Laparoscopic Findings Research Articles

Laparoscopy for diagnosing resectability of disease in women with advanced ovarian cancer.

This is an update of a Cochrane Review that was originally published in 2014, Issue 2.The presence of residual disease after primary debulking surgery is a highly significant prognostic factor in women with advanced ovarian cancer. In up to 60% of women, residual tumour of > 1 cm is left behind after primary debulking surgery (defined as suboptimal debulking). These women might have benefited from neoadjuvant chemotherapy (NACT) prior to interval debulking surgery instead of primary debulking surgery followed by chemotherapy. It is therefore important to select accurately those women who would best be treated with primary debulking surgery followed by chemotherapy from those who would benefit from NACT prior to surgery. To determine if performing a laparoscopy, in addition to conventional diagnostic work-up, in women suspected of advanced ovarian cancer is accurate in predicting the resectability of disease. We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 6) in the Cochrane Library; MEDLINE via Ovid, Embase via Ovid, MEDION and Science Citation Index and Conference Proceedings Citation Index (ISI Web of Science) to July 2018. We also checked references of identified primary studies and review articles. We included studies that evaluated the diagnostic accuracy of laparoscopy to determine the resectability of disease in women who are suspected of advanced ovarian cancer and planned to receive primary debulking surgery. Pairs of review authors independently assessed the quality of included studies using QUADAS-2 and extracted data on study and participant characteristics, index test, target condition and reference standard. We extracted data for two-by-two tables and summarised these graphically. We calculated sensitivity and specificity and negative predictive values. We included 18 studies, reporting on 14 cohorts of women (including 1563 participants), of which one was a randomised controlled trial (RCT). Laparoscopic assessment suggested that disease was suitable for optimal debulking surgery (no macroscopic residual disease or residual disease < 1 cm (negative predictive values)) in 54% to 96% of women who had macroscopic complete debulking surgery (no visible disease at end of laparotomy) and in 69% to 100% of women who had optimal debulking surgery (residual tumour < 1 cm at end of laparotomy).Only two studies avoided partial verification bias by operating on all women independent of laparoscopic findings, and provided data to calculate sensitivity and specificity. These two studies had no false positive laparoscopies (i.e. no women had a laparoscopy indicating unresectable disease and then went on to have optimal debulking surgery (no disease > 1 cm remaining)).Due to the large heterogeneity pooling of the data was not possible for meta-analysis. Laparoscopy may be a useful tool to identify those women who have unresectable disease, as no women were inappropriately unexplored. However, some women had suboptimal primary debulking surgery, despite laparoscopy predicting optimal debulking and data are at high risk of verification bias as only two studies performed the reference standard (debulking laparotomy) in test (laparoscopy)-positive women. Using a prediction model does not increase the sensitivity and will result in more unnecessarily explored women, due to a lower specificity.

Pelvic Endometriosis: Correlation of US and MRI With Laparoscopic Findings

Pelvic Endometriosis: Correlation of US and MRI With Laparoscopic Findings

Laparoscopic partial-ALPPS, stage 1. Initial experience

Background: Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS), continues to evolve into different variations and provoking debate about indications, associated morbidity and oncologic outcomes. Throughout this progression, the benefits of a laparoscopic approach and a partial parenchymal transection on the initial stage are becoming more evident (as opposed to a complete transection) in achieving the desired hypertrophy of the future liver remnant (FLR), while decreasing the overall severity of associated complications and simplifying their management between stages . We present our initial experience with Laparoscopic Partial-ALPPS, focused on the stage 1. Methods: 4 cases reviewed at multidisciplinary HPB tumor board, decided to proceed with extended right hepatectomy via ALPPS. Laparoscopic Partial ALPPS was performed during stage 1. Technical steps: 1-Cholecystectomy; 2-Traction cystic-duct stump exposing Right Hepatic Artery (RHA) and Main Portal Vein (MPV) extending into Right Portal Vein (RPV); 3-Circumferential dissection RHA and RPV; 4-Ligation RPV (tie and/or clips); 5- Partial parenchymal transection 50% preserving Middle Hepatic Vein (MHV) outflow. Postoperative imaging confirmed desired hypertrophy of the remnant liver volume within 9-11 days and the stage 2 ALPPS was carried out 14–16 days after stage 1. Three out of the four stage 2 cases were initiated with laparoscopy and intentionally converted to open extended right hepatectomy following a planned learning curve. Results: Case 1: 74F HCV s/p Harvoni, 6 cm HCC in segment 8, abutting the right hepatic and middle hepatic veins. Advanced liver fibrosis. Total liver volume 950 ml, volume of FLR 253 ml. Stage 1-Lap Partial ALPPS. Discharged POD#4. Repeat imaging POD#11, hypertrophied FLR 501ml. Stage 2-POD#16 Lap converted-to-open right extended hepatectomy. Discharged POD#6. Case 2: 58F PMHx of colon cancer, synchronous metastasis to the liver. FOLFOX+ Avastin. Total liver volume 910 ml. Right lobe 622 ml, 2 lesions occupy 58 ml. Left lobe 288 ml, 1 lesion occupies 23ml. Stage 1-Lap wedge LLS lesion+Lap Partial ALPPS. POD#2 Re-laparoscopy, bleeding-control hemostasis. Stage 2: preop imaging hypertrophied FLR 369 ml. POD#15- Open right hepatectomy + extended right colectomy. Discharged on POD#6. Case 3: 66M HCV s/p Harvoni, 3.5 cm HCC segment 8, abutting right hepatic vein, close to middle hepatic vein. Advanced liver fibrosis. Volume FLR 557 ml. Stage 1-Lap Partial ALPPS. Discharged POD#4. Repeated imaging POD#11, hypertrophied FLR 720 ml. Stage 2- POD#15, Lap converted-to-open right extended hepatectomy. Discharged POD#5. Case 4: 67M HCV s/p Harvoni) with 5 cm HCC segment 7, abutting right hepatic vein, close to middle hepatic vein. Advanced liver fibrosis. Volume FLR 583 ml. TACE followed 3 weeks later by Stage 1-Lap Partial ALPPS. Discharged POD#4. Repeated imaging POD#9. Hypertrophied FLR 976 ml. Stage 2-POD#14 Lap converted-to-open right extended hepatectomy. Complicated postop course, bleeding and infection. Reoperation/washout. Discharged POD#23. Conclusion: Each case is presented with a short video clip highlighting the technical steps of the Laparoscopic Partial-ALPPS during Stage 1, which were overall carried out without intraoperative difficulties and with satisfactory recovery and prompt discharge in all cases, while achieving the FLR hypertrophy within the expected timeframe. An additional video clip presents the laparoscopic findings during stage 2 prior to converting to open procedure, illustrating the amount of inflammation that challenged the laparoscopic completion of Stage 2 during this initial experience.

Clinicophysiological, haematobiochemical and electrocardiographic effects of homogenous and heterogenous blood transfusion in traumatized dogs

Twenty four clinical cases of dogs having the history of the accidents irrespective of their age and sex were included in this study. The definite diagnosis was made on the basis of haematobiochemical, radiographic, ultrasonographic and laparoscopic findings. The animals were divided randomly into 3 groups, viz. A, B and C comprising equal number of animals. After the definite diagnosis, patients were subjected to surgical intervention i.e. splenectomy. The animals of groups A, B, and C were subjected to the administration of anaesthetic combination of atropine sulphate, diazepam and thiopental sodium just to pass endotracheal tube followed by either isoflurane (2–2.5%) or sevoflurane (3–3.5%) and also subjected to whole blood transfusion of cattle, buffalo and dogs in groups A, B &amp; C respectively either during the operation or just after the operation.The efficacy of blood transfusion was judged on the basis of effects on various clinicophysiological and haematobiochemical parameters recorded before and after the administration of blood. Electrocardiographic studies were also made. It was concluded that in case of the trauma of spleen, homogenous transfusion of the blood in traumatized patient is most beneficial however in case of the emergency condition, heterogenous blood transfusion from cattle and buffaloes may also be made to save the life of the patients.

Role of laparoscopy in the diagnosis of chronic pelvic pain

Introduction: Chronic pelvic pain (CPP) is noncyclic pain of 6 or more months' duration that localizes to the anatomical pelvis, anterior abdominal at or below the umbilicus, and the lumbosacral and is of sufficient severity to cause functional disability. Lower abdominal pain can be caused by chronic pelvic inflammatory disease, pelvic adhesions, certain ovarian cysts, pelvic vascular congestion, uterine fibroids, and adenomyosis, but pain arising from organs outside the pelvis may also radiate to the lower abdomen. Only 20%–25% of patients respond to conservative management. When such treatment fails, a diagnostic laparoscopy is usually performed. Aim: We aim to study the role of laparoscopy in the diagnosis of CPP. Objective: The objective was (1) to evaluate the causes of CPP by diagnostic laparoscopy and (2) to compare the clinical finding and ultrasound findings with laparoscopic findings. Materials and Methods: The present study includes fifty patients presented with lower abdominal pain of at least 6-month duration. A detailed history was taken about the pattern of the pain and its association with other problems. Gynecological examination included inspection of the vulva and perineum, speculum examination of the cervix and vagina, bimanual examination to assess the shape, size, direction, mobility of the uterus and adnexa, mass and tenderness of the urethra, vaginal fornix and cervical motion tenderness. The patients were further evaluated by ultrasound examination (transvaginal and abdominal) and diagnostic laparoscopy. Results: Most of the women were of the mean age group of 29.30 years. The pain was most commonly associated with dysmenorrhea in 76% of the patients. Nine patients out of 26 who showed normal findings on bimanual examination revealed abnormal findings on laparoscopy. Five patients out of 22 who showed normal findings on ultrasonography showed abnormal findings on laparoscopy. Conclusion: Laparoscopy is a gold standard tool in the evaluation of women with CPP because diagnosis and treatment can be done in the same sitting.

Laparoscopy and the Era of ART in Unexplained Primary Infertility: Randomized Clinical Trial

OBJECTIVES: To compare the outcomes (effectiveness and safety) of laparoscopic surgery as a treatment option of unexplained primary infertil-ity with ART. DESIGN: Randomized prospective clinical trial. PATIENTS AND METHODS: 536 patients with primary unexplained infertility diag-nosed by normal hormonal profile and ovulatory at ovulation testing, nor-mal HSG, and normal semen analysis were randomized according to com-puter based system into: group I, 267 patients were managed with laparos-copy with aim of diagnosis and treatment. While in group II, 269 patients were treated by controlled ovarian stimulation and IUI up to 3 trials, if failed ICSI was performed. We calculated cumulative pregnancy outcome after two years for each group. RESULTS: In group I, Laparoscopic find-ings were as follow: minimal to mild endometriosis was found in 83 cases (31.1%), moderate to severe endometriosis 44 cases (16.5%) managed by adhesiolysis and ablation-excision of endometriotic implants. The preg-nancy rate after two years was 55.4% (46 cases), 38.6% (17 cases) in both respectively, significant periadnexal and pelvic adhesions 41 cases (15.3%) managed by adhesiolysis with pregnancy occurred in 22 cases (53.7%), while laparoscopy revealed hypo plastic tubes 33 cases (12.4%), and 66 cases (24.6%) remained unexplained. With the expectant manage-ment, pregnancy rate was 21.2% (7 cases), and 15.2% (10 cases) respec-tively. The overall pregnancy rate in group I is 102 cases (38.2%). In group II, 114 cases (42.3) got pregnant as 27 cases (8.78%) by IUI, and 87 cases (33.52%) by ICSI. OHSS occurred in 3 cases, multiple pregnancy occurred in 13 cases, abortion and miscarriage 6 cases in group II, while 2 cases of ectopic pregnancy in group I, and the patients of both groups did not suffer any significant operative complications. CONCLUSION: Laparoscopy is safe and effective as a treatment option in unexplained infertility and its performance provides diagnostic findings which are valuable in manage-ment of the unidentified causes, enabling good number of patients to have pregnancy spontaneously which is comparable to ART while avoiding economic, psychological and physical burdens of ART, like OHSS, multi-ple pregnancy and abortion which are higher in cases treated with ART. In the future if ART is needed, the success rate is increased by closure of (undiagnosed) hydrosalpinx and reposition of the ovary to facilitate oocyte retrieval.

Cost analysis of the use of deep endometriosis transvaginal ultrasound in the workup of patients with symptoms of endometriosis

Background Despite demonstrated evidence that ultrasound is accurate in the detection of ovarian endometriomas and deep endometriosis, realization of ultrasound's full potential remains variable, resulting in generally poor adoption of the tool in clinical practice. The traditional pathway of a planned two-step approach (diagnostic laparoscopy possibly followed by operative laparoscopy, based on initial results) remains a reality. Besides the clinical implications to patients who suffer greatly from their symptoms, the economic impact on the healthcare system is significant. Methods We aim to compare the economic costs of two models of care in the workup and management of patients with potential endometriosis, both of which hypothetically take place in a tertiary care clinic with high disease prevalence in New South Wales, Australia. The conventional model (M1) includes patients having a basic pelvic ultrasound, which exclusively assesses the uterus and ovaries, whereas the novel model (M2) includes patients undergoing a deep endometriosis ultrasound, which evaluates the uterus, ovaries, anterior and posterior compartment (bladder, ureters, bowel, uterosacral ligaments, torus uterinus, rectovaginal septum, vagina, pouch of Douglas (POD)), soft markers (ovarian mobility, site-specific tenderness), and POD obliteration state using the sliding sign technique. A state-based Markov model with a 12-month time horizon was built to estimate the change to government, health service and patient costs with the adoption of the novel deep endometriosis ultrasound. Cost data were sourced from the Australian government's Medicare Benefits Schedule and the Independent Hospital Pricing Authority. Transition probabilities were sourced from the best available evidence from the literature and clinical consensus. The models utilized a population of 1000 patients visiting a public gynaecology clinic for signs and symptoms of endometriosis. Estimates for endometriosis prevalence and severity were drawn from local data, which was based on laparoscopic and/or histological findings and has been previously published: normal pelvis, 16%; isolated superficial endometriosis, 35%; endometriomas, 16%; deep endometriosis and/or pouch of Douglas obliteration, 33%. Results The total annual costs of the two models are (M1) $13,472,161.67AUD and (M2) $12,547,724.03AUD. Conclusions For a population of 1000 women with signs and symptoms of endometriosis visiting a tertiary care clinic, the integration of the novel deep endometriosis ultrasound may save healthcare costs of $924,437AUD annually. The combined healthcare savings and the clinical value of reducing the incidence of invasive diagnostic laparoscopy by integrating deep endometriosis ultrasound should encourage governing bodies and others responsible for healthcare expenditures to improve practices.

Impact of Laparoscopy to Assess Resectability in Stage IIIC Epithelial Ovarian, Tubal and Peritoneal Cancer Patients

Aims: To evaluate overall survival (OS) and progression-free survival (PFS) in patients with stage IIIC epithelial ovarian, tubal and peritoneal cancer (EOC) who underwent a laparoscopy to assess surgical resectability prior to Primary Debulking Surgery (PDS) or Interval Debulking Surgery (IDS). Methods: Retrospective cohort study that included all women with stage IIIC EOC treated at our center between 2000 and 2010. Patients were classified in groups: PDS, neoadjuvant chemotherapy (NACT) with IDS, NACT without IDS; and then sub-classified based on residual tumor (RT). A laparoscopy to assess resectability was performed before PDS and IDS. Results: Among 111 patients included, 66 underwent PDS, and 45 were treated with NACT, 80% of them receiving subsequent IDS. OS was 75.6 months in the PDS group, and 52.8 months for IDS group (p = 0.100); the PFS was 30 months and 19.2 months respectively (p = 0.049). Median OS was 104.4 and 52.8 months for patients with optimal cytoreduction (RT = 0) in the PDS and IDS group respectively (p < 0.05). Laparoscopy did not modify the preoperative consideration for PDS; however, 9 laparotomies were avoided based on laparoscopic findings after NACT. Conclusion: Laparoscopy for the assessment of surgical resectability in stage IIIC EOC has no impact on survival; but it still could be useful for the reduction of unnecessary laparotomies after NACT.

Multicentre retrospective study to assess diagnostic accuracy of ultrasound for superficial endometriosis-Are we any closer?

To establish whether the ultrasound findings of minimal endometriosis are confirmed at laparoscopy and that a correlation can be established as to the anatomical sites in this mild form of the disease. Patients with pain and suspicion of endometriosis had an ultrasound scan by a sonologist with expertise in endometriosis as part of their pre-operative workup. The clinical histories of 53 patients who had laparoscopy to investigate pelvic pain were reviewed. Ultrasounds were performed between 2012 and 2015 by a single sonologist with expertise in endometriosis assessments. The ultrasound findings were divided into subgroups as follows - presence of uterosacral ligament thickness, thickened pericolic fat, ovarian mobility and focal tenderness. These were compared with operative findings of those patients with superficial endometriosis. Evidence Level 3 - observational studies with controls and health services research that includes adjustment for likely confounding factors. Seventy-nine percent (42/53) of the patients had laparoscopic findings consistent with their ultrasound findings (95% CI 68-90%, P<0.0001). Of the subgroups that we reviewed, uterosacral thickening (P<0.05) and thickened pericolic fat (P<0.05) were the most associated with superficial endometriosis at the time of laparoscopy. Markers on ultrasound that reliably demonstrated inflammation (thickened uterosacral ligaments and thickened pericolic fat) were shown to be significantly associated with the disease.

Rehabilitation therapy as a component of the complex approach to the treatment of chronic forms the pelvic inflammatory disease in women

Issues of treatment and rehabilitation patients with pelvic's inflammatory diseases are still remain highly relevant, so relapses and chronic inflammation processes are worsen the prognosis for generative function in women, which is an important social and economic problem in modern time. Purpose of the study. Monitoring the effectiveness of therapeutic measures of rehabilitation step in chronic forms of this disease. Materials and methods. We examined 110 patients who handled to the clinic for women with complaints about the absence of pregnancy, of which a survey group was formed. The duration of pelvic inflammatory desiase (PID) in patients of the examination group did not exceed 2 years. The age of the patients was 25-35 years old. In patients of the examination group, according to clinical, laboratory and ultrasound ultrasound, laparoscopy, hysteroscopy and morphological findings, PID was verified including the presence of chronic endometritis and other endometrial pathology (for example, endometrial polyp, simple endometrial hyperplasia). Results. The rehabilitation stage of treatment (6 months) in patients with PID was aimed at restoring the morphofunctional potential of the tissue and eliminating the effects of secondary injuries, which include the restoration of hemodynamics and activity of the endometrial receptors. This stage of treatment is extremely important, especially for reproductive disorders. At this stage, the patients of the examination group were given hormone therapy and treatment with vasoactive drug (dipyridamole). The obtained results testified to the significance of the restoration of the vascular blood flow of the uterus and the functional layer of the endometrium. Conclusion. Rehabilitation therapy in patients with PID was primarily aimed at restoring the functional ability of the endometrium. Hormone therapy was a priority role, but at modern time, role of the vasoactive drugs that affect the blood flow in the uterus is emphasized. One of these drugs is dipyridamole, which contributes to the formation of collaterals (bypass paths) in ischemic zones. The results indicate that at the end of the 6-month rehabilitation phase, than of a three-layer endometrium was diagnosed (according to ultrasound on day 8-10 of the cycle) in 85 (77.27±4.00%) patients in the examination group.

Evaluating the Positive Predictive Value of Alkaline Phosphatase in Diagnostic Peritoneal Lavage (DPL) for the Need of Further Surgery in Patients with Torso Traumas

Background: Diagnostic Peritoneal Lavage (DPL) is a routine method for evaluating internal organ damage in patients with blunt or penetrating torso trauma. Internal organ damage can lead to elevated alkaline phosphatase (ALP) levels in the DPL fluid. In this study, the researchers aimed to assess the prognostic value of elevated alkaline phosphatase levels and the need for laparotomy. Methods: In this study, the researchers evaluated 42 patients with torso trauma (18 penetrating and 24 blunt traumas). The ALP was positive for all the patients in DPL (2 IU/mL <). The hemodynamic status was stable, and there were no other positive findings in their DPL. All the patients underwent diagnostic laparoscopy to evaluate the Positive Predictive Value (PPV) of ALP in DPL. Results: There were only three patients with significant laparoscopic findings, none of which required laparotomy. The PPV of ALP in DPL fluid for the diagnosis of internal organ damage was 7.1%. Conclusions: Elevated DPL alkaline phosphatase levels have no predictive value to warrant for further laparotomy in hemodynamically stable patients, who had torso trauma, which had no other positive finding in their DPL.

Which Therapeutic Option Is Optimal for Surgery-Related Perineal Hernia After Abdominoperineal Excision in Patients with Advanced Rectal Cancer? A Report of 3 Thought-Provoking Cases

Case seriesPatient: Male, 72 • Male, 71 • Male, 76Final Diagnosis: Postoperative perineal herniaSymptoms: Perineal discomfortMedication: —Clinical Procedure: Hernia repairSpecialty: SurgeryObjective:Rare diseaseBackground:Although perineal hernia (PH) is considered a surgery-related complication after abdominoperineal excision, the optimal therapeutic option for PH remains controversial.Case Reports:The first case involved a 72-year-old man in whom PH was diagnosed 6 months after surgery. Laparoscopic findings revealed moderate adhesion at the pelvic floor, and a perineal approach was added. The pelvic floor defect was repaired by composite mesh. Combined laparoscopic surgery with a perineal approach was effective. The second case involved a 71-year-old man in whom PH was diagnosed 7 months after surgery. Laparoscopic findings revealed severe adhesion of the pelvis, and a perineal approach was added. The pelvic floor defect was repaired by composite mesh. The seromuscular layers of the small intestine were injured, and the damaged small intestine was resected and anastomosed. Composite mesh did not cause postoperative infection even with simultaneous bowel resection. The third case involved a 76-year-old man in whom PH was observed 12 years after surgery. Combined laparoscopic surgery with a perineal approach was performed from the beginning of surgery. Laparoscopic findings clearly demonstrated an intractable adhesion. Unexpected injury of the small intestine caused intra-abdominal contamination; therefore, the pelvic floor defect was primarily closed by absorbable sutures. Combined laparoscopic surgery with a perineal approach was effective even in this patient with a huge PH and intractable adhesion.Conclusions:The combination of laparoscopic surgery with a perineal approach is an adequate option for PH treatment, and the perineal approach should be added without hesitation if needed.

The diagnostic performance and interrater agreement of seven CT findings in the diagnosis of internal hernia after gastric bypass operation

A reliable and immediate diagnosis of internal hernia is important for optimal and timely management of patients with a history of gastric bypass surgery. The aims of this study were to evaluate the interrater agreement and diagnostic performance characteristics of seven predefined CT findings of internal herniation in patients admitted on clinical suspicion of internal herniation after laparoscopic Roux-en-Y gastric bypass (LRYGB). Abdominal CT scans of 117 patients performed on clinical suspicion of internal hernia after LRYGB surgery were evaluated by three radiologists (two experts and one resident) for the following: (1) Swirl sign, (2) strangulation of superior mesenteric vein (SMV), (3) engorged mesenteric vessels and edema, (4) engorged lymph nodes, (5) ascites, (6) mushroom sign, (7) hurricane eye sign, and finally the overall conclusion. The CT findings were compared to the laparoscopic explorative findings. The highest interrater agreements were seen for the swirl sign, SMV strangulation, ascites, and overall conclusion (all Kappa 0.82-0.83). The presence of internal hernia was significantly and independently associated with SMV strangulation (OR 18.3; 95% CI 4.3-78.1; p < 0.001) and mesenteric edema (OR 5.2; 95% CI 1.4-19.6; p < 0.001) on multivariate analysis, while the other CT findings were not independently associated with herniation. The highest sensitivity was observed for mesenteric edema (85.0%), while SMV strangulation had the highest specificity (94.8%). CT is an accurate diagnostic tool for detection of internal hernia after LRYGB. SMV strangulation and mesenteric edema are highly predictive and easily identified features of internal herniation.

Pelvic MRI staging of endometriosis at 3 T without patient preparation or anti-peristaltic: Diagnostic performance outcomes

PurposeEndometriosis is a disease of significant burden among pre-menopausal women characterised by the appearance of functional endometrial tissue in locations outside the uterus. Deep infiltrating endometriosis (DIE) is an invasion of the endometriotic lesion that exceeds 5 mm in depth into the peritoneum. In most cases, pelvic MRI is the imaging modality of choice for the pre-operative workup for DIE to guide surgery. The recommended standard for pelvic MRI images is at 1.5 T with patient preparations in the form of laxatives, anti-spasmodics and/or rectal contrast. However, there appears to be equally diagnostic quality imaging obtainable with a 3 T system using fast imaging acquisition without any patient preparation. This reduces imaging time, movement artefacts, is more comfortable for the patient and is easier for workflow coordination. This study aims to confirm that this approach reaches diagnostic performance outcomes comparable to reported international standards, particularly in the detection of endometriotic bowel lesions, in order to guide surgical pre-operative planning. Methods and MaterialsPre-operative diagnostic radiology reports were identified by a search of the Radiology Information System (RIS) for all pelvic MRI studies performed at a tertiary referral centre, King Edward Memorial Hospital for Women, between January 2015 to April 2017 that contained the keyword “endometriosis”. Reported sites of endometriotic deposits at MRI findings were tallied based on anatomical location and correlated to laparoscopic surgical report findings and/or pathology report as a reference standard. Pooled sensitivities and specificities were then calculated and compared with established studies. ResultsNinety-eight MRI studies were identified, of which 76 identified DIE and 22 were normal studies. Sixty-one patients did not have a surgical or pathology record. Of the remainder who underwent laparoscopy, operative and/or pathology reports were obtainable in 37 female patients, with a median age of 35 years (range: 24 to 49 years). The average time interval from MRI report to surgical operation was 195 days (range: 5 to 563 days). Middle compartment estimated sensitivity was 79.4% (95% CI = (69.4%, 89.4%)), specificity 95.1% (95% CI = (91.2%, 98.9%)). Posterior compartment estimated sensitivity was 76.5% (95% CI = (66.4%, 86.6%)), specificity 99.4% (95% CI = (98.1%, 100%)). Overall sensitivity 76.9% (95% CI = (69.7%, 84.0%)), specificity 98.5% (95% CI = (97.3%, 99.6%)). Sensitivity and specificity of detecting bowel endometriosis were estimated to be 94.4% (95% CI = (83.9%, 100%) and 94.7% (84.7%, 100%)) respectively. ConclusionUsing a 3 T MRI system without patient preparation is feasible and achieves benchmark diagnostic performance outcomes in the pre-operative assessment for DIE, especially in detecting posterior compartment lesions and bowel DIE to correctly guide surgical planning.

Laparoscopic Diagnosis of Peritoneal Tuberculosis

Peritoneal tuberculosis is a form of abdominal tuberculosis that involves the parietal and visceral peritoneum, the omentum, and the intestinal mesentery. The 3 types of peritoneal tuberculosis are (1) the wet type, which is noted in 90% of cases and is usually associated with ascites; (2) the dry type, which is associated with adhesions; and (3) the fixed fibrotic type, which is associated with omental thickening, loculated ascites, and matted bowel loops [1Bhargava D.K. Shriniwas N.V. Chopra P. et al.Peritoneal tuberculosis: laparoscopic pattern and its diagnostic accuracy.Am J Gastroenterol. 1992; 87: 109-112PubMed Google Scholar]. Peritoneal involvement is caused by hematogenous spread, lymphatic spread, or direct spread from tuberculous salpingitis [2Abid H. Charif I. Mellouki I. et al.Role of laparoscopy in diagnosis of peritoneal tuberculosis (about 414 cases).Open J Gastroenterol. 2013; 3: 205-207Crossref Google Scholar]. There is often a delay in diagnosis because of vague and nonspecific symptoms. The differential diagnosis for peritoneal tuberculosis is disseminated carcinomatosis, primary peritoneal serous carcinoma, and peritoneal seeding by ovarian/fallopian tubal papillary serous carcinomas. Diagnostic laparoscopy with tissue biopsy is the gold standard for the diagnosis of peritoneal tuberculosis [1Bhargava D.K. Shriniwas N.V. Chopra P. et al.Peritoneal tuberculosis: laparoscopic pattern and its diagnostic accuracy.Am J Gastroenterol. 1992; 87: 109-112PubMed Google Scholar, 2Abid H. Charif I. Mellouki I. et al.Role of laparoscopy in diagnosis of peritoneal tuberculosis (about 414 cases).Open J Gastroenterol. 2013; 3: 205-207Crossref Google Scholar]. Typical laparoscopic findings of peritoneal tuberculosis are (1) multiple yellow-white tubercles scattered all over the visceral and parietal peritoneum, (2) omental thickening with ascites, (3) fibrous bands extending from the parietal peritoneum to the visceral peritoneum, and (4) an abdominal cocoon with a matted small bowel Fig. 1, Fig. 2, Fig. 3, Fig. 4.Fig. 2Omental thickening with straw-colored ascites.View Large Image Figure ViewerDownload Hi-res image Download (PPT)Fig. 3Fibrous bands from the parietal to visceral peritoneum.View Large Image Figure ViewerDownload Hi-res image Download (PPT)Fig. 4An abdominal cocoon with a matted small bowel.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Risk factors for recurrence of external genital endometriosis after surgical treatment: prospective cohortant study

Objectives of the study: improve early non-invasive diagnosis of external genital endometriosis (EGE) using the mass spectrometry method, and determine the risk factors for recurrence of EGE after surgical treatment. Material and methods: a prospective cohort study included 100 patients with EGE who underwent surgical treatment during the 2014 to 2016 period. The EGE diagnosis was made on the basis of diagnostic and therapeutic laparoscopic findings and finally confirmed at histological exam. All patients underwent blood sampling before and after surgical treatment to detect recurrence of endometriosis using direct mass spectrometry method. Results: recurrences of EGE were diagnosed in 22% of patients at 18–36 months postoperatively. High incidence of recurrent EGE was reported in the group of patients who did not receive post-surgical hormonal therapy. The hormone therapy with dienogest 2 mg for 6-9 months, as well as with goserelin 3.6 mg for 3-6 months showed the greatest efficacy for the prevention of recurrent EGE. Significant predictive factors of recurrence after surgical treatment for EGE include intensive acyclic pelvic pain; presence of surgical interventions for the history of EGE; infertility; stimulation of ovulation with hormonal drugs as part of the Assisted Reproductive Technologies Program; degree 3-4 disease spread; pronounced adhesions of the small pelvis; infiltrative forms of endometriosis; endometrioid cysts of large size; bilateral ovarian lesions. The plasma lipid profile including determination of phosphatidylcholines, phosphoethanolamines, diglyceride and sphingomyelin in the patients with endometriosis provides an approach for noninvasive early diagnosis of recurrence of this disease by mass spectrometry (sensitivity 93%, specificity 95%). Conclusion: This study developed an individual comprehensive approach to the prevention of recurrent EGE, including surgical treatment, hormonal therapy and diagnosis of the disease at an early stage of development. Timely administration of a-GnRH or dienogest 2 mg at the post-surgery stage is associated with a minimal or total absence of recurrent EGE. The administration of COCs showed no efficacy in preventing the recurrence of EGE, and therefore COCs cannot be recommended as a prophylactic drug, but exclusively for contraceptive use.

Hepatogonadal fusion in cryptorchidism

Abstract Persistence of fetal mesonephric sheath with abnormal attachment of the upper pole of the testis to the inferior border of the liver has been observed during laparoscopy for assessment of an infant with right impalpable testis. Details of the laparoscopic findings are reported and discussed in this article.

Imaging and Laparoscopic Findings in a Patient with Congenital Uterine Arteriovenous Malformation

A 49-year-old woman, gravida 5, para 1, with a diagnosis of congenital uterine arteriovenous malformation (AVM), presented to our hospital for a further hysterectomy. The patient underwent uterine artery embolization (UAE) to treat profuse vaginal bleeding on October 9, 2017. During the process of UAE, a tortuous and dilated uterine artery with focal aneurysm were seen. And there were also aboudant arteriovenous shunting (Fig. 1). At 1 week after UAE, magnetic resonance imaging (MRI) revealed an enlarged uterus and thickened myometrium (Fig. 2A), with malformed vessels involving almost the entire myometrium (Fig. 2B and C) and some ectatic feeding vessels around the uterus (Fig. 2D).

Diagnostic Hysterolaparoscopy for Evaluation of Infertility: Our Experience in a Tertiary Care Hospital.

Objective:The objective of this study is to analyze the role of diagnostic hysterolaparoscopy (DHL) for evaluation of infertility in a tertiary care hospital.Materials and Methods:This retrospective study was conducted from July 2014 to June 2016.Results:Out of 151 patients, 58.28% and 41.72% had primary and secondary infertility, respectively. In primary infertility group 37.5% and in secondary infertility group 49.2% had abnormal findings. Most common finding was adnexal adhesions (pelvic inflammatory disease) and laparoscopic findings were more common than the hysteroscopic ones.Conclusion:DHL was helpful in finding some reversible causes of infertility such as adnexal adhesions, tubal blockade, and uterine synechiae, etc.

Management of gallbladder carcinoma

Last few decades have seen changes in the approach toward the management of gallbladder cancer (GBCA). Availability of high-definition imaging modalities and accurate interpretations of their findings have helped in early and accurate diagnosis. A structured approach toward the disease with the aid of clinical, noninterventional/interventional radiology and laparoscopic findings has helped surgeons to choose between an aggressive approach of radical cholecystectomy for those with a resectable growth and suitable palliation for those who are unlikely to benefit from therapeutic laparotomy, thereby helping in proper and judicious utilization of health-care resources. Better understanding of the tumor biology is encouraging oncologists for trials with different targeted therapies in advanced disease. This review addresses some of the key issues related to the management of GBCA based on extensive search of available literatures and current international guidelines.