We report a case of giant hysteromyoma and complex pelvic adhesion treated by robotic assisted laparoscopic total hysterectomy and bilateral salpingectomy. The patient was diagnosed with uterine fibroids after physical examination in 1998 but did not receive any treatment, and regular examinations reported progressive growth of the fibroids. Ultrasound suggested multiple uterine fibroids, and pelvic MRI indicated large uterine fibroids with bleeding. Robot-assisted laparoscopic total hysterectomy and bilateral salpingectomy were performed after relevant examinations, and the operation was completed smoothly. The patient was discharged 4 days after surgery with good appearance of the abdominal wall and good recovery during the follow-up. With its unique advantages, robot-assisted laparoscopy provides a minimally invasive surgical approach for giant hysterectomy with complex pelvic adhesions.
Female ; Humans ; Hysterectomy ; Laparoscopy ; Leiomyoma/surgery* ; Robotics ; Uterus

Scrotal leiomyomas with atypical bizarre nuclei are rare, which might be misdiagnosed as malignant tumor. We describe a case of scrotal bizarre leiomyoma in a 65-yr-old man. The tumor was a 1 cm-sized, well circumscribed, oval mass arising from the tunica dartos muscle. Histologically, it was formed by whorling bundles of fusiform cells with occasional atypical, pleomorphic nuclei and pseudoinclusions. Mitosis was not found. Although morphologically atypical, scrotal bizarre leiomyomas take on a biologic behavior not different from that of conventional leiomyoma, they should be distinguished from leiomyosarcoma to avoid unnecessary treatment.
Aged ; Genital Neoplasms, Male/*pathology/surgery ; Human ; Leiomyoma/*pathology/surgery ; Male ; Scrotum/*pathology

This study was undertaken to evaluate the various gynecologic endoscopic surgical techniques including resectoscopic myomectomy, laparoscopic myomectomy, and laparoscopy assisted vaginal hysterectomy (LAVH) used in the treatment of uterine myomas. The medical records of 136 cases of uterine myomas treated using one or more of the gynecologic endoscopic surgical techniques in the Department of Obstetrics and Gynecology at Yonsei University were retrospectively reviewed from March 1997 to September 1998. Of the 136 cases reviewed, there were 40 submucosal myomas and 96 intramural and subserosal myomas. For statistical analysis, Student's t-test was used. Submucosal myomectomy using the resectosope was performed in 35 cases (mean age: 39 +/- 1.5 years), laparoscopic myomecotmy in 35 cases (mean age: 36 +/- 1.9 years), and LAVH in 66 cases (mean age: 42 +/- 1.1 years). In cases of huge myomas, the GnRH agonist was used prior to surgery, and in cases of heavy uterine bleeding, angioblock of the uterine artery was undertaken before the endoscopic procedures. The mean operating time was significantly shorter in resectoscopic myomectomy (41 +/- 12 min), followed by laparoscopic myomectomy (85.0 +/- 10.3 min) and LAVH (123 +/- 5.3 min). The mean hospital stay for resectoscopic myomectomy, laparoscopic myomectomy, and LAVH was 1.9 +/- 0.5, 2.5 +/- 0.5, and 3.4 +/- 0.8 days (p < 0.001), respectively. There were 3 cases of complications including pulmonary edema and uterine perforation in the resectoscopic myomectomy group, and 4 cases of complications including bladder, ureter, and epigastric vessel injury in the LAVH group. In conclusion, the therapeutic effect of various gynecologic endoscopic surgical techniques can be maximized in terms of shorter operation time, shorter hospital stay, faster recovery, and less blood loss by the appropriate management of uterine myoma in well-chosen patients.
Adult ; Female ; Human ; Hysterectomy, Vaginal* ; Laparoscopy* ; Leiomyoma/surgery* ; Uterine Neoplasms/surgery*

Leiomyomas, originating in the bile duct, are very rare, and only few cases have been reported in the literature. We experienced a case of leiomyoma of the distal common bile duct, mimicking bile duct cancer. A 39-year-old woman presented with intermittent jaundice and general weakness for three months. Clinical profiles showed obstructive jaundice, and the abdominal computed tomography and cholangiography revealed diffuse bile duct dilatation with distal common bile duct stricture. A pylorus-preserving pancreaticoduodenectomy was performed and the pathologic specimen disclosed leiomyoma of the common bile duct accompanying severe fibrosis. This is the first case of leiomyoma in the bile duct reported in Korea.
Adult ; Common Bile Duct Neoplasms/*diagnosis/pathology/surgery ; Female ; Humans ; Leiomyoma/*diagnosis/pathology/surgery ; Pancreaticoduodenectomy

Colonic inflammatory fibroid polyp (IFP) is an uncommon benign polypoid lesion, which is composed of fibroblasts, numerous small vessels and edematous connective tissue with marked eosinophilic inflammatory cell infiltration. This condition is frequently detected in the stomach and small intestine, but uncommon in the colon. Although IFP is a benign lesion, surgical resections are performed in most colonic cases because the polyps are usually too large to resect endoscopically. Only three patients underwent endoscopic polypectomy in our literature reviews. Here, we present a case of IFP in the descending colon successful endoscopically resected using a novel technique of trapping its stalk with an endoloop, forming the stalk into an omega shape, and then dissecting the stalk with a needle knife.
Adult ; Colectomy ; Colonic Polyps/*pathology/*surgery ; Colonoscopy/*methods ; Female ; Humans ; Leiomyoma/pathology/*surgery

OBJECTIVETo report the first case of transumbilical laparoendoscopic single-site surgery-assisted vaginal hysterectomy in South China, and discuss its feasibility and safety.

METHODSA 42-year-old woman with multiple myoma of the uterus underwent laparoendoscopic single-site surgery-assisted vaginal hysterectomy performed using a single multiple-channel port inserted through a solitary 2 cm upper umbilicus incision.

RESULTSThe total operative time was 3 h, and duration of the laparoendoscopic procedure was 2 h. The surgery was completed uneventfully without an additional port incision or transfer to open surgery. The intraoperative blood loss was 100 ml. Bowel peristalsis was recovered 3 days after the operation. The vaginal stump and abdominal incision healed smoothly without occurrence of vaginal bleeding.

CONCLUSIONWith the development of surgical instruments and improvement of the surgeons' skills, laparoendoscopic single-site surgery, due to its invasiveness, can be a promising approach to the management of gynecological disease including gynecological malignant tumors.

Adult ; Female ; Humans ; Hysterectomy, Vaginal ; methods ; Laparoscopy ; methods ; Leiomyoma ; surgery ; Uterine Neoplasms ; surgery

Adult ; Female ; Humans ; Hysterectomy ; Leiomyoma ; diagnosis ; Middle Aged ; Muscle Neoplasms ; complications ; surgery ; Uterine Neoplasms ; complications ; surgery

OBJECTIVETo assess the prognosis and reproductive outcomes of laparoscopic intracapsular myomectomy.

METHODSA total of 673 women received subserosal and intramural intracapsular laparoscopic myomectomy between March, 2007 and March, 2012, and their post-operative complications, the need for subsequent surgery, symptomatic relief and reproductive outcomes were analyzed.

RESULTSOf these patients, 42.4% had subserosal myomas and 57.6% had intramural myomas. The mean total operative time was 96∓41 min with a mean blood loss of 128∓46.2 ml, and 82.3% of the patients were discharged 48 h after the operation without early complications. A small fraction (2.3%) of the patients had a second laparoscopic myomectomy for recurrent fibroids. Of the fertility-demanding women who underwent myomectomy, 71% achieved pregnancy, 49.8% underwent caesarean section, 8% had operative vaginal deliveries, and 42.2% had spontaneous deliveries; uterine rupture occurred in none of the cases.

CONCLUSIONLaparoscopic intracapsular myomectomy, by preserving the fibroid pseudocapsule and myometrial integrity, has no early postoperative complications and ensures good fertility rates and reproductive outcomes.

Adult ; Female ; Fertility ; Humans ; Laparoscopy ; Leiomyoma ; surgery ; Prognosis ; Retrospective Studies ; Uterine Myomectomy ; Uterine Neoplasms ; surgery

While endoscopic submucosal dissection (ESD) is widely used to treat gastrointestinal tumors, it is rarely used for subepithelial tumors (SETs) originating from the muscularis propria of the esophagus and gastric cardia because of the risk of perforation and problems with inadequate space and field of view during procedures. Submucosal tunneling endoscopic resection (STER) is a new therapeutic method for treating SETs in specific locations in the esophagus and stomach. This technique is highly skill-dependent, using a mucosal flap that covers a deeper part of the gut wall, but is safe and minimally invasive compared with conventional endoscopic approaches such as ESD in SETs originating from the muscularis propria.We report a patient who underwent STER to remove a SET located at the gastric cardia. The patient recovered without any complications. We believe that our case shows the efficacy and safety of the STER technique for patients with a SET originating from the muscularis propria.
Cardia/pathology/surgery ; Endosonography ; Gastric Mucosa/pathology/surgery ; Gastroscopy ; Humans ; Leiomyoma/*diagnosis/surgery ; Male ; Middle Aged ; Stomach Neoplasms/*diagnosis/surgery

Tumors originating from the muscularis propria layer of esophagus are usually removed by thoracoscopic resection. With the introduction of new endoscopic therapeutic techniques, some of these tumors could be treated by endoscopic submucosal dissection (ESD). However, the above endoscopic methods are associated with a high risk of perforation and it is hard to close the perforation through the endoscopy. Recently we successfully resected a tumor originating from the muscularis propria layer of the esophagus by submucosal tunneling endoscopic resection (STER), which was based on peroral endoscopic myotomy (POEM) and ESD. Compared with ESD, STER is a safe, economic and less invasive treatment. Even when perforation happens, it is easier to close the tunnel with the endoscopic clips which can help stopping the leak of air and digestive fluids. In this case, we found STER wss an effective and safe endoscopic procedure to remove tumors originating from the muscularis propria layer in the esophagus.
Adult ; Dissection ; methods ; Esophageal Neoplasms ; pathology ; surgery ; Esophagoscopy ; methods ; Esophagus ; pathology ; surgery ; Humans ; Leiomyoma ; pathology ; surgery ; Male