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The development of endoscopic techniques and instruments is traced from Bozzini's light transmitter in the early 1800's to the present. Early use of laparoscopes, cystoscopes, hysteroscopes and culdoscopes is described. While the site of use of these instruments differs, certain general aspects are similar. Modern instrumentation permits visualization into almost any body cavity.
Luteolysis in Shiba goats was spontaneous (N = 5) or induced by prostaglandin F-2 alpha (N = 5). Blood sampling and the test for oestrous behaviour were carried out at 2-h intervals, and the time of follicular rupture (ovulation) was determined by culdoscopic observations performed every 2 h around the periovulatory period. In both groups plasma LH concentrations showed a temporary but significant increase during the abrupt fall in plasma progesterone concentrations at luteolysis. This LH rise may be responsible for the preovulatory development of antral follicles and the increase in oestradiol secretion from them. The total number of antral follicles (spontaneous luteolysis 3.6 +/- 0.6, induced luteolysis 4.2 +/- 0.7; mean +/- s.e.m.) and the number of ovulations (1.8 +/- 0.4, 2.4 +/- 0.2) did not differ significantly between the two groups. There was also no significant difference in the timing of oestrus, LH surge and ovulation following the two modes of luteolysis. The interval from luteolysis to the peak of the LH surge averaged 65 h (range 56-72 h). The period of oestrous behaviour coincided with the acrophase of the LH surge and lasted for 22 h (12-28 h). Ovulations occurred 21 (16-24) h after the LH peak and 7 (2-12) h after the end of oestrus.
The University Department of Obstetrics and Gynecology, Kandang Kerbau Hospital in Singapore, initiated a study in early 1974 of failure rates for various methods of sterilization and the factors responsible for the failures. During the period January 1974 to March 1976, 51 cases of first pregnancy following ligation were discovered. Cumulative failure rates at 24 months were 0.34 per 100 women for abdominal sterilization, 1.67 for culdoscopic, 3.12 for vaginal, and 4.49 for laparoscopic procedures. Findings for 35 patients who underwent religation showed that recanalization and the establishment of a fistulous opening caused the majority of failures. Clearly, more effective methods of tubal occlusion in sterilization are needed.
To determine the safety of tubal sterilization performed at the time of induced abortion, we compared data on 616 women who underwent induced abortion and concurrent tubal ligation (Group 1) with 1,805 women who had induced abortion only (Group 2). These two groups of women were healthy, seven to 12 weeks pregnant, and between the ages of 16 and 44 years. The partly-standardized morbidity rates for Group 1 and Group 2 were 5.4 and 3.6%, respectively. Thus, the sterilization procedure added 1.8% to the complication rate of induced abortion only. The complication rate for women who had interval culdoscopic ligation under the same conditions in the same department was 2.4%. This is not significantly different from the complication rate of 1.8% attributable to sterilization procedures in women who had abortion and concurrent ligation. We conclude that these data support our present practice of performing tubal ligation at the time of induced abortion, rather than changing to the practice of abortion followed by interval sterilization six weeks later, with its many disadvantages to the patient as well as to those providing family-planning services.
The culdoscope was used for easy approach to the fallopian tube, which was delivered into the vagina, and a Foley catheter (No. 8 French) was introduced through its fimbrial end for collection of human tubal secretion. It was left from one to eight days. The technique was successful in 54 cases out of 60, but we succeeded in collecting enough fluid in 44 cases only. The volume of human tubal fluid was studied in relation to the phase of the cycle. A peak of fluid volume was found to occur at the midcycle.
From the array of sterilization procedures that are safe, simple and effective, the service provider must select procedures that fit his or her logistical criteria, which include the cost and maintenance of equipment, availability of supplies, and training of the requisite personnel. In this paper, these criteria are discussed for each of the various sterilization procedures. Information about female sterilization equipment for conventional postpartum laparotomy, minilaparotomy, colpotomy, laparoscopy, and culdoscopy is presented, together with facts about the related tubal occlusion techniques. The standard ligation techniques for male sterilization are compared with the newer electrocoagulation and thermocoagulation methods. A variety of methods for both female and male sterilization that are in the research stage are also mentioned. It is concluded that, from a programmatic point of view, vasectomy and postpartum ligation via laparotomy are the optimal sterilization procedures. For women who have not recently been pregnant, minilaparotomy with a standard tubal ligation technique is recommended, except in large teaching hospitals where laparoscopy can be performed efficiently.
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We studied 332 patients with proven pregnancies. Prediction of hemoperitoneum by assessment of the Douglas pouch during bimanual examination had a false negative rate of 42.1%. The false negative rate for culdocentesis was 14.8%. It is therefore concluded that culdocentesis is not a useful tool in the diagnosis of suspected ectopic pregnancies.
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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.
A new, reusable uterine manipulator was developed to facilitate pelviscopic surgery and laparoscopic hysterectomy. The device is weighted to hold the uterus in an anteverted position and allow easy access to the cul-de-sac. It is spring loaded to create a tight seal for tubal insufflation. The instrument is calibrated in centimeters and has a sliding cervical plug that allows it to be inserted into the fundus to a depth of 15 cm for uterine manipulation during laparoscopic hysterectomy. The spring-loading mechanism holds the device firmly to the cervical tenaculum regardless of the depth of penetration, and rotates 180 degrees for use in the retroverted uterus.
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