INTRODUCTION: This was a single-center pilot study that sought to describe an innovative use of 4DryField® PH (premix) for preventing the recurrence of intrauterine adhesions (IUAs) after hysteroscopic adhesiolysis in patients with Asherman's syndrome (AS). MATERIAL AND METHODS: Twenty-three patients with AS were enrolled and 20 were randomized (1:1 ratio) to intrauterine application of 4DryField® PH (n = 10) or Hyalobarrier® gel (n = 10) in a single-blind manner. We evaluated IUAs (American Fertility Society [AFS] score) during initial hysteroscopy and second-look hysteroscopy one month later. Patients completed a follow-up symptoms questionnaire three and reproductive outcomes questionnaire six months later. RESULTS: The demographic and clinical characteristics, as well as severity of IUAs, were comparable in both groups. The mean initial AFS score was 9 and 8.5 in the 4DryField® PH and Hyalobarrier® gel groups, respectively (p = .476). There were no between-group differences in AFS progress (5.9 vs. 5.6, p = .675), need for secondary adhesiolysis (7 vs. 7 patients, p = 1), and the follow-up outcomes. CONCLUSION: 4DryField® PH could be a promising antiadhesive agent for preventing the recurrence of IUAs, showing similar effectiveness and safety to Hyalobarrier® gel. Our findings warrant prospective validation in a larger clinical trial. CLINICAL TRIAL REGISTRY NUMBER: ISRCTN15630617.

• Klíčová slova
• Asherman’s syndrome, Prevention of intrauterine adhesions, hyaluronan gel, hysteroscopic adhesiolysis, modified starch,
• MeSH
• adheze tkání prevence a kontrola   MeSH
• dospělí MeSH
• gely MeSH
• gynatrézie * chirurgie   MeSH
• hysteroskopie * metody   MeSH
• jednoduchá slepá metoda MeSH
• kyselina hyaluronová * aplikace a dávkování   MeSH
• lidé MeSH
• nemoci dělohy * prevence a kontrola   MeSH
• pilotní projekty MeSH
• průzkumy a dotazníky MeSH
• recidiva MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• randomizované kontrolované studie MeSH
• srovnávací studie MeSH
• Názvy látek
• gely MeSH
• kyselina hyaluronová * MeSH

OBJECTIVE: The aim of this study was to analyze the clinical and reproductive outcomes of patients treated with myomectomy who were histologically diagnosed with uterine smooth muscle tumor of uncertain malignant potential (STUMP). METHODS: Patients who were diagnosed with STUMP and underwent a myomectomy at our institution between October 2003 and October 2019 were identified. Variables of interest obtained from the institution's database included patient age, relevant medical history, pre-operative appearance of the tumor on ultrasound, parameters of the surgical procedure, histopathological analysis of the tumor, post-operative clinical course, and course of follow-up, including reinterventions and fertility outcomes. RESULTS: There were a total of 46 patients that fulfilled the criteria of STUMP. The median patient age was 36 years (range, 18-48 years) and the mean follow-up was 47.6 months (range, 7-149 months). Thirty-four patients underwent primary laparoscopic procedures. Power morcellation was used for specimen extraction in 19 cases (55.9% of laparoscopic procedures). Endobag retrieval was used in nine patients and six procedures were converted to an open approach due to the suspicious peri-operative appearance of the tumor. Five patients underwent elective laparotomy due to the size and/or number of tumors; three patients had vaginal myomectomy; two patients had the tumor removed during planned cesarean section; and two underwent hysteroscopic resection.There were 13 reinterventions (five myomectomies and eight hysterectomies) with benign histology in 11 cases and STUMP histology in two cases (4.3% of all patients). We did not observe any recurrence as leiomyosarcoma or other uterine malignancy. We did not observe any deaths related to the diagnosis. Twenty-two pregnancies were recorded among 17 women, which resulted in 18 uncomplicated deliveries (17 by cesarean section and one vaginal), two missed abortions, and two pregnancy terminations. CONCLUSIONS: Our study found that uterus-saving procedures and fertility-preservation strategies in women with STUMP are feasible, safe, and seem to be associated with a low risk of malignant recurrence, even while maintaining the mini-invasive laparoscopic approach.

• Klíčová slova
• Gynecologic Surgical Procedures, Pathology, Uterine Neoplasms,
• MeSH
• císařský řez MeSH
• fertilita MeSH
• kojenec MeSH
• laparoskopie * metody   MeSH
• lidé MeSH
• myomektomie * škodlivé účinky   MeSH
• nádor z hladké svalové tkáně * patologie   MeSH
• nádory dělohy * patologie   MeSH
• předškolní dítě MeSH
• retrospektivní studie MeSH
• těhotenství MeSH
• uterus patologie   MeSH
• Check Tag
• kojenec MeSH
• lidé MeSH
• předškolní dítě MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

OBJECTIVE: A case report of a patient with interstitial pregnancy and a history of hyperprolactinemia. CASE REPORT: A 30-year-old woman was hospitalized for a suspicion of ectopic pregnancy and referred for laparoscopy. During the laparoscopic surgery, interstitial pregnancy was dia-gnosed and solved with cornuostomy. CONCLUSION: Ectopic interstitial pregnancy represents a serious worldwide issue because unrecognized, it can endanger a womans life, despite advances in ultrasound examination, the dia-gnosis often remains inaccurate. Laparoscopic surgical approach with evacuation of pregnancy with subsequent uterus suture represents one of the possible approaches. This method is minimally invasive and safe.

• Klíčová slova
• Methotrexate, interstitial pregnancy, laparoscopy, methotrexate,
• MeSH
• dospělí MeSH
• intersticiální těhotenství * diagnostické zobrazování   chirurgie   MeSH
• laparoskopie * MeSH
• lidé MeSH
• těhotenství MeSH
• ultrasonografie MeSH
• uterus MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

OBJECTIVE: To summarize recent data and knowledge of laparoscopic power morcellation. METHODS: Review of articles. RESULTS: Laparoscopic morcellation has been introduced to gynecologic surgery in 90s. In 2014, Food and Drug Administration announced negative statement about the morcellation use due to the risk of potential spreading of malignant tumor cells. This statement reduced utilization of morcellation, especially in the United States. Since that, many health institutions and organizations started new researches focused on the safety of this surgical technique. After a couple of years, the morcellation is considered as a useful tool if certain rules are followed. CONCLUSION: Morcellation has a place in laparoscopic operative procedures even in 2022, in condition of correct selection of patients and possible utilization of contained in-bag morcellation.

• Klíčová slova
• Hysterectomy, laparoscopy, morcellation, myomectomy,
• MeSH
• hysterektomie metody   MeSH
• laparoskopie * metody   MeSH
• leiomyom * chirurgie   MeSH
• lidé MeSH
• morcelace * škodlivé účinky   metody   MeSH
• myomektomie * metody   MeSH
• nádory dělohy * patologie   chirurgie   MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Spojené státy americké MeSH

OBJECTIVE: The purpose of this study was to evaluate the appropriate surgical treatment of adenomyosis and its impact on reproductive outcomes. CONCLUSION: Patients with adenomyosis and fibroids may show a lower pregnancy rate and higher miscarriage rate than healthy individuals. However, there is no standard protocol for their optimal treatment, particularly in pregnancy-seeking or infertile women. Myomectomy is generally a commonly performed procedure that preserves fertility. On the other hand, the role of surgery in extensive uterine adenomyosis remains controversial, because adenomyosis often involves the whole uterus diffusely. It is almost impossible to remove all pathological tissue from the surrounding myometrium. Therefore, this procedure is called debulking/cytoreductive surgery. However, adenomyomectomy has also become a more common type of surgical intervention in recent years.

• Klíčová slova
• adenomyomectomy, cytoreductive procedure, myoma,
• MeSH
• adenomyóza * komplikace   chirurgie   MeSH
• leiomyom * MeSH
• lidé MeSH
• myomektomie * škodlivé účinky   metody   MeSH
• těhotenství MeSH
• uterus patologie   chirurgie   MeSH
• ženská infertilita * etiologie   chirurgie   MeSH
• Check Tag
• lidé MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

OBJECTIVE: Case report of a gynecologically polymorbid patient with enhanced myometrial vascularity, and review of current scientific literature on incidence, dia-gnostic method, and management of this phenomenon. CASE REPORT: A 38-year-old patient that has been treated long-term for secondary sterility with a medical history of laparotomic cytoreduction surgery for adenomyosis and subsequent development and treatment of postoperative intrauterine adhesions. Currently presenting with enhanced myometrial vascularity after spontaneous abortion. For symptomatic prolonged course of the observation period without tendency for spontaneous regression and risk of acute hemorrhage, she was initially indicated for selective embolization of uterine arteries and consecutive definitive treatment via hysteroscopic resection. CONCLUSION: Due to low incidence and tendency for spontaneous resorption, early recognition, and correct management of enhanced myometrial vascularity, it still represents a medical challenge.

• Klíčová slova
• endometrial cancer, enhanced myometrial vascularity, hysteroscopy, retained products of conception, uterine artery embolization,
• MeSH
• adenomyóza * MeSH
• adheze tkání MeSH
• dospělí MeSH
• hysteroskopie MeSH
• lidé MeSH
• myometrium MeSH
• nemoci dělohy * chirurgie   MeSH
• těhotenství MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

INTRODUCTION: The aim of this study was to evaluate hysteroscopic findings after laparoscopic and laparotomic myomectomy with a focus on the presence of postoperative intrauterine adhesions in groups of patients with and without perioperative uterine cavity breach (UCB). MATERIAL AND METHODS: This is a historical cohort study. Our database was searched to identify patients with UCB during myomectomy and matched the same number of patients after myomectomy without UCB to create a control group. All relevant data were retrieved from our medical records. In both groups, the results of follow-up hysteroscopy were analyzed. RESULTS: Low prevalence of intrauterine adhesions after myomectomy was observed in only 3.5% of the 170 patients in our samples. No significant difference in the occurrence of synechiae between the patients with and without UCB was found (2 vs. 4, RR 0.5, 95% CI 0.1-2.7, p = .341), nor was the difference in other hysteroscopic findings. Follow-up hysteroscopy was performed with slender optics and expandable casing system without need of any anesthesia in 87.1% of cases. CONCLUSIONS: According to our findings, the prevalence of post-myomectomy intrauterine adhesions after myomectomy is low. Our study did not demonstrate that UCB during myomectomy is a risk factor for the formation of intrauterine synechiae.

• Klíčová slova
• Fertility, hysteroscopy, intrauterine adhesions, leiomyoma, myomectomy,
• MeSH
• adheze tkání epidemiologie   etiologie   chirurgie   MeSH
• hysteroskopie škodlivé účinky   metody   MeSH
• kohortové studie MeSH
• laparoskopie * škodlivé účinky   metody   MeSH
• leiomyom * chirurgie   MeSH
• lidé MeSH
• myomektomie * škodlivé účinky   metody   MeSH
• nádory dělohy * chirurgie   MeSH
• nemoci dělohy * chirurgie   MeSH
• těhotenství MeSH
• Check Tag
• lidé MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

INTRODUCTION: This study was designed to evaluate the feasibility and effectiveness of hysteroscopy in the management of symptoms related to endometrial polyps and submucous leiomyomas in women using a levonorgestrel-releasing intrauterine system (LNG-IUS). MATERIAL AND METHODS: Twenty-three LNG-IUS users presenting with endometrial polyps and/or submucous leiomyomas and irregular uterine bleeding were recruited for hysteroscopic examination and surgery. Intrauterine pathology was investigated and treated by hysteroscopic resection with the LNG-IUS in situ, and the effect of the procedure on symptoms was evaluated after three to six months. RESULTS: Intrauterine pathology was successfully resected by hysteroscopy in 23 (100.0%) out of 23 cases. Following hysteroscopy, 18 (78.3%) women reported amenorrhea, one (4.3%) regular spotting, three (13.0%) irregular spotting and one (4.3%) patient resumed normal menstrual cycle. We conclude that 19 (82.6%) patients were postoperatively asymptomatic. All procedures were uncomplicated and 4 (17.4%) were carried out without general anesthesia as office procedures. CONCLUSION: Endometrial polyps and submucous leiomyomas can develop in LNG-IUS users, and this can cause irregular uterine bleeding. Hysteroscopic resection of these pathologies is a feasible method in the clinical management of symptoms.

• Klíčová slova
• LNG-IUS, abnormal uterine bleeding, endometrial polyp, hysteroscopy, uterine leiomyoma,
• MeSH
• děložní krvácení MeSH
• leiomyom * farmakoterapie   chirurgie   MeSH
• levonorgestrel terapeutické užití   MeSH
• lidé MeSH
• nádory dělohy * farmakoterapie   chirurgie   MeSH
• nitroděložní tělíska hormonální * MeSH
• polypy * farmakoterapie   chirurgie   MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• levonorgestrel MeSH

STUDY OBJECTIVE: Women with adenomyosis may show a lower pregnancy rate and a higher miscarriage rate than healthy women. There is also a general agreement that leiomyomas, either submucosal or intramural, negatively affect fertility, when compared with women without myomas. Some of these women may benefit from adenomyomectomy, however this cytoreductive procedure is considered invasive and technically challenging especially in severe diffuse cases. The study aimed to compare the clinical and reproductive outcomes of patients who underwent adenomyomectomy with those of patients who underwent intramural myomectomy. DESIGN: A retrospective study. SETTING: Department of Obstetrics & Gynecology, Center of Gynecological Endoscopy and Minimally Invasive surgery, First Faculty of Medicine, General University Hospital in Prague. PATIENTS: A total of 55 women who underwent surgical resection of uterine adenomyosis and 55 patients who underwent myomectomy for intramural uterine myomas were included in this study. All study participants wished to retain and possibly improve their reproductive potential. INTERVENTIONS: Between 2004 and 2019, 110 women underwent laparoscopic or open uterus-sparing surgery for clinically significant uterine adenomyosis (group A) or myomas (group B), respectively. MEASUREMENTS AND MAIN RESULTS: Two groups of women who underwent different fertility-saving procedures were compared. Although all women entering the study had declared their wish to conceive, only 28 patients in group A (group A1) and 24 women in group B (group B1) finally aimed toward pregnancy. The mean age and follow-up period was 35.0 years and 76.81 months, respectively, in group A and 34.8 years and 72.5 months, respectively, in group B. The pregnancy and delivery rates were 75.0% and 46.4%, respectively, in group A1 vs 96.0% and 70.8%, respectively, in group B1, with no significant differences between the 2 groups. The open surgical approach was significantly more frequently employed in group A (47.3% vs 16.4%; p <.01). CONCLUSION: In this study, women who underwent surgery involving the uterine muscularity, including myomectomy or adenomyomectomy, had comparable reproductive outcomes, with no significant differences.

• Klíčová slova
• Adenomyosis, Fertility outcome, Fertility saving procedure, Myoma,
• MeSH
• adenomyóza * chirurgie   MeSH
• laparoskopie * metody   MeSH
• leiomyom * chirurgie   MeSH
• lidé MeSH
• myomektomie * metody   MeSH
• nádory dělohy * chirurgie   MeSH
• retrospektivní studie MeSH
• těhotenství MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

INTRODUCTION: The aim was to compare the surgical experience and the clinical results of laparoscopic myomectomy (LM) with or without pre-treatment with ulipristal acetate (UPA). MATERIAL AND METHODS: Fifty-four women who underwent LM for intramural myomas and were pre-treated with three months of UPA were matched with 54 patients with the same procedure but no hormonal pre-treatment. All operations were performed by one team. The technical features of the procedures were reviewed and evaluated by two other laparoscopists, unaware of the eventual use of UPA. The clinical, histological, and reproductive outcomes of each patient were assessed and the results of both groups were compared. RESULTS: The groups did not significantly differ in operation time, intra-operative blood loss, drop in hemoglobin concentration, number of complications, pregnancy rate, and delivery rate. Women pre-treated with UPA had significantly longer hospital stays, higher numbers of histologically abnormal leiomyomas, and higher rates of fibroids peri-procedurally assessed as soft and disintegrating. The other four technical parameters of LM were comparable in both groups. CONCLUSIONS: The surgeons performing LM in women pre-treated with UPA should be aware of the abnormal texture of enucleated myomas. Nevertheless, this does not negatively affect the other surgical and clinical outcomes of these patients.

• Klíčová slova
• Laparoscopy, myomas, myomectomy, pre-treatment, selective progesterone receptor modulator,
• MeSH
• laparoskopie * MeSH
• lidé MeSH
• myomektomie * MeSH
• nádory dělohy * farmakoterapie   chirurgie   MeSH
• norpregnadieny * MeSH
• těhotenství MeSH
• Check Tag
• lidé MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• norpregnadieny * MeSH
• ulipristal acetate MeSH Prohlížeč