Non-invasive prenatal testing (NIPT) identifies fetal aneuploidy by sequencing cell-free DNA in the maternal plasma. Presymptomatic maternal malignancies have been incidentally detected during NIPT based on abnormal genomic profiles. This low coverage sequencing approach could have potential for leimoyosarcoma screening in the non-pregnant population. Our objective was to investigate whether plasma DNA sequencing with a clinical whole genome NIPT platform can detect early- and late-stage high-grade leimyosarcoma compared to their benign controls. Case control study of prospectively-collected biobank samples comprising preoperative plasma from 4 women with metastatic leiomyosarcoma and 20 benign controls. Plasma DNA was sequenced using a commercial NIPT platform and chromosome dosage measured. Sequencing data were blindly analysed with two methods: (1) Subchromosomal changes were called using an open source algorithm WISECONDOR (WIthin-SamplE COpy Number aberration DetectOR). Genomic gains or losses ≥ 20 Mb were prespecified as “screen positive” calls, and mapped to recurrent copy number variations reported in cancer genome atlas; (2) Selected whole chromosome gains or losses were reported using the routine NIPT pipeline for fetal aneuploidy. We detected 1/4 cancer cases using the subchromosomal analysis (specificity 86% (95% CI 0.66-0.97)). All of the 20 benign controls did not have any subchromosomal gains ≥ 20 Mb. For the positive result in the leiomyosarcoma patient, the NIPT pipeline resulted in a gain in 1q, loss in 10p and 10q and loss of 13. Low coverage plasma DNA sequencing used for prenatal testing detected 25% of all leimyosarcomas, with all benign controls screening negatives. Our findings demonstrate the potential of a high throughput sequencing platform to screen for leiomyosacoma in plasma based on characteristic multiple segmental chromosome gains and losses. The performance of this approach may be further improved by refining bioinformatics algorithms and targeting selected cancer copy number variations. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

To determine if pre-operative endometriosis focused ultrasound (US) and Magnetic Resonance Imaging (MRI) combined with multidisciplinary meeting (MDM) improves the prediction for need for bowel resection at time of surgery compared to US or MRI alone.

Surgical treatment of DIE is complex and preoperative diagnosis benefits both surgeon and patient. Several studies have reported high accuracy for the TVUS diagnosis of DIE, however, these studies were performed by experts who developed these novel techniques. The clinical utility and external validity can only be determined if such results can be replicated by others. The aim of this study was to assess how fast this level of diagnostic accuracy could be achieved by other centers with no prior experience. Following 1 week of training with Dr Goncalves and Prof Abrao, who published their technique in 2009 [Goncalves et al. Int J Gynaecol Obstet. 2009;104:156], all TVUS in this study were performed by a single sonologist (SP). Patients with symptoms or a past history of endometriosis were referred for TVUS after minimal bowel preparation. The decision to perform surgery was based on clinical and imaging findings. When surgery was performed, the TVUS was compared with the laparoscopy to assess the accuracy of TVUS in the diagnosis of pouch of Douglas (POD) obliteration and bowel nodules. The results of this study were compared with previously published results. 205 consecutive patients referred for DIE-TVUS between Nov 2009 and Sep 2011 were included. Feedback was obtained for all patients. 85 patients underwent surgery. The prevalence of bowel nodules was 29% and of POD obliteration 40%. The results for the diagnosis of bowel nodules (sens 88%, spec 97%, PPV 92%, NPV 95%) and POD obliteration (sens 88.2%, spec 90%, PPV 85.7%, NPV 91.8%) compared well with published literature. The learning curve to diagnose POD obliteration and bowel nodules was only10 patients. After 1 week of training and a learning curve of 10 patients, TVUS in the hands of someone with general TVUS experience allows diagnosis of DIE with a similar diagnostic accuracy as published by centres of excellence. This study supports the proposition that DIE-TVUS should be performed routinely for patients who present with significant pain and/or infertility.

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The objective of this pilot study was to evaluate the extent to which laparoscopic gynaecological surgery could be completed as planned in overweight and obese patients versus patients of normal weight. A prospective surgical audit was conducted of 64 women undergoing laparoscopy for benign gynaecological conditions. Patients were grouped according to their body mass index (BMI). The number of attempts required for successful laparoscopic entry, the ability to identify key surgical landmarks, the ability to complete the planned surgery, the rate of conversion to laparotomy and the complication rates were recorded. Surgery was completed as planned in 95.31% of participants. Completion rates declined with increasing BMI. Increased entry attempts and an inability to identify key surgical landmarks were associated with increased BMI, although the sample size was insufficient to provide any statistically significant conclusions. The overall complication rate was 6.25%. There was a higher mean BMI in patients with a complication; however, there was insufficient data to show a significant difference. This study suggests an association between increasing BMI and increased entry attempts for laparoscopy, increased difficulty in surgical landmark identification and an overall reduction in completion of gynaecological laparoscopy as planned.

Study Objective: To assess and quantify whether laparoscopic gynaecological surgery could be completed as planned in overweight and obese patients versus patients of normal weight. The number of attempts at entry, the ease of identification of vital surgical landmarks, conversion to laparotomy and the complication rate were quantified. Design: A prospective surgical audit of 64 women undergoing laparoscopy for benign gynaecological conditions at the Mercy Hospital for Women during 2009. Patients: Women were grouped according to their BMI with 67.19% being overweight or obese. Intervention: 95.31% participants had their surgery completed as planned. The completion rate was highest (100%) in the group of women with a normal BMI however completion rates declined with increasing BMI due to poor surgical access to the pelvis. Measurements and Main Results: The percentage of women requiring more than one attempt at laparoscopic entry was highest in the morbidly obese group when compared with women in all other weight ranges. Ease of identification of the inferior epigastric arteries and ureters was measured qualitatively. An inability to identify these landmarks was associated with an increased BMI although the sample size was insufficient to provide any significant conclusions. The conversion rate to laparotomy was 1.56% in the study population. This occurred in an overweight patient (BMI 29.64) due to poor laparoscopic access. The overall complication rate was 6.25%. There was a higher mean BMI in patients with a complication (29.8) compared to the group with no complications (28.04) however there was insufficient data to show a significant difference. Conclusion: This pilot study suggests an association between increasing BMI and increased entry attempts for laparoscopy; increased difficulty in identifying key surgical landmarks and an overall reduction in completion of gynaecological laparoscopy as planned. A larger study will answer the question: Can planned laparoscopic surgery be successfully completed in the overweight and obese patient?

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Structured matrices: recent developments in theory and computation, edited by D. A. Bini, E. Tyrtyshnikov and P. Yalamov. Pp. 206. 2001. ISBN 1 56072 890 6 (Nova Science Publishers, Inc.). - Volume 88 Issue 513

Objective To assess the effects on patient discomfort of an intraabdominal passive gas drain left for four hours postoperatively following gynaecologic laparoscopic surgeryDesign A prospective randomised double-blinded placebo controlled trial.Setting University tertiary hospital and private hospital.Population or sample Eighty women having a laparoscopic gynaecological procedure for benign disease.Methods A drain was placed via the umbilical port at the conclusion of the surgical procedure and was removed four hours postoperatively. The researcher, assessor Visual analogue scale (VAS) to assess overall pain, shoulder and chest pain, abdominal pain, bloating and energy prior to surgery and at intervals up to five days postoperativelyResults and conclusions No complications were attributed to the presence and withdrawal of the drain tube. Shoulder pain following operative or diagnostic laparoscopy was significantly reduced for 12, 24, 48 and 72 hours by the presence of a patent passive gas drain for the first four hours postoperatively The drains were easy to use and had no associated morbidity We recommend that in the absence of the need for an active drain, all patients undergoing laparoscopy should have a gas drain inserted for a period of four hours after the completion of the procedure.

The medical records of all women who underwent hysterectomy for benign disease performed between 1986 and 1995 were reviewed to ascertain the incidence of morbidity and mortality of abdominal, vaginal, and laparoscopically assisted vaginal hysterectomy at a university teaching hospital. A total of 1940 hysterectomies were performed during this period; 74% of hysterectomies were performed abdominally, 24% vaginally and 2% were laparoscopically assisted. In 80% of the patients uterine leiomyomas, adenomyosis, dysfunctional uterine bleeding or uterine prolapse were the indications for hysterectomy The overall complication rate was 44% for abdominal hysterectomy (AH) and 27.3% for vaginal hysterectomy (VH). An unintended major surgical procedure was required in 3% and 1% of women undergoing AH and VH respectively The rate of return to the operating room for haemostasis was 0.6% for AH and 0.2% for VH. The AH group was four times more likely than the VH group to require surgical intervention (36% versus 9%) at readmission. Vaginal hysterectomy was associated with a lower febrile morbidity and minor complication rate. Prophylactic antibiotics reduced the febrile morbidity for VH and AH by 50% (Student's t-test, p = 0.02) and 40% (Student's t-test, p < 0.001) respectively The overall mortality rate was 1.5 per 1000.

The details of surgical techniques for laparoscopic removal of endometriosis and adenomyosis are described briefly in textbooks and gynaecological journal articles. We have described a wide variety of techniques for the various procedures required in the treatment of endometriosis and adenomyosis, excluding hysterectomy. The principles are based upon those used in removal of primary cancer lesions. The limitations of thermal ablation are discussed, and evidence of improved results after excision of lesions have been submitted for publication.

Intestinal involvement by endometriosis traditionally required open laparotomy for bowel resection and anastomosis. Operative laparoscopy may offer the most effective form of treatment for these women. Two women with endometriosis of the rectum and right hemicolon, respectively, underwent transvaginal resection of the rectum and laparotomy for hemicolectomy, assisted by laparoscopy. The only morbidity was postoperative ileus in the former patient. Both women were asymptomatic at the 6-week postoperative visit.

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Summary: An open prospective observational study was performed, aiming to measure symptom severity following operative gynaecological laparoscopy and explore any associated factors. Women having concomitant procedures were excluded. Each woman had standardized analgesia, completed a symptom diary for 7 days postoperation, and had a standardized form completed by the surgeon detailing the operation. Back pain, nausea and vaginal pain were found to not be of clinical significance. Cutting major vessels, ligaments, vagina or ovary had major impacts on postoperative symptoms. In the presence of a standardized analgesic regimen, symptoms did not resolve for at least 5 days.

Large bowel perforation associated with laparoscopic surgery is a serious complication but even if suspected, it may prove difficult to find and therefore treat. Five interesting cases are reported.