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Objective To evaluate the feasibility, surgical outcomes and complications of laparoscopic restaging surgery for women with unexpected ovarian malignancy. Study design We conducted a retrospective chart review of 14 women with unexpected ovarian malignancy who underwent laparoscopic restaging surgery including peritoneal washing cytology, laparoscopic pelvic and paraaortic lymphadenectomy up to the left renal vein level, omentectomy, and multiple peritoneal biopsies, and hysterectomy except three fertility saving surgery. Results The median age and median body mass index women were 49 years (range, 22–63) and 24.2 m/kg 2 (range, 18.9–25.3), respectively. The median operating time was 230 min (range, 155–370). The median numbers of harvested pelvic and paraaortic lymph nodes were 26 (range, 6–41) and 18 (range, 2–40), respectively. The median return of bowel activity was 28 h (range, 21–79). Four of the women were upstaged from the initial presumed stage. There were two intraoperative complications, laceration of the inferior vena cava and cisterna chyli rupture. There was one postoperative complication, port-site metastasis. There was no conversion to laparotomic surgery. The median follow-up period was 33 months. Thirteen of the patients have no evidence of recurrences, however one patient died after 22 months after the surgery. Conclusion Laparoscopic restaging surgery, performed by a specialized laparoscopic oncologist with sufficient laparoscopic experience and a well-trained operating team, is both feasible and effective in the management of unexpected ovarian malignancies.

Video Objective In approximately 0.6 % of cases, ectopic endometrium has been found in extrapelvic sites, such as the umbilicus, skin, upper abdominal peritoneum and organs (liver, spleen), diaphragm, pleural cavity, lungs, and pericardium. The prevalence of diaphragmatic endometriosis has been reported in up to 0.19 % of lesions. No guidelines exist about treatment of diaphragmatic endometriosis, and this rare condition is still a matter of debate because it raises several diagnostic and treatment challenges. We present a case of patient affected by diaphragmatic endometriosis who was treated by laparoscopy. Setting Case study, University hospital in Korea. Interventions A 41-year-old woman was referred to our department because of dyspareunia and dysmenorrhea. Laparoscopic finding showed left ovarian cyst adherent to peritoneum, cul-de-sac partial obliteration and endometriotic nodule on right diaphragm. We performed laparoscopic adhesiolysis, right ureter peritonectomy and diaphragmatic resection of endometriosis. An accidental diaphragmatic injury was occurred during the laparoscopic diaphragmatic resection. We performed successful laparoscopic primary repair of diaphragm and then chest tube was also inserted. The patient was uneventfully discharged home 4 days later. Conclusion Laparoscopic primary repair after resection of diaphragmatic endometriosis is feasible.

Study Objective The aim of this study was to assess the surgical and oncologic outcome of laparoscopic primary cytoreductive surgery on advanced epithelial ovarian cancer in comparison with conventional laparotomy surgery. Design Retrospective cohort study. Setting University hospital in Korea. Patients or Participants Patients with FIGO stage up to III ovarian cancer undergoing laparoscopic primary cytoreductive surgery from January 2011 to March 2019 were matched to controls treated with laparotomic cytoreduction during the same period. Interventions Laparoscopic and laparotomic optimal cytoreduction. Measurements and Main Results The surgical and long-term outcome with advanced ovarian cancer were compared. The laparoscopic group (n=30) and laparotomic group (n=24) had similar age, BMI, stages, histologic type and final stage. There were no significant differences in operating time (P = 0.08) and blood loss (P = 0.34). The laparoscopic group exhibited significantly shorter hospital stay (P = 0.002) and time to start to treat adjuvant chemotherapy (P Conclusion Laparoscopic and laparotomic primary cytoreduction were similar in surgical and oncologic outcome. Laparoscopic primary cytoreduction in highly selected patients with advanced ovarian cancer was feasible and not to inferior in laparotomic surgery. Prospective randomized trials are required to evaluate the overall oncologic outcomes.

Video Objective To investigate the safety and feasibility of laparoscopic management for vesicovaginal fistula developing after TLH. Setting Case study, University hospital in Korea. Interventions A 51-year-old Korean woman underwent of immediate laparoscopic management for vesicovaginal fistula developing after total laparoscopic hysterectomy. A 51-year-old Korean woman was referred to my department for having urinary leakage two weeks before. She underwent total laparoscopic hysterectomy due to heavy vaginal bleeding and leiomyoma four weeks ago. We performed a laparoscopic vesicovaginal fistula repair with omental interposition on November 8th, 2016. We encountered a large adhesion from prior surgery in the pelvic cavity, so performed adhesiolysis using a harmonic sheers. After adhesiolysis, I performed bilateral ureterolysis that continued to the posterior bladder until it reaches the vesicovaginal space, which is then sharply dissected laterally and distally until the fistula is encountered. A bulb syringe were used to mobilize the vaginal cuff so that the dissection of the vesico-vaginal space and mobilization of the vagina could be performed easily. After adequate dissection and resection of the fistula tract from both the vagina and the bladder, a double-layer closure using 3-0 Vicryl was placed in a interrupted suture to secure the bladder. After the first layer of closure, the bladder was retrograde filled with 300cc of sterile water. Then second layer was closed in the same manner. And a single-layer closure of the vagina using a 1-0 Vicryl was placed transvaginally. After omental interposiotion to the fistula site, the procedure was over. There were no serious intraoperative or postoperative complications. Conclusion Laparoscopic approach for vesicovaginal fistula is safe and feasible.

Study Objective To evaluate the feasibility and efficacy of laparoscopic management of complications without conversion to laparotomy in gynecologic laparoscopic surgery. Design Retrospective clinical study (Canadian Task Force classification III). Setting University teaching hospital. Patients A total of 2668 women who underwent gynecologic laparoscopic surgeries from March 2003 through February 2008. Interventions Gynecologic laparoscopic surgeries. Measurements and Main Results We investigated major complications during gynecologic laparoscopic surgery. Based on patients’ medical records, we reported types of laparoscopic surgery, types of complication, early recognition of complications, and treatment method of complications. Overall, 33 (1.24%) complications occurred in this study. There were 18 (0.67%) bladder injuries, 6 (0.22%) major vessel injuries, 3 (0.11%) bowel injuries, 3 (0.11%) ureteral injuries, 2 (0.07%) diaphragmatic injuries, and 1 (0.04%) intravesical foreign body. In all, 32 of 33 complications were successfully repaired laparoscopically. In 1 case, rectal perforation occurred on the third day after surgery; Hartmann operation followed by colostomy reversal was performed. Conclusion Laparoscopic management of complications in gynecologic laparoscopic surgery is feasible and efficient.