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At least 199 records · Page 11Linked to original sources
PubMed1984

Comparison of three types of tubal sterilisation: the medan experience.

Three methods of tubal sterilisation, viz. laparoscopy, culdoscopy and minilaparotomy, were evaluated in a trial involving 300 voluntary acceptors at the University Hospital in Medan, Indonesia. Equal numbers of women were randomly assigned to the three surgical groups. The results showed little differences among patients in the three groups for age, number of living children, contraceptive and abortion histories and pre-existing medical conditions. As expected, average surgical time for minilaparotomy was significantly higher than the times reported for the endoscopic techniques. Minilaparotomy also produced the highest incidence of operative complications while culdoscopy accounted for the highest rate of hospitalisation following operation. Four-year follow-up of the patients revealed only one case of pregnancy in the culdoscopy group, three years after tubectomy .

Adolescent↗
PubMed1975

Early complications of sterilization in women not recently pregnant.

This study was conducted to evaluate the complications occurring during operation and from the time of operation until the follow-up vist at one to eight weeks after operation, for patients sterilized by culdoscopy, colpotomy, laparoscopy, or laparotomy. Surgeons were unable to perform the elected procedure in less than 1 per cent of the patients, independent of the method of approach. With endoscopic techniques, the most common operative difficulty was in obtaining an adequate view of the tubes. Excessive blood loss appeared more frequent with both vaginal techniques. Postoperatively, pelvic infections were more frequent with both the vaginal techniques, while incisional complications were more frequent with both the abdominal techniques. Operative and hospitalization times were significantly shorter, and the proportion of women resuming normal activities within four weeks of sterilization was higher with the endoscopic methods. Laparoscopy appeared to be the preferable procedure. While technical difficulties, operative complications, surgical and hospitalization times, and the time until the patient resumed normal work activities were similar with laparoscopy and culdoscopy; infection of the pelvis was more frequent after culdoscopy.

Adult↗
PubMed2005

One stop fertility clinic.

UNLABELLED: The objective of this study was to determine the feasibility and acceptability of out-patient based investigation of infertile couples using a prospective observational study based in a large undergraduate teaching hospital. We studied couples referred to secondary care for investigation of their infertility. Investigations involved pelvic ultrasound, diagnostic hysteroscopy and culdoscopy. The main outcome measures were feasibility of investigations, findings, patient views, and a management plan. RESULTS: 199 of 347 (57.3%) couples referred met our selection criteria, and 162 of this group have attended. Thirty-one (19.1%) were judged to be unsuitable for culdoscopy, and culdoscopy failed in a further 29 (17.9%). The average time for the three procedures was 41.2 (SD 17.2) minutes, and over 1/3 of patients were found to have pelvic pathology. The investigations were well tolerated and there was only one complication necessitating admission to hospital. Most patients appreciated the need for a single hospital visit and the availability of immediate results. CONCLUSIONS: A One Stop approach to the investigation of infertility is attractive but not suitable for or desired by all infertile couples. Organisational issues were also identified.

Adult↗
PubMedDate not supplied

Culdolaparoscopy: a preliminary report.

OBJECTIVE: To introduce a surgical technique that combines culdoscopy with laparoscopy and microlaparoscopy. METHODS: This was a feasibility study conducted at The Mount Sinai Hospital of Queens. The technique is used when a larger port is required during laparoscopy or microlaparoscopy procedures. The additional port is placed in the vagina and, under laparoscopic surveillance, into the posterior cul-de-sac. RESULTS: This operation has been performed successfully in 5 oophorectomies, 4 myomectomies, 3 salpingoophorectomies, and 1 salpingectomy. CONCLUSION: This technique reduces the need for abdominal ports in excess of 5 mm. These ports can have a visual or operative function depending on the nature or stage of the procedure. The vaginal port can serve a visual function similar to that of culdoscopy or may be used for the introduction of operative instruments and the extraction of specimens. A principal benefit of using the larger vaginal port is derived from the capability of assisting laparoscopy and allowing the surgeon to use fewer and smaller abdominal trocars.

Combined Modality Therapy↗
PubMed1981

Evaluation of contemporary female sterilization methods.

Different methods of sterilization were evaluated. Laparoscopic techniques were the most satisfactory because they had lower pelvic and incision infection rates and shorter hospitalization and convalescent times than laparotomy lower pelvic infection rates than culdoscopy and culpotomy. Via laparoscopy, sterilization by coagulation and cutting, spring-loaded clips and bands was an effective, safe method. Mechanical problems with the applicator and optics and decreased visibility resulted in more technical failures and difficulties and more misapplication with the clip applicator. Although the total complication rates were similar with all methods, bleeding from the tubes and wound and pelvic infections were more frequent with silastic-band technique. Long-term complications, such as dysmenorrhea and menometrorrhagia and especially those resulting in hysterectomy after laparoscopy, are infrequent. Pregnancy rates are low after laparoscopic sterilization with coagulation and silastic bands as compared to the clip. Rates of complications with sterilization combined with abortion or delivery are only slightly higher than after abortion without sterilization and much less than the combined complications that would be anticipated from abortion and interval sterilization. To make colpotomy, culdoscopy and minilaparotomy easier and potentially safer, mechanical techniques using the spring-loaded clip and silastic band are being evaluated. Simplified techniques that can be administered via the cervix, such as Quinacrine, may be practical in the future.

Abortion, Induced↗
PubMed2000

Reinventing the culdoscope.

The purpose of this study was to reassess culdoscopic visualization of the female pelvis using a small flexible fiberoptic choledochoscope introduced via a disposable trochar system. A disposable 5-mm retractable laparoscopic trochar was used to gain access to the peritoneal cavity via the posterior fornix of the vagina. A 4.9-mm flexible choledochoscope then was introduced through this trochar to visualize the pelvic organs. The initial procedures were performed with the patient under general anesthesia using direct laparoscopic visualization of the cul-de-sac. Subsequent procedures were performed on women who were awake, using local anesthesia and sedation with the patients in a knee-chest position. In this study, 18 women taken to the operating room for a planned transvaginal hysterectomy or laparoscopically assisted vaginal hysterectomy underwent flexible culdoscopy. Three procedures were performed with the patients under general anesthesia using direct laparoscopic visualization, and 15 procedures were performed in a blind fashion with the patient awake in a knee-chest position. The average Quetelet Index was 31.2 (range, 22.8-43.1). Of the 18 procedures, 16 were successful in adequately visualizing the pelvic organs. There were no significant complications from the procedures, and no injury to adjacent organs. Culdoscopy with a small flexible scope can be performed safely in awake patients, providing adequate visualization of the female pelvis.

Adult↗
PubMedDate not supplied

Patrick C. Steptoe: laparoscopy, sterilization, the test-tube baby, and mass media.

In the late 1950s, Patrick C. Steptoe, a British gynecologist, established contact with Palmer of Paris and Frangenheim of Wuppertal, Germany, and studied laparoscopic technique under the tutelage of these pioneers. Despite the negative attitude among his colleagues, Steptoe soon became one of the most innovative researchers in the field of abdominal endoscopy, particularly laparoscopic sterilization. In the late 1960s, Steptoe began working with Robert Edwards, an embryologist, and launched an in-vitro fertilization project obtaining eggs by means of laparoscopy. Both researchers experienced years of frustration, disappointment, ethical and scientific criticism as well as a difficult relationship with the mass media. Finally, in July 1978, Louise Brown, the first test-tube baby, was born in England. Like many of his colleagues in the 1950s and 1960s, Patrick Christopher Steptoe (1913-1988), a gynecologist in Oldham, Great Britain, was concerned about the number of unnecessary laparotomies. Unfortunately, the Oldham group of hospitals was not a university clinic and Steptoe had scanty opportunity to develop his own research. In the late 1950s, he searched the medical literature for an alternative form of examination and came across publications about Decker's culdoscopy, the vaginal approach to view of the abdomen. Since this method was not widespread in England, Steptoe, in 1958, went to Montreal, Boston, and New York in order to observe and learn the practical use of culdoscopy. However, Steptoe left America disappointed.

Fertilization in Vitro↗
PubMedDate not supplied

Risks and benefits of culdoscopic female sterilization.

This paper reviews the risks and benefits of the culdoscopic approach to female sterilization in an alnalysis of 2153 culdoscopic sterilization procedures performed at 11 centers in nine countries. Inability to occlude the tubes as planned was reported for approximately 6.0% of the cases including 1.4% in which one or both tubes could not be occluded by any technique. Surgical difficulties were reported for about 13.0% of the procedures, and surgical complications, of which the most frequent was torn or bleeding tubes, occurred in 2.0% of the cases. Pregnancy rates were significantly higher for patients whose tubes were occluded by tantalum clips (7.7 per 100 women at 12 months), indicating that this is not the preferred technique of tubal occlusion; the 12-month life table pregnancy rates were 0.1 per 100 women for tubal ring and 0.0 for Pomeroy and fimbriectomy. Comparison of these data with similar pooled data on laparoscopy and minilaparotomy indicates that culdoscopy is associated with greater technical difficulty and morbidity. Thus, abdominal procedures will continue to be preferred for use in most large-scale programs.

Culdoscopy↗
PubMedDate not supplied

Sterilization of women: benefits vs risks.

Voluntary sterilization is the birth control method most widely practiced throughout the world. The last ten years have witnessed great improvements in techniques and perfection of innovations, explaining the important role that it now plays in the regulation of fertility. Different methods are examined and it is concluded that hysterectomy is the best, if medically indicated; conventional laparotomy is not justified unless required by concomitant intraabdominal pathology; minilaparotomy is mostly suitable postpartum; colpotomy is better left to specialists; laparoscopy is ideal for nonpregnant patients; culdoscopy is a relic of the past; and hysteroscopy, although still experimental, may be the way of the future. The advantages of voluntary sterilization lie in its remarkable and immediate efficiency, freedom from ongoing motivation, the convenience of a one-time operation, the absence of side effects and the reduction of total costs. Its disadvantages are the complexity of any surgical intervention for a woman, its indisputable finality, its uncertain legality and the risks inherent in any operation. Hysterectomy and tubal ligation are practically never fatal, so this argument does not influence the choice of either method. However, incidence of morbidity is higher following hysterectomies, which must therefore be justified. The balance is clearly in favor of voluntary sterilization for the woman who is convinced that the size of her family is complete.

Adult↗
PubMed1980

Mortality risk associated with female sterilization.

The mortality risk associated with female sterilization in an analysis of 255 812 procedures performed in developing countries from 1973 to 1979 is reviewed. Fifteen sterilization-related deaths were reported during this period. The overall mortality was 5.86/100 000 procedures. The most common cause of death was the result of anesthetic complications, with infection in second place. The risk of death by procedure was higher with culdoscopy than with minilaparotomy or laparoscopy. The authors believe that low mortality figures are realistic and can be achieved in developing countries when experienced surgical teams are provided with adequate facilities, observe strict medical standards, utilize minilaparotomy and laparoscopy and avoid general and spinal anesthesia.

Adult↗
PubMed2000

Transvaginal hydrolaparoscopy, a new technique for pelvic assessment.

Transvaginal hydrolaparoscopy is based on classic culdoscopy. With alterations in equipment and method, the procedure holds promise for evaluation of pelvic pathology. We performed transvaginal hydrolaparoscopy in the operating room just before operative laparoscopy in 15 patients, to evaluate the feasibility of this procedure. Excellent images of the cul-de-sac, fimbriae, and caudal surface of the uterus, ovaries, and pelvic sidewall were obtained. We believe this is a practical and convenient office diagnostic procedure.

Adnexal Diseases↗
PubMed2005

The lithotomy versus the supine position for laparoscopic advanced surgeries: a historical review.

Laparoscopic advanced surgery has been taught in many institutions in the United States. Initially, proctoring for the laparoscopic technique was performed by European surgeons; therefore, the lithotomy position was suggested as the preferred approach. Many American and European surgeons have adopted the supine position. Laparoscopy initially entered the clinical realm in the field of gynecology. Albert Decker, at the Knickerbocker and Gouverneur Hospital in New York, performed culdoscopy as early as 1928. This was done in the "knee-chest" position without the use of pneumoperitoneum. Raoul Palmer, at the Hopital Broca in Paris, popularized "colposcopie," utilizing pneumoperitoneum, with the patient in the lithotomy position. Laparoscopy then advanced in Europe to the general surgery arena. As a result, patient positioning for laparoscopic procedures in Europe was performed in what is now referred to as the French position (i.e., lithotomy). Many of these procedures are modified to a side approach, or American position, when performed in the United States. There is a clear association between the dorsal lithotomy position and the development of postoperative compartment syndrome. Compartment syndrome occurs when elevated pressure in an osteofascial compartment compromises local perfusion, and often results in neurovascular damage and permanent disability. Many centers have adopted the lithotomy position for their laparoscopic advanced procedures. At our institution, however, we prefer all procedures be performed in the American position (patient supine and the surgeon at the side of the patient), since this resembles the position used for other, open surgeries. The advantage of this approach is that it eliminates the risks associated with placement of the patient in the lithotomy position.

Compartment Syndromes↗
PubMed1976

Dydrogesterone and endometriosis.

The results are reported of the administration of dydrogesterone, 5 mg twice daily, to 49 patients with endometriosis. All but five patients were symptom-free after nine months of therapy. Most subjective symptoms had disappeared within four to eight weeks; dyspareunia usually took longer. In 30 out of 32 patients who had a culdoscopy after one or two treatment courses, a 'cure' of endometriosis was confirmed. Ten out of nineteen infertile patients became pregnant following treatment. The only side-effects were transient mastalgia and dizziness in two patients. No amenorrhoea or other disturbances of the menstrual cycle were reported.

Adult↗
PubMed2000

[Fertiloscopy].

Fertiloscopy is a useful first level alternative procedure in order to diagnose infertility. It is a new diagnostic technique, which combines culdoscopy, dye-test, salpingoscopy and hysteroscopy and uses a specific disposable kit (Fertiloscopy Soprane). Fertiloscopy has the advantage of limiting pelviscopy only when strictly indicated, while maintaining a high diagnostic quality. Furthermore, it is more cost-effective by reducing the use of the operating theatre, the number of doctors and nurses involved and also by decreasing surgical risks and therefore leading to a better compliance by the patients.

Coloring Agents↗
PubMedDate not supplied

Culdolaparoscopic cholecystectomy during vaginal hysterectomy.

BACKGROUND: Exploration of the abdominal cavity is routinely performed during abdominal and laparoscopic hysterectomies. The visualization of the abdomen during vaginal hysterectomy, however, is not usually done. During a vaginal hysterectomy, after the uterus is removed, an opening is present in the cul-de-sac, which offers a unique opportunity for the performance of not only exploratory but also concomitant surgeries, such as a cholecystectomy. METHOD: Culdolaparascopy is a culdoscopy assisted laparoscopic technique that utilizes a 12-mm trocar in the vagina as a multifunctional port in conjunction with laparoscopy and minilaparoscopy. A cholecystectomy was performed utilizing the vaginal trocar as an insufflation, visual, and extracting port during a vaginal hysterectomy. CONCLUSION: Culdolaparoscopy, when performed during vaginal hysterectomy, can be used for exploration and operation in the abdominal cavity. This case report illustrates the feasibility of a cholecystectomy performed using this surgical concept.

Aged↗
PubMed1958

Ectopic pregnancy; early diagnosis, clinical errors and conservative operation.

This report of eight years' experience with extrauterine pregnancy by a single gynecologist is an exposition of how the diagnosis was made or why it was missed. Of 26 diagnoses of ectopic pregnancy, five were false (20 per cent); and in three cases (10 per cent) the diagnosis was not made promptly-a total error of 30 per cent. Ectopic pregnancy will be discovered earlier if obstetric patients are always examined shortly after missing the first menstrual period.A palpable adnexal mass was present in 19 of 21 ectopic pregnancies (90 per cent). A mass was palpable in only one of five cases erroneously diagnosed as ectopic pregnancy (20 per cent).Decidual casts were passed by four patients, two of whom did not have ectopic pregnancy. If two gynecologists do not agree on the question of extrauterine pregnancy, a third opinion should be sought or culdoscopy employed. Enucleation of the conceptus and salvage of the oviduct is advocated.

Culdoscopy↗
PubMed1981

A new study of intrauterine synechiae.

This study is based on a series of 37 hysteroscopies performed in the knee-chest on patients undergoing culdoscopy as part of an infertility work-up. Local anesthesia was used for the two procedures. All the patients had a thorough infertility work-up that was completely negative. Ruled-out by hysterogram prior to the procedure were congenital abnormalities of the uterus, endometrial polyps, and submucous myomas. There were several different types of endometrial scars in nine patients and this was the only intrauterine pathology discovered. They were intrauterine synechiae typical of the Asherman's syndrome in four cases, cesarean section scars in two, adhesions due to an infected IUD in two, and in one patient there were vertical linear scars secondary to an endometrial biopsy. In this study, the hysterogram was particularly accurate in predicting major endometrial abnormalities, but specific evidence as to the type of minor intrauterine pathology had to be obtained with a hysteroscope. The firmer adhesions that were not of the Asherman's type were difficult to remove and could not be broken up with a hysteroscope. The types of scar visualized are described in some detail. Intrauterine synechiae probably derive ultimately from any type of trauma to a decidual or predecidual endometrium and need not be pregnancy related.

Adult↗