The indications and complications of laparoscopic myomectomy were evaluated with regard to its limitations, benefits and feasibility. Surgical technique with related difficulty was also reported. From a population of 89 patients, a total of 104 myomas were removed laparoscopically. A retrospective study was carried out of 54 patients with myomas >3 cm. Indications for surgery were pain or abnormal bleeding (37%), increase in size of the myoma in infertile patients (48.1%) and infertility requiring assisted reproductive technology (14.9%). A total of 57 myomas >3 cm were removed from these patients. The number of myomas per patient varied from 1 to 4. The myomas were intramural (n = 34), subserosal (n = 19) and submucosal (n = 4). The size of the dominant myoma ranged from 3-8 cm (mean 4.16). In all cases the uterine wall was sutured either in one (n = 42) or two planes (n = 15) depending on the depth of the myometrial defect. The laparotomy conversion rate was 1.8% (n = 1); mean blood loss was 84 ml; average hospital stay was 2.09 days and the overall complication rate was 1.8%. Five patients went on to conceive; the pregnancy was uneventful and proceeded to Caesarean section at 38 weeks. No adhesions at myomectomy sites were observed in these patients. At 6 months follow-up, 18 out of 20 patients with pain or haemorrhagic disorders prior to surgery showed remission of their complaints. Our study confirms the feasibility of laparoscopic myomectomy as a technique leading to a low complication rate and remission of symptoms. At the present time, statistically significant data concerning post-surgical adhesion formation or pregnancy outcome are not available.

We report a series of eight cases of ovarian pregnancy treated by operative laparoscopy during the last 12 years. This rare ectopic pregnancy (2.6% of all extra-uterine pregnancies in our experience) is difficult to diagnose prior to surgery. Earlier diagnosis is now possible, owing to the availability of highly specific radioimmunoassay for human chorionic gonadotrophin and the development of transvaginal ultrasonography. Primary ovarian pregnancy is distinguished by some authors from distal tubal pregnancy, in which a secondary ovarian implantation is possible. The therapy is surgical and currently more conservative than in the past, because of improvement in operative laparoscopy. Laparoscopy allows a short hospital stay, less physical stress and a favourable cost-benefit ratio. Moreover, its low risk of adhesion formation is important with regard to reproductive prognosis: in the light of this, since the patients are generally young and desire future childbearing, laparoscopy may be the treatment of choice.

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Cases of giant mucinous ovarian borderline tumors are rarely described in literature, with different clinical manifestations and difficult diagnostic assessment. In the present paper we report the case of a 60 years old woman with a giant mucinous borderline left ovarian tumor (>34 cm in maximum diameter) with 15.000 ml of free fluid inside. Laparotomic approach is usually preferred in these cases, but it exposes patients to higher rate of complications. We demonstrate that laparoscopy is safe and effective in managing large adnexal masses more than 30 cm in diameter.

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