1/5. Mesh repair of a pelvic bone defect caused by a migrated acetabular cup.Conventional transacetabular removal of the migrated acetabular cup can be hazardous due to intraoperative injury to iliac vessels. We present a case of a migrated acetabular cup, in which we used a combined preperitoneal and acetabular approach for its removal. With a bimanual approach, the procedure was safer and easier and allowed mesh repair of the pelvic bone defect. The preperitoneal mesh repair is a well-known method for inguinofemoral hernias. However, it has not been used before in the repair of an acetabular defect after removal of a migrated cup.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/5. Laparoscopic uterine artery dissection in an undiagnosed endometrial stromal sarcoma. Case report.We present a case of a 24-year-old woman, gravida 0, with menometrorrhagia and pelvic pain. A uterine hemorrhagic fibroid was diagnosed after ultrasound and magnetic resonance imaging (MRI). The endometrial biopsy was negative for malignancy. Laparoscopic sentinel lymph node sampling, lavage, and myometrial biopsy with negative results were performed before dissection of the uterine vessels. The final diagnosis of endometrial stromal sarcoma was made by myomectomy and hysterectomy one year later. This case should demonstrate the difficulty of making the right diagnosis of sarcoma before laparoscopic dissection of uterine vessels in patients with symptomatic fibroids.- - - - - - - - - - ranking = 2keywords = vessel (Clic here for more details about this article) |
3/5. A simple technique for anticipating and managing secondary puncture site hemorrhage during laparoscopic surgery. A report of two cases.BACKGROUND: Clinically significant hemorrhage from secondary port sites at laparoscopy is an uncommon but serious complication and can go unrecognized intraoperatively. CASES: A 28-year-old woman undergoing operative laparoscopy sustained abdominal wall vessel injury and required a blood transfusion. A second patient received the same injury but, when the author's technique was used, had minimal blood loss and a benign postoperative course. With this technique, a blunt instrument is placed through the sheath and into the peritoneal cavity before any secondary port is removed. The sheath is withdrawn, only the probe is kept in the abdomen, and then hemorrhage usually becomes evident. CONCLUSION: A new technique aids the diagnosis of occult abdominal vessel injury and allows rapid recanalization of the secondary trocar sheath paths.- - - - - - - - - - ranking = 2keywords = vessel (Clic here for more details about this article) |
4/5. Traumatic hypogastric artery bleeding controlled with bipolar desiccation during operative laparoscopy.During multipuncture operative laparoscopy to excise peritoneal endometriosis involving the pelvic sidewall near the origin of the uterine artery, the lower portion of the hypogastric artery was perforated. The acute hemorrhage was controlled by immediately grasping the lacerated blood vessel with a 5-mm atraumatic grasping forceps. A Kleppinger bipolar forceps set at 25 W desiccated and sealed the artery successfully. As no further bleeding was noted, the procedure was terminated. The patient remained overnight for observation, and was discharged from the hospital the next day. She is doing well 18 months after the injury and repair.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
5/5. Management of chylous ascites following laparoscopic presacral neurectomy.chylous ascites is an extremely rare complication of laparoscopic presacral neurectomy (LPSN), and treatment is still controversial. Four patients undergoing LPSN for dysmenorrhoea or chronic pelvic pain were complicated with chylous ascites. Two were successfully treated with bipolar cauterization and one, after the failure of initial treatment by bipolar cauterization, was then effectively managed by compression with Gelform and closure of the peritoneum of the presacral area by suture through laparoscopy. The fourth patient had persistent chyle leakage from the drainage tube after electrocauterization and was finally cured by conservative management including removal of the drainage tube and a low-fat diet for 3 weeks. chylous ascites has not been reported in laparoscopic presacral neurectomy. Management that is quick, effective and subjects the patients to the least amount of suffering is still unresolved. Repeated laparoscopy can be considered to identify the possibility of injury to lymphatic vessels, to relieve abdominal distention due to chyle accumulation, and to apply electrocauterization or compression with Gelform and closure of the peritoneum. Conservative treatment with a low-fat diet may need a longer time. The use of a drainage tube may provide negative pressure allowing a continuous leakage of chyle. However, more controlled study is required to identify the most proper and effective management.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |