Prospective Study on the Use of Endo-Stapler for Enclosed Colpotomy to Prevent Tumor Spillage in Gynecologic Oncology Minimally Invasive Surgeries.

Background and Objectives: This is a prospective trial of the endo-stapler application for vaginal closure before colpotomy in cases of carcinoma endometrium and carcinoma cervix, managed by minimally invasive surgery with due consideration of its surgical technique and short-term oncologic follow-up outcomes. Methods: This was a prospective, single center study completed between March 1, 2020 and December 31, 2022. A total of 62 patients (43 cases of carcinoma endometrium and 19 cases of carcinoma cervix) were recruited for the study. Oncologic survival outcomes at the end of 1 and 2 years were documented. Results: There were no major intraoperative bowel, urinary, or vascular injuries. None of the cases required conversion to laparotomy peroperatively. Our study had 8 patients with carcinoma endometrium (8/43) and 7 patients of carcinoma cervix (7/19) who have completed 24 months of follow-up without any recurrence to date. Conclusion: Endo-stapler application for enclosed colpotomy to prevent tumor spillage is a futuristic step in gynecologic oncology cases managed by laparoscopy.

Iatrogenic Thermal Energy-Induced Distal Ureteric Injury and Its Management by Laparoscopy Ureteroureterostomy.

Background and Objectives: Most thermal energy-induced distal ureter injuries are missed intraoperatively as they are caused by delayed ischemia-induced necrosis of the affected part leading to fistula, and a delayed presentation. The injuries of the distal ureter are commonly managed by ureteroneocystostomy, which has long-term complications related to vesico-ureteric reflux (VUR). We present our experience of management of distal ureter injury due to thermal energy by laparoscopy ureteroureterostomy and the role of various methodologies for its diagnosis. Methods: It is a retrospective, single-center study that was conducted from January 1, 2020 - December, 31 2022. Results: A total of 8 cases were enrolled in the study. All cases had an uterovaginal fistula (UVF) post-laparoscopic gynecology surgery. The bilateral ureteric injury was observed in 2 cases. The median post-surgery time to diagnose UVF in the study was 10 days. All cases were managed by laparoscopy ureteroureterostomy (LUUS). Six cases underwent immediate surgery after the diagnosis; whereas 2 cases had initial double-J stent placement as treatment, which subsequently failed following which the LUUS was performed. There were not any immediate or long-term complications such as leakage, stenosis, fistula, or any requirement for revision surgery. Conclusion: The management of thermal energy-induced ureteric injury is exceptional as compared to other types of ureteric injury. Our approach should be toward immediate surgical management rather than a conservative one to avoid long-term complications and sequelae. Iatrogenic lower ureteral injury can be managed successfully by LUUS, maintaining the normal anatomy and physiology of VUR.

Bowel Endometriosis Management by Colorectal Resection: Laparoscopic Surgical Technique & Outcome.

Background and Objectives: Bowel deep infiltrating endometriosis (DIE) management by colorectal resection is a complex procedure. The purpose of the present study is to delineate a meticulous approach to the assessment of the patient, step-wise surgical technique, pre, and postoperative care, and its short-term and long-term outcomes. Methods: This is a single-center retrospective study done on patients of bowel DIE managed by colorectal resection between January 1, 2019 to June 30, 2021. Results: There was a significant improvement in the symptomatology of patients post-surgery. Our surgical technique is feasible with acceptable short-term and long-term outcomes. Conclusion: Bowel DIE management can be proficiently executed with a proper diagnostic approach, appropriate surgical expertise with exhaustive pelvic anatomy knowledge especially concerning autonomic nerve plexus.

Barbed Suture Causing Acute Small Bowel Obstruction Post Laparoscopic Sacrocolpopexy.

Introduction: A case report of small bowel obstruction related to barbed suture in a postoperative patient of laparoscopic sacrocolpopexy. Case Description: A 61 -year-old female with a body mass index of 27 with vault prolapse underwent laparoscopic sacrocolpopexy. The patient was discharged on postoperative day two. She presented again in the emergency department on the fifth postoperative day with complaints of frequent vomiting episodes with intermittent and colicky pain in the abdomen. Her imaging (computed tomography abdomen/pelvis with oral contrast) suggested distal small bowel mechanical obstruction at midileum with significant free fluid in the peritoneum. Emergency laparoscopic exploration was done. Peroperative V-LocTM 180 suture tail end barbs were found anchored to the mesentery of midileum causing a loop that led to compression and occlusion of distal bowel. The barbed suture tail end was detached from the mesentery and thus relieving the compression. No additional procedure was required for the bowel wall. The excess barbed suture tail end outside the peritoneum was trimmed. The postoperative course was uneventful. Conclusion: Bowel complication is an uncommon but serious issue following the use of barbed sutures. It should be used with utmost caution as none of the preventive measures are completely safe. Further studies need to be done for preventive measures.

Step-wise Technical Description of Performing Ureteric Tunnel Dissection in Laparoscopic Radical Hysterectomy.

OBJECTIVES: Technical description of performing ureteric tunnel dissection in laparoscopic radical hysterectomy (LRH) surgery. MATERIALS AND METHODS: This is a retrospective analysis. A total of 91 patients of the International Federation of Gynaecology and Obstetrics Stage IA2, IB1, and IB2 of cervical cancer were operated by the same surgeon between January 2015 and December 2019 were analyzed. RESULTS: The median time for one side ureteric tunnel dissection was 3 min 15 s (range 2 min 35 s- 6 min 18 s). None of the cases were converted to laparotomy. The patients' median hospital stay was 2 days (range 1-4 days). There were no short-term or long-term complications related to ureteric tunnel dissection. CONCLUSION: This analysis explains the descriptive methodology of operative technique, especially for ureteric tunnel dissection in LRH. This technique is easily reproducible and replicable, with chances of marginal or negligible complication rates.

Vault Endometriosis: Detailed Step-by-Step Laparoscopic Surgical Management Technique.

BACKGROUND AND OBJECTIVES: The aim of this study was to demonstrate a detailed and elaborative step-wise laparoscopic surgical management technique of vault endometriosis. METHODS: A total of 5 patients were operated on for laparoscopic management of vault endometriosis performed at our center between January 1 2015 and December 31, 2019. RESULTS: There were no short or long term complications related to laparoscopic management of vault endometriosis with a satisfactory prognosis. CONCLUSION: This analysis explains the descriptive methodology of assessment of patients and operative technique for vault endometriosis.

Vaginal Closure Before Colpotomy with an Endo-Stapler to Prevent Tumor Spillage in Laparoscopic Surgery for Gynecological Malignancy.

BACKGROUND AND OBJECTIVES: The aim of this study was to define new techniques for performing vaginal closure with endo-staplers to prevent tumor spillage during laparoscopic surgeries for endometrial cancer and early stage cervical cancer. METHODS: Thirteen patients were retrospectively studied for the use of endo-staplers for vaginal closure before colpotomy during laparoscopic surgeries for endometrial cancer and early stage cervical cancer to prevent tumor spillage. RESULTS: There were no short-term or any long-term complication related to the use of the endo-staplers for colpotomy in the surgeries included in this study. CONCLUSION: Use of the endo-staplers to close the vagina before colpotomy according to the technique described is safe and feasible, with prevention of gross spillage of any malignant cells in the peritoneal cavity or vagina, which will further have a favorable oncologic outcome.

Laparoscopic Hemostasis of Intractable Delayed Postpartum Hemorrhage.

Postpartum hemorrhage (PPH) is associated with considerable morbidity and mortality, particularly when relaparotomy is necessary. The etiology of spontaneous intractable PPH in a hemodynamically stable patient is poorly understood and remains open to speculation. Secondary, or delayed, PPH is usually defined as the excessive bleeding from the genital tract, with a loss of 500 ml or more of blood occurring after the first 24 hours after delivery until the sixth week of puerperium. In this report, we present three cases of severe, diffuse postpartum bleeding unresponsive to conventional hemostatic measures, which were successfully managed laparoscopically at our center. In all three cases, hemostasis was accomplished by using a laparoscopic procedure: with the excision of cervical stump bleeding in the first case, bilateral uterine artery ligation accompanied by laparoscopic hysterectomy in the second case, and bilateral internal iliac artery ligation in the third case.

Surgicopathological Outcomes and Survival in Carcinoma Body Uterus: A Retrospective Analysis of Cases Managed by Laparoscopic Staging Surgery in Indian Women.

OBJECTIVES: The context of this article is based on two main titles those being Gynecologic Oncology and Minimal invasive surgery. The aim of this study was to report the laparoscopic management of a series of cases of endometrial carcinoma managed by laparoscopic surgical staging in Indian women. MATERIALS AND METHODS: This study was conducted in a private hospital (referral minimally invasive gynecological center).This was a retrospective study (Canadian Task Force Classification II-3). Eighty-eight cases of clinically early-stage endometrial carcinoma staged by laparoscopic surgery and treated as per final surgicopathological staging. All patients underwent laparoscopic surgical staging of endometrial carcinoma, followed by adjuvant therapy when needed. Data were retrieved regarding surgical and pathological outcomes. Recurrence-free and overall survival durations were measured at follow-up. Survival analysis was calculated using Kaplan-Meier survival analysis. RESULTS: The median age of presentation was 56 years, whereas the median body mass index was 28.3 kg/m2. Endometroid variety was the most commonly diagnosed histopathology. There were no intraoperative complications reported. The median blood loss was 100 cc, and the median intraoperative time was 174 min. There were a total of 5 recurrences (5.6%). The outcome of this study was comparable to studies conducted in Caucasian population. The predicted 5-year survival rate according to Kaplan-Meier survival analysis is 95.45%, which is comparable to Caucasian studies. CONCLUSION: Laparoscopic management of early-stage endometrial carcinoma is a standard practice worldwide. However, there is still a paucity of data from the Indian subcontinent regarding the outcomes of laparoscopic surgery in endometrial carcinoma. The Asian perspective has been highlighted by a number of studies from China and Japan. To our knowledge, this study is the first from India to analyze the surgicopathological outcomes following laparoscopic surgery in endometrial carcinoma. The outcome of this study was comparable to studies conducted in Caucasian population.

Circumferential Vault Excision and Reconstruction: Technical Description of Management of Intractable Secondary Vault Hemorrhage after Hysterectomy in Resource-Limited Settings.

Hemorrhage after gynecologic surgery is an infrequent complication. It can be divided based on time of onset into primary and secondary. Secondary hemorrhage is a life-threatening complication with a reported incidence of .17% to .45%. When the etiology cannot be ascertained and when the hemorrhage does not respond to conservative management, it is aptly labeled as an intractable hemorrhage. Numerous techniques have been used to manage secondary hemorrhage, including vaginal exploration and securing of the bleeding vessels, laparotomy and ligation of uterine and internal iliac arteries, and transarterial embolization of uterine or internal iliac vessels using interventional radiologic modalities. Circumferential vault excision and reconstruction is a methodic technique to effectively control this condition using a total laparoscopic route with systematic and easily replicable steps.