- Email: [email protected]
Lateral heat spread with bipolar diathermy during laparoscopic hysterectomy
Selected Scientific Abslracts
and subsequent hysterectomy rates. A response rate of over 90% was achieved during follow-up of 9 to 67 months. No major operative morbidity occurred, and there were no cases of hemorrhage or transfusion, no uterine perforations with the operating instruments, and no immediate laparotomies or hysterectomies. Patient satisfaction rate was over 85% and the subsequent hysterectomy rate remains under 8%. In conclusion, with or without submucous fibroids, endometrial laser ablation was a consistently successful and safe treatment for dysfunctional uterine bleeding.
min) and the mean hospital stay was 1.48 days (range 1-5 days). Ninety-five patients returned to work within 2 weeks. Hysterectomy by the laparoscopic route may be performed safely in private and academic hospitals as long as one surgeon is experienced and has appropriate credentialing and training.
Bipolar Coagulation of Laparoscopic Leiomyomata DR Phillips. Department of Gynecologic Endoscopy and Laser Surgery, South Nassau Communities Hospital, Oceanside, NY, and Department of Obstetrics and Gynecology, School of Medicine, State University of New York at Stony Brook, Stony Brook, New York.
Lateral Heat Spread With Bipolar Diathermy During Laparoscopic Hysterectomy
From February 1992 through March 1995, 167 women (age 22-52 yrs, mean 44.7 yrs) with symptomatic leiomyomas underwent laparoscopic leiomyoma bipolar coagulation (myolysis). Women with chronic menorrhagia had concomitant transcervical endomyometrial resection (TEMR) and resection of any existing submucous leiomyomas. Depot leuprolide acetate was administered for 3 months before surgery to 165 (98.8%) of the women. Mean followup was 26.2 months (range 6-37 mo). The operations were evaluated in terms of number and type of concomitant procedures, whether or not symptoms were controlled, and changes in uterine and leiomyomata volumes. Nineteen participants (11.4%) had elective second-look laparoscopy 6 months postoperatively. Four women (2.4%) later complained of recurring symptoms; three subsequently had hysterectomies that revealed extensive adenomyosis in one uterus and numerous large leiomyomas not previously treated by myolysis in two. Of 52 women with chronic menorrhagia, 33 (63.5%) developed amenorrhea, 17 (32.7%) had hypomenorrhea or eumenorrhea, and 2 (3.8%) required repeat TEMR. Mean total uterine volume decreased from 623 cm 3 (before leuprolide treatment) to 139 cm 3 (77.7% reduction) 7 to 12 months postoperatively (p <0.0001).
AG Phillips. Women's Endoscopic Laser Foundation, South Cleveland Hospital, Middlesbrough, and St. James's Hospital, Leeds, United Kingdom.
Concern has been expressed regarding the potential risks of using bipolar diathermy to desiccate the uterine artery in the region of the ureter during laparoscopic hysterectomy. A study was carried out using thermocouples to assess heat transfer around the uterine and ovarian vessels as they are secured with bipolar diathermy using the ERBE electrosurgical generator with its autostop facility. This detects rising tissue impedance as the tissues are desiccated and automatically shuts offpower. We found that slight rises in temperature do occur adjacent to the ureter, but they are insufficient to cause thermal necrosis of the ureter when correct, safe surgical technique is used.
Laparoscopic Hysterectomy and Its Variations in Private and Academic Hospitals DR Phillips. Department of Gynecologic Endoscopy and Laser Surgery, South Nassau Communities Hospital, Oceanside, NY, and Department of Obstetrics and Gynecology, School of Medicine, State University of New York at Stony Brook, Stony Brook, New York.
From July 1990 to August 1994 1 performed 100 laparoscopic hysterectomies and variations in 17 private and academic institutions. Bipolar coagulation was used exclusively in 22 cases, Endo GIA 30 exclusively in 58, and a combination of the two in 20. Bilateral ureteral catheters were used 49 times. Of the 108 hysterectomies attempted, 8 were converted to laparotomy. Five complications occurred: two transfusions, two transient febrilities, and one Richter hernia. The repair of the hernia was the only delayed laparotomy. Mean operating time was 123 minutes (range 45-235
LaparoscopicManagement of Heterotopic Pregnancies GA Pistofidis, MJ Mastrominas, K Dimitropoulos. Fertility Centre, Mitera Hospital, Athens, Greece.
The frequency of heterotopic pregnancy after in vitro fertilization (IVF) is reportedly as high as 2.9%. Early management is of paramount importance for both the safety of the mother and the continuation of the intrauterine gestation. We reviewed four cases of
$42
and subsequent hysterectomy rates. A response rate of over 90% was achieved during follow-up of 9 to 67 months. No major operative morbidity occurred, and there were no cases of hemorrhage or transfusion, no uterine perforations with the operating instruments, and no immediate laparotomies or hysterectomies. Patient satisfaction rate was over 85% and the subsequent hysterectomy rate remains under 8%. In conclusion, with or without submucous fibroids, endometrial laser ablation was a consistently successful and safe treatment for dysfunctional uterine bleeding.
min) and the mean hospital stay was 1.48 days (range 1-5 days). Ninety-five patients returned to work within 2 weeks. Hysterectomy by the laparoscopic route may be performed safely in private and academic hospitals as long as one surgeon is experienced and has appropriate credentialing and training.
Bipolar Coagulation of Laparoscopic Leiomyomata DR Phillips. Department of Gynecologic Endoscopy and Laser Surgery, South Nassau Communities Hospital, Oceanside, NY, and Department of Obstetrics and Gynecology, School of Medicine, State University of New York at Stony Brook, Stony Brook, New York.
Lateral Heat Spread With Bipolar Diathermy During Laparoscopic Hysterectomy
From February 1992 through March 1995, 167 women (age 22-52 yrs, mean 44.7 yrs) with symptomatic leiomyomas underwent laparoscopic leiomyoma bipolar coagulation (myolysis). Women with chronic menorrhagia had concomitant transcervical endomyometrial resection (TEMR) and resection of any existing submucous leiomyomas. Depot leuprolide acetate was administered for 3 months before surgery to 165 (98.8%) of the women. Mean followup was 26.2 months (range 6-37 mo). The operations were evaluated in terms of number and type of concomitant procedures, whether or not symptoms were controlled, and changes in uterine and leiomyomata volumes. Nineteen participants (11.4%) had elective second-look laparoscopy 6 months postoperatively. Four women (2.4%) later complained of recurring symptoms; three subsequently had hysterectomies that revealed extensive adenomyosis in one uterus and numerous large leiomyomas not previously treated by myolysis in two. Of 52 women with chronic menorrhagia, 33 (63.5%) developed amenorrhea, 17 (32.7%) had hypomenorrhea or eumenorrhea, and 2 (3.8%) required repeat TEMR. Mean total uterine volume decreased from 623 cm 3 (before leuprolide treatment) to 139 cm 3 (77.7% reduction) 7 to 12 months postoperatively (p <0.0001).
AG Phillips. Women's Endoscopic Laser Foundation, South Cleveland Hospital, Middlesbrough, and St. James's Hospital, Leeds, United Kingdom.
Concern has been expressed regarding the potential risks of using bipolar diathermy to desiccate the uterine artery in the region of the ureter during laparoscopic hysterectomy. A study was carried out using thermocouples to assess heat transfer around the uterine and ovarian vessels as they are secured with bipolar diathermy using the ERBE electrosurgical generator with its autostop facility. This detects rising tissue impedance as the tissues are desiccated and automatically shuts offpower. We found that slight rises in temperature do occur adjacent to the ureter, but they are insufficient to cause thermal necrosis of the ureter when correct, safe surgical technique is used.
Laparoscopic Hysterectomy and Its Variations in Private and Academic Hospitals DR Phillips. Department of Gynecologic Endoscopy and Laser Surgery, South Nassau Communities Hospital, Oceanside, NY, and Department of Obstetrics and Gynecology, School of Medicine, State University of New York at Stony Brook, Stony Brook, New York.
From July 1990 to August 1994 1 performed 100 laparoscopic hysterectomies and variations in 17 private and academic institutions. Bipolar coagulation was used exclusively in 22 cases, Endo GIA 30 exclusively in 58, and a combination of the two in 20. Bilateral ureteral catheters were used 49 times. Of the 108 hysterectomies attempted, 8 were converted to laparotomy. Five complications occurred: two transfusions, two transient febrilities, and one Richter hernia. The repair of the hernia was the only delayed laparotomy. Mean operating time was 123 minutes (range 45-235
LaparoscopicManagement of Heterotopic Pregnancies GA Pistofidis, MJ Mastrominas, K Dimitropoulos. Fertility Centre, Mitera Hospital, Athens, Greece.
The frequency of heterotopic pregnancy after in vitro fertilization (IVF) is reportedly as high as 2.9%. Early management is of paramount importance for both the safety of the mother and the continuation of the intrauterine gestation. We reviewed four cases of
$42