Abstract Objectives: To evaluate the association between preoperative ultrasound-based International Ovarian Tumor Analysis (IOTA) classification and postoperative histopathological diagnosis in women undergoing laparoscopy for presumed benign adnexal masses, and to describe perioperative outcomes, including cyst rupture/spillage, conversion to laparotomy, complications, and the rate of unexpected borderline or malignant pathology. Materials and Methods: This retrospective study included 425 women aged 15–49 years who underwent laparoscopic surgery for presumed benign adnexal masses at Aga Khan University Hospital, Karachi, from January 2015 to December 2023. Women with suspected malignancy or incomplete records were excluded. Preoperative assessment included imaging, tumor markers, and IOTA classification. Surgical outcomes, including intraoperative findings and final histopathology, were analyzed in relation to the preoperative assessment. Agreement between IOTA classification and histopathology was assessed using Cohen’s kappa (κ), and diagnostic performance measures were calculated using histopathology as the reference standard. A two-sided P < 0.05 was considered statistically significant. Results: The median age was 29 years, and 70.6% of participants were married. IOTA classification showed 95.53% concordance with final histopathology, with a specificity of 98.31% and a negative predictive value of 98.44%. Discordance occurred in 4.47% of cases. Hemorrhagic/endometriotic cysts (49.41%) and mature cystic teratomas (dermoid cysts) (20.24%) were the most common diagnoses. Intraoperative cyst rupture occurred in 41.88% of cases, and conversion to laparotomy was required in 0.71%. Postoperative complications were minimal. Unexpected malignancy was identified in 1.41% of cases and was managed appropriately. Conclusion: Laparoscopic management of presumed benign adnexal masses appears safe and effective, with high concordance between preoperative IOTA classification and final histopathology and a low complication rate. It remains a preferred minimally invasive approach that supports fertility preservation and enables timely management when unexpected malignancy is encountered.
Abstract Objectives: The objective is to describe reproductive outcomes following hysteroscopic adhesiolysis for intrauterine adhesions (IUAs) secondary to uterine artery embolization (UAE) and to discuss perioperative management and subsequent pregnancy complications. Materials and Methods: This retrospective study included nine women treated between 2006 and 2023 at a single tertiary center. UAE was performed for fibroids ( n = 3), postpartum hemorrhage ( n = 4), cervical pregnancy ( n = 1), and retained placental polyp ( n = 1). Adhesiolysis was conducted under transabdominal ultrasonographic guidance using scissor forceps. Postoperative management consisted of intrauterine device placement, estrogen therapy, and scheduled early second- and third-look hysteroscopies at 2 and 8 weeks postoperatively. Results: Five women had moderate, and four had severe adhesions according to the American Fertility Society (1988) classification. The mean interval between UAE and adhesiolysis was 51 months (range, 11–166). Surgery was performed once in eight patients and twice in one, with no cases of uterine perforation. All four women whose UAE indication was postpartum hemorrhage achieved pregnancy, three via assisted reproductive technology. There were three live births, all preterm cesarean deliveries, and two required hysterectomy for placenta accreta. One patient developed postoperative pulmonary embolism but recovered completely following treatment. Conclusion: Although limited by its small sample size and retrospective design, this study suggests that ultrasound-guided hysteroscopic adhesiolysis using scissor forceps, combined with early postoperative surveillance, can restore fertility even after UAE-related IUA. Vigilant prenatal monitoring is essential due to the high risk of placenta accreta spectrum.
Abstract We report a rare case of bilateral ovarian tumor resection using vaginal natural orifice transluminal endoscopic surgery (vNOTES) at 12 weeks of gestation. A 33-year-old primigravida presented with two cystic ovarian masses, wherein bilateral mature teratomas were suggested based on magnetic resonance imaging. Given the risks associated with the masses during pregnancy, vNOTES was the preferred surgical approach. The tumors were extracorporeally resected after aspiration through the posterior vaginal fornix. The postoperative course was uneventful, without complications. The patient delivered vaginally at 40 weeks without severe perineal injury. vNOTES enabled safe and direct access to the tumors without uterine manipulation or abdominal incisions. vNOTES offers advantages including reduced postoperative pain, shorter operative time and hospital stay, and lower complication rates compared with conventional transabdominal laparoscopy. In addition, during pregnancy, accessing lesions in the Douglas pouch and minimizing postoperative uterine contractions might be particularly useful.
Abstract Objectives: The objective of this study was to investigate the complications of hysterectomy. Materials and Methods: This retrospective cohort study was conducted at Tertiary Care Hospital and Institute of National Importance in Central India, including 310 patients, to analyze the complications associated with the hysterectomy. Medical records were obtained, and the demographic details, associated co-morbidities, surgical details, including indication, timing, and route of hysterectomy, were noted. Intraoperative and postoperative complications were noted. The data were collected, entered into a spreadsheet, and analyzed using statistical methods. Results: Majority of the patients were in the 40–49 years (mean of 47 years) age group, parous, premenopausal (69.7%), with associated comorbidities such as hypertension, diabetes, and obesity. Vaginal route was the most common (48.4%), followed by the abdominal (38.7%) and laparoscopic routes. The most common indications were abnormal uterine bleeding (45.2%) and uterine prolapse (36.8%). The common intraoperative complications were hemorrhage of > 1000 ml (5.8%), bladder injury (1.3%), bowel injury (0.65%), and conversion to laparotomy. The common postoperative complications were fever, urinary tract infections, paralytic ileus, deep venous thrombosis, wound/vault infections, burst abdomen, and urinary fistula. The complication rate was higher in abdominal than laparoscopic and vaginal hysterectomy (VH), leading to prolonged stay in hospital and intensive care unit admissions. Conclusion: Although hysterectomy is a common procedure in gynecology, it is accompanied by complications. VH was the preferred route, with minimal complications. The data can be used for patient counseling, surgical planning, and deciding treatment costs.
