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Laparoscopic retropubic culposuspension
Selected Scientific Abstracts
survey. Inclusion criteria were a primary diagnosis of menorrhagia, premenopausal status, normal endometrial biopsy, and uterine size less than 12 weeks. Outcome criteria were estimated blood loss, operative time and complications, length of hospital stay, work lost, perceived change in work and leisure, and successful treatment of menorrhagia. Statistical analysis was performed using Z2 and unpaired t test. Study and control populations were similar, with no statistically significant differences in age, presence of fibroids, nulliparity, duration of follow-up, or obesity. The ablation group had significantly shorter operating time, less blood loss, shorter hospital stay, and fewer days of work lost. Complication rates were similar between the two groups. Ablation was successful in treating menorrhagia in 86% of patients and hysterectomy in 100% (p <0.05). Three women underwent an additional hysteroscopic procedure, and subsequent success was 93 % for ablation versus 100% for hysterectomy (NS). The study is currently being expanded and will include a total of 120 patients.
tionnaire was 92%. Postoperative detrusor symptomology was 17%. No significant operative or postoperative complications occurred. Enterocele recurred in two patients and required correction by sacral culpopexy. Results in this series are comparable with or better than existing data on traditional open procedures, and report significantly lower morbidity.
Unusual Ureteric Complication after Laparoscopic Hysterectomy P Maher, C Wood, M Pelosi. Melbourne Gynoscopy Centre, Melbourne, Victoria, Australia.
The risk of ureteric trauma was reported to be increased risk during laparoscopic hysterectomy. Therefore, we passed ureteric catheters in 92 procedures, but ceased the practice when further reports suggested no increased risk of ureteric trauma. Oliguria and anuria occurred in 7 of 92 women undergoing ureteric catheterization. No ureteric trauma occurred in over 400 patients having laparoscopic hysterectomy without ureteric catheterization. Provided surgical techniques incorporate various procedures to avoid ureteric injury, routine ureteric catheterization during laparoscopic hysterectomy is not indicated.
LaparoscopicMyomectomy in Pregnancy D Luxman, JR Cohen, MP David. Department of Obstetrics and Gynecology "B," Serlin Maternity Hospital, Sourasky Medical Center, Tel Aviv, Israel.
LaparoscopicManagement of Benign Ovarian Dermoid Cysts
Pregnancy is generally considered a strong relative or absolute contraindication to laparoscopic surgery. Nevertheless, various pelvic and abdominal operations in gravid patients have been carried out successfully by laparoscopy, including cholecystectomy, appendectomy, and adnexal cystectomy. We recently performed laparoscopic extirpation of an 8-cm, twisted, pedunculated, subserous m y o m a in a 28-year-old woman at 15 weeks' estimated gestation. To the best of our knowledge, this is the first report of its kind.
PR Mangeshikar. Center for Gynecological Endoscopic Surgery, Bombay, India.
Between January 1988 to March 1995, 97 women underwent laparoscopic surgery for dermoid cysts of the ovary. The cysts were bilateral in seven women. The 104 cysts were between 4 and 20 cm in diameter (mean 7 cm), and were decompressed deliberately before enucleation or removal of the ovary. Spillage of cyst contents was not a concern since the pelvis was repeatedly lavaged with warm Ringer's lactate solution. Enucleation of 76 dermoids was performed using the vector of forces of the grasping forceps through a 5-mm short Hunt-Reich cannula (Apple) aided by aquadissection. Unilateral or bilateral adnexectomy or ovariectomy was performed in 28 women with sequential bipolar coagulation-scissor dissection and/or endosuturing techniques. Removal of the cysts or ovaries was accomplished either by traction through the 11m m cannula or through the culdotomy incision using the CCL vaginal extractor (Karl Storz). The ovary was preserved in 76 (73.1%) of 104 cysts.
Laparoscopic Retropubic Culposuspension TL Lyons. Center for Women's Care and Reproductive Surgery, Atlanta, GA.
The retropubic approach to urinary stress incontinence is acknowledged as the most effective surgical technique for this extremely common malady. Minimally invasive methods of performing this procedure have been developed in the last 3 years in an attempt to replicate the Butch procedure and its attendant efficacy. We performed the Burch procedure on 100 women and followed them for a minimum of 1 year. Clinical success determined by patient ques-
$28
survey. Inclusion criteria were a primary diagnosis of menorrhagia, premenopausal status, normal endometrial biopsy, and uterine size less than 12 weeks. Outcome criteria were estimated blood loss, operative time and complications, length of hospital stay, work lost, perceived change in work and leisure, and successful treatment of menorrhagia. Statistical analysis was performed using Z2 and unpaired t test. Study and control populations were similar, with no statistically significant differences in age, presence of fibroids, nulliparity, duration of follow-up, or obesity. The ablation group had significantly shorter operating time, less blood loss, shorter hospital stay, and fewer days of work lost. Complication rates were similar between the two groups. Ablation was successful in treating menorrhagia in 86% of patients and hysterectomy in 100% (p <0.05). Three women underwent an additional hysteroscopic procedure, and subsequent success was 93 % for ablation versus 100% for hysterectomy (NS). The study is currently being expanded and will include a total of 120 patients.
tionnaire was 92%. Postoperative detrusor symptomology was 17%. No significant operative or postoperative complications occurred. Enterocele recurred in two patients and required correction by sacral culpopexy. Results in this series are comparable with or better than existing data on traditional open procedures, and report significantly lower morbidity.
Unusual Ureteric Complication after Laparoscopic Hysterectomy P Maher, C Wood, M Pelosi. Melbourne Gynoscopy Centre, Melbourne, Victoria, Australia.
The risk of ureteric trauma was reported to be increased risk during laparoscopic hysterectomy. Therefore, we passed ureteric catheters in 92 procedures, but ceased the practice when further reports suggested no increased risk of ureteric trauma. Oliguria and anuria occurred in 7 of 92 women undergoing ureteric catheterization. No ureteric trauma occurred in over 400 patients having laparoscopic hysterectomy without ureteric catheterization. Provided surgical techniques incorporate various procedures to avoid ureteric injury, routine ureteric catheterization during laparoscopic hysterectomy is not indicated.
LaparoscopicMyomectomy in Pregnancy D Luxman, JR Cohen, MP David. Department of Obstetrics and Gynecology "B," Serlin Maternity Hospital, Sourasky Medical Center, Tel Aviv, Israel.
LaparoscopicManagement of Benign Ovarian Dermoid Cysts
Pregnancy is generally considered a strong relative or absolute contraindication to laparoscopic surgery. Nevertheless, various pelvic and abdominal operations in gravid patients have been carried out successfully by laparoscopy, including cholecystectomy, appendectomy, and adnexal cystectomy. We recently performed laparoscopic extirpation of an 8-cm, twisted, pedunculated, subserous m y o m a in a 28-year-old woman at 15 weeks' estimated gestation. To the best of our knowledge, this is the first report of its kind.
PR Mangeshikar. Center for Gynecological Endoscopic Surgery, Bombay, India.
Between January 1988 to March 1995, 97 women underwent laparoscopic surgery for dermoid cysts of the ovary. The cysts were bilateral in seven women. The 104 cysts were between 4 and 20 cm in diameter (mean 7 cm), and were decompressed deliberately before enucleation or removal of the ovary. Spillage of cyst contents was not a concern since the pelvis was repeatedly lavaged with warm Ringer's lactate solution. Enucleation of 76 dermoids was performed using the vector of forces of the grasping forceps through a 5-mm short Hunt-Reich cannula (Apple) aided by aquadissection. Unilateral or bilateral adnexectomy or ovariectomy was performed in 28 women with sequential bipolar coagulation-scissor dissection and/or endosuturing techniques. Removal of the cysts or ovaries was accomplished either by traction through the 11m m cannula or through the culdotomy incision using the CCL vaginal extractor (Karl Storz). The ovary was preserved in 76 (73.1%) of 104 cysts.
Laparoscopic Retropubic Culposuspension TL Lyons. Center for Women's Care and Reproductive Surgery, Atlanta, GA.
The retropubic approach to urinary stress incontinence is acknowledged as the most effective surgical technique for this extremely common malady. Minimally invasive methods of performing this procedure have been developed in the last 3 years in an attempt to replicate the Butch procedure and its attendant efficacy. We performed the Burch procedure on 100 women and followed them for a minimum of 1 year. Clinical success determined by patient ques-
$28