Y Sato

A Prospective Randomized Study Comparing Endocrinological and Clinical Effects of Two Types of GnRH Agonists in Cases of Uterine Leiomyomas or Endometriosis

Objective: In order to assess the endocrinological changes associated with 2 types of low‐dose GnRH agonists depot as well as their clinical efficacy, we performed a randomized prospective comparison study of patients having uterine leiomyomas or endometriosis.

Pathological study of Fitz-Hugh-Curtis syndrome evaluated from fallopian tube damage

Aim:  To analyze the causative pathogen, surgical indication and fallopian tube damages in Fitz–Hugh–Curtis syndrome (FHCS) cases diagnosed by laparoscopy.

Comparison of anesthetic methods for microlaparoscopy in women with unexplained infertility.

STUDY OBJECTIVE To evaluate the effectiveness of ketamine compared with fentanyl as analgesia or sedation for microlaparoscopy. DESIGN Prospective, randomized study (Canadian Task Force classification I). SETTING University-affiliated hospital. PATIENTS Forty-one infertile women. INTERVENTIONS Twenty-one patients were randomly assigned to have analgesia with fentanyl and 20 sedation with ketamine during microlaparoscopy. Maximum doses were 0.2 and 200 mg, respectively. Local anesthesia was provided with 0.25% bupivacaine 5 ml injected into cannula sites. MEASUREMENTS AND MAIN RESULTS Abnormal findings such as endometriosis and periadnexal adhesions were identified in 24 patients. Ablation, coagulation, and adhesiolysis were easily performed in 14 (82.4%) of 17 women receiving ketamine, but difficulties were encountered in operating on 16 patients receiving fentanyl. Ketamine was administered to 10 patients (47.6%) in the fentanyl group because anxiety and pain were not sufficiently controlled by fentanyl. There were no significant differences in visual analog scale scores and recovery time between groups. On questionnaire, 19 (95%) of 20 patients receiving ketamine indicated they would choose the same anesthesia again if offered, compared with only 4 (19%) of 21 receiving fentanyl (p <0.001). CONCLUSION Microlaparoscopy in infertile women was performed more effectively under sedation with ketamine than with fentanyl.

A novel method of ninth-intercostal microlaparoscopic approach for patients with previous laparotomy

Background. To evaluate the availability of a primary laparoscopic approach for a patient with previous laparotomy and to assess postoperative adhesion to the abdominal wall. Methods. A total of 172 patients with a history of laparotomy who were undergoing laparoscopic surgery in our hospital were evaluated. The primary trocar insertion was performed via the ninth‐intercostal microlaparoscopic approach for these patients. Results. This procedure could be performed on all patients and there were no complications. Postoperative abdominal wall adhesion was found in 53 (30.8%) of 172 patients, and periumbilical adhesion was found in 16 patients (9.3%). Among the 172 patients, 150, 19, and three patients had undergone laparotomy once, twice, and thrice, respectively, prior to this study. Considering the number of previous laparotomies, the frequency of periumbilical adhesion was 5.3% (eight of 150 patients), 36.8% (seven of 19 patients), and 33.3% (one of three patients), respectively. Among 150 patients who had undergone laparotomy once, the type of laparotomy was an obstetric‐and‐gynecologic surgery in 126 patients and other surgeries in 24 patients. There was no significance in the frequency of adhesion between types of previous laparotomies. Surgical incisions were classified as median infra‐umbilical incision (94 patients), median supra‐umbilical incision (three patients), Pfannenstiels incision (33 patients), para‐rectal incision (15 patients), and peri‐rectal incision (five patients). A high frequency of periumbilical adhesion was recognized in the all three median supra‐umbilical incisions. Conclusion. Ninth‐intercostal microlaparoscopic approach is safe for laparoscopic surgery in patients who have undergone laparotomy previously, and this procedure could prevent the risk of bowel injury.

Accurate preoperative diagnosis and laparoscopic removal of the cavitated non-communicated uterine horn for obstructive Mullerian anomalies

Obstructive Mullerian anomalies cause severe dysmenorrhea following menarche as a result of disturbed menstrual outflow. Therefore, surgical management such as extirpation of the obstructive uterine horn is required for treatment of these patients. It is necessary to have a detailed understanding of the pathological conditions of the pelvic organs and urinary system prior to surgery. We report three cases of reproductive, nulligravid patients diagnosed as having obstructive Mullerian anomalies. Preoperative accurate diagnosis was obtained by magnetic resonance imaging (MRI) and 3‐D computed tomography (CT) angiography. Laparoscopic resection of the rudimentary uterine horn was performed safely and completely, and resolved all problems. MRI and 3‐D CT angiography are useful tools for diagnosing complex Mullerian anomalies, and operative laparoscopy may be an alternative treatment for these cases.