Infertility

Laparoscopy has revolutionized the practice of modern operative gynecology and has progressed from simple diagnostic work to advanced operative procedures.[

Diagnosis and treatment of endometriosis is the most frequent reason for gynecologic operative laparoscopy in the United States (Peterson et al,1990). Therefore, the laparoscopist must be thoroughly familiar with the current standards of diagnosis and management of this complex disease.

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.

The 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.

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%.

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.

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.

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.

60 obese infertile women (BMI >30) and 60 non-obese infertile women (BMI

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.

Acute on-set of Hematometra and Hematosalpinx in a non-communicating Rudimentary Horn of an Unicornuate Uterus: Laparoscopic Management

A 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.

Following 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.

In order to evaluate uterine fibroids, we need to know what is on the inside of the uterus. Many times ultrasound (or saline enhanced ultrasound) or MRI will provide the information we need. Many women are subjected to endometrial biopsy which is good to rule out cancer, but useless in diagnosing submucous fibroids and polyps. Fortunately it is easy to look directly into the uterus using a thin telescope called a hysteroscope.

As doctors, we often consult closely with colleagues regarding treatment and diagnosis. However, for a reproductive endocrinologist like myself, sometimes the most important colleague is one who does not have an office down the hall. Ob/gyns are likely the first specialists to field patient questions about fertility, and patients rely on ob/gyns to alert them when they need to see a fertility specialist.

In this article month’s blog I’ll discuss one of the various uterine causes of infertility, focusing specifically on a condition in which the uterus is congenitally very small in size-the hypoplastic uterus.

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.

James E. Carter, MD, PhD, FACOG, OBGYN.net Editorial Advisor interviews Charles Miller, MD

Dr. 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:

Mackendrodt 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.

OBGYN.net Conference CoverageFrom American Association of Gynecological LaparoscopistsOrlando, Florida, November 2000. "AAGL The Founding Years" Jordan Phillips, MD, OBGYN.net Editorial Advisor and General Chairman andFounder of AAGL with Dr. Louis Keith, MD OBGYN.net Editorial Advisor

An ectopic pregnancy is a pregnancy implanted in an abnormal location (outside of the uterus). During the past 40 years its incidence has been steadily increasing concomitant with increased STD rates and associated salpingitis (inflammation of the Fallopian tubes). Such abnormalities of the tubes prevent normal transport of the fertilized egg to the uterus.

Endometrium refers to the tissue lining the uterus. The primary function of the endometrium is to participate in the implantation of the fertilized ovum and the subsequent formation of the maternal portion of placenta.

Whenever 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.