Lynne Chapman

The mini-resectoscope: A new instrument for office hysteroscopic surgery

Background. Outpatient hysteroscopy has become well‐established for the investigation abnormal uterine bleeding. Although “See and Treat” clinics have been widely introduced, the types of procedures offered are limited, and many patients with intrauterine pathology continue to be admitted as in‐patients for hysteroscopic surgery. We wanted to investigate the feasibility and acceptability of surgery for small intrauterine lesions without the need for general anesthesia by using a miniature resectoscope. Methods. This was a prospective observational study on 30 women with abnormal uterine bleeding associated with endometrial polyps or small (<3 cm) type 0 or 1 submucous fibroids. Hysteroscopic polypectomy (n = 26) or myomectomy (n = 4) was carried out using a 16 Fr gauge mini‐resectoscope. Results. Ten procedures were carried out in the outpatient clinic and 20 in the operating theatre. Sixteen procedures were done without any anaesthesia and 14 after intra‐cervical local anesthetic injections. The polyps and fibroids ranged in size from 1 to 5 cm, and all procedures took less than 15 minutes from the time the vagina was instrumented to the end of surgery. All procedures were completed successfully and were well tolerated with little discomfort. There were no complications. Conclusions. The mini‐resectoscope appears to be an efficient and acceptable instrument for hysteroscopic surgery and can be used without general anesthesia for minor procedure such as polypectomy and the resection of small submucous fibroids.

Currently available devices for female sterilization

Sterilization is now the method of family planning most commonly used in the world. Over the last 150 years, research has evolved in the search for the ideal method of female sterilization. The procedure should ideally have high efficacy, be readily accessible and be personally and culturally acceptable. The method should be simple, quick, easily learned and be able to be performed in an outpatient setting without general anesthesia. The most common and effective method for sterilization has, thus far, been via the laparoscopic route. Hysteroscopic sterilization, however, potentially fulfills many of these ideal criteria, but until recently has remained more of a concept than a reality.

Where is the aorta? Is it worth palpating the aorta prior to laparoscopy?

Background. Injury to major retroperitoneal vessels is the most catastrophic complication of laparoscopy. Knowledge of the site of the aortic bifurcation prior to inserting the umbilical port would be expected to reduce the risk of this type of injury. The aim of the study is to determine the feasibility of identifying the aortic bifurcation by palpation prior to the operation. Methods. We studied 100 patients undergoing laparoscopic surgery or laparotomy. After prepping and draping, the operating surgeon felt for the aortic bifurcation to determine its position in relation to the umbilicus. We then related our findings to the height, weight, and body mass index of the patient. Results. The aorta could not be palpated in 15% of cases, including almost 2/3 of women who were obese (body mass index >30). In the remaining 85% cases, where the aorta was palpable, the bifurcation was above the level of the umbilicus in 30 (35%) cases, at the umbilicus in 45 (53%) cases, and below in 10 (12%) cases. We did not find any significant effect of body mass index, height, or weight on the level of the aortic bifurcation by palpation. No vascular injury occurred in the laparoscopic cases during the study. Conclusions. The aortic bifurcation is palpable in the majority of women undergoing surgery, including 93% of those with a low or normal body mass index who are at higher risk of vascular injury. We recommend the routine palpation for the aortic bifurcation as a simple means to reduce the risk of injury to a major retroperitoneal vessel.