On the Shoulders of Giants Through the Lens of the Laparoscope Dr. Harry Reich: Empathy, Optics and Courage.

Harry Reich, MD, FACOG, FRCOG, FACS is known worldwide as a pioneer in the field of laparoscopic surgery. He performed the first laparoscopic hysterectomy, the first pelvic lymphadenectomy for cancer, and the first excision of cul-de-sac endometriosis that included rectal resection. This article explores his life and contributions.

Resectoscopic Surgery Part III: Advanced Resectoscopic Surgery.

In this final section of our three-part series, we will apply the basic and intermediate skills described in the first two parts to advance the gynecologist's skills to accomplish the most demanding of resectoscopic surgical challenges. In Part I of this series, we reviewed the benefits of the continuous flow gynecologic resectoscope (CFGR) and how the motivated gynecologist can assemble an operative team and overcome the impediments to learning the use of this versatile and minimally invasive instrument. In this first section, we outlined and analyzed basic resectoscopic surgery-endometrial ablation, the resection of small submucous myomas and endometrial polyps, as well as the treatment of mild Asherman's syndrome and the removal of retained products of conception.

Resectoscopic Surgery Part II: Introducing Ultrasound Guidance for Intermediate-Level Surgical Procedures.

In Part I of this three-part series, the author reviewed the importance of resectoscopic surgery and the many advantages it provides to the patient and to the minimally invasive gynecologic surgeon. In Part I, we reviewed the obstacles to mastering this 30-year-old technology and how the motivated surgeon can overcome them. Although many basic resectoscopic procedures have been supplanted by global endometrial ablation (GEA) devices and hysteroscopic morcellators (HMs), the limitations of these restrictive technologies are quickly evident as the surgeon encounters increasingly complex and demanding cases.

Office-Based Gynecologic Surgery (OBGS): Past, Present, and Future: Part II.

Office-based gynecologic surgery (OBGS) has become an integral part of modern practice. The technological achievements of the past few decades have dramatically improved our ability to diagnose and treat a variety of common issues that affect fertility and menstruation. Procedures that once required the complex milieu of a hospital or outpatient setting-diagnostic hysteroscopy, endometrial ablation, hysteroscopic polypectomy, and myomectomy-are now well within the reach of motivated and well-trained practitioners.

Office-Based Gynecologic Surgery (OBGS): Past, Present, and Future: Part I.

The gynecologist's office was, historically speaking, the original setting for surgical practice. In 1809, Ephraim McDowell performed the first ovariotomy and removed a 22.5-pound tumor from Jane Crawford in his Danville, Kentucky office-decades before the development of anesthesia or the aseptic technique.

Endometrial Ablation: Past, Present, and Future Part II.

Endometrial ablation (EA) is the most commonly performed surgical procedure for the management of abnormal uterine bleeding unresponsive to medical therapy. In well-selected subjects, EA provides a safe, inexpensive, and convenient alternative to hysterectomy with a rapid return to normal function. The first generation of EA techniques were introduced in 1886 by Professor Sneguireff of Moscow.

Endometrial Ablation: Past, Present, and Future Part I.

Endometrial ablation (EA) is a commonly performed minimally invasive technique to manage intractable uterine bleeding that is unresponsive to medical therapy. It originated in ancient times when chemical astringents were used to control uterine hemorrhage associated with childbirth and a variety of other gynecologic conditions. In the late 19th century, the use of astringents and chemical cauterants gave way to the application of a variety of thermal energy technologies to cause selective destruction of the endometrium.

Urinary ascites in late onset of bladder injury post laparoscopic hysterectomy.

Urinary tract injuries are unfortunate complications of pelvic surgery. With the increasing popularity of minimally invasive surgery, a thorough understanding of electrosurgical instrumentation and their thermal spread is important to reduce patient injuries. The index patient was a 50 year old woman who underwent a supracervical hysterectomy 5 years prior to her presentation with pelvic pain and dysuria.

Late-onset endometrial ablation failure.

Endometrial ablation, first reported in the 19th century, has gained wide acceptance in the gynecologic community as an important tool for the management of abnormal uterine bleeding when medical management has been unsuccessful or contraindicated. The introduction of global endometrial ablation (GEA) devices beginning in 1997 has provided unsurpassed safety addressing many of the concerns associated with their resectoscopic predecessors. As of this writing the GEA market has surpassed a half-million devices in the United States per annum and has an expected compound annual growth rate (CAGR) projected to be 5.

Postablation Endometrial Carcinoma.

Background: Many women have undergone both resectoscopic and nonresectoscopic (or global) endometrial ablation (EA) during the past 20 years. These women are now approaching their sixth and seventh decades of life, a time frame in which endometrial carcinoma (EC) is most frequently diagnosed.

Database: In several reports, surgeons have expressed concern that endometrial ablation may leave a sequestered island of EC that may escape detection, possibly delaying its diagnosis or causing it to appear at an advanced stage.

Should We Abandon the Gynecologic Resectoscope in Favor of Hysteroscopic Morcellators?

The treatment of intrauterine masses, such as endometrial polyps and leiomyomas, has undergone a technological revolution in the past few decades. Gynecologists may now choose from a variety of unipolar and bipolar resectoscopes as well as an assortment of both mechanical and bipolar hysteroscopic morcellators. We present a comparison of these technologies to better practitioners understanding of the strengths and limitations of these devices.

Post-Ablation Endometrial Carcinoma (PAEC) Following Radiofrequency Endometrial Ablation: A Case Report and Its Implications for Management of Endometrial Ablation Failures.

Endometrial ablation (EA) has become one of the most commonly performed gynecologic procedures in the United States and other developed countries. Global endometrial ablation (GEA) devices have supplanted resectoscopic ablation primarily because they have brought with them technical simplicity and unprecedented safety. These devices, all of which received FDA approval between 1997 and 2001, are typically used to treat abnormal uterine bleeding (AUB) in premenopausal women.

"See-and-Treat" Hysteroscopy in the Management of Endometrial Polyps.

Endometrial polyps (EPs) are a common cause of abnormal uterine bleeding (AUB) in perimenopausal and postmenopausal women and are typically suggested by a screening transvaginal ultrasound. In addition, the increasing use of pelvic imaging often discloses asymptomatic EPs. In the past, saline infusion sonography (SIS) has been advocated in order to triage patients to undergo a blind curettage or a diagnostic or operative hysteroscopy.

Ultrasound-guided reoperative hysteroscopy for managing global endometrial ablation failures.

Study Objective: To determine whether ultrasound-guided reoperative hysteroscopy can reduce the need for hysterectomy in women experiencing delayed complications after global endometrial ablation (GEA) procedures.

Design: Retrospective review (Canadian Task Force classification III).

Setting: Private physician's office.

Sonographically guided hysteroscopic myomectomy (SGHM): minimizing the risks and maximizing efficiency.

Hysteroscopic myomectomy (HM), first described by Neuwirth and Amin in 1976,1 is an important technique in the management of selected women presenting with infertility, abnormal uterine bleeding (AUB), or both. The complications of HM include excessive bleeding, uterine perforation, prolonged operative times, and excessive intravasation of distention media. The author describes his technique of sonographically guided hysteroscopic myomectomy (SGHM).

Operative hysteroscopy in an office-based surgical setting: review of patient safety and satisfaction in 414 cases.

Study Objective: To determine the safety and satisfaction among patients undergoing operative hysteroscopy in an office-based setting.

Design: Retrospective analysis (Canadian Task Force classification II-2).

Setting: Physician's private office.

Sonographically Guided Hysteroscopic Endomyometrial Resection.

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.

Diagnosis of abnormal uterine bleeding with biopsy or hysteroscopy.

Abnormal uterine bleeding in women is a common cause for gynecologic consultation. Physicians must maintain a low threshold for endometrial assessment in abnormal uterine bleeding. Accurately determining the etiology of the bleeding permits appropriate treatment, minimizes unnecessary delays in therapy, and prevents needless worry in women.

Instituting an office-based surgery program in the gynecologist's office.

Office-based surgery (OBS) provides many advantages for the patient, physician, operating room team, and health care system. Newer technologies provide an array of procedures appropriate to the office setting, and with careful preparation, many can be performed without compromising patient safety or comfort. Several states have specific regulatory requirements for OBS, although half of them provide neither guidelines nor regulation.

Hysteroscopic endomyometrial resection.

Objective: To determine the efficacy of hysteroscopic endomyometrial resection in treating women with intractable uterine bleeding.

Methods: A retrospective analysis was carried out on 304 women with intractable uterine bleeding treated between August 1, 1991, and December 31, 1997. The average patient was 41.