Objective To assess the efficacy of deferred surgery on fertility preservation in women with early ovarian malignancy discovered at laparoscopy.Methods Over a 3-year period, patients who had laparoscopic surgery for ovarian cysts underwent a defined protocol that included preoperative malignancy assessment, non-spillage laparoscopic technique and frozen-section histological determination. In a retrospective analysis, four cases of ovarian malignancy were found in reproductive age patients. Their staging laparotomy was deferred until after the final histological results were obtained. The avoidance of extensive surgery and achievement of pregnancy was considered to be a successful outcome.Results Deferring the staging laparotomy until after the final histological results informed us of the grading of the tumour and allowed us to avoid hysterectomy or removal of the contralateral ovary in cases of stage I, grade I tumours. Only one patient underwent hysterectomy. Two patients had wedge resection from the contralateral ovary, and one had bilateral ovariectomy. The latter three have already achieved pregnancy, including the patient with bilateral ovariectomy who had a successful IVF treatment with donor ova.Conclusion In cases of ovarian malignancy discovered at laparoscopy, deferring the staging laparotomy till after the final histological results may give the opportunity of preserving fertility as well as that of scheduling a gynaecological oncologist for the operation.

OBJECTIVE:To compare an operative and postoperative course of open vaginal cuff hysterectomy and closed vaginal cuff hysterectomy, and to correlate the length of stay, febrile morbidity and the incidence of pelvic fluid collections to the type of surgery.PARTICIPANTS:One-hundred women scheduled for hysterectomy were prospectively randomized into two groups that underwent either a closed or an open vaginal cuff technique.RESULTS:The open vaginal cuff technique took on average 19% more time than the closed vaginal cuff operation (P < 0.05, t-test). The incidence and size of pelvic fluid collections was significantly higher after the closed vaginal cuff hysterectomy than after the open technique (P < 0.01, t-test). However, the postoperative length of stay, febrile morbidity and the rate of complications were similar.CONCLUSIONS:Both techniques of hysterectomy produced a similar postoperative course despite the fact that the closed vaginal cuff technique resulted in a higher incidence of pelvic fluid collections. Therefore considering a shorter operation time for the closed vaginal cuff hysterectomy, this technique seems slightly preferable.

Abdominal wall vessel injury occurs with increasing frequency as the practice of laparoscopic surgery becomes wider and trocars become sharper. Precautions for avoiding vessels have been advocated and should be implemented at every laparoscopy. Nevertheless, injury of abdominal wall blood vessels occurs in approximately 2% of cases. Several methods of treatment have been advocated. We compared the efficacy and outcome of suturing and Foley catheter insertion for managing bleeding trocar sites. Both methods controlled haemorrhage effectively, but suturing took 11 min and involved two to four insertions of the needle, whereas the catheter was inserted and set to compress the trocar site in 30 s. Removal of the Foley catheter, 20–24 h later, did not renew the bleeding in any of the patients, and was not associated with aggravation of pain. We recommend that in most cases a Foley catheter should be used to stop bleeding of the abdominal wall.

Ultrasound in Obstetrics & GynecologyVolume 4, Issue 5 p. 355-357 OpinionFree Access New technologies in obstetrics and gynecology: the test of time I. E. Timor-Tritsch, Corresponding Author I. E. Timor-Tritsch Department of Obstetrics and Gynecology, Bnei Zion Medical Center, Haifa, IsraelDepartment of Obstetrics and Gynecology, Bnei Zion Medical Center, Haifa, IsraelSearch for more papers by this authorA. Condrea, A. Condrea Department of Obstetrics and Gynecology, Bnei Zion Medical Center, Haifa, IsraelSearch for more papers by this author I. E. Timor-Tritsch, Corresponding Author I. E. Timor-Tritsch Department of Obstetrics and Gynecology, Bnei Zion Medical Center, Haifa, IsraelDepartment of Obstetrics and Gynecology, Bnei Zion Medical Center, Haifa, IsraelSearch for more papers by this authorA. Condrea, A. Condrea Department of Obstetrics and Gynecology, Bnei Zion Medical Center, Haifa, IsraelSearch for more papers by this author First published: 1 September 1994 https://doi.org/10.1046/j.1469-0705.1994.04050355.xCitations: 2AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Citing Literature Volume4, Issue51 September 1994Pages 355-357 RelatedInformation