Hysteroscopic Resection of a Complete Uterine and Vaginal Septum Under Laparoscopic Ultrasound Guidance
The aim of this video is to demonstrate the use of laparoscopic ultrasound guidance during hysteroscopic resection of a congenital uterine and vaginal septum.
A 42 year old G4P2022 with two prior cesarean sections presents with secondary infertility and intermenstrual spotting. Transvaginal ultrasound shows 1.8 × 1.0 × 1.9 cm fluid filled cesarean scar defect (Figure 1). The patient elected for surgical management and underwent laparoscopic resection and primary closure of her cesarean scar niche. Hysteroscopy was performed under laparoscopic visualization to identify the location of the niche. The bladder was dissected off the lower uterine segment to the level below the defect.
ConclusionWhilst radical completion surgery should be advised in UA, this case, in addition to all published conservatively managed cases of UA, demonstrates that conservative management is possible in appropriately selected women. Intensive monitoring post-operatively is essential owing to the risk of recurrence; however, this may pose deleterious side effects which require consideration.
ConclusionDue to the heterogeneity of the tissue sampling techniques, diverse patient populations, and significant conflicting recommendations, no conclusive recommendation on the optimal tissue sampling technique can be made. However, it is of the authors opinion that it would be reasonable to limit uterine tissue sampling for confirmatory diagnosis of adenomyosis in those patients with a suspicion of adenomyosis based on both symptom profile and pelvic ultrasound, where a planned diagnostic laparoscopy for either infertility or pelvic pain has already been contemplated and scheduled, and where the confirmatory results ma...
ConclusionCurettage for miscarriage or undesired pregnancy is not exempt from complications, such as hemorrhage, simple perforation, and infection. Intrauterine fallopian tube incarceration is uncommon but can affect fertility. This diagnosis is important to avoid destruction of the fimbriae and necrosis of the tube and also to reduce the risk of ectopic pregnancy.
A 22-year-old woman, consulted for secondary infertility, she had no complaints. Her history included a first-trimester surgical evacuation of the uterus 2 years ago. Gynecological examination was normal. Transvaginal ultrasound revealed a hypoechoic, irregular tissue within the endometrial cavity. The ovaries were normal. Hysterosalpingography showed synechia with hydrosalpix .The patient underwent diagnostic hysteroscopy and laparoscopy. Hysteroscopy showed a fallopian t ube in the uterine cavity.
SUMMARY An isthmocele, a cesarean scar defect or uterine niche, is any indentation representing myometrial discontinuity or a triangular anechoic defect in the anterior uterine wall, with the base communicating to the uterine cavity, at the site of a previous cesarean section scar. It can be classified as a small or large defect, depending on the wall thickness of the myometrial deficiency. Although usually asymptomatic, its primary symptom is abnormal or postmenstrual bleeding, and chronic pelvic pain may also occur. Infertility, placenta accrete or praevia, scar dehiscence, uterine rupture, and cesarean scar ectopic preg...
ConclusionsIt is important for clinicians and radiologists managing women with risk factors for a scar ectopic pregnancy to maintain a high index of suspicion during follow-up. Failure to diagnose and initiate prompt management may lead to uterine rupture, massive hemorrhage, and maternal death.
ConclusionMore and more patients are asking for the removal of their implants. The surgical technique has to be adapted to the location of the implants and has to allow their complete removal to avoid leaving fragments that can cause the persistence of side effects.
We report a case of misdiagnosed endometrial cancer by D&C, but with a positive cytopathological finding. Following that, a meta-analysis including 4,179 patients of endometrial diseases with cyto-histopathological results was performed to assess the value of the endometrial cytological method in endometrial cancer diagnosis. The pooled sensitivity and specificity of the cytological method in detecting endometrial atypical hyperplasia or cancer was 0.91[95% confidence interval (CI) 0.74–0.97] and 0.96 (95% CI 0.90–0.99), respectively. The pooled positive likelihood ratio and negative likelihood ratio was 25.4 (...
ConclusionThe technique of VaSUS for the resectoscope of LVS appears to be safe and effective with good outcomes, even in terms of dyspareunia.