Giant mucinous cystadenocarcinoma of the ovary is rarely described. Huge ovarian masses are mostly benign, but malignancy should be ruled out by investigations and clinical assessment. Here, we present a case of a large mucinous cystadenocarcinoma of the ovary in a 48-year-old postmenopausal woman. Imaging examinations revealed a large cystic tumor that filled the whole abdominal cavity. Despite the difficulties presented by the size of the tumor and its malignant potential, laparotomy was carried out, which included bilateral salpingo-oophorectomy, total abdominal hysterectomy, exploration of other intra-abdominal organs, and pelvic lymphadenectomy. Histopathology indicated the presence of mucinous cystadenocarcinomas. Adjuvant chemotherapy was given post-operatively, and the patient maintained remission during follow-up. This case emphasizes the need for early detection by simple imaging modalities such as ultrasonography in cases of ovarian masses. Most adnexal masses, if detected early, are amenable to surgical management with a good prognosis. Large masses underline the need for a multidisciplinary approach to improve patient outcomes.

Uterine arteriovenous malformation (AVM) is a potentially life-threatening condition. The vast majority of cases are acquired. Uterine artery embolization (UAE) is currently the treatment of choice for symptomatic women desiring future childbearing. However, there is no consensus on the number of UAE procedures that can be performed on an individual woman. We report a case of recurrent uterine AVM and discuss the challenges in diagnosis and management. A 35-year-old multiparous woman presented with heavy menstrual bleeding (HMB). She had been diagnosed with uterine AVM six years ago and had undergone two previous UAE procedures. Her abdominal examination revealed a healthy Pfannensteil scar. Bimanual examination revealed a normal-sized uterus that was firm, mobile, and fornices were free. Her haemoglobin was 10.2 g/dl. Greyscale two-dimensional ultrasound revealed a normal-sized uterus with multiple hypoechoic lesions in the myometrium. Colour Doppler ultrasound showed intense vascularity with multidirectional flow in the myometrium, suggestive of uterine AVM. In view of previous failed UAE procedures, she opted for a hysterectomy. A total abdominal hysterectomy with a bilateral salpingectomy was performed. Blood loss during the procedure was greater than average, and she was transfused with a unit of packed cells. Her post-operative course was uneventful. Histopathology confirmed the diagnosis of a uterine AVM. To conclude, the UAE is considered the treatment of choice for symptomatic women with uterine AVM desiring future childbearing. In cases of failure of UAE procedures, hysterectomy is therapeutic but may be associated with more than average blood loss.

OBJECTIVE: To investigate changes in surgical procedures and patient outcomes of patients diagnosed with endometrial cancer (EC) at a German university hospital between 1998 and 2014.
METHODS: A monocentric, retrospective review was conducted to identify patients diagnosed and treated with EC during the aforementioned period at the Department of Gynecology and Obstetrics at the University Hospital Kiel, Germany.
RESULTS: 303 patients were identified. Patient demographics, risk factors, histological subtypes and stages of EC remained consistent over time. The most common surgical procedure was total abdominal hysterectomy (TAH) (81.9%). In 2011, the institution carried out its first total laparoscopic hysterectomy (TLH) for EC, resulting in a significant increase in laparoscopic surgical procedures (2011-2014: N = 70; TAH 44.2%; TLH 51.4%). Although the total number of lymph node stagings remained consistent over time, there was a significant increase in the performance of simultaneous pelvic and para-aortic lymphonodectomy (LNE) compared to pelvic LNE alone (2.6 in 2001-2005 vs. 18.0% in 2011-2014, p ≤ 0.001). The duration of hospital stays significantly decreased over time, with a mean of 20.9 days in the first and 8.5 days in the last period. When comparing surgical procedures, TLHs resulted in significantly shorter postoperative stays with an average of 6.58 vs. 13.92 days for TAH. The surgical procedure performed did not affect 5-year overall survival rates in this study (84.9% for TAH and 85.3% for TLH, p = 0.85).
CONCLUSIONS: Our retrospective single-center study demonstrates that laparoscopic surgery for endometrial cancer is oncologically safe and shortens hospital stays.

UNASSIGNED: To compare the operative and postoperative outcomes of total laparoscopic hysterectomy (TLH) and total abdominal hysterectomy (TAH).
UNASSIGNED: In this retrospective comparative study, we reviewed all hysterectomies performed in the Al-Karak Governmental Hospital in Al-Karak, Jordan, from September 2018 to July 2022. We enrolled 129 patients who underwent hysterectomy. The patients were divided into the TLH (n = 39) and TAH (n = 90) groups. Patient data were accessed through hospital records and analyzed using SPSS 25.0.
UNASSIGNED: The most common indication for TLH was uterine fibroid, and that for TAH was abnormal uterine bleeding, although the specimen weights were comparable. There was no significant between-group difference in the patient\'s demographics. Although the TLH group had longer operative time, the hospital stay was shorter and there were no reported cases of wound infection. The estimated blood loss was significantly lower in the TLH group than in the TAH group, but there was no difference between the two groups in terms of blood transfusion requirement and postoperative hemoglobin level.
UNASSIGNED: TLH and TAH had comparable overall outcomes in the Al-Karak Governmental Hospital. However, TLH was superior to TAH in terms of blood loss, and patients with TLH recovered faster without postoperative wound infection.

This research intended to investigate the influence of the operation of both kinds of hysterectomies in the risk of wound infection and the degree of wound dehiscence. Both of them were open field and laparoscope. In this research, we looked into four databases: PubMed, Web of Science, Embase and Cochrane Library. Research was conducted on various operative methods for hysterectomy in obese patients between 2000 and October 2023. Two independent investigators performed an independent review of the data, established the inclusion and exclusion criteria, and managed the results with Endnote software. It also evaluated the quality of the included literature. Finally, the data were analysed with RevMan 5.3. This study involved 874 cases, 387 cases received laparoscopy and 487 cases received open access operation. Our findings indicate that there is a significant reduction in the rate of post-operative wound infection among those who have received laparoscopy compared with who have received open surgical procedures (odds ratio [OR], 0.04; 95% confidence interval [CI], 0.01-0.15; p < 0.001); There was no statistical difference between the rate of post-operative wound dehiscence and those who received laparotomy compared with those who received open surgical procedures (OR, 0.33; 95% CI, 0.10-1.11; p = 0.07); The estimated amount of blood lost during the operation was less in the laparoscopy group compared with the open procedure (mean difference, -123.72; 95% CI, -215.16 to -32.28; p = 0.008). Generally speaking, the application of laparoscopy to overweight women who have had a hysterectomy results in a reduction in the expected amount of bleeding during surgery and a reduction in the risk of post-operative wound infections.

Introduction Listening to music is a safe and low-cost way to reduce preoperative anxiety among patients, but more research is needed to evaluate its effectiveness fully. Aims The aim of the study is to identify the effect of intraoperative music therapy on the visual analogue scale for anxiety (VASA) scores (VASA 1 and VASA 2) and patient satisfaction score (PSS) perioperatively. Methods In a study of 188 patients aged 40-70, those in group A (94 patients) listened to pre-approved music during their surgery for abdominal hysterectomy, while group B (94 patients) did not. Both groups wore noise-cancelling earphones. VASA was recorded before (VASA 1) and after (VASA 2) the surgery. PSS was recorded in the postoperative ward. Music preferences were kept confidential from the investigator recording the scores. Result The two groups of patients had similar demographic profiles and baseline characteristics. The VASA 1 of both groups was similar, with a mean value of 4.36 ± 1.13 for group A and 4.23 ± 1.05 for group B (p = 0.606). However, group A had lower VASA 2 (1.79 ± 0.83) than group B (3.77 ± 0.98). The difference was statistically significant (p < 0.001). The patient satisfaction score in group A was notably higher than those in group B. A total of 52 patients were highly satisfied in group A as compared to none in group B (p < 0.001), and a total of 42 patients were moderately satisfied as compared to eight patients in group B (p < 0.001). Eighty-six patients in group B were unsatisfied. Conclusion According to our research, playing specific music at the right volume can significantly lower anxiety levels and increase patients\' satisfaction scores for those who have had abdominal hysterectomy surgeries.

Background Major abdominal surgeries are often accompanied by excruciating pain, which, if not adequately managed, can reduce patient comfort and satisfaction, delay mobilization, compromise respiratory and cardiac functioning, and increase healthcare costs. The transversus abdominis plane (TAP) block is an efficient and safe complement to multimodal postoperative analgesia for abdominal surgery. This study evaluates the efficacy of combining magnesium sulfate (MgSO4) with bupivacaine for TAP block in patients posted for total abdominal hysterectomy (TAH). Methodology Seventy female patients between the ages of 35 and 60 who were scheduled to have a TAH under spinal anesthesia were divided randomly into two groups of 35 each: group Bupivacaine (B) and group Bupivacaine-Magnesium sulfate (BM). Group B received 18 milliliters (mL) of bupivacaine 0.25 percentage (%) 45 milligrams (mg) with 2 mL normal saline (NS) whereas group BM received 18 mL of bupivacaine 0.25% (45 mg) with 1.5 mL of 10% weight/volume (w/v) MgSO4 (150 mg) and 0.5 mL NS in the ultrasonography-guided (USG) bilateral TAP block performed after the end of surgery. Groups were compared for the postoperative visual analog scale (VAS) scores, the time required for first rescue analgesia, the number of analgesic rescues at various time intervals, patient satisfaction score, and any side effects. Results Postoperative VAS scores at 4, 6, 12 and 24th hour (hr) (p < 0.05) in group BM were lower compared to group B. Time required for rescue analgesia was significantly prolonged in group BM (882.94 ± 70.22 minutes) compared to group B (459 ± 100.53 minutes) with minimal usage of rescue analgesia (p < 0.05) up to 12 hr. In group BM, the patient satisfaction score was higher (p = 0.001). Conclusion In addition to a considerable reduction in post operative VAS scores and overall use of rescue analgesia, the addition of magnesium to bupivacaine significantly prolongs the TAP block and increases the initial postoperative period of bearable pain.

Aim To study the role of vaginal hysterectomy in non-descent uterus and to compare it with abdominal hysterectomy with respect to operative time, intraoperative blood loss and complications, ambulation, and postoperative complications. Materials and methods A prospective non-randomized study was carried out on 200 cases at a rural tertiary care center in B.G. Nagara, Karnataka, India for a period of 18 months after obtaining institutional ethical committee approval. One hundred patients underwent a vaginal hysterectomy, and there other 100 underwent an abdominal hysterectomy for similar indications. Results Mean age, parity, mode of delivery, BMI, uterine size, and anesthesia were similar between the groups. The most common indication was fibroid uterus (50%). It was found that the vaginal hysterectomy group was associated with significantly reduced mean operative duration and a decline in postoperative Hemoglobin when compared to the abdominal hysterectomy group. Patients who underwent vaginal hysterectomy had less postoperative pain and were ambulated earlier and discharged earlier. Also, postoperative complications were more common in those who underwent abdominal hysterectomy. Conclusion Vaginal hysterectomy is a safe and the least invasive route and is associated with lesser complications and should be chosen as the preferred method of hysterectomy, whenever feasible.

OBJECTIVE: Therapeutic plasma exchange (TPE) is a treatment option to reduce thyroid hormones in the event of contraindication or unresponsiveness to antithyroid drugs (ATDs).
METHODS: We analyzed 11 patients with hyperthyroidism who received TPE prior to surgery between January 2008 and December 2016 at our center.
RESULTS: In total, 41 processes were applied to 11 patients with hyperthyroidism. The median age was 40 years, and 90.9% of the patients were female. Seven patients had Graves\' disease, while four had a toxic multinodular goiter. The distribution of TPE indications comprised contraindication to ATDs (64%) and insufficient response to ATDs (36%). An adequate response was not obtained with TPE in two patients, and cholestyramine plus methimazole and Lugol solution were applied. The median number of TPE sessions was 3. During the TPE period, a β-blocker was applied concurrently except in one patient who was contraindicated for the drug. The reduction in FT3 and FT4 hormones and the increase in TSH levels were statistically significant after TPE application (p values of 0.003, 0.033 and 0.008, respectively). Regarding adverse events of TPE application, an allergic reaction was seen in one patient, while prolongation of prothrombin time without any clinical findings was seen in another patient. Ten patients underwent total thyroidectomy, and one patient underwent a gynecological surgery procedure without any major complications.
CONCLUSIONS: The American Society for Apheresis guideline, which is the most referenced guideline, mentions the utilization of TPE before thyroid surgery, only in patients with thyrotoxicosis despite the wider necessity of this treatment choice under the condition of uncontrolled hyperthyroidism prior to any kind of surgery. We concluded that TPE is a reliable and effective application in patients with hyperthyroidism before any surgical procedure, according to our study results.

BACKGROUND: As a common female pelvic tumor, uterine fibroids remain the leading cause for hysterectomy in China. Hysterectomy provides a good surgical treatment of uterine fibroids, and it guarantees the removal of all uterine fibroids without lower risk of recurrence. This study compares the cost effectiveness of total laparoscopic hysterectomy (TLH) versus total abdominal hysterectomy (TAH) for women with uterine fibroids from a societal perspective.
METHODS: An economic analysis was conducted in 392 patients (TLH n = 75; TAH n = 317), including all relevant costs over a 12-month time horizon. Primary outcome was major surgical complications; secondary outcomes were postoperative discomfort symptoms and time of return to normal activities. Clinical, outcomes and costs data were collected from medical records, telephone survey and financial information system. Generalized linear models were used to assess costs and outcomes differences between the two groups. Incremental cost effectiveness ratio (ICER) was used to estimate the cost effectiveness.
RESULTS: Mean direct costs were $2,925.71 for TLH, $2,436.24 for TAH, respectively. Mean indirect costs were $1,133.22 for TLH, $1,394.85 for TAH, respectively. Incremental societal costs were $256.86 (95%CI: 249.03-264.69). Mean differences in outcome were: 4.53% (95%CI: 4.35-4.71) for major surgical complications; 6.75% (95%CI: 6.45-7.05) for postoperative discomfort symptoms; 1.27 (95%CI: 1.23-1.30) weeks for time to return to normal activities. ICER of TLH was $5,669.16 (95%CI: 5,384.76-5,955.56) per complication averted, $3,801.54 (95%CI: 3,634.81-3,968.28) per postoperative discomfort symptoms averted and $202.96 (95%CI: 194.97-210.95) per week saved to return to normal activities.
CONCLUSIONS: TLH is cost effective compared with TAH in preventing additional complications based on our estimated conservative threshold in China. The findings provide useful information for researchers to conduct further cost effectiveness analysis based on prospective study which can provide stronger and more evidence, in China. In addition, the data may be useful for Chinese health care policy-makers and medical insurance payers to make related health care decisions.