April 18th 2024
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Expert Illustrations & Commentaries™: Targeting Immune Cells to Treat Multiple Sclerosis
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15th Annual International Symposium on Ovarian Cancer and Other Gynecologic Malignancies™
May 11, 2024
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Community Practice Connections™: 14th Annual International Symposium on Ovarian Cancer and Other Gynecologic Malignancies
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4th Annual International Congress on the Future of Women’s Health™
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Patient, Provider, and Caregiver Connection™: Exploring Unmet Needs In Postpartum Depression – Making the Case for Early Detection and Novel Treatments
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Identifying Health Care Inequities in Screening, Diagnosis, and Trial Access for Breast Cancer Care: Taking Action With Evidence-Based Solutions
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A Modified Technique for Laparoscopic Assisted Vaginal Hysterectomy
June 29th 2011Vaginal 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.
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Laparoscopic Radical Hysterectomy and Bilateral Pelvic Lymphadenectomy using the Harmonic Scalpel
June 29th 2011The patient was a 30 year old female patient, para 0, who was diagnosed to have a cervical adenocarcinoma on a screening PAP smear. A subsequent endocervical curettage revealed a moderately differentiated adenocarcinoma with focal invasion. She underwent a cone biopsy and a repeated endocervical curettage which revealed an adenocarcinoma in situ with two foci of microinvasion consisting with a Stage IA2 lesion.
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Laser Surgery for Endometriosis
June 28th 2011To 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.
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Laser surgery for endometriosis : deep endometriosis
June 28th 2011Endometriosis 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%.
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Laparoscopy, looking inside the abdomen through a tube placed through a small incision, is a procedure commonly used by gynecologists to diagnose and treat a number of medical conditions. Since the early 1900's when rudimentary laparoscopes were used to visualize, but not treat, abdominal diseases, advancements in this technique have led to the ability to perform complex surgical procedures through a few small incisions, rather than the larger incisions used in the past.
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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.
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Most patients with endometriosis do not have intestinal (GI) involvement. Among the difficult cases of endometriosis I see from around the world, only 27% have GI involvement. Since over 1900 patients with endometriosis have undergone surgery at St. Charles, that means I’ve operated on over 500 patients with GI involvement. The symptoms of GI involvement depend on the severity and location of the disease. The severity of disease depends on the depth of invasion into the bowel wall.
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S.I.G.N. for Hysteroscopic Surgery
June 28th 2011If we consider how the management of our patient's medical problems has changed throughout the years, it is easy to despair at the well-meaning intentions of our predecessors. Though we still cannot be complacent about many of the current treatment options for patients, a new era of evidence based practice as opposed to the intuitive based practice of former times has evolved. Evidence based practice is not a panacea, but it can provide us with an insight into the advantages and disadvantages of existing therapies, and expose their weaknesses thus encouraging further research.
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Diagnostic Laparoscopy in Gynaecological Problems: A Retrospective Study
June 28th 2011Objective: 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.
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Tubal Ectopic Pregnancy: Laparoscopy vs. Laparotomy
June 28th 2011Objectives: 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.
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Extraperitoneal Laparoscopic Aortic Lynphadenectomy in Gynecological Cancer
June 28th 2011A preliminary examination under anaesthesia should be performed, the results of pre-operative investigations should be checked to confirm the indications and limitations of the proposed procedure. The retroperitoneal lomboaortic lymphadenectomy achieved via a left internal iliac approach (Dargent et al, 2ooo). The left side is chosen for this approach because most of the lymphnodes are found in the left paraortic region (Michel et al,1998) and because it is also possible to dissect on the right side via this approach (Dargent et al, 2000).If the preoperative work-up reveals right side adenopathy, a similar approach on the right is entirely possible.
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FERTILOSCOPY in the MANAGEMENT OF FEMALE INFERTILITY
June 28th 2011Following the first studies carried on by S. Gordts, the technique of Fertiloscopy has been developed, starting in 1997, by A.Watrelot at the "Centre Lyonnais de recherche et d'étude de la stérilité (CRES®)". Fertiloscopy is a new minimally invasive methods for the exploration of the posterior cul-de-sac which allows a complete work out of the mechanical factors of female infertility.
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Total laparoscopic hysterectomy (TLH) has for me since 1996 completely replaced all abdominal hysterectomies, except when the uterus is bigger than 1 kilo. A series of larger uteri have been operated (my biggest was 1850 grams) but when a uterus is larger than 1 kilo it is preferable to discuss the surgery in detail with the patient beforehand.
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Endometriosis is still poorly understood despite a high and still increasing publication rate of over 500 articles a year, i.e. 455 426, 448, 504 and 534 in the last 5 years respectively. It is considered to be one of the most important causes of pelvic pain and of infertility. The exact prevalence is not known since a laparoscopy is required to make the diagnosis and since the recognition varies with the training and the interest of the laparoscopist. Moreover the pathophysiology is poorly understood, which makes it difficult to formulate and test simple hypotheses.
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Great Debate: Laparoscopic Myomectomy is a Safe Procedure
June 23rd 2011Dr. Dubuisson stated that there is is a great demand from patients for minimally invasive surgery and it is important that the surgeon apply certain conditions to the selection of patients for successful treatment of leiomyomas by laparoscopy. Dr. Dubuisson said that the indications for a safe laparoscopic myomectomy include the following:
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Bipolar Electrosurgery and Hemostasis
June 23rd 2011When performing operative laparoscopy and using bipolar current to achieve hemostasis or desiccate vessels, there are a couple of simple techniques that can make the task easier for the surgeon. The first trick alleviates the frustration when one is attempting to desiccate either vessels or tissue with a bipolar instrument, and the instrument keeps sticking to the tissue and the char. Inevitably then when the surgeon attempts to remove the instrument or pull it from contact with the tissue, the seal is broken and the vessel or tissue begins bleeding again.
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Laparoscopic Resection of Sigmoid Endometrioma
June 23rd 2011Mackendrodt performed the first colonic resection for sigmoid endometriosis in 1909. Research has revealed that approximately 10 percent of menstruating women have endometriosis and up to 34 percent may have intestinal involvement.
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Laparoscopy has been steadily replacing laparotomy because the abdomen does not have to be opened up, resulting in faster recovery and reduction of complications. In laparoscopy, only three small incisions are made for the entry of a small camera and other instruments. Thus, the operation that is taking place inside the abdomen/pelvis can be viewed on a video screen placed next to the operating table.
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The word Laparoscopy simply means visual examination of the abdomen by means of a laparoscope. Laparoscopy (often called "belly button surgery", endoscopy, or key hole surgery) is a surgical technique involving small incisions in the abdomen through which major surgical procedures can be performed. One of the incisions is made in the umbilicus ("belly button").
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For pelvic floor repair we use the following principles.1. Site specific repair i.e. repair of the defect only. 2. Restrictive use of a mesh i.e. when necessary only. A mesh by definition carries a little risk of complications such as infection, of mesh erosion and more complicated subsequent surgery when necessary. 3. The use of a mesh when the vaginal wall is opened should be avoided.
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Advanced Operative Hysteroscopy & Laparoscopy
June 22nd 2011Whenever the surgery that is considered can be performed equally well and equally safely by either laparoscopy or laparotomy, the decision as to the type of incision to be used can (and in my opinion really should) include the patient.
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Laparoscopic Repair of Female Organ Prolapse
June 22nd 2011The goal of laparoscopic repair of female organ prolapse is to restore normal functioning by correcting female organ supporting defects in the pelvis. The supporting system in the female pelvis is quite complex; however, it is dynamic rather than static. There are basically two systems in the pelvis that provides the active and passive support of pelvic organs to their proper places.
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A significant number of women experience infertility due to surgically correctable causes. Most cases are a result of endometriosis and/or adhesions (scar tissue) from previous surgery or pelvic infection. Endometriosis and adhesions cause distortion and blockage of the fallopian tubes, thus causing infertility. Infertility surgery tries to unblock, release and restore normal anatomy of the fallopian tube.
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