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Introduction: Laparoscopic myomectomy offers women many benefits over conventional open surgery, including an expedited recovery and return to employment. Our study evaluates the time taken for women to return to work after laparoscopic myomectomy and identifies factors prolonging recovery to > 8 weeks.Material and Methods: We prospectively evaluated 94 women undergoing laparoscopic myomectomy by a single surgeon between January 2012 and March 2015. Women had standardized preoperative counseling and completed a validated return to work questionnaire 3 months postoperatively via telephone, post or in clinic.Results: In all, 71/94 (75.5%) women completed the questionnaire. Results were analyzed comparing women who returned to work in ≤ 8 weeks [43/71 (60.6%)] with those who returned > 8 weeks postoperatively [28/71 (39.4%)]. A higher proportion of Asian and Caucasian women returned to work in ≤ 8 weeks (24/29) compared with black African and Caribbean women (19/42) (p = 0.003). Mean number of fibroids removed (2.59 and 5.75, respectively) was the only significantly differing factor between the two groups (p = 0.004). There was a significant difference in body mass index (BMI) and time to return to normal activity between the ≤ 8-week and > 8-week groups (p = 0.027, p = 0.011, respectively). Logistic regression analysis demonstrated that BMI and time to return to normal activity were the only factors prolonging recovery to > 8 weeks (p = 0.039, p = 0.015, respectively).Conclusions: Time to return to normal activity and BMI significantly influenced the time taken for women to work after laparoscopic myomectomy. Further data would support clinicians in counseling women appropriately and optimizing their postoperative return to employment. [ABSTRACT FROM AUTHOR]

Key content Mini laparotomy (suprapubic, transumbilical, ancillary port-site) and posterior colpotomy are methods that have been used for the removal of specimens excised laparoscopically, with the use of morcellators and endoscopic bags growing in popularity in recent years., The size, cystic versus solid component and the risk of malignancy are essential factors influencing the route of specimen retrieval. The risk of spillage (especially in suspected early malignancy) has to be considered during excision and retrieval., Natural orifice transluminal endoscopy ( NOTES) may be the operative and retrieval route of the future., Learning objectives To be aware of the different methods and routes of retrieving laparoscopically excised specimens., To be aware of the risks associated with each method and route., To review the factors that will influence the optimal choice of route and method., Ethical issues In the age of specialisation, a clinician who is not specially trained in operative laparoscopic surgery should not be practicing it. To minimise complications, the excision and retrieval of specimens via minimally invasive incisions should be limited to specially trained individuals. [ABSTRACT FROM AUTHOR]

We evaluated 35 cases of a mechanical approach to abdominal wall lifting, used in office-based gasless laparoscopic sterilization under local anesthesia. Lifting of the abdominal wall, using the camera trocar as an anchoring device and complemented by suprapubic lifting by means of a towel clamp, led to passive intra-abdominal air filling, giving sufficient space to identify, anesthetize, coagulate and cut the Fallopian tubes. Only mild sedation was necessary. All women walked to and from the operating room. All had successful tubal ligation. The overall satisfaction rate was 97%. The mechanical lifting moment was not painful. With the exception of one woman with failed tubal anesthesia, all women had a low mean pain score of 2.6 (VAS 0-10). No complications occurred except one wound infection. The costs were < or = 1/4 of those of traditional laparoscopic sterilization and office hysteroscopic sterilization. This approach is effective for office-based laparoscopic sterilization. Room air, two strings and a needle replace active gas insufflation and narcosis. [ABSTRACT FROM AUTHOR]

Background. To study the feasibility, complications and symptom relief of laparoscopic treatment in patients with deep infiltrating endometriosis. Methods. From January 2004 to March 2005, 24 patients with deep infiltrating endometriosis were treated with laparoscopic techniques. Preoperative symptoms, staging, involvement of the disease, and surgical procedures were recorded. Operating time and perioperative complications were also registered, as well as follow-up of the patients. Results. The surgical treatment was individualized with removal of deep infiltrating endometriosis in all 24 patients, additional bladder resection in five patients and colorectal resection in eight patients. In two cases laparoconversion was performed, and one patient had a temporary loop ileostomy. We observed no major peri- or postoperative complications. Median operating time was 3.4 h (range 1.4–8.0 h). All patients with bladder involvement were relieved of their urinary dysfunction, while all except three patients were successfully treated for their pain problems, and also these three patients had symptom relief. Conclusions. Patients with deep infiltrating endometriosis represent a challenge to surgical procedures. Our results show that radical laparoscopic surgery including colorectal and bladder resection is feasible, safe, and effective in almost all patients. [ABSTRACT FROM AUTHOR]