Water intoxication may be induced by the use of intrauterine fluid overload in hysteroscopic surgery. We report a patient with a uterine myoma and anemia (Hb, 9.3 g/dl), who developed severe hyponatremia during a hysteroscopic myomectomy. The submucosal myoma was resected using a monopolar resectoscope following 6 courses of GnRH agonist therapy. The procedure was performed by a combination of lumbar and intravenous anesthesia. The total amount of 3% solbitol was 27,000 ml and the duration of the procedure was 75 minutes. Severe hyponatremia (104 mEq/l) was diagnosed during the procedure, although there were no abnormal symptoms and vital signs. The serum Na level recovered to a normal level following the administration of diuretics.
  This case suggests that hyponatremia may occur during extensive resection of non-protruding submucosal myomas. Therefore, frequent measurements of intake and output of fluids and measurement of the serum Na level are required to prevent severe hyponatremia during hysteroscopic procedures for such cases.

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Background: Atypical polypoid adenomyomas (APAMs) are tumors of the uterine cavity. APAMs are difficult to distinguish from endometrial polyps or submucosal myomas. An APAM is composed of atypical endometrial glands surrounded by smooth muscle.
Case: A 33-year-old woman had dysmenorrhea and hypermenorrhea. An ultrasound and MRI revealed a 2-cm tumor in the uterine cavity. The histologic diagnosis of a specimen obtained by hysteroscopic resection showed an APAM. After 1 year, an APAM recurred. Multiple polypoid lesions were resected through a hysteroscope.
Conclusion: Although difficult to diagnosis; however, a pathologic diagnosis can be made on APAMs following hysteroscopic resection.

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Capsule
Successful pregnancy and delivery after endoscopic revision of a uterine bicornis bicollis and septate vagina.
Abstract
Internal genital abnormalities which occur in fetuses are often diagnosed after menarche with symptoms of dysmenorrhea. We report a patient who was diagnosed with uterine bicornis bicollis and a septate vagina. She achieved a successful pregnancy and delivery after undergoing endoscopic surgery in childhood.

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Objective: We report a relatively rare case of laparoscopic hysterectomy (LH) performed in a young girl for urogenital sinus anomaly.
Patient: We scheduled hysterectomy for a 13-year-old girl who had a history of recurrent colpitis and cystitis with pyometra and pyocolpos caused by vaginal obstruction. At the age of 2 years, she had undergone a radical operation of urogenital sinus anomaly. At the age of 12 years and 10 months, she had undergone re-vaginoplasty. Even after the surgery, she had recurrent episodes of colpitis and cystitis with pyometra and pyocolpos caused by menstruation and vaginal re-obstruction. Since we preferred to reduce the risks of repeated infections and interventions rather than conserve the uterus, we performed hysterectomy. We decided to perform laparoscopic hysterectomy.
Conclusion: This case has shown that LH is more suitable than one-sided approaches such as total abdominal hysterectomy and total vaginal hysterectomy for patients who have obstructions in their urogenital tracts.

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  We describe a case of torsion of the fallopian tube due to a hydosalpinx. The symptoms were acute abdominal pain. The initial diagnosis was a torsion of an ovarian tumor based on ultrasonography, computed tomography, and magnetic resonance imaging. A laparoscopic examination showed a dark-red, round, necrotic left hydosalpinx. A left laparoscopic salpingectomy was performed. The histologic examination showed a hydrosalpinx of the left tube with extensive hemorrhage and edema. We could not preserve the fallopian tube in this case. In some cases, removing occluded or pathologic fallopian tubes is useful for increasing fertility before performing IVF treatment. Further discussion about diseases of the fallopian tube is required to optimize how abnormal fallopian tubes are treated.

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Objective: To compare one surgeon's outcomes involving total laparoscopic cystectomies (TLCs) for mature ovarian cystic teratomas between two time periods (1995-1998 and 2007-2008).
Design: Retrospective study (Canadian Task Force Classification III).
Setting: Two university hospitals.
Patients: Sixty-three women with mature cystic teratomas.
Interventions: Women who underwent TLCs in 1995-1998 or 2007-2008 for mature cystic teratomas.
Main outcome, Measures: We determined the age of the patient, diameter of the tumor, surgical time, blood loss, intra-operative leakage, and post-operative hospital stay,
Results: In 32 women, 38 mature cystic teratomas were treated by TLC during 1995-1998 (group A). In 31 women, 32 mature cystic teratomas were treated by TLC during 2007-2008 (group B). The 70 mature cystic teratomas were performed by one surgeon (the first author). The incidence of intra-operative leakage was significantly decreased in group B compared to group A (2 vs. 16, P<0.001) and the post-operative hospital stay was significantly shorter in group B compared to group A (mean, 4.0 vs. 6.6 days, P<0.001). The age of the patients, diameter of the tumor, surgical time, and blood loss were not significantly different between groups A and B.
Conclusion: Increased laparoscopic surgical experience was significantly associated with a decreased incidence of intra-operative leakage during TLC, and may reflect advances in laparoscopic instrumentation.

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With increasing focus on patient safety, the surgical education curriculum must address the inherent conflict between a trainee's right to learn and the patient's expectation of high quality surgery. Is it possible to satisfy both? Since 1997, more than 7,000 cases of laparoscopic surgery have been performed in our hospital. With the increase of cases, 12 trainees have been educated for the past 2 years, and 5 trainees are now under-training. Our Total Laparoscopic Hysterectomy (TLH) is divided into 8 steps, and each trainee can perform until the 7th step according to each one's ability. If the quality of one procedure performed by a trainee is not high, the leading surgeon performs the procedure on behalf of the trainee. The comparison between 2007 and 2008 involving bleeding volume, operating time, uterine weight and incidence of complications showed no significant difference statistically. The result showed our surgical education curriculum for TLH is efficient and safe as well as keeps the operative outcome stable.

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Vaginal cuff dehiscence is a rare, but a potentially critical complication after total laparoscopic hysterectomy (TLH). TLH has been reported as having a higher incidence of dehiscence compared with the abdominal and/or vaginal hysterectomy. This complication causes the abdominal content to fall through the vaginal possibly leading to serious infection.
The cause of vaginal dehiscence after TLH is not clear. The possible causes may be early resumption of regular activities, the use of thermal energy for vaginal incision and reduced suturing width due to not enough tissue involvement causing poor blood perfusion. Magnification and low quality of laparoscopic suturing skills also plays a role.
We performed 677 cases of TLH for benign diseases such as fibroids or adenomyosis from January 2007 to December 2008 in our institute. We experienced 4 cases (0.6%) of vaginal cuff dehiscence. Sexual intercourse was the triggering event for 3 cases (96 days, 103 days, 47 days after TLH) and another 1 case occurred during defecation (18 days and no sexual intercourse after TLH). We closed the vaginal cuff promptly via the vaginal. No complications occurred after the closure operation.
After these 4 cases of vaginal cuff dehiscence, we recognized the need to review these cases carefully in order to discover the cause and how to prevent this from occurring in other patients. Appropriate management of this complication by reducing the use of power source and attempting different suturing techniques are important steps towards preventing this potentially serious complication.

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Objectives: The aims of this study were to report the feasibility of laparoscopic surgery for early-stage endometrial cancer and to assess the effects of laparoscopic surgery on the survival of patients.
Methods: Twenty-three patients with clinical stage I and IIa endometrial cancer were treated by laparoscopy (laparoscopy group [LS]). The surgical procedures included hysterectomy, salpingo-oophorectomy, and para-aortic-pelvic lymphadenectomy. Peri-operative morbidities and outcomes were compared with 20 control patients who were treated with traditional open surgery (laparotomy group [LT]). The recurrence rate, overall survival, and progression-free survival were also compared between the groups.
Results: All 23 patients were treated successfully with laparoscopy. The mean operative time was 419.5 and 321.8 min in the LS and LT groups, respectively. Two intra-operative and 5 post-operative complications occurred in the LS group, but the complication rates were not significantly different from in the complications in the LT group. An earlier recovery and a shorter hospital stay were features of the LS group. There were no differences in recurrence rate, progression-free survival, and overall survival between the LS and LT groups.
Conclusion: Laparoscopic surgery of early-stage endometrial cancer is a valid alternative to traditional open surgery, with an earlier recovery and improved quality of life without compromising prognosis.

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