[COMPARISON OF LAPAROSCOPIC ASSISTED VAGINAL HYSTERECTOMY AND VAGINAL HYSTERECTOMY FOR BENIGN DISEASES AND LESIONS OF THE FEMALE GENITAL SYSTEM].

OBJECTIVE: To compare the efficacy of laparoscopic assisted vaginal hysterectomy (LAVH) and vaginal hysterectomy (VH) carried out on the occasion of non-malignant diseases and lesions of the female genital system, by assessing the: operative time, price, blood loss, hospital stay, intra and postoperative complications, satisfaction of the patient. MATERIALS AND METHODS: The study included 187 women aged 38-71 years, with hysterectomy with or without salpingo-oophorectomy by LAVH-58 (31%) women or VH-129 (69%) women, on the occasion of non-malignant diseases and lesions of the female genital system. The patients are including in the study groups according to including and excluding criteria. Operation preparation, research and intra and postoperative follow-up of patients in both groups were the same. Standard, as performance is the surgical technique in both groups. The indicators are analyzed with the statistical program SPSS 10.1 for windows. Shi-square test, Fisher exact test were used in appropriate cases. RESULTS: No significant difference between groups in terms of age (LAVH 48.7 ± 3.2 years; VH 52.7 ± 4.8 yrs), live births (1-3)/2 (1-2), total weight (62.6 kg/59 ± 7.2 kg) weight of the uterus (227 ±116.5/234 ±: 68.3). Most often Indications for LAVH are: CIN/CA in situ coli uteri--16.1%; myoma uteri--22.5%; ovarian tumor--15.5%, etc. Indications for VH: genital prolapse--53.5%; CIN/CA in situ--14.7%; recurrent endometrial polyp--14%, etc. Operative time: LAVH (126 ± 18.2), VH (68 ± 11.1), (p ≤ 0.05). Intraoperative blood loss: LAVH (16 ± 7 average drop in hemoglobin Hb), VH (10 ± 5 decline in Hb array) (p ≤ 0.05). We didn't find out significant differences between the patients of both groups in terms of hospital stay and satisfaction with the carried out operation. Intraoperative complications are more in the LAVH group and almos absence in VH group. Post-operative complications occur without statistical differences (we exclude urinary infections) in both groups studied. CONCLUSIONS: In our study the VH showed better or equal results in the studied indicators in comparison with LAVH, therefore it is surgical intervention of choice compared to LAVH for removal of the uterus with or without the adnexa in non-malignant diseases and lesions of the female genital system. LAVH is the right choice in comparison with VH only in ovarian tumors and when we expected problems in women small pelvis.

[VAGINAL LEIOMYOMA AFTER TOTAL ABDOMINAL HYSTERECTOMY--CLINICAL CASE AND REVIEW OF LITERATURE].

Vaginal myomas are rare benign, mesenchyme, monoclonal tumors. They originate from smooth muscle cells and have a diverse and non-specific clinical feature. They are normally presented as single solid nodules localized in anterior vaginal wall in women between the ages of 35-50 years. Often times they are secondary originating from a cervical or vaginal lesion in woman who had undergone a hysterectomy on account of a myoma. We present a rare case of vaginal myoma localized in the posterior vaginal wall in a patient, who had undergone a total hysterectomy 19 years ago on account of a myoma.

[COMPLICATIONS OF DIAGNOSTIC AND OPERATIVE HYSTEROSCOPY--REVIEW].

Hysteroscopy is a diagnostic or surgical mini-Invasive gynecologic operating procedure. The complications of this standard procedure are relatively rare. According to retrospective studies they are 0.95-13.6%. They occur more often by an operative rather than a diagnostic hysteroscopy. These complications could be divided into two groups of an approximately equal occurrence--due to a dilation and passing through the cervix uteri (cervical laceration, creative a false cervix uteri, perforation, bleeding, impossibility to pass through the inner orifice of the cervical canal, insufficiency of the cervix uteri) and due to the operative technique itself (uterine perforation, fluid overload, thermal or mechanical trauma of the inner urinaiy and gastrointestinal tract, infection, rupture of the uterus during a subsequent pregnancy). The most occurring complication is namely the uterine perforation--1-9%, the most severe could indeed be the fluid overload--0.01-11%. The gynecologist performing the hysteroscopy should be well grounded in the typical complications. Unveiling and performing a quick intervention of the latter could prevent unwanted consequences for the patient and the legal issues that could follow occur.