Implementation of laparoscopic sacrocolpopexy: establishment of a learning curve and short-term outcomes.

PURPOSE: To evaluate the learning curve of senior urogynecologic surgeons performing laparoscopic sacral colpopexy (LSCP) and to assess outcomes and complications of LSCP. METHODS: We conducted a retrospective study of 47 consecutive women who underwent LSCP for pelvic organ prolapse repair between March 2009 and December 2010 at one tertiary medical center. Preoperative, intraoperative, postoperative, and demographic data were retrieved from patients' electronic charts. Pelvic organ support was assessed objectively using the Pelvic Organ Prolapse Quantification scale (POP-Q). Anatomic failure was determined as POP-Q stage ≥ II. RESULTS: The mean age of patients was 58 years (range 35-73 years). Seven (15 %) who opted to retain their uterus underwent sacrohysteropexies. The median POP-Q was III (II-IV). Of the 47 operations, 96 % (45) were completed by laparoscopy. The duration of surgery decreased as experience of the surgical team increased, from a mean of 196 ± 62 min for the first 15 cases to 162 ± 30 min for the subsequent 30. Four patients (9 %) presented with recurrence of prolapse; three (7 %) had de novo stress urinary incontinence; two sustained a cystotomy during adhesiolysis, and one had a port-site hernia. CONCLUSIONS: LSCP is a safe and effective treatment for pelvic organ prolapse, with very few complications. Following the first 15 cases of one surgical team, operative time decreased considerably.

Ovarian adrenal rest tumor in a congenital adrenal hyperplasia patient with adrenocorticotropin hypersecretion following adrenalectomy.

OBJECTIVE: Ovarian adrenal rest tumors (OARTs) are rare in contrast to testicular adrenal rest tumors. We report a case of OART in a patient with congenital adrenal hyperplasia who developed Nelson's syndrome after bilateral adrenalectomy. METHODS: We describe the clinical, imaging, and laboratory findings of the patient and review the relevant literature regarding OART and the possible interaction between ACTH and brown adipose tissue. RESULTS: An 18-year-old female with congenital adrenal hyperplasia, who had undergone bilateral adrenalectomy at the age of 10 years, presented with severe hyperpigmentation and hirsutism. Rectal ultrasonography showed a mass in the right ovary. (18)F-fluorodeoxyglucose PET/CT revealed intense uptake both in this mass and in brown adipose tissue located in typical supradiaphragmatic sites. Laparoscopic removal of the ovarian mass confirmed the diagnosis of OART. A systematic review revealed 9 documented cases of OART. As in our case, all presented with elevated ACTH levels. CONCLUSIONS: Common to all documented cases of OART are sustained high ACTH levels that activate the adrenal anlagen tissue in the ovaries.