EUROMEDICA  Hanover 6-7  Juni 2008	Advanced methods of diagnosis, treatment and prophylactics
	European Academy of Natural Sciences, Hanover European Scientific Society, Hanover Russian Academy of Natural Sciences, Moscow

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Actuality. The advantages of simultaneous operations such as reduction of traumatic intervention, intraoperative and postoperative complications, less hospital stay and temporary disability and postoperative lethality are continuously proved. Nevertheless the number of simultaneous operations with laparoscope methods remains as insignificant as before their introduction.

Objective: To assess the possibilities of laparoscope surgery in women with gynecological disorders and renal cyst, to optimize the approaches of planned simultaneous laparoscope operations in gynecology.

Materials and Methods. 74 women underwent laparoscope surgery of renal cyst and 21 women underwent laparoscopic renal cyst excision. Average age of patients was 37,5 ± 4,6 years.

Results. The indications for simultaneous operations were following gynecological disorders: in 6 cases (28,6 %) – symptomatic uterus myoma and adenomyosis, in 7 cases (33,3%) – external genital endometriosis (EGE), detected in the course of the operation, in 5 cases (23,%) – cystous changes and ovary cystadenoma, in 3 cases (14,3 %) – tube-peritoneal sterility (TPS). It is necessary to note, that the total laparoscope hysterectomy (TLH) was accomplished in 3 patients with uterus myoma, subtotal pan hysterectomy (STLH) – 1 patient with uterus myoma and 1 with ovary cystadenoma during postmenopause. 5 patients of reproductive age with subserous and intramural- subserous localization myomatosis nodes had myomectomy, 3 of them in combination with coagulation focus of external genital endometriosis. Cystodenomectomy was was performed in 3 cases in 4 patients with ovary cystodenomas. The operarions in TPS patients distributed in the following way: in 2 cases there was neosalpingostomy with duplex salpingoovariolysis and to 1 patient – tubectomy, in view of sactosalpinse presence. Coagulation of endometriosis focus was accomplished to 8 patients with external genital endometriosis I-II stages, which was diagnosed in the course of diagnostic laparoscopy (7 patients with isolated form and 1 in TPS combination. In patients with simultaneous operations the preference was given to trancperitonial approach to kidney (71,4 %), application of which enables simultaneous intervention without additional troacar openings. It was necessary to resort to retroperitonial approach only in 6 cases (28,6 %), in view of cyst localization on the back kidney surface, moreover, for gynecological operation stage realization was used tranceperitonial approach in addition, typical for surgeon-gynecologist.

Comparative estimation of aggressivity index of endovideosurgical operation in groups under study

index	Quarantined operation (n=74)	Malingering operation (n=21)
Duration of operation (min)	53,3 ± 13	81 ± 21
Duration of anesthesia (min)	62,4 ± 14,6	94 ± 20
Hemorrhage volume (ml)	55,7 ± 11,3	76 ± 37
necessity of hemotransfusion	0	2 (9,5 %)*

p < 0,05

Duration of endovideosurgical operation, which implement quarantine or malingering as comparable as duration of anesthesia. No display any significant distinctions in these indexes. Fluctuation of operations duration was in considerable limits, which depended on concrete anatomical situation, stage methods assimilation and also that during malingering gynecological stages the operations of high difficulty score were carried out in 9 cases (42,8%) – TLH (2 patients), STLH ((2 patients), conservative myomectomy (5 patients). Two patients (9,5%) needed intraoperative introduction of blood preparation during malingering operation due to initial anaemia associated with the gynecological pathology (uterus myoma).

There were not any complications in postoperative period, it was typical. No lethal outcome. No difference between average period of hospital treatment (malingering operations) and hospital treatment cause of laparoscopic hysterectomy or adnexectomy.

Conclusions. Therefore, we can note that application (case: renal cyst ) of auxiliary simultant stages of surgical treatment of gynecologic pathology does not increase complication frequencies. If compared endovideosurgical quarantined and malingering operation results it is shown that in the first case relative quantity of complication is less because of small numbers of patients who undergo such malingering operation (p > 0,05).

Performance of andovideosurgical malingering treatment in cases of gynecologic pathology has a number of features, connected with the choice of access. For cysts localization in back surfaces or in lower kidney pole it is preferably to use retroperitoneoscopic access, and for cysts which situated on front surfaces or in upper pole and also parapelvical cysts localization - transperitonealic.

Therefore, in patients with indication for malingering surgical treatments of with renal cysts in combination with gynecologic pathology we recommend to use transperitonealic access. Retroperitoneoscopic access might be justified only in cases when malingering diagnostic laparoscopia is needed.