Abstract:

The efficacy of medical therapy in endometriosis-associated infertility has been called into question. For decades, surgery has been used in the treatment of endometriosis. However, before the 1960s it consisted of either excision or hysterectomy and bilateral adnexectomy. Although controversy exists about whether laparotomy or operative laparoscopy is the more efTective therapeutic approach for endometriosis, the efficacy of surgery in reducing implants, relieving dysmenorrhea and pelvic pain, and improving fertility has been well-established.

Authors:

Jaime Vasquez, M.D.; Cristina Bastias, M.D.; Mary Beth Mink, B.S.N. - Center for Reproductive Health, Reproductive Endocrinology and Infertility; Arthur Fleischer, M.D. - Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn.

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Abstract:

In the present study, a modified application of the surgical instrument with double balloon is described in the ovarian cystectomy procedure. This technique has been proved effective and safe especially in removing chocolate-like cystoma. This new instrument, which we originally designed, has two balloons at the tip of the catheter. After a cyst is punctured, the inner and outer balloons are inflated to fix the cyst well. After fixing the cyst with two balloons, the internal needle of the instrument can be removed. This catheter, named the SAND balloon catheter, is advantageous in laparoscopic ovarian cystectomy.

Authors:

Kenichiro Ikuma, M.D.; Yasuki Koyasu, M.D.; Yukio Yamada, M.D.; Shuichi Ohashi, M.D.; S.M. Manzurul Haque, M.D. - Takarazuka City Hospital, Takarazuka, Hyogo, Japan

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Abstract:

Pelvic adhesions observed in gynecologic patients are a major contributing factor to infertility, pelvic pain, and/or intestinal obstruction. Such adhesions may be the sequelae to inflammatory processes, endometriosis, and prior surgical intervention. The latter will be the main topic of this chaprer.

Authors:

Michael P. Diamond, M.D.; Diaa M. El-Mowafi, M.D. - Wayne State University, Detroit, Mich.

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Abstract:

One particularly controversial form of laparoscopic hysterectomy is subtotal hysterectomy (LSH). LSH was first described by Semm. Since that report, several authors have reported their initial experience with vanous methods for LSH. A recent clinical commentary by Munro discussed the pros and cons of LSH in an editorial entitled "Supracervical Hysterectomy: A Time for Reprisal. In a recently published report, we discussed our initial experience with laparoscopic subtotal hysterectomy. The article reported our experiences utilizing bipolar instruments, an electromechanical morcellator, and other modifications of LSH we feel simplify and reduce the procedural operaríve time and potential intraoperative and postoperative complications.

Authors:

James F. Daniell, M.D., F.A.C.O.G.; Calvin Channell, M.D.; James Lindsay, M.D.; Stephen Staggs, M.D. - Centennial Medical Center, Nashville, Tenn.

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Abstract:

Ultrasonic Surgical Aspiration (USA) is a technique which employs a hand-held instrument that selectively fragments and aspirates tissues of high-water content. The selectivity of the device permits preservation of underlying vital structures while the aspiration provides a tissue specimen for histologic analysis. Application of this device to neoplastic disease of the lower genital tract has been reported to provide durable success rates of 78% for conyloma acuminata and vulvar intraepithelial neoplasia (VIN) and 81% for vaginal intraepithelial neoplasia (VAIN).Employment of USA in patients with advanced ovarian cancer has been shown to improve surgical cytoreduction without increasing blood loss or complication rates.

Authors:

Robert McLellan, M.D.; Anne P. Shapter, M.D. - Lahey Hitchcock Medical Center, Burlington, Mass.

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Abstract:

At both laparoscopy and hysteroscopy, controlled movement of fluids is necessary. In addition, at laparoscopy, suctioning of accumulated smoke from lasers or electrosurgery is an essential venting technique to enhance visibility. This chapter will describe and discuss a unique, simple, cost-effective system that can be used for both hysteroscopy and laparoscopy to accomplish movement of fluids and management of smoke. Aquadissection or hydrodissection has been used for many years as an adjuvant to operative laparoscopy.' It has been found useful for operative laparoscopic treatment of conditions such as endometriosis, pelvic adhesions, and tubal obstructron. Most current systems are cumbersome, wastefully use large volumes of fluid, and often require a mechanical pump for pressurizing the fluid suction and irrigation systems. Usually, during combined laparoscopy and hysteroscopy, a separate system is used for accomplishing uterine distention when fluids are used for the hysteroscopic portion of surgery. The Pump Vac Plus can be used for both hysteroscopic distention and laparoscopic suction and irrigation. This article will describe our techniques for using the Pump Vac for both of these endoscopic approaches.

Authors:

James F. Daniell, M.D., F.A.C.O.G. - Vanderbilt University Medical Center, Nashville, Tenn.

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