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A case of ectopic adrenal gland tissue in mesosalpinx is reported. A 52-year-old patient was admitted to the hospital for irregular vaginal bleeding for 2 months. Ultrasound scan showed multiple hypoechoic masses in the myometrium of the anterior wall of uterus with regular shape and clear boundary. Laparoscopic hysterectomy and bilateral adnexectomy were performed. In the course of pathological diagnosis, we accidentally found ectopic adrenal gland tissue in the left mesosalpinx. We believe this is worthy of reporting since this case is rare.

A twelve-year-old, female Hermann’s tortoise (Testudo hermanni) was presented with an oviductal prolapse after showing tenesmus for three days prior to presentation. Radiography revealed a soft tissue opacity in the caudal coelomic cavity that ultrasonographically presented as a congested, invaginated tubular structure and was deemed to comprise the left oviduct. After repositioning the oviductal prolapse, coelioscopy confirmed that the invaginated structure consisted of the anterior part of the left oviduct and incorporated a part of the ipsilateral mesovarium and mesosalpinx. A transplastron osteotomy was carried out to perform unilateral salpingectomy and bilateral ovariectomy. A definitive diagnosis of an oviductal leiomyoma was made based on histopathological and immunohistochemical examination of the invaginated part of the oviduct. In the present case, the authors highlight that neoplastic disorders should be considered as a cause of oviductal invagination and prolapse in chelonians. To the authors’ knowledge, this is the first report of the diagnosis and successful treatment of an oviductal leiomyoma in a Hermann’s tortoise.

The ovarian bursa is a small peritoneal cavity enclosed by the mesovarium and mesosalpinx, which surrounds the ovaries and oviductal infundibulum in mammals. The ovarian bursa is considered as the structure facilitating the transport of ovulated oocytes into the oviduct. Our previous study revealed reduced oocyte pick-up function in the oviduct of lupus-prone MRL/MpJ-Fas(lpr)(/)(lpr)mouse, suggesting the possibility of an escape of ovulated oocytes into the peritoneal cavity, despite the presence of an almost complete ovarian bursa in the mouse. In this study, we revealed anatomical and histological characteristics of the ovarian bursa in C57BL/6 N, MRL/MpJ, and MRL/MpJ-Fas(lpr)(/)(lpr)mice. All strains had the foramen of ovarian bursa (FOB), with a size of approximately 0.04 to 0.12 cm(2), surrounded by the ligament of ovarian bursa (LOB), which is part of the mesosalpinx. The LOB was partially lined with the cuboidal mesothelial cells and consisted of a thick smooth muscle layer in all strains. In 6-month-old MRL/MpJ-Fas(lpr)(/)(lpr)mice, in which the systemic autoimmune abnormality deteriorated and oocyte pick-up function was impaired, the size of the FOB tended to be larger than that of other strains. Additionally, in MRL/MpJ-Fas(lpr)(/)(lpr)mice at 6 months of age, there was infiltration by numerous immune cells in the mesosalpinx suspending the isthmus; however, the LOB prevented severe inflammation and showed deposition of collagen fibers. These results not only indicate that the FOB is a common structure within mice, but also imply the physiological function of the LOB and its role in maintaining the microenvironment around the ovary, as well as regulating healthy reproduction.

Objective To examine the effect of simethicone on reducing operative difficulty associated with bowel interference during minilaparotomy for postpartum modified Pomeroy partial salpingectomy. Study design We enrolled 20–45-year-old women planning the procedure from March 2018 to February 2019. We randomized participants to chew simethicone 160 mg with water 50 mL 2–8 h before surgery or no treatment. The participants were not blinded; however, surgeons, care providers, and outcome assessors were blinded to the study allocation. We measured surgeon-rated operative difficulty using a 10-cm visual analog scale that represented the difficulty perceived to be resulting from bowel interference. Secondary outcomes included operative time and intraoperative and postoperative complications. Results We enrolled 60 women in each group; baseline characteristics and procedural profiles were comparable. Women in the intervention group used simethicone a median of 157 min (interquartile range 127–192) before the procedure. Surgeons rated the procedure difficulty score as 4.8 in the simethicone group and 4.5 in the control group (p = 0.57). Operative time in the two groups were 26 and 24 min, respectively (p = 0.14). We found no difference in intraoperative adverse events including blood loss and mesosalpinx tear, postoperative morbidities, hospital stay, and patient-rated satisfaction scores. Conclusion Preprocedural simethicone has no demonstrable benefit in reducing operative difficulty caused by bowel interference during minilaparotomy for postpartum tubal sterilization. Implications Preprocedural simethicone as given in this study did not result in reduced bowel interference and improved procedure difficulty. Further research examining simethicone in this setting would not be worthwhile as clinically meaningful benefit is unlikely.

Thai Journal of Obstetrics and Gynaecology, 30, 1, 33-40

Introduction/Background* The Wolffian tumor is a rare, usually benign tumor first described in 1973 as a ‘female adnexal tumor of probable Wolffian origin (FATWO)’’. There have been less than 100 cases reported in the literature, with fewer than 30 cases of malignant or recurrent disease.1,2 These tumors are solid or cystic and characterised by small, closely packed cells like a ‘sieve-like’ patern.3-6 The majority of tumors occur within the broad ligament, fallopian tubes, mesosalpinx, or ovary.7 In the following report we describe the case of FATWO of the fallopian tube, discovered in a 55-year-old female undergoing laparoscopic bilateral salpingo-oophorectomy. Methodology A 55-year-old asymptomatic, postmenopausal patient was referred to our hospital with an adnexal mass for evaluation. Pelvic transvaginal ultrasound revealed a uterus myomatosus and a 8 x 4 cm partially cystic, solid mass in the pouch of Douglas. The colour Doppler examination was negative. Serum tumor markers were negative (CEA, CA-125). The patient was prepared for a laparoscopic bilateral salpingo-oophorectomy which was successfully performed. Intraoperatively, an approx. 6.5x4 cm twisted, round, solid-cystic structure with an irregular surface was discovered on the right fallopian tube. The mass was excised laparoscopically with both of adnexa using electrocautery. The postoperative phase was uneventful. The histology initially described an undifferentiated tumor which was shown by immunohistochemistry analysis to be a Wolffian tumor. Result(s)* After negative staging with abdomen and thorax CT, the case was presented to the hospital’s tumor board where treatments were discussed and a total laparoscopic hysterectomy was indicated. The patient underwent a total laparoscopic hysterectomy and abdominal biopsies with negative histology. The rarity of the disease has led to poorly-defined therapeutic options. It has been considered that the most effective therapy is complete surgical resection with hysterectomy and bilateral adnexectomy.8,9 Sole tumor resection is a risk factor for relapse. The role of adjuvant chemotherapy or radiation is controversial.8 Conclusion* Due to rarity of cases and data concerning the malignant progression of such tumors, more studies are required to decide upon the appropriate management. Although some cases are benign, there has been evidence of malignant behavior. The efficacy of adjuvant therapy is still in question. Following surgical treatment, regular follow-up examinations should be planned for the long-term.

Diseases of the uterus and adnexa uteri should be considered when evaluating female patients with lower abdominal pain. Diseases caused by defects in the supporting ligaments of the female reproductive system should also be considered.

To map the distribution of the sites most affected by endometriosis in patients with unilateral ovarian endometriomas. A descriptive case series of 84 patients with unilateral endometriomas undergoing laparoscopy for the treatment of endometriosis. To evaluate the distribution of the sites of endometriosis lesions, the peritoneal compartments were divided into 5 zones: zone 1/the anterior compartment, including the anterior uterine serosa, vesicouterine fold, round ligament, and bladder; zone 2/the lateral compartment, including the left and right ovary, ovarian fossa, tubes, mesosalpinx, uterosacral ligaments, parametrium, and the ureter; zone 3/the posterior compartment, including posterior uterine serosa, the pouch of Douglas, posterior vaginal fornix, and bowel; zone 4 consisting of the abdominal wall; and zone 5 consisting of the diaphragm. Of the 5 zones evaluated, the lateral compartment (zone 2) was the most affected, with 60.7% of the patients having dense adhesions around the left ovarian fossa and 57.1% around the right ovarian fossa. The ovarian endometriomas were more commonly found on the left side (54.8%) compared to the right (45.2%). In the posterior compartment (zone 3), the posterior cul-de-sac was obliterated in 51.2% of the patients. In the anterior compartment (zone 1), there were lesions in the vesicouterine fold in 30.9% of the patients and in the bladder in 19%. Lesions were found in the abdominal wall (zone 4) and diaphragm (zone 5) in 21.4% and 10.7% of patients, respectively. Unilateral endometriomas are important markers of the severity of endometriosis.

Paratubal cysts may mimic ovarian cysts, and most of them are diagnosed postoperatively. They originate from the mesosalpinx between the ovary and the fallopian tube. Only a few are large, and most paratubal cysts are less than 10 cm. We report a huge paratubal cyst in a 30-year-old woman, whose only preoperative complaint was abdominal distention over 4 months. Conservative surgery was performed with cyst removal while preserving the ovaries and tubes. A paratubal cyst should be included in the differential diagnosis of a large pelvic masses, especially in the reproductive age.

Background The aim of this study was to determine whether the treatment with doxycycline before and after oocyte retrieval is as effective as salpingectomy in minimizing the detrimental effect of hydrosalpinx on the outcomes of IVF-ET. Methods A retrospective analysis was done for the outcomes of the IVF-ET cycles of patients with hydrosalpinx who underwent laparoscopic salpingectomy prior to IVF cycle (n = 260) or were treated with extended doxycycline treatment during the IVF cycle (n = 45). In doxycycline group, doxycycline (100 mg twice daily) was started 1 week before anticipated oocyte retrieval and was continued for 1 week after oocyte retrieval. In salpingectomy group, the mesosalpinx was coagulated as close as possible to the fallopian tube. Results The implantation, clinical pregnancy, ongoing pregnancy and live birth rates were significantly higher in the salpingectomy group (20.87% Vs. 9.91%, P value =0.007, 44.62% Vs. 20%, P value = 0.002, 39.62% Vs. 17.78%, P value = 0.005 and 37.31% Vs. 15.56%, P value = 0.005 respectively). Conclusion Salpingectomy is more effective than extended doxycycline treatment in improving the outcomes of IVF-ET in patients with hydrosalpinx undergoing IVF-ET. Further, larger well designed randomized controlled trials should be conducted to confirm the findings of this study.

The ovarian bursa is a small peritoneal cavity enclosed by the mesovarium and mesosalpinx, which surrounds the ovaries and oviductal infundibulum in mammals. The ovarian bursa is considered as the structure facilitating the transport of ovulated oocytes into the oviduct. Our previous study revealed reduced oocyte pick‐up function in the oviduct of lupus‐prone MRL/MpJ‐Fas(lpr) (/) (lpr) mouse, suggesting the possibility of an escape of ovulated oocytes into the peritoneal cavity, despite the presence of an almost complete ovarian bursa in the mouse. In this study, we revealed anatomical and histological characteristics of the ovarian bursa in C57BL/6 N, MRL/MpJ, and MRL/MpJ‐Fas(lpr) (/) (lpr) mice. All strains had the foramen of ovarian bursa (FOB), with a size of approximately 0.04 to 0.12 cm(2), surrounded by the ligament of ovarian bursa (LOB), which is part of the mesosalpinx. The LOB was partially lined with the cuboidal mesothelial cells and consisted of a thick smooth muscle layer in all strains. In 6‐month‐old MRL/MpJ‐Fas(lpr) (/) (lpr) mice, in which the systemic autoimmune abnormality deteriorated and oocyte pick‐up function was impaired, the size of the FOB tended to be larger than that of other strains. Additionally, in MRL/MpJ‐Fas(lpr) (/) (lpr) mice at 6 months of age, there was infiltration by numerous immune cells in the mesosalpinx suspending the isthmus; however, the LOB prevented severe inflammation and showed deposition of collagen fibers. These results not only indicate that the FOB is a common structure within mice, but also imply the physiological function of the LOB and its role in maintaining the microenvironment around the ovary, as well as regulating healthy reproduction.

Female adnexal tumors of probable Wolffian origin (FATWO) are a rare neoplasm from the mesonephric duct remnants with less than 90 cases having been reported worldwide. A 34-year-old nulliparous woman was referred to our clinic for a recent discovery of a pelvic mass, the diagnosis of FATWO has been confirmed based on the pathological and immunohistochemical results.

We are conducting a prospective study trying to determine, in both sexes, the frequency of appearance of ectopic Leydig cells, their preferred location, their relationship with nerve structures and the possible causes of their appearance. We have studied 86 cases that were removed according to different clinical indications for pathological study: uterine leyomiomas (n = 12), ovarian cystadenoma (n = 4), endometrial hyperplasia (n = 8), endometrial carcinoma (n = 12), cervical carcinoma (n = 4), seminoma (n = 4), fallopian tube ligatures (n = 24), vasectomies (n = 8), nonspecific orchiepididymitis (n = 2), and unknown (n = 8). We have observed ectopic Leydig cells in 13/86 cases (15.11%), 9/72 in the female samples (12.50%) and 4/14 in male samples (28.57%). The most frequent location was the mesosalpinx (4 of 13: 30.76%). These high figures lead us to believe that the ectopia of Leydig cells is not really a pathologic entity, but a finding related to specific functions yet to be determined.

Hilus cell heterotopia is defined as ovarian hilus cells found in abnormal locations, especially in the fallopian tube and mesosalpinx. It may be due to aberrant migration during embryonic developm...

Mesonephric ducts regress in genotypic females, leaving behind few remnants. These vestigial structures are often recognized in the mesosalpinx and paracervical regions. We report here 3 cases of female-to-male transgenders who underwent hysterectomy following testosterone treatment. Both female and male genital structures were identified on histologic examination. Although the morphologic appearances of the specimens were unremarkable, histologically 1 case revealed a well-formed fallopian tube as well as an epididymis and 2 cases showed prostate glands to be present in the cervical squamous epithelium.

Ovulation and oocyte-pick-up are essential processes in fertilization. Herein, we found associations between autoimmune disease and the aforementioned processes in mice. At three and six months, along with the evaluation of autoimmune disease indices, the ovary, mesosalpinx, and oviducts were histologically examined in C57BL/6, MRL/MpJ, and MRL/MpJ-Fas lpr/lpr mice as healthy control, mild and severe models of autoimmune disease, respectively. In superovulated mice, the number of “oocyte cumulus complexes” found in the ampulla was macroscopically counted, and that of “ovulated oocytes” was histologically evaluated, as indicated by ruptured follicles or corpora hemorrhagica in ovaries. Finally, the oocyte-pick-up rate was calculated. In MRL/MpJ-Fas lpr/lpr mice, the oocyte-pick-up rate decreased with disease-related deterioration, unlike in other mouse strains. Further, more ovulated oocytes were found in MRL/MpJ mice than in C57BL/6 mice, and this number significantly decreased with aging in MRL/MpJ-Fas lpr/lpr mice. Numerous T-cells infiltrated into the infundibulum or a part of the mesosalpinx in aged MRL/MpJ-Fas lpr/lpr mice, and their infundibulum showed swelling and fewer ciliated epithelial cells compared to that of C57BL/6 mice. In conclusion, the progression of severe autoimmune disease affected the oocyte-pick-up process through histopathological changes in the infundibulum. These results provide important insights into female infertility associated with autoimmune disease.

BACKGROUND The aim of the study is to evaluate the effectiveness of subcutaneous pre-incisional and mesosalpinx infiltration of 0.5% bupivacaine in post-operative pain relief. MATERIALS AND METHODS This is a randomised placebo-controlled double-blind study conducted at Bangalore Medical College and Research Institute on 50 patients scheduled for elective tubal ligation by minilaparotomy under general anaesthesia from April to October 2014. Patients were randomised into 2 groups of 25 each by computer generated random list. Group A patients received 0.5% bupivacaine 10 cc pre-incisional subcutaneous and 5 cc in the mesosalpinx, while Group B patients received normal saline infiltration. In this study, the intensity of post-operative pain was assessed using Verbal Rating Scale (VRS). Data collection was done using questionnaire and collected data was analysed by Student’s t-test, Chi-square and Fisher Exact test using SPSS software and descriptive statistical programme, p value < 0.01 was considered significant. RESULTS 50 patients were studied in two groups. Age and weight of the patients were comparable between 2 groups. Pain score in recovery room 2, 4, 6, 8, 10 hours post-surgery were significantly less in bupivacaine group (p < 0.005). Time for rescue analgesia is 3.92 ± 1.07 hrs. in Group A compared to 1.32 ± 0.54 in Group B with p < 0.01. CONCLUSION Pre-incisional and mesosalpinx infiltration of 0.5% bupivacaine in abdominal tubectomies by minilaparotomy led to significant reduction of post-operative pain with prolonged period for rescue analgesia.

Objectives To investigate the role of ultrasound in the preoperative diagnosis of adnexal torsion and describe its histological spectrum and outcomes at different ages. Methods This study comprised a retrospective investigation of a data set that included 195 female patients with clinically suspected adnexal torsion between January 2010 and July 2015. Each patient received a detailed pelvic ultrasound examination by an experienced ultrasound examiner, and a definitive diagnosis was achieved via surgery. The accuracy of an ultrasonic diagnosis of adnexal torsion was assessed. The patients were divided into three groups: female children and adolescents, fertile women, and postmenopausal women. The size, type, histological spectrum, and outcome of adnexal torsion in the different groups were also described. Results The sensitivity, specificity, and accuracy of ultrasound were 0.84, 0.77, and 0.81, respectively. There were significant differences in the presence of ultrasonic hallmarks among the true positive, false positive, and false negative cases of adnexal torsion. Ovarian torsion was identified in 94 cases, and isolated tubal torsion was identified in 15 cases. The most common histologic diagnoses of the pediatric group and the other two groups were a normal ovary and teratoma, respectively. The most common histologic diagnoses in the cases of isolated tubal torsion were mesosalpinx cyst and oviduct inflammation. Conclusions Ultrasonography plays an important role in the preoperative diagnosis of adnexal torsion. Despite ovarian involvement in most of the cases, isolated oviduct torsion was not uncommon. The spectrum of histological diagnoses varied among the age groups.

In the present study, a detailed histological description of the female reproductive tract of South American fur seal (Arctophoca australis) pups has been conducted. The uterine tube was covered by cuboidal to columnar epithelium; nerve fibers were present in the mesosalpinx and beneath the muscular layer. The uterus was bipartitus; the endometrial surface of the horns was lined by a simple cuboidal or columnar epithelium with deep tubular glands; caudally ("the transition area"), the epithelium changed to pseudostratified columnar, few tubular glands were present and the myometrium increased in width. A bistratified epithelium internally coated the uterine body, whereas it changed to cylindrical stratified epithelium with a highly vascularized lamina propria and a strong muscular layer in the cervix; no endometrial glands were observed in this region. From the transition area of the uterus to the vagina there were several nerve fibers and ganglia belonging to the uterovaginalis plexus. In the vestibule, hymenal folds were poorly developed; adnexa structures included the major vestibular glands and a neurovascular structure similar to the vestibular bulb. Minor vestibular glands were associated with the clitoris. The skin of the perineum was lined by a keratinized stratified epithelium, pigmented, with sebaceous glands, sweat glands and hair follicles. This is the first detailed histological description of the reproductive tract of South American fur seal pups, including the glandular adnexa and nerve structures. These results contribute to the reproductive biology in Pinniped species, and give a better understanding of the utero-placental perfusion mechanism during diving. Anat Rec, 2017. © 2017 Wiley Periodicals, Inc. Anat Rec, 300:600-613, 2017. © 2016 Wiley Periodicals, Inc.

Los quistes paratubáricos son estructuras quísticas simples llenas de líquido seroso ubicadas a lo largo de la trompa de Falopio, que generalmente se originan del ligamento ancho o el mesosálpinx. Es importante siempre considerar la torsión de la trompa como un diagnóstico diferencial en las pacientes que presentan dolor abdominal agudo y reconocer que se necesita un diagnóstico y tratamiento quirúrgico rápido para preservar la fertilidad de la paciente, especialmente aquellas en edad reproductiva. Se presenta el caso de una paciente de 16 años quien refirió dolor hipogástrico intenso junto con vómitos. Durante la laparoscopia, se encontró un quiste paratubárico torcido y se realizó la salpingectomía, debido a que la trompa derecha estaba deformada. El análisis histológico demostró que la tumoración era un quiste paratubárico.

Female adnexal tumor of Wolffian origin (FATWO) is a rare, poorly understood lesion characterized by variety of epithelial patterns and is known to occur in the broad ligament, mesosalpinx, fallopian tube, ovary, and pelvic peritoneum. About 80 cases of FATWO have been reported till date. A 70-year-old posthysterectomized woman reported with lump abdomen. She was provisionally diagnosed as malignant ovarian tumor. The patient was taken up for staging laparotomy. A solid mass arising from the left adnexa was removed along with the right-sided salpingo-oophorectomy and pelvic lymphadenectomy. Histopathological report was “benign Wolffian adnexal tumor.” FATWOs are rare tumors arising from the remnants of the mesonephric duct. Although most of them are benign, some have the potential for malignant behavior. Diagnosis is often based on exclusion of other neoplasms. Total abdominal hysterectomy and bilateral salpingo-oophorectomy are considered the recommended mode of therapy. The role of adjuvant radiation therapy or chemotherapy remains debatable.

von Hippel-Lindau disease (vHLD) is a rare autosomal dominant disorder with multiple benign and malignant tumors of different organs. We report a papillary cystadenoma of the mesosalpinx found in close association with an adenomatoid tumor discovered incidentally following tubal ligation in a patient with vHLD.

Study Objective To demonstrate the safe laparoscopic management of a tubal ectopic pregnancy presenting at an advanced gestational age. Design Narrated video tutorial for safe laparoscopic management of this rare presentation. Setting Ectopic pregnancy most often occurs within the fallopian tube commonly presenting as vaginal bleeding and abdominal or pelvic pain during the first trimester. Second-trimester tubal ectopic pregnancies are extremely rare and carry a significantly higher level of maternal morbidity and mortality compared to first-trimester presentation. Second-trimester tubal ectopic pregnancies are challenging to diagnose by ultrasound alone and may appear as peritoneal or ovarian ectopics. A high degree of suspicion must be maintained to ensure the best maternal outcomes. Patients or Participants We present a case of a bleeding tubal ectopic pregnancy diagnosed at 13 weeks and 4 days at an academic tertiary care hospital. Interventions A laparoscopic approach to manage a tubal ectopic pregnancy at 13 weeks and 4 days gestational age. Measurements and Main Results Laparoscopic approach was utilized with several key steps: 1. Confirmation of the tubal location of the ectopic pregnancy 2. Sequential cuts through the mesosalpinx minimizing injury to the adjacent ovary while limiting intraoperative blood loss 3. Specimen containment and umbilical extraction Conclusion Advanced gestational age tubal ectopic pregnancy represents an extremely rare clinical situation that requires the surgeons appreciation for the potential for massive maternal bleeding. Ultrasound diagnosis alone can be very challenging and thus high clinical suspicion should be maintained and appropriate preoperative planning is crucial.

Study Objective To evaluate the effect and feasibility of using bulldog clamps for temporary occlusion of bilateral uterine and utero-ovarian vessels on blood loss during robotic-assisted laparoscopic myomectomy. Design Retrospective chart review. Setting Academic tertiary care center. Patients or Participants A total of 15 consecutive patients, who underwent robotic-assisted laparoscopic myomectomy using bulldog clamps performed by single minimally invasive gynecologic surgeon, from 2018 to 2020. Interventions Patients were taken to the operating room for robotic-assisted laparoscopic myomectomy. Bilateral retroperitoneal dissection was performed with development of avascular spaces and ureterolysis. The uterine artery was skeletonized at its origin bilaterally and bulldog clamp was applied to each side, taking care to avoid ureteral and/or vascular injury. Furthermore, an avascular window was created in the mesosalpinx bilaterally and bulldog clamps were placed, occluding both left and right utero-ovarian vessels. Myomectomy was performed and once completed, all four clamps were removed allowing return of uterine blood flow. Measurements and Main Results Mean age and body mass index were 35.2 and 30.9 kg/m2, respectively. Most patients were black (53.3%). Mean myoma size and total myoma weight per patient were 6.6 cm and 106 g (standard deviation or SD = 82.7). Most leiomyomas were located in the fundus (41.4%). Mean estimated blood loss was 83 ml (range 20-200 ml). Mean operative time was 186 minutes. There were no intraoperative complications and all patients were discharged home on the same day of surgery. Conclusion Temporary bilateral uterine and utero-ovarian vessel occlusion using bulldog clamps can minimize blood loss during robotic-assisted laparoscopic myomectomy. Placement and removal of bulldog clamps for temporary uterine and utero-ovarian vessel occlusion are relatively easy and safe, compared to other methods of uterine artery ligation.

There is increasing adoption of opportunistic salpingectomy for ovarian cancer prevention at the time of gynecologic surgery, which includes the postpartum period. However, there is no consensus on an ideal surgical approach for the parturient vasculature. We describe a safe, low-cost, and accessible approach for bilateral salpingectomy during cesarean delivery that we call the "Mesosalpinx Isolation Salpingectomy Technique" (MIST) that can guide institutions to standardize their postpartum salpingectomy procedures when advanced vessel-sealing devices are not available. In the MIST technique, avascular windows are created within the mesosalpinx close to the tubal vessels. The vasculature is thus fully skeletonized and isolated from the adjacent mesosalpinx before suture ligation, which ensures security of the free-tie to the individual vessels and avoids sharp injury to the mesosalpinx. Not using vessel-sealing devices also eliminates the risk of thermal injury to the adjacent ovarian tissue and vasculature and potentially achieves a cost-savings for the hospital and patient. MIST has been performed in 141 cesarean deliveries in the past 4 years. There were no noted bleeding complications during the salpingectomy procedure, blood transfusions, or instances of postoperative surgical reexploration. In our experience, a surgeon who is new to the procedure takes approximately 15 minutes to complete a bilateral salpingectomy. Those surgeons who are experienced in MIST need only 5 minutes. A video is included that demonstrates the technique.

Introduction Ovarian reserve is a major prognosic factor for Medical Assisted Procreation. Tubal surgery, realised close to mesosalpinx and ovarian vascularization, could impare ovarian function. However, salpingectomy is currently used to treat ectopic pregnancies or hydrosalpinx before IVF attempt. Disponible studies on this subject are unclear. The aim of this study is to evaluate the impact of salpingectomy for ectopic pregnancy on the ovarian response during IVF attempt. Material and methods It was a single center comparative study. Included patients were the one receiving oocyte puncture for IVF attempt, with a history of unilateral tubal surgery: salpingectomy for ectopic pregnancy. We conducted a case-control study, comparing the sonographic parameters of the surgery ovary (case) to those of the safe ovary (control) during the first IVF attempt after salpingectomy. The ovarian sonographic response was evaluated according to the follicular antral count on day 3 and the sonographic follicular count on trigger day. Results 55 patients were included. There was no significant difference in the number of recruited follicles on the operated side versus control side (p = 0.85 for >14 mm follicles, p = 0,46 for 10 to 14 mm, p = 0,52 for total amount of recruited follicles). There was no significant difference for the follicular antral count neither (p = 0.79). Discussion In our population, there was no significant difference in the sonographic ovarian response to IVF stimulation between the ovary on the operated side and the control ovary among patients treated by unilateral salpingectomy for ectopic pregnancy.

Study question Is there perfusion to the fallopian tubes in ex-vivo and in-vivo uteri at the time of total laparoscopic hysterectomy (TLH), as observed using laser angiography with indocyanine green (ICG)? Summary answer The fallopian tubes may have perfusion from the utero-ovarian vasculature alone. What is known already The fallopian tubes are perfused by the uterine and utero-ovarian vessels. Perfusion can be measured using laser angiography with ICG. Study design, size, duration This prospective pilot cohort study included 15 women, ages 32-59 years old, who underwent TLH with bilateral salpingectomy for benign indications. Participants/materials, setting, methods In five participants, TLH was performed and the utero-ovarian artery was cannulated ex vivo and injected with ICG. The other 10 participants underwent the in-vivo protocol. The mesosalpinx and uterine vessels were transected in the partial protocol. Colpotomy was also performed in the complete protocol. All fallopian tubes were imaged using laser angiography with ICG. The relative fluorescence and the fluorescence intensity ratio (length of fluorescent fallopian tube/total length of fallopian tube) of the fallopian tubes were measured in the ex-vivo and in-vivo protocols, respectively. Main results and the role of chance Ex vivo, the fimbria of the ipsilateral fallopian tube had 47% median relative fluorescence as compared to the contralateral fallopian tube, which had 2.4% median relative fluorescence. In vivo, the post-ICG fluorescence intensity ratios were 0.61 ± 0.40 for the partial protocol, and 0.78 ± 0.30 for the complete protocol, with mean differences of 0.37 (95% CI: 0.23-0.50, P 75% tubal length fluorescence) was seen in 60% of fallopian tubes. Limitations, reasons for caution This is a pilot study with a small sample size and pathologic uteri, which would not be appropriate for uterine transplantation. No conclusions can be made regarding the functionality of the fallopian tubes. Wider implications of the findings The fallopian tubes may have perfusion with the utero-ovarian vasculature alone, potentially allowing for future animal studies regarding tubal viability in recipients of uterine-tubal transplants. If successful, human uterine-tubal transplantation may allow for spontaneous conception rather than IVF. Study funding/competing interest(s) No external funding was used. S.F., P.F.P., K.A.S. and R.F. have no conflicts of interest to report. M.L.S. is an educational consultant for Medtronic (Dublin, Republic of Ireland) and Applied Medical (Rancho Santa Margarita, CA, USA), as well as a stockholder for SynDaver Labs (Tampa, FL, USA). S.E.Z. is an educational consultant for Applied Medical (Rancho Santa Margarita, CA, USA) and is on the advisory board for AbbVie Inc. (Chicago, IL, USA). Trial registration number Not applicable.

Study Objective To investigate the advantages of using robotic assistance in tubal reanastomosis surgery. Design A narrated instructional video. Setting University Hospital, Baylor College of Medicine, Houston, Texas (Canadian Task Force Classification III). Patient A 33-year-old woman, G2P2003, who regretted her prior tubal ligation; she continued to request for a tubal reversal with a desire to conceive in the near future. A single-site approach was decided on when she expressed concern for the cosmetic aftermath of multiport surgery. Interventions Robotic single-site tubal reanastomosis. Measurements and Main Results We performed robotic single-site tubal reanastomosis on the patient. We used the energy instruments of the monopolar hook and the bipolar slotted grasper. Entry was performed in the umbilicus, after which an abdominal survey was conducted to determine and locate the blocked fallopian tubes. A cold scissor, to avoid additional damage to the tubes, was used to resect the portion of the right blocked tube, and a neonatal feeding tube was inserted though both sections of the tube to ensure proper alignment during the repair. Additionally, a figure of eight suture was placed in the mesosalpinx to reduce the amount of tension during the tubal reanastomosis. We used 4 interrupted 5-0 PDS sutures, with 2 wristed needle drivers, to establish and precisely align the 2 sections of tube, first in the mucosal layer and then in the serosal layer, to achieve proper retention. Upon successful chromopertubation with methylene blue dye, the process was repeated on the left side. A successful tubal reanastomosis was completed and chromopertubation clearly demonstrated that the tubes were patent. Total operation time was approximately 100 minutes, resulting in a successful surgery. Estimated blood loss was only 20 mL. At 2 months after surgery a fluoroscopic hysterosalpingogram was conducted to verify the patency of the tubes. We concluded that both tubes were patent. Conclusions The single-site robotic approach provides a potent and valuable method for tubal reanastomosis, rendering difficult surgical techniques more accessible.

Female adnexal tumors of probable Wolffian origin (FATWO) are rare tumors, which are mostly localized in the broad ligament or the mesosalpinx. They show high intratumor and intertumor variability of histological patterns (e.g. solid, tubular, cribriform and cystic) with usually unremarkable cellular and nuclear morphology and a lower mitotic rate. In general, they behave in a benign fashion but there are rare cases with malignant transformation, so that careful examination and surveillance are necessary. Differential diagnoses include Sertoli-Leydig cell tumors, metastasized endometrioid carcinoma and the FATWO-like variant of the endometrioid carcinoma of the fallopian tubes. The FATWOs express pancytokeratin, CD10, vimentin, calretinin and inhibin A. Estrogen and progesterone receptors are expressed in a minority of cases, whereas epithelial membrane antigen (EMA) is not detectable.

The differential diagnosis of lesions arising in the broad ligament is quite large. Many of these lesions can be clinically interpreted before surgery as adnexal or uterine neoplasms. Although some lesions are similar to those arising in other müllerian sites, there are unique lesions as well. The lesions are uncommon and may prove challenging to clinicians. The purpose was to review the scope of lesions affecting the broad ligament. A literature review was conducted. A Medline search was performed using the terms broad ligament, mesosalpinx, and mesovarium. A review of the scope of broad ligament lesions is presented to assist in developing a differential diagnosis if a patient with such a lesion is encountered.

The present work was aimed at characterizing the regional vascularization of the oviduct in the pig to ascertain whether the number of terminal mesosalpingeal arterioles supplying the isthmus and ampulla is influenced by reproductive maturity and state of the estrous cycle. The total number of terminal arterioles (NTA) in the mesosalpinx was quantified under a stereomicroscope in latex injected ex-vivo reproductive tracts from pre-pubertal (n = 10) and mature sows (n = 34), the latter allocated into three phases of the estrous cycle: follicular (n = 12); early luteal (n = 11); and late luteal (n = 11). The NTA and density of terminal arterioles (DTA) changed little between pre-pubertal and mature sows or among sows of different reproductive status (P > 0.05). Conversely, both in pre-pubertal and mature sows the isthmus showed higher DTA (P

The current study was conducted to address the pathological conditions of uterine tubes of cows slaughtered at the abattoir in Sulaimani, Kurdistan Region-Iraq. The pathologic conditions were objected to macroscopic and microscopic examination of 404 samples of female genitalia collected from slaughtered non-pregnant cows. Collection of female genitalia samples was conducted from February to September 2014 by visiting the Qaragol slaughterhouse twice a week. The organs were observed macroscopically for pathological abnormalities and stained tissues with Haematoxyline and eosin. They were examined under microscope for determination of the type of lesion present in the organ. Among the 404 genitalia samples collected from the non-pregnant animals, 206 (51%) were found without gross pathological abnormalities (with cyclic activity) and the 71(17.57) samples were found with gross pathological abnormalities of uterine tubes. Detected lesions in the uterine tubes included salpingitis 9.15%, pyosalpinx 4.21%, hemosalpinx 1.48%, uterine tube adhesion 0.74%, mesosalpinx cyst 0.74%, nodules on mesosalpinx 0.74%, occluded uterine tube 0.25%, and presence of cysts on the uterine tube wall 0.25%. Histopathologically, salpingitis was characterized by erosion of the mucosal layer lining, while pyosalpinx showed a heavy inflammatory cell reaction composed of a mixture of neutrophils and lymphocysts. Hemosalpinx showed the stromal hemorrhage in the core of the villus like folds of epithelium. Cystic uterine tube, (paratubal paramesonephric cyst), revealed a single layer of tubal type ciliated columnar epithelium resting on fibrous tissue of the normal fallopian tube. It was concluded that uterine tube abnormalities constitutes an percentage of 17.57% and salpingitis is the most common pathology of uterine tubes in non-pregnant cows.

Objective Sarcoidosis is a multisystem inflammatory disorder of unknown cause that affects multiple organs. To date, only isolated cases of extrapulmonary sarcoidosis of the female reproductive tract, which rarely affects postmenopausal women, have been reported. Methods We describe the case of a postmenopausal woman with sarcoidosis of multiple structures of the genital tract accompanied by pulmonary involvement. A review of the literature was performed to examine the role of sex hormones in the pathogenesis of sarcoidosis. Results We describe the case of a 60-year-old white, nulliparous, nulligravid postmenopausal woman with sarcoidosis of the cervix, uterus, mesosalpinx, and right ovary, accompanied by pulmonary involvement. The diagnosis was based on the identification of noncaseating granulomas in reproductive tract organs. Although imaging methods (high-resolution CT and chest x-ray) and pulmonary function tests did not reveal any abnormality, lung involvement was confirmed histologically by transbronchial biopsy. Treatment with steroids was successful and led to normalization of serum biomarker (serum angiotensin-converting enzyme, soluble interleukin-2 receptor, and neopterin) levels. Conclusions This particular case and a brief literature review of female genital tract sarcoidosis in postmenopausal women suggest the role of sex hormones in the pathogenesis of sarcoidosis. Hormone therapy may be a prospective therapeutic alternative to corticosteroids in postmenopausal women.

We describe gross, histopathologic, and immunonocytologic features of a primary uterine T-cell lymphoma with multiple metastases in an adult female Atlantic spotted dolphin (Stenella frontalis). Neoplastic T-cell lymphocytes (CD3+) partially effaced the uterus, ovaries, mesosalpinx, and urinary bladder and variably infiltrated abdominal and thoracic organs. Herpesvirus and morbillivirus PCR were negative.

Introduction: Gartner ducts are vestigial remnants of the mesonephric ducts that regress after the eighth week of embryologic development. In the adult female, remnant Gartner ducts from the mesosalpinx to the cervix via the broad ligament and are typically located along the anterolateral vaginal wall. Cysts can arise when the ducts become obstructed and secretions from the remnant epithelium accumulate. Gartner duct cysts represent only about 11% of benign vaginal cysts. They often occur in pregnancy, but typically in the third trimester.Aim of Study: The purpose of this case report is to present a very unusual case of Gartner duct cyst that presented during the first trimester of pregnancy with our management strategy.Patients and Methods: After a 19-year-old primiparous patient presented with a painful midline vaginal mass in her first trimester, ultrasound and MRI were used to obtain the diagnosis of Gartner duct cyst. Bedside incision and drainage was performed to avoid general anesthesia for surgical excision.Results: The patient’s symptoms resolved after drainage, and she continued her pregnancy without complication. Complete healing of prior incision occurred with mild re-accumulation of glandular fluid. The patient had further symptoms.Conclusion: Gartner duct cyst should be on the differential diagnosis for a woman who has a midline vaginal cyst, even though they more typically occur more laterally. General anesthesia in the first trimester of pregnancy should be avoided. Therefore, we suggest bedside incision and drainage as an option for the management of symptomatic Gartner duct cysts in the patient who is not the ideal candidate for surgical excision

A female Indian star tortoise (Geochelone elegans) was evaluated for anorexia and suspected coelomic masses. Clinical examination indicated follicular stasis. The tortoise was anesthetized and placed in dorsal left lateral recumbency for a right prefemoral approach. The ovaries and oviducts were exposed through the right prefemoral incision. The ovarian vasculature, the mesovarium, the oviduct, mesosalpinx and associated vasculature were ligated and transected. Bilateral oophorosalpingectomy was performed through the incision, without coelioscopy. Since then, the same procedure has been performed in five other tortoises, and all recovered well. These results suggest that bilateral oophorosalpingectomy, performed through a prefemoral incision, without coelioscopy, is a safe and practical approach for treating follicular stasis in tortoises.

Patients with Swyer syndrome, which is also known as 46,XY pure gonadal dysgenesis, are at an increased risk of gonadoblastoma and germ cell tumor. Prophylactic gonadectomy is recommended for these patients. We report a case of stage IIA dysgerminoma arising in a streak gonad in a patient with Swyer syndrome, which was not diagnosable preoperatively and intraoperatively. The patient was primarily amenorrheic and identified as female phenotypically. She underwent gonadectomy at 27 years of age. Preoperative image analysis showed a relatively small uterus without adnexal masses. Laparoscopic findings showed bilateral streak gonads. Postoperatively, histopathological examination revealed that the patient had dysgerminoma in her left streak gonad. Preoperative and intraoperative diagnosis of dysgerminoma in normal size ovaries is thought to be difficult. Although it is rare, considering the occurrence of dysgerminoma in streak gonad with extension to the mesosalpinx, prompt prophylactic gonadectomy is strongly recommended for these patients regardless of the size of the ovaries.