Common iliac artery injury during the abdominal entry phase of gynecologic laparoscopy: a case report.

BACKGROUND: Although not frequent, major vascular injury (MVI) during laparoscopy in gynecologic surgery can cause a sharp increase in morbidity and mortality. CASE: During the abdominal entry stage of operative laparoscopy, perforation of the left common iliac artery occurred. Prolonged hiccups might have played a role. CONCLUSION: Entry into the abdominal cavity during laparoscopy should be performed with the safer, controlled technique. In spite of the fact that no surgical procedure or de- * vice is absolutely foolproof, the laparoscopic abdominal approach should be performed with the technique that maximally reduces the likelihood of MVI. Once a major vascular injury is recognized or suspected, immediate conversion to laparotomy should be considered.

Office hysteroscopy: comparison of 2.7- and 4-mm hysteroscopes for acceptability, feasibility and diagnostic accuracy.

OBJECTIVE: To compare 2.7- and 4-mm rigid optics, with 3- and 5-mm outer sheaths, respectively, in office diagnostic hysteroscopy by evaluating pain, patient tolerability, optical view and diagnostic accuracy of the procedure. STUDY DESIGN: Three hundred seventy-one consecutive patients undergoing hysteroscopy were included in a prospective, randomized clinical trial, and the outcomes were analyzed. A saline solution was used as the distension medium. The t test for unpaired samples, chi2 tables of contingency and ANOVA 2 x 3 were used where appropriate. The study took place at Tor Vergata University Hospital of Rome, Rome, Italy. The 371 women were referred consecutively for suspected endometrial pathologies and were separated into 2 groups. Diagnostic accuracy of the hysteroscopic procedure, pain experienced by the 2 groups (as assessed by a visual analogue score) and patient acceptability were assessed with a questionnaire. RESULTS: Satisfactory hysteroscopy was achieved in 253 of 310 patients with a 2.7-mm hysteroscope and in 47 of 61 patients with a 4-mm hysteroscope. This difference was not significant. Menopausal status was the most important factor influencing the practicability of the hysteroscopic procedure (p < 0.001). CONCLUSION: The narrower-diameter hysteroscopes tended to lower the incidence of pain associated with office hysteroscopy, but this was not significant. Parity did not show any influence on hysteroscopic practicability. Menopausal status was the most important factor influencing the feasibility of the hysteroscopic procedure.