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At least 289 records · Page 16Linked to original sources
PubMed1979

Current status of hysteroscopy in gynecologic practice.

During the past century hysteroscopy has developed into a highly sophisticated and effective technique with increasing applicability. Hysteroscopic instruments have been refined with fiberoptics, allowing light to be introduced into the uterine cavity with high intensity but without danger of thermal injury. Safe methods for uterine distention provide an undistorted panoramic view of the uterine cavity. As a diagnostic technique, hysteroscopy affords accuracy in detecting intrauterine conditions which may not be revealed by traditional methods of exploration. As an operative technique, hysteroscopy increases the precision of surgery and minimizes trauma to the endometrial lining, and may, on some occasions, preclude major surgical intervention. In addition, hysterscopy is potentially useful for female sterilization and offers promise as an investigative tool for studies of the intratubal milieu.

Carbon Dioxide↗
PubMed1997

Gynecologic causes of the acute abdomen and the acute abdomen in pregnancy.

Evaluation of a female patient who presents with an acute abdomen must always consider surgical and gynecologic disorders. Laparoscopy and pelviscopy have had a major impact on the surgical approach in gynecology. Most acute abdomens can now be approached laparoscopically. Certain conditions that are discussed require the traditional laparotomy. Preservation of reproductive capability has a major impact on the wellness of a woman.

Abdomen, Acute↗
PubMed2001

Promontofixation for the treatment of prolapse.

Genital prolapse is a common problem in women. The wide variety of surgical techniques used to treat this problem demonstrate how difficult it is to manage. Laparoscopic surgery offers a new approach. It allows a good view of the anterior and posterior compartments so that a global approach for the prolapse is possible by the same surgical route. Traditional promontofixation can be combined with a new approach to the posterior compartment. Laparoscopic promontofixation through installation of an intervesicouterine prosthesis for the treatment of hysterocele and cystocele is associated with paravaginal repair of lateral defects and a Burch anterior colposuspension for urinary stress incontinence. When combined with laparoscopic treatment of rectocele by myorrhaphy and reinforcement of the fascia by means of a prosthesis, it provides a complete range of treatment for all types of feminine prolapse. After 20 years of experience through laparotomy, promontofixation using a triangle has been carried out by laparoscopy at the authors' center since 1991 in an attempt to eliminate the cystocele by solidly anchoring the uterus and bladder floor to the promontory. This laparoscopic technique follows the usual steps for pelvic prolapse repair: 1. Total or subtotal hysterectomy or suspension of the uterus is performed in such a way that it returns to normal physiologic position, and a solid subvesical floor is created. 2. The physiologic axis of the vagina is restored by creating a strong, low posterior point of support and by performing culdoplasty. 3. Evident or latent stress incontinence is treated. It would be pointless to treat the hysterocele on its own because, once the prolapse has been cured, the subvesical mass will disappear and allow urinary incontinence to appear. 4. Reconstruction of the posterior rectovaginal support structures seems to be mandatory and is carried out in almost all cases. The first phase of the laparoscopic approach to pelvic prolapse allowed the authors to explore the technical aspects. Several approaches are possible by laparoscopy. Herein, the authors report 8 years of technical research and assessment. This experience confirms the tremendous potential of laparoscopic surgery for the treatment of all aspects of this pathology by the same route. Stress incontinence, cystocele, hysterocele, rectocele, or enterocele can be treated. The operative time is longer than with the open route, and the surgeon must be highly experienced. Based on their experience, the authors are discovering new concepts. More data are required before a conclusion can be drawn concerning this promising new approach.

Culdoscopy↗
PubMed2002

Uncertainty.

Explore the source record for details and available documents.

Anecdotes as Topic↗
PubMed1982

Ectopic pregnancy--a brief review.

Despite the advent of improved methods of diagnosis and therapy, ectopic pregnancy remains a significant cause of morbidity and mortality worldwide. The diagnosis is often difficult to make clinically, but should be included in the differential of any woman of gestational age presenting with lower abdominal pain, even with a normal menstrual history. With a high index of suspicion, improving methods of diagnosis such as the immunoassays for B-hCG and ultrasonography may lower mortality rates by enabling more diagnoses to be made before rupture. The significant infertility rate following ectopic pregnancy remains a problem despite newer, more conservative approaches to surgical therapy.

Culdoscopy↗
PubMed1999

Falloposcopy.

The role of the human fallopian tube in reproduction is more than a passive conduit. This organ is involved in oocyte pick-up, fertilization, and embryo transport. Metabolic substrates, cytokines, and immunoglobulins have been identified within the tubal lumen. Complex and coordinated endocrine secretions, neuromuscular activity, and cilial action are required for successful tubal function.

Cilia↗
PubMed1995

Clinical analysis of pelviscopic classic intrafascial Semm hysterectomy.

STUDY OBJECTIVE: To evaluate the efficacy of pelviscopic classic intrafascial Semm hysterectomy (CISH). DESIGN: Review of hospital records of 90 women undergoing pelviscopic CISH between April 1993 and June 1994. SETTING: Department of Obstetrics and Gynecology at a university teaching hospital. PATIENTS: Sequential sample of 90 women undergoing pelviscopic intrafascial hysterectomies. INTERVENTIONS: All of the hysterectomy procedures were performed in the classic manner with grasping forceps, scissors, ligatures, and sutures. No lasers, electrocoagulation, or stapling devices were used. MEASUREMENTS AND MAIN RESULTS: Indications, associated procedures, surgical outcomes, and complications were analyzed. The most common surgical indication was leiomyomata uteri. No major complications occurred even in patients who had extremely large leiomyomata. The mean uterine weight was 207.49 +/- 104.9 g. The average operating time (169.89 +/- 56.19 min) was consistent with that of other methods. Blood loss (160 +/- 182 ml) was lower than during conventional abdominal hysterectomy. No procedure was converted to laparotomy. CONCLUSIONS: Pelviscopic CISH is truly a minimally invasive and organ-preserving surgery, and in our study was associated with significantly low morbidity and no major complications. Pelvic floor support is maintained and the ureters are not in danger. Coring out the cervix with the calibrated uterine resection tool may prevent the development of cervical cancer. Therefore, we think that CISH may be an acceptable technique for benign uterine disease.

Adnexa Uteri↗
PubMed1994

Histologic features of the CISH procedure.

STUDY OBJECTIVE: To evaluate the classic intrafascial SEMM (serrated-edge macromorcellated) hysterectomy (CISH) performed by pelviscopy and by laparotomy, and determine the histologic features of the procedures. DESIGN: The first 253 women who required hysterectomy were assigned to undergo the procedure by pelviscopy or laparotomy based on uterine size. PATIENTS: One hundred fifty-two women underwent CISH by pelviscopy and 101 by laparotomy. INTERVENTIONS: Between September 1991 and December 1993, the patients underwent the two procedures. Uterine leiomyomas with menstrual disorders and pressure symptoms were the principal indications (61%). MEASUREMENTS AND MAIN RESULTS: Histologic findings were in agreement with indications for the procedures. Leiomyomas and leiomyomas with adenomyosis were the most frequent findings. Histologic analysis revealed that the squamocolumnar transformation zone was totally removed in all cases, and all cervical glands were excised in 92%. CONCLUSION: Cervical dysplasia is not a contraindication to CISH, but emphasizes the importance of adequate preoperative screening. This is a conservative operation that my protect against some cervical cancers.

Adult↗
PubMed2002

"People sometimes react funny if they're not told enough": women's views about the risks of diagnostic laparoscopy.

OBJECTIVES: To explore women's views about the risks and benefits of diagnostic laparoscopy in the investigation of chronic pelvic pain, including how much information it is thought appropriate to give about three specific risks: death, major complications and the chance that the procedure would have an inconclusive result. DESIGN: A qualitative analysis of semi-structured, audio-taped interviews with 20 women about their experiences of undergoing a diagnostic laparoscopy in a day surgery unit. Interviews were conducted 3-6 months after the procedure. RESULTS: All the women who were interviewed were aware that diagnostic laparoscopy carried risks, including the small risk of death associated with general anaesthesia. One-third of respondents said that they had initially been reluctant to discuss the risks of the procedure in general terms. However, when specific examples of complications and risks were introduced all but one of the respondents reported that they would have liked to discuss these at the time that the decision to have the operation was made. Women maintained that the information was needed to make an informed decision about whether to have the operation, to help them understand and cope should things go wrong and in order to make appropriate plans to cover contingencies. Most were surprised to hear that the procedure is frequently inconclusive and thought that this information should be made clear to women contemplating a laparoscopy. CONCLUSIONS: Women undergoing diagnostic laparoscopy for the investigation of chronic pelvic pain wish to be given full and accurate information about complication rates such as bowel perforation, what to expect during their recovery, and the chances of finding a cause for their pain. Although they may not want to dwell on the risk of death, they do need to be informed about the specific risks associated with the procedure in order to make a balanced decision.

Adult↗
PubMed1995

Diagnosis of early ectopic pregnancy by measurement of the maternal serum to cul-de-sac fluid beta-hCG ratio.

In patients suspected of having an ectopic pregnancy, because of a positive beta-human chorionic gonadotropin (beta-hCG) test and a sonographically undetectable gestational sac, even laparoscopy cannot always achieve a precise diagnosis, when the gestational age is very early. This means that the patient has to be followed by repeated beta-hCG measurements and repeated laparoscopy, which are expensive and inconvenient for the patient. This paper reports on a method that is simple to perform and that will provide the clinician with valuable information about the strong likelihood of a tubal pregnancy when ultrasound and beta-hCG measurements raise the suspicion but are not diagnostic. A prerequisite for this approach is the availability of a minimal volume (1-2 ml) of peritoneal fluid in the pouch of Douglas. A total of 131 patients who had a positive beta-hCG test and an undetectable gestational sac within the uterine cavity and who had a small volume of cul-de-sac fluid were studied. The fluid was obtained transvaginally by means of an ultrasound-guided automatic puncture system. The beta-hCG level was determined in the cul-de-sac fluid and in the maternal serum, for comparison. In two cases with tubal pregnancy, concentrated viscous blood samples were aspirated and beta-hCG concentrations could not be measured for technical reasons. In 129 cases, the ratio of levels of beta-hCG between serum and cul-de-sac fluid could be measured. In 42 out of 44 patients with intrauterine pregnancy, the ratio was greater than unity; in 82 out of 85 patients with a tubal pregnancy, the ratio was less than unity. With this ratio used for detection of tubal pregnancy, the diagnostic sensitivity of the test was 95.4% and the specificity was 95.2%. The positive predictive value was 97.6% and the negative predictive value 91.3%. We conclude from these findings that the measurement of the maternal serum to cul-de-sac fluid beta-hCG ratio facilitated the early diagnosis of an ectopic pregnancy in the Fallopian tube.

Ascitic Fluid↗
PubMed1984

Ectopic pregnancy. 'Thinking ectopic,' key to diagnosis.

During the past decade, the number of ectopic pregnancies in the United States nearly tripled. Although maternal mortality from this cause declined over the same period, the rate could be further reduced with earlier diagnosis and treatment. After a pregnancy has been confirmed by urine or blood testing, its location, if questionable, should be determined by sonography. The possibility of ectopic pregnancy should be considered not only for patients at high risk but also for those whose signs and symptoms differ from textbook descriptions of ectopic pregnancy. Definitive treatment is surgical, with the choice of technique determined in part by the patient's feelings about future fertility.

Diagnosis, Differential↗
PubMed2002

Culdolaparoscopic oophorectomy with vaginal hysterectomy: an optional minimal-access surgical technique.

BACKGROUND AND PURPOSE: Oophorectomy during vaginal hysterectomy may be difficult or impossible when the ovaries lie high in the pelvis or when adhesions are present. A new technique of culdolaparoscopic oophorectomy during vaginal hysterectomy is described. PATIENTS AND METHODS: After the uterus is removed, a 12-mm cannula is introduced into the culde-sac, and a pneumoperitoneum is created. A 10-mm telescope is inserted through the vaginal port, and, under culdoscopic surveillance, two or three 3-mm abdominal ports are placed. The 10-mm telescope is removed, and a minilaparoscope is introduced through one of the abdominal cannulas. Oophorectomy is performed with a coagulator and scissors introduced via the vaginal port, and the ovaries are extracted through the vaginal cannula. Eight patients with pelvic adhesions found at the time of vaginal hysterectomy underwent culdolaparoscopic oophorectomy. RESULTS: The procedure lasted between 28 minutes and 45 minutes, including adhesiolysis, removal of an enlarged ovary, and a liver biopsy. No complications occurred in any of the patients. CONCLUSION: Culdolaparoscopic oophorectomy is a simple minimal-access surgical technique for removing the ovaries when these are not easily accessible at vaginal hysterectomy.

Culdoscopy↗