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Endometrial ablation in the large uterus
August 1995, Vol. 2, No. 4. Supplement The Journal of the American Association of Gynecologic Laparoscopists
Laparoscopic Approach of Total Pelvic Prolapse
Endometrial Ablation in the Large Uterus
A Wattiez, M Canis, F Alexandre, C Pomel, S Bhoughizane, JL Pouly, G Mage, MA Bruhat. Polyclinique de I'Hotel Dieu, Universite de Clermont-Ferrand I, Clermont-Ferrand, France.
~T Whalen, 2RJ Gimpelson. Department of Obstetrics and Gynecology, St. John's Mercy Medical Center; 2St. Louis University School of Medicine, St. Louis, MO.
Of 758 endometrial ablations performed between May 1986 and September 1994, 29 were done on uteri sounding to 12 cm or more, or that were believed to be 12-week size or more on examination or pelvic ultrasound. This paper compares the results of endometrial ablation in the enlarged uterus with that of uteri less than 12 cm or 12-week size.
Total pelvic prolapse is still managed by laparotomy or the vaginal route. The choice is guided mainly by the extent of the disease and the age of the patient. Laparotomy is preferred in young patients and allows the placement of mesh. The vaginal route is reserved for older patients by many surgeons. Endoscopy has improved sufficiently to allow total laparoscopic treatment of this pathology. This has also been shown by our preliminary results with more than 30 cases, with follow-up of 6 months to 3 years.
A Comparison of 100 Laparoscopic-Assisted Doderlein Hysterectomies With 100 LaparoscopicAssisted Vagina[ Hysterectomies MD Whittaker, P Hercz, R Garry. Women's Endoscopic Laser Foundation, South Cleveland Hospital, Middlesbrough, and St. James's University Hospital, Leeds, United Kingdom.
Pelviscopic Leiomyoma Coagulation L Weather. Omni Fertility and Laser Institute, and Xavier University, New Orleans, LA.
The laparoscopic-assisted Doderlein approach to hysterectomy is a modification of laparoscopic-assisted vaginal hysterectomy (LAVH). Doderlein described his procedure in 1908 and Saye described the laparoscopic version (LAD) in 1992. We modified Saye's technique to a method that requires only reusable instruments and compared our last 100 standard LAVHs with 100 LADs. The LAD approach gave better protection to the urinary tract and more secure hemostasis with less risk of anemia or requiring a blood transfusion. In addition, it was performed more rapidly and was associated with earlier discharge from hospital than standard LAVH. Our results suggest that LAD hysterectomy is safer and quicker to perform than LAVH.
From February 1994 to February 1995 we reduced subserous and intramural leiomyomas by pelviscopic bipolar needle coagulation in 21 patients. The women all had symptomatic uterine leiomyomas that responded to pretreatment with either depot leuprolide or goserelin, and had no desire for childbearing. They were discharged the day of surgery from an ambulatory surgical center. A reduction in uterine size of 50% to 70% was realized, with no regrowth.
The Frequency of Endometriosis in the Pelviscopic Evaluation of Patients With Pelvic Pain and Large Pelvic Abdominal Masses L Weather. Omni Fertility and Laser Institute, and Xavier University, New Orleans, LA.
The Design, Development and Delivery of Interactive Computer-Based Learning Materials for Minimal-Access Gynecologic Surgery
From April 1989 to February 1995 we performed video laser operative pelviscopy to evaluate pelvic pain in 67 patients with abdominal pelvic masses size 16 weeks or greatm. The average mass was 19 weeks and the largest was 38 weeks. The procedures were done at an ambulatory surgical center and all patients were discharged the day of surgery. Endometriosis was found in 56 women (83.58%). Endometriosis should be considered in patients with large pelvic abdominal masses who complain of pelvic pain.
MD Whittaker, W Cooper. Women's Endoscopic Laser Foundation, South Cleveland Hospital, Middlesbrough, and St. James's University Hospital, Leeds, United Kingdom.
Interactive multimedia offer new opportunities for the production of computer-based learning materials for training large numbers of surgeons to perform minimal-access gynecologic surgery with maximum efficiency. Multimedia technology allows vast quantities of information, including text, graphics, audio, and full-screen television-quality video to be stored on
$59
Laparoscopic Approach of Total Pelvic Prolapse
Endometrial Ablation in the Large Uterus
A Wattiez, M Canis, F Alexandre, C Pomel, S Bhoughizane, JL Pouly, G Mage, MA Bruhat. Polyclinique de I'Hotel Dieu, Universite de Clermont-Ferrand I, Clermont-Ferrand, France.
~T Whalen, 2RJ Gimpelson. Department of Obstetrics and Gynecology, St. John's Mercy Medical Center; 2St. Louis University School of Medicine, St. Louis, MO.
Of 758 endometrial ablations performed between May 1986 and September 1994, 29 were done on uteri sounding to 12 cm or more, or that were believed to be 12-week size or more on examination or pelvic ultrasound. This paper compares the results of endometrial ablation in the enlarged uterus with that of uteri less than 12 cm or 12-week size.
Total pelvic prolapse is still managed by laparotomy or the vaginal route. The choice is guided mainly by the extent of the disease and the age of the patient. Laparotomy is preferred in young patients and allows the placement of mesh. The vaginal route is reserved for older patients by many surgeons. Endoscopy has improved sufficiently to allow total laparoscopic treatment of this pathology. This has also been shown by our preliminary results with more than 30 cases, with follow-up of 6 months to 3 years.
A Comparison of 100 Laparoscopic-Assisted Doderlein Hysterectomies With 100 LaparoscopicAssisted Vagina[ Hysterectomies MD Whittaker, P Hercz, R Garry. Women's Endoscopic Laser Foundation, South Cleveland Hospital, Middlesbrough, and St. James's University Hospital, Leeds, United Kingdom.
Pelviscopic Leiomyoma Coagulation L Weather. Omni Fertility and Laser Institute, and Xavier University, New Orleans, LA.
The laparoscopic-assisted Doderlein approach to hysterectomy is a modification of laparoscopic-assisted vaginal hysterectomy (LAVH). Doderlein described his procedure in 1908 and Saye described the laparoscopic version (LAD) in 1992. We modified Saye's technique to a method that requires only reusable instruments and compared our last 100 standard LAVHs with 100 LADs. The LAD approach gave better protection to the urinary tract and more secure hemostasis with less risk of anemia or requiring a blood transfusion. In addition, it was performed more rapidly and was associated with earlier discharge from hospital than standard LAVH. Our results suggest that LAD hysterectomy is safer and quicker to perform than LAVH.
From February 1994 to February 1995 we reduced subserous and intramural leiomyomas by pelviscopic bipolar needle coagulation in 21 patients. The women all had symptomatic uterine leiomyomas that responded to pretreatment with either depot leuprolide or goserelin, and had no desire for childbearing. They were discharged the day of surgery from an ambulatory surgical center. A reduction in uterine size of 50% to 70% was realized, with no regrowth.
The Frequency of Endometriosis in the Pelviscopic Evaluation of Patients With Pelvic Pain and Large Pelvic Abdominal Masses L Weather. Omni Fertility and Laser Institute, and Xavier University, New Orleans, LA.
The Design, Development and Delivery of Interactive Computer-Based Learning Materials for Minimal-Access Gynecologic Surgery
From April 1989 to February 1995 we performed video laser operative pelviscopy to evaluate pelvic pain in 67 patients with abdominal pelvic masses size 16 weeks or greatm. The average mass was 19 weeks and the largest was 38 weeks. The procedures were done at an ambulatory surgical center and all patients were discharged the day of surgery. Endometriosis was found in 56 women (83.58%). Endometriosis should be considered in patients with large pelvic abdominal masses who complain of pelvic pain.
MD Whittaker, W Cooper. Women's Endoscopic Laser Foundation, South Cleveland Hospital, Middlesbrough, and St. James's University Hospital, Leeds, United Kingdom.
Interactive multimedia offer new opportunities for the production of computer-based learning materials for training large numbers of surgeons to perform minimal-access gynecologic surgery with maximum efficiency. Multimedia technology allows vast quantities of information, including text, graphics, audio, and full-screen television-quality video to be stored on
$59