M. Erian

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.

Laparoscopic appendectomy in modern gynecology

Gynecologists frequently manage women with acute or chronic pain in the right iliac fossa. Appendicitis is one of the common conditions encountered in this setting. From the gynecologic perspective, issues regarding the role of laparoscopic appendectomy include radioimaging and laparoscopic diagnosis, operative technique, advantages and disadvantages, and laparoscopic appendectomy in pregnancy and in complicated appendicitis. Most studies are in favor of the procedure, and it seems reasonable to include it in training programs in gynecology.

Transcervical endometrial resection

STUDY OBJECTIVES To determine the safety and efficacy of endometrial resection, and to provide an indicator of the operative problems and treatment outcomes. DESIGN Prospective study. SETTING Academic practice tertiary care setting. PATIENTS One hundred twenty-six consecutive women undergoing endometrial resection because of menorrhagia, who wished to retain their uterus. INTERVENTION Hysteroscopic endometrial resection performed as a day procedure. MEASUREMENTS AND MAIN RESULTS In 126 women, 2 cases of uterine perforation were readily identified on the operating monitor screen; they had no serious sequelae. Three patients had heavy uterine bleeding, which was controlled by intrauterine tamponade. No women had other serious complications. CONCLUSION Hysteroscopic endometrial resection is a safe, successful, and cost-effective treatment of menorrhagia.

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.

UNUSUAL CONTENTS OF A DERMOID CYST OF THE OVARY REMOVED BY LAPAROSCOPY

Summary: Benign cystic teratoma (dermoid cyst) of the ovary is a common pathological entity. Usually, the cyst contains representative tissues of the 3 embryonic germ cell layers: ectoderm, mesoderm and endoderm. Sebaceous material, hairs, cartilages, teeth, even thyroid tissue are frequently observed. In this case, the tumour was a well‐formed jaw and tongue, and was successfully removed via the laparoscope.

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.

A new laparoscopic aspiration technique for ovarian dermoid cysts

A new method for aspirating benign dermoid cysts enables removal of the collapsed cyst wall without the need for extending laparoscopic incisions or opening the pouch of Douglas. The technique has been used by one of the authors in 10 patients with good effect and minimal or no spillage of dermoid cyst contents into the peritoneal cavity.

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).

Notable Points from the Recent Literature

GYNAECOLOGY Endometrial Thickness The measurement of endometrial thickness with vaginal ultrasound has found several applications in gynaecology. In premenopausal women endometrial thickness may be useful in the detection of abnormal pregnancies. The initial endometrial stripe thickness measured in patients with an ectopic pregnancy is significantly thinner than in those with an intrauterine pregnancy ( I ). In women undergoing ovulation induction with HMG a periovulatory endometrial thickness 210 mm was seen in 91% of conception cycles. No pregnancy occurred when the endometrium measured <7 mm (2). On IVF programmes embryo implantation, clinical and ongoing pregnancy rates were significantly higher in patients with an endometrial thickness >9 mm at the time of embryo transfer (3). In a study of 118 women with postmenopausal bleeding a histopathological diagnosis of atrophic endometrium corresponded to an endometrial thickness of 3.1 * 1.7 mm. The measurement in endometrial carcinoma was 18.4 + 8.2 mm, and no endometrial carcinoma was diagnosed if the endometrial thickness was 56 mm (4).