Management of adnexal cystic masses with unexpected intracystic vegetations detected during laparoscopy.

Study Objective: To evaluate a prospective series of consecutive patients with unexpected intracystic vegetations detected during operative laparoscopy for adnexal masses.

Design: Prospective series of consecutive patients (Canadian Task Force classification: II-2).

Setting: Tertiary care university hospitals.

Laparoscopic excision of adnexal masses.

Study Objective: The purpose of the present study was to evaluate a prospective series of consecutive patients with adnexal masses selected with strict preoperative clinical and ultrasonographic criteria.

Design: Prospective series of consecutive patients (Canadian Task Force classification II-2).

Setting: Tertiary care university hospitals.

Salpingoscopy.

Purpose Of Review: Salpingoscopy is an endoscopic technique that allows direct evaluation of the ampullary tubal mucosa at the time of laparoscopy. It has been reported that the presence of ampullary mucosal adhesions can negatively affect reproductive outcome and increase the risk of ectopic tubal pregnancy. Various studies have suggested that the extent of intra-luminal adhesions may not correlate with the nature and extent of periadnexal adhesions.

Current practical application of office endoscopy.

Outpatient hysteroscopy has shown good correlation of findings compared with inpatient hysteroscopy, but one limitation is pain and discomfort in some women, and vasovagal reaction. Various forms of local anaesthesia have been evaluated in the past year, with controversial results, and a narrow 3.5 mm sheath hysteroscope has been introduced.

Fallopian tube disease: the cobblestone pattern as a radiographic sign.

Purpose: To identify radiographic signs of mucosal damage by comparing hysterosalpingography with salpingoscopy in a prospective study.

Materials And Methods: Forty-one candidates for laparoscopy underwent hysterosalpingography and peroperative salpingoscopy; at both, tubal patency was noted. Radiographic criteria for mucosal abnormality were rounded filling defects (ie, the cobblestone pattern) and the absence of longitudinal radiolucent bands in the ampullary tract.

Improvement of hysterosalpingographic accuracy in the diagnosis of peritubal adhesions.

Objective: Our purpose was to compare hysterosalpingography with laparoscopy in the diagnosis of peritubal adhesions and to verify whether a combination of radiographic signs improves hysterosalpingographic accuracy.

Subjects And Methods: Thirty candidates for laparoscopy underwent hysterosalpingography before surgery. Two radiologists evaluated the presence or absence and types of radiographic signs of peritubal adhesions (convoluted tubes, vertical tubes, loculation of contrast medium in peritoneum, halo effect, and fixed laterodeviation of the uterus) using two different criteria for normality or abnormality: no sign means a normal result, one or more signs mean an abnormal result (first criterion); no sign or one sign means a normal result, two or more signs mean an abnormal result (second criterion).

Postoperative administration of monophasic combined oral contraceptives after laparoscopic treatment of ovarian endometriomas: a prospective, randomized trial.

Objective: We sought to evaluate the efficacy of postoperative administration of monophasic, combined, low-dose oral contraceptives on endometrioma recurrence and on persistence-recurrence of associated pain symptoms after laparoscopic treatment of moderate-to-severe endometriosis.

Study Design: In a prospective, randomized trial 70 patients who were not attempting to conceive, aged 20 to 35 years, underwent laparoscopic excision of ovarian endometriomas, followed by either postoperative administration of low-dose cyclic oral contraceptives for 6 months or no treatment on the basis of a computer-generated sequence. At 3 and 6 months after surgery and then at 6-month intervals, both groups underwent ultrasonographic examination for possible evidence of endometrioma recurrence and for evaluation of the absence, persistence, or recurrence of pain symptoms.

Stress responses to endoscopic surgery.

Growing evidence in the literature suggests that laparoscopic surgery should be performed instead of laparotomy for the treatment of pelvic benign diseases whenever feasible, as it results in a lower stress response on the part of the patient and possibly a shorter recovery time.

The prognostic role of salpingoscopy in laparoscopic tubal surgery.

The present study was designed to evaluate the prognostic value of salpingoscopy in patients undergoing tubal laparoscopic surgery for infertility due to periadnexal adhesion or distal tubal occlusion. In addition, the clinical value of salpingoscopy was compared with a current classification system of adnexal adhesions and distal tubal occlusion. A total of 51 patients with either adnexal adhesions (24 patients) or hydrosalpinx (27 patients) were prospectively evaluated.

Operative laparoscopy.

Operative laparoscopy has replaced the conventional approach by laparotomy to the treatment of most benign gynecological diseases (benign adnexal cysts, ectopic pregnancy, tubal infertility, polycystic ovarian disease, endometriosis, myomas), with advantages in terms of shorter hospital stay, less discomfort and complications for the patient, minor social costs due to the early resumption of normal working activities, and comparable results in terms of reproductive outcome.

Endometriosis externa and interna: endoscopic diagnosis.

Endometriosis is defined as the presence of the endometrium outside the endometrial cavity. If the ectopic mucosa is located within the endometrium, the disease is defined as endometriosis interna, or adenomyosis, whereas the localization of the endometrium outside the uterus is defined as endometriosis externa, or pelvic endometriosis. The diagnosis of pelvic endometriosis requires invasive techniques, such as laparoscopy or laparotomy, with histologic confirmation on the surgical specimen.

Tubal factor infertility.

Various studies demonstrated that there is no close correlation between the intratubal damage and the extent and type of pelvic adhesions. Moreover, the results of prospective studies on the prognostic value of salpingoscopy showed that the tubal mucosal status is the most important prognostic factor in terms of reproductive outcome. Salpingoscopy has modified the management of patients with tubal infertility, since the accurate evaluation of the tubal mucosa permits the selection of patients with a normal mucosa (34-42% of the patients with hydrosalpinx and 76-80% of those with periadnexal adhesions) who can benefit from tubal reconstructive surgery.

Laparoscopically assisted vaginal hysterectomy versus total abdominal hysterectomy: a prospective, randomized, multicenter study.

Objective: The objective of this study was to evaluate short-term results of laparoscopically assisted vaginal hysterectomy with those of total abdominal hysterectomy in a prospective, randomized, multicenter study.

Study Design: One hundred sixteen patients referred for abdominal hysterectomy were randomized to either laparoscopically assisted vaginal hysterectomy (58 patients) or abdominal hysterectomy (58 patients). Inclusion criteria were one or more of the following, where a vaginal hysterectomy would be traditionally contraindicated: uterine size larger than 280 g, previous pelvic surgery, history of pelvic inflammatory disease, moderate or severe endometriosis, concomitant adnexal masses or indication for adnexectomy, and nulliparity with lack of uterine descent and limited vaginal access.

Postoperative adhesion formation and reproductive outcome using Interceed after ovarian surgery: a randomized trial in the rabbit model.

The efficacy of an oxidized regenerated cellulose barrier (Interceed) in reducing postoperative adhesion formation and improving reproductive outcome after ovarian surgery was evaluated in a prospective randomized trial. Twenty-nine New Zealand White female rabbits were submitted to a mid-line laparotomy and a standardized surgical incision was made on both ovaries. At random, one ovary was entirely wrapped in a sheet of Interceed, whereas the contralateral ovary was left uncovered.

Correlation between endometriosis-associated dysmenorrhea and the presence of typical or atypical lesions.

Objective: To evaluate the correlation between the severity of endometriosis-associated dysmenorrhea and the extent of the disease assessed both with a current classification system and with the number and type of endometriosis lesions.

Design: Prospective, blinded study.

Setting: Tertiary care, university hospital.

Endometriosis-Associated Dysmenorrhea Is Not Related to Typical or Atypical Peritoneal Implants.

From April 1, 1995, to December 31, 1995, 45 patients undergoing diagnostic or operative laparoscopy for infertility, pelvic pain, or both, were found to have endometriosis. No woman had undergone any preoperative medical or surgical treatment for the disease. Preoperatively they answered a questionnaire, including a visual analog scale (VAS) to evaluate their associated symptoms.

Operative laparoscopy for ovarian cysts. Excision vs. aspiration.

Objective: To evaluate operative laparoscopy for excision vs. aspiration of ovarian cysts.

Study Design: From July 1, 1990, to June 30, 1993, 100 women under 40 years of age were subjected by the senior author to laparoscopic cyst excision, and 31 patients with similar characteristics underwent laparoscopic cyst aspiration by their attending physicians.

Laparoscopy versus microsurgery by laparotomy for excision of ovarian cysts in patients with moderate or severe endometriosis.

Study Objective: To compare the efficacy of laparoscopy versus microsurgery by laparotomy in the treatment of ovarian endometriomas.

Design: Retrospective study with historical controls.

Setting: A tertiary university hospital.

The prognostic significance of minimal intracystic vegetations during operative laparoscopy for adnexal masses in women of reproductive age.

Study Objective: To evaluate the prognostic significance of minimal intracystic vegetations in ovarian cysts approached by laparoscopy.

Design: Prospective study.

Setting: A tertiary care university hospital.

Laparoscopically assisted vaginal hysterectomy as an alternative to abdominal hysterectomy. A pilot study.

Laparoscopically assisted vaginal hysterectomy (LAVH) allows for conversion of some abdominal hysterectomies to a vaginal route. LAVH may be particularly useful when adnexectomy is indicated. In this study the authors evaluate the results obtained in a series of 21 patients prospectively selected for LAVH.

Use of fibrin sealant for reproductive surgery: a randomized study in the rabbit model.

The present study was undertaken to compare adhesion formation and reproductive outcome after reproductive surgery with or without the application of fibrin sealant. At laparotomy, the ovaries and uterine horns of 20 rabbits were longitudinally incised on the antimesenteric side using a monopolar microneedle. At random, one ovary and the ipsilateral uterine horn were covered with fibrin sealant, while those on the contralateral side were left uncovered without application of sutures.

Laparoscopic findings after transvaginal ultrasound-guided aspiration of ovarian endometriomas.

From 1 July 1990 to 31 January 1994, 55 patients underwent operative laparoscopy for the excision of monolateral endometriomas. None of the patients had previously undergone surgery by laparotomy or laparoscopy. At the time of laparoscopy, the surgeon staged the disease according to the American Fertility Society classification of endometriosis.

Correlation between the American Fertility Society classifications of adnexal adhesions and distal tubal occlusion, salpingoscopy, and reproductive outcome in tubal surgery.

Objective: To compare the prognostic value of salpingoscopy with a current classification system of adnexal adhesions and distal tubal occlusion in patients with tubal infertility undergoing reconstructive tubal surgery.

Design: Prospective clinical study.

Setting: Department of Obstetrics and Gynecology of the Catholic University, a tertiary care University Center in Rome, Italy.