Chao Ht

Major Complications of Operative and Diagnostic Laparoscopy for Gynecologic Disease

STUDY OBJECTIVEnTo compare complication rates of diagnostic and operative laparoscopy. Design. Retrospective study (Canadian Task Force classification II-2).nnnSETTINGnOne medical center and three teaching hospitals.nnnPATIENTSnSix thousand four hundred fifty-one women with various indications for laparoscopic diagnosis and/or laparoscopic surgery from January 1994 through June 1999.nnnINTERVENTIONnDiagnostic and operative laparoscopies.nnnMEASUREMENTS AND MAIN RESULTSnForty-two major complications occurred that directly resulted in one death. One patient had stomach injury, 3 had major vessel injuries, 5 had ureter injuries, 10 had intestinal injuries, and 23 had bladder injuries. The overall complication rate for all laparoscopies was 0.65% (42/6451); however, it rose to 0.80% (39/4865) for operative laparoscopy compared with 0.19% for diagnostic laparoscopy (3/1586; p <0.001, Fishers exact test).nnnCONCLUSIONnLaparoscopic surgery is appropriate for managing various gynecologic diseases and has an acceptable complication rate. However, operative laparoscopy should be performed carefully because its rate of complications is significantly higher than that of diagnostic laparoscopy, especially for laparoscopic-assisted vaginal hysterectomy. (J Am Assoc Gynecol Laparosc 8(1):68-73, 2001)

Ovarian tumors complicating pregnancy

Because of the rarity of malignant ovarian w x tumors complicating pregnancy 1 , the characteristics have not been evaluated sufficiently. In this study, we attempted to study the characteristics of ovarian cancer during pregnancy and tried to make an early diagnosis possible. We retrospectively reviewed the medical records of six pregnant women with malignant ovarian tumors from January 1, 1980 to December 31, 1995. The histology was different in each of these six patients and consisted of clear cell carcinoma, endometrioid cell carcinoma, poorly differentiated carcinoma, granulosa cell tumor, mucinous tumor of low malignant potential and serous tumor of low malignant potential, respectively. There were 174 patients receiving ovarian surgery during pregnancy or puerperium during the same period of the study. We found that tumor size greater than 10 cm seemed to increase malignant potential Ž with comparison to that less than 10 cm Ps . 0.0295, Fisher’s exact test , see Table 1. If we

Surgico-pathological stage I primary fallopian tube adenocarcinoma

Due to the rarity of primary fallopian tube Ž . adenocarcinoma PFTA , the optimal management has not been well defined, especially in the early-stage of the disease. Furthermore, the role of adjuvant therapy in the early-stage of the disw x ease has not shown a benefit in survival 1 . It may be contributed partly to underestimated staging, or ineffective adjuvant therapy. For evaluating the value of adjuvant therapy, we retrospectively studied the patients with proven surgicopathological stage I PFTA. Eleven patients from 1970 to 1995 were confirmed to have full surgical staging I after receiving a complete, thorough surgical staging surgery including washing cytology, abdominal total hysterectomy, bilateral salpingo-oophorectomy, partial omentectomy, retroperitoneal lymphadenectomy and excisional

Malignant Mixed Mesodermal Tumors of the Ovary: Preoperative Diagnosis

Early diagnosis of malignant mixed mesodermal tumors of the ovary is very difficult because of the rarity and the insidious onset. The purpose of this report is to review the magnetic resonance imaging features of an ovarian malignant mixed mesodermal tumor, which occurred in a 52-year-old woman, aiding in the differential diagnosis.