{"title":"Anesthesia concerns in laparoscopic myomectomy.","authors":"Manju Sinha, Sheetal Chiplonkar","doi":"10.4103/0974-1216.85274","DOIUrl":"https://doi.org/10.4103/0974-1216.85274","url":null,"abstract":"<p><p>Recent advances in the practice of anesthsiology ensure that we move closer to our goal of zero morbidity. It is of critical importance that we couple our clinical expertise with the sophisticated monitoring equipment and get the best out of them.</p>","PeriodicalId":89586,"journal":{"name":"Journal of gynecological endoscopy and surgery","volume":"2 1","pages":"18-20"},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4103/0974-1216.85274","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30524650","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Adhesion prevention in myomectomy.","authors":"Bhaskar Pal","doi":"10.4103/0974-1216.85275","DOIUrl":"https://doi.org/10.4103/0974-1216.85275","url":null,"abstract":"<p><p>Adhesions are abnormal fibrous connections, joining tissue surfaces in abnormal locations. Adhesions form after any trauma involving the peritoneum and the injured tissue surface or directly between the injured tissue surfaces. The ideal anti-adhesion agent should be safe, efficacious, easy to use in all types of surgery, and economical. It should prevent adhesions at the site of surgery as well as throughout the peritoneal cavity. Needless to say, the ideal agent is still elusive.</p>","PeriodicalId":89586,"journal":{"name":"Journal of gynecological endoscopy and surgery","volume":"2 1","pages":"21-4"},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4103/0974-1216.85275","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30524651","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Actionable 'deficiencies' in medical practice.","authors":"Gopinath N Shenoy","doi":"10.4103/0974-1216.85276","DOIUrl":"https://doi.org/10.4103/0974-1216.85276","url":null,"abstract":"<p><p>Services provided by healthcare providers have been the subject matter of judicial review time and again. The Consumer Disputes Redressal Commissions have laid down decisively what is and what is not 'deficiency' in the services provided by a healthcare provider. 'Deficiency' means, any fault, imperfection, shortcoming or inadequacy in the quality, nature, and manner of performance that is required to be maintained by or under any law for the time being in force or has been undertaken to be performed by a person in pursuance of a contract or otherwise, in relation to any service.</p>","PeriodicalId":89586,"journal":{"name":"Journal of gynecological endoscopy and surgery","volume":"2 1","pages":"25-9"},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4103/0974-1216.85276","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30522946","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Laparoscopic myomectomy with aquadissection and barbed sutures.","authors":"Rajesh Modi","doi":"10.4103/0974-1216.85283","DOIUrl":"https://doi.org/10.4103/0974-1216.85283","url":null,"abstract":"<p><p>The objective of this study was to evaluate the efficacy of aquadissection technique to reduce the blood loss in myomectomy and to assess the benefits and feasibility of the use of barbed suture for myometrial defect closure. Vasopressin is diluted with saline as 10 units of vasopressin for every 100 ml of saline. For a fibroid of about 8 cm size, 40 units of vasopressin is diluted in 400 ml of normal saline. The whole of 400 ml of this saline is injected in the myometrium. Incision is made on the uterus with just simple scissors (no energy source is required). As the uterus is cut, instead of bleeding, saline leakage takes place. This helps to keep the field clear and it is easier to get the correct plane between the fibroid and the myometrium. The separation of the fibroid is helped due to the dissection of the correct plane by the saline injection.</p>","PeriodicalId":89586,"journal":{"name":"Journal of gynecological endoscopy and surgery","volume":"2 1","pages":"47-52"},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4103/0974-1216.85283","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30522951","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Single-port access laparoscopic hysterectomy: a new dimension of minimally invasive surgery.","authors":"Mereu Liliana, Pontis Alessandro, Carri Giada, Mencaglia Luca","doi":"10.4103/0974-1216.85273","DOIUrl":"https://doi.org/10.4103/0974-1216.85273","url":null,"abstract":"<p><p>The fundamental idea is to have all of the laparoscopic working ports entering the abdominal wall through the same incision. Single-incision laparoscopic surgery is an alternative to conventional multiport laparoscopy. Single-access laparoscopy using a transumbilical port affords maximum cosmetic benefits because the surgical incision is hidden in the umbilicus and reduces morbidity of minimally invasive surgery. The advantages of single-access laparoscopic surgery may include less bleeding, infection, and hernia formation and better cosmetic outcome and less pain. The disadvantages and limitations include longer surgery time, difficulty in learning the technique, and the need for specialized instruments. This review summarizes the history of SPAL hysterectomy (single-port access laparoscopy), and emphasizes nomenclature, surgical technique, instrumentation, and perioperative outcomes. Specific gynecological applications of single-port hysterectomy to date are summarized. Using the PubMed database, the English-language literature was reviewed for the past 40 years. Keyword searches included scarless, scar free, single-port/trocar/incision, single-port access laparoscopic hysterectomy. Within the bibliography of selected references, additional sources were retrieved. The purpose of the present article was to review the development and current status of SPAL hysterectomy and highlight important advances associated with this innovative approach.</p>","PeriodicalId":89586,"journal":{"name":"Journal of gynecological endoscopy and surgery","volume":"2 1","pages":"11-7"},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4103/0974-1216.85273","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30524649","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Fibroids, infertility and laparoscopic myomectomy.","authors":"Pankaj Desai, Purvi Patel","doi":"10.4103/0974-1216.85280","DOIUrl":"https://doi.org/10.4103/0974-1216.85280","url":null,"abstract":"<p><strong>Objective: </strong>To review the literature and summarize the available evidence about the relationship of fibroids with infertility and to review the role of laparoscopic myomectomy in infertility.</p><p><strong>Materials and methods: </strong>Medline, PubMed, and Cochrane Databases were searched for articles published between 1980 and 2010.</p><p><strong>Results: </strong>Fertility outcomes are decreased in women with submucosal fibroids, and myomectomy is of value. Subserosal fibroids do not affect fertility outcomes, and removal may not confer benefit. Intramural fibroids appear to decrease fertility, but the results of therapy are unclear. Although pregnancy rates for women with leiomyomata, managed endoscopically, are similar to those after laparotomy, there is a risk of uterine rupture. The risk is essentially unknown. Finally, the risk of recurrence seems higher after laparoscopic myomectomy compared to laparotomy.</p><p><strong>Conclusions: </strong>Laparoscopic myomectomy, when performed by an experienced surgeon, can be considered a safe technique, with an extremely low failure rate and good results in terms of the outcome of pregnancy.</p>","PeriodicalId":89586,"journal":{"name":"Journal of gynecological endoscopy and surgery","volume":"2 1","pages":"36-42"},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4103/0974-1216.85280","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30522949","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Law demands \"care\" - not \"cure\".","authors":"Gopinath Shenoy","doi":"10.4103/0974-1216.71610","DOIUrl":"https://doi.org/10.4103/0974-1216.71610","url":null,"abstract":"<p><p>In today's medicolegal scenario specially related to endoscopic surgery, patient expects a miraculous result or a definite cure. However the author who has experience of both the fields i.e. gynecological endoscopy and medicolegal aspects, clears that the law doesn't expect a 100% cure but expects proper medical care by the concerned gynecologist, gynecological endoscopist. Patient also has to be informed about this important fact.</p>","PeriodicalId":89586,"journal":{"name":"Journal of gynecological endoscopy and surgery","volume":"1 2","pages":"71-2"},"PeriodicalIF":0.0,"publicationDate":"2009-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4103/0974-1216.71610","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30523126","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Hysteroscopy in postmenopausal bleeding.","authors":"Sunita Tandulwadkar, Prashant Deshmukh, Pooja Lodha, Bhavana Agarwal","doi":"10.4103/0974-1216.71614","DOIUrl":"10.4103/0974-1216.71614","url":null,"abstract":"<p><strong>Objectives: </strong>1) To study the etiology of postmenopausal bleeding (PMB). 2) To study the significance of hysteroscopy in evaluation of the etiopathogenic factors. 3) Correlating the diagnosis after transvaginal sonography (TVS), hysteroscopy and histopathologic diagnosis. 4) Feasibility of conservative management with hysteroscopy in PMB.</p><p><strong>Design: </strong>Prospective study from January 2008 to June 2009.</p><p><strong>Setting: </strong>Department of Obstetrics and Gynecology of Ruby Hall Clinic, Pune.</p><p><strong>Patients: </strong>Sixty postmenopausal women with complaint of bleeding per vaginum.</p><p><strong>Interventions: </strong>Clinical and sonographic evaluation, followed by diagnostic and/or therapeutic hysteroscopy and guided biopsy. Hysteroscopic images were analyzed and compared with histopathologic results.</p><p><strong>Measurements and main results: </strong>On hysteroscopy, endometrium was classified as suggestive of normal, atrophic, endometrial hyperplasia or endometrial carcinoma. Histopathologic diagnosis is taken as a gold standard to determine the efficacy of hysteroscopy in diagnosing endometrial pathologies. The sensitivity and specificity of hysteroscopy in diagnosing endometrial pathologies was assessed.</p><p><strong>Conclusions: </strong>In women with PMB, hysteroscopy is the basic tool that allows precise diagnosis of various endouterine pathologies. The average sensitivity of hysteroscopy was 97% in our study and the specificity was 98.66%. Hence, we can conclude that it is highly accurate for evaluating endometrial pathologies. For obvious benign lesions, it also provides treatment in the same sitting, therefore avoiding an extensive, morbid, and expensive procedure like hysterectomy.</p>","PeriodicalId":89586,"journal":{"name":"Journal of gynecological endoscopy and surgery","volume":"1 2","pages":"89-93"},"PeriodicalIF":0.0,"publicationDate":"2009-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3304274/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30524640","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Parasitic myoma after morcellation.","authors":"Rakesh Sinha, Meenakshi Sundaram, Smita Lakhotia, Pratima Kadam, Gayatri Rao, Chaitali Mahajan","doi":"10.4103/0974-1216.71612","DOIUrl":"https://doi.org/10.4103/0974-1216.71612","url":null,"abstract":"<p><p>We report an interesting case of parasitic fibroid which developed from a morcellation remnant following laparoscopic myomectomy. The patient presented with incidental finding of pelvic mass in 2005. She underwent laparoscopic myomectomy for a myoma extending from the Pouch of Douglas to both sides of broad ligament. She subsequently presented with abdominal pain 3 years later in 2008. She underwent total laparoscopic hysterectomy with removal of broad ligament fibroids. During her hysterectomy, a right lumbar mass attached to the omentum was detected, which was excised laparoscopically. Histopathology of the mass confirmed it to be consistent with leiomyoma. This mass could probably be a morcellation remnant that has grown to this size taking blood supply from the omentum. We report this case to emphasize that all tissue pieces that are morcellated should be diligently removed. Even small bits displaced into the upper abdomen can result in parasitic fibroids. Thus, it can be concluded that parasitic myomas can arise from morcellated remnants and grow depending on the blood supply.</p>","PeriodicalId":89586,"journal":{"name":"Journal of gynecological endoscopy and surgery","volume":"1 2","pages":"113-5"},"PeriodicalIF":0.0,"publicationDate":"2009-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4103/0974-1216.71612","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30524644","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Angioleiomyoma of broad ligament.","authors":"S Agarwal, S K Gupta, N Tejwani","doi":"10.4103/0974-1216.71609","DOIUrl":"https://doi.org/10.4103/0974-1216.71609","url":null,"abstract":"<p><p>Angioleiomyoma is an uncommon benign mesenchymal neoplasm that originates from smooth muscle cells and contains numerous thick-walled blood vessels. Here, we are presenting a case report of a huge broad ligament angioleiomyoma because of its rarity.</p>","PeriodicalId":89586,"journal":{"name":"Journal of gynecological endoscopy and surgery","volume":"1 2","pages":"116-7"},"PeriodicalIF":0.0,"publicationDate":"2009-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4103/0974-1216.71609","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30524645","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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