Technology assessment in women's health care.
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Clinical Protocols↗
Biomedical subjects
M G Munro
Publications and source records attributed to M G Munro.
Incisional hernia following laparoscopy: a survey of the American Association of Gynecologic Laparoscopists.
OBJECTIVE: To estimate the risk factors for and incidence of post-laparoscopy incisional hernia. METHODS: A questionnaire was sent to all individuals on a mailing list from the American Association of Gynecologic Laparoscopists. Adequately completed responses were entered into a computer-based data bank for analysis. Of the 11,500 surveys mailed, 3293 were returned; of these, 3217 were evaluable. RESULTS: A total of 933 hernias was reported from an estimated 4,385,000 laparoscopic procedures (an incidence of 21 per 100,000); 167 (17.9%) were reported to have occurred despite fascial closure. Six hundred sixty-five patients (71:3%) had subsequent surgical repair. Seven hundred twenty-five (86.3%) of the 840 hernias in which the size of the original fascial defect was noted, occurred in sites where ports 10 mm in diameter or larger had been placed. The occurrence of hernias is a function of the number of laparoscopies performed (P < .0001) and is not related to the length of the surgeon's career (P = .41). In at least 157 instances (16.8%), the presenting symptom or morbidity of the hernia was directly related to the involvement of the large or small intestine. CONCLUSION: Post-laparoscopy incisional hernias occur at an approximate incidence of 21 per 100,000 and are associated with significant morbidity. These hernias are most likely to occur when large ports are used. As currently practiced, closure is not completely protective. Further methods or devices should be developed to minimize the risk of hernia formation.
Female↗
Successful pregnancy following zygote intrafallopian transfer for congenital cervical hypoplasia.
BACKGROUND: Congenital cervical atresia and hypoplasia are rare abnormalities that generally require reconstructive or extirpative procedures to relieve outflow tract obstruction. Infertility is a common sequel, and only four previous pregnancies have been reported. In selected cases, zygote intrafallopian transfer (ZIFT) or other assisted reproductive techniques may offer alternatives for conception. CASE: A 21-year-old amenorrheic woman experienced a spontaneous gush of vaginal bleeding following an 11-year history of cyclic lower abdominal pain. Regular but prolonged and painful menses ensued. After another 8 years of primary infertility, transcervical and transfundal hysteroscopy demonstrated congenital cervical hypoplasia and a normal endometrial cavity. Conception was achieved during her third cycle of ZIFT. Delivery occurred by elective cesarean at 39 weeks for a persistent oblique fetal lie. CONCLUSION: A successful pregnancy was established following ZIFT in a woman with congenital cervical hypoplasia. The endometrial cavity was evaluated by a previously unreported technique, transfundal hysteroscopy. The use of appropriate surgical or assisted reproductive techniques in conjunction with individualized post-conception management may permit successful pregnancy and delivery in selected women with congenital cervical hypoplasia and atresia.
Adult↗
Automated laparoscope positioner: preliminary experience.
A new automated laparoscope positioner was designed that is easy to use and provides the surgeon with an opportunity to perform most laparoscopically directed procedures efficiently and safely without the need for an assistant. Potential additional benefits are reduced cost of care, development of laparoscopic simulators suitable for training residents, and development of surgical procedures and devices.
Equipment Design↗
Office sonography and office hysteroscopy.
Researchers involved in assessing technology and healthcare, including gynecologic care, have identified differences among the terms efficacy, effectiveness and efficiency. In order to assess the efficiency of procedures such as office sonography and hysteroscopy, it is first necessary to compare them with the alternatives in terms of patient-focused outcomes. Office sonography has been used to diagnose early pregnancy disorders such as ectopic gestations and evaluate other adnexal pathology, with mixed results. The use of office hysteroscopy to assess abnormal bleeding may replace procedures that are associated with greater risk and expense. More information regarding outcomes is needed for both procedures before they can be recommended as efficient alternatives for the diagnosis or treatment of gynecologic conditions.
Clinical Competence↗
A classification system for laparoscopic hysterectomy.
The term "laparoscopic hysterectomy" has been applied to a variety of procedures, ranging from lysis of adhesions laparoscopically followed by vaginal hysterectomy, to removal of the entire uterus under endoscopic direction. These procedures vary in a number of ways, including cost, morbidity, operating time, and surgical skill required. To facilitate training, credentialing, and outcome evaluation, we present the following classification system: type I--division of one or both pedicles containing the ovarian arteries, type II--dissection including one or both uterine arteries, type III--type II plus separation of part of at least one cardinal-uterosacral ligament complex, and type IV--type II plus separation of the entire cardinal-uterosacral ligament complex on at least one side. Each of the types may be subclassified according to the degree of dissection of structures located anterior and posterior to the cervix. Supracervical hysterectomy has a separate system of classification. Operations are categorized by management of the ovarian and uterine arteries and subdivided according to treatment of the cervical canal.
Female↗
Canadian Medicare: view from Utopia.
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Canada↗
Treatment of Gardnerella vaginalis vaginitis.
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Female↗
Giant hydrosalpinx.
A rare case of giant hydrosalpinx is presented, together with a review of the English literature on the subject. The pathology and pathophysiology of hydrosalpinx are reviewed.
Adult↗
Evaluation of fetal monitoring by telemetry.
A radiotelemetry system for the direct monitoring of fetal heart rate and intrauterine pressure during labor has been evaluated at 5 different institutions. A conventional fetal scalp electrode and a special intrauterine pressure sensor are connected to a radio transmitter placed on the patient's thigh. The receiver can be located up to 50 feet away from the transmitter and is either a self-contained monitor or a unit that converts a conventional fetal monitor to a telemetric one. The telemetry recordings are of similar quality to those obtained from conventional monitors. Telemetry allows for greater patient comfort and mobility as well as greater convenience to the clinical staff. Continuous data can be obtained from patients while they are ambulatory or sitting in a chair as well as while they are in bed.
Electrodes↗