Stefan Ivanovic

Reported complication rates in gynecologic laparoscopy are widely used as indicators of safety, yet they often describe fundamentally different clinical realities. Variations in definitions, severity classification, duration of follow-up, and procedural context mean that superficially similar outcomes are frequently not comparable. As a result, the literature is rich in data, but limited in interpretability. This review addresses that gap by critically examining complications not only as events but as phenomena shaped by methodological heterogeneity, procedural complexity, and the conditions under which they are recognized. A search of PubMed/MEDLINE, Scopus, and Web of Science was performed, with additional manual reference screening. Given the predominance of heterogeneous retrospective series, cohort studies, registries, and targeted systematic reviews, a narrative synthesis was undertaken. Across studies, the most clinically significant complications remain hemorrhage, bowel injury, and urinary tract injury, while pneumoperitoneum-related events, vaginal cuff dehiscence, port-site complications, port-site metastasis, and morcellation-related dissemination represent rarer but disproportionately consequential outcomes. Importantly, complication risk consistently clusters around identifiable domains, including prior surgery and adhesions, procedural complexity, energy use, operative duration, surgeon experience, and center-level standardization. This review shows that complications in gynecologic laparoscopy cannot be meaningfully interpreted through incidence alone. Their true clinical significance lies in the interaction between risk architecture, intraoperative decision-making, and the timeliness of postoperative recognition. The principal contribution of this work is therefore not a single summary rate but a clinically oriented framework that integrates interpretation of the literature with practical principles of prevention and early diagnosis.

Background and Objectives: Following the removal of the uterus, due to prolapse or other indications, disruption of the apical support structures may result in descent of the vaginal apex. As the condition progresses, the cystocele, rectocele, and/or enterocele are formed, finally creating a complex vaginal eversion that generally requires surgical multi-compartmental repair. This review aimed to provide a comprehensive overview of cur-rent surgical modalities for post-hysterectomy vaginal vault prolapse, which could sup-port personalized treatment. Materials and Methods: MEDLINE, Scopus and Google Scholar databases were searched to retrieve freely available manuscripts published in English language since the year 2000. Results: Surgical correction remains the basis of management for symptomatic post-hysterectomy vaginal vault prolapse. The primary objective of treatment is restoration of robust apical support, normalization of vaginal axis, preservation of sexual and urinary function along with minimization of operative complications and recurrence. Several reconstructive approaches have been established as safe and comparatively reliable. They are classified into native tissue vaginal repairs (sacrospinous ligament fixation, uterosacral ligament suspension), abdominal or minimally invasive sacro-colpopexy, mesh-augmented techniques, and obliterative procedures. No single surgical approach appears universally superior across anatomical, functional, and safety outcomes, and procedure selection should therefore be individualized according to patient characteristics, treatment priorities, and surgeon expertise. Consequently, procedure selection should be individualized according to patient characteristics and surgeon expertise. Conclusions: Post-hysterectomy vaginal vault prolapse remains a complex and clinically significant condition. Current evidence supports the central importance of apical suspension during all hysterectomies. Optimal treatment outcomes are achieved through patient-centered decision-making that balances durability, safety, functional recovery, and individual expectations.

Catamenial pneumothorax is a rare form of recurrent spontaneous pneumothorax occurring in women in temporal association with the menstrual cycle, most commonly within 72 h before or after the onset of menstruation, and is frequently encountered as part of thoracic endometriosis syndrome. Thoracic endometriosis represents an extrapelvic manifestation of endometriosis in which ectopic endometrial tissue may involve the pleura, diaphragm, lung parenchyma, or airways, leading to cyclic pleuropulmonary symptoms. The clinical spectrum includes catamenial pneumothorax, catamenial hemothorax, catamenial hemoptysis, and pulmonary endometriotic nodules. This narrative review critically analyzes the diagnostic challenges and limitations of imaging modalities in thoracic endometriosis, with particular emphasis on diagnostic delay, radiological pitfalls, and the discrepancy between morphological detection and etiological confirmation. Chest radiography and computed tomography are useful for documenting acute thoracic events, whereas magnetic resonance imaging may provide additional tissue characterization in selected cases, particularly when hemorrhagic or diaphragmatic lesions are suspected. However, imaging findings are often nonspecific, temporally variable, and insufficient to establish the diagnosis when interpreted in isolation. Recognition of thoracic endometriosis therefore requires correlation of imaging findings with menstrual cyclicity, gynecological history, clinical phenotype, and, when indicated, surgical and histopathological assessment. The available evidence remains limited by retrospective designs, small case series, inconsistent diagnostic criteria, and lack of validated thoracic-specific imaging pathways. Accordingly, an integrated clinical–radiological–surgical approach should be regarded as a pragmatic diagnostic framework rather than a validated algorithm. Such an approach may improve clinical suspicion, reduce diagnostic delay, and support more appropriate multidisciplinary management of this underrecognized condition.

Background: Ectopic pregnancy remains a significant cause of maternal morbidity in early pregnancy. While most ectopic pregnancies happen within the fallopian tube, implantation may rarely occur in atypical locations such as the ovary or abdominal cavity. These rare forms often present with nonspecific clinical findings and may represent a considerable diagnostic challenge. Methods: We report a case series of three rare ectopic pregnancies managed at a tertiary referral center. Two cases involved ovarian pregnancy, and one case represented an exceptionally rare hepatic ectopic pregnancy. Clinical presentation, diagnostic pathway, surgical management, and outcomes were analyzed and compared with available literature. Results: In the first two cases, ovarian pregnancy was confirmed intraoperatively and treated surgically, with ovarian preservation in one patient and adnexectomy in the other due to active bleeding. The third case had an unusual course: initial surgery was performed for hemoperitoneum caused by a ruptured corpus luteum cyst, while persistent β-hCG elevation later led to identification of hepatic ectopic pregnancy, confirmed by imaging and surgery. All patients recovered favorably, with complete β-hCG negativization. Conclusions: Rare ectopic implantation sites may mimic acute abdominal conditions and remain difficult to diagnose preoperatively. High clinical suspicion, serial β-hCG monitoring, and appropriate imaging are essential. Surgical management remains central, particularly in life-threatening bleeding. Standard algorithms for tubal ectopic pregnancy may not be fully applicable and should be adapted to the clinical context.

Background and Clinical Significance: Uterine smooth muscle tumors range from benign leiomyomas to highly aggressive leiomyosarcomas. Smooth muscle tumors of uncertain malignant potential (STUMP) represent an intermediate and diagnostically challenging category defined by borderline or discordant histological features. Their clinical management remains complex due to limited possibilities for reliable preoperative differentiation and the absence of clearly established surveillance protocols. The situation becomes particularly sensitive in postmenopausal patients, in whom tumor growth or abnormal bleeding raises concern for malignancy. Case Presentation : We report a 66-year-old postmenopausal woman presenting with persistent uterine bleeding and interval growth of a previously presumed leiomyoma. Transvaginal ultrasound demonstrated a heterogeneous intramural mass measuring approximately 5–7 cm, while endometrial sampling revealed inactive, atrophic endometrium without evidence of malignancy. Given the patient’s postmenopausal status and progressive symptoms, total abdominal hysterectomy with bilateral adnexectomy was performed. Histopathological examination identified moderate cytological atypia, focal coagulative tumor necrosis, and mitotic activity of up to five mitoses per ten high-power fields, findings insufficient for leiomyosarcoma but exceeding those expected for a benign leiomyoma. A diagnosis of STUMP was established. Postoperative staging showed no residual or metastatic disease, and structured long-term follow-up was initiated. Discussion: This case illustrates the limitations of current preoperative diagnostic tools in distinguishing between benign and borderline or malignant uterine smooth muscle tumors. Clinical presentation, imaging, and endometrial sampling were not predictive of the final diagnosis. In postmenopausal women, enlargement of a presumed leiomyoma should prompt careful evaluation, as histological assessment after complete surgical removal often remains the only reliable method of diagnosis. The unpredictable biological behavior of STUMP and reported cases of late recurrence support the need for prolonged surveillance, even after apparently adequate surgical treatment. Conclusions: STUMP remains primarily a postoperative diagnosis and represents a persistent gray zone in gynecologic oncology. Postmenopausal tumor growth and abnormal bleeding warrant an individualized and cautious approach. Careful histopathological evaluation and long-term follow-up are essential to ensure early detection of possible recurrence and optimal patient management.

In relation to the most commonly described ampullary ectopic pregnancies in contemporary gynecological practice, rare localizations of ectopic pregnancies represent a diagnostic and therapeutic challenge whose clinical significance far exceeds their frequency. In contrast to tubal ectopic pregnancy, these implantation localizations are characterized by specific anatomical relationships and early trophoblastic invasion into highly vascularized tissues, which is why classical diagnostic algorithms and therapeutic patterns are often not applicable in clinical practice. Clinical uncertainty is further increased by the fact that a large proportion of these pregnancies in early gestation cannot be precisely mapped and initially present as pregnancies of unknown location. This narrative review integrates contemporary evidence and guidelines of relevant professional societies with the aim of highlighting patterns of diagnostic errors, systemic weaknesses of existing approaches, and key points for safe clinical decision-making. Special emphasis is placed on the role of disciplined transvaginal ultrasound evaluation, terminological precision, and timely recognition of high-risk and nonspecific implantations. Analysis of the available literature indicates that therapeutic decisions must be individualized and guided by the implantation site and assessment of hemorrhagic risk, rather than gestational age or absolute β-hCG values. Understanding these principles represents the basis for reducing serious complications and for the development of future diagnostic and therapeutic algorithms, thereby improving treatment outcomes.

Background and Clinical Significance: Metastases of prostate adenocarcinoma most commonly involve the skeletal system, while orbital metastases, including those in the lacrimal gland, are extremely rare. Despite significant advances in the sensitivity of available imaging methods, their diagnosis is often delayed due to nonspecific clinical presentation and rarity of occurrence. Although exceedingly uncommon, orbital metastases have also been reported in other solid tumors, including certain gynecologic malignancies. Case presentation: A 49-year-old patient treated at our center for prostate adenocarcinoma with a Gleason score of 9, regional lymphadenopathy and bone metastases presented to the outpatient clinic with ptosis of the left eyelid, which had developed 7 days prior to examination (13 months after diagnosis of PC). Radiological diagnostics, including CT of the endocranium, revealed enlargement of the left lacrimal gland. An exploratory anterior orbitotomy was performed with an incisional biopsy of the tumor change under retrobulbar anesthesia, and histopathological analysis confirmed a metastatic tumor of the lacrimal gland originating from prostate adenocarcinoma. Despite the application of all available therapeutic measures, a fatal outcome occurred 6 months after the onset of ophthalmic symptoms. Discussion: Orbital involvement in metastatic prostate cancer remains poorly characterized due to its extreme rarity and nonspecific clinical presentation. This case emphasizes the need for a high index of suspicion for metastatic disease in patients with known advanced prostate cancer presenting with new orbital or lacrimal gland lesions, as imaging findings alone may be insufficient to distinguish metastases from primary orbital tumors. Conclusions: Metastasis of prostate adenocarcinoma to the lacrimal gland is an extremely rare clinical manifestation. Timely diagnosis and adequate radiological assessment are crucial for patient management and survival. The aims of this case report areto present a rare metastatic manifestation of prostate adenocarcinoma with orbital/lacrimal metastasis of prostate adenocarcinoma origin, and to highlight metastatic prostate disease as a potential differential diagnosis in orbital lesions and the importance of imaging methods in their detection.

The most severe premalignant lesion of glandular epithelium of the cervix is adenocarcinoma in situ (AIS). In most cases it is associated with persistent human papillomavirus (HPV) infection and most often occurs in women in the fourth decade of life. In most high-income countries, primary screening has shifted to HPV testing, while cytology is used for patient triage. Even with current robust screening protocols, their sensitivity for glandular lesions remains limited. Diagnosis of AIS obtained by biopsy, brushing or curettage is confirmed by excisional methods and pathohistological verification. Therapy depends on the patient’s lifestyle and reproductive age. In our case, we present a nulliparous patient with persistent ASC-US, multiple-type HPV infection without HPV 16 and 18 types, and AIS which was diagnosed after conization, follow-up and two biopsies with curettage of cervical canal. Our case report highlights limitations in detection of glandular lesions and need for caution in patients with persistent and seemingly low-grade cytological abnormalities, notably in young patients with high-risk HPV types.

Background and Clinical Significance: Acute aortic dissection is the most common and most severe manifestation of acute aortic syndrome. An isolated dissecting aneurysm of the abdominal aorta is defined as a dissecting aneurysm distal to the diaphragm and is an extremely rare disease. Detection of an intimal flap between two lumens using different imaging methods is a definitive diagnostic sign of aortic dissection. A number of studies have validated ultrasound, including point-of-care ultrasound, as the standard initial imaging modality for the diagnosis of aortic dissection. Case Presentation: We present a 39-year-old patient who was sent to our institution under the suspicion of renal colic. The clinical findings revealed pale discoloration of the skin with sweating and abdominal pain. An emergency ultrasound showed an abdominal aortic aneurysm with an intimal flap, as well as free perirenal fluid on the left side. Multislice computed tomography aortography was then performed and the findings indicated rupture of a dissecting aneurysm of the abdominal aorta with a large retroperitoneal hematoma. The patient was then sent to a tertiary institution where he underwent emergency surgery and successfully recovered. Conclusions: Isolated abdominal aortic dissection is a rare condition with often non-specific clinical presentation, making imaging crucial for diagnosis. Ultrasound plays an important role as an initial imaging modality, as the detection of direct or indirect signs of dissection enables timely referral for CT aortography, confirmation of the diagnosis, and initiation of appropriate treatment.

The most severe premalignant lesion of glandular epithelium of the cervix is ade-nocarcinoma in situ (AIS). In most cases it is associated with persistent Human papillo-mavirus (HPV) infection and most often occurs in women in the fourth decade of life. In most high-income countries, primary screening has shifted to HPV testing, while cytology is used for patient triage. Even with current robust screening protocols, their sensitivity for glandular lesions remains limited. Diagnosis of AIS obtained by biopsy, brushing or curettage is confirmed by excisional methods and pathohistological verification. Therapy depends on the patient’s lifestyle and reproductive age. In our case, we present nulliparous patient with persistent ASC-US, HPV infection with alpha-7 types (without HPV 16 and 18 types), and AIS which was diagnosed after conization, follow up and two biopsies with curettage of cervical canal. Our case report highlights limitations in detection of glandular lesions and need for caution in patients with persistent and seemingly low-grade cytological abnormalities, notably in young patients with high-risk HPV types.