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Novel technique of extracorporeal intrauterine morcellation after total laparoscopic hysterectomy: Three emblematic case reports

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World Journal of Clinical Cases 2021年第20期9卷 5655-5660页

作者： Antonio Macciò elisabetta sanna Fabrizio Lavra Piergiorgio Calò Clelia Madeddu Department of Gynecologic Oncology Businco HospitalARNAS G.BrotzuCagliari 09100Italy Department of Surgical Sciences University of CagliariCagliari 09100Italy Department of Medical Sciences and Public Health University of CagliariCagliari 09100Italy

BACKGROUND In the presence of a large uterus,total laparoscopic hysterectomy(TLH),always requires morcellation to allow removal of the tissues from the abdominal ***,uncontained morcellation has been scrutinized because of the possible spread of occult ***,in-bag extracorporeal morcellation has been ***,tissue containment and extraction are extremely challenging,especially when considering the increasing uterine size to be removed through minimally invasive *** SUMMARY Herein,we describe a novel technique for extracorporeal intrauterine morcellation using the uterus outermost layer as a bag to achieve tissue extraction of very large uteri with suspected occult leiomyosarcoma after *** study enrolled patients who were planned for TLH for large uteri(weight>500 g).TLH was performed following the procedure reported in our previous *** novel technique has been described step-by-step in a video,which representatively describes the preoperative imaging and morcellation procedure of three very large uteri weighing 1500 g,1700 g,and 3700 g,*** procedures were performed without any *** patients had an uneventful postoperative course,and in all cases,the pathology was benign *** Extracorporeal intrauterine morcellation using the uterus outmost layer as a bag was found to be a feasible technique that allows a careful diagnosis and safe removal of suspected occult *** technique herein presented may be adopted in surgical practice,by adding it to the other available techniques of contained *** may represent a valid and feasible alternative,especially useful in cases of very large uteri exceeding the capacity of specimen retrieval bags.

关键词： Laparoscopy Minimally invasive surgery Morcellation myomas Large uterus Total laparoscopic hysterectomy Case report

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Laparoscopic management of a giant mucinous benign ovarian mass weighing 10150 grams:A case report

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World Journal of Clinical Cases 2020年第16期8卷 3527-3533页

作者： elisabetta sanna Clelia Madeddu Luca Melis Sonia Nemolato Antonio Macciò Department of Gynecologic Oncology Azienda Ospedaliera BrotzuCagliari 09100Italy Department of Medical Sciences and Public Health University of CagliariMonserrato 09042Italy Department of Nuclear Medicine Azienda Ospedaliera BrotzuCagiari 09100Italy Department of Pathology Azienda Ospedaliera BrotzuCagliari 09100Italy

BACKGROUND Giant ovarian cysts(≥15 cm in diameter)are *** size limit of cysts and the methodology for a safe and successful minimally invasive surgery has not been *** we report a case of a large 10-kg multi-locular ovarian mass,which was successfully laparoscopically removed:Our aim was to innovate the surgical practice in this field by providing a safe,effective,and minimally invasive management method for such complex and rare *** SUMMARY A 49-year-old nulliparous woman presented with abdominal distension,lasting from six Mo prior to admission;she reported worsening abdominal pain,abdominal swelling,and mild *** showed a presumed benign multi-locular(>10 locules)left ovarian cyst that measured about 30 cm in *** on the IOTA-ADNEX model the mass had a 27.5%risk of being a borderline or malignant *** patient was successfully treated via a direct laparoscopic approach with salpingo-oophorectomy,followed by the external drainage of the *** spillage was successfully avoided during this *** final volume of the drained mucinous content was 8950 L;the cyst wall,extracted through the minilaparotomy,weighed about 1200 *** pathologic gross examination revealed a 24 cm×15 cm×10 cm mass;the histologic examination diagnosed a mucinous *** our knowledge,this is the first case of a giant multi-locular ovarian cyst treated with a direct laparoscopy with salpingo-oophorectomy followed by external *** Choosing the appropriate technique and surgeon skill are necessary for a safe and effective minimally-invasive approach of unique cases involving giant ovarian cysts.

关键词： Giant ovarian cyst Minimally-invasive surgery Laparoscopy Benign ovarian mass Spillage Case report

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Laparoscopic hysterectomy as optimal approach for 5400 grams uterus with associated polycythemia: A case report

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World Journal of Clinical Cases 2019年第19期7卷 3027-3032页

作者： Antonio Macciò Giacomo Chiappe Fabrizio Lavra elisabetta sanna Romualdo Nieddu Clelia Madeddu Department of Gynecologic Oncology Azienda Ospedaliera BrotzuCagliari 09100Italy Department of Medical Sciences and Public Health Medical Oncology UnitUniversity of CagliariCagliari 09042Italy

BACKGROUND Uterine myomas are the most common benign gynecological soft tissue tumors in women but polycythemia associated with these tumors is *** is significantly associated with risk of venous thromboembolism(VTE),which is further increased in case of a large pelvic mass and *** we report the surgical challenges in the case of an obese patient with a giant fibromatous uterus and associated *** SUMMARY A 42-year-old obese woman was referred to our department for treatment for a huge fibromatous *** suffered of pelvic pressure and abdominal distension and reported severe dyspnea from several *** analyses including hemoglobin(Hb)19.2 g/dL and hematocrit(Hct)59.7%were indicative of *** blood gas analysis showed arterial oxygen pressure(pO2)of 81.5 *** computed tomography confirmed a giant fibromatous uterus measuring 28.2 cm×17 cm×25 *** reduce the thromboembolic risk,the patient underwent low molecular weight heparin,phlebotomy twice before surgery,and we opted for a laparoscopic *** uterus weighed 5400 g and the histology confirmed a diagnosis of *** did not find increased erythropoietin levels in the supernatant of the myomatous uterine *** were no *** postoperative day 1,the Hb and the Hct levels normalized to 13.3 g/dL and 41.7%,*** blood gas analysis after surgery showed a pO2 of 144.7 *** results suggested the diagnosis of myomatous erythrocytosis *** patient was discharged on the second postoperative day in very good condition with no *** We believe this is the first reported laparoscopic hysterectomy in a patient with a giant uterus,polycythemia and *** VTE risk factors warranted a laparoscopic approach.

关键词： Hysterectomy Laparoscopy Myoma Myomatous erythrocytosis syndrome Polycythemia,huge uterus Total laparoscopic hysterectomy Case report

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Therapeutic challenges in metastatic follicular thyroid cancer occurring in pregnancy:A case report

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World Journal of Obstetrics and Gynecology 2022年第3期11卷 33-39页

作者： Claudio Spinelli Beatrice sanna Marco Ghionzoli elisabetta Micelli Division of Pediatric and Adolescent Surgery Department of SurgicalMedicalMolecular Pathology and of the Critic AreaUniversity of PisaPisa 56100Italy Division of Gynecology and Obstetrics University of PisaPisa 56100Italy

BACKGROUND Hormones could play a role in the evolution of follicular thyroid cancer(FTC)for which we discuss an unusual presentation of FTC occurring during *** SUMMARY A pregnant woman was admitted with FTC metastasis resulting in a gluteal *** abdominal computed tomography revealed liver metastasis for which the patient underwent total thyroidectomy and liver resection,oral radioiodine therapy and radiotherapy,followed by embolization of the pelvic *** patient died of cerebral hemorrhage 16 mo after the initial *** Human chorionic gonadotropin and estrogen stimulation might have a role in cancer growth,especially during *** management aims to stop disease progression and overcome hormonal imbalances after thyroidectomy thus reducing fetal *** is still under debate whether it is possible to combine optimal timing for treatment to ensure the best possible outcome with reduction of fetal complications and risk of cancer growth.

关键词： Gluteal pain Follicular thyroid cancer Metastases Pregnancy Unusual presentation Case report

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