Persistent ectopic pregnancy following laparoscopic linear salpingostomy

Article Abstract:

Ectopic pregnancy (pregnancies in which implantation of the embryo takes place outside the uterus) is currently treated whenever possible with less invasive techniques; instead of undergoing abdominal surgery, women with ectopic pregnancies are often offered laparoscopic surgery (accomplished via a small abdominal incision through a fiberoptics tube). However, evidence exists that salpingostomy (opening the fallopian tube to remove the pregnancy) performed with the laparoscope is associated with a higher rate of persistent ectopic pregnancy; the pregnancy is not completely removed. In such cases, repeat surgery or additional medical treatment is needed. To evaluate this possibility, a retrospective review was conducted of the charts of all patients who underwent surgery for ectopic pregnancy at one medical institution over a three-year period. Eighty-one patients underwent laparoscopic salpingostomy, after which their blood levels of beta-human chorionic gonadotropin (beta-hCG, produced in association with pregnancy) were monitored. Eleven women had persistent ectopic pregnancy, evidenced by pain (in nine) or an abnormal beta-hCG level. Ten underwent repeat surgery, which involved opening the abdomen for nine (one had another laparoscopy). In 3 of the 11 cases, the pathology reports from the first procedure did not report the presence of fetal tissue. Women with persistent ectopic pregnancies had smaller pregnancies at the time of laparoscopic surgery, and were fewer days from their last menstrual periods. The results suggest that retrieval of all tissue by the surgeon may be more difficult when the laparoscope is used. However, further studies are needed to determine the optimal approach for preventing persistent ectopic pregnancy. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, Evaluation, Surgery, Pregnancy, Ectopic, Ectopic pregnancy, Gynecology, Operative, Gynecological surgery

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Ureteral injuries at laparoscopy: insights into diagnosis, management and prevention

Article Abstract:

Laparoscopy involves the use of a small tube affixed with lighted magnifying lens inserted into the abdomen to visualize internal structures. It is can be used to diagnose pelvic diseases or as a therapeutic intervention. However, the procedure is not without risk. The laparoscope can perforate the bowel, bladder, uterus or blood vessels. There is also added risk when electrical currents are used to achieve sterilization. Laparoscopically induced injury to the ureter, the tube carrying urine from the kidneys, has been reported in eight cases. The outcomes of an additional five cases are reported. Symptoms of ureteral damage surfaced within 48 to 72 hours after the procedure. Patients complained of lower back pain and abdominal pain. White blood cell counts were increased and there was evidence of swelling of the membrane surrounding the abdomen (peritonitis) and fever. The injuries were diagnosed by intravenous pyelogram (IVP), an X-ray image of radioactive contrast material within the urinary structures. All but one of the injuries were sustained with electrocoagulation, used for either sterilization (four patients) or treatment of endometriosis (38 percent). Three of the 13 patients lost kidney function on the affected side and two required kidney removal. In some cases, the ureter is difficult to visualize near the cervix, particularly when endometriosis is present, because the condition can distort the anatomy of ureter. Surgeons should exercise extreme caution when performing laparoscopy in this area. (Consumer Summary produced by Reliance Medical Information, Inc.)

Injuries, Ureters, Ureter, Surgical errors

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Unsuspected leiomyosarcoma: treatment with a gonadotropin-releasing hormone analogue

Article Abstract:

Leiomyoma, uterine fibroids, are benign masses within the uterus. Abnormal bleeding and pain are the most common symptoms. Surgery is often delayed until symptoms worsen or the leiomyoma has changed dramatically in size. A 46-year-old woman with a two-year history of a leiomyoma was recommended for surgery when the tumors appeared larger. Leiomyomas have a increased affinity for the hormone estrogen and are known to shrink when patients are given a drug which mimics human gonadotropin releasing hormone (GnRH). GnRH inhibits the release of estrogen, thereby reducing the size of the tumors. Since this patient wanted to preserve her uterus, seeking alternatives to surgery, she opted for GnRH therapy. However, the size of the tumor remained large after treatment and the surgical removal of just the tumors (myomectomy) and not the entire uterus (hysterectomy) was performed. Visual inspection of the uterus suggested cancer but since the patient requested uterine preservation, only the mass was removed. After the cancer was confirmed, a second operation was performed. Cancer diagnosis may be delayed in postmenopausal women who elect conservative hormone therapy to treat suspected leiomyoma. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Gonadotropin, Gonadotropins, Leiomyosarcoma

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