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Abstract: Objective: To examine the effect of uterosacral–cardinal ligament complex stretching prior to vaginal hysterectomy on uterine descent. Study design: A prospective trial of 25 consecutive women undergoing vaginal hysterectomy. Pre-operative, apical, anterior and posterior wall POP-Q measurements were recorded for each patient before and after uterosacral–cardinal ligament complex stretching during general anesthesia. Results: Uterosacral–cardinal ligament complex stretching yielded a significant increase in mean stage of uterine and anterior wall descent (2.6±0.6 vs. 3.2±0.6cm, p <0.001, and 2.5±0.8 vs. 2.9±0.8cm, respectively, p <0.004). There was no significant change in posterior wall prolapse measurements (1.3±0.7 vs. 1.4±0.8cm, p =0.05). Conclusion: Uterosacral–cardinal ligament complex stretching prior to vaginal hysterectomy increase uterine descent. [Copyright &y& Elsevier]

Objective: To evaluate the efficacy and safety of 3 months of vaginal mifepristone treatment on leiomyoma volume and related symptoms. Design: Prospective, open-label, two tertiary centers, phase II clinical trial. Setting: Two tertiary medical centers in Israel. Patient(s): Thirty-three enrolled women, ages 30–53 years, diagnosed with symptomatic uterine fibroids. Intervention(s): Patients received 10 mg mifepristone vaginally daily for 3 months. Main Outcome Measure(s): Reduction in uterine leiomyoma volume. Improvement in symptoms related to uterine fibroids was assessed with the use of the “Uterine Fibroid Symptoms Quality of Life Questionnaire” (UFS-QoL). The number of bleeding days, safety, and tolerability were secondary measures. Result(s): Mifepristone treatment significantly reduced leiomyoma volume from 135.3 ± 22.9 cc at enrollment to 101.2 ± 22.4 cc after 3 months of treatment. The UFS-QoL Score significantly decreased from 20.7 ± 0.7 at enrollment to 14.0 ± 0.8 after 3 months of treatment. The number of bleeding days significantly decreased by 3.5 days. Endometrial biopsies showed no evidence of endometrial hyperplasia or cellular atypia. There were no major side effects during the course of the study, and treatment was well tolerated. Conclusion(s): Vaginal mifepristone may offer an effective treatment option for women with symptomatic uterine leiomyoma and can improve the patients' quality of life. Clinical Trial Registration Number: NCT00881140 [ABSTRACT FROM AUTHOR]

Introduction: Options for preserving fertility in children and adolescents with cancer depend on patient age, the available time frame, and the treatment regimen. Ovarian stimulation with mature oocyte preservation is often the optimal method in post-menarcheal adolescents. We describe a case of a 17-year-old girl with vaginal soft-tissue Ewing sarcoma in whom transvaginal oocyte collection for fertility preservation was ruled out by the large tumor. To overcome the limitations of the transabdominal approach, we applied a novel method of laparoscopically-assisted ultrasound-guided percutaneous transabdominal oocyte collection. In this manner, we were able to both perform oophorectomy and obtain superficial and deep ovarian follicles for cryopreservation.

With the increasing demand of Laparoscopic surgery, many departments are considering the development of surgical skills centers. The authors describe their hospitaLs endoscopic training program which includes a theoretical curriculum and an inexpensive laparoscopic simulator The system is designed in order to improve basic skills of laparoscopic surgery. Other systems available elsewhere are discussed.

Uterine fibroids (leiomyoma) are the most common benign tumors in women. Better understanding of the pathophysiology, as well as recent technical advancements opened the gates for new options for women who suffer from symptomatic uterine fibroids. Treatments are categorized in four groups: surgical removal, minimally invasive or noninvasive approach causing damage to cellular viability, medical treatments to reduce volume and relieve symptoms, and complementary medicine. This review may assist in tailoring the type of treatment according to age, desire for future fertility, size and location of the fibroids.