Abstract:

Andometrial ablation is an excellent alternative to hysterectomy in women with menorrhagia and small intramural fibroids. Preoperative evaluation, which includes office hysteroscopy or saline infusion sonography, is critical to patient management and choice of procedure. A vast array of endometrial ablation technology is available currently that includes balloon therapy, cryosurgery hot circulating saline, bipolar impedance technology, and microwave: (1) ThermaChoice UTB System (Gynecare, Inc., Somerville, NJ, USA), (2) Uterine Balloon Therapy (UBT) System, HerOption Uterine Cryoblation Therapy System (American Medical Systems, Inc., Minnetonka, MN, USA), (3) Hydro ThermAblator HTA System (BEI Medical/ Boston Scientific, Natick, MA), (4) NovaSure System (Novacept, Palo Alto, CA, USA), and (5) Microsulis Microwave Endometrial Ablation (MEA) System (Microsulis Medical Ltd., Pompano Beach, FL, USA). Each method is described herein, and Summary of Safety and Effectiveness Data (SSED) data for each product are reviewed.

Authors:

Linda D. Bradley, M.D. - Department of Obstetrics and Gynecology, Cleveland Clinic, Cleveland, Ohio

For Direct IP Access please click this link

Abstract:

The Tension-free Vaginal Tape (TVT) procedure is the first of a new generation of minimally invasive operations for treatment of female urinary stress incontinence. A new theory of the cause of stress incontinence, the "Mid-urethra Theory," was the bases for development of the TVT operation. Systematic, prospective clinical trials have proved the TVT procedure is effective and safe in curing stress incontinence. Assessed by strict objective and subjective outcome measures, cure rates of 85% were reported, with another 5%-10% being improved significantly. The method is equally effective in groups of patients with uncomplicated genuine stress incontinence, recurrent incontinence, mixed incontinence, and those with intrinsic sphincter deficiency. Careful prospective registering of complications associated with the procedure indicate complication rates are low when proper training is provided and the operation is performed in its standardized method. Five years of follow up show a cure rate of 85%, which indicates little decline in cure rates by time. Preliminary analysis of seven-year results shows a cure rate of 81%.

Authors:

Carl Gustaf Nilsson, M.D., Ph.D. - Department of Obstetrics and Gynecology, Helsinki University Central Hospital, Helsinki, Finland

For Direct IP Access please click this link

Abstract:

Clinical and basic science research in endometriosis has been severely hampered by the lack of accurate noninvasive diagnostic tools. The advent of powerful genomic and proteomic technology may help elucidate the etiology and pathophysiology of this complex and enigmatic disease and open new avenues for diagnosis and treatment. Genomic techniques have demonstrated that certain gene products are abnormally expressed in endometriotic tissues.

Authors:

Arezou Azarani, Ph.D. - Protogen, Palo Alto, California; Joelle Osias , M.D. - Stanford University School of Medicine, Department of OB/Gyn, Palo Alto, California; Bulent Berker, M.D. - Stanford University Medical Center, Palo Alto, California; Ceana Nezhat, M.D., F.A.C.O.G., F.A.C.S. - Gynecology, Endocrinology, Endometriosis & Infertility, Nezhat Medical Center, Atlanta, Georgia; Camran Nezhat, M.D., F.A.C.O.G, F.A.C.S. - Stanford University Medical School, Stanford University, Center for Special Minimally Invasive Surgery, Palo Alto, California

For Direct IP Access please click this link