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The area of pelvic health in women is a growing area of concern for health care providers as well as women with disorders that involve the pelvic area (bladder, pelvic floor muscle, rectum and uterus.) Chronic pelvic pain and vulvodynia, two frustrating pelvic disorders seen in young adult women, is not well understood.

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Meigs´s syndrome is defined as the presence of ascites and hydrothorax in association with a benign ovarian tumor. It is a rare clinical entity, which is also considered to be an uncommon complication of benign leiomyomas of the female genital tract. The case of a 33 year-old female patient who presented rapid weight loss and a quickly increasing abdominal circumference is described. Clinical and ultrasonographic studies revealed a mobile, semi-solid right adnexal tumor in the lower abdominal quadrants of 15 x 14-cm and ascites as well as hydrothorax of the left lung, confirmed by chest radiography.

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.

Research is the challenging process aiming at the knowledge of truth. It involves our past, is supported by individual aspirations and needs and could be responsible for our own future, for that of other people and for the future of the surrounding environment.

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.

The role of reproductive surgery has been questioned in the current environment of improving techniques and success rates with in vitro fertilization (IVF). Another emerging obstacle is the declining number of these types of surgeries being performed in response to the increasing numbers of patients opting for IVF.

Since the first laparoscopy was performed in humans by Jacobaeus in 1910, great strides have been made by surgeons in utilizing this valuable tool.1 Unfortunately, the expense of performing even diagnostic laparoscopy has become prohibitive. With the high cost of medical care, measures must be taken to decrease this monumental problem. For years, laparoscopy has been performed under local anesthesia with minimal reported complications.

Reported in the literature are more than 100 different kinds of surgical treatments for stress urinary incontinence in women, including anterior colporrhaphy (Kelly plication), retropubic urethropexy (Marshall-Marchetti-Krantz procedure, Burch procedure, ), paravaginal suspension, various kinds of needle urethropexy, and suburethral sling procedure.

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.

Over the past decade, a technique has been developed that can reduce or stop your periods without a hysterectomy. This surgery can be done in women who have flooding either with or without fibroid tumors. Dr. Dott was one of the surgeons who introduced this minimally invasive procedure in Atlanta. He has performed this procedure many times and is certified by the Accreditation Council for Gynecological Endoscopy in Advanced Hysteroscopic Surgery. He has taught this procedure in training institutions both in the United States and Russia.

A recent study found that postmenopausal women may be at risk of developing breast cancer, and that this risk is tied to factors other than family history.

This patient is a 50 year old GoPo female whose last period was four years ago. She was being followed by a gynecologist for pelvic pain and recently had an ultrasound showing a thickened endometrium. It was recommended that she have a D & C. She sought a second opinion prior to having the procedure.

Laparoscopic hysterectomy was first described in 1989 (Reich) and rapidly thereafter in 1991 laparoscopic pelvic lymphadenectomy was also described (Querleu). During the 1990s the role of pelvic and latterly para aortic lymphadenectomy has been extended and is now an integral part of best practice Gynaecological Oncology Departments.

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.