Several complications can occur during laparoscopic gynecological surgery. The insertion of trocars and the induction of pneumoperitoneum are essential steps, but they can still pose potential risks during laparoscopic surgery. Bowel injuries are the most common during gynecological procedures as a result of thermal damage and trocar placement, while vessel injuries may carry a high mortality rate. Gynecologic surgeons should be aware of the risks associated with laparoscopic procedures and be able to prevent and treat potential complications. We conducted a literature search using three electronic databases (Pubmed/MEDLINE, Google Scholar, Embase) from inception to May 2024 to identify the most common intraoperative gynecological laparoscopic complications, including those related to trocar insertion, bowel, urinary, and vessel injury. The aim of this narrative review is to describe the most common complications during gynecological laparoscopic surgery and to outline the safety rules and techniques necessary for their prevention and treatment.

To evaluate the feasibility of hysteroscopy with morcellator without anesthesia and the diagnostic accuracy of 2D, 3D and power Doppler transvaginal sonography (TVS) in patients with abnormal uterine bleeding (AUB). This was a retrospective study including women with AUB. All patients underwent 2D, 3D and power Doppler TVS evaluation of the uterine cavity, and patients with suspicion on ultrasound (US) of endometrial pathology (EP) underwent hysteroscopy with morcellator without anesthesia. The painful symptomatology was assessed during the procedure using a visual analogue scale (VAS). Additionally, histological evaluation was performed. A total of 182 women underwent US imaging, of whom 131 (72%) had hysteroscopy. 130/131 patients completed the hysteroscopic examination with good compliance (VAS <4). One patient (0.8%) was unable to complete the procedure due to nulliparity and cervical stenosis. Of the 130 patients the US diagnosis was confirmed in 120 (92.3%), while in 10 patients (7.7%) the hysteroscopic diagnosis was different from the US diagnosis. Histological examination confirmed benign endometrial polyps in 115/130 patients (88.5%), while premalignant conditions were diagnosed in 3/130 patients (2.3%) and malignant conditions in 2/130 (1.5%). Of the 10 patients with endometrial thickening, two were diagnosed with a malignant condition. This study confirmed the feasibility of managing patients with AUB and suspicion of EP using "see-and-treat" hysteroscopy with morcellator without anesthesia. This procedure has the potential to yield desired outcomes while minimizing pain and discomfort, presenting a feasible outpatient approach for both treating and preventing endometrial carcinoma without requiring anesthesia.

Background: The introduction of the Morphological Uterus Sonographic Assessment (MUSA) 2022 criteria for diagnosing adenomyosis has reduced diagnoses compared with previous criteria. However, the impact of each ultrasonographic sign on diagnosis and symptom management remains unexplored. Methods: We retrospectively re-evaluated data from our 2015 study, which used criteria available before the first MUSA consensus. Nulligravid women aged 18–30 years without endometriosis were included to determine whether MUSA 2022 criteria result in fewer diagnoses than previous criteria. Sonographic images were reviewed and MUSA 2022 criteria applied. The primary outcome was to estimate previous overdiagnosis; the secondary outcome was to identify correlations between ultrasound features and symptoms. Results: Among 156 patients, at least one direct MUSA 2022 sign was present in 36 women; 17 had only indirect signs; and 103 had no ultrasound signs. MUSA 2022 criteria reduced adenomyosis prevalence from 34% to 23.1%. Direct signs were associated with greater dyspareunia (44.4% vs. 11.8%) and higher VAS scores. Hypermenorrhoea was associated with asymmetrical thickness (Odds Ratio 2.84) and a globular uterus (Odds Ratio 4.03). Conclusions: Applying MUSA 2022 criteria reduces adenomyosis diagnoses, suggesting that previous criteria may have overestimated prevalence. Nevertheless, ultrasound remains an adjunct to clinical assessment, and symptoms should guide management when direct signs are absent.