Gynecology

I saw a long time patient yesterday in the office. Gloria drops in once a year for a checkup. She brought me a funny birthday card and we teased each other about the effects of gravity and aging. During her exam she detailed for me how much fun she and her husband Francis are having running a small entrepreneurial business (home remodeling).

This depends on the types and the severity of the prolapse. Generally, most women are not aware of the presence of mild prolapse. When prolapse is moderate or severe, symptoms may include sensation of a lump inside the vagina or disturbance in the function of the affected organs, such as: Bladder: stress incontinence, urgency, frequency, incomplete emptying, dribbling, recurrent urine infections.

A 27-year study of 1300 women undergoing retropubic cystourethropexy using either the modified Marshall-Marchetti-Krantz procedure or the modified Pereyra procedure compares long-term results when the type of surgery is selected on the basis of patient criteria.

Urinary incontinence impacts 15 to 35% of the adult ambulatory population. Men after the removal of the prostate for cancer can experience incontinence for several weeks to years after the surgery.

Cleft surgery in infants includes special risks due to the kind of the malformation. These risks can be attributed in part to the age and the weight of the patient. Whereas a lot of studies investigated the long-term facial outcome of cleft surgery depending on the age at operation, less is known about the complications arising during a cleft surgery in early infancy.

Women who have a diminished number of eggs in their ovaries, either because they are older or for some other reason such as ovarian surgery, may be more at risk of a trisomic pregnancy than women with an ovarian reserve within the normal, fertile range.

This week, I spent over 3 hours struggling with my chief resident in a clinic case doing a robotic hysterectomy and staging. Granted, the patient was an obese, hypertensive diabetic, who benefited from avoiding a big midline incision, but it did make me think of one of my mentors from fellowship.

Although uncommon, insulation failure (IF) during minimally invasive surgical procedures can cause electrosurgical injuries that can lead to significant complications. For instance, the resulting burns of these injuries involve a high risk of tissue necrosis and abscess formation that can lead to the perforation of internal organs, such as the bowel, which in turn can result in bacterial contamination of the abdominal cavity.

It is important to find a surgeon who takes time to talk to you and after a thorough evaluation discusses all of your treatment options. It's difficult to evaluate surgical skills without talking to medical personnel who observe surgery, but you can get some idea of someone's comfort level with a procedure by talking to them.

What is different with the MRI diagnostic test the doctor’s order to help them determine if a uterine fibroid patient is a candidate for the ExAblate procedure?

Approximately a week or two before the surgery ask you Doctor if it is ok to take vitamins or herbal sport drinks (certain vitamins, herbs, etc. can cause bleeding).

One of my favorite professors in medical school was fond of saying “There is nothing so constant in medicine as variation.” From my perspective, more than 25 years in clinical medicine, there is nothing so constant in medicine as change. At times the rate at which this change goes on is quite amazing. This can especially be said for the treatment of uterine fibroids over the last 100 years.

One of the most effective treatments for bleeding is to stop the blood supply to the area that is bleeding by blocking the vessels from the inside, this is known as “embolization”. Embolization of the arteries to the uterus has been used as a treatment for severe uterine bleeding after surgery or childbirth since at least the late 1970s, and is used as a treatment for uterine fibroids.

afe abdominal entry and prevention of retroperitoneal vascular injuries during laparoscopic surgery are the ultimate goals of any laparoscopic surgeon. Dr. Linda Nicoll and colleagues very capably have been able to describe a new technique and technology that prevent almost all retroperitoneal vascular injuries during laparoscopic entry.

Laparoscopy is one of the most common surgical procedures performed in the United States today. It is the modality of choice for many physicians for removal of ectopic pregnancy, bilateral tubal sterilization, treatment of endometriosis, lysis of adhesions, cholecystectomy, appendectomy, splenectomy, prostatectomy, etc. It is becoming increasingly popular for more complex procedures, including laparoscopic hysterectomy and myomectomy.

Fibroids are non-cancerous (benign) growths of the muscle wall of the uterus. They are probably responsible for more unnecessary gynecologic surgery than any other condition. Every year a staggering 600,000 American women have a hysterectomy. And about 30 percent of those hysterectomies, 180,000 in all, are performed because of fibroids.

Hysterectomy is no longer the only treatment for uterine fibroids. Now, GnRH agonists and laparoscopic coagulation with lasers and bipolar needles are treatment options.

This series describe an innovative approach for anterior placenta percreta surgery. The procedure has been developed in Argentina and is intended to limit obstetric bleeding and hysterectomy incidence. Though definite results will be reported later, a uterine preservation rate of about 90% with a mean transfusion need of 1000 ml has been achieved.

The aim of this study was to evaluate the role of TV-SH in the assessment of tubal patency and to compare these results with those obtained using HSG and laparoscopy.

Urge urinary incontinence (UUI) can be a troublesome symptom following surgery for stress incontinence and may be most likely to occur in women with a history of preoperative UUI. Meanwhile, the number of these procedures has grown, mostly due to the availability of the less invasive midurethral sling procedure

Many options are currently available to treat the symptoms of endometriosis. Of these options, surgery is the only one that actually removes or destroys the endometriosis itself. There seems to be a fair amount of confusion surrounding the issue of which surgical technique (excision, laser vaporization, etc.) is the best method to surgically remove endometriosis.

At a resident's education conference, Dr. Richard M. Soderstrom, M.D. presented the following handout on today's evidence based evaluation of laparoscopic sterilization methods. Dr. Soderstrom is the author covering this subject in the USA'a first textbook on Laparoscopy, Ed. JM Phillips, Williams & Wilkins, 1977. Since then he has published widely on the subject and continues to act as a consultant to the FDA when new devices for sterilization are entertained.

Feasibility and preliminary results of our technique for radical laparoscopic hysterectomy.

Unroofing the ureter in the cardinal ligament is the most important step during radical hysterectomy. At our institution we developed a modified laparoscopic technique to free the ureter from its roof through the cardinal ligament. The technique is based on the advantages of laparoscopic surgery which mainly are: more accurate haemostasis, magnification of the anatomical structures and positioning of the scope parallel to the ureteral course instead of perpendicular like in open surgery.

The forces that drive the development and refinement of surgical technique are multifocal. Physicians value effective procedures that combine safety, simplicity, and reproducibility. Third-party payers seek techniques that are cost effective, require shorter hospital stays, and result in less morbidity. Patients flock to physicians who are able to perform procedures that entail less discomfort, shorter recovery times, better cosmetic results, and also preserve or improve the equality of their lives. Such has been the case with the evolution of laparoscopic hysterectomy.

Laparoscopic Hysterectomy and Health Care in America -Finding the Balance Between Costs and Outcomes

The mean uterine weight was 146 g (60-569 g). The mean operating time was 94 minutes (60-225 min.). Actual morcellation time was available in 19 cases by reviewing videotape with an average morcellation time of 11.8 minutes (4-23 min.). Average blood loss was 125 cc (20-600 cc) with one case of late postoperative bleeding requiring operative intervention. The average cost for the procedure was $7,998 ($6,989 - $11,581). Thirty-six patients were discharged within 23 hours from the time of admission and all patients were discharged within 48 hours of the time of admission.

In spite of readily available alternatives to hysterectomy such as endometrial ablation, hysterectomy rates have not fallen. Several comparative trials of hysterectomy have shown shorter hospital stay and convalescence after laparoscopic approach compared to an abdominal approach.

The diagnosis of uterine and/or tubal pathology as causes of female infertility represents a fundamental step in the evaluation of the infertile couple. Apart from the invasive diagnostic procedures, several others diagnostic techniques useful to the clinical evaluation of the uterine cavity and tubal anatomy are: transvaginal sonography (TVS), hysterosalpingography (HSG), hysteroscopy and hydrosonography (HDS) and laparoscopy.

Laparoscopic staging of apparent early ovarian cancer may be accomplished in patients where disease appears limited to the adnexa. For example a completely resected complex adnexal mass with intraoperative frozen-section revealing malignancy and no obvious limitation to complete laparoscopic staging.