Glenda McLaren

Reducing costs of laparoscopic hysterectomy

STUDY OBJECTIVE To establish the role of laparoscopic hysterectomy using reuseable surgical equipment. DESIGN Prospective, observational study (Canadian Task Force classification II-2). SETTING Tertiary major teaching hospital. PATIENTS Fifty consecutive women carefully selected for laparoscopic hysterectomy. INTERVENTIONS The ultrasonically activated (harmonic) scalpel was used for coagulative cutting of pedicles and ligaments attached to the uterus and adnexa, backed by bipolar diathermy. No nonabsorbable material was left in the pelvis at the conclusion of the procedures. MEASUREMENTS AND MAIN RESULTS Patient characteristics, uterine weight, histology, operating time, recovery, analgesic requirements, and hospital stay were recorded. Complications were noted and critically assessed for constructive quality assurance appraisal. Outcomes were satisfactory according to both patients and gynecologists. CONCLUSION This pilot study suggests that the method is an efficacious, cost-effective, and well-controlled technique of laparoscopic hysterectomy.

Advanced hysteroscopic surgery training.

Hysteroscopic surgery is pivotal in management of many gynecological pathologies. The skills required for performing advanced hysteroscopic surgery (AHS), eg, transcervical hysteroscopic endometrial resection (TCRE), hysteroscopic polypectomy and myomectomy in the management of menorrhagia, hysteroscopic septulysis in fertility-related gynecological problems and hysteroscopic removal of chronically retained products of conception and excision of intramural ectopic pregnancy ought to be practiced by contemporary gynecological surgeons in their day-to-day clinical practice. AHS is a minimally invasive procedure that preserves the uterus in most cases. Whilst the outcome is of paramount importance, proper training should be adopted and followed through so that doctors, nurses, and institutions may deliver the highest standard of patient care.

Be wary of “natural” therapy in gynecological surgery

It is estimated that more than 4 billion people throughout the world use natural herbs for some aspect of primary health care. These over-the-counter medications, commonly referred to as “complementary and alternative medicines,” despite their proposed health benefits, may have serious and potentially fatal side effects. This paper presents the case of a patient who underwent a gynecological operation and suffered heavy postoperative bleeding as a result of her taking large doses of oral raw garlic in the weeks prior to her operation and discusses the issue of patients’ perioperative intake of herbal supplements. To our knowledge, this is the first paper to demonstrate the relationship between a natural therapy and postoperative bleeding in gynecological surgery. The patient presented with severe postoperative bleeding following a routine, unremarkable vaginal hysterectomy. The bleeding required a multidisciplinary management intervention involving gynecological surgeons, general surgeons, oncology surgeons, hematologists, anesthetists, and intensive care unit specialists. After careful history taking (unfortunately, undertaken postoperatively), it was unanimously agreed that the postoperative hemorrhage was due to the patient’s excessive preoperative oral ingestion of raw garlic. The case and brief literature review presented in this paper concern an area of paucity in gynecological surgery and highlight the relationship between a commonly taken over-the-counter herbal medication and postoperative hemorrhage.

The wandering Mirena: laparoscopic retrieval.

Levonorgestrel-containing intrauterine contraceptive devices may be involved with uterine perforation. The authors note that an experienced gynecological laparoscopist should be able to safely remove an intraperitoneal device without complication.

Advanced hysteroscopic surgery: quality assurance in teaching hospitals

Advanced hysteroscopic surgery (AHS) is a vitally important technique in the armamentarium for the management of many day-to-day clinical problems, such as menorrhagia, surgical excision of uterine myomata and septa in the management of female infertility, hysteroscopic excision of chronically retained products of conception (placenta accreta), and surgical removal of intramural ectopic pregnancy. In todays climate of accountability, it is necessary that gynecologists take a more active role in assuring the quality of their work. In this article, we discuss the quality assurance system from the point of view of the surgical audit meetings in some of the major teaching hospitals affiliated with the University of Queensland (Brisbane, Queensland, Australia).

Current Practices in the Management of Cervical Intraepithelial Neoplasia in Australia

Summary: Responses from 181 returned questionnaires (from members of the Australian Society for Colposcopy and Cervical Pathology) regarding the management of cervical intraepithelial neoplasia (CIN) were analysed. The preferred methods of ablation of CIN were laser treatment and electrocoagulation diathermy. Diathermy of lesions was more commonly used by older respondents and those in provincial centres. Fifty‐percent of those surveyed used a combination of local and general anaesthesia for ablation of CIN; 30% used either local or general anaesthesia but 15% reported no use of anaesthesia.