Asherman’s syndrome is a global disease with a significant impact on the reproductive career among women. Its exact prevalence is quite difficult to ascertain as there are different methods to diagnose and several classifications being used. Its increasing incidence has been credited to a great number of uterine surgeries and improved accuracy of imaging studies. The clinical manifestations of this condition range from secondary amenorrhea, hypomenorrhea, dysmenorrhea, infertility, and recurrent pregnancy loss. Hysteroscopy played an important role in its diagnosis and management.

Human ; Female ; Adult: 25-44 Yrs Old

This report discusses a rare case of adenomyosis in a noncommunicating functional rudimentary horn, initially described as a subserous myoma on imaging. A 35-year-old nulligravid presented with dysmenorrhea since menarche, acute right lower quadrant pain, and a palpable right pelvic mass. A myomectomy was initially planned, but during the laparoscopic procedure, a rudimentary horn adjacent to a unicornuate uterus was discovered. The patient underwent a second procedure for diagnostic hysteroscopy, diaphonoscopy, chromotubation, laparoscopic excision of the rudimentary horn, and right salpingectomy, recovering without complications. Histopathology revealed diffuse adenomyosis with proliferative endometrium. The case emphasizes the challenges in diagnosing such conditions through imaging. It highlights the importance of considering Müllerian anomalies in pelvic mass diagnoses, particularly when atypical symptoms or imaging findings are present.

Human ; Female ; Adult: 25-44 Yrs Old ; Adenomyosis

The case report discusses a rare occurrence of tubal pregnancy in a patient with uterine didelphys, managed using combined hysteroscopy and laparoscopy. A 29-year-old Gravida 2 Para 0 (0010) with a right tubal ectopic pregnancy alongside incidental uterine didelphys detected via physical examination and three-dimensional transvaginal ultrasound. The patient underwent a combined diagnostic and operative laparoscopy, where a right salpingectomy was performed using a harmonic scalpel. Diagnostic laparoscopy showed two uterine horns with each attached fallopian tube and ovary with an interostial length of 4 cm. Diagnostic hysteroscopy confirmed the presence of two separate uterine cavities and cervices without communication. The procedure demonstrated that the technique for laparoscopic salpingectomy in cases of uterine didelphys parallels that for a normal uterus. The use of combined hysteroscopy and laparoscopy proved effective in evaluating both the external uterine structure and internal cavity, facilitating accurate diagnosis and treatment of Müllerian anomalies with ectopic pregnancy.

Human ; Female ; Adult: 25-44 Yrs Old ; Hysteroscopy ; Laparoscopy ; Pregnancy, Tubal ; Uterine Didelphys

OBJECTIVE

The aim of this study was to determine the different attitudes and perception of obstetrics and gynecology residents on laparoscopic skills training.

METHODS

A cross-sectional research was conducted in a tertiary hospital’s Department of Obstetrics and Gynecology using a survey questionnaire. The respondents were resident physician trainees using population sampling. An approval to use the survey questionnaire from its developer was obtained. Descriptive statistics was used for analysis of the demographic profile. Pearson product moment correlation was used to determine correlation between expectancy-value constructs, simulation use and surgical experience.

RESULTS

The average hours the residents spent in simulation laparoscopic exercises was 11 h in the last 12 months and at least 1 h per week with supervision (76%). The reasons for using laparoscopic simulation include skill development (94%), proximity to the simulation lab (90%), free time (85%), recommendation of attending surgeon (84%), and requirement for rotation (84%). Among the expectant value constructs, only intrinsic interest utility value (r = −0.390) showed statistical correlation suggesting a weak negative correlation with simulation use. Hours of simulation use were significantly negatively correlated with self-efficacy for learning skills required to become proficient at minimally invasive surgery (MIS) (r = −0.390) and self-efficacy for learning sufficient MIS skills to perform procedures safely (r = −0.351).

CONCLUSIONS

The residents were motivated to do well and had greater self-belief and enjoyed performing and mastering the laparoscopic skills training. The residents’ perception revealed that there was an improvement in their MIS skills with the laparoscopic simulation exercises in the short time they spent in the simulation. Despite the residents’ positive attitude and perceptions, voluntary participation was limited. The most commonly cited barriers to the access of the surgical knowledge improvement laboratory and laparoscopy simulation unit were the lack of time due to the workload, conflicting schedules, and COVID-19 pandemic restrictions. Supervision of the residents is of great importance to provide guidance and motivation to the residents in improving their technical skills and performance in the operating room.

Human ; Minimally Invasive Surgery ; Minimally Invasive Surgical Procedures