No abstract

To present a technique to correct the misplacement of tape during laparoscopic cervical cerclage. Catching and introducing the wrong needle resulted in a knot formed around the right adnexa. Design:Step-by-step demonstration of the mistake and the technique to correct it. Setting: A patient para 0+V (V corresponds to 5) with cervical insufficiency was managed with laparoscopic interval cerclage [1 −3]. The patient's 2 most recent pregnancies had been managed with emergency transvaginal cerclage, which failed to prolong her gestation beyond 24 weeks. Interventions: Before the cerclage procedure a 2.0 £ 0.8-cm deep endometriotic nodule was excised. Both curved needles were straightened extracorporeally, and the tape was dropped inside the peritoneal cavity. The first needle was introduced successfully through the right side. After insertion of-what was believed to be-the same needle through the left side following the opposite direction, it was discovered that a tight knot had been formed around the right adnexa (Fig. 1). To avoid complete removal, the needleless tape was pulled back completely from the right side (Supplemental Fig. 1), and this end was stitched to a straight needle 2-0 polyglactin suture. The much thinner needle passed easily through the already created path, along with the tape (Supplemental Fig. 2), and the procedure was completed as planned (Supplemental Fig. 3). Conclusion:When performing laparoscopic cervical cerclage with the tape and needles inside the abdomen, it is important to keep both under constant view. In the event of misplacement, no need to completely remove the tape. The tape's cut end can still be reintroduced successfully, stitched to a straight needle suture.

Aim To examine the influence of mechanical bowel preparation on surgical field visualization and patients' quality of life during benign gynecologic laparoscopic procedures. Methods A single blind, randomized, controlled trial was undertaken with laparoscopic gynecologic surgical patients to one of the following three groups: liquid diet on the preoperative day; mechanical bowel preparation with oral polyethylene glycol (PEG) solution; minimal residue diet for 3 days. Primary outcomes included assessment of the condition of small and large bowel and the overall quality of the surgical field. Additional measures included assessment of patients' preoperative symptoms, tolerance of the preparation method and compliance to the protocol, postoperative symptoms and bowel function. Results One hundred forty‐four patients were randomized as follows: 49 to liquid diet, 47 to mechanical bowel preparation, and 48 to minimal residue diet. Most characteristics were similar across groups. The intraoperative surgical view and the condition of large and small bowel were equal or inferior at the patients who received mechanical bowel preparation compared with the other groups. The 4‐point Likert scale scoring for small bowel (2.51 vs. 2.72 vs. 2.81, p = 0.04), large bowel (2.26 vs. 2.38 vs. 2.48, p = 0.32) and overall operative field quality (2.34 vs. 2.67 vs. 2.67, p = 0.03) demonstrated no advantage from the use of preoperative mechanical bowel preparation over liquid diet and minimal residue diet, respectively. Preoperative discomfort was significantly greater in the mechanical bowel preparation group. Conclusion Mechanical bowel preparation before gynecologic laparoscopic operations for benign pathology could be safely abandoned. Clinical Trial Registration ISRCTN registry, https://doi.org/10.1186/ISRCTN59502124 (No 59502124).