Current treatments for female pelvic floor dysfunctions Mun- Kun Hong, Dah- Ching Ding Gynecology and Minimally Invasive Therapy 2019 8(4):143-148 As global population aging, the issue of pelvic floor dysfunctions becomes increasingly. Millions of women were affected every year. The treatment of pelvic floor dysfunction has evolved in the past decade. This review aims to provide the current information on the treatment for female pelvic floor dysfunction, including pelvic organ prolapse (POP), urinary, fecal incontinence (FI), and myofascial pelvic pain among women. We used PubMed, Embase, and Web of Science to search for studies that were related to pelvic floor dysfunction regarding the POP, urinary, FI, and treatments. The development of laparoscopic surgery and synthetic and biological materials for pelvic floor reconstructive surgery were summarized. The surgical outcomes and complications of different pelvic floor reconstructive surgeries were compared. New devices for FI and the potential modified pelvic floor reconstructive surgery were also discussed here. Female pelvic medicine will continue to evolve for better treatment in the future. The pelvic floor reconstructive surgery tends to be minimally invasive approach with synthetic graft use.

The management of heterotopic pregnancy with transvaginal ultrasound-guided local injection of absolute ethanol Conghui Liu, Hong Jiang, Feng Ni, Ying Liu, Wenxiang Zhang, Cuie Feng Gynecology and Minimally Invasive Therapy 2019 8(4):149-154 Aims: The aim of the study is to present five cases of heterotopic pregnancy (HP) patients who received transvaginal ultrasound-guided local injection of absolute ethanol (AE). Settings and Design: This was a case series and literature review in Reproductive Medicine Center of the 105th Hospital of the People's Liberation Army. Materials and Methods: Five primary infertile women who underwent assisted reproductive technology were diagnosed with HP and treated with local injection of AE (1.0–2.5 ml) under transvaginal ultrasound guidance. The size of intrauterine (IU) and ectopic sacs and the level of serum beta-human chorionic gonadotropin as well as pregnancy outcomes were monitored after treatment. Statistical Analysis Used: Not applicable. Results: Four of five cases presented with lack of Doppler flow in the injected area after AE injection. Meanwhile, IU pregnancy proceeded well after treatment and delivered a normal newborn. One case received emergency surgery 3 h after local injection of 2.5 ml AE because of the rupture of ectopic gestational sac (GS). An early abortion was identified 7 days after the surgery. Conclusions: Transvaginal ultrasound-guided local injection of AE is an alternative nonsurgical treatment for HP, yet overdose injection of AE will increase the risk of ectopic GS rupture.

Comparison between laparoendoscopic single-site and conventional laparoscopic surgery in mature cystic teratoma of the ovary Myeong Seon Kim, Chel Hun Choi, Jeong- Won Lee, Byoung- Gie Kim, Duk- Soo Bae, Tae- Joong Kim Gynecology and Minimally Invasive Therapy 2019 8(4):155-159 Objective: The objective of the study is to compare the intra- and post-operative outcomes of laparoendoscopic single-site surgery (LESS) and conventional laparoscopic surgery (CLS) in mature cystic teratoma (MCT) of the ovary. Methods: We reviewed 254 patients who underwent surgery (cystectomy) for ovarian MCT from March 1, 2014, to August 31, 2016. During the study period, 216 patients underwent LESS and 38 patients underwent CLS. The outcome measures included operation time, estimated blood loss, changing hemoglobin (Hb) level, postoperative pain, and complications. Statistical analysis was performed using SPSS 24. Results: There was no statistically significant difference in age, body mass index, sexual experience, cyst size, operative time, adhesiolysis, preoperative Hb, Hb changes, postoperative pain scores (visual analog scale), hospital days, and complications between the two groups. In emergent situation, the frequency of CLS was high as three cases (7.9%) versus one case (0.5%, P = 0.007) with LESS. As the year progressed, the frequency of LESS increased. There were one case of re-operation for bleeding control and transfusion, one case of postoperative peritonitis and transfusion, and one case of postoperative transfusion in LESS. During LESS, additional port(s) was/were created in 13 cases (6.0%, P = 0.249). Conclusions: LESS is not inferior to CLS in MCT surgery, and LESS is useful for the surgery of MCT. Our study demonstrates that LESS confers feasibility, convenience, and safety regarding cystectomy of MCT.

Deep sedation or paracervical block for daycare gynecological procedures: A prospective, comparative study Nishant Sahay, Mukta Agarwal, Mamta Bara, Nutan Raj, Divendu Bhushan Gynecology and Minimally Invasive Therapy 2019 8(4):160-164 Context: Many minor gynecological procedures are done for diagnostic and therapeutic reasons. A balance has to be struck between ability to discharge a patient at the earliest with minimum procedure-related discomfort to ensure patient safety as well as satisfaction. Aim: This prospective randomized study was designed to compare deep sedation versus paracervical block for minor gynecological surgeries comparing the time to discharge readiness, pain after the procedure, and overall patient satisfaction. Setting and Design: This prospective randomized comparative study was conducted at a tertiary level hospital after institutional ethics committee approval and registry of trial at CTRI (India). Methods: Seventy young women underwent minor gynecological procedures under these two modes of anesthesia. Time to discharge readiness from hospital to home was assessed using modified postanesthesia discharge score system (PADSS). Pain after procedure as well as patient satisfaction was evaluated. Patients were also asked whether they would recommend the same anesthetic technique for the procedure in the future. Answers were noted on a Likert scale. Results: Patients were ready to be discharged faster in deep sedation group compared to paracervical block group based upon modified PADSS score (1 h 9.6 min vs. 1 h 18 min) (P = 0.005). Pain in the perioperative period was analyzed using repeated-measures ANOVA and found to be significantly lesser in deep sedation group when considered till 80 min after surgery. The mean satisfaction score in patients who underwent deep sedation was 91.24 (standard deviation [SD] 2.8) compared to patients given paracervical block which was low at 64.67 (SD 15.8). All patients given deep sedation were ready to recommend the anesthesia technique as compared to only 53.3% of patients who were given paracervical block. Conclusions: Deep sedation may be preferred over paracervical block for daycare minor gynecological procedures.

Evaluation of uterine artery embolization on myoma shrinkage: Results from a large cohort analysis Talshyn Ukybassova, Milan Terzic, Jelena Dotlic, Balkenzhe Imankulova, Sanja Terzic, Fariza Shauyen, Simone Garzon, Luopei Guo, Long Sui Gynecology and Minimally Invasive Therapy 2019 8(4):165-171 Objective: There are still contradictory opinions on the success rates of uterine artery embolization (UAE) for the treatment of myomas. In this scenario, our study aims to assess the effect of UAE on myoma shrinkage. Materials and Methods: The study included 337 women in reproductive age affected by a single symptomatic intramural myoma and declined surgery, undergoing UAE. The uterus and myoma diameters and volumes were determined on ultrasonographic scans before and 3, 6, and 12 months after the procedure. Results: The mean uterine volume before intervention was 226.46 ± 307.67 mm3, whereas myoma volume was 51.53 ± 65.53 mm3. Further myoma progression was registered in only four patients. In remaining women, uterus volume in average decreased for 149.99 ± 156.63 mm3, whereas myomas decreased for 36.57 ± 47.96 mm3. The mean volume reduction rate of the uterus was 49.54 ± 35.62 and for myoma was 57.58 ± 30.71. A significant decrease in both uterine and myoma volume was registered in every stage of the follow-up. The highest average decrease in uterine volume was in the first 3 months and myoma volume between 3 and 6 months following UAE. After 12 months follow-up, successful outcome (volume regression >50% respect to the baseline) was registered for uterus in 97.4% and for myoma in 67.9% of investigated patients. Conclusion: UAE was proven to allow a good success rate and can be considered as an effective alternative procedure for myoma treatment.

Laparoscopic Repair for Vesicoperitoneal Fistula with Vesicouterine Abscess Tamaki Yahata, Eiji Boshi, Kazuhiko Ino, Takenori Nishi Gynecology and Minimally Invasive Therapy 2019 8(4):172-175 Vesicoperitoneal fistula (VPF) is a rare form of urogenital fistulas. It is usually associated with an accidental trauma or iatrogenic injury including postoperative complications. Although it is difficult to heal the fistula conservatively, a laparoscopic repair is one of the effective methods. We report a case of VPF with vesicouterine abscess and repaired it laparoscopically. The transvaginal sonography showed the vesicouterine abscess, and a cystoscopy revealed a fistula between the vesicouterine abscess and the bladder. The abovementioned condition was confirmed at the time of laparoscopic surgery, and the fistula tract was closed laparoscopically.

Incidental finding of an accessory ovary at laparoscopic surgery Toshio Fujimoto, Keiko Tanaka, Kyoko Yamada, Kenji Shimahata Gynecology and Minimally Invasive Therapy 2019 8(4):176-178 An accessory ovary is one of the rare gynecologic abnormalities of the female genital tract. The etiology of accessory ovary has been reported to be acquired origin, such as postsurgical or postinflammatory implants, and true embryologic origin. However, as in the present case with unremarkable medical history and no urogenital abnormalities, there are accessory ovaries that cannot be explained by these etiologies. In such cases, the etiology of accessory ovary might possibly be torsion of functional ovarian cyst during the fetal period or asymptomatic torsion of the functional ovarian cyst at some time after birth.

Extragonadal giant endometrial cyst with endometrioid borderline tumor Hiroyuki Yazawa, Karin Imaizumi, Asami Kato, Kaoru Takiguchi Gynecology and Minimally Invasive Therapy 2019 8(4):179-184 We describe an extremely rare case of a borderline tumor arising from an extragonadal giant endometrial cyst. A 41-year-old woman complaining of abdominal pain was referred to our hospital with a diagnosis of large ovarian tumor. Magnetic resonance imaging revealed a large cystic tumor approximately 27 cm × 9 cm in area. The cyst contents were largely removed by suction, and then the tumor was resected laparoscopically. Both adnexa were normal in size and location. The tumor did not originate from the ovaries, and it was adherent only to the bilateral uterosacral ligaments and uterine body. The postoperative histopathological evaluation confirmed the presence of endometrioid borderline tumor with transition from endometriosis. Staging laparotomy was performed, and no remnant tumor was detected. This case is extremely unusual because such a large cystic tumor originating from extragonadal endometriosis is very rare, as is endometrioid borderline tumor arising from endometriosis.

Successful pregnancy outcome immediately after methotrexate treatment for cesarean section scar pregnancy Ibrahim A Abdelazim, Mohannad Abu-Faza, Gulmira Zhurabekova, Svetlana Shikanova, Sakiyeva Kanshaiym, Bakyt Karimova, Mukhit Sarsembayev, Tatyana Starchenko Gynecology and Minimally Invasive Therapy 2019 8(4):185-187 A 27-year-old cesarean section scar pregnancy (CSSP) case diagnosed by the vaginal ultrasound which showed gestational sac located in the lower uterine anterior quadrant close to the site of the previous scars (with yolk sac inside) with β-hCG 15,373 mIU/ml in September 2017 was managed by intramuscular (IM) multidose methotrexate (MTX). The studied woman discharged home when the β-hCG decreased to 11,630 mIU/ml on the 1st week after the first MTX dose. On the 5th week after the first dose of IM-MTX, the β-hCG dropped to zero and the gestational sac completely disappeared. She was counseled about the risk of pregnancy in the first 6 months after the MTX and the possibility of the CSSP recurrence. She presented on December 16, 2018, with preterm delivery at 35 weeks' gestation. After delivery, her neonate admitted to the neonatal intensive care unit (NICU) due to mild respiratory distress and discharged from the NICU on the 4th day in good condition. Multi-dose MTX regimen for the treatment of CSSP supported by many authors with follow-up by β-hCG and vaginal ultrasound. This report highlights the successful outcome immediately after the proper management of CSSP cases.

A case of synchronous primary corpus and ovarian cancer with pseudo-meigs syndrome: Utilization of a diagnostic laparoscopy for the accurate diagnosis Shimpei Shitanaka, Koji Yamanoi, Jumpei Ogura, Tsutomu Ohara, Yoshihide Inayama, Takahiro Hirayama, Mie Sakai, Haruka Suzuki, Koji Yasumoto, Koh Suginami Gynecology and Minimally Invasive Therapy 2019 8(4):188-191 We report a case of synchronous primary corpus and ovarian cancer (SPC) with massive ascites due to Pseudo-Meigs syndrome (PMS). A 48-year-old woman presented with complaints of abnormal genital bleeding and abdominal discomfort. Massive ascites and tumors in the endometrium and right ovary were detected. Although imaging tests showed no evidence of dissemination, and ascites cytology was negative, we performed a diagnostic laparoscopy to exclude the possibility of microdissemination because pathological findings of the corpus tumor were suggested to be so-called Type-2 endometrial cancer. Laparoscopy clearly confirmed no dissemination in the peritoneum. We ultimately diagnosed this patient with SPC with massive nonmalignant ascites due to PMS and performed an appropriate treatment. This report is the first case of SPC that developed PMS.