[DIFFICULTIES IN DISSECTION OF URINARY BLADDER IN TOTAL LAPAROSCOPIC HYSTERECTOMY.]

The dissection of urinary bladder is a crucial phase of the laparoscopic operation of hysterectomy. The latter dissection may become even more difficult in the context of history of operative interventions as cesarean section or cervical conization, presence of cervical or isthmic myomatous nodes, as well as upon a bad operative technique. The obeying of some basic principles (knowledge of pelvic anatomy and topographic interrelations; considering of present risk factors; intraoperative screening for complications and their early treatment) results in the optimal performance of laparoscopic hysterectomy.

[Sentinel lymph node biopsy in endometrial cancer--our experience].

PURPOSE: The objective of the study was to determine the feasibility of a method described for the first time by Altgassen et al. of labeling sentinel lymph nodes in patients with endometrial cancer using blue dye. PATIENTS AND METHODS: 4 ml of blue dye was administreted in 12 patients with endometrial cancer subserosaly at eigth sites. After 10 min sentinel lymph nodes were harvested. RESULTS: Detection rate was 91.6%., In only one patient there was no detection of sentinel lymph node and in one patient the sentinel lymph node was marked only in one hemipelvis. CONCLUSIONS: This method for detection of sentinel lymph nodes in patients with endometrial cancer is promising, fast and easy to implement, but need to conduct additional studies to become part of the standard for the surgical treatment of endometrial cancer

[Laparoscopic hysterectomy--brief history, frequency, indications and contraindications].

Hysterectomy is the most common gynecological operation after Caesarean section and the laparoscopic access to uterus removal is one of the contemporary methods showing slow but steady growth in time. In reference to indications and contraindications for laparoscopic hysterectomy, the following directions emerge as controversial: malignant gynecological tumors, uterus size, and high body mass index. Laparoscopic hysterectomy can be taken into consideration at the first stage of endometrial, cervical and ovarian cancer. If there is doubt about an uterus sarcoma and a laparoscopic access is accomplished, a conversion to abdominal hysterectomy must be done. Obesity and big uteri are not a contrarindication for that minimally-invasive access. Today, laparoscopic hysterectomy is a reasonable alternative to total abdominal and vaginal hysterectomy.

[Terminological and classification aspects of laparoscopic hysterectomies].

There is a great variety of terms and concepts describing laparoscopic hysterectomy in scientific literature. The term "laparoscopic hysterectomy" includes different operations where the laparoscope is used as an aid for a hysterectomy. The first classifications related to hysterectomy laparoscopic procedures were suggested by Munro and Parker (1993) Johns and Diamonds (1994) and Garry et al. (1994). Based on them is the American Association of Gynecologic Laparoscopists (AAGL) classification of 2000. Reich defined basic terms easy to use in clinical practice. The elaboration of a suitable classification system describing the size of laparoscopic intervention in hysterectomy is a prerequisite for an adequate comparison of the results of scientific researches.

[Lymphorhoea--complication after lymph node dissection in cervical cancer].

UNLABELLED: The lymphorrhea is a problem that we fase in the early postoperative period in patients undergoino lymph node dissection (LND) for treatment of cervical cancer (CC). MATERIAL AND METHOD: In a retrospective study of 2-year period (January 2001-December 2003). We covered totaly 129 cases with invasive CC. All patients in the study have undergone surgical remove of the uterus and adnexes but in a different volume, an extended hysterectomy was performed in 125 women, in 3 patients was carried out only supravaginal hysterectomy due to failure to remove the cervix, without direct life-threatening intraoperative complications, only in one case was performet LHT with adnexes because of severe co-morbidities of patients. We don't have cases in which LND was carried out in whatever type it is--a diagnostic or therapeutic. All women undergone LND in a different volume 123 cases pelvic LND/PLND/ and/or paraaortic LND/PALND/, selective LND in 3 patients, only PAND in 2 cases and biopsy of pelvic lymph node--only one case. AIM AND GOALS: Our aim is to present the role of lymphorrhea in the observed cases according the type of LND applied to treat invesiv CC. We set the following goals--To present the frequency of lymphorrhea in the early postoperative period in our patients treated for invasive CC, and the presence or absence of a link between the level of LND and the observed lymphorrhea. RESULTS: On the basis of the above data we can make the following conclusions: Lymphorrhea was recorded in 24 or 18.60% of the cases of our study. It is a complication that directly depends on the type of the performed LND. It is the second most common complication--24 women the undercoing PLND--11 (45.8%) and PLND+PALND--13 (54.2%).