It has been reported that approximately 670,000 hysterectomies are performed each year in the United States. Close to one third (more than 200,000) of these operations are done because of intractable menorrhagia not responsive to medical therapy or to dilation and curettage. The Nd:YAG laser was first used by Goldrath and colleagues showing that this laser can photocoagulate the endometrium and the menstrual flow reduced to little or none.
Uterine myomas are the most common tumors of the female genital tract. = Hysterectomy has been a very common therapy in patients who have completed reproduction. In fact, uterine myomas = account for 20% of the 650,000 hysterectomies performed annually in the United States. Interest in uterine = preservation and organ preserving surgery through techniques of minimally invasive surgery has increased since the first = reports of laparoscopic myomectomy in 1980.
Laparoscopic urinary bladder surgery primarily involves retropubic bladder neck suspension procedures. Because variations of the laparoscopic Burch procedure (Tanagho, Hodgkinson) are most frequently performed, this chapter will focus on the complications of the laparoscopic Burch procedure - avoidance, recognition, and treatment.
After more than 50 years, pneumoperitoneum with carbon dioxide remains the standard for creating a working space for laparoscopic surgery. Although the physiologic problems resulting from CO2 pneumoperitoneum have been well documented, they are becoming more of a concern as older, more debilitated women are undergoing longer, more extensive laparoscopic procedures
Hysterectomy continues to be a common gynecologic operation. Approximately 600,000 patients undergo surgical removal of the uterus annually at a considerable cost to payers, patients, and society at large. Currently most hysterectomies are via the abdominal or vaginal approach but fortunately for patients laparoscopic assisted procedures are becoming more popular. Many studies have shown the laparoscopic approach as safe, effective, and a less intrusive alternative to open surgery.
Dr. J. B. Dubuisson began the great debated entitled Laparoscopic Myomectomy is a Safe Procedure by outlining the conditions under which laparoscopic myomectomy is a safe procedure.
Endometriosis is a gynecological disease affecting women in their reproductive years. The reported incidence of endometriosis among infertile women is 20-50%, and 39-59% among those with pelvic pain. This is in contrast to 15-18% incidental findings of endometriosis among women undergoing tubal sterilization. The question of whether endometriosis causes infertility has been a subject of debate for many years. In this review, the association between infertility and endometriosis and the treatment are discussed.
Transvaginal hydro laparoscopy (THL) is a new approach to pelvic anatomic evaluation in the infertile woman. In this procedure a dilating trocar is inserted through the osterior vaginal wall for endoscopic pelvic examination. Normal saline is used to float the bowel out of the pelvis so that one can evaluate the distal Fallopian tubes, ovarian surfaces, pelvic sidewalls, and the cul-de-sac. The THL procedure makes in-office pelvic endoscopy, hysteroscopy, and dye hydrotubation a reality.
Hysteroscopy performed with liquid media at a sufficient pressure, usually between 70 mm and 90 mm Hg of true intrauterine pressure, will bring about satisfactory uterine distention, but not necessarily adequate visualization. Depending on the amount of intraoperative bleeding, an adequate flow rate of the media with separate channels of entry and egress is necessary to have a clear operative field.
For the gynecologist, the introduction of the resectoscope revolutionized the management of submucous myomata that cause uncontrollable uterine bleeding, infertility and pregnancy wastage, and the con-servative control of persistent and excessive uterine bleeding unrelated to uterine filling defects.
Laparoscopy has revolutionized the practice of modern operative gynecology and has progressed from simple diagnostic work to advanced operative procedures.[
Introduction: Intestinal endometriosis is a disabling disease present in 6% to 30% of deep endometriosis cases. It can be the cause of abdominal bloating, constipation, intestinal cramping and painful bowel movements, defecation pain and intestinal stenosis up to intestinal occlusion. Colorectal endometriosis requires surgical treatment that can be performed by abdominal route or by laparoscopy. The present study describes the total laparoscopic rectosigmoid resection in case of deep endometriosis with bowel involvement.
Vaginal hysterectomy can be the standard procedure for removing the uterus, but surgical skills and indications to vaginal surgery are variable. Laparoscopic assistance to vaginal hysterectomy is a way to change the approach to hysterectomy. In this paper we describe our retroperitoneal technique for laparoscopic securing of the uterine pedicles.
Research shows that to reduce the risk of gestational diabetes, exercise intensity should reach at least 60% of the heart rate reserve during pregnancy while gradually increasing physical-activity energy expenditure.
To interpret the literature describing the results of surgery for endometriosis, a clear understanding of the evolution and limitations of the various techniques is necessary. Up to the end of the 1970’s, minimal and mild endometriosis was destroyed endoscopically by heat application (endothermia) and by unipolar or bipolar coagulation. Treatment of more severe endometriotic disease was mostly radical by hysterectomy, often leaving some rectovaginal endometriosis which has not been fully recognised before 1989.
Endometriosis can infiltrate the surrounding tissues resulting in an important sclerotic, and inflammatory reaction which can translate clinically in nodularity, bowel stenosis and ureteral obstruction. The most severe forms such as rectovaginal endometriosis and endometriosis invading the rectum or the sigmoid have been known since the beginning of this century. These conditions, however, are relatively rare with an estimated prevalence of less than 1%.
The medical literature has reported an increase in myomectomy during caesarean section in the past decade. However, myomectomy performed during pregnancy remains a rarity. The management of uterine fibroids during pregnancy is usually expectant and surgical removal is generally delayed until after delivery. We present a case of a large, symptomatic uterine fibroid diagnosed during pregnancy which was successfully managed by antepartum myomectomy.
Objective: To evaluate the laparoscopically assisted vaginal hysterectomy (LAVH) in terms of indications, uterine size that can be operated upon, surgical procedures and their safety, intraoperative complications and blood loss, operative time, concomitant surgical procedures, postoperative period and complications, and average total cost.
The use of levonorgestrel-releasing intrauterine system (LNG-IUS) results in a remarkable decrease in endometrial proliferation and a remarkable increase in apoptosis in the endometrium ; therefore it is effective for long-term management of menorrhagic women with uterine myomas because of the striking reduction in menorrhagia.
Three Questions to the Editorials Author
Welcome to this, my first column for OBGYN.net. My hope is that my monthly articles will entertain, question and stimulate you in all areas of OBGYN. I am a general obstetrician and gynecologist working in North London, United Kingdom with particular interests in endoscopic surgery and urogynaecology. I am also an award winning medical journalist. Over the coming months I hope to share my experiences and thoughts with you, challenge our beliefs and contribute to the ongoing debate that shapes improvements in clinical care. I welcome your feedback.
Objective: To study the findings obtained by diagnostic laparoscopy in gynaecological problems in order to re-assess the role of laparoscopy in the diagnosis of gynaecological problems during the study period.
Objectives: To compare the efficiency of laparoscopic treatment versus conventional abdominal surgery in the treatment of ectopic pregnancy (EP) and to review the clinical presentation, evaluate methods of diagnosis, and identifying the risk factors.
One of the important problems in the clinical management of cancer is the early detection of its occurrence. The demonstration of immunoreactive substances, which are specific or associated with cancer and measurable in serum, provides an interesting and promising approach to cancer detection
Acute on-set of Hematometra and Hematosalpinx in a non-communicating Rudimentary Horn of an Unicornuate Uterus: Laparoscopic Management
