Livio Leo

Laparoendoscopic single-site surgery for treatment of concomitant ovarian cystectomy and cholecystectomy.

Since the first laparoscopic appendectomy was performed by Semm in 1983, laparoscopic surgery has become the criterion standard surgical route for treatment of several pathologic conditions across disciplines. Attempts to minimize access-related injuries and complications resulted in development of laparoendoscopic single-site surgery (LESS), which, because of the decreased number of ports used, may be the next generation of minimally invasive surgery. Laparoscopic single-site surgery has been reported in nephrectomy, pyeloplasty, radical prostatectomy, cholecystectomy, and colorectal, bariatric, and gynecologic surgery. This technique may increase the benefits of traditional minimally invasive surgery such as decreased blood loss and postoperative pain, faster recovery time, fewer complications, and better cosmetic results, without increasing costs. Herein, we present a case report of single-port laparoscopic ovarian cystectomy and concomitant cholecystectomy performed with a multi-instrument access port (TriPort; Olympus America Inc., Center Valley, Pennsylvania). Single-port surgery eliminates the problem of multiple and different site placement for accessory ports, typical of these procedures when performed simultaneously at conventional laparoscopy.

Narrow Band Imaging in Endometrial Lesions

Fig. 1. Conventional hysteroscopy shows irregular polypoid hypertrophy of softened consistency. Hysteroscopy with directed biopsies has a key role in the diagnosis of intrauterine pathologies. In a series of 4054 patients, sensitivity of hysteroscopic view for endometrial cancer is 80%, suggesting that visual identification of morphologic changes in the endometrial mucosa is not always enough for a diagnostic conclusion [1]. In the literature, several studies indicate that angiogenic intensity may play a prognostic role in malignancies [2,3] and a report in 2006 showed that, in endometrial cancer, tumor-associated vessels are structurally and functionally abnormal and that structural changes are associated with increased frequency of vascular invasion and decreased survival [4]. Narrow band imaging (NBI) is a novel endoscopic technique able to enhance the accuracy of diagnosis by using narrowbandwidth filters in a red-green-blue sequential illumination system. The light penetration depth depends on the wavelength used: the blue filter is designed to correspond to the peak absorption spectrum of hemoglobin so that NBI allows appreciation of the mucosal pattern and surface microvasculature simply through an on-off switch located on the head of the endoscope. NBI appears to be a promising tool for diagnosis of gastrointestinal lesions, early detection of squamous cancer of the head-neck region, preneoplastic lesions in heavy smokers, and follow-up in patients affected by urothelial carcinoma of the bladder [5,6].

Narrow-Band Imaging in Diagnosis of Endometrial Cancer and Hyperplasia: A New Option?

STUDY OBJECTIVE To estimate whether the use of narrow-band imaging (NBI) hysteroscopy increases concordance between visual identification and a histologic diagnosis of endometrial cancer and hyperplasia. DESIGN Prospective study (Canadian Task Force classification: II-2). SETTING Department of obstetrics and gynecology, University of Eastern Piedmont, Novara, Italy. PATIENTS 209 consecutive patients with abnormal uterine bleeding. INTERVENTIONS White-light hysteroscopy and NBI hysteroscopy followed by direct biopsy. MEASUREMENTS AND MAIN RESULTS The sensitivity and specificity of conventional hysteroscopy in predicting a diagnosis of cancer and hyperplasia were, respectively, 84.21% (95% confidence interval [CI], 79.27-89.15) and 99.47% (95% CI, 98.49-100.0), and 64.86% (95% CI, 58.39-71.34) and 98.77% (95% CI, 97.27-100.0), and of NBI hysteroscopy were 94.74% (95% CI, 91.71-97.76) and 97.89% (95% CI, 95.95-99.84), and 78.38% (95% CI, 72.8-83.96) and 97.67% (95% CI, 96.63-99.72). The concordance of conventional and NBI hysteroscopy with the histopathologic findings (measured using the Cohen kappa) was, respectively, 88.80% (95% CI, 86.2%-96.3%) and 91.78% (95% CI, 89.6%-98.2%), a difference of 2.98% (95% CI, 0-9) in favor of NBI. CONCLUSION Narrow-band imaging hysteroscopy can accurately predict a histologic diagnosis of endometrial cancer or hyperplasia.

A multicenter study comparing surgical outcomes and ultrasonographic evaluation of scarring after laparoscopic myomectomy with conventional versus barbed sutures

To compare clinical outcomes after laparoscopic myomectomy using traditional interrupted sutures (TIS) versus continuous barbed suture (CBS) for treatment of symptomatic uterine myomas.

Dichorionic pregnancy: delayed interval delivery with endoloop ligation.

We describe two cases of delayed delivery in dichorionic, diamniotic pregnancies, where we used an Endoloop ligature to clamp the umbilical cord with excellent maternal and fetal long-term outcome.

O046 DICHORIONIC PREGNANCY: DELAYED INTERVAL DELIVERY WITH ENDOLOOP LIGATION

Objectives: We describe two cases of delayed delivery in dichorionic, diamniotic pregnancies, where we used an Endoloop ligature to clamp the umbilical cord with excellent maternal and fetal long term outcome. Materials: we report two cases of DID with Endoloop ligation of the umbilical cord, a new method that was first described in literature in 2009 and that we have used, at our institution, since 2006. Methods: After delivery of the first twin, it’s mandatory to tie the umbilical cord with absorbable thread placed as much as possible proximal to placenta. The aseptic ligation close to the placenta lead to the possibility to cut off the umbilical cord stump, reducing infection risk due to maceration. The use of Endoloop allows to place the suture higher in the birth canal, beyond the internal uterine os. Results: In both cases, we obtained good results, with no mother complications and long interval between deliveries; the babies had no sequelae during the follow up. Conclusions: Endoloop ligature of umbilical cord that, allowing high cord ligature, can minimize infection risk and subsequent chorioamniotitis.

M365 NARROW-BAND IMAGING IN DIAGNOSIS OF ENDOMETRIAL CANCER AND HYPERPLASIA: A NEW OPTION?

Case report: A young woman 39 years old, Caucasian, with a background of hypothyroidism, hypertension, and morbid obesity (BMI 97). The patient was admitted to the hospital with moderate genitorragia and lower abdominal pain. In the genital examination, a 8 cm tumor, friable protruding through the cervix, was found. Uterus was difficult to assess because the biotype of the patient. In the evolution presented metrorrhagia with hypovolemic shock. An emergency abdominal hysterectomy was performed. During the surgery an enlarged uterus such as pregnancy of 4 months was found. The cavity was completely occupied by friable tumor protruding through the cervix. The histopathological report showed a biphasic tumor with glandular tubule epithelial component without atypia. Hypercellular mesenchymal component, with small atypical cells and high rated of mitosis. Morphology suggests that even heterologous myeloid origin. High proliferation index (Ki67, 70%). We concluded it was a Mixed Mullerian tumor biphasic (adenosarcoma) with malignant mesenchymal component, highgrade undifferentiated. Conclusions: The myeloid adenosarcoma may occur in several anatomic sites, but at the genital tract is extremely rare. Most cases are preceded or occur concomitantly with acute myeloid leukemia. We report a case of a patient presenting with this histologic type of tumor, exclusively in the genital tract.