Objective To introduce the surgical outcome of a combined laparoscopy and minilaparotomy hysterectomy (LMH) approach for the management of very large fibroid uteri. Methods From May 2011 to December 2013, 10 women underwent a combined laparoscopy and laparotomy hysterectomy for very large fibroid uteri ( larger than 1000 grams) .Among them, 6 cases combined with salpingo-oophorectomy. The patient characteristics, surgical data and clinical outcome are presented retrospectively.Briefly, this combined laparoscopy and minilaparotomy approach is to use the laparoscopy to perform a prior assessment of the ovaries, tubes, adhesions, sizes and positions of fibroids.A minilaparotomy wound of less than 6 cm is performed.Under the laparoscopic lighting and vision, coagulation of ovarian or uterine vessels can be performed via the minilaparotomy wound.Similarly round ligaments, tubes or ovarian infundibulo-pelvic ligaments can also be coagulated and divided using conventional open surgical instruments and technique.For very large fibroid uteri, tissue reduction by myomectomy is often necessary prior to a standard open hysterectomy for small sized uterus or to perform a subtotal hysterectomy to separate the large fibroid uterus from the cervix, the large uterus can be removed via the minilaparotomy wound with morcellation techniques as described previously in the literature. Results All hysterectomies were successfully completed without any intraoperative or postoperative complication.The mean operation time is 2 hours.All patients recovered well after operation and had an early discharge from hospital (1.5 -3 d). Conclusions This combined laparoscopy and minilaparotomy approach for hysterectomy can replace open abdominal hysterectomy for very large fibroid uterus more than 1000 g.It is a safe and feasible alternative to laparoscopic hysterectomy as a minimally invasive surgery.

[Summary] This paper reports a postmenopausal woman with a rare florid cystic endosalpingosis presenting as an ovarian cyst, with many cystic lesions in the pelvis.She had chronic pelvic pain and ultrasound diagnosed of multiple cystic lesions in the pelvis. Not being aware of this rare condition of endosalpingiosis,she was laparoscopically managed successfully when the condition was diagnosed at the time of operation.There are only a few reports in the literature presenting florid cystic endosalpingiosis as ovarian or pelvic mass.This paper would not only highlight this uncommon presentation,it also raises issues for discussion relating to pre-operative diagnosis,laparoscopic appearance,pathological features and the current practice of routine salpingectomy in high risk patients in order to reduce high grade serous ovarian neoplasms.

OBJECTIVETo explore the epidemiology of meconium stained amniotic fluid pero-delivery.

METHODS6,206 one-fetal delivery cases were divided into meconium stained amniotic fluid and normal amniotic fluid groups. Statistics were analysed on two groups using Cohort study.

RESULTSIncidence of meconium stained amniotic fluid was 16.4%. There was no significant difference on maternal medical complication between two groups. The percentage of parity, gestational week > or = 42 weeks and big birth weight were higher in meconium stained amniotic fluid group than that in normal amniotic fluid group (P < 0.001). The average Apgar score in meconium stained amniotic fluid group was lower than that in normal amniotic fluid group (P = 0.001). The percentage of stillbirth, low birth weight and transferred newborn care unit in meconium stained amniotic fluid group were higher than that in normal amniotic fluid group (P < 0.001).

CONCLUSIONSThe relative factors on meconium stained amniotic fluid were maternal parity, gestational weeks > or = 42 weeks and big birth weight. No correlation between meconium stained amniotic fluid and maternal medical complication. Morbidity of newborn baby was higher in meconium stained amniotic fluid. Meconium stained amniotic fluid is a important clinical factor on evaluating pregnancy outcome.

Adult ; Amniotic Fluid ; Apgar Score ; China ; epidemiology ; Cohort Studies ; Female ; Fetal Distress ; epidemiology ; etiology ; Fetal Weight ; Gestational Age ; Humans ; Infant, Newborn ; Infant, Premature ; Meconium ; Meconium Aspiration Syndrome ; etiology ; Pregnancy ; Pregnancy Outcome

Adult ; Endometriosis ; diagnosis ; etiology ; therapy ; Female ; Humans ; Perineum

Aged ; Endoscopy ; methods ; Female ; Humans ; Laparoscopy ; Lymph Node Excision ; methods ; Video-Assisted Surgery ; methods ; Vulvar Neoplasms ; surgery

Objective　To evaluate the incidence of deep venous thrombosis (DVT) after gynaecological laparoscopy. Methods　The incidence of DVT was studied in 72 consecutive patients who underwent gynaecological laparoscopy in the Liverpool Health Service between May and September 1997. B-mode ultrasound supplemented by Doppler was used to examine venous patency and intraluminal echoes to diagnose DVT. Sixty-one patients who had pneumoperitoneum less than 60 minutes were classified a minor procedure and 11 who had pneumoperitoneum more than 60 minutes were classified as major procedure. Two Doppler ultrasound scans were planned for every patient. The first one was done within 24 hours and the second was performed on day 7 post-surgery. All 72 patients had the first scan and 40 out of 61 in the minor procedure group and 9 out of 11 in the major procedure had the second scan. Twenty-three patients who did not come for the second scan were followed up by phone. Results　No DVT was found in our study. Conclusion　This study confirms an impression that gynaecological laparoscopic procedure has a very low incidence of DVT. If it occurs, the diagnosis and treatment must be made as soon as possible so that the fatal complications such as pulmonary embolus can be avoided.

BACKGROUNDOccult stress urinary incontinence may lead to de novo stress urinary incontinence after pelvic floor repair surgery. A measurement of pudendal nerve terminal motor latency can reflect the integrity of the nerves. We aimed to explore the value of pudendal nerve terminal motor latency in the diagnosis of occult stress urinary incontinence in pelvic organ prolapse patients.

METHODSTen patients with stress urinary incontinence (SUI group), 10 with SUI and uterine or vaginal prolapse (POP + SUI group) and 10 with uncomplicated uterine or vaginal prolapse (POP group) were evaluated for their pudendal nerve terminal motor latency using a keypoint electromyogram.

RESULTSThe amplitude of positive waves was between 0.1 and 0.2 mV. The nerve terminal motor latency was between 1.44 and 2.38 ms. There was no significant difference in the wave amplitudes of pudendal nerve evoked action potential among the three different groups (P > 0.05). The pudendal nerve latency of the SUI group, POP + SUI group and POP group were (2.9 ± 0.7) seconds, (2.8 ± 0.7) seconds and (1.9 ± 0.5) seconds respectively. The difference between the SUI group and POP + SUI group was not statistically significant (P > 0.05), whereas the difference between the SUI and POP groups and between the POP + SUI and POP groups were statistically significant (P < 0.05). There was a positive correlation between pudendal nerve latency and the severity of SUI; the correlation coefficient was 0.720 (P < 0.01).

CONCLUSIONSPatients with SUI may have some nerve demyelination injuries in the pudendal nerve but the damage might not involve the nerve axons. The measurement of pudendal nerve latency may be useful for the diagnosis of SUI in POP patients.

Evoked Potentials ; physiology ; Female ; Humans ; Middle Aged ; Pelvic Organ Prolapse ; physiopathology ; Pudendal Nerve ; physiopathology ; Urinary Incontinence, Stress ; diagnosis ; physiopathology ; Uterine Prolapse ; physiopathology

Less invasive transcatheter tricuspid therapies are optimal alternative for surgery in high-risk individuals with severe symptomatic tricuspid regurgitation on medical therapy. Various techniques are available with Transcatheter Edge-to-Edge Repair (TEER) having the greatest experience worldwide. When the coaptation gap becomes too large for TEER, caval valve implantation (CAVI) emerge as a better option. We described a series of 4 patients who underwent CAVI with the TricValve system and periprocedural computed tomography angiography imaging for the purpose of TricValve sizing. There were few procedural complications, with significant improvements in New York Heart Association functional class and right ventricular function post-procedure.