PubMed · 15212008
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Steven D Wexner, Kenneth A Forde. 2004. Perforation during colonoscopy.. https://doi.org/10.1016/s0016-5107(04)00458-4
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Ambulatory surgery offers advantages to both patients and providers. It is imperative to ensure appropriate case selection, pre-operative counseling, a suitable environment, trained staff, adequate analgesia and post-operative care both in the hospital and the community. Many well-established urogynaecological procedures such as cystoscopy and vaginal repair may be performed in an ambulatory setting. Newer procedures such as injection of botulinum toxin or peri-urethral bulking agents and tension-free tapes for stress incontinence may also be performed in this way. To date, the literature is deficient in robust studies comparing outcomes and patient satisfaction between conventional and ambulatory surgical procedures, and randomized controlled trials are required.
The transcervical approach to permanent female sterilization has been studied for more than 150 years. Methods for accessing the tubes via this approach include blind, radiological and visual (hysteroscopic) techniques. Modalities for occluding the fallopian tubes include thermal, chemical and mechanical means. Some combination of the approach and the occlusive method define all known procedures. Initial attempts at transcervical sterilization were not widely adopted due to an inability to occlude the tube reliably, resulting in pregnancy and/or high morbidity from the procedure. Quinacrine sterilization is a procedure that is widely used in the developing world, but this has not been taken up by the developed world. There are limitations in diagnosing tubal occlusion with this technique. New methods for transcervical sterilization include the Essure and the Adiana procedures. These methods involve hysteroscopic placement of devices that rely on both mechanical occlusion and stimulation of tissue ingrowth to effect tubal occlusion. These new devices can be delivered to more than 90% of tubes, have very high success rates of pregnancy prevention (>99% in studies to date) and are acceptable to patients. Most importantly, they can be fitted under local anaesthesia in an ambulatory setting. The cost advantages of transcervical sterilization have not yet been investigated. It is possible that such a modality for permanent female sterilization may be demonstrated to be highly cost-effective.
This descriptive study aimed to characterize the profile of 167 subjects who were treated at the Ambulatory Surgical Center of a University Hospital in São Paulo State and procedures realized at the Ambulatory Surgical Center, as well as to identify the biological and psychosocial needs of these patients. Data were obtained through a semistructured interview and patients' files and were subject to descriptive analysis. The group was characterized by an equal number of individuals from both genders; average age was 51 years and socioeconomic levels were poor. The most common surgical and anesthetic procedures were ophthalmologic procedures and use of local anesthesia with or without sedation. The biological needs were: altered arterial pressure, electrocardiographic alterations, use of medication, allergy to medication, prolonged fasting, nausea, vomiting and pain. The psychosocial needs were: worry, fear, anxiety, discomfort caused by waiting for the realization of procedures and doubts or lack of information concerning perioperative care.