Prevention and Management of Complications in Laparoscopic Myomectomy.

Myomectomy aims to preserve fertility, treat abnormal uterine bleeding, and alleviate pain. It should cause minimal damage to the endometrium, while being tolerable and durable, and reduce the incidence of myoma recurrence and complications including bleeding, hematoma, adhesions, and gravid uterus perforation. Training and experience are crucial to reduce complications. The surgical strategy depends on imaging information on the myomas. The position of the optical and secondary ports will determine the degree of ergonomic surgery performance, time and difficulty of myoma enucleation, and the suturing quality. Appropriate hysterotomy length relative to myoma size can decrease bleeding, coagulation, and suturing times. Bipolar coagulation of large vessels, while avoiding carbonization and myometrium gaps after suturing, may decrease the risk of myometrial hematoma. Quality surgery and the use of antiadhesive barriers may reduce the risk of postoperative adhesions. Slow rotation of the beveled morcellator and good control of the bag could reduce de novo myoma and endometriosis. Low intra-abdominal CO2 pressure may reduce the risk of benign and malignant cell dissemination. The benefits a patient gains from laparoscopic myomectomy are greater than the complication risks of laparoscopic morcellation. Recent publications on laparoscopic myomectomies demonstrate reduced hospitalization stays, postoperative pain, blood loss, and recovery compared to open surgery.

Miomectomía laparascópica de puerto único (LESS) utilizando puerto SILS: experiencia inicial en Latinoamérica / Single port laparoscopic myomectomy (LESS) using SILS port: initial experience in Latin America

Los miomas son la neoplasia benigna más común de la mujer. Su tratamiento puede ser variado aunque generalmente es quirúrgico. La miomectomía permite conservar el útero conservando a su vez la fertilidad. Kurt Semm introdujo a finales de los 70`s la vía laparoscópica como una opción para realización de miomectomía y desde entonces ha demostrado ser una opción segura y con buenos resultados clínicos y terapéuticos. En 2008, Dr. Y.W. Kim inicia con las técnicas laparoscópicas de un solo puerto (LESS) haciendo que la cirugía laparoscópica sea cada vez menos invasiva...

Non-contraceptive benefits of hormonal contraceptives.

Besides the contraceptive effect of the various hormonal contraceptives, it is intended to demonstrate the non-contraceptive health benefits for treatment and prevention of bleeding problems, menstruation-related pain and other disorders, such as premenstrual syndrome and signs of androgenization. The effectiveness can be improved by choosing the proper progestogen with antiandrogenic action. Treatment but also prevention can be achieved with hormonal contraceptives in benign proliferative diseases of women, such as ovarian cysts, endometriosis, adenomyosis, endometrial hyperplasia, myoma and benign breast disease. Furthermore, hormonal contraceptives such as estrogen/progestogen combinations reduce pelvic inflammatory disease, rheumatoid arthritis, asthma symptoms and preserve bone density. In addition, a major impact in oncological prevention seems to be possible for ovarian, endometrial and colon cancer and these positive preventive effects seem to persist also after discontinuation of hormonal contraceptives. In addition, practical concepts for hormonal contraceptive selection will be outlined.

Esquistosomiasis tubárica: un sorprendente hallazgo / Tubal schistosomiasis: a surprising finding

Se describe el hallazgo casual de afección tubárica por esquistosoma en una paciente de 57 años, puesta de manifiesto en el estudio histopatológico de una pieza de histerectomía con salpingoooforectomía bilateral por mioma uterino. En el aspecto macroscópico se reveló como una lesión nodular de la trompa uterina izquierda, identificándose en el estudio microscópico las modificaciones compatibles con parasitosis por esquistosoma. Se discuten las distintas localizaciones, así como las características clínicas, epidemiológicas e histopatológicas de la afección genital por esta parasitosis (AU)