Precarious preoperative diagnostics and hints for the laparoscopic excision of uterine adenomatoid tumors: two exemplary cases and literature review

Alkatout, İbrahim; Bojahr, Bernd; Dittmann, Linda; Warneke, Viktoria; Mettler, Liselotte; Jonat, W.; Schollmeyer, Thoralf

doi:10.1016/j.fertnstert.2010.10.017

Cited by 14 publications

(4 citation statements)

References 15 publications

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“…Patients undergoing laparoscopic procedures must be informed of the risks and potential complications as well as alternative surgical methods. Counseling before laparoscopy should include a discussion of the entry technique used and the risks associated with laparoscopic entry 1 , 2 : injury to the bowel; the urinary tract; blood vessels; omentum; and other surrounding organs. Potential complications at a later point in time include wound infections, pain due to adhesions, and the formation of hernias.…”

Section: Counseling and Informed Consentmentioning

confidence: 99%

Complications of Laparoscopy in Connection with Entry Techniques

Alkatout

2017

Journal of Gynecologic Surgery

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The anatomy of the human being has not changed. However, technical developments in operating materials and methods call for improvements in surgical procedures as well as the management of complications. A fundamental distinction between any operating method and laparoscopy is that, in the latter, the initial entry is usually performed in blind fashion. Blind entry may result in vessel or organ damage, especially in patients who have undergone previous surgery. One of the difficulties associated with the entry is that the damage may not be identified immediately and then necessitate major abdominal repair. Furthermore, the improvement of surgical instruments and techniques enables the surgeon to perform even major operations by the laparoscopic approach. This is associated with renewed learning curves and a high rate of complications due to vascular, bowel, uterine, or bladder damage. The improvement of surgical techniques must be accompanied by advancements in the management of complications. The aim of this review is to address the risks of laparoscopy as well as their correct and professional management. (J GYNECOL SURG 33:81)

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Section: Counseling and Informed Consentmentioning

confidence: 99%

Complications of Laparoscopy in Connection with Entry Techniques

Alkatout

2017

Journal of Gynecologic Surgery

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“… 7 , 9 In addition, because adenomatoid tumor is densely adherent to the surrounding myometrium without capsule, it may be difficult to enucleate and surgeons should modify the procedure during laparoscopic tumor resection under the diagnosis of leiomyoma. 10 , 11 Therefore, it is important to differentiate adenomatoid tumor from leiomyoma for the adequate treatment. The purpose of this study is to evaluate the MRI findings of adenomatoid tumor for the differentiation from leiomyoma.…”

Section: Introductionmentioning

confidence: 99%

MR Imaging Findings of Uterine Adenomatoid Tumors

et al. 2024

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Purpose: Adenomatoid tumor is a rare benign genital tract neoplasm of mesothelial origin. Uterine adenomatoid tumors occur in the outer myometrium and may mimic leiomyomas. Because hormonal treatment is not applicable to adenomatoid tumors and laparoscopic enucleation is not easy as myomectomy, it is important to differentiate adenomatoid tumors from leiomyomas for the adequate treatment. The purpose of this study is to evaluate the MRI findings of adenomatoid tumor for the differentiation from leiomyoma.Methods: MRI findings of surgically proven 10 uterine adenomatoid tumors in 9 women were retrospectively evaluated with correlation to histopathological findings.Results: All 10 tumors appeared as solid myometrial masses and showed heterogeneous signal intensity with admixture of partially ill-defined slight high-intensity areas containing abundant tubular tumor cells and well-defined myoma-like low-intensity areas reflecting smooth muscle hypertrophy on T2WI including 4 lesions with peripheral ring-like high intensity. High-intensity areas on T2WI tended to show high intensity on diffusion-weighted imaging (DWI) with relatively high apparent diffusion coefficient (ADC), suggesting T2 shine-through effect due to abundant tubules. Intra-tumoral hemorrhage revealed on MRI was rare. Early intense contrast-enhanced areas on dynamic contrast-enhanced study were observed dominantly within the high-intensity areas but rarely within the low-intensity areas on T2WI. Conclusion:The outer myometrial mass with the admixture of well-defined low-and ill-defined highintensity areas on T2WI may be suggestive of adenomatoid tumor. Peripheral ring-like high intensity on T2WI and DWI may also be suggestive. Dynamic contrast-enhanced MR study may be helpful for the differentiation from leiomyoma.

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“…The goal of surgical endometriosis therapy is to relieve pain, restore pelvic anatomy, and improve fertility. Thus, optimal therapeutic management includes resection of all endometriosis lesions and long-term treatment by avoiding persistence of endometriosis lesions [13][14][15][16][17]. Double-J (DJ) stent insertion is recommended as a preoperative preparation for better intraoperative visualization of the ureters, especially in cases of deep infiltrating endometriosis of the genitourinary tract [12].…”

Section: Introductionmentioning

confidence: 99%

Are double-J stents in surgery for deep infiltrating endometriosis always necessary? A retrospective analysis.

Piriyev¹,

Schiermeier²,

Römer³

2022

Videosurgery and Other Miniinvasive Techniques

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Introduction:The therapy of deep infiltrating endometriosis places the highest demands. Double-J (DJ) stent insertion is recommended preoperatively. However, we could not find any publication in PubMed that showed the relevant advantages of double-J stent insertion in surgery of deep infiltrating endometriosis (DIE). Aim: To report the advantages and disadvantages of inserting double-J stents in surgery for deep infiltrating endometriosis. Material and methods: All patients who underwent surgery for deep infiltrating endometriosis at Academic Hospital Cologne Weyertal (a level III endometriosis center with up to approximately 900 endometriosis laparoscopic procedures annually) between January 2017 and September 2021 were included in this retrospective analysis. A total of 197 cases were included. The urinary tract complications were analyzed and they were divided into infections, pyelonephritis, urosepsis, intraoperative and postoperative ureteral lesions. Patients were divided into three groups: 1) with DJ stents in whom DJ stents were left in place postoperatively for at least 2 weeks, 2) with DJ stents in whom DJ stents were removed directly at the end of the surgery, 3) without DJ stents. Results: There was a significant difference between all three groups in urinary tract complications: group 1 -32%, group 2 -11.6% and group 3 -7%. The p-value of 0.01 shows statistical significance between group with DJ stents and the group without DJ stents. Urinary tract infection occurred in 25.5% in the first group, 11.6% in the second group and 3.6% in the third group. Here, too, the p-value shows statistical significance between the group with DJ stents and the group without DJ stents. Ureteral injury, on the other hand, occurred rarely and no statistically significant difference was found between group 3 and the total population, 3.6% versus 2.5%. In group 1, the injury rate was minimally higher, 6.4%. After comparing groups 1 and 2 with group 3, there was also no significant difference in ureter injury (6.4% vs. 3.6%, p = 0.42). Conclusions: The authors of this study recommend that DJ stent insertion should not be part of the general preoperative preparation.

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Precarious preoperative diagnostics and hints for the laparoscopic excision of uterine adenomatoid tumors: two exemplary cases and literature review

Cited by 14 publications

References 15 publications

Complications of Laparoscopy in Connection with Entry Techniques

Complications of Laparoscopy in Connection with Entry Techniques

MR Imaging Findings of Uterine Adenomatoid Tumors

Are double-J stents in surgery for deep infiltrating endometriosis always necessary? A retrospective analysis.

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