Alfonso Rossetti

Diagnosis of deep infiltrating endometriosis: accuracy of magnetic resonance imaging and transvaginal 3D ultrasonography.

PurposeTo compare two different imaging modalities, magnetic resonance (MR), and three-dimensional sonography (3DUS), in order to evaluate the specific role in preoperative work-up of deep infiltrating endometriosis.Materials and methods33 women with endometriosis underwent 3DUS and MR followed by surgical and histopathological investigations. Investigators described the disease extension in the following sites: torus uterinus and uterosacral ligaments (USL), vagina, rectovaginal-septum, rectosigmoid, bladder, ovaries. Results were compared with surgical and histopathological findings.ResultsOvarian and deep pelvic endometriosis were found by surgery and histology in, respectively, 24 (72.7%) and 22 (66.6%) of the 33 patients. Sensitivity and specificity values of 3DUS for the diagnosis of endometrial cysts were 87.5% and 100%, respectively; those of MRI were 96.8% and 91.1%, respectively. Sensitivity and specificity of 3DUS for the diagnosis of deep infiltrating endometriosis in specific sites were: USL 50% and 94.7%; vagina 84% and 80%; rectovaginal-septum 76.9% and 100%; rectosigmoid 33.3% and 100%; bladder 25% and 100%. Those of MR were: USL 69.2% and 94.3%; vagina 83.3% and 88.8%; rectovaginal-septum 76.4% and 100%; restosigmoid 75% and 100%; bladder 83.3% and 100%.ConclusionsMR accurately diagnoses deep infiltrating endometriosis; 3DUS accurately diagnoses deep infiltrating endometriosis in specific locations.

DILUTE ORNITIN VASOPRESSIN AND A MYOMA DRILL FOR LAPAROSCOPIC MYOMECTOMY

To improve enucleation of uterine myomas, we designed a reusable 5-mm laparoscopic drill with a distal forked pin and locking system. Because the device is jointed, it can apply traction not only along its own axis, but also along planes, depending on its bending radius. We compared enucleation time for myomas 5 to 8 cm in size before and after introduction of the drill. The last 23 procedures performed with this instrument were easier, with a reduction in operating time of about 28.5% for the enucleation part of the procedure (p <0.001). (J Am Assoc Gynecol Laparosc 6(2):189-193, 1999)

Laparoscopic Ablation of a Pelvic Retroperitoneal Epidermoid Cyst

Experience with minimally invasive approaches, such as laparoscopic ablation and transanal endoscopic microsurgery, to resection pelvic retroperitoneal and presacral tumors is limited. Masses arising from this anatomic position are usually removed using a transsacral approach or laparotomy. We report a detailed description of the laparoscopic procedure performed in a 32-year-old woman to remove a mass, which was detected with both ultrasonography and magnetic resonance imaging, that was closely adherent to the left sacrospinous ligament and compressing the rectum. Histopathologic findings were consistent with a rare case of pelvic retroperitoneal epidermoid cyst. This tumor, which usually occurs in the face, the scalp, the trunk, or the neck, has been described in the pelvic retroperitoneal space in only a few cases.