Camran Nezhat

Laparoscopic treatment of infiltrative rectosigmoid colon and rectovaginal septum endometriosis by the technique of videolaparoscopy and the CO2 laser

Objective To present the technique and results of videolaparoscopy and the CO, laser as a treatment for deep, infiltrative endometriosis of the rectovaginal septum, uterosacral ligaments, pouch of Douglas and anterior wall of the rectosigmoid colon.

Laparoscopic Treatment of Obstructed Ureter Due to Endometriosis by Resection and Ureteroureterostomy: A Case Report

AbstractPartial ureteral resection and ureteroureterostomy were accomplished using operative laparoscopy in a 36-year-old woman with a long-standing history of endometriosis, left ureteral obstruction and nephrostomy.

Laparoscopic disk excision and primary repair of the anterior rectal wall for the treatment of full-thickness bowel endometriosis.

We used a new laparoscopic technique to treat infiltrative symptomatic intestinal endometriosis. Eight women, ages 29–38, with extensive symptomatic pelvic endometriosis were included in this series. All were diagnosed as having severe pelvic endometriosis and had not responded to previous conservative surgical and hormonal therapy. In a 5–18-month postoperative followup, six women have reported complete relief of the symptoms. Two have right lower quadrant pain and menstrual cramping. Second-look laparoscopy was offered to all patients and so far, two have accepted. These procedures were performed 6 weeks postoperatively. At that surgery, we found that the anastomotic site had healed completely with filmy adhesions between the posterior aspect of the uterus and the rectosigmoid colon in one patient. The second woman had undergone extensive adhesiolysis at the first surgery, and these adhesions recurred; however, the anastomotic site had healed completely. One of the two infertility patients has achieved pregnancy. The only complication was one patient with ecchymosis of the anterior abdominal wall. Sigmoidoscopy was performed 6 weeks postoperatively, and has been or will be performed at 6 months postoperatively. To date, all anastomotic sites have healed well with no sign of stricture. Our results with this technique in a small series were positive, and it appears that, in the hands of experienced laparoscopists, it may prove useful in treating symptomatic infiltrative endometriosis.

A simplified method of laparoscopic presacral neurectomy for the treatment of central pelvic pain due to endometriosis.

Objective To describe optimal procedures and preliminary results for videolaparo‐scopic presacral neurectomy as part of the surgical treatment of endometriosis associated with intractable dysmenorrhoea.

Operative laparoscopy for the treatment of ovarian remnant syndrome

OBJECTIVEnTo present the technique and assess the efficacy of operative laparoscopy to manage ovarian remnant syndrome.nnnDESIGNnObservational with a follow-up of 6 to 32 months.nnnSETTINGnPrivate subspecialty practice with a large referral base.nnnPATIENTSnThirteen women, 9 with previous bilateral salpingo-oophorectomy and 4 with previous unilateral salpingo-oophorectomy and pain on the ipsilateral side.nnnINTERVENTIONSnMultipuncture advanced operative laparoscopy.nnnMAIN OUTCOME MEASURESnPatient pain relief was assessed through return examinations, telephone interviews, or contact with referring physicians.nnnRESULTSnNine patients reported complete pain relief. One reported incomplete but satisfactory pain relief. Two required bowel resection by laparotomy to obtain pain relief, and one, despite subsequent laparotomy, had persistent pain. No intraoperative or postoperative complications were noted.nnnCONCLUSIONnLaparoscopy can be effective in managing ovarian remnant syndrome when performed by an experienced laparoscopist.

Laparoscopic proctectomy for infiltrating endometriosis of the rectum

Proctectomy for deep endometriosis of the rectal wall was performed without laparotomy. Although laparoscopic pelvic surgery and transperineal proctectomy with primary double-stapled anastomosis are established procedures in gynecological and gastrointestinal surgery, this is the first reported case in which these procedures are combined to mobilize the rectum and perform an extracorporeal transanal rectal resection and anastomosis.

Laparoscopic treatment of symptomatic diaphragmatic endometriosis : a case report

Extreme caution and meticulous surgery are imperative when treating the surface of the diaphragm. This procedure should only be performed by an experienced laparoscopic surgeon after appropriate consultation with a cardiothoracic surgeon. Proper care, a thorough understanding of surrounding anatomic structures, and familiarity with laparoscopic instrumentation including the CO2 laser are required for the safe laser vaporization or excision of any peritoneal surface using hydrodissection (7).