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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.

Hysterectomy is the most frequently performed surgery in women. The difference in life time risk between countries probably reflect the mainly the attitude of the surgeon and the available techniques.

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.

Both types of surgery are complimentary. Each has specific advantages and indications. It is an advantage to have and to be able to use both.

Pelvic floor disorders: Cystocoele, Rectocoele - Enterocoele, Descensus Uteri, Incontinence

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.

During pregnancy, every mother-to-be undergoes radical psychological and physiological changes (endocrinologic, immunologic, metabolic, or vascular) whose influence may trigger various skin manifestations, even during the very first weeks of gestation.

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

The source of chronic pelvic pain may be reproductive organ, urological, musculoskeletal - neurological, gastrointestinal, or myofascial. A psychological component almost always is a factor whether as an antecedent event or presenting as depression as result of the pain.

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:

The first carefully described abdominal supracervical hysterectomy was performed by Wilhelm Alexander Freund in 1878 and it was the leading technique for over 80 years. Tervilä described the danger of cervical cancer to be 0.3-1.9% following supracervical hysterectomy. Since 1950, hysterectomy has been performed almost exclusively as total hysterectomy, though since the 1990 interest in supracervical hysterectomy has been reawakened thanks to the introduction of Classic Intrafascial Supracervical Hysterectomy CISH) pelviscopic and laparotomy techniques .

Laparoscopic hysterectomy is indeed promising, but it is not yet within the capability of most gynecologists. Further refinement in the technique is needed before it is ready for general endorsement.

When 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.

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.

bout 30% of those with blocked tubes have proximal obstruction. Blockage where the tubes connect to the uterus. This may be due to adhesions, spasm of the opening from the uterus to the tube (tubal osteum) or dryed up dead cells and mucus. The first probably can't be helped. We often see it with a condition called SIN (salpingitis isthmica nodusum) seen after sever pelvic infection. Spasm means the tubes are not really blocked but they show up that way. It's the dried up stuff blocking the tube that makes a difference.

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

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.

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.

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").

Even though the anterior repair is the most commonly utilized operation for correction of a cystocele, it is probably not the most effective, nor is it the correct operation for restoring a woman's anatomy and maintaining vaginal length and function. The problem with using this operation in young healthy sexually active woman with a paravaginal defect (cystocele) is the surgeon does not really surgically support the bladder, but instead reduces the bulge by "scrunching " the fascia under the bladder together.

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.

Pathophysiology of visceral pain

Hysterectomy is the most frequently performed operation in women, with a life time risk varying from country to country from less than 20% to more than 40%. Overall these differences reflect more medical practice than differences in pathology between countries.

The FDA recently approved a new genetic test, called Inform Dual ISH, that helps determine whether women with breast cancer have the human epidermal growth factor receptor 2 (HER2)-positive type.1 In about 20% of breast cancers, the cancer cells produce an excess of the protein HER2 because of a gene mutation. HER2-positive breast cancers tend to be more aggressive and respond less well to hormone therapy.

Laparoscopy is now an option for many gynecological conditions. This overview discusses specific laparoscopic procedures and the conditions they treat.