Abstract:

Experience in minimally invasive surgery has increased at a rapid pace, and previous abdominal surgery with adhesion formation is no longer considered a contraindication for laparoscopic surgery. Therefore, surgeons across all specialties should be well equipped to approach a reoperative abdomen with minimal complications and satisfactory patient outcomes. Previous abdominal scarring and adhesions present distinct challenges for surgeons performing minimally invasive surgery, and postsurgical adhesions are considered one of the main reasons for conversion from laparoscopy to laparotomy. In this review article, we present the influence of previous abdominal surgeries and pathogenesis of adhesion formation. Methods of laparoscopic entry and technical aspects of adhesiolysis to the ventral abdominal wall, intestinal, and pelvic adhesions are reviewed. Surgeons should have a keen sense of awareness of adhesion-related complications to reduce the morbidity of laparoscopic reoperations.

Authors:

Rebekah S. Kim, MD, Fellow in Colon and Rectal Surgery, Orlando Health, Colon and Rectal Clinic, Orlando, Florida, Francisco P. Itriago, MD, Fellow in Minimally Invasive Surgery, Orlando Health, Colon and Rectal Clinic, Orlando, Florida, James C. Rosser, Jr. MD, FACS, Professor of Surgery, Morehouse School of Medicine, Atlanta, Georgia, Jay A. Redan, MD, Associate Professor of Surgery, Director of Minimally Invasive Surgery Celebration Hospital, Florida Hospital, University of Central Florida, Celebration, Florida

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Abstract:

When ovarian preservation is desired, a minimally invasive laparoscopic surgical procedure using a "cross bag" technique is effective to consistently manage and remove ovarian cysts of concern. In addition to the standard preoperative preparation of patients, a bowel prep is critical, especially if the mass is large or the patient obese. Visualization of all internal structures is achieved using a multi-screen HD system and 5-mm laparoscope. Over 100 cases have been performed using the "cross bag" technique with no spillage of cysts.

Authors:

James Dana Kondrup, MD, FACOG, Assistant Clinical Professor of Obstetrics and Gynecology, Upstate Medical Center, Binghamton, New York Campus and Syracuse, New York, Becky Quick, BSN, CNOR, Laparoscopic Team Leader, Operating Room, Our Lady of Lourdes Memorial Hospital, Binghamton, New York, Fran Anderson, PhD, RN, Research Coordinator, Our Lady of Lourdes Memorial Hospital, Binghamton, New York

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Abstract:

Hysteroscopic endomyometrial resection (EMR) was first reported by this author in 1994.[1] Several refinements have been made through the years including the addition of sonographic guidance as well as its adaptation into an office-based environment. EMR has many outstanding benefits including its adaptability to a "see-and-treat" procedure appropriate to an office setting. Importantly, EMR has a very high rate of hysterectomy avoidance and provides a complete histologic specimen of the endometrium and superficial myometrium. Finally, EMR is a superior method of managing both resectoscopic and non-resectoscopic endometrial ablation failures.

Authors:

Morris Wortman, MD, FACOG, Director, Center for Menstrual Disorders, Clinical Associate Professor of Gynecology, University of Rochester Medical Center, Rochester, New York

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Abstract:

Vulvar cosmetic surgery is becoming an increasingly requested and performed surgical procedure in women. Though there are many beliefs as to the desires of the patient's postoperative expectations, scientific research is lacking. The current paper evaluates patients' preoperative perceptions and postoperative expectations of cosmetic vulvar surgery. This is a retrospective analysis of 550 patients who are considering labia minora reduction. Preoperative questionnaires that address patients' preoperative perceptions of their labia as well as their postoperative expectations were reviewed and analyzed. Mean age was 36 (range 12 to 65) and parity 1.52 (range 0 to 8). On examination, 99.5% (547/550) of patients had labia minora protruding beyond the distal edge of the majora. Patients' postoperative desires included: 97.8% preferred the labia minora to be "at" or "below" the level of the labia majora compared with 2.2% preferring it to be "at" or "just above" the labia majora; 96.9% preferred "pink" edges compared with 3.1% desiring "dark" edges. Women presenting for vulvar cosmetic surgery have preoperative perceptions and postoperative expectations that should be considered with regard to surgery. Understanding a patient's postoperative labiaplasty expectations should be considered prior to engaging in surgery. Doing so could possibly alter the surgeon's labiaplasty technique and reduce the need for subsequent revision surgeries.

Authors:

John R. Miklos, MD, Director of Urogynecology, Reconstructive & Cosmetic Vaginal Surgery, Atlanta Urogynecology Associates, Alpharetta, Georgia, Robert D. Moore, DO, Co-Director of Urogyencology, Reconstructive & Cosmetic Vaginal Surgery, Atlanta Urogynecology Associates, Alpharetta, Georgia

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Abstract:

Removing tissue using minimally invasive surgery (MIS) techniques is a work in progress. A review of existing technologies and techniques is presented along with potential pros and cons of these procedures. Existing data as well as new investigations into prospective avenues in the area of tissue removal at laparoscopy are presented.

Authors:

JThomas L. Lyons, MS, MD, FACOG, Director, Center for Women's Care and Reproductive Surgery, Atlanta, Georgia

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