Gynäkologie und Geburtshilfe
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Nicht diagnostizierte Adnextumoren: Können sie durch eine laparoskopisch unterstützte Kolpotomie behandelt werden?

Hend S. Saleh, Azza A. abd El Hameid, Hala E. Mowafy und Walid A. Abdelsalam

Laparoscopic procedures were moved ahead in management of gynecological problems. Improving the skill makes rate of complications of this procedure is low. Recently, it is believed the chosen practice for delighting adnexal Lesions. As Posterior colpotomy is applied only in laparoscopic hysterectomy. So, this study aimed to evaluate the safety and potential advantages of laparoscopy when assisted by colpotomy for organization of undiagnosed masses in adnexa through estimation of intraoperative events such as estimated blood loss, operative time and complications also postoperative pain and complications.

Patients and methods: Retrospective study on 200 patients underwent laparoscopy assisted by colpotomy for managing an adnexal mass From December 2011 to November 2014. At laparoscopic unit of Zagazig University Hospitals 190 cases had completed procedure. Laparoscopy was renovate to open surgery because of practical complexities in inclusion in 6 case, in other 3 cases due to dense adhesions intra abdominally and one case as a result of bleeding which was so difficult to be managed securely by laparoscopy.

Results: Our study consisted of 200 women underwent laparoscopy due to adnexal mass which was diagnosed clinically benign and assisted by colpotomy for removal of adnexal mass. The average operative time was estimated statistically by the mean =75 minutes (SD ± 19), and the blood loss was estimated by median 40 mL (range 10-200). Pain scores on a 10 cm visual analog scale showed estimated mean time of pain by hour is 1.4 hour (1.6), ±1.9 hour (±1.8) and 0.6 hour (±1.3) for 1 hour, 3 hour assessment and 24 hours after incision closure. Histopathologically showed endometriosis was the most common as diagnosed in (%35.7), Dermoid in (%27.3), Cystoadenoma in (%13.1), Ovarian fibroma in (%8.9), Functional cysts in (%6.8), paraovarian in (%3.1), Malignant ovarian tumor in (%2.6) and Border cell tumor in (%2.1).

Conclusion: The advancement of laparoscopic procedure enhanced the management of most cases of the adnexal masses after careful evaluation assisted by colpotomy and so, offering the potential for safe, effective and minimally invasive initial surgical evaluation.