The Journal of the American Association of Gynecologic Laparoscopists最新文献

{"title":"New Helical Incision for Removal of Large Uteri during Laparoscopic-Assisted Vaginal Hysterectomy","authors":"Yue-Shan Lin M.D.","doi":"10.1016/S1074-3804(05)60086-2","DOIUrl":"10.1016/S1074-3804(05)60086-2","url":null,"abstract":"<div><p>The objective of our study was to evaluate the feasibility of a new incision technique for vaginal removal of large uteri during laparoscopic-assisted vaginal hysterectomy (LAVH). The helical uterine incision with uterine arteries preligation was performed during LAVH. The medical records for 522 women with uterine tumors who underwent LAVH from January 2001 through November 2003 were studied retrospectively. The mean uterine weight of all 522 patients was 325 ± 213 g (range 32–1350 g), and the mean operation duration was 73 ± 21 minutes. The patients were divided into three subgroups: patients with uteri weighing less than 300 g (group A), patients with uteri weighing between 300 and 500 g (group B), and patients with uteri weighing more than 500 g (group C). The mean uterine weight was 172 ± 69 g, 374 ± 56 g, and 678 ± 181 g for groups A, B, and C, respectively; and the mean operation duration was 67 ± 17 minutes, 73 ± 19 minutes, and 90 ± 24 minutes for groups A, B, and C, respectively. No linear relationship between uterine weight and operation duration was noted in the regression analysis and analysis of variance testing in group B. Uteri weighing between 300 and 500 g were extracted vaginally without difficultly using the new helical uterine incision technique. Use of the helical incision technique reduced operation duration, and restoration of the uterine anatomy for pathologic examination was made easily. The complication rate was 0.8%, which is relatively low compared with our previous report (1.38%) in 580 LAVH procedures. In conclusion, the helical transvaginal uterine incision proved to be an efficient and safe procedure for removal of large uteri during LAVH.</p></div>","PeriodicalId":79466,"journal":{"name":"The Journal of the American Association of Gynecologic Laparoscopists","volume":"11 4","pages":"Pages 519-524"},"PeriodicalIF":0.0,"publicationDate":"2004-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1074-3804(05)60086-2","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24949329","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative Study of Different Dosages of Goserelin in Size Reduction of Myomatous Uteri","authors":"Nilo Bozzini Ph.D. ,&nbsp;Marcos L. Messina Ph.D. ,&nbsp;Rodrigo Borsari M.D. ,&nbsp;Sandro G. Hilário M.D. ,&nbsp;José A. Pinotti Ph.D.","doi":"10.1016/S1074-3804(05)60075-8","DOIUrl":"10.1016/S1074-3804(05)60075-8","url":null,"abstract":"<div><h3>Study Objective</h3><p>To compare uterine size reduction obtained with three monthly subcutaneous injections of 3.6 mg of goserelin versus a single subcutaneous injection of 10.8 mg.</p></div><div><h3>Design</h3><p>Prospective, randomized clinical trial (Canadian Task Force classification I).</p></div><div><h3>Setting</h3><p>Department of Gynecology and Obstetrics at the Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo.</p></div><div><h3>Patients</h3><p>Forty-five premenopausal women with uterine leiomyomas and uterine size greater than 600 cm³ randomized to one of two groups.</p></div><div><h3>Intervention:</h3><p>Group A: 23 women received three monthly subcutaneous 3.6-mg doses of goserelin. Group B: 22 women received a single subcutaneous injection of 10.8 mg of goserelin. Follicle-stimulating hormone (FSH), estradiol, and hemoglobin levels were measured monthly. After 3 months, uterine size was determined by transvaginal and/or abdominal ultrasound.</p></div><div><h3>Measurements and Main Results</h3><p>In group A, mean reduction of uterine size was 43% (426 cm³) at the end of treatment. In Group B, mean reduction of uterine size was 54% (494 cm³). Serum levels of FSH and estradiol were in postmenopausal range during treatment. Hemoglobin level improvement was equivalent in both groups.</p></div><div><h3>Conclusion</h3><p>Use of single injection of 10.8 mg of goserelin promoted significantly greater reduction in uterine size than three monthly 3.6-mg injections in patients with voluminous uterine leiomyomas.</p></div>","PeriodicalId":79466,"journal":{"name":"The Journal of the American Association of Gynecologic Laparoscopists","volume":"11 4","pages":"Pages 462-463"},"PeriodicalIF":0.0,"publicationDate":"2004-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1074-3804(05)60075-8","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24948763","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hysterectomy after Endometrial Ablation-Resection","authors":"Rafael Comino Ph.D. ,&nbsp;Rafael Torrejón M.D.","doi":"10.1016/S1074-3804(05)60082-5","DOIUrl":"10.1016/S1074-3804(05)60082-5","url":null,"abstract":"<div><h3>Study Objective</h3><p>To evaluate the reasons for performing a hysterectomy in patients who had previously undergone endometrial ablation-resection (EA-R), after a follow-up of at least 6 years.</p></div><div><h3>Design</h3><p>Retrospective study (Canadian Task Force classification II-3).</p></div><div><h3>Setting</h3><p>University-affiliated hospital.</p></div><div><h3>Patients</h3><p>Eighty-nine premenopausal women who underwent EA-R from February 1991 through February 2003.</p></div><div><h3>Interventions</h3><p>Endometrial ablation-resection by electrocoagulation using a rollerball of the uterine fundus and tubal ostia zone, and electroresection using a cutting loop of the rest of the uterine cavity.</p></div><div><h3>Measurements and Main Results</h3><p>During a minimum follow-up period of 6 years, hysterectomy was performed in 16 of 89 (17.97%) patients. In eight (9%) patients, hysterectomy was performed exclusively because of the failure of EA-R. The only factor that was related significantly to the increased possibility of requiring subsequent hysterectomy was the existence of myomas.</p></div><div><h3>Conclusion</h3><p>After long-term follow-up (more than 5 years), approximately one out of every five women who undergo EA-R will require a hysterectomy. The majority of these will be required during the first 2 years following EA-R. The existence of uterine myomas at the time of EA-R can be considered a risk factor for the subsequent need for hysterectomy.</p></div>","PeriodicalId":79466,"journal":{"name":"The Journal of the American Association of Gynecologic Laparoscopists","volume":"11 4","pages":"Pages 495-499"},"PeriodicalIF":0.0,"publicationDate":"2004-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1074-3804(05)60082-5","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24949325","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does a Minimally Invasive Surgery Fellowship Impact Surgical Experience Among Gynecology Residents?","authors":"Jon I. Einarsson M.D. ,&nbsp;Audra Timmins M.D. ,&nbsp;Amy E. Young M.D. ,&nbsp;Robert K. Zurawin M.D.","doi":"10.1016/S1074-3804(05)60076-X","DOIUrl":"10.1016/S1074-3804(05)60076-X","url":null,"abstract":"<div><h3>Study Objective</h3><p>To examine the impact of a minimally invasive surgery (MIS) fellowship on resident experience and to survey the general attitude toward effects of fellowship programs on resident education.</p></div><div><h3>Design</h3><p>Survey (Canadian Task Force classification III).</p></div><div><h3>Setting</h3><p>An accredited obstetrics and gynecology program in the United States.</p></div><div><h3>Subjects</h3><p>Obstetrics and gynecology residents.</p></div><div><h3>Intervention</h3><p>Residents received a survey regarding the potential impact of a MIS surgery fellowship on resident experience.</p></div><div><h3>Measurements and Main Results</h3><p>One-year after creation of a MIS fellowship at our institution, we conducted an anonymous survey among residents. We also compared total number of surgical procedures and laparoscopic procedures performed before and after the fellowship commenced. We had a response rate of 70%. The overall impact of the newly established fellowship was regarded as positive. The median approval rating of endoscopic training before and after institution of the fellowship was 3.0 and 4.0, respectively (p &lt;.001). There were no statistically significant changes in caseload between the two periods.</p></div><div><h3>Conclusion</h3><p>A fellowship in MIS at an academic institution does not detract from resident experience in gynecologic surgery, with most residents viewing the fellowship positively.</p></div>","PeriodicalId":79466,"journal":{"name":"The Journal of the American Association of Gynecologic Laparoscopists","volume":"11 4","pages":"Pages 464-466"},"PeriodicalIF":0.0,"publicationDate":"2004-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1074-3804(05)60076-X","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25124317","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical Technology in Obstetrics and Gynecology","authors":"Ronald L. Levine M.D.","doi":"10.1016/S1074-3804(05)60090-4","DOIUrl":"10.1016/S1074-3804(05)60090-4","url":null,"abstract":"","PeriodicalId":79466,"journal":{"name":"The Journal of the American Association of Gynecologic Laparoscopists","volume":"11 4","pages":"Page 543"},"PeriodicalIF":0.0,"publicationDate":"2004-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1074-3804(05)60090-4","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"111836874","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Put Your Money Where Your Mouth Is","authors":"William H. Parker M.D","doi":"10.1016/S1074-3804(05)60070-9","DOIUrl":"10.1016/S1074-3804(05)60070-9","url":null,"abstract":"","PeriodicalId":79466,"journal":{"name":"The Journal of the American Association of Gynecologic Laparoscopists","volume":"11 4","pages":"Pages 443-444"},"PeriodicalIF":0.0,"publicationDate":"2004-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1074-3804(05)60070-9","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24948757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Retroperitoneal Hematoma after a Rectus Sheath Block","authors":"Pong Mo Yuen M.D. ,&nbsp;Pui Shan Ng M.D.","doi":"10.1016/S1074-3804(05)60072-2","DOIUrl":"10.1016/S1074-3804(05)60072-2","url":null,"abstract":"","PeriodicalId":79466,"journal":{"name":"The Journal of the American Association of Gynecologic Laparoscopists","volume":"11 4","pages":"Page 448"},"PeriodicalIF":0.0,"publicationDate":"2004-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1074-3804(05)60072-2","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24948760","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trocar-Assisted Sling Suspension for Stress Urinary Incontinence: Three-Year Follow-up","authors":"Chyi-Long Lee M.D. ,&nbsp;Chih-Feng Yen M.D. ,&nbsp;Chin-Jung Wang M.D. ,&nbsp;Pei-Shan Lee B.S.C. ,&nbsp;Hsiao-Chen Chiu M.D.","doi":"10.1016/S1074-3804(05)60087-4","DOIUrl":"10.1016/S1074-3804(05)60087-4","url":null,"abstract":"<div><h3>Study Objective</h3><p>To evaluate 3-year outcomes of trocar-assisted sling suspension (TASS) for genuine stress incontinence.</p></div><div><h3>Design</h3><p>Retrospective review (Canadian Task Force classification II-2).</p></div><div><h3>Setting</h3><p>University-based, tertiary-level center for endoscopic surgery.</p></div><div><h3>Patients</h3><p>One hundred forty women with genuine stress incontinence with bladder neck hypermobility.</p></div><div><h3>Intervention</h3><p>After standard surgery preparation and general endotracheal anesthesia, TASS was performed. The periurethral space and thicker parts of the pubocervical fascia were opened from the vagina. A 0.5-cm incision was made on both sides of the lower abdomen and was measured 4-cm lateral to the linea album and 2–3-cm above the pubic bone. A trocar was used to penetrate the incision site to the space of Retzius. A 2-cm × 30-cm folded polypropylene mesh was placed inside the vagina and was then pulled out of the trocar sheath by a laparoscopic forceps.</p></div><div><h3>Measurements and Main Results</h3><p>All patients completed the procedures without exception. The average blood loss was less than 50 mL (range 10–200 mL). The operative time ranged from 20 to 90 minutes with a mean time of 32 ± 12 minutes. Eleven patients had voiding difficulty. Six of them voided well after intermittent self-catheterization performed 28 days postoperatively. Seven patients had poor healing of the anterior vaginal wall; therefore, removal of mesh and wound repair were performed. One patient suffered from a retroperitoneal hematoma, and one patient had an intraoperative bladder injury. The overall complication rate was 14.3%. During 12–36 months of follow-up, 134 of 140 patients (95.7%) were satisfied with the surgery.</p></div><div><h3>Conclusions</h3><p>Based on the results of our pilot study, TASS is quite feasible as a method of treatment for stress urinary incontinence. The surgery is not difficult to perform when compared with Burch colposuspension. Moreover, it encompasses the simplicity and effectiveness of tension-free vaginal tape surgery. In addition, TASS also can correct lateral wall defects such as cystocele.</p></div>","PeriodicalId":79466,"journal":{"name":"The Journal of the American Association of Gynecologic Laparoscopists","volume":"11 4","pages":"Pages 525-529"},"PeriodicalIF":0.0,"publicationDate":"2004-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1074-3804(05)60087-4","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24949269","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chronic Pelvic Pain","authors":"Kenneth A. Levey M.D., M.P.H.","doi":"10.1016/S1074-3804(05)60094-1","DOIUrl":"10.1016/S1074-3804(05)60094-1","url":null,"abstract":"","PeriodicalId":79466,"journal":{"name":"The Journal of the American Association of Gynecologic Laparoscopists","volume":"11 4","pages":"Page 546"},"PeriodicalIF":0.0,"publicationDate":"2004-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1074-3804(05)60094-1","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24949272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Detection of Nonpigmented Endometriotic Lesions with 5-Aminolevulinic Acid-Induced Fluorescence","authors":"Dr. Olaf Buchweitz M.D. ,&nbsp;Dr. Pia Wülfing M.D. ,&nbsp;Dr. Anette Staebler M.D. ,&nbsp;Dr. Ludwig Kiesel M.D.","doi":"10.1016/S1074-3804(05)60084-9","DOIUrl":"10.1016/S1074-3804(05)60084-9","url":null,"abstract":"<div><h3>Study Objective</h3><p>To evaluate the feasibility of fluorescence diagnosis of nonpigmented (red and white) endometriotic lesions with 20 mg/kg of 5-aminolevulinc acid (5-ALA) 5–7 and 10–14 hours before surgery.</p></div><div><h3>Design</h3><p>Prospective analysis (Canadian Task Force classification II-2).</p></div><div><h3>Setting</h3><p>University hospital.</p></div><div><h3>Patients</h3><p>Twenty-four consecutive patients with suspected endometriosis undergoing laparoscopy.</p></div><div><h3>Intervention</h3><p>Laparoscopic surgery under white light illumination and fluorescence diagnosis.</p></div><div><h3>Measurements and Main Results</h3><p>The total number of endometriotic lesions detected under white light illumination was compared with the number of lesions detected with fluorescence diagnosis. Fluorescence diagnosis yielded an overall improvement of 35% in the detection of nonpigmented endometriotic lesions compared with white light illumination. Sensitivity (91%) and specificity (79%) were similar 5–7 and 10–14 hours before surgery.</p></div><div><h3>Conclusion</h3><p>The dosage of 20 mg/kg body weight of 5-ALA is feasible for fluorescence diagnosis of nonpigmented endometriosis. Sensitivity of fluorescence diagnosis with 20 mg/kg is similar to that achieved with a 30-mg/kg dose. Sensitivity does not change within the application period 5–7 and 10–14 hours before surgery.</p></div>","PeriodicalId":79466,"journal":{"name":"The Journal of the American Association of Gynecologic Laparoscopists","volume":"11 4","pages":"Pages 505-510"},"PeriodicalIF":0.0,"publicationDate":"2004-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1074-3804(05)60084-9","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24949327","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}