Introduction: Abnormal uterine bleeding is frequently a symptom of gynecologic disease. Recently, a cesarean section scar diverticulum was found to be a cause of persistent and irregular uterine bleeding.

  A 42-year-old multigravid woman with prior cesarean deliveries developed persistent irregular vaginal bleeding in association with an anterior extrauterine cystic mass detected by ultrasound. Based on pelvic magnetic resonance imaging (MRI), cesarean section scar diverticulum was suspected to be the cause of the uterine bleeding. Total laparoscopic hysterectomy was performed and histological examination identified a diverticulum lined with endometrium at a low uterine segment.
  Uterine scar defects can be associated with abnormal uterine bleeding. Cesarean section scar diverticulum is rare. However, it should be differentiated from other pelvic masses. Surgical treatment may be necessary to treat atypical uterine bleeding and dysmenorrhea.

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  Pregnancy in the rudimentary horn is rare, with a reported incidence of 1 in 76,000-150,000. We report a case of a twin pregnancy in the rudimentary horn at 8 weeks of gestation. The patient was a 19-year-old nullipara. Before the surgery, she was administered methotrexate (MTX) and the serum hCG level was monitored. After we confirmed that the hCG level had decreased to within the normal range, and angio-CT imaged the absence of blood flow in the rudimentary horn, laparoscopic surgery was performed. The rudimentary horn was successfully excised with minimal bleeding. Laparoscopic surgery with preoperative MTX administration followed by minimally invasive surgery for pregnancy in the rudimentary horn is both safe and effective.

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  Transvaginal ultrasound-guided aspiration and sclerotherapy with ethanol is a conservative means of treating an ovarian endometrial cyst. Its simplicity, minimal invasiveness, and a relatively low recurrence rate make it an attractive option. However, if ethanol should leak into the pelvic cavity, inflammation is incited, and pelvic adhesions may result. Herein, we report a case of successful laparoscopic surgical intervention for a subileus due to past ethanol sclerotherapy. The patient, a 26 year-old single female, underwent ethanol sclerotherapy eight years previously at another hospital for a right ovarian cyst. During the procedure, some leakage of ethanol was evident, and she had since suffered from intestinal problems, such as severe constipation. Sudden onset of severe right lower abdominal pain prompted her visit to our center.
  Based on our evaluation, a diagnosis of the ruptured right ovarian cyst and subileus was made. Laparoscopic findings documented extensive adhesions of small intestine, sigmoid colon, and omentum with abdominal wall. Rupture of a right ovarian cyst was also confirmed. Past ethanol leakage was the presumed etiology, because (1) the adhesions were mostly limited to pelvic cavity, (2) sclerotic, thickened, fibrous peritoneum and band-like adhesions had formed around the pouch of Douglas, and (3) there was no other likely explanation. Following laparoscopic lysis of adhesions, her intestinal problems resolved and pertinent diagnostic parameters (ie, abdominal x-ray) have subsequently improved.
  We conclude that if the ethanol sclerotherapy is elected, the possibility of ethanol leakage should be subject to direct scrutiny and precautionary measures should be taken to avoid later complications.

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  Cervical pregnancy is an unusually complicated form of pregnancy, accounting for one out of 1000~95000 pregnancies. Women with these pregnancies are often required to have hysterectomies due to severe, uncontrollable hemorrhage. It is necessary to diagnose and treat these types of pregnancies as early as possible, not only to prevent maternal hemorrhage but also to preserve the uterus. A 28-year-old woman was referred for suspected cesarean scar pregnancy at 5 weeks gestation. A flattened gestational sac was seen underneath the uterine anterior wall, located at the previously-incurred cesarean scar. We initially diagnosed this as a cesarean scar pregnancy and treated it with umbilical artery embolization and intra-arterial injection of actinomycin D. However, she had persistent uterine bleeding with the gestational sac descending into the cervical canal. We ultimately diagnosed her with a cervical pregnancy, because the degenerated tissue of the gestational sac was revealed to be attached to the inside of the uterine cervix on hysteroscopic imaging. We successfully performed a trans-cervical resection of the gestational mass after laparoscopic temporal ligation of both uterine arteries.

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  The incidence of uterine fistula following a Cesarean section is reported to be 6.6%. The menstrual fistula is known as the cause of dysmenorrhea and irregular uterine bleeding. We experienced a case of large uterine wall scarred fistula successfully repaired by a laparoscopic surgery. The patient was 24 years old, gravida 3 para 2, female. She delivered her 2 offspring by cesarean sections. After 13 months following the last operation, she was referred to our institution with the chief complaint of prolonged menstruation. A hematoma of 5cm in diameter, located on the surface of the vesicouterine pouch, and the uterine wall defects from dehiscence of the Cesarean section scar were observed by the ultrasound scan and MR imaging. Follow the 6 months of the Gn-RHa administration, a surgical repair was performed. By laparoscopic observation, a hematoma covered by thin membrane was found at vesicouterine pouch, and the membrane was incised. Upon opening the hematoma, the uterine wall fistula was identified as a defect, as wide as the half length of the lower uterine segment. After removing the scar tissue, the uterine wall was sutured by 2 layers using 1-0 Monocryl. 1.5 months after operation, her menstruation was recovered and the patient has no previous complaints.

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Case Report: A 42 year-old woman with previous laparotomy underwent laparoscopic surgery for a left ovarian dermoid cyst. There was a risk of colon injury in the primary approach because of abdominal wall adhesions. To avoid this risk, we chose open laparoscopy through the left lower abdominal approach. However, when the fascia was cut the external iliac artery was injured . We inspected the method and the anatomy around the area. We also conducted a multi-institutional questionnaire survey about the method of laparoscopy with previous laparotomy, which found that 6.7% of 104 Japanese hospitals active in laparoscopic surgery are performing open laparoscopy through the lower abdominal approach. The computed tomography of the patient suggested that open laparoscopy in the area distal to the iliac crest was close to the artery and is better done with mechanical skin traction.

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  Monopolar current is essential in laparoscopic surgery. However complications of monopolar electrosurgery include thermal injury due to wrong contact, capacity coupled current, and shunting . This report deals with a new mechanism of shunting in laparoscopic surgery. The specimen bag is the insulator. In this case, the monopolar current cut tumor in the collecting bag. Typically this can't happen. Electricity should have flowed to the surface of the abdomen. When the bag had full contact with organs it did not cause shunting burns. If there was point contact, shunting burns occurred. We propose that the causes of shunting burns are point-contact and the water in the abdominal cavity. Electrothermal burns are reported more often in laparoscopic surgery than in laparotomy. This report aims to reduce these injuries through understanding of the characteristics of the electric scalpel and water management in the abdominal cavity.

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  We report a case of laparoscopic myomectomy in which the uterine manipulator was sutured into the endometrium. A 37 year old woman underwent a laparoscopic myomectomy after 3 injections of leuprolide acetate over 12 weeks. During the operation, we used a uterine manipulator, which is useful for resection of the myoma and for suturing the myometrium. When we finished the operation, we discovered that we had sutured the top of the uterine manipulator to the endometrium and left it inside the uterus. The sutures were absorbable, so we decided to await expulsion of the manipulator after natural dissolution of the sutures. At 135 days after the operation, we confirmed that the manipulator had been expelled from the uterine cavity.

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Objective: Chlamydia trachomatis is the most frequently encountered infectious disease in daily practice in gynecology. The infection exhibits a wide range of presentations, from asymptomatic infection to severe pelvic peritonitis, which is often difficult to differentiate from other forms of peritonitis. There have been reports of patients developing chlamydial peritonitis in the early postoperative stage after laparoscopic surgery. Here, we report 4 cases of chlamydial peritonitis that developed soon after laparoscopic surgery in asymptomatic patients.
Patients: Patient ages ranged from 26-50 years. The surgeries included 1 total laparoscopic ovarian cystectomy (TLC), 1 total laparoscopic hysterectomy (TLH), and 2 laparoscopic assisted myomectomies (LAM). There were no operative findings suggestive of adhesive chlamydial infection, but increased levels of chlamydial IgA were confirmed in all 4 patients. Repeat laparoscopic surgery was required in 1 patient who developed ulcerative colitis after LAM due to delayed resolution of inflammatory response. Operative findings included severe pelvic peritonitis with extensive abscess formation from the pelvic cavity to the muscular layer at the site of the myomectomy. The repeat surgical procedure included exfoliation of inflammatory adhesions, drainage of the abscess, removal of the suture in uterine muscle, and thorough irrigation of the abdominal cavity with normal saline solution.
Conclusions: We test all patients for Chlamydia antibodies as part of the pre-operative workup. Patients who test positive are treated with oral azithromycin hydrate before surgery.

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  Hysteroscopic myomectomy is indicated for symptomatic submucosal uterine fibroids. The main complications associated with the procedure are uterine perforation and water intoxication. This report details a case of water intoxication that presented with acute hyponatremia during hysteroscopic myomectomy. The procedure was suspended and the patient's electrolyte imbalance was managed in the intensive care unit (ICU).
  The patient was a 36-year-old nulligravid female with a history of hypermenorrhea and a 6cm submucosal myoma with 100% protrusion from the uterine fundus. Excision of the tumor by laparoscopy combined with hysteroscopic myomectomy was attempted to preserve the uterus. At three hours and thirty minutes into the procedure, the patient's blood pressure dropped to 70/40mmHg. Infusion volume was 15,000ml and drainage was 12,000ml. An immediate electrolyte panel revealed severe hyponatremia, with a serum sodium level of 96mEq/l. The operation was suspended and the patient was transferred to the ICU. She left the ICU the next day with a serum sodium level of 132mEq/l. On the 6th post-operative day, she was discharged without significant sequelae. The size of the remaining myoma on follow-up ultrasound was 3cm, but a repeat hysteroscopy revealed that the intrauterine protrusion had receded. After six months, the patient underwent open myomectomy.
  This case suggests that operative duration in hysteroscopy should be less than 2 hours to avoid water intoxication. In addition, infusion and drainage volumes must be monitored, with special attention required when the difference between the two volumes exceeds 750ml. The operation should be suspended when the difference exceeds 1500ml.

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  Gartner's duct cysts are dilated Wolffian duct remnants commonly found in the lateral part of the vagina. We report a case of Gartner's duct cyst arising from the cervix, which was resected laparoscopically.
  A 13-year-old girl complained of lower abdominal pain. An ultrasound scan revealed a pelvic tumor and MRI showed a 3.8 × 4 cm cervical cyst. There were no malformations in the uterus or kidneys. The cyst was diagnosed as a Gartner's duct cyst arising from the cervix. The patient underwent laparotomy, and the cyst was found in the upper side of the right sacrouterine ligament. Visibility was limited by the narrow surgical incision, and resection of the cyst was difficult. The cyst was aspirated, and the contents were negative for malignancy. Several months postoperatively, the patient had a recurrence of the pain. Treatment options were laparoscopic surgery, marsupialization, and sclerotherapy. On operation, we incised the serosa of the cyst and peeled it off from the surrounding area. The cyst was connected to the cervical canal, and the defect in the cervical canal that resulted from its resection was sutured. The patient was pain-free after laparoscopic surgery. We suggest that Gartner's duct cyst arising from the cervix and protruding toward the pelvic cavity is a potential candidate for laparoscopic resection.

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  Atypical polypoid adenomyoma (APAM) is an endometrial tumor that usually occurs in premenopausal women. APAM frequently recurs after resection, and coexists with or progresses to endometrial adenocarcinoma. Uterine conservative therapy is often selected for patients who desire to conceive, and several studies show good outcomes with conservative therapy. We report here a patient with APAM who achieved pregnancy and delivered a child with continuous infertility treatment after hysteroscopic resection of the tumor. The patient was a 34-year-old infertile woman. We performed hysteroscopic resection of multiple endometrial polyps for the purpose of infertility treatment, and found that a part of the polyps was APAM. After confirming that there was no remaining tumor in the uterus, we restarted infertility treatment. Endometrial cytology was performed at regular intervals and hysteroscopic resection was performed when a polypoid lesion was detected. She conceived after several cycles of infertility treatment, and delivered a healthy baby. No recurrence of APAM has been detected as of this writing. Consensus on a method of conservative treatment for APAM has not yet been achieved. It is necessary to assess the grade of malignancy and to perform careful follow-up after complete resection.

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Cesarean scar pregnancies have been diagnosed with increasing frequency in the last decade. We present a case of successful endoscopic uterine artery clipping in combination with subsequent dilation and curettage. Uterine artery clipping can be a useful procedure for preventing uncontrollable bleeding and unnecessary uterine loss.

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  Prolactin(PRL) affects more physiological process than all other pituitary hormones combined. Normal myometrium and uterine fibroids secrete PRL, but the function of myometial PRL is unknown. We report a case of complete remission of hyperprolactinemia after laparoscopic myomectomy. The patient was 37 years-of-age, gravid 0, para 0. She was referred to our hospital elsewhere because of a diagnosis with hyperprolactinemia and uterine myoma. At the age of 35, she had been diagnosed with secondary amenorrhea and hyperprolactinemia. Brain MRI and CT scans failed to detect any morphological abnormality. She had been taking cabergoline followed by terguride for nearly two years, but her hyperprolactinemia failed to respond to the deopamine agonists despite a gradual increase of their dosages. However, the hyperprolactinemia unexpectedly regressed completely after the patient underwent laparoscopic myomectomy. The rapid normalization of this patient's high-dose dopamine agonist resistant hyperprolactinemia after myomectomy clearly demonstrates that these conditions were due to her uterine myoma.

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  Single port access laparoscopic surgery is becoming a standard minimally invasive surgical technique for ovarian cyst, ectopic pregnancy, myoma uteri, and other benign pelvic diseases. We have primarily used a SILS™ port for this technique. However, it is difficult to extract a myoma from the abdominal cavity through the small incision at the umbilicus. More recently, we are choosing EZ-access. The parallel method, which is mainly used for complex operations such as total laparoscopic hysterectomy (TLH) or laparoscopic myomectomy (LM), is easily implemented by it. When we have attempted LM using EZ-access, it is less difficult to extract the myoma from the abdominal cavity through the incision at the navel. We suggest EZ-access as a safe and speedy method of myoma extraction without disruption.

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  Recently, an increasing number of women with multiple uterine myomas have opted for laparoscopic myomectomy, and with this increase, the need to define the indications and limitations of this approach has become apparent. The purpose of this study was to investigate these factors. A total of 130 patients undergoing laparoscopic myomectomy per standard indications between January, 2005 and December, 2010 were studied. Those with complications such as endometriosis and adnexal disease were excluded. The sum of the maximum myoma diameters (SMD), reflecting both size and count, served as a new unit of measurement. Operative blood loss correlated at a statistically significant level with maximum diameter and number of enucleated myomas (r= 0.286, p= 0.001 and r= 0.194 p= 0.028, respectively), as did with operating time (r= 0.277, p= 0.001 and r= 0.405, p< 0.001). With respect to SMD and operative blood loss or operating time, the positive correlations were even more significant (r= 0.380, p< 0.001 and r= 0.562, p<0.001, respectively). In cases exceeding the 90^th percentile of operative blood loss and operating time, the average of SMD was 183.3mm. When the average of SMD was more than 183.3mm, odds ratios (OR) for the relationship between SMD and excessive bleeding (>90^th percentile) and excessive operating time (>90^th percentile) were 6.06 (95%CI;1.58-23.18, P=0.013) and 7.14 (95%CI;2.31-22.08, P=0.001), respectively. Thus, SMD was considered an appropriate determinant for laparoscopic myomectomy in borderline cases. Evaluation of eligibility criteria is equally important as equipment and technique advancements in improving the patient safety and outcomes in this setting.

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  Holding a needle and suturing, fundamental techniques, in laparoscopic surgery are difficult for beginners to learn, including residents. There are various training methods, but no ultimate training method is used. We developed a training instrument for total laparoscopic myomectomy (TLM) based on the measurement results of the ranges of the distance and angle of 2 points measured with the forceps during the performance of TLM. We established the training method using baseball sutures for the perimetrium and calculated the time required in laparoscopic operations. The training provided a realistic simulation of manipulation and the results indicates this training method is effective.

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  A 37 year old woman, gravida 1, para 0 was referred to our department for persistent hypermenorrhea over the last two years. She had a 2 cm polypoid submucosal uterine leiomyoma. She took dienogest (2mg/d) for two weeks before transcervical resection (TCR), and we enucleated the leiomyoma with placental forceps. On postoperative day 14, after taking oral contraceptives for 10 days, she had sudden massive vaginal bleeding, and was brought back to our hospital. Since the arterial bleeding could not be controlled transvaginally, we performed blood transfusion and emergency transcatheter arterial embolization (UAE). After UAE, the patient had no further bleeding, and she resumed normal menstruation. It is possible to develop massive or delayed postoperative hemorrhage due to vessel injury after TCR, even if the myoma nodule is small. Careful attention should be paid during TCR procedures.

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Objective: The purpose of this study was to assess the safety, operative outcomes and cosmetic value of 2-port laparoscopic surgery using the MiniLap Alligator Grasper.
Design: Retrospective Study
Setting: General Hospital
Patients: We performed laparoscopic surgery for 22 patients presenting with unilateral adnexal masses from June 2010 to August 2011. Thirteen of the 22 patients underwent traditional 4-port laparoscopic surgery, while 4 patients underwent 2-port laparoscopic surgery using the MiniLap Alligator Grasper, and 5 patients underwent single-port laparoscopic surgery. The surgical procedures included salpingo-oophorectomy (n=9) and ovarian cystectomy (n=13). The clinical diagnoses consisted of endometriotic cyst (n=6), mature cystic teratoma (n=12) and serous cystadenoma (n=4).
Results: The average operative times for 4-port, 2-port, and single-port laparoscopic salpingo-oophorectomy were 71.7 (41-119) minutes, 73 minutes, and 82.4 (53-150) minutes, respectively. The average operative times for 4-port and 2port laparoscopic cystectomy for endometriotic cyst were 63.7 (36-113) minutes and 80 (68-92) minutes, respectively. The average operative times for 4-port and 2-port laparoscopic cystectomy for mature cystic teratoma were 50.7 (26-70) minutes and 55 minutes, respectively. The intraoperative procedures associated with 2-port laparoscopic surgery were easier to perform than those related to single-port laparoscopic surgery. The length of the surgical incision of the MiniLap Alligator Grasper was 2 mm, and it resulted in almost no visual scar when examined at 1 month after the operation.
Conclusion: The operative time and intraoperative procedures of 2-port laparoscopic surgery are not inferior to that of 4-port laparoscopic surgery. As a result, 2-port laparoscopic surgery using the MiniLap Alligator Grasper is thus considered to be equivalent to single-port laparoscopic surgery in cosmetic value.

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Objective: To assess whether coagulation or suture for hemostasis during laparoscopic excision of unilateral endometrioma affects short-term ovarian reserve.
Methods: From April 2008 to March 2011, 48 women underwent laparoscopic excision of endometrioma. In 26 patients, bipolar electrocoagulation was used for hemostasis, while in 22, the ovary was sutured. We reviewed these cases retrospectively. Age, BMI, menstrual cycle day, tumor size, and American Society for Reproductive Medicine (rASRM) score at laparoscopy were observed as baseline clinical characteristics for each patient. Serum anti-Mullerian hormone (AMH), follicle-stimulating hormone (FSH), and estradiol levels were measured preoperatively and 1 month postoperatively and compared in both groups. The antral follicle count from the operated ovary and the intact ovary in each group were also analyzed 1 month postoperatively.
Results: Age, BMI, and menstrual cycle day were similar in the 2 groups. There was no significant difference between the 2 groups in rASRM score or size of endometriomas. No significant differences in preoperative and post-operative serum FSH and Estradiol levels were found in either group. Serum AMH levels were significantly decreased postoperatively in both groups. In the suture group, the mean number of AFC was significantly reduced in the operated ovary compared with the contralateral intact ovary.
Conclusions: Laparoscopic excision of unilateral endometrioma appears to adversely affect AMH hormonal values 1 month after operation. Our results suggest that suturing of the ovarian parenchyma after laparoscopic excision of endometrioma adversely affects ovarian reserve in the short-term. We suggest that these findings might be of particular interest when treating women with risk factors of postoperative ovarian reserve impairment.

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Purpose
  Hysteroscopy is one of the least invasive gynecologic endoscopic surgical methods. However, it is associated with specific complications including uterine perforation and water intoxication. This study retrospectively analyzed the results of hysteroscopic surgeries performed in a single facility to obtain useful data for reducing complications.
Methods
  290 hysteroscopic surgical cases performed between 1996 and 2010 were divided by operative time (cut-off 120 minutes) and by difference between infusion and drainage volumes (cut-off 750ml). Pre- and post-operative difference in mean sodium concentration and incidence of water intoxication were compared between the groups. Other complications were also investigated. Water intoxication caused by hyponatremia is characterized by intraoperative symptoms, including tremor, hypothermia, hypoxemia, asphyxia, and mydriasis, and postoperative symptoms, including headache, hypotension, general malaise, muscle cramps/twitching, disturbed consciousness, nausea, and vomiting. We present an incidence of water intoxication defined as hyponatremia (< 130 mEq/L) characterized by these symptoms.
Results
  Pre- and post-operative difference in mean sodium concentration was -0.3mEq/L for operative duration < 120 minutes and 10.2mEq/L for operative time > 120 minutes (p<0.01). Incidence of water intoxication was 0% for operative time < 120 minutes and 22.2% for operative time > 120 minutes (p<0.01). Pre- and post-operative difference in mean sodium concentration was 1.3mEq/L when infusion exceeded drainage by < 750 ml and 7.2 mEq/L when infusion exceeded drainage by > 750ml (p < 0.05). Incidence of water intoxication was 0.4% when infusion exceeded drainage by < 750ml and 6.8 % when infusion exceeded drainage by > 750ml (p<0.01). Overall complication rate was 2.1%, including 2 cases of uterine perforation and 4 cases of water intoxication.
Discussion
  Recommended surgical conditions for hysteroscopy include operative duration of < 120 minutes and difference between infusion and drainage volumes of < 750ml to avoid water intoxication.

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Objective: Our purpose was to compare the laparoscopic surgical techniques for ovarian dermoid cysts and to determine the safety and efficacy of laparoscopic ovarian cystectomy.
Design: We conducted a retrospective study of 100 patients who underwent laparoscopic cystectomy for ovarian dermoid cyst at Gifu Municipal Hospital from April 2008 to September 2010. Based on surgical approach, we divided the laparoscopic cystectomy into 2 surgical methods: the laparoscopy-assisted cystectomy (LAC) and the total laparoscopic cystectomy (TLC). Cases of TLC were further divided into 2 groups, those with or without cyst aspiration.
Results: Forty-seven cases, including larger cyst (≥80 mm diameter), complicated pregnancy, and bilateral or polycystic tumors, were safely treated by LAC without leakage of the cyst contents. Among cases managed by TLC without cyst aspiration (non-puncture group, n=32), cyst contents leaked during cystectomy in 14 cases (43.8%). TLC cases with cyst aspiration (puncture group, n=21) were operated more safely compared to the non-puncture group, and the leakage of cyst contents occurred in 8 cases (38.0%). In all TLC cases, there were significant differences (p<0.05) in the probability of leakage during operation between cysts ≥60mm and those <60mm (non-puncture group 100% vs. 33.3% puncture group; 70.0% vs. 9.1% overall). Chemical peritonitis did not occur in any of the cases reviewed.
Conclusion: To prevent the leakage of cyst contents, LAC surgery might be a better option for more difficult cases, including those with cysts ≥60mm in diameter. In TLC surgery for cysts <60 mm, although the puncture method tends to be superior to non-puncture method with regard to preventing leakage, we should select the best procedure according to the conditions of each case.

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Objective: To discuss the risk of hemoperitoneum during pregnancy after laparoscopic surgery for the treatment of endometriosis
Case: A 32-year-old primigravida underwent Cesarean section at 36 weeks and 1 day gestation due to hemoperitoneum and non-reassuring fetal status. Four months before her pregnancy, she had undergone laparoscopic surgery for the treatment of endometriosis and infertility. At laparotomy, bleeding was noted from a left ovarian endometrioma and at the right sacro-uterine ligament, points which were exactly coincident with those identified during the laparoscopic procedure. Total blood loss approached 5,000 mL, but the patient was resuscitated after appropriate hemostasis and transfusion.
Conclusion: Ectopic endometriotic tissue is known to be decidualized during pregnancy, becoming very fragile and prone to bleeding. Therefore, endometriosis is a risk factor for spontaneous hemoperitoneum during pregnancy. In addition, surgical intervention for peritoneal endometriotic lesions makes surrounding vessels and tissues more friable and exacerbates the fragility. Therefore, careful attention must be paid during pregnancy in women who have a history of surgical intervention for deep infiltrating endometriosis.

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Objective
  Ovarian tumor is reported to complicate 1% to 4 % of all pregnancies. Laparoscopic surgery is currently the gold standard for benign ovarian tumors because it is a minimally invasive procedure. However, the effects of laparoscopic surgery on the fetus from anesthesia, surgical infection, and pneumoperitoneum are unknown. This retrospective study compared operative results and pregnancy outcomes of laparoscopic and open surgeries performed for pregnancies complicated by benign ovarian tumor.
Method
  This study included 59 patients (23 laparoscopy and 36 open surgery cases) with a preoperative diagnosis of benign ovarian tumor, who underwent surgery between January 1993 and December 2010. Patient characteristics, operative results, intraoperative cyst rupture rate, postoperative pathology, pregnancy outcome including fetal status at delivery were compared between laparoscopic and open surgery groups.
Results
  The mean blood loss and duration of postoperative hospitalization in the laparoscopy group were 22 ± 34 mL and 6.0 ± 2.7 days, respectively, and in the open surgery group were 102 ± 99 mL and 11.6 ± 2.9 days, respectively, which were significant (P < 0.05 and P < 0.01, respectively). No significant difference was found in the mean number of weeks of gestation or the mean infant birth weight (3131 g in laparoscopy group vs 3071 g in the open surgery group including one threatened premature labor). Both groups included no fetal anomaly.
Conclusion
  Laparoscopic surgery is a safe procedure for pregnancy complicated by benign ovarian tumor, providing better or comparable results with respect to adverse effects, blood loss, duration of hospitalization, cyst rupture rate, and pregnancy outcome compared with open surgery.

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