Laparoscopic Repair of Vaginal Evisceration after Abdominal Hysterectomy for Uterine Corpus Cancer: A Case Report and Literature Review.

Vaginal cuff dehiscence is a rare but serious complication that can develop after hysterectomy. Emergent surgical intervention is required for vaginal cuff dehiscence due to the potential subsequent vaginal evisceration, which may lead to necrosis of the small bowel. A 62-year-old nulliparous woman with a 30-year history of smoking, diabetes mellitus, and rheumatoid arthritis (treated with oral steroids) presented with a vaginal cuff dehiscence. Thirty-eight days before the admission, she had undergone a radical operation including total abdominal hysterectomy for uterine corpus cancer at another hospital. We performed emergent laparoscopic surgery to reduce the prolapsed small bowel into the abdominal cavity and repaired the vaginal cuff with a two-layer continuous closure using absorbable barbed sutures. The patient experienced no postoperative complications, and no recurrence of the vaginal cuff dehiscence occurred. Vaginal cuff dehiscence and evisceration can be surgically managed using an abdominal, vaginal, or laparoscopic approach, and the choice of method should be based on patient characteristics and the surgeon's skills. Laparoscopic vaginal cuff repair with a two-layer continuous closure using absorbable barbed sutures is a minimally invasive technique that is safe and effective for medically stable patients with no small bowel injury or vascular compromise and no pelvic abscess.

Mimic mini-laparoscopic surgery is a simple and secure approach using direct placement of 3-mm trocars without noticeable scars.

Minimally invasive surgery is widely used in gynecology. Women who seek a cosmetic advantage (i.e., concealed scars) choose minimally invasive surgery. Although laparoendoscopic single-site surgery could be an ideal solution, some of our patients have had cosmetic problems, such as pigmentation and cicatrix of the umbilicus. In addition, umbilical eversion and umbilical herniation occasionally develop. Therefore, mini-laparoscopic surgery using 3-mm trocars can be recommended for patients who do not want the natural appearance of the navel to be altered. We have developed an approach to achieve a superior cosmetic outcome by direct placement of 3-mm trocars in the lateral wall of the abdomen and at the lower border of the pubic hair. We refer to this method as mimic mini-laparoscopic surgery and report cases in which this procedure was used.