Laparoscopic Retrieval Research Articles

Laparoscopic Retrieval of Migrated IUD for a Patient with Stage Ib2 Cervical Cancer: Case Report

To report a successfully laparoscopic retrieval of a translocated IUD for a patient with cervical cancer. Case report. University hospital Patient with cervical cancer. A 54-year-old woman (gravida 6, para 6) was referred to our department in January 2011 because of post-menopausal vaginal bleeding and abdominal pain. Pelvic examination revealed a large cervical lesion over 5 cm in greatest diameter, and biopsy analysis confirmed the moderately to poorly differentiated squamous cell cervical carcinoma. She was referred to radiation therapy as her diagnosis was FIGO stage Ib2 and she preferred radiation therapy. Pelvic magnetic resonance imaging failed because she was found to have metals in her body. A plain abdominal X-ray revealed an IUD in her pelvis. Furthermore, the IUD was found to be translocated. The migrated IUD was confirmed during CT scan which was found to be located between the tumor and rectum. An ultrasound showed an empty uterine cavity. She started her external beam radiation in January 2011. Two weeks from her initial radiation, the radiologist referred her to our clinic for the removal of IUD. Informed consent was signed. She was placed in the dorsal lithotomy position, general anesthesia was used. During laparoscopic examination, the uterus appeared normal. The IUD was located near the lower uterine segment. Half of the IUD was easily visualized, half of it submerged under the peritoneal layer, embedded in the uterine wall. The IUD was grasped; the loop was cut into two strings, and removed separately. Hemostasis was achieved by careful cautery of the peritoneal edges. The patient was discharged on postoperative day four uneventfully, and continued her radiotherapy. Translocated IUD retrieval prior to radiotherapy for patient with cervical cancer should be considered. Laparoscopy is a useful tool for the management of translocated IUD.

Successful Intraoperative Retrieval of Dislocated Femoral Trial Head During Total Hip Arthroplasty

Since the advent of modular hip prostheses in the early 1970s, dissociation of the femoral trial head and migration into the deep tissue space of the pelvis are rarely reported complications of total hip arthroplasty. Several case reports have described this complication, but the actual incidence is unknown and likely underreported. Two cases are presented here using a new technique to retrieve a trial femoral head from within the pelvis without use of an extensile approach, laparoscopic retrieval, or secondary incisions.

SPECT/CT and a Portable γ-Camera for Image-Guided Laparoscopic Sentinel Node Biopsy in Testicular Cancer

The purpose of this study was to evaluate the utility of SPECT/CT and real-time intraoperative imaging with a portable γ-camera for laparoscopic sentinel node (SN) localization in stage I testicular cancer. Ten patients with clinical stage I testicular cancer were studied between November 2006 and November 2010. Their mean age was 37 y (range, 25-50 y). The primary tumors were situated on the right side in 5 patients and on the left side in 5. After a funicular block with 2% lidocaine, an average dose of 80 MBq (range, 59-98 MBq) of (99m)Tc-nanocolloid in a volume of 0.2 mL was injected into the testicular parenchyma. Shortly after injection, a 10-min dynamic study was performed, followed by the acquisition of static planar images at 15 min and 2 h. SPECT/CT was performed at 2 h. After image fusion, SNs were visualized, and their exact anatomic location was determined. The SPECT/CT images were displayed in the operation room to guide SN detection using a laparoscopic γ-ray probe and a portable γ-camera. Lymphatic drainage to the retroperitoneum was seen in all patients. SPECT/CT identified interaortocaval or paracaval SNs in the 5 patients with right-sided tumors, one of whom had an additional SN adjacent to the testicular vessels. In all 5 patients with left-sided tumors, paraaortic SNs were visualized; a node along the testicular vessels was visualized in 2 of these 5. Twenty-six SNs were laparoscopically removed (range, 1-4 per patient). An SN contained metastases in 1 case. No recurrences developed in the 9 patients with a tumor-free SN during a median follow-up of 21 mo (range, 2-50 mo). SPECT/CT enables accurate anatomic localization of retroperitoneal SNs in patients with testicular cancer, facilitating their laparoscopic retrieval. Real-time image guidance by a portable γ-camera improves intraoperative SN detection and appears to identify (20%) additional SNs.

Laparoscopic extirpation of a fork from the duodenum

A 23-year-old woman who 2 weeks before visiting our institution swallowed a plastic fork while attempting to induce vomiting during a party presented with progressive abdominal pain. Various techniques for removing foreign bodies from the intestinal tract have been described. We present the laparoscopic retrieval of a 15-cm fork from the duodenal bulb. The patient presented with leukocytosis and epigastric tenderness. An upper endoscopy revealed a plastic fork, tines up, perforating the duodenal bulb. The handle was irremovably lodged in the opposite part of the duodenum. Perforating objects and objects larger than 7 cm ought to be removed surgically to prevent esophageal perforation. The patient was placed in supine position with the surgeon standing between her legs. Four trocars, two 10-mm and two 5-mm, were used. We saw a slight swelling of the duodenum with few fibrin stripes and roughly 250 ml of white exudate. The fork tines were visible; there were no injuries to the liver. The tines were held with a clamp while the perforated intestinal wall was carefully dissected with a monopolar hug and later with an ACE harmonic scalpel due to bleeding. The fork was extracted in the proximal direction through the perforation injury. There was no severe necrosis and debridement was not necessary. The bowel was irrigated and continuously sutured with 3-0 PDS. Finally, the fork was retrieved through the 10-mm trocar incision. Operating time was 60 min and blood loss was roughly 100 ml. The patient's postoperative course was uneventful. One year after intervention, the patient is doing well. A fork may be swallowed, but usually does not spontaneously pass through the gastrointestinal tract. Early removal should be advised to avoid perforation and to minimize morbidity. Laparoscopic removal is a safe and feasible method of managing foreign bodies that are not removable endoscopically.

V377 TECHNIQUE OF ROBOTIC ASSISTED LAPAROSCOPIC PARTIAL NEPHRECTOMY FOR MULTIPLE RENAL LESIONS

You have accessJournal of UrologyMale Voiding Dysfunction (BPH & Incontinence), Oncology & Prostate Cancer1 Apr 2011V377 TECHNIQUE OF ROBOTIC ASSISTED LAPAROSCOPIC PARTIAL NEPHRECTOMY FOR MULTIPLE RENAL LESIONS David Josephson, Chris Whelan, John Yamzon, Clayton Lau, Bertram Yuh, and Timothy Wilson David JosephsonDavid Josephson Duarte, CA More articles by this author , Chris WhelanChris Whelan Duarte, CA More articles by this author , John YamzonJohn Yamzon Duarte, CA More articles by this author , Clayton LauClayton Lau Duarte, CA More articles by this author , Bertram YuhBertram Yuh Duarte, CA More articles by this author , and Timothy WilsonTimothy Wilson Duarte, CA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.464AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES We highlight the technical aspects of robotic assisted laparoscopic partial nephrectomy for multiple left renal masses on a patient with Von Hippel-Lindau syndrome (VHL). METHODS The patient is a 24 old female with bilateral renal masses, with 4 lesions on the right and 9 on the left, the largest being 3 cm. We approached this as a staged bilateral partial nephrectomy utilizing robotic assistance. Management of her left kidney proceeded as described. She is secured to the table in a left modified flank position. Following establishment of a pneumoperitoneum, a 12 mm midline camera port is placed followed by two lateral 8mm robotic ports. After the robot is docked, the operation commences with standard robotic techniques for renal dissection and exposure of the hilum. Next, the perirenal fat is mobilized with sharp dissection and monopolar cautery, exposing the renal capsule in its entirety. Laparoscopic ultrasound is used to confirm the location and depth of the tumors. The hilum is clamped and all lesions were sharply excised. Retrograde ureteral injection of methylene blue identifies a collecting system defect, which is closed with vicryl suture. Running renorrhaphy sutures through the capsule are used to close the renal defects. Hemostatic agents are placed followed by removal of the hilar bulldog clamps. Excised tumors are removed through a laparoscopic retrieval bag. RESULTS Procedure time was 240 minutes. Warm ischemia time was 34 minutes. Blood loss was 350 ml. The patient was discharged home on postoperative day 4 and recovered well. Creatinine was unchanged from baseline at 1.08. Final pathology shows 9 separate tumors, all clear cell carcinoma, grade 2. All permanent margins were negative. CONCLUSIONS Robotic assisted laparoscopic partial nephrectomy is safe and effective for management of multiple renal tumors in a single operative setting. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e153 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information David Josephson Duarte, CA More articles by this author Chris Whelan Duarte, CA More articles by this author John Yamzon Duarte, CA More articles by this author Clayton Lau Duarte, CA More articles by this author Bertram Yuh Duarte, CA More articles by this author Timothy Wilson Duarte, CA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

V2092 NOTES TRANSVAGINAL NEPHRECTOMY

You have accessJournal of UrologySingle Port Surgery1 Apr 2011V2092 NOTES TRANSVAGINAL NEPHRECTOMY Jihad H. Kaouk, Wesley White, Shahab Hillyer, Michael White, Riccardo Autorino, Gregory Spana, Yang Bo, Humerto Laydner, fatih Altunrende, Wahib Isac, Robert Stein, and Georges P. Haber Jihad H. KaoukJihad H. Kaouk Cleveland, OH More articles by this author , Wesley WhiteWesley White knoxville, TN More articles by this author , Shahab HillyerShahab Hillyer Cleveland, OH More articles by this author , Michael WhiteMichael White Clevland, OH More articles by this author , Riccardo AutorinoRiccardo Autorino Cleveland, OH More articles by this author , Gregory SpanaGregory Spana Cleveland, OH More articles by this author , Yang BoYang Bo Cleveland, OH More articles by this author , Humerto LaydnerHumerto Laydner Cleveland, OH More articles by this author , fatih Altunrendefatih Altunrende Cleveland, OH More articles by this author , Wahib IsacWahib Isac Cleveland, OH More articles by this author , Robert SteinRobert Stein Cleveland, OH More articles by this author , and Georges P. HaberGeorges P. Haber Cleveland, OH More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.2389AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To present the first two cases of Natural Orifice Translumenal Endoscopic Surgery (NOTES) transvaginal nephrectomy. METHODS An IRB-approved study was performed to evaluate the feasibility and safety of NOTES transvaginal nephrectomy. Operative candidates included females with a non-functioning kidney and a compelling indication for removal. Both patients underwent complete history and physical examination, serologic testing, and appropriate imaging studies. A 3cm posterior colpotomy was made and the peritoneal cavity accessed. Standard and articulating instruments were employed to perform pelvic adhesiolysis, reflect the colon, and expose the renal hilum. An endovascular stapler was deployed transvaginally to divide the renal artery and vein. The upper pole attachments were divided using a 65cm articulating monopolar hook. The kidney was entrapped in a laparoscopic retrieval bag and removed. RESULTS NOTES transvaginal nephrectomy was successfully completed in both patients. Mean patient age was 57.5 years. Mean BMI was 30.57 kg/m2. Mean operative time was 405 minutes. Mean EBL was 75mL. Mean length of hospitalization was 18.5 hours. Mean visual analog pain scale score at discharge was 1/10. No intraoperative or postoperative complications occurred. A 5mm umbilical port was placed in one patient who had undergone prior pelvic surgery to direct safe vaginal entry. The second patient was completed exclusively from the vagina without additional instrumentation from the abdomen. CONCLUSIONS NOTES transvaginal nephrectomy is technically feasible even without the hybrid abdominal approach. In patients with prior pelvic surgery, access to the peritoneal cavity should be performed under visual guidance. Future study is needed to better define patient selection criteria and indications for NOTES transvaginal urologic surgery. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e836 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jihad H. Kaouk Cleveland, OH More articles by this author Wesley White knoxville, TN More articles by this author Shahab Hillyer Cleveland, OH More articles by this author Michael White Clevland, OH More articles by this author Riccardo Autorino Cleveland, OH More articles by this author Gregory Spana Cleveland, OH More articles by this author Yang Bo Cleveland, OH More articles by this author Humerto Laydner Cleveland, OH More articles by this author fatih Altunrende Cleveland, OH More articles by this author Wahib Isac Cleveland, OH More articles by this author Robert Stein Cleveland, OH More articles by this author Georges P. Haber Cleveland, OH More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Laparoscopic retrieval of retained intraperitoneal drains in the immediate postoperative period

Retained intraperitoneal Penrose drain secondary to fracture and adhesions in the immediate postoperative period happens on occasion. Most are unreported because of the fear of medico-legal problems. Previous management of such iatrogenic complications requires repeated laparotomy or wound exploration. Two patients who underwent appendectomy for ruptured appendicitis, with retained intraabdominal drains in the immediate postoperative period, managed eventually by laparoscopic retrieval are presented. Both patients had right low transverse incisions and intraabdominal drains exiting through a separate right lateral abdomen skin opening. Patient 1 had a stuck intraabdominal drain unable to be removed up to the second week. Patient 2’s drain retracted intraperitoneally after its mobilization on the sixth post-op day. Both were managed by laparoscopy under general anesthesia with successful removal of both drains. Patient 1 underwent the procedure 3 weeks after the appendectomy, whereas Patient 2 had the procedure on her sixth post-op day. An additional new 1-cm wound in the periumbilical area was done for the introduction of pneumoperitoneum and 10-mm port for which the laparoscope was inserted. The second 5-mm port was inserted through the old drain site wound with peritoneal entry opening separate from the previous peritoneal defect viewed from laparoscope. Both drains had some marked adhesions from ingrowth of omentum to the side holes of the drain, causing it to get stuck in the pelvic cavity. This laparoscopic approach in the management of such iatrogenic complication, besides being cosmetically acceptable, contributes to early recovery and discharge of the patient, and helps to lessen the friction in the recently worsening doctor-patient relationship in Taiwan.

A Novel Laparoscopic Tissue Retrieval Device

A persistent problem in operative laparoscopy is the removal of laparoscopically resected tissue specimens. This study is a consecutive series demonstrating a device designed to facilitate the removal of laparoscopically resected tissue specimens. Forty-two patients met the criteria for inclusion in this study. These patients included gynecologic operative laparoscopy patients with a laparoscopically resected tissue specimen placed in a tissue retrieval sac. The sac could not to be removed from a subumbilical trocar incision with axial traction. The device was placed and an attempt was made to remove the sac/specimen. When successful, the wound was inspected for a fascial defect and closed, and if unsuccessful the wound was enlarged to remove the tissue specimen. Thirty-four patients had successful removal of the laparoscopic tissue specimen. In 8 patients, the device was not successful. No adverse intraoperative outcomes occurred. Three patients had superficial postoperative wound infection treated successfully with outpatient oral antibiotic therapy. There were no other postoperative complications. This novel medical device allows an easy and effective means to remove trapped laparoscopic tissue retrieval sacs. Prudent use of this device appears to convey no increased risk of adverse surgical outcomes.

Laparoscopic Retrieval of Gossypibomas—Short Series and Review of Literature

Laparoscopic removal of retained abdominal foreign bodies represents an obscure domain of minimally invasive surgery. Although not an infrequent situation in general surgical practice, there are very few papers presenting laparoscopic approache in these circumstances. An iatrogenic foreign body following surgery, is a serious complication that may lead to medico-legal problem. We present our experience and a literature review.Methods : In the last 20 years 48 patients with abdominal foreign bodies were referred to us. Out of these four gossypibomas were managed laparoscopically.Results : Retained swabs represent the most common iatrogenic abdominal foreign bodies. Removal of gossypiboma present more problems in laparoscopic environment due to encapsulation and difficulties in localisation, as retained swabs unusually display radio-opaque markings. There was one conversion due to dense adhesion to the gastric wall. Postoperative recovery was uneventful in all cases.Conclusions : Gossypibomas, among abdominal foreign bodies, represent a certain reality with significant legal implications. Prevention should prevail and all efforts should be made in such respect. Laparoscopic approach is possible in selected cases (small swabs, encapsulated, no complications).

85 DOMESTIC CAT KITTENS BORN AFTER TRANSFER OF CRYOPRESERVED EMBRYOS PRODUCED BY IN VITRO FERTILIZATION OF OOCYTES WITH FLOW-SORTED SPERM

For successful application of sperm sorting technology to a particular species, the various assisted reproductive techniques required for in vivo or in vitro embryo production must be established. Previously, we have demonstrated the in vivo developmental competence of cat embryos derived by IVF 1) with presumptive X-chromosome bearing sperm and 2) after controlled-rate cryopreservation. Here, our intent was to determine in vivo viability by transfer to recipients of cryopreserved cat embryos produced by IVF with flow-sorted sperm. Semen collected from a single male using an artificial vagina was extended in electrolyte-free solution and shipped overnight (4°C) to the sorting facility. After sorting immediately upon arrival, sperm were concentrated by centrifugation, suspended in TEST yolk buffer, and return-shipped to the IVF laboratory at 4°C. At 48 h after semen collection, in vivo matured oocytes (n = 64) recovered from 2 gonadotropin-treated donors were inseminated in vitro with presumptive X-chromosome-bearing sperm. At 5 h post-insemination, oocytes were rinsed and placed in modified Tyrodes+BSA and NEAA (IVC-1) at 38°C in a humidified atmosphere of 5% O2, 5% CO2, and 90% N2. At 27 h post-insemination (Day 1), 43 two-cell embryos (67% cleavage rate) were equilibrated (3 steps) in 1.4 M propylene glycol, 0.125 M sucrose, and 10% dextran 70, cooled at a slow controlled rate (0.3°C min–1) from –6°C to –30°C, and plunged into liquid nitrogen. After 26 to 43 months in cryostorage, 4 straws, each containing 8 or 9 embryos, were thawed in air (22°C) and cryoprotectant was removed from the embryos by a 5-step rinse. Then, embryos were cultured for 17 to 20 h in IVC-1, as described earlier. On Day 2, 35 embryos were transferred (8 or 9 per recipient) by laparoscopy to the oviduct of four Day 1 gonadotropin-treated recipients at 24 h after laparoscopic oocyte retrieval (16 to 25 oocytes/donor). Most embryos (83%) were at the four- to eight-cell stages at transfer. Three recipients established pregnancies and delivered, without assistance, litters of 1, 2, and 3 live kittens (27% embryo survival) between Day 64 and Day 67 of gestation. Four kittens were female, and two were male. Birth weights ranged from 73 to 133g (mean = 117 g). Overall, of 18 kittens [12 from fresh (2009 Theriogenology, 71, 864) +6 from frozen embryos] born after transfer of embryos produced by IVF with sex-sorted sperm, 16 (89%) have been female. The variation in sex ratios between kittens born from fresh v. cryopreserved embryos probably is a reflection of the sort purity of the different sperm samples used for IVF. The ability to produce kittens after transfer of cryopreserved embryos derived by in vitro insemination with sex-sorted sperm represents an expansion in the assortment of assisted reproductive techniques that may be useful for selective propagation of biomedically relevant and endangered felids.

Clinical complications after transvaginal oocyte retrieval in 7,098 IVF cycles

We report the complications observed after transvaginal oocyte retrieval guided by ultrasound in 7,098 IVF cycles. The frequency of severe complications in our patients was 0.08%, of which four cases were intraperitoneal bleeding (0.06%) and two were cases of ovarian abscess (0.003%).

Comparison between transumbilical and transabdominal ports for the laparoscopic retrieval of benign adnexal masses: a randomized trial

Objective To compare the feasibility, operative time, specimen retrieval time, and effect on postoperative pain of laparoscopic retrieval of benign adnexal masses between a 10-mm transumbilical and a 10-mm transabdominal port. Study design Fifty women with adnexal masses who were scheduled for a laparoscopic procedure between July 2008 and April 2009 were enrolled. The patients were randomized into two groups; these were patients where a transumbilical port was used for specimen retrieval (transumbilical group, n = 25) and patients where a transabdominal port was used for specimen retrieval (transabdominal group, n = 25). Preoperative suspicion of malignancy and indications suggesting a need for hysterectomy or myomectomy were considered to be exclusion criteria. Randomization was centralized and computer-based. Patients recorded the severity of incisional pain on a visual analog scale (VAS) with 0 meaning no pain and 10 meaning unbearable pain. Results There were no significant differences in age, body mass index, umbilical thickness, abdominal thickness, cyst size, cyst amount, cyst weight, histology, complications and duration of hospital stay when the two groups were compared. Patients in the transumbilical group had a significantly shorter specimen retrieval time (0.7 ± 1.8 min vs. 4.9 ± 12.6 min, p = 0.006) and a significantly lower postoperative day (POD) 0 VAS pain score (5.2 ± 2.1 vs. 6.6 ± 2.2, p = 0.015). Significantly fewer patients in the transumbilical group had a specimen retrieval time of ≥10 min (0% vs. 20%, p = 0.025) and a POD 0 VAS pain score of >5 (36% vs. 84%, p < 0.001). However, the average POD 1 VAS pain score (3.2 ± 1.8, vs. 3.6 ± 1.6) and the proportion with a POD 1 VAS pain score >5 (12% vs. 12%) were similar for the two groups. Conclusion When laparoscopic surgery on benign adnexal masses is carried out using a 10-mm incision wound, removal of the specimen via the umbilical port has a shorter retrieval time and produces less postoperative pain than retrieval via a lateral abdominal port.

Endoscopic Retrieval of Migrated IUCD from the Rectum

ABSTRACT A 23 years old patient had presented with history of 2 to 3 cm white thread protruding out of anal orifice and pricking pain while defecating. On examination found to have impacted Cu-T in postfornix. X-ray and CT-scan delineated exact position of Cu-T. Laparoscopic retrieval was done successfully. Complications of fecal contamination was avoided by meticulous bowel preparation.

Laparoscopic Retrieval of Intrauterine Device Perforating the Sigmoid Colon

The intrauterine device (IUD) is a well-tolerated, widely used contraceptive. A major but infrequent complication of the IUD is perforation of the uterus or cervix and migration of the device into the abdomen. Our case of laparoscopic retrieval of an IUD perforating the sigmoid colon illustrates this rare complication. A 36-year-old woman with a history of IUD placement 4 years earlier presented with complaints of abdominal pain and bright red blood per rectum. She had conceived 9 months after IUD placement and suffered a spontaneous abortion requiring an evacuation of the retained products of conception. At presentation, she was afebrile with normal vital signs. Physical examination was significant for tenderness to palpation over the left lower quadrant. Computed tomography (CT) scans of the abdomen and pelvis showed a foreign body through the wall of the uterus and entering the colon. Colonoscopy revealed an IUD penetrating the sigmoid wall, and multiple failed attempts were made to remove the IUD colonoscopically. Diagnostic laparoscopy was performed that revealed an IUD perforating the uterus and entering the sigmoid. The IUD was manipulated free and removed, and a suture closed the sigmoid defect. The patient was discharged home on the first postoperative day without complication. The IUD is one of the most effective, safe, and economic contraceptive methods. Uterine perforation and intraperitoneal translocation is an unusual complication of an IUD. Perforation of hollow viscous is likely even less common. Confirmation of a "missing" IUD is mandatory if pregnancy occurs after IUD placement. Removal of a translocated IUD is recommended, and operative laparoscopy is the preferred method.

199 IN VITRO EMBRYO PRODUCTION IN THE CLOUDED LEOPARD (NEOFELIS NEBULOSA)

The clouded leopard, a spotted, mid-sized cat native to southeast Asia, is classified as Endangered by the U.S. Fish and Wildlife Service. The Species Survival Plan (SSP) program has designated that clouded leopards in North American zoological institutions are a research population with the focus of enhancing management and developing assisted reproductive techniques. In this study, we examined (1) ovarian response to exogenous gonadotropin stimulation, (2) in vitro production of embryos by IVF and intracytoplasmic sperm injection (ICSI), and (3) in vivo developmental ability of in vitro-derived embryos. Eight females at Audubon Center for Research of Endangered Species (ACRES) in New Orleans, LA, were used as oocyte donors and embryo recipients. During non-estrual, but otherwise unknown, stages of the estrous cycle, females 4 to 10 years old at our first treatment were administered a total of 15 (n = 8) or 20 (n = 7) IU of porcine FSH (i.m; Sioux Biochemical Co., Sioux City, IA) daily for 4 days. On Day 5, 10 (n = 8) or 15 (n = 7) IU of porcine LH (i.m; Sioux Biochemical Co.) was given and laparoscopic oocyte retrieval (LOR) was done 24 h later. One, 2, or 3 LOR were performed on 3, 3, and 2 females, respectively (total n LOR = 15), 10 (67%) of which were done on females that were 8 to 12 years of age. A total of 176 pre-ovulatory oocytes (mean = 14.7; range = 3-31) were recovered from 12 LOR performed on 6 females. Two females, a 5-year-old and an 11-year-old, did not respond to gonadotropin treatment. Of 5 females with ≥2 LOR, an average of 16.2 and 14.6 oocytes were recovered at the first and second LOR, respectively. Luteal tissue was present on the ovaries at 3 of 4 LOR performed during January-April as compared with 0 of 11 LOR performed from June-December. Semen was obtained by electroejaculation of 3 males (6, 9, and 11 years of age) and used after cryopreservation [TEST-yolk (media prepared with egg yolk, TES, and Tris) + 6% glycerol] or after storage at 4°C for 24 h (cooled). In vitro production, cryopreservation, and transfer of embryos were done as described by Pope et al. (2006 Theriogenology 66, 1518-1524). Cleavage frequency was 43% overall, 55% (64/117) after IVF, and 20% after ICSI with frozen (10/43) or cooled (2/16) sperm. After IVF with frozen sperm, cleavage rate was 63% (48/76) v. 39% (16/41) with cooled sperm. On Days 5, 57, 26, and 17% of embryos were morula (&gt; 16 cells), early morula (≈16 cells) and pre-morula (&lt; 16 cells), respectively. Forty-four Day 5 embryos were cryopreserved at a slow, controlled rate, 24 of which were thawed and transferred by laparotomy to the uteri of 3 Day 5 gonadotropin-treated recipients (7-9 embryos/female). Similarly, 28 Day 5 fresh embryos were auto-transferred to 3 Day 5 recipients (5-15 embryos/female). Most embryos transferred were morulae (83%) produced by IVF using frozen sperm (71%). None of the recipients established pregnancies, a failure that, undoubtedly, was multifaceted. Age may have been a factor because most recipients were 8 to 11 years old. Nonetheless, we have (1) shown that clouded leopard females are responsive to exogenous gonadotropins, (2) produced embryos in vitro, both by IVF and ICSI, using both cryopreserved and cooled sperm, and (3) provided further evidence of seasonality in ovarian activity.

Laparoscopic retrieval of disconnected shunt catheters from the peritoneal cavity as a day-case procedure in children—early feasibility report

The aim of this study was to report our experience with laparoscopic retrieval of disconnected shunt catheters in children. Demographic data, indications for shunt insertion, time to disconnection, symptomatology, time to retrieval, operative details, length of stay and complications were recorded retrospectively. Laparoscopy was performed using two 5-mm ports and 10-12-mmHg CO(2) pneumoperitoneum. Seven children (five boys, two girls) had laparoscopic retrieval of disconnected ventriculoperitoneal (VP; n = 6) and lumboperitoneal (n = 1) shunt catheters between 2006 and 2008. Median age was 8 (5-15) years. The indications for shunt insertion were hydrocephalus (n = 4), traumatic subdural haematoma (n = 1), pinealoblastoma (n = 1) and idiopathic intracranial hypertension (n = 1). Median interval from insertion to disconnection was 3 (range 1-10) years. Presenting symptoms were headache (n = 3) and neck swelling (n = 1). Three children were asymptomatic. Median referral-to-procedure time was 69 (range 2-224) days. One child underwent emergency removal of disconnected shunt with laparoscopic-assisted VP shunt insertion under the same anaesthetic. One child had a laparotomy as the catheter tip had penetrated the sigmoid mesocolon close to the bowel and could not be safely removed laparoscopically. Of the remaining five children, four had the procedure performed as day cases. There was no intra- or post-operative morbidity or subsequent shunt infections. Peritoneally migrated shunt catheters have a risk of viscus injury, particularly bowel perforation. In our experience, laparoscopic retrieval of migrated shunt catheters was safe both as an emergency procedure and electively, when it was performed as a day-case basis in selected patients with excellent outcome.

Laparoscopic Radical Parametrectomy for Incidental Invasive Cervical Cancer after Previous Simple Hysterectomy

Study Objective: To evaluate the outcome of laparoscopic radical parametrectomy performed for in incidental invasive cervical cancer following a simple hysterectomy in patient with benign pelvic disease or with in situ carcinoma of cervix. Design: Retrospective study. Setting: Department of Obstetrics and Gynecology, Southwest Hospital, Third Military Medical University. Patients: From July 2002 to December 2008. 29 patients underwent laparoscopic or laparotomy hysterectomy that were found to have incidental early stage cervical cancer. At the same time, negative surgical margins and no gross tumor were found at initial hysterectomy specimen. Intervention: We performed laparoscopic radical parametrectomy and pelvic lymph nodes resection. Measurements and Main Results: The mean age of these patients was 43.6 ± 3.2 years (range 36 to 51). The laparoscopic radical parametrectomy was performed on average 4.23 ± 0.32 weeks after a simple hysterectomy (range 2 to 6) with benign diseases, and was performed immediately after an extrafascial hysterectomy with in situ carcinoma of cervix. All patients were performed successfully laparoscopic retrieval of pelvic lymph nodes and radical parametrectomy. The mean number of laparoscopic retrieval of pelvic lymph nodes was 21.6 ± 1.31 (17 to 32). The mean blood loss was 252.2 ± 21.1 ml (150 to 300). The mean reoperation time was 178 ± 26 min (range 96 to 196). Operative complications occurred in only one patient with cystotomy and repaired laparoscopically. Operative pathologic findings of radical specimens indicated no evidence of residual lesions in 93.1% (27/29) patients. The average of admission was shortened 7.7 days than primary radical hysterectomy. Only one patient had a local recurrence within a median follow-up 49.6 ± 8.8 months (5 to 82). Conclusion: Laparoscopic radical parametrectomy was an acceptable option for patient with incidental early stage of cervical cancer after a simple hysterectomy and produces low morbidity with excellent oncological outcome.

Fewer medications for in vitro fertilization can be better: thinking outside the box

Minimal stimulation or mild stimulation protocols for in vitro fertilization offer many advantages for all patients, but especially for low and high responders. In the current practice of reducing the number of embryos transferred to a maximum of two for a significant number of patients, using aggressive and high-dose gonadotropins to obtain a large, and sometimes excessive, number of oocytes should be questioned.

NOTES Transvaginal Nephrectomy: First Human Experience

To present the operative outcomes of the first natural orifice translumenal endoscopic surgery (NOTES) transvaginal nephrectomy. A 57-year-old woman with hypertension, right-sided flank pain, and radiographic evidence of an atrophic right kidney consented for NOTES transvaginal nephrectomy. Pneumoperitoneum was achieved with a Veress needle inserted deep in the umbilicus. Under direct vision, a colpotomy was made and a transvaginal port positioned. Using standard and articulating operating instruments inserted transvaginally, the kidney was mobilized and the renal hilum was controlled with an endovascular stapler. The kidney was placed in a laparoscopic retrieval bag and extracted through the vaginal incision. Salient demographic and operative data were obtained. NOTES transvaginal nephrectomy was successfully completed, with all the operative steps performed transvaginally. Dense pelvic adhesions from a prior hysterectomy necessitated the use of a 5-mm umbilical port during vaginal port placement and for retraction of the ascending colon during division of the renal hilum. No intraoperative complications occurred. Operative time was 307 minutes, with 124 minutes dedicated to vaginal port placement and 183 minutes dedicated to adhesiolysis and nephrectomy. The duration of hospitalization was 23 hours. The visual analog pain scale score was 1 of 10 on postoperative day 2. Our experience shows that NOTES transvaginal nephrectomy is technically feasible. Access to the peritoneal cavity should be performed under visual guidance and after insufflation through the umbilicus. Additional experience is needed to better define patient selection criteria and indications for NOTES transvaginal urologic surgery.

A Review Of Laparoscopy At A Dedicated Assisted Reproductive Technology (Art) Centre In Nigeria.

Background: Laparoscopy is currently considered the ‘gold standard' for pelvic endoscopic procedures. However the expertise and availability of equipments are still in short supply in most parts of Nigeria. Objective: To review the practice of laparoscopy at a dedicated Assisted Reproductive Technology (ART) centre in Abuja, Nigeria. Materials and Methods: Retrospective descriptive study. Case notes of all patients who underwent laparoscopy between January 2000 and December 2004 at Nisa Premier Hospital (Nordica Fertility centre) Abuja, were reviewed. All cases were done by the consultant Gynaecologists. Results: Two hundred and fourteen (214) laparoscopic procedures were carried out during the period under review. Majority of the patients (120 or 55.3%) had laparoscopy on account of secondary infertility. Of the 53 cases that had primary infertility, 5(9.43%) had primary amenorrhoea while 3 cases were diagnosed with Androgen Insensitivity Syndrome. Seventy eight (36.44%) patients had combined laparoscopy and hysteroscopy done. While 4 patients had laparoscopic tubal sterilization with Filshie clip, 1 patient each had laparoscopic ovarian cyst drainage and IUCD retrieval. The overall complication rate was 2.34%. Conclusion: Laparoscopy is a useful tool in trained hands as important diagnostic and surgical procedures can be carried out, obviating the need for laparotomy. Keywords : Laparoscopy, hysteroscopy, Infertility Ebonyi Medical Journal Vol. 7 (1&2) 2008: pp. 21-26