Laparoscopic hysterectomy - JSLS

Overtreatment by Misdiagnosis of Pseudoinvasion in TLH

SLS — Mon, 08 Feb 2016 01:00:46 +0000

Junko Wroblewski, MD, PhD, Hidehiro Kawagoe, MD, PhD, Hiroki Nasu, MD, Kyoko Kawamura, MD, PhD, Yoshihiko Tashiro, MD, PhD, Greggory Wroblewski, BS, MA, Naofumi Okura, MD, PhD

Department of Obstetrics and Gynecology (Drs J. Wroblewski, Kawagoe, Nasu, Kawamura, and Okura) and Pathology (Dr Tashiro), National Hospital Organization Kokura Medical Center, Kitakyushu, Japan. Division of Functional Neuroanatomy, Yamaguchi University Graduate School of Medicine, Ube, Japan (G. Wroblewski).

ABSTRACT

Introduction: Despite reports of pseudo lymphovascular space involvement (LVSI) in total laparoscopic hysterectomy (TLH) in recent years, we recently experienced a misdiagnosis of pseudo-LVSI after TLH for uterine myoma, having observed irregularities in excised specimens. Additional surgery found no abnormalities, resulting in an unfortunate case of overtreatment. For this reason, we reviewed cases of TLH for benign uterine disorders performed at our hospital for the presence of similar pseudoinvasion.

Case Description: We re-examined 53 cases for the presence of intravascular endometrial tissue from patients who had undergone TLH for benign uterine disorders. In a 42-year-old patient who had undergone TLH for uterine myoma, we found a small amount of complex atypical endometrial hyperplasia and observed intravascular agglomerations of atypical endometrial cells at multiple sites, leading to a diagnosis of LVSI. We performed additional surgery (laparotomy), but findings were unremarkable. Pseudo-LVSI was identified in 8 of 53 cases (15.1%): in 2 of 21 (9.5%) operations performed with the ClearView uterine manipulator and in 6 of 32 (18.8%) performed with the Vcare uterine manipulator.

Discussion: Differentiation between “true” LVSI and grossing artifacts remains difficult, and a noteworthy case of overtreatment such as this highlights the need to reinstitute differentiation as a salient topic of discussion among surgeons and pathologists. Similarly, the existence of pseudoinvasion in a significant number of the retrospectively reviewed cases, in light of its still-undetermined clinical significance, is an interesting finding that warrants additional investigation to avoid both overtreatment and undertreatment of such cases.

Key Words: Laparoscopic hysterectomy, LVSI, Misdiagnosis, Overtreatment, Pseudoinvasion.

[gview file=”https://crsls.sls.org/wp-content/uploads/2016/02/jls101163548001.pdf”]

The post Overtreatment by Misdiagnosis of Pseudoinvasion in TLH first appeared on JSLS.

Parasitic Myomas Due to Laparoscopic Intra-abdominal Morcellation

SLS — Tue, 31 Mar 2015 12:02:12 +0000

Giulia Giovanardi, MD, Stephane Oden, MD, Haitham Khalil, MD, Loic Marpeau, MD, PhD, Renato Seracchioli, MD, Horace Roman, MD, PhD

Minimally Invasive Gynaecological Surgery Unit, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy (Drs. Giovanardi, Seracchioli). Department of Gynecology and Obstetrics, Rouen University Hospital, Rouen, France (Drs. Oden, Khalil, Marpeau, Roman).

ABSTRACT

Introduction: The use of electric tissue morcellators is crucial to allow the extraction of voluminous parts from a small laparoscopic incision, especially when the vagina is not opened. This report discusses how morcellation could be associated with the risk of intra-abdominal parasitic myomas developing.

Cases Description: Three women were affected by intra-abdominal parasitic myomas several years after laparoscopic hysterectomy or myomectomy with specimen extraction by morcellation. The myomas were discovered either by accident (case 3) or because the patients were symptomatic (cases 1 and 2). The symptoms are usually unspecific.

Discussion: The use of a morcellator may be associated with the risk of disseminated myoma fragments during the procedure and the rare development of complications from parasitic myomas. Meticulously inspecting the abdominal cavity at the end of the procedure and assessing the size of the uterus and fibroids before the procedure can reduce this risk. It is very likely that these cases are underestimated because patients may be asymptomatic and these parasitic myomas can occur years after the operation.

Key Words: Myoma, Parasitic myoma, Morcellation, Myomectomy, Laparoscopic hysterectomy.

[gview file=”https://crsls.sls.org/wp-content/uploads/2015/04/jls101153198001.pdf”]

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Hand-Assisted Total Laparoscopic Hysterectomy of a 5200-Gram Uterus

SLS — Thu, 13 Nov 2014 16:24:10 +0000

Xiaoming Guan, MD, PhD, Anze Urh, MD, Teresa M. Walsh, MD, Vicki Ng, MD

Department of Obstetrics & Gynecology, Baylor College of Medicine, Houston, TX, USA (Drs. Guan, Walsh). Department of Obstetrics & Gynecology, Brown University, Providence, RI, USA (Dr. Urh). Department of Obstetrics & Gynecology, St. Luke’s Women’s Center, San Francisco, CA, USA (Dr. Ng).

ABSTRACT

Introduction: Hysterectomy is one of the most common gynecologic procedures performed. Minimally invasive laparoscopic techniques are preferred; however, laparotomy is still commonly performed for large uteri.

Case Description: We performed hand-assisted total laparoscopic hysterectomy of a 5200-g uterus.

Discussion: Hand-assisted laparoscopy is an alternative approach to laparotomy for large uteri and has similar benefits to traditional laparoscopic surgery. To our knowledge, the uterus in our patient is the largest uterus reported to have been removed laparoscopically.

Key Words: Large uterus, Fibroids, Hysterectomy, Laparoscopic hysterectomy, Hand assist.

[gview file=”https://crsls.sls.org/wp-content/uploads/2014/11/13-00313-.pdf”]

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