Laparoscopic Vaginal-Assisted Hysterectomy With Complete Vaginectomy for Female-To-Male Genital Reassignment Surgery.

STUDY OBJECTIVE: Total hysterectomy with bilateral salpingo-oophorectomy and vaginectomy for genital reassignment surgery is a complex procedure that is usually performed with a combined vaginal and abdominal approach. The aim of this study was to describe the feasibility of laparoscopic vaginectomy in sex reassignment surgery. METHODS: We reviewed the relevant medical history, intra/postoperative complications, and surgical results of all patients diagnosed with gender dysphoria and submitted to totally laparoscopic gender confirmation surgery in our department between January 2007 and March 2015. In total, 23 patients underwent total hysterectomy with bilateral salpingo-oophorectomy and vaginectomy in a single intervention. The vaginal mucosa was conserved to be used for the penile neourethra during the subsequent phalloplasty. MEASUREMENTS AND MAIN RESULTS: The surgeries had an average operating time of 155 ± 42 minutes. No intraoperative complications were registered. In all patients, the vagina was totally removed, and, in most cases (n = 20), we were able to remove laparoscopically more than 50% of the vagina. Three patients had postoperative complications. One patient presented with hemoperitoneum on the second postoperative day; another presented with prolonged urinary retention, and a third patient developed a perineal hematoma 1 month after surgery. Patients were discharged less than 72 hours after surgery, except the patient who developed a postoperative hemoperitoneum. For all patients, we obtained an adequate specimen of vaginal mucosa to reconstruct the penile neourethra for the subsequent phalloplasty. CONCLUSION: This study suggests the feasibility of laparoscopic vaginectomy in genital reassignment surgery. The procedure can be executed as a continuation of the hysterectomy with the potential advantage of the laparoscopy providing better exposure of the anatomic structures with low blood losses (less than 500 mL) and few complications. Furthermore, using this approach, adequate-sized vaginal mucosa flaps were obtained for the urethral reconstruction.

Is Vaginal Breech Delivery Still a Safe Option?

OBJECTIVE: To determine whether there was any difference in neonatal and maternal outcomes between breech vaginal delivery and cephalic vaginal delivery. METHODS: A retrospective, case-control study was conducted between January 2015 and December 2017 in a Portuguese hospital. A total of 26 cases of breech vaginal delivery were considered eligible and 52 pregnant women formed the control group. RESULTS: Induced labor was more frequent in the breech vaginal delivery group (46% versus 21%, p = 0.022). Episiotomy was more common in the breech vaginal delivery group (80% versus 52%, p = 0.014), and one woman had a 3rd degree perineal laceration. Newborns in the study group had a lower birthweight (2,805 g versus 3,177 g, p < 0.001). There was no significant difference in the neonatal outcomes. CONCLUSION: The present study showed that breech vaginal delivery at term compared with cephalic presentation was not associated with significant differences in neonatal and maternal morbidity. It also suggests that breech vaginal delivery remains a safe option under strict selection criteria and in the presence of an experienced obstetrician.

OBJETIVO: Avaliar se existem diferenças nos desfechos perinatal e materno entre os partos pélvicos vaginais e eutócicos. MéTODOS: Realizou-se um estudo retrospectivo, caso controle, entre janeiro de 2015 e dezembro de 2017 em um hospital terciário em Portugal. Foram incluídos 26 casos de parto pélvico vaginal e o grupo controle foi formado por 52 grávidas. RESULTADOS: A indução do trabalho de parto ocorreu com mais frequência no grupo do parto pélvico vaginal (46% versus 21%, p = 0.022), bem como a realização de episiotomia (80% versus 52%, p = 0.014). Verificou-se um caso de laceração perineal de 3° grau. Os recém-nascidos do grupo de estudo apresentaram um peso inferior ao nascimento (2.805 g versus 3.177 g, p < 0.001). Em relação aos desfechos perinatais, não se observaram diferenças estatisticamente significativas. CONCLUSãO: O presente estudo mostrou que o parto pélvico vaginal no termo quando comparado com o parto eutócico não se associou a diferenças estatisticamente significativas na morbidade perinatal e materna, e sugere ainda que o parto pélvico vaginal parece ser uma opção segura em casos rigorosamente selecionados e na presença de um obstetra experiente.

A fetus with an immature umbilical cord teratoma associated with exomphalos: case report and review of the literature.

OBJECTIVE: To describe the antenatal and pathological features of an immature umbilical cord teratoma associated with exomphalos, and to review the literature on this subject. CASE PRESENTATION: An abdominal wall defect, suspected to be an exomphalos, was identified during routine ultrasound examination performed at 13 weeks of gestation. The pregnancy was terminated. Fetopathological examination revealed an immature umbilical cord teratoma associated with exomphalos. Chromosomal microarray analysis was normal. CONCLUSIONS: Umbilical cord teratomas, albeit very rare, should be emphasized as a possible differential diagnosis when abdominal wall defects are detected. Since cord teratomas may lead to adverse fetal or neonatal outcomes, close follow-up of the fetus is recommended.