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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.

The first use of hysteroscopy as a diagnostic tool occurred in 1869 by Pantaleoni who used a tube with an external light source to detect “vegetations in the uterine cavity.”[1] Since that time, improvements in optics, light sources and video cameras have made office hysteroscopy an invaluable tool in the diagnosis of abnormal uterine bleeding. Additionally, the office hysteroscope has the potential for use in treatment of certain disorders of the uterine cavity.

For the gynecologist, the introduction of the resectoscope revolutionized the management of submucous myomata that cause uncontrollable uterine bleeding, infertility and pregnancy wastage, and the con-servative control of persistent and excessive uterine bleeding unrelated to uterine filling defects.

In the last 20 years there has been an increased acceptance of hysteroscopic surgery into the gynecological surgical armamentarium. Endometrial ablation and resection offer viable alternatives to hysterectomy for women with intractable uterine bleeding.

Over the past decade and a half there has been a standardization in the use of the colposcope for photo documentation in the evaluation of child sexual abuse cases. The use of colposcopy has become the standard of care for pre-adolescent children, and medical professionals recognize the added specific benefits of video colposcopy for the evaluation of adolescent and adult sexual assault victims.

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

Urinary incontinence is defined as the involuntary loss of urine that is objectively demonstrated and is a social and hygienic problem. The condition may effect up to 40% of women during the course of their lives and could be present in as many as 20 million patients annually.

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.