Single port laparoscopically assisted hysterectomy with the TriPort system. A case report and review of the literature.

AIM: We report our recent experience with the TriPort system (trademark of Advanced Surgical Concepts, Wicklow, Ireland) to perform a laparoscopically assisted hysterectomy via a single periumbilical incision. CASE REPORT: A 48-year-old multiparous woman was referred to us on March 2009 because of menometrorrhagia and uterine fibroids. RESULTS: The procedure was performed without intraoperative complications. The weight of the uterus was 360 gr. At the 10 months follow-up the patient did not refer any problem. DISCUSSION: Although our experience represented a potentially difficult surgery because of the size of the uterus, severe adhesions (two previous caesarean sessions) and the lack of experience with the new system, the procedure demonstrated to be feasible. As for our knowledge the present report represents the first case of single port laparoscopically assisted hysterectomy performed with the TriPort system in Italy. CONCLUSION: Single port laparoscopy is feasible and could potentially decrease postoperative pain as well as increase patient satisfaction. Although the early experience with TriPort system is promising, experienced laparoscopic skills are essential for the safe and effective performing of the procedure.

Laparoscopic management of ureteral endometriosis: the Stanford University hospital experience with 96 consecutive cases.

PURPOSE: We report the clinical characteristics and the principles of laparoscopic management of ureteral endometriosis at our institution. MATERIALS AND METHODS: We retrospectively reviewed the charts of patients with ureteral endometriosis. RESULTS: Preoperatively 97% of patients complained of pain but only a third had urinary symptoms. The left ureter was affected in 64% of cases and disease was bilateral in 10%. Four patients had hydroureter and 2 had hydronephrosis. CONCLUSIONS: To our knowledge this report represents the largest series of laparoscopically treated, pathologically confirmed ureteral endometriotic cases to date. It confirms that laparoscopic diagnosis and management of ureteral endometriosis are safe and efficient. All patients who undergo laparoscopy for endometriosis should be evaluated for possible ureteral involvement regardless of the presence or absence of urinary symptoms, or prior radiological evaluation since undiagnosed ureteral disease may result in loss of renal function.

Endometriosis of the diaphragm: four cases treated with a combination of laparoscopy and thoracoscopy.

STUDY OBJECTIVE: We aim to describe the clinical characteristics and the principles of combined laparoscopic and thoracoscopic management of women with diaphragmatic endometriosis at our institution. DESIGN: Case series (Canadian Task Force Classification II2). SETTING: Tertiary care referral center. PATIENTS: Four women with diaphragmatic endometriosis. INTERVENTIONS: Laparoscopy and thoracoscopy. MEASUREMENTS: We retrospectively reviewed the charts of 4 consecutive women with diaphragmatic endometriosis who underwent laparoscopy and thoracoscopy from June 2008 through September 2008. MAIN RESULTS: Four patients underwent a combination of laparoscopy for treatment of abdominopelvic endometriosis and thoracoscopy for treatment of diaphragmatic endometriosis. All patients had a history of chest pain. Three had a history of pelvic pain. Two had a history of catamenial hemothorax or pneumothorax. Two had been previously diagnosed with endometriosis, and three had a history of hormonal pharmacotherapy. All underwent laparoscopy and thoracoscopy without complications. All had uneventful recoveries. At nine-month follow-up, all patients were free of chest pain, and one patient had recurring pelvic pain. CONCLUSIONS: To the best of our knowledge, this constitutes the only reported series of patients with endometriosis who underwent a procedure systematically combining both laparoscopy and thoracoscopy for treatment of abdominopelvic and thoracic disease. It confirms that combined laparoscopic and thoracoscopic diagnosis and management of diaphragmatic endometriosis is reasonable. The inferior aspect of the diaphragm should be evaluated in all patients undergoing laparoscopy for endometriosis. Concomitant thoracoscopy should be considered for all patients with history of catamenial hemopneumothorax, cyclic chest or shoulder pain, or cyclic dyspnea. The aim of treatment should be to remove endometriotic lesions, to provide symptomatic relief, and to avoid recurrence. The use of these minimally invasive techniques may reduce the need for laparotomy or thoracotomy in affected patients.