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Pregnancy outcome, and adhesion formation and reformation after laparoscopic cystectomy of ovarian endmetriomas
August 1996, Vd. 3, No. 4 Supplement The Journal of the American Association of Gynecologic Laparoscopists
by conscious sedation given by an on-site anesthesiologist. Lately, alternative methods of anesthesia including hypnosis and acupuncture have had some initial success. To date, we have performed 156 tubal ligations, 293 diagnostic laparoscopies, 151 treatments of endometriosis, 43 ovarian cyst aspirations, 29 adhesiolyses, 263 second-look procedures, 21 ectopic pregnancy removals, 198 diagnostic hysteroscopies, 64 endometrial biopsies, 20 fibroid resections, and 39 endometrial ablations. Patient response has been rewarding, thanks to decreased time off work, decreased cost of procedures to health insurance carriers, and immediate satisfaction from the diagnosis and treatment of their conditions.
adhesions, if present, were lysed. The ovarian cortex was closed with a few interrupted 6-0 polyglactin sutures using extracorporeal knot technique. A secondlook laparoscopy was performed in 25 patients to evaluate adhesion formation, reformation, postoperative crude pregnancy rates, and factors that would predict conception.
Reproductive Performance of Women with Uterine Anomalies after Abdominal or Hysteroscopic Metroplasty or no Surgical Treatment PK Heinonen. Department of Obstetrics and Gynecology, Tampere University Hospital and Medical School, Tampere, Finland.
The reproductive outcome of 404 women with confirmed uterine malformations was studied. The most common uterine anomaly was complete or incomplete septate uterus (48%). Bicornuate uterus was found in 17% of women, and unicornuate and didelphic both in 10%. The fetal survival rates without metroplasty were 70% for the partially bicornuate group, and 76% and 63% for the septate and subseptate groups, respectively. Metroplasty was performed in 64 (26%) of 247 women with a septate, subseptate, or partially bicomuate uterine abnormality. The indication for operation in most women was recurrent spontaneous abortions. Abdominal metroplasty (Strassmann or Jones procedure) was carried out in 12 (22%) of 55 women with a partially bicornuate uterus. Metroplasty was done in 52 (27%) of 192 women with a septate or subseptate uterus. Abdominal metroplasty (Jones or Tompkins procedure) was used in 20 patients, and transcervical metroplasty by means of hysteroscopic scissors or resectoscopic division in 32. In all, the reproductive outcome improved from 9% successful pregnancies before to 84% after metroplasty.
Cannula Wound Closure with the Laurus PC Suture Device GC Gunn. St. Jude Medical Center, Fullerton, CA.
The Laurus PC suturing device closes cannula wounds of 10 mm diameter and larger. It uses a special suture-needle combination that is double armed on either absorbable or nonabsorbable suture. One end of the suture is loaded into the device and placed through the wound into the peritoneal cavity. With a single push of a button, the needle is driven through the peritoneum and rectus fascia and is captured within the device, forming a suture loop. The device is withdrawn, reloaded with the other needle end of the suture and fired through the opposing side of the wound. The suture is tied and the skin is closed with adhesive strips. The closure time is less than 1 minute.
Pregnancy Outcome, and Adhesion Formation and Reformation after Laparoscopic Cystectomy of Ovarian Endmetriomas T Gurgan, H Yarali. Department of Obstetrics and Gynecology, Hacettepe University, Ankara, Turkey.
Trends in Oophorectomy by Laparoscopic versus Open Techniques
Unilateral or bilateral cystectomy for endometriomas was performed in 90 infertile women. Using a multipuncture technique, a cortical incision was made on the medial aspect of the ovary with sharp-tipped unipolar coagulation. Cystectomy was performed by stripping the cyst capsule from the normal ovarian cortex with the aid of atraumatic grasping forceps. If the capsule removal was incomplete due to technical difficulties, the remaining capsular fragments were vaporized with the carbon dioxide laser. Endometriosis implants elsewhere in the pelvis were vaporized and
D Hidlebaugh, S Vulgaropulos, R Orr. Fallon Clinic, Worcester, MA.
We studied all patients who underwent oophorectomy either by laparoscopy or laparotomy performed by one of our physicians from 1988 to 1995. Preoperative screening for women over 40 included a CA 125 and ultrasound examination. Malignant masses were immediately staged by laparotomy with the assistance of our surgical oncologist (R.O.). We
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by conscious sedation given by an on-site anesthesiologist. Lately, alternative methods of anesthesia including hypnosis and acupuncture have had some initial success. To date, we have performed 156 tubal ligations, 293 diagnostic laparoscopies, 151 treatments of endometriosis, 43 ovarian cyst aspirations, 29 adhesiolyses, 263 second-look procedures, 21 ectopic pregnancy removals, 198 diagnostic hysteroscopies, 64 endometrial biopsies, 20 fibroid resections, and 39 endometrial ablations. Patient response has been rewarding, thanks to decreased time off work, decreased cost of procedures to health insurance carriers, and immediate satisfaction from the diagnosis and treatment of their conditions.
adhesions, if present, were lysed. The ovarian cortex was closed with a few interrupted 6-0 polyglactin sutures using extracorporeal knot technique. A secondlook laparoscopy was performed in 25 patients to evaluate adhesion formation, reformation, postoperative crude pregnancy rates, and factors that would predict conception.
Reproductive Performance of Women with Uterine Anomalies after Abdominal or Hysteroscopic Metroplasty or no Surgical Treatment PK Heinonen. Department of Obstetrics and Gynecology, Tampere University Hospital and Medical School, Tampere, Finland.
The reproductive outcome of 404 women with confirmed uterine malformations was studied. The most common uterine anomaly was complete or incomplete septate uterus (48%). Bicornuate uterus was found in 17% of women, and unicornuate and didelphic both in 10%. The fetal survival rates without metroplasty were 70% for the partially bicornuate group, and 76% and 63% for the septate and subseptate groups, respectively. Metroplasty was performed in 64 (26%) of 247 women with a septate, subseptate, or partially bicomuate uterine abnormality. The indication for operation in most women was recurrent spontaneous abortions. Abdominal metroplasty (Strassmann or Jones procedure) was carried out in 12 (22%) of 55 women with a partially bicornuate uterus. Metroplasty was done in 52 (27%) of 192 women with a septate or subseptate uterus. Abdominal metroplasty (Jones or Tompkins procedure) was used in 20 patients, and transcervical metroplasty by means of hysteroscopic scissors or resectoscopic division in 32. In all, the reproductive outcome improved from 9% successful pregnancies before to 84% after metroplasty.
Cannula Wound Closure with the Laurus PC Suture Device GC Gunn. St. Jude Medical Center, Fullerton, CA.
The Laurus PC suturing device closes cannula wounds of 10 mm diameter and larger. It uses a special suture-needle combination that is double armed on either absorbable or nonabsorbable suture. One end of the suture is loaded into the device and placed through the wound into the peritoneal cavity. With a single push of a button, the needle is driven through the peritoneum and rectus fascia and is captured within the device, forming a suture loop. The device is withdrawn, reloaded with the other needle end of the suture and fired through the opposing side of the wound. The suture is tied and the skin is closed with adhesive strips. The closure time is less than 1 minute.
Pregnancy Outcome, and Adhesion Formation and Reformation after Laparoscopic Cystectomy of Ovarian Endmetriomas T Gurgan, H Yarali. Department of Obstetrics and Gynecology, Hacettepe University, Ankara, Turkey.
Trends in Oophorectomy by Laparoscopic versus Open Techniques
Unilateral or bilateral cystectomy for endometriomas was performed in 90 infertile women. Using a multipuncture technique, a cortical incision was made on the medial aspect of the ovary with sharp-tipped unipolar coagulation. Cystectomy was performed by stripping the cyst capsule from the normal ovarian cortex with the aid of atraumatic grasping forceps. If the capsule removal was incomplete due to technical difficulties, the remaining capsular fragments were vaporized with the carbon dioxide laser. Endometriosis implants elsewhere in the pelvis were vaporized and
D Hidlebaugh, S Vulgaropulos, R Orr. Fallon Clinic, Worcester, MA.
We studied all patients who underwent oophorectomy either by laparoscopy or laparotomy performed by one of our physicians from 1988 to 1995. Preoperative screening for women over 40 included a CA 125 and ultrasound examination. Malignant masses were immediately staged by laparotomy with the assistance of our surgical oncologist (R.O.). We
S17