Abstract:

Transcervical hysteroscopic permanent sterilization is currently Federal Drug Administration (FDA) approved. The hysteroscopic approach obviates the need for general anesthesia and surgical incision. The device is a dynamically expanding micro-insert that, when placed in the proximal portion of the fallopian tube, generates a benign tissue response that results in anchoring of the device and subsequent occlusion of the tube. The current trial of 745 women seeking birth control from Australia, Europe, and the United States were evaluated for successful micro-insert placement at three months. Comfort, safety, and return to normal activity were evaluated. All patients were followed for five years and returned for annual gynecologic status. Procedure time was 18 minutes; 92% returned to work in one day. There were no reported pregnancies among these patients in 27,526 months. The transcervical approach for sterilization represents ease of application, low morbidity, and convenience to the patient.

Authors:

Glenn M. Collins, M.D., F.A.C.O.G., Seth J. Herbst, M.D., F.A.C.O.G., Keith A. Aqua, M.D., F.A.C.O.G.

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Abstract:

Endometriosis is best treated by surgical excision. This can be accomplished either by excision of the endometriosis with reproductive tract preservation or by excision of endometriosis with hysterectomy. This latter approach eliminates endometriosis in the muscle of the uterus (where it is called adenomyosis) and is especially effective for pelvic pain. Ovarian preservation can be considered using hysterectomy if the surgeon excises most of the endometriosis. Techniques to excise endometriosis, including rectosigmoid disease, and perform hysterectomy are detailed in this chapter.

Authors:

Harry Reich, M.D., Jay A. Redan, M.D., F.A.C.S., Iris Kerin Orbuch, M.D

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Abstract:

In the mid-1990s, the authors introduced a minimally invasive system of cesarean delivery. This article illustrates the improvements made since the technique's initial publication. The Pelosi Minimalist Cesarean procedure is the simplest and least traumatic approach of cesarean delivery. The procedure described herein features a short operating time, minimal instrumentation, reduced surgical dissection, decreased postoperative pain, and reduced risk of blood loss, infection, and wound complications. It is easily learned and cost-effective, with a brief postoperative recovery period.

Authors:

Marco A. Pelosi, II, M.D., Marco A. Pelosi, III, M.D.

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Abstract:

In this study, laparoscopic hysterectomy was done with a special lift system that elevates the abdominal wall without carbon dioxide (CO2) insufflation. During this procedure, bipolar diathermy scissors also were used, which disconnected the uterus from its vessels and ligaments. The uterus was then removed through the vagina. In 403 cases, variables including operation time, complication rate, blood loss, postoperative pain, hospital stay, vaginal discharge, and convalescence time were examined. Compared with other laparoscopic methods [laparoscopic-assisted vaginal hysterectomy (LAVH), supracervical hysterectomy, and total laparoscopic hysterectomy], all those examined showed better results. Further advantages of the gasless Lift-laparoscopic total hysterectomy are lower costs and an effective "learning curve." Use of this method routinely could decrease the number of conventional-surgical hysterectomies that result in additional complications.

Authors:

Daniel Kruschinski, M.D., Shirli Homburg, Ph.D., Achim Wöckel, M.D., Anupam Kapur, M.D., Harry Reich, M.D.

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Abstract:

The authors' technique of minilaparotomy hysterotomy is a new modality that combines the technical benefits of conventional laparotomy with the minimally invasive convalescent and cosmetic advantages of laparoscopic surgery. For patients in whom vaginal hysterectomy is considered contraindicated, this procedure offers an effective and safe minimal access alternative. This redesigned minilaparotomy approach relies on traditional open techniques and experience instrumentation that avoid the cost of expensive equipment, long learning curve, and prolonged operating time associated with laparoscopic surgery, as well as the convalescent disadvantages of a standard laparotomy.

Authors:

Marco A. Pelosi, II, M.D., Marco A. Pelosi, III, M.D.

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Abstract:

An increasing number of adnexal masses are currently managed laparoscopically, which has hampered progress regarding the different techniques of laparoscopic surgery. In this chapter, a modified application of surgical instrument was described in laparoscopic ovarian cystectomy—we named this device, Lap-Disc Mini™. This new instrument has three rings, an inner flexible ring fixed to a middle ring by a rubber corset, and an additional dynamic outer ring that has a rubbery-like iris opening, which allows the application of different-sized trocars and extracorporeal ovarian cystectomy. This technique has proved to be effective and safe, especially in removing large ovarian cyst.

Authors:

Kenichino Ikuma, M.D., Magdy Amin, M.D., Yamada Yukio, M.D., Okuo Hisato, M.D., Ito Yoshihiro, M.D., Ueda Shintaro, M.D., Tanaka Masako, M.D., Koyasu Yasuki, M.D.

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Abstract:

This innovative sling system places the sling between the obturator foramens using a perineal approach while preserving an intact retropubic space. Potential complications associated with tension-free sling systems that use needle-carrier placement through the retropubic space, such as the tension-free vaginal tape (TVT™, Gynecare, Ethicon, Somerville, NJ, USA), are eliminated and routine cystoscopy is not required. The procedure is effective and safe for the primary treatment of stress urinary incontinence in patients with urethral hypermobility, intrinsic sphincter deficiency, or both. It is equally efficient in treatment of recurrent and mixed urinary incontinence. Short-term results are similar to those of the retropubic tension-free slings.

Authors:

Marco A. Pelosi, II, M.D., Marco A. Pelosi, III, M.D.

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