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SURGICAL TECHNOLOGY INTERNATIONAL IV.
$175.00
STI IV contains 65 articles with color illustrations.
Universal Medical Press, Inc.
San Francisco, 1995, ISBN: 0-9643425-2-9
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Gynecology
Hysteroscopy: Techniques, Technology, and Controversies
Thierry G. Vancaillie, M.D., Center for Gynecologic Endosurgery, San Antonio, TX
Hysteroscopy is a procedure with a century-long history, yet it may be said that few gynecologists actually have a hysteroscopy set-up in their office. At the same time, however, it would be surprising to find a urologist’s office devoid of cystoscopy equipment.
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Hysterosscopic Myometrial Biopsy to Diagnose Adenomyosis and Its Clinical Application
Arthur M. McCausland, M.D., F.A.C.O.G., Sutter Medical Group-Sutter Community Hospital, The University of California Medical School at Davis, Sacramento, CA
With the advent of hysteroscopy, the diagnosis of intrauterine pathology has greatly improved. Endometrial polyps and submucous fibroids are easily visualized; however, normal appearing cavities have been reported in over 50% of patients with menorrhagia.1 For this reason a myometrial biopsy was originally developed to see what percentage of these patients with a hysteroscopically normal-appearing cavity might have adenomyosis.1 The myometrial biopsy was taken from the posterior endometrial wall with a 5-mm loop electrode at the time of operative hysteroscopy. The specimen was sent to two pathologists, Dr. Anthony Mathios and Dr. John Abele, to see if adenomyosis could be diagnosed. It was found that with proper orientation, the amount of endometrial penetration into the myometrium could be measured. Therefore, superficial and deep adenomyosis can be diagnosed with a myometrial biopsy. But for a single myometrial biopsy to have any clinical relevance, two questions must be answered. First, does a single myometrial biopsy showing adenomyosis represent the entire endometrial cavity? Second, does the deepest adenomyosis occur in any certain area of the myometrial wall?
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Hysteroscopic Vaginoscopy in the Diagnosis of Vaginal Bleeding
Tamas Major, M.D., György Bacsko, M.D., Ph.D., Laszlo Lampe, M.D., D.Sc., Antal Borsos, M.D., D.Sc. University Medical School of Debrecen, Debrecen, Hungary
A complete gynecological examination of young children and senile patients requires special considerations and techniques. Due to the intact hymenal ring or the very narrow, atrophic vagina, the routinely used instruments, specula, will not allow sufficient visualization. To establish exact diagnosis and apply adequate therapy, proper examination of the vagina is required. For this purpose Huffman–Huber or Cameron–Muller equipment is traditionally used (Fig. 1). A modified Foley catheter was used by Redman,1 further improving the obtained picture, and the application of a balloon vaginoscope has been described by Terruhn.2 In spite of all these developments, examinations frequently turn out to be difficult due to insufficient vaginal wall distension and bleeding. Based on our previous experience,3 we describe a modified vaginoscopy, using hysteroscope and continuous liquid irrigation.
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Laparoscopic Surgery for Colpopoiesis with the Pelvic Peritoneum: First Report in Japan
Kenichiro Ikuma, M.D., Shuichi Ohashi, M.D., Takarazuka City Hospital, Takarazuka, Hyogo, Japan
Several methods have been developed for colpopoiesis in patients with vaginal agenesis. Nonetheless, various problems remain, including technical difficulty, invasiveness, operative stress, and poor cosmetic results, as well as the insufficient naturalness of the vagina itself. We have successfully completed colpopoiesis using the pelvic peritoneum in a laparoscopic surgery for Rokitansky-Küster-Hauser syndrome (RKH).
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Laparoscopic Myomectomy Using Ultrasonic Dissection
Charles E. Miller, M.D., F.A.C.O.G., Mary Johnston, R.N., The Center for Human Reproduction, Schaumburg, IL
Laparoscopic myomectomy is gaining in popularity as a means of treating leiomyoma uteri, avoiding hysterectomy, and thereby preserving or restoring fertility, when compared with traditional laparotomic surgery. While technically demanding, a laparoscopic procedure has advantages beneficial to the patient; these include decreased postoperative pain and discomfort, decreased length of stay and cost, and more rapid return to full activity. The disadvantages of laparoscopic myomectomy include increased operative time, inability to palpate the uterus at myomectomy, and the requirement of advanced technical skills. We report on our experience with laparoscopic myomectomy for treatment of infertility, habitual abortion, or to treat symptomatic myomata while preserving fertility.
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Laparoscopic Surgery for Gynecologic Cancer
Camran Nezhat, M.D., F.A.C.S., F.A.C.O.G., Daniel S. Seidman, M.D., Stanford University School of Medicine, Stanford CA; Farr Nezhat, M.D., F.A.C.S., F.A.C.O.G., Ceana H. Nezhat, M.D., F.A.C.O.G., Stanford University School of Medicine Stanford, CA, Center for Pelvic Surgery, Atlanta, GA, and Palo Alto, CA
Operative laparoscopy is an alternative to laparotomy for most gynecologic surgical procedures, but its role in gynecologic oncology has been considered only recently. Laparoscopy has been applied to gynecologic cancer with good results. Advantages include better visualization of the abdominal cavity and more rapid recovery, allowing earlier initiation of either chemotherapy or radiotherapy. Concerns include the risk for dissemination of neoplastic disease if less radical surgery is performed. With improvements in technology and advanced clinical experience, laparoscopic radical surgery can be performed with adequate tissue margins, conforming to accepted guidelines. Further, studies have shown that the yield of pelvic nodes significantly increases with experience. The danger of abdominal wall tumor implantation after laparoscopy for malignant conditions should be considered, but is infrequent. Careful techniques and the use of a laparoscopic pouch can prevent peritoneal dissemination and protect the abdominal wall. By cooperating closely, the surgical team and oncologists can offer the cancer patient optimal management with the lower morbidity and rapid recovery associated with laparoscopic surgery. However, follow-up studies are needed to determine the long-term survival following operative laparoscopy.
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Initial Experience with a Bipolar Coagulating/Cutting Forceps
Michael R. Seitzinger, M.D., Community Health Network, Berlin Memorial Hospital, Berlin, WI
Bipolar coagulation has long been a safe and effective method of achieving surgical hemostasis. With the advent of laparoscopic procedures, the safety of bipolar coagulation has become even more vital. Unfortunately, the inability of this technology to divide tissue safely has limited its use. For the last 18 months, a new bipolar coagulating/cutting forceps has been evaluated. Its overall benefit has been its ease of use and a reduction in operating time and cost.
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Laparoscopic Ovarian Cautery for Polycystic Ovarian Syndrome
Ellen M. Greenblatt, M.D., F.R.C.S.C., The Toronto Hospital, Ontario, Canada
Approximately 15% of all couples suffer from infertility, and in 10% of cases, anovulation or oligoovulation is a factor. One of the most common clinical syndromes in which anovulation occurs, often presenting as infertility, is the polycystic ovary syndrome (PCOS).
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