Ectopic pregnancies are a frequently encountered cause of first-trimester metrorrhagia. They occur when an embryo is implanted and grows outside the normal uterine space. Uncommonly, the embryo can be implanted in the intramural portion of the uterine tube, a condition referred to as interstitial localization. This specific type of ectopic pregnancy may have an unpredictable course, potentially leading to severe uterine rupture and catastrophic bleeding if not promptly diagnosed and managed. We present a rare case of a multiparous 36-year-old female patient who underwent pelvic ultrasonography in the emergency department for intense pelvic pain associated with hypotension and moderate anemia. A history of right salpingectomy for a ruptured tubal ectopic pregnancy 10 years previously was noted. High beta-HCG levels were also detected. A pelvic ultrasound allowed us to suspect a ruptured ectopic interstitial pregnancy at 8 weeks of amenorrhea. An association with hemoperitoneum was suspected, and an emergency laparoscopy was performed. The condition was confirmed intraoperatively, and the patient underwent a right corneal wedge resection with suture of the uterine myometrium. The postoperative course was uneventful, and the patient was discharged on the fourth day postoperatively. Interstitial ectopic pregnancy is a rare yet extremely perilous situation. Timely ultrasound-based diagnosis is crucial as it can enable conservative management with Methotrexate. Delayed diagnosis can lead to uterine rupture with consecutive surgery based on a transection of the pregnancy and cornual uterine resection.

Cryptorchidism is defined as the extra-scrotal position of the testes. It is a common disorder in male children, but rarely in adult patients. The association of cryptorchidism with hernia is a common finding in childhood, but is not frequent in adults or the elderly. Herein, we report a series of three cases (28-, 24-, and 34-year-old men) of adult inguinal hernia combined with cryptorchidism successfully managed by laparoscopic surgery under the same operative view. Laparoscopic transabdominal preperitoneal repair and orchiectomy were performed in all patients. No complications occurred in the postoperative period, and the patients were discharged on the first or second postoperative day. Pathological examination of the specimens revealed atrophic testes without malignancy. No hernia recurrence was observed during follow-up. The laparoscopic approach in the combined pathology of inguinal hernia and cryptorchidism is feasible in adult patients and has multiple advantages in terms of diagnosis and management.

The diagnosis in the early stages of renal tumors, as well as the oncological outcomes equivalent to extensive nephrectomies, have increased interest in partial nephrectomy (PN), which is the preferred method for treating renal cell carcinoma less than 7 cm. The literature confirms that PN offers oncological outcomes equivalent to radical nephrectomy, especially in early stages. This is a prospective study, conducted in a single university center over a period of three years, aimed to evaluate the surgical and oncological outcomes regarding positive safety margins after PN performed using laparoscopic and open approaches. Following the analysis of the causes and consequences of incomplete tumor resection, the obtained results align with data from the literature. We found that specimens from laparoscopic surgery were approximately twice as likely to have positive surgical margins compared to tumors resected using the open approach, meaning that these patients require more intense follow-up both clinically and imaging. According to current published studies, positive safety margins are not predictors for disease recurrence rate, progression-free survival, or overall survival.

Octav GINGHINA*, Marius ZAMFIR, Mara MARDARE, Andrei VACARASU, Irina BONDOC, Alin BURLACU, Razvan IOSIFESCU, Theodor VOIOSU, Carmen PANTIS, Bogdan TANASE. Ann Hepatobiliary Pancreat Surg 2023;27:S432. https://doi.org/10.14701/ahbps.2023S1.EP-166