Abstract:

This study is a retrospective chart review comparing 195 women who underwent rectocele repair with either a porcine dermal xenograft or human allogenic cadaveric dermal graft augmentation over a two year period. A site-specific defect repair was completed prior to augmentation with the graft. Examinations were performed preoperatively and postoperatively using the pelvic organ prolapse quantification system. Questionnaires were used to assess constipation and dyspareunia. De novo dyspareunia and cure rates for constipation and dyspareunia were not statistically different between the two groups. Site-specific fascial rectocele repairs with xenograft or allograft augmentation were found to have similar complication rates as well as objective and subjective cure rates.

Authors:

Roger C. Biehl., M.D., Atlanta Urogynecology Associates, Atlanta, Georgia, USA, Robert D. Moore, D.O., Atlanta Urogynecology Associates, Atlanta, Georgia, USA, John R. Miklos, M.D., Atlanta Urogynecology Associates, Atlanta, Georgia, USA, Neeraj Kohli, M.D. Harvard Medical School, Boston, Massachusetts, USA, Indu S. Anand, M.D., Atlanta Urogynecology Associates, Atlanta, Georgia, USA, T. Fleming Mattox, M.D. Carolina Continence Center, Division of Urogynecology, Greenville, Georgia, USA

For Direct IP Access please click this link

Abstract:

The objective of this study was to assess the feasibility and safety of laparoscopic rectosigmoid anterior wall discoid resection for endometriosis using the circular stapler. A retrospective analysis was conducted of nine consecutive patients undergoing laparoscopic radical excision of pelvic endometriosis, including bowel anterior wall discoid excision, at the Fertility and Pelvic Surgery Clinic and private hospitals in São Paulo, Brazil. The selected intervention was a radical laparoscopic endometriosis resection, including rectosigmoid anterior wall excision with the circular stapler. For certain types of bowel endometriosis, the anterior wall discoid stapler excision proved a suitable option that diminishes the chances of serious complications such as bowel fistula or anastomosis dehiscence.

Authors:

Ricardo M.A. Pereira, M.D., Associate Professor, Obstetrics and Gynecology Department, Londrina State University, Londrina, Paraná, Brazil, Pelvic Surgery Department, Huntington Reproductive Medicine Centre, São Paulo, Brazil, Alysson Zanatta, M.D., Pelvic Surgery Department, Huntington Reproductive Medicine Centre, São Paulo, Brazil, Harry Reich, M.D., Advanced Gynecologic Laparoscopy Centre New York, New York, USA, Paulo H.M. Bianchi, M.D., Pelvic Surgery Department, Huntington Reproductive Medicine Centre, São Paulo, Brazil, Paula B. Fettback, M.D., Pelvic Surgery Department, Huntington Reproductive Medicine Centre, São Paulo, Brazil, Eduardo L.A. Motta, M.D., Director, Pelvic Surgery Department, Huntington Reproductive Medicine Centre, São Paulo, Brazil, Paulo C. Serafini, M.D., Director, Pelvic Surgery Department, Huntington Reproductive Medicine Centre São Paulo, Brazil

For Direct IP Access please click this link

Abstract:

The LAPMAN® (Medsys, Gembloux, BELGIUM) is a dynamic laparoscope holder guided by a joystick clipped onto the laparoscopic instruments under the index finger of the operator. It confers optimal control of the visual field while operating, ensures stable and smooth displacement of the laparoscope, and allows the operator to work in conditions of restricted surgical assistance, due to either unavailability of staff or economic constraints. It has been tested successfully in pilot studies in laparoscopic gynecologic surgery.

Authors:

Roland Polet, M.D., Consultant, Jaques Donnez, M.D., Ph.D., Professor, Department of Gynecology, Cliniques Universitaires Saint-Luc, Louvain-en-Woluwe, BELGIUM

For Direct IP Access please click this link

Abstract:

A61-year-old postmenopausal woman with ovarian carcinoma was treated with two surgical operations and a series of platinum-based chemotherapy. A solitary metastasis into the splenic parenchyma was identified 33 months after the second surgery by abdominal computed tomography with an increased serum level of CA-125. She underwent a pancreaticosplenectomy and received platinum-based adjuvant chemotherapy continuously for 2 years. Her serum CA-125 level decreased to a normal range and she has lived without any recurrence for more than 10 years after the splenectomy. Solitary metastases from ovarian cancer into the splenic parenchyma are extremely rare. Among 18 cases previously reported, this present case shows the longest disease-free survival. Because these cases show favorable prognosis after splenectomy, surgical treatment should be considered along with adjuvant chemotherapy.

Authors:

Ryuji Yoshioka, M.D., Chief Resident, Department of Surgery, Takehiro Okabayashi, M.D., Assistant Professor, Department of Surgery, Isao Nishimori, M.D., Assistant Professor, Department of Gastroenterology and Hepatology, Nagamasa Maeda, M.D., Associate Professor, Department of Gynecology, Takeki Sugimoto, M.D., Associate Professor, Department of Surgery, Takuhiro Kohsaki, M.D., Assistant Professor, Department of Gastroenterology and Hepatology, Saburo Onishi, M.D., Professor, Department of Gastroenterology and Hepatology, Takao Fukaya, M.D., Professor, Department of Gynecology, Michiya Kobayashi, M.D., Professor, Department of Clinical Health and Medical Services, Kazuhiro, Hanazaki, M.D., Professor, Department of Surgery, Kochi Medical School, Nankoku, Kochi, Japan

For Direct IP Access please click this link

Abstract:

Sacral colpopexy is the gold standard for vaginal vault suspension throughout the literature. The operation is considered to be invasive yet very effective. The laparoscopic approach to the sacral colpopexy is not only effective but can have minimal morbidity in the correct surgeon's hands. The authors have performed more than 500 sacral colpopexy via laparoscopy with minimal morbidity and thus share their technique with the reader.

Authors:

Robert D. Moore, D.O., Co-Director of Urogynecology & Reconstructive Pelvic Surgery, Atlanta Center for Laparoscopic Urogynecology, Atlanta Urogynecology Associates, Atlanta, GA, John R. Miklos, M.D., Co-Director of Urogynecology & Reconstructive Pelvic Surgery, Atlanta Center for Laparoscopic Urogynecology, Atlanta Urogynecology, Associates, Atlanta, GA

For Direct IP Access please click this link

Abstract:

Laparoscopic removal is widely accepted as the treatment of choice for dermoid tumors. However, the spillage of dermoid content with the laparoscopic approach is very high compared to laparotomy. The potential malignancy of dermoid tumors and the rare, but difficult to treat, chemical peritonitis in cases of spillage of dermoid content should lead to an adaptation of procedures during an endoscopic operation on a dermoid tumor to comply with the precautions of the "open" technique. Lift-laparoscopy combines laparoscopy with the standard procedures of laparotomy and thus may help reduce the spillage of dermoid contents. In a retrospective study of 108 patients with dermoid tumors, the frequency of the rupture of a dermoid tumor during a lift-laparoscopic operation was examined. Among the 79 cases of organ-preserving treatment, there were only three cases (3.8%) where a rupture of the dermoid capsule occurred. Even in cases of ruptures, it was possible to avoid spillage by closing the lesion with a clamp and continue the enucleation of the dermoid tumor during a lift-laparascopic operation. After thorough abdominal cavity lavage, none of these three cases showed a cytological contamination of the abdominal cavity with dermoid cells. None of the ovariectomy or adnexectomy cases showed a rupture. Histologically, there was also no carcinoma in any of the examined dermoid tumors. By adapting the endoscopic dermoid surgery to the precautions established in an open surgery technique using gasless lift-laparoscopy, ruptures and cell spilling can be avoided to a large extent but not completely excluded. Compared with other methods, the number of ruptures and spillage of dermoids by organ-preserving treatment as well as ovariectomy is lowest using a lift-laparoscopic procedure.

Authors:

Daniel Kruschinski, M.D., Medical Director, Endoscopic Gynecology Centers, Rotthalmünster, Germany, Shirli Homburg, Ph.D., Scientist, Endoscopic Gynecology Centers, Rotthalmünster, Germany, Swapnil Langde, M.D., Assistant Surgeon, Endoscopic Gynecology Centers, Rotthalmünster, Germany, Anupam Kapur, M.D., Assistant Surgeon, Endoscopic Gynecology Centers, Rotthalmünster, Germany

For Direct IP Access please click this link

Abstract:

With the advent of new technology, it is crucial to understand the mechanics of how instruments work to fully be able to utilize them and prevent injury. One of the cornerstones which makes laparoscopy possible is the use of vessel sealing instruments. Cutting, coagulation, and dissection are some paramount qualities of vessel sealing instruments; however, knowledge of the type of energy being used on tissue is of utmost importance. The various forms of energy vessel sealing instruments have advantages and disadvantages depending on the task. In the following text, monopolar, bipolar, and ultrasonic vessel sealing instruments for laparoscopic surgery are discussed at length. From how these instruments work to their cost, a detailed look at the available and most widely used laparoscopic vessel sealing instruments is reviewed. The accompanying illustrations are to aid in recognition and understanding of their use.

Authors:

Royshanda Smith, M.D., Clinical Fellow, Resad Pasic, M.D., Ph.D., Assistant Professor of Obstetrics and Gynecology, Department of OB/GYN and Women's health, University of Louisville, School of Medicine, Louisville, Kentucky, USA

For Direct IP Access please click this link