Intraoperative sigmoidoscopy in gynecologic surgery.

Intraoperative sigmoidoscopy is underused by the majority of practicing gynecologists and is not widely taught in obstetrics and gynecology training programs. In this report, a step-by-step approach is provided in order to perform sigmoidoscopy. Indications for use, along with various intraoperative applications, are discussed.

Laparoscopic repair of gastric perforation secondary to umbilical trocar insertion.

A postmenopausal woman was scheduled to undergo laparoscopic treatment of an 8-cm simple ovarian cyst. During abdominal entry, umbilical trocar insertion caused a gastric perforation that was diagnosed immediately and repaired laparoscopically. Following completion of the procedure, the patient was observed for 24 hours with a nasogastric tube in place and was discharged to home on the second postoperative day without further complications.

Laparoscopic management of ovarian remnant.

Objective: To report outcomes of laparoscopic management of patients with ovarian remnant (OR).

Design: Retrospective chart review.

Setting: Referral practice and tertiary medical center.

The role of intraoperative proctosigmoidoscopy in laparoscopic pelvic surgery.

Study Objective: To report the outcome of rigid sigmoidoscopy during operative laparoscopy in patients at high risk for rectosigmoid and large bowel injury.

Design: Prospective patient database with retrospective chart review (Canadian Task Force classification II-3).

Setting: Referral practice and tertiary medical center.

Laparoscopic management of 15 patients with infiltrating endometriosis of the bladder and a case of primary intravesical endometrioid adenosarcoma.

Objective: To report laparoscopic management of 15 patients with infiltrative bladder wall endometriosis and to report a case of endometrioid adenosarcoma.

Design: Prospective chart review.

Setting: Referral center for endometriosis.

The role of leiomyomas in infertility.

Study Objective: To assess the role of leiomyomas and their surgical removal on pregnancy rates.

Design: (Canadian Task Force classification II-1). Setting.

Long-Term Follow-up of Laparoscopic Myomectomy.

One hundred fourteen women (average age 37.1 yrs) underwent laparoscopic myomectomy for pain (77.8%), abnormal bleeding (53.

Incisional Hernias after Advanced Laparoscopic Surgery.

A retrospective case review was performed to determine the risk factors and frequency of incisional hernias after advanced operative laparoscopy. Ten incisional hernias occurred in nine women over 13 years, a frequency of about 0.1%.

Laparoscopic Removal of the Cervical Stump after Supracervical Hysterectomy for Persistent Pelvic Pain and Endometriosis.

We evaluated the safety of laparoscopic removal of the cervical stump after supracervical hysterectomy. In six women the cervical stump was left due to the presence of severe endometriosis or adhesions in the posterior cul-de-sac between the rectum or uterosacral ligaments and cervix. One woman also expressed a desire to preserve her cervix.

Laparoscopic Management of Intentional and Unintentional Cystotomies.

We evaluated the outcome of laparoscopic closure of intentional or unintentional bladder openings during operative laparoscopy. The unintentional cystotomies occurred in six women during ancillary suprapubic cannula insertion (1), sharp dissection of the bladder from the uterus in preparation for hysterectomy (2), development of the space of Retzius for bladder neck suspension (1), myomectomy (1), and resection of an ovarian remnant (1). In the remaining 13 women, bladder entry was required for treatment of endometriosis (3), and full-thickness partial cystectomy was necessary for deeply infiltrative endometriosis (7) or embedded ovarian remnants (2), or to repair a vesicovaginal fistula (2).

Laparoscopic retropubic cystourethropexy.

Study Objective: To evaluate the efficacy of laparoscopic retropubic urethrovesical suspension.

Design: Retrospective review of charts of 62 women over a follow-up period ranging from 8 to 30 months.

Setting: A suburban hospital in a major metropolitan area.

Is Hormonal Suppression Efficacious in Treating Functional Ovarian Cysts?

We randomly assigned 95 women, age 17-55 (mean 36.5) with unilateral or bilateral ovarian cysts measuring 1.1 to 6.

Complications of 361 Laparoscopic Hysterectomies.

We evaluated the results and complications of 361 hysterectomies performed at operative laparoscopy to treat a variety of benign gynecologic conditions. The hysterectomies were classified according to the number of steps performed endoscopically. There were no conversions to laparotomy for the hysterectomy, although one required laparotomy for rectosigmoid resection and anastomosis due to severe stricture of the rectosigmoid colon.

The Incidence of Endometriosis in Posthysterectomy Women.

One hundred consecutive patients, age 24-62, status post total hysterectomy with and without bilateral oophorectomy (BSO), presented with chronic pelvic pain. All underwent laparoscopy. Of those who did not have BSO, 30 had definite endometriosis found at laparoscopy and five had questionable endometriosis.

Hospital cost comparison between abdominal, vaginal, and laparoscopy-assisted vaginal hysterectomies.

Objective: To evaluate and compare the hospital charges for total abdominal hysterectomy (TAH), vaginal hysterectomy, and laparoscopy-assisted vaginal hysterectomy performed with the linear stapler.

Methods: Thirty cases of each of the three types of hysterectomies, performed at the same hospital by various surgeons, were selected at random. The authors did not participate in any of the cases evaluated.

Laparoscopic repair of a vesicovaginal fistula: a case report.

Background: Operative laparoscopy was performed for the management of ovarian remnant syndrome involving the bladder, bowel, vagina, and ureters, and requiring extensive dissection. A vesicovaginal fistula developed postoperatively.

Case: Because of the complexity and location of the fistula, a vaginal approach was not appropriate.

Laparoscopic amputation of a noncommunicating rudimentary horn after a hysteroscopic diagnosis: a case study.

This report describes the diagnosis and management of a noncommunicating rudimentary horn complicated by severe pelvic pain and associated endometriosis. This condition was diagnosed by simultaneous laparoscopic and hysteroscopic examinations. The hysteroscopic evaluation was significant in the diagnosis, as the noncommunicating horn was not recognized during a previous laparoscopy.

Laparoscopic radical hysterectomy and laparoscopically assisted vaginal radical hysterectomy with pelvic and paraaortic node dissection.

Nineteen women underwent laparoscopic radical hysterectomy or laparoscopically assisted vaginal radical hysterectomy, with pelvic node dissection and paraaortic node dissection when indicated. One procedure was converted to laparotomy due to equipment failure (at The University of Puerto Rico). There were two minor postoperative complications.

Endometriosis of the intestine and genitourinary tract.

As with other organs, the etiology of bowel endometriosis is unknown. Its occurrence was reported as early as 1922 by Sampson. Following his investigation of nineteen cases, he proposed that "implantation adenoma of endometrial type of some portion of the intestinal tract may be present in at least one half of the cases of perforated ovarian hematoma of endometrial type with peritoneal implantations.

Laparoscopically assisted myomectomy: a report of a new technique in 57 cases.

Objective: This study was undertaken to assess the efficacy of a combined operative laparoscopy and minilaparotomy technique to remove single and multiple large leiomyomas.

Procedure: Laparoscopy was used to treat associated pelvic pathology, to identify the leiomyoma(s) and bring it to a minilaparotomy incision and to remove by irrigation blood clots and debris at the end of the procedure. Through this incision, the leiomyoma(s) is grasped, shelled, morcellated, and the uterine defect is repaired in layers.

Adhesion formation after endoscopic posterior colpotomy.

Twenty-two women who had undergone laparoscopic posterior colpotomy at initial operative laparoscopy and later underwent a second laparoscopic procedure were evaluated for adhesion formation. Fifteen women (68%) had myomata removed, 3 (14%) had a dermoid cystectomy, 1 (5%) had a serous cystadenoma removed, and 3 (14%) who had large endometriomata and severe adhesions underwent salpingo-oophorectomy. Although filmy adhesions were noted in nine women, no adhesions were noted in the cul-de-sac.

Laparoscopic repair of small bowel and colon. A report of 26 cases.

This is a retrospective review of laparoscopic repair for enterotomies created during therapeutic or diagnostic laparoscopy in 26 women. All patients had mechanical and antibiotic bowel preparation preoperatively. The indication for operative laparoscopy was endometriosis (18), severe abdominal adhesive disease (7), and adhesions with Crohn's disease (1).

Laparoscopic surgery with a new tuned high-energy pulsed CO 2 laser.

Although CO 2 lasers have gained popularity in operative laparoscopy, it has been suggested that they do not deliver sufficiently high power density at the distal end of a laparoscope. Heating of the insufflation gas inside the laparoscope by absorption of some of the laser power causes the gas density to change and creates distortion and defocusing, resulting in lower power density at the tissue as the laser power is increased. A new laser uses the carbon-13 isotope in the laser gas mix instead of the carbon-12 isotope, which is used in both conventional lasers and CO 2 insufflation gas.

Laparoscopic segmental resection for infiltrating endometriosis of the rectosigmoid colon: a preliminary report.

The following is a description of the first series of laparoscopic partial proctectomies performed without a separate surgical incision. Sixteen women were treated for extensive endometriosis invading the rectal wall. This original series of patients tolerated the procedure well, with no major intraoperative or postoperative complications noted.