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Uterine myoma is the most frequent benign tumor of female organs. Intraligamentary myomas in the broad ligament are rare. We present a case of 50 years old patient with 22 cm intraligamentary myoma with cystic degeneration, who is referred to the Gynecological Department of Ob/Gyn Hospital "Dr. Shterev" with complains of severe pain. This case is interesting for its rareness and diagnostic dilemma, because degenerative myomas can imitate malignant mass. Total laparoscopic hysterectomy with ablastic vaginal morcellation of the specimen in endobag was performed. The patient was discharged from the clinic next day.

Transvaginallaparoscopy (TVL) has been described by S. Gords in 1990's. Comparig to histerosaqlpingograpy (HSG) it allows visualization of tubal mucosa. Transvaginal laparoscopy is alternative of conventional laparoscopy for infertility patients. It has significant advantage regarding minimal invasiveness and absence of abdominal incisions. Literature data shows 96.1% accuracy of TVL against laparoscopy regarding operative findings. Presence of operative port ensures possibility of doing minimal interventions like adhesiolysis, ovarian drilling and endometrioma ablation. Although these advantages this procedure is not very popular in our country yet.

Leiomyomas of the Fallopian tubes are rare and their correct diagnosis is extremely difficult. Usually they are incidental findings seen at autopsy or unrelated surgical procedures: A 34-year-old woman presented with lower abdominal pain. Transvaginal ultrasound revealed a solid 7 cm extrauterine mass. Both ovaries are normal. Our preoperative diagnosis was torsion of the fallopian tube due intratubal leiomyoma. Laparoscopic surgery was performed and the leiomyoma was found to have originated from the isthmus of the right Fallopian tube. Laparoscopic myomectomy was performed with preservation of the ramus tubarius dextra. The histological examination concluded to a leiomyoma with ischemic changes. We report a case of torsion of a tubal leiomyoma, which was successfully managed laparoscopically.

Introduction: The advanced ovarian cancer usually have bad prognosis. The main methods for treatment of these types of tumors are: primary cytoreductive surgery and platin-based chemotherapy., Aim: Our aim was to evaluate our and foreign experience in treatment of advanced ovarian cancer stage III C--IV treated by neodjuvant chemotherapy followed by cytoreductive surgery and patients treated by primary cytoreductive surgery followed by adjuvant chemotherapy. We wanted to research the survival rate, postoperative adverse effects, mortality rate, the size of residual tumor and the metastases in these patients., Material and Methods: We researched for 10 years period--50 patients treated by primary cytoreductive surgery and 50 patients treated by neoadjuvant chemotherapy., Results: The postoperative adverse effects and mortality rate are lower by neoadjuvant chemotherapy followed by cytoreductive surgery. The most important independent prognostic factor for overall survival rate was the lack of residual tumor in both types of treatment., Conclusion: The neoadjuvant chemotherapy followed by cytoreductive surgery in ovarian cancer stage III C--IV is considered as a standard treatment.

Laparoscopic myomectomy and total laparoscopic hysterectomy are challenging surgical procedures for gynecologists, which can result in great blood loss. Most of the conversions to laparotomy happened because of intraoperative bleeding. Blocking uterine perfusion during,, Class II" laparoscopic procedures is valuable and feasible for the management of our patients. We present our modification of uterine artery identification and clipping.

Uterine myoma is the most common benign uterine tumor in women of reproductive age and occurs in 20-25 % of the worldwide population. Heavy menstrual bleeding, pelvic pressure and pain and reproductive disfunction are common symptoms that impair women's health and quality of live. No currently approved medical treatment is able to completely eliminate fibroids. Until recently, gonadotropin-releasing hormone agonist were the only available drugs for preoperative treatment of fibroids. Since February 2012, ulipristal acetate (UPA) is also approved in Europe for preoperative fibroid treatment. One-third from them need adjuvant surgical treatment.

In the recent years according to WHO, genital chlamydia is the mos't common sexually transmitted infection. Chlamydia Trachomatis is an intracellular parasite which target are the tubular epithelial cells of the urethra, endocervix, endometrium, endosalpinx, conjunctiva, synovial lining of the joints, Glisson's capsule of the liver Our study, as well as some international researches, shows that in the cases of genital chlamydia there are changes in the ovarian hormones (estradiol and progesterone), their impact on the immune system and their importance for the development and the complications of the infection with Chlamydia trachomatis. The physiological level of the steroid hormones in its turn contributes for the normalization of the local immunity and reduces the possibility of recurrences.

Unlabelled: The aim of our research work was to show our results in the field of reconstructive and cosmetic surgery for vulvar cancer., Material and Methods: We evaluated 18 patients for 10 years period., Results: We applied all surgical techniques that are possible at the moment in the world: laps from mons pubis, rhomboid flaps, myocutaneous flaps from gluteal region. We used surgical techniques with the following muscle groups: musculus gracilis, musculus gluteus maximus, musculus tensor fasciae latae, musculus rectus abdominis., Conclusions: With our research work we tried to better the quality of life of our patients, to achieve better esthetic and cosmetic effect after very radical surgical interventions connected with vulvar cancer.

Lymphadenectomy has traditionally been performed using large incisions during laparotomy. Since the initial report by Dargent and colleagues in the late 1980s, laparoscopic lymphadenectomy has been utilized in the management of gynecologic malignancies. After Dargent's description of the first pelvic lymphadenectomy performed laparoscopically, Nezhat et al. described the first para-aortic lymphadenectomy performed laparoscopically forcancer of the uterine cervix. Many raports since have described the safety and effectiveness of laparoscopic lymphadenectomy for gynecologic malignancies.

The insulin-like growth factor IGFBP-1 is a binding protein (IBP-1), also known as placental protein (PP12), is encoded in people as IGFBP-1 gene. The IGFBP-1 is an especially vital hormone in the female reproductive physiology. The presence of it in large quantities in the amniotic fluid can be used as a biochemical marker for preterm birth and premature rupture of membranes. Fetal fibronectin is a high-molecular glycoprotein, that is produced during pregnancy and has a role as biological glue, binding the foetus membranes to the endometrium. fFN can be found in the cervicovaginal secretions until 22nd gestational week and later on during the last trimester (1 to 3 weeks before birth). fFN is usually absent between 24th and 34th gestational week. Thirty sixth (30%) of all the 120 females tested had positive fFN test results and were, therefore, at high risk for preterm delivery. Despite the implemented tocolytic therapy, 15 (12.5%) of them delivered before the 37th gestational week. The results from the investigation for the presence of pLGFBP-1 in 120 pregnant women show that 35.8% (43 women) were positive and 15(12,5%) of them delivered before the 37th gestational week despite the implemented tocolytic therapy In both tests, the average gestational age of the premature fetus was 32.5 ÷ 2.8 gestational weeks.

Pelvic exenteration is an operative method for one-moment removal of pelvic organs, including reproductive tract, bladder and rectosidgmoid. It most common indicated in gynecologic oncology for treatment of locally advanced cancer or recidive with central location. Pelvic exenteration can be used for healing of patients with genital cancer. Frequency of serious complications can reach 50%, that emphasizes the need of careful discuss of risks and benefits with the patients who are indicated for that kind of operation. For the period 2004-2012 common 46 exenterations are performed at FSHOG "St. Sofia", form which 9 are total (TE), 14 anterior (AE), 7 posterior (PE), 16 modified posterior exenterations (MPE). Average operative time is 459 min (237-620 min), depending on the type of operation. Average blood loss is 1200 ml (800-2500 ml). Report of the complications shows that eight patients have had 1-st degree complication.

Numerous surgical procedures have been described for the management of pelvic organ prolapse. Laparoscopic sacrocolpopexy has evolved from classical abdominal sacrocolpopexy and provides the potential to combine the success rate of an abdominal approach with faster recovery time associated with a minimally invasive technique. Pelvic organ support was assessed objectively using the pelvic organ prolapse quantification scale (POP-Q). Tissue dissection and mesh placement are facilitated by magnification of the operating field using laparoscopic approach. Our results confirm previous findings that laparoscopic sacrocolpopexy is a safe and efficacious surgical treatment for pelvic organ prolapse. It provides excellent support and good functional outcome with overall improvement in sexual function.

A great number operative techniques for correction of retroverted uterus are reported in the last years. The aim of these different methods is correction of the retroversion of the uterus, which is connected with pelvic congestion and symptomatic relief. We present a clinical case of 26 years old patient with one Caesarean section. The lady complains of chronic pelvic pain, dispareunia and dismenorrhea. The US exam shows an uterus in strong retroversion position. We restored the anatomic position of the uterus using laparoscopic anterior ligementopexy.

Objective: To evaluate the differences in the intraoperative blood loss during laparoscopic myomectomy with or without uterine artery clipping (UAC)., Methods: From January 2013 to April 2015, we enrolled prospectively 119 women with symptomatic intramural myomas who were scheduled to undergo laparoscopic myomectomy (37 with UAC (study group) and 82 without (control group))., Results: Characteristics of the myomas, operating time, duration of hospital stay and blood loss were comparable between the two groups. The average operating time and blood loss were 75 +/- 11 minutes and 100 +/- 20 ml for the experimental group and 60 +/- 9 minutes and 178 +/- 56 ml for the control group respectively statistically significant., Conclusion: Concurrent UAC during laparoscopic myomectomy reduces the intraoperative blood loss and the frequency of excessive bleeding. This study demonstrated the superiority of laparoscopic uterine artery ligation combined with myomectomy in treatment of symptomatic myomas.

Uterine leiomyomas are one of the most common benign smooth muscle tumors in women, with a prevalence of 20 to 40% in women over the age of 35 years. Fifty percent of them may necessitate treatment, because of bleeding, pelvic pain and infertility. Laparoscopic myomectomy is one of the treatment options. The major concern of myomectomy either by open procedure or by laparoscopy is the bleeding encountered during the operation. One of the methods to reduce the intraoperative blood loss and to prevent excessive bleeding is the clipping of both uterine arteries and aa. ovaricae.

The aim of this study is to determine the most appropriate method for operative treatment of uterine myoma through comparison of laparoscopic myomectomy (LM) and abdominal myomectomy (AM). We will examine perioperative indicators and results for patients with uterine myomas. We operated 172 women for the period from January 2011 to April 2014. 106 patients were operated by abdominal myomectomy and 66 were operated by laparoscopic myomectomy. In this study were included only cases with intramural fibroids bigger than 5 cm. We explored the following indicators: age, BMI, preoperative Hgb, preoperative Hct, size, number and location of the myomas for both groups. We analyzed intra- and postoperative indicators operating time, hospital stay, postoperative Hgb and Hct. Data shows less postoperative decrease of Hgb and Hct, less blood loss, shorter hospital stay for the group with laparoscopic myomectomy, but significantly increased operative time compared to the group with abdominal myomectomy.

Bidirectional barbed suture introduces a new paradigm in laparoscopic suturing. The aim of our study is to evaluate the efficacy and safety of using bidirectional barbed suture in laparoscopic myomectomy. It included 102 women, requiring a laparoscopic myomectomy for symptomatic uterine fibroids from June 2011 to May 2014. They are divided into two groups according to the thread used for closing the uterine incision. We used bidirectional barbed suture Quill and Vicryl in the control group. The mean operative time was shorter in the Quill group than in control group. Both intraoperative blood loss and drop of hemoglobin were significantly lower in the Quill group. The use of bidirectional barbed suture appears to be safe for closing the hysterotomy site during a laparoscopic myomectomy.

Laparoscopic gynecologic procedures have become increasingly popular but their widespread use has been limited by training issues. Recent technological advancements have led to the introduction of new three-dimensional (3D) cameras in laparoscopic surgery. The use of 3-dimensional (3 D) vision may aid in training and performance of laparoscopic tasks. 3-D visualization improves the learning curve forlaparoscopic surgery. Surgeons must consider 3D systems when leaming complex laparoscopic surgeries.

Stress incontinence is involuntary loss of urine that occurs during periods of increased intraabdominal pressure, such as sneezing, coughing or exercise. Retropubic Burch colposuspension has been considered by many to be the "gold standard" procedure for treatment of female stress urinary incontinence for almost 50 years. The firs reported retropubic surgery performed via the laparoscopic approach was described by Vancaillie and Schuessler in 1991. We present a clinical case of a female patient with stress incontinence who has been operated by laparoscopic approach by our team.

Objective: To investigate the risk of adhesions after laparoscopic myomectomy (LM). To establish the percentage of adhesions, their kind, situation and magnitude., Materials and Methods: For the period form June 2011 to November 2013 totally 81 patients were operated by LM. In the study only patients with intramural leymyomas bigger than 5 sm were included. For this period 14 patients had second-look because of the need of another operation--LS or Ceasarean section. 22 myoma incisions were checked. We established 35.7% adhesions per patient. After LM adnexas were engaged in 14.2%., Conclusion: The factors, responsible for the formation of postoperative adhesions are: the location of the myoma in the posterior uterine wall, excessive accumulation of suturing materials and additional operative interventions. For patients underwent LM and willing pregnancy we recommend second look laparoscopy.

Laparoscopic myomectomy (LM) has been an alternative to abdominal myomectomy in cases of subserosal and intramural myomas since 1990. In the literature less attention is paid to the factors responsible for the length of the surgical time of the LM. Our study comprehends 66 patients underwent laparoscopic myomectomy for one or more intramural myomas with size > 5 sm. In order to evaluate the factors that are responsible for the duration of the procedure we survey the following indicators: age, BMI, year of the operation, previous abdominal operations, way of delivery, size, number and localization of the myomas. Our results show that statistically significant effect for the duration of LM have the yearof the operation, numberof the myomas and their localization in the uterine wall. Significantly longer operative time is detected in 2012 (133.57 +/- 17,805 min.) and the shorter time was in 2014 (66.67 +/- 20, 237 min.) (P < 0.05). We established statistically significant relation between the number of the myomas and duration of the operation (P=0.023). The analysis of the indicator localization of the myomas shows that myomas in the anterior uterine wall are with shortest average surgical time--90.5 +/- 33, 321 min., next are these in the posterior uterine wall--93.81+/- 39, 176 min. Myomas in the fundus of the uterus have longest average surgical time--115.83 +/- 35, 253 min.

In recent decades, interest in laparoscopic gynecological practice increase. This technic applied first as a diagnostic tool in women with infertility. Subsequently starts to be used to perform surgery in small region of the fallopian tubes and ovaries, being increasingly developed and today, it is considered that any gynecological operation can be performed laparoscopically.