A.P. Bailey

Robot-assisted single-incision laparoscopic myomectomy: initial report and technique.

Single-incision laparoscopic surgery for gynecologic applications has recently been described. Such an ultra-minimally invasive technique is attractive to patients and may have clinical advantages because of the reduced number of abdominal incisions. However, because of its extreme geometrical challenges and instrument crowding, single-incision laparoscopy is such a major deviation from optimum surgical ergonomics that it is unlikely to gain popularity. Robot assistance in single-incision laparoscopy has recently been described for some ablative gynecologic procedures, and it seems to have technical advantages. However, no suture-intensive applications of this technique have yet been reported. We describe our initial experience with robot-assisted single-incision laparoscopic myomectomy and provide essential technical detail to enable successful replication of this technique in the context of an advanced robotic surgical team.

Fertility Preservation Options for Females

Oncofertility is an interdisciplinary field in which providers of oncology and reproductive health care provide patients with options for fertility after cancer treatment. Infertility following cancer treatment occurs for various reasons including the need for removal of reproductive organs as well as the effects of chemotherapy and radiation on gametes and reproductive hormones. Unfortunately, few patients have comprehensive counseling on fertility preservation options prior to undergoing treatment (Schover et al., Cancer 86(4):697–709, 1999). This chapter explains the options for maintenance of fertility including oophoropexy/ovarian transposition, conservative surgical and medical management of gynecologic cancers, embryo cryopreservation via in vitro fertilization, oocyte cryopreservation, use of donor oocytes and donor embryos, gestational surrogacy, ovarian cortex cryopreservation and transplantation, in vitro maturation, ovarian suppression, uterine transplantation, and the potential for generation of gametes from somatic cells.

Greater Surgical Precision of a Flexible Carbon Dioxide Laser Fiber Compared to Monopolar Electrosurgery in Porcine Myometrium

The objective of this experimental animal study was to compare the surgical precision of a flexible CO2 laser fiber with that of monopolar electrosurgery in porcine myometrium. The subjects were 6 live adult non-pregnant female pigs. Linear injury to the uterine horns was created using a flexible CO2 laser fiber at 5W, 10W, and 15W and with monopolar electrosurgery at 10W, 20W, 30W, and 40W in both cut and coagulation modes. Hysterectomy was then performed in the live animals. Cross-sections of the tissue were processed and stained using Masson trichrome to differentiate damaged from undamaged myometrium. Measurement means were compared using analysis of variance with Tukey honest significant difference correction; p <.05 indicated significance. Incision width of the laser at 5W and 10W was significantly less than both monopolar coagulation at all power settings and monopolar cut at 30W and 40W (all p <.01), at 5W was also significantly less than monopolar cut at 10W (p = .03), and at 15W was significantly less than monopolar coagulation at 40W (p = .001). Incision depth of the laser at 5W was significantly less than monopolar coagulation at 40W and laser at 15W (both p = .01), at 15W was significantly greater than monopolar coagulation at 10W and monopolar cut at 10, 20, and 30W (p ≤.01), and increased proportional to power for all 3 energy types. Collateral thermal damage width at all laser power settings was significantly less than at all monopolar coagulation power settings (p ≤.04) with the exception of the laser at 15W compared with monopolar coagulation at 10W (p = .30), and at all laser power settings was significantly less than at all monopolar coagulation power settings (p <.001). Collateral thermal damage depth of the laser at 5W and 10W was significantly less than monopolar cut at 30W (p ≤.002) and increased proportional to power in monopolar coagulation mode but remained constant with the laser. Incising efficiency of the laser at 5W was significantly greater than monopolar coagulation at 10W (p = .04), at 10W was significantly greater than at all monopolar power settings (p ≤.007) except cut at 40W (p = .29), and at 15W was significantly greater than that of every other energy type and power setting tested (p ≤.04). These findings support the hypothesis that CO2 laser energy delivered via a flexible fiber system would exhibit greater surgical precision than monopolar electrosurgery, in both cut and coagulation modes, as defined by 3 parameters: incising efficiency, changes in incision depth compared with width as power increases, and variability in the resulting incision measurements. Because increased thermal damage has been associated with delayed tissue necrosis and adhesion formation, these findings prompt the design of a comparative survival animal study to assess additional clinically relevant parameters.