Single-incision laparoscopic adnexectomy in an obese patient with previous laparotomies.

INTRODUCTION: No case of single-incision laparoscopic surgery in obese patients who had previously undergone multiple midline vertical laparotomies has been described in the literature to date. Hence we report the first case of single-port laparoscopic salpingo-oophorectomy in an obese patient who was affected by a left adnexal mass and who had previously undergone 3 midline vertical laparotomies. CASE DESCRIPTION: A postmenopausal 57-year-old woman with a body mass index of 31.2 kg/m(2) and a history of 3 midline vertical cesarean deliveries and a right salpingooophorectomy was diagnosed with a left adnexal mass and underwent a single-incision laparoscopic salpingo-oophorectomy. DISCUSSION: The patient was treated successfully. The operative blood loss was minimal. The postoperative hospital stay lasted 18 hours, and postoperative pain was short-lasting. No early or long-term postoperative complications were registered. On histopathologic examination, a diagnosis of ovarian serous cystadenoma was made. Even though this unique case is the first to be reported in the literature, its encouraging results suggest the use of this new surgical technique in similar clinical situations to verify whether the feasibility and safety reported in this article are confirmed.

The significance of visualising coronary blood flow in early onset severe growth restricted fetuses with reverse flow in the ductus venosus.

OBJECTIVE: To evaluate the incidence and significance of coronary blood flow visualisation in early onset severe intrauterine growth restriction (IUGR) fetuses and to assess its relationship with the presence of reverse flow in ductus venosus (DV). METHODS: The examination of coronary artery was performed at a gestational age <26 weeks in 19 IUGR fetuses from mothers without medical complications and characterised by the presence of reverse flow in DV. Visualisation or non-visualisation of coronary circulation were compared with fetal and neonatal outcome. RESULTS: Coronary flow was seen in 7/19 (36.8%) of the IUGR fetuses and these fetuses showed a higher incidence of fetal death (71.4%vs. 16.6%, p = 0.044), delivery or fetal death at an earlier gestational age (23.71 vs. 26.57 weeks, p = 0.011) and a lower birthweight (310 vs. 586 g, p = 0.011). Kaplan-Meier survival analysis demonstrated that visualisation or non-visualisation of coronary flow in such fetuses provides an independent contribution in the prediction of the time interval between Doppler study and delivery or fetal death (chi square = 15.36, p < 0.001). CONCLUSIONS: Visualisation of coronary flow in IUGR fetuses with reverse flow in the DV identifies a subgroup of fetuses with a poorer fetal and neonatal outcome.