More than ten years have passed by since we first performed a laparoscopic myomectomy in our Department using Semm’s technique. As far as a subserous myoma is concerned, there are no particular problems; difficulties arise when dealing with intramural myomas.
From its beginnings back in 1991, in our Department, the laparoscopic approach to pelvic prolapse has changed considerably over the decade. Initially limited to strict reproduction of the techniques carried out by laparotomy, the introduction of a number of complementary procedures has provided an answer to all the situations encountered in the field of female genital prolapse repair.
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.
The first laparoscopic lymphadenectomy was reported in the late 1980’s and safety of this procedure has been largely proved. Familiarity with instrumentation and management of complication is a prerequisite to perform this procedure.
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.
After having been almost abandoned, supracervical hysterectomy has been recently re-advocated, especially after the development of laparoscopy, because it is stated to have less morbidity and minor intra-operative complications. However, long term outcomes report high incidences of late complications
Electro-surgery is very important in operative endoscopic surgery and probably represents the cheapest way to carry out a section and a coagulation.
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.
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.
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%.
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.
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.
OBJECTIVE: To evaluate a new resectoscopic electrode design intended to vaporize large intrauterine myomate.
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.
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.
If 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.
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.
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
Objective: To present a case of catamenial pneumothorax and diaphragmatic endometriosis that was managed thoracoscopically. A review of the literature is also presented. A 28-year-old woman initially presented with bloody stools and chronic constipation. During a review of systems, the patient described monthly chest pain associated with her menses. The initial workup included a pre-operative chest x-ray that revealed a right pneumothorax and colonoscopy that revealed biopsy-proven endometriosis of the sigmoid colon.
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.