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Cervical sarcomas are extremely rare tumors associated with a poor prognosis. We report the case of a 63-year-old woman who was admitted to our institution due to abnormal vaginal bleeding and abdominal pain. Physical examination revealed a large cervical mass that was biopsied. Pathological features were compatible with a leiomyosarcoma of the uterine cervix. The patient underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy. All histological and Immunohistochemical findings confirmed the diagnosis of leiomyosarcoma of the cervix. Adjuvant chemotherapy was started but unfortunately the disease progressed and 1 year after completion of the chemotherapy the patient developed lung metastases and eventually died.

A 31-year-old nulligravid underwent laparoscopic myomectomy and the masses were removed by an electric morcellator. Five years later, this patient suffered from acute pelvic pain and received an operation. During laparoscopic surgery, an 8-cm right-sided multiloculated ovarian cyst with chocolate-like content was seen. After adhesiolysis, two parasitic myomas (each ∼2 cm in diameter) were found attached to the right ovarian cyst and the other two parasitic myomas (each ∼1 cm in diameter) were found at the right infundibulopelvic ligament and omentum respectively. These tumors were successfully removed by laparoscopic procedure. Histopathological examination confirmed that all masses were leiomyomas and the right ovarian cyst was confirmed to be endometriosis. The formation of parasitic myomas was assumed that myomatous fragments during morcellation at the time of myomectomy may have been left behind unintentionally. Thus, morcellator should be used carefully. With that being said, all of the myomatous fragment should be removed after morcellation.

Laparoscopic gynecologic surgery has been widely used with a range of benefits. However, there are complications that are related to the abdominal entry process. Serious complications are gastrointestinal tract and major blood vessel injuries. This review introduces the recent available literature to prevent and eliminate the laparoscopic entry complications. The open entry technique is associated with a significant reduction of failed entry, compared to the closed entry technique; however there is no difference in the incidence of visceral or vascular injury. Laparoscopic entry by the left upper abdomen (i.e., Palmer's point) or the middle upper abdomen (i.e., the Lee-Huang point) could be considered in patients with suspected periumbilical adhesions or a history of umbilical hernia, or after three failed attempts of insufflation at the umbilicus. The Lee-Huang point has its own benefit for the operative laparoscopy in large pelvic pathologies and gynecology malignancy cases. The angle of Veress needle insertion varies from 45° in nonobese women to 90° in extraordinarily obese women. The high intra-peritoneal pressure entries, which range from 20 mmHg to 25 mmHg, minimize the risk of vascular injury. Therefore, this will not adversely affect the cardiopulmonary function in healthy women. The Veress intraperitoneal pressure (

Endometrial cancer (EC) is the most frequent gynecological malignancy in developed countries, and accounts for 6–9% of female malignancies. The prevalence is growing in overweight individuals and those with medical comorbidities such as diabetes and hypertension. Nodal status is a key determinant of the outcome and there is a strong rationale incorporating sentinel lymph node (SLN) biopsy in the management of EC. We performed a systemic review concerning studies investigating the role of laparoscopic detection of SLN in early-stage EC. The detection rate and sensitivity of the laparoscopic approach in SLN ranged from 69.6% to 100% and 58.6% to 100%, respectively. The combination of dye and radiocolloid detection substances is the best method for SLN detection in EC. The use of pericervical injection and the laparoscopic approach increase the detection rate of SLNs, especially in the iliac lymph node groups. The hysteroscopy injection technique highlights the presence of isolated para-aortic lymph node metastasis. However, the precise method of SLN biopsy in EC needs to be determined further.

A new technique of extensive surgical intervention, namely nerve sparing radical hysterectomy (NSRH), was introduced as one of the treatment options for early stage cervical cancer patients because cervical cancer patients suffer from postoperative complications following radical hysterectomy procedure. The step of nerve preservation can reduce postoperative complications, such as bladder or sexual dysfunction problems that occur after a traditional radical hysterectomy procedure. The surgical outcomes seem to be favorable and no serious morbidity was noted. However, further study of the nerve sparing technique is necessary to improve this surgical advantage in the future.

Bevacizumab (BEV) has been used for ovarian cancer (OC) for years in Taiwan, but the associated data related to outcome is scant. This retrospective study reviewed patients with OC treated with BEV and analyzed their results.All patients with OC treated with BEV from 2009 to 2015 in the Linkou branch of Chang Gung Memorial Hospital in Northern Taiwan were included. According to the means of administration, the patients were classified into 6 groups as follows: A-BEV plus chemotherapy (C/T) for initial platinum-resistant (PR) recurrent OC, B-BEV plus C/T for initial platinum-sensitive (PS) recurrent OC, C-BEV alone for recurrent OC, D-BEV plus 1st adjuvant C/T, E-BEV plus neoadjuvant C/T, and F-intraperitoneal (IP) BEV. Progression-free survival (PFS), overall survival (OS), hazard ratios (HRs), overall response rate (ORR), and mean number of BEV cycles were analyzed for groups A to E. Clinical improvement of ascites was assessed for group F.A comparison of early use (only one round of prior C/T) versus late use (multiple rounds of prior C/T) in patients of groups A and B showed a superior PFS (8.27 vs. 3.67, p = 0.037) in the early use group. No significant differences were found between groups A and B (PFS: 4.24 vs. 4.17 months, p = 0.690; OS: 10.06 vs. 9.93 months, p = 0.819; mean BEV cycles: 4.63 vs. 5.0 p = 0.992; ORR: 48.1% vs. 53.5%, p = 0.425). Comparing the response and non-response subgroups of patients in groups A and B, a better outcome was associated with endometrioid type cell (HR = 0.28, p = 0.008), good ECOG performance status (HR = 0.51, p = 0.005), and lack of ascites (HR = 0.67, p = 0.004). Comparing group C with groups A plus B, the BEV alone group had a poorer PFS (1.02 VS. 4.19, p = 0.04) and OS (1.42 VS. 9.99 p = 0.001) than the BEV plus C/T group. In group F, a good clinical benefit rate (85.6%) of ascites improvement was noted. Two patients had grade 5 gastrointestinal bleeding and venous/arterial thromboembolic events after administration of BEV. Grade 3 neutropenia and thrombocytopenia occurred more frequently in our study.Early use of BEV combined with chemotherapy had a significant benefit in PFS for patients with recurrent OC. BEV plus chemotherapy was better than BEV alone for recurrent OC. In addition, IP BEV was helpful for improving clinical ascites.

Herein, we report a case of a 63-year-old, nonobese, woman who underwent laparoscopic surgical staging for endometrial cancer with pelvic and para-aortic lymph node dissection. After being discharged, the patient presented to the emergency department with fever and abdominal pain, 1 week after the procedure. Abdominal tenderness, fever, and anemia were the key clinical and laboratory findings. A computed tomography (CT) scan revealed a cystic mass with air bubbles, located in the right iliopsoas region. The features were consistent with an infected hematoma at the right iliopsoas region, which was managed with antibiotics and CT-guided pigtail drainage. Laparoscopic surgical staging for endometrial cancer has been shown to have fewer early complications than open surgery. However, complications can still occur in the most experienced hands. Abscess arising from hematomas after laparoscopic surgical staging can be managed adequately with noninvasive CT-guided drainage.

Cervical cancer remains a common malignancy in women. Lymph node is one of the significant important prognostic factors. Until now, there is no reliable investigative study that can evaluate nodal status the same as the International Federation of Gynecology and Obstetrics (FIGO) clinical staging system. Radical hysterectomy and pelvic lymphadenectomy is still one option in the standard treatment of patients with early-stage cervical cancer that can reveal metastatic lymph node but which can also produce treatment-related morbidities and complications. Sentinel lymph node identification has become a valuable technique for nodal status assessment. If lymph node metastasis was identified early, then unnecessary invasive surgical operations and complications may be avoided.

Laparoscopic hysterectomies increase recently due to several advantages of minimally invasive surgery. Controversy exists for laparoscopic hysterectomies for large uteri weighing >500 g because some reports show increased complications and morbidities and high laparoconversion rate in the past. With familiarity of laparoscopic procedures and progress in surgical techniques, the issue should be discussed and reviewed by evidence again. Hence, we conducted a systematic review of laparoscopic hysterectomies for large uteri.

Great advances in technology offer meticulous options of minimally invasive surgery to empower the gynecologists to manage patients of early ovarian cancer. Laparoscopy affords improved visualization of the pelvic peritoneum, diaphragm and the deep pelvic structures, and offers many advantages in the avoidance of long abdominal incision, including shorter hospital stay and a more rapid recovery time. Most studies showed that laparoscopy did not compromise the survival and recurrence prognosis in comparison with open abdominal approach of staging surgery. Contrarily, laparoscopy precludes the advantage of open surgery, such as manual examination of the full extent of the bowel and palpation of lymph nodes. Besides, laparoscopy technically hampers the removal of large ovarian mass, and laparoscopic cancer surgery has a potential risk of trocar site metastasis. As the trend shows that laparoscopy has been playing an important role in treating early ovarian cancer, we could expect laparoscopy to become an attractive surgical option in the future for ovarian cancers.

Advancements in technology have increased the availability of valuable minimally invasive techniques for gynecologists to use in the management of patients with endometrial cancer. Hysteroscopy has recently been confirmed as an accurate diagnostic method for endometrial carcinoma. Several retrospective studies have found increased positive peritoneal cytology in women who underwent hysteroscopy, but recent studies have indicated that there is currently no evidence to suggest that diagnostic hysteroscopy increases the risk of malignant cells spreading into the peritoneal cavity, or worsens the prognosis in women with endometrial carcinoma. Laparoscopy plays an important role in treating endometrial cancer. Most studies have shown no differences in recurrence rates or survival between patients who underwent laparoscopic or abdominal staging surgery. Laparoscopy offers many advantages, including avoidance of an abdominal incision, a shorter hospital stay, and a probable more rapid recovery time.

Cervical cancer is the third most common female cancer worldwide. Radical hysterectomy with lymph node dissection has become a standard method for treating early stage cervical cancer. Laparoscopic radical hysterectomy for early stage cervical cancer can provide a good survival outcome, fewer complications and a faster recovery time than open surgery. For patients who wish to retain their fertility, fertility-sparing surgery is considered. Laparoscopic radical trachelectomy is a good example of such surgery. Several series have shown that it is feasible, safe and has an acceptable overall survival rate compared with radical hysterectomy. It also provides the benefits of minimally-invasive surgery. It is a good choice for fertility-sparing surgery in cervical cancer. There are currently several methods of approach to radical trachelectomy, with different fertility and oncological results.

Cervical cancer is one of the most common malignancies of the female lower genital tract. There is mounting evidence that surgical management of cervical cancer could not only reduce mortality and recurrence, but it could also improve the quality of life of patients, especially if the treatment results of surgery are compared to those of radiation therapy. There is already consensus regarding the treatment of endometrial cancer using laparoscopy, since compared with laparotomy, laparoscopy results in a shorter hospital stay, fewer complications, less pain, and earlier resumption of normal activities. Most importantly, there is no significant difference in 3-year survival and recurrence rate of endometrial cancer with laparoscopy compared with laparotomy. Thus, there is now a trend of using laparoscopy to treat endometrial cancer. Some reports have pointed out that laparoscopic radical hysterectomy would have fewer complications. Our prospective study showed that the intraoperative complication rate from laparoscopy was comparable to that of laparotomy, but the incidence of postoperative complications was less with laparoscopy. No difference was noted in terms of operating time or recurrence rate between these two groups. Regarding blood loss, postoperative recovery, return of bladder function, external appearance of incisions, and gastrointestinal complications during radiation therapy, laparoscopy seems to have the better edge. Laparoscopy appears to be a promising method of managing cervical cancer. Moreover, in our experience, operative laparoscopy is easier in the management of stump cancer and trachelectomy. Thus, gynecologists should realize that laparoscopy will play a much more important role in the management of early stage cervical cancer in the near future.

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Objective: To report a case of a patient with cervical squamous cell carcinoma stage IIIB who was diagnosed with malignant mixed müllerian tumor (MMMT) 5 years after radiotherapy. Case Report: A 57-year-old female patient with cervical squamous cell carcinoma FIGO stage IIIB received pelvic irradiation for her disease. After radiotherapy, she was followed-up every 6 months. At 60 months, Papanicolaou smear revealed abnormal cancer cells and secondary MMMT was diagnosed. The patient underwent surgical treatment followed by chemotherapy. However, the cancer recurred 8 months after surgery and the patient died 1 month later. Conclusion: Patients with cervical cancer administered irradiation many years previously remain at high risk of secondary malignancies. In these cases, long-term follow-up with extreme caution is mandatory. For patients with any types of symptoms, aggressive and immediate investigation is suggested in order to detect possible occult malignancies.