Gynaecological Endoscopy最新文献

To describe the technique of laparoscopic reconstruction of the uterine wall defect after laparoscopic enucleation of intramural fibroid, using a modified type of reusable laparoscopic knot pusher which enhances precise positioning and adequate tightening of the Roeder knot.

A stand-alone one-day surgery unit.

Six patients having laparoscopic enucleation of an intramural fibroid.

The defect in the uterine wall was reconstructed with open surgery sutures tied extracorporeally using a Roeder knot which was slid and tightened with the knot pusher.

Since the Roeder knots were slid and tightened without blockage and the uterine wall was reconstructed without postoperative intramural haematoma in all patients, the impression is that the modified type of Roeder knot pusher used on standard sutures could be a low-price alternative to endoscopic sutures.

To ascertain whether microwave endometrial ablation under local anaesthesia is feasible in unselected women.

A partially randomized patient preference pilot study.

A large teaching hospital in North-east Scotland.

98 women who were referred and suitable for endometrial ablation and who agreed to participate after informed consent had been given.

Women were randomly allocated to receive general or local anaesthesia for microwave endometrial ablation, or if they had a strong preference they were allocated to their chosen anaesthesia. All procedures were performed in the theatre setting and on a day case basis.

Acceptability and satisfaction were primarily assessed in each group using validated tools. Operating times, failure under local anaesthesia, postoperative analgesia and postoperative discharge times were also recorded.

Microwave endometrial ablation under local anaesthesia was feasible in 75% of unselected women. Acceptability was higher in those who chose local anaesthesia.

Local anaesthesia should be offered to women undergoing microwave endometrial ablation and a randomized controlled trial is a feasible option for assessing prognostic factors and satisfaction.

Hysterectomy is traditionally performed by the abdominal route, and is frequently done for benign uterine pathologies. Laparoscopic procedures have been used widely because of advances in technological development and increased laparoscopic experience. We therefore wished to evaluate the role of laparoscopic hysterectomy in comparison with traditional abdominal hysterectomy.

A prospective study.

Department of Obstetrics and Gynaecology, Akdeniz University School of Medicine, Turkey.

We recorded details from all patients between 1998 and 2000 with indications for hysterectomy on account of benign uterine pathologies. Both types of hysterectomy were performed throughout this period. The operating times, complications and analgesia dosage were compared.

In all 84 patients underwent hysterectomy. Of these patients, 38 (45.2%) had laparoscopic-assisted vaginal hysterectomy, 34 (40.4%) had total abdominal and 12 (14.2%) had vaginal hysterectomy. Laparoscopic hysterectomy showed the advantages of shorter hospital stay, less analgesic medication and earlier postoperative recovery.

Laparoscopic hysterectomy, with the advantages of laparoscopic surgery, was the preferable approach to hysterectomy for benign uterine pathology in this series. It can replace traditional hysterectomy in patients who are suitable for laparoscopic surgery.

To present a case of recurrent laryngeal nerve paralysis after laparoscopic surgery.

A 26-year-old nulligravid woman.

The patient underwent laparoscopic left ovarian cystectomy and myomectomy under general anaesthesia. A few hours later, she complained of throat discomfort and hoarseness. Indirect laryngoscopy showed an immobile left vocal cord. The hoarseness continued for 4 weeks.

Recurrent laryngeal nerve paralysis might present as a complication of laparoscopic surgery under general anaesthesia.

Advanced endometriosis is a common cause of infertility. It has traditionally been treated surgically by laparotomy. The surgeon had to cope mainly with adhesions, endometriotic implants and, quite often, endometriotic cysts of various diameters. In this study, we report our laparoscopic technique for treating advanced endometriosis with large endometriomata, using conventional instrumentation, and we discuss our main problems and our results.

The study population consisted of 68 subfertile patients with large endometriomata who underwent laparoscopic removal of the cysts.

The Infertility Clinic at the Alexandra Maternity Hospital, Athens, Greece, between January 1990 and October 1997.

Laparoscopic excision of endometriotic cysts in subfertile women.

Success of treatment modality; postoperative complications; postoperative cumulative pregnancy rates.

The technique is described. Postoperative complications were minimal. Of the patients, 32 (47%) became pregnant during the 2-year postoperative follow-up period. The estimated cumulative pregnancy rates at 6, 12, 18 and 24 months were 22%, 35%, 45% and 47%, respectively.

Our experience favours the use of traditional laparoscopic tools over laser treatment for the management of extensive endometriosis with endometriomata, since the results are similar to those observed after laser treatment, and the training of a larger number of physicians and availability of equipment are more readily achieved for the former method. Postoperative pregnancy rates are high.

To compare the tensile strengths of commonly used extracorporeal slipknots when tied with poliglecaprone and polydioxanone.

The tensile strength of seven extracorporeal slip knots and the flat square knot were tested using a tensiometer. Knots were tied in random order with 2/0 poliglecaprone and polydioxanone. The study was designed to demonstrate a 5-newton difference in knot strength with 95% confidence at 80% power. Five knots were studied in each arm of the experiment.

A laboratory experiment.

Force required to break or cause slippage of knots.

Knots tied with polydioxanone had a marginal yet significantly stronger tensile strength of 2.3 N (95% CI 0.1–0.75 N, P = 0.0332). The Tayside, Blood, Hutchon and Western knots had lower tensile strengths than the flat square knot in both poliglecaprone and polydioxanone. The modified Roeder knot was also stronger than the other ligatures when tied in poliglecaprone and more secure than the Western and Tayside knots when tied in polydioxanone.

Slip knots tied in poliglecaprone are marginally less strong than those tied in polydioxanone. No extracorporeally tied slip knot is stronger than the modified Roeder knot.

To review complications in both diagnostic and operative laparoscopic procedures at a university-affiliated major teaching hospital and to assess possible risk factors for complications.

A retrospective review of all laparoscopic procedures at the Royal Women's Hospital Brisbane, Australia, from 1990 to 1997 inclusive. A non-medical or nursing independent assessor reviewed charts. Data were collected on a standard form. Incomplete charts were excluded from analysis.

There was a total of 1505 procedures. Analysis was based on 1435 complete data records. The overall complication rate was 2.86% with infection (1.3%) being the most common. The rate of gastrointestinal injury was 0.14%. Compared with women who had diagnostic laparoscopies, a higher rate of complication was found in women who had undergone operative laparoscopic procedures. However, this difference did not reach statistical significance. The complication rate was unrelated to seniority of the surgeon.

Complications can occur in any laparoscopic procedure. Regular reviews, especially in teaching hospitals, will provide feedback to clinicians to improve quality of care.

We report a fatal outcome using 1.5% glycine as distension/irrigation fluid for hysteroscopic myomectomy.

During general anaesthesia for transcervical endoscopic resection of myoma, a healthy 35-year-old woman developed severe pulmonary hyponatraemia and cerebral oedema, and was declared brain dead. Postmortem findings did not reveal pontine myelinolysis. Through the procedure, the net fluid absorption of 1.5% glycine was 1.6 L plus 1 L of maintenance intravenous Ringer’s lactate solution.

Regional anaesthesia is recommended for hysteroscopy, since general anaesthesia may mask neurologic signs, and meticulous attention should be paid to intraoperative fluid balance.