leiomyoma. Laparoscopic surgery was performed and the leiomyoma was found to have originated from the isthmus of the right Fallopian tube. Laparoscopic myomectomy was performed with preservation of the ramus tubarius dextra. The histological examination concluded to a leiomyoma with ischemic changes. We report a case of torsion of a tubal leiomyoma, which was successfully managed laparoscopically.

[LAPAROSCOPIC PELVIC LYMPNADENECTOMY OF EARLY ENDOMETRIAL CANCER].

Lymphadenectomy has traditionally been performed using large incisions during laparotomy. Since the initial report by Dargent and colleagues in the late 1980s, laparoscopic lymphadenectomy has been utilized in the management of gynecologic malignancies. After Dargent's description of the first pelvic lymphadenectomy performed laparoscopically, Nezhat et al. described the first para-aortic lymphadenectomy performed laparoscopically forcancer of the uterine cervix. Many raports since have described the safety and effectiveness of laparoscopic lymphadenectomy for gynecologic malignancies.

[LAPAROSCOPIC MYOMECTOMY AFTER ULIPRISTAL ACFTATF TRFATMFMT.]

Uterine myoma is the most common benign uterine tumor in women of reproductive age and occurs in 20-25 % of the worldwide population. Heavy menstrual bleeding, pelvic pressure and pain and reproductive disfunction are common symptoms that impair women's health and quality of live. No currently approved medical treatment is able to completely eliminate fibroids. Until recently, gonadotropin-releasing hormone agonist were the only available drugs for preoperative treatment of fibroids. Since February 2012, ulipristal acetate (UPA) is also approved in Europe for preoperative fibroid treatment. One-third from them need adjuvant surgical treatment.

[NEW TECHNIQUE FOR UTERINE ARTERY IDENTIFICATION.]

Laparoscopic myomectomy and total laparoscopic hysterectomy are challenging surgical procedures for gynecologists, which can result in great blood loss. Most of the conversions to laparotomy happened because of intraoperative bleeding. Blocking uterine perfusion during,, Class II" laparoscopic procedures is valuable and feasible for the management of our patients. We present our modification of uterine artery identification and clipping.

[LAPAROSCOPIC ANTERIOR UTERINE LIGAMENTOPEXY--OUR EXPERIENCE].

A great number operative techniques for correction of retroverted uterus are reported in the last years. The aim of these different methods is correction of the retroversion of the uterus, which is connected with pelvic congestion and symptomatic relief. We present a clinical case of 26 years old patient with one Caesarean section. The lady complains of chronic pelvic pain, dispareunia and dismenorrhea. The US exam shows an uterus in strong retroversion position. We restored the anatomic position of the uterus using laparoscopic anterior ligementopexy.

[LAPAROSCOPIC MYOMECTOMY WITH UTERINE ARTERY CLIPPING VERSUS CONVENTIONAL LAPAROSCOPIC MYOMECTOMY].

OBJECTIVE: To evaluate the differences in the intraoperative blood loss during laparoscopic myomectomy with or without uterine artery clipping (UAC). METHODS: From January 2013 to April 2015, we enrolled prospectively 119 women with symptomatic intramural myomas who were scheduled to undergo laparoscopic myomectomy (37 with UAC (study group) and 82 without (control group)). RESULTS: Characteristics of the myomas, operating time, duration of hospital stay and blood loss were comparable between the two groups. The average operating time and blood loss were 75 +/- 11 minutes and 100 +/- 20 ml for the experimental group and 60 +/- 9 minutes and 178 +/- 56 ml for the control group respectively statistically significant. CONCLUSION: Concurrent UAC during laparoscopic myomectomy reduces the intraoperative blood loss and the frequency of excessive bleeding. This study demonstrated the superiority of laparoscopic uterine artery ligation combined with myomectomy in treatment of symptomatic myomas.

[LAPAROSCOPIC MYOMECTOMY WITH UTERINE ARTERY CLIPPING VERSUS CONVENTIONAL LAPAROSCOPIC MYOMECTOMY].

Uterine leiomyomas are one of the most common benign smooth muscle tumors in women, with a prevalence of 20 to 40% in women over the age of 35 years. Fifty percent of them may necessitate treatment, because of bleeding, pelvic pain and infertility. Laparoscopic myomectomy is one of the treatment options. The major concern of myomectomy either by open procedure or by laparoscopy is the bleeding encountered during the operation. One of the methods to reduce the intraoperative blood loss and to prevent excessive bleeding is the clipping of both uterine arteries and aa. ovaricae.

[Factors affecting duration of the laparoscopic myomectomy].

Laparoscopic myomectomy (LM) has been an alternative to abdominal myomectomy in cases of subserosal and intramural myomas since 1990. In the literature less attention is paid to the factors responsible for the length of the surgical time of the LM. Our study comprehends 66 patients underwent laparoscopic myomectomy for one or more intramural myomas with size > 5 sm. In order to evaluate the factors that are responsible for the duration of the procedure we survey the following indicators: age, BMI, year of the operation, previous abdominal operations, way of delivery, size, number and localization of the myomas. Our results show that statistically significant effect for the duration of LM have the yearof the operation, numberof the myomas and their localization in the uterine wall. Significantly longer operative time is detected in 2012 (133.57 +/- 17,805 min.) and the shorter time was in 2014 (66.67 +/- 20, 237 min.) (P < 0.05). We established statistically significant relation between the number of the myomas and duration of the operation (P=0.023). The analysis of the indicator localization of the myomas shows that myomas in the anterior uterine wall are with shortest average surgical time--90.5 +/- 33, 321 min., next are these in the posterior uterine wall--93.81+/- 39, 176 min. Myomas in the fundus of the uterus have longest average surgical time--115.83 +/- 35, 253 min.