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We report a rare case with the late occurrence of growing teratoma syndrome (GTS). A 24-year-old woman with Grade 3 immature teratoma of ovary underwent complete surgery and chemotherapy. Nineteen years later, she developed hematuria and pelvic mass that was completely resected and pathology revealed mature cystic teratoma. She has regularly followed up with tumor marker and computed tomography every three months. No evidence of disease has been detected throughout 14 years. In addition, we present a brief review of literature of ovarian GTS in the last decade. We have found that advanced stage, high grade, or early recurrence of germ cell tumor (GCT) could be the risk factors of GTS. It tends to appear within 1 year if the patients had the incomplete resection of primary disease. We stress the importance of long-term follow-up after treatment GCT to early recognition and treatment.

Background: Placenta previa carry high morbidity and mortality due to massive hemorrhage occur during surgery. So, there should be a standard surgical approach with less morbidity. Methods: This is a retrospective study that reviewed all deliveries in Al-karak governmental hospital between 2019–2022. Placenta previa cases were divided into two groups according to management. Group A was managed by incising the uterus at the level of fundus to avoid opening through the placenta, while Group B was managed by opening the lower uterine segment and delivering the baby through placenta after incising it. Result: This study included 26 cases of placenta previa, 12 of them (Group A) were managed by avoiding the placenta and the other 14 cases (Group B) were managed by opening through the placenta. There was no difference between the two groups in terms of age and the number of previous caesarean sections (table 1). Patients who underwent the suggested surgical approach (Group A) had less blood loss (Mdn = 775 cc) while Group B (Mdn = 1700 cc) U = 20.0 p = 0.001 was significantly higher in terms of blood loss. Similarly, the number of blood units given for Group B (Mdn = 5 units) was significantly higher than Group A (Mdn = 1 unit) U = 29.5. p = 0.005. lastly, the duration of hospital stay for Group A (Mdn = 2 days) was significantly less than Group B (Mdn = 6 days) U = 10.0. p = 0.000 Conclusion: Incising the upper uterine segment to avoid the placenta may have better outcome regarding blood loss and its consequences.

Aim: To describe techniques used in our setup as an aide to completion of colpotomy in total laparoscopic hysterectomy (TLH), in situations where usage of a uterine manipulator is not feasible. Background: Over the years, various uterine manipulators have flooded the markets to make the step of colpotomy easier. But there are certain conditions that render the usage of manipulators impossible like narrow vagina, virgin women, retracted or pulled up cervix, and non availability of advance manipulators due to financial constraints. Performing TLH in these conditions is challenging, and certain technical innovations aid in ensuring safe completion of the surgery. Technique: We describe the techniques utilizing a gauze on the sponge holder to delineate the cervicovaginal junction. The anterior approach, posterior approach, approach through uterosacral ligament, and cardinal ligament are described for completion of colpotomy. Conclusion:In situations where the application of vaginal manipulators is not feasible, certain technical modifications and varying approaches to the cervicovaginal junction can aid in the successful completion of colpotomy in TLH. Clinical significance: Vaginal manipulator is a useful instrument in laparoscopic hysterectomy. It manipulates the uterus in cephalad, lateral, and anteroposterior directions, making surgical steps in laparoscopic hysterectomy easier and quicker to perform. Its vital role in safely delineating anatomical landmarks like a uterocervical junction, uterosacral ligaments, and ureter cannot be denied. However, there are certain circumstances where the vaginal route is not accessible, and insertion of a uterine manipulator becomes impossible. In these circumstances, the surgeon should know the other options that help in opening the cervicovaginal junction so that he can complete the surgery safely. Our techniques provide an aid for such difficult situations.