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Simplified intrafascial technique of total laparoscopic hysterectomy
Abstracts
below 12 mm Hg; activate the insufflator overpressure valve; carefully remove endobags through the abdominal wall; and critically evaluate new products and their functions. Conclusion. These tips can help to avoid insufflation problems and malfunction, over- and under-pressure peaks, laparoscopic hypothermia, gas embolization, and bacterial contamination, and shorten anesthesia time, thereby saving time, money, and nerves.
ament was fenestrated and the opening widened in the direction of the uterosacraJ ligament if the adenexa was to be conserved, or toward the infundibulopelvic ligament if the adenexa was to be removed. With this dissection the uterine artery and ureter were nicely exposed and bipolar coagulation of uterine artery was easy. A uterine manipulator and vaginal fornix delineator were used. Mean operating time was 120 minutes. All patients were discharged in 24 hours. Conclusion. True intrafascial technique offers advantages of clear anatomic exposure of uterine arteries and ureter, minimizing injury to the ureter, and simple tacking of the uterine artery.
92. Beneficial Effect of Injecting Methotrexate on Achieving Intrauterine Pregnancy after Laparoscopic Management of Ectopic Pregnancy M Jain, N Jain, K Tyagi. Vardhrnan Infertility and Endoscopic Centre, Muzaffarnagar, India.
94. Occult Inguinal Hernias in Women with Chronic Pelvic Pain
Objective. To analyze of laparoscopic salpingectomy for ruptured ectopic pregnancy. Measurements and Main Results. Twenty women had ruptured ectopic pregnancy at about 7 to 9 weeks. Most had either infertility or history of abortions. They had significant amount of clots and adhesions of bowel and omentum in the pouch of Douglas and corresponding adenexa. All patients had unilateral salpingectomy and contralateral tubal patency, although the remaining tube appeared quite bad for future pregnaxmies, with adhesions and delayed or partial spill. The women were given methotrexate 75 mg intramuscularly. Over a period of 3 years 16 women (80%) achieved a live intrauterine pregnancy. Conclusion. We would like other centers to carry out similar studies before we can conclude that methotrexate has beneficial role in achieving intrauterine pregnancy after laparoscopic management of ectopic pregnancy.
1TI Janicki, 1R Onders, 2BJ Bloom, 2AE Green. 1Case Western Reserve University; 2University Hospitals of Cleveland, Cleveland, Ohio.
Objective. To assess efficacy of repair of occult inguinal hernias in patients with CPP. Measurements and Main Results. Twenty-one women with history of CPP and several laparoscopies underwent laparoscopic occult inguinal hernia repair with mesh. The diagnosis of hernia was made by reproducing pelvic pain by digital vaginal palpation of the intemal inguinal ring and/or pain mapping during laparoscopy under conscious sedation. Two women were lost to follow-up. At 6 weeks after surgery 15% showed no improvement, 20% showed some improvement, and 65% showed great improvement or no pain. At 6 months, 26% had persistent or recurrent pain and 74% had great improvement or no pain; figures at 12 months (some results pending) were 22% and 78%, respectively. Conclusion. Occult inguinal hernias are a possible cause of CPP and their repair treats pain in most women.
93. Simplified Intrafascial Technique of Total Laparoscopic Hysterectomy M Jain, N Jain, K Tyagi. Vardhrnan Infertility and Endoscopic Centre, Muzaffarnagar, India.
95. Some Patients with Chronic Pelvic Pain May Suffer from a Form of Reflex Sympathetic Dystrophy
Objective. To assess efficacy and safety of true intrafascial TLH. Measurements and Main Results. Indications for hysterectomy in 50 women were menorrhagia, pelvic pain, and dysmenorrhea. Uterus size ranged from bulky to 18 weeks. The round ligament was first coagulated and cut, and both leaves of broad ligament were laid open. Dissection continued anteriorly to the vesicouterine space. Then the posterior leaf of broad lig-
TI Janicki. Case Western Reserve University, Cleveland, Ohio.
Objective. To present a new theory of CPP in women with generalized hyperalgesia or organ-related pain who do not respond to usual treatment.
$28
below 12 mm Hg; activate the insufflator overpressure valve; carefully remove endobags through the abdominal wall; and critically evaluate new products and their functions. Conclusion. These tips can help to avoid insufflation problems and malfunction, over- and under-pressure peaks, laparoscopic hypothermia, gas embolization, and bacterial contamination, and shorten anesthesia time, thereby saving time, money, and nerves.
ament was fenestrated and the opening widened in the direction of the uterosacraJ ligament if the adenexa was to be conserved, or toward the infundibulopelvic ligament if the adenexa was to be removed. With this dissection the uterine artery and ureter were nicely exposed and bipolar coagulation of uterine artery was easy. A uterine manipulator and vaginal fornix delineator were used. Mean operating time was 120 minutes. All patients were discharged in 24 hours. Conclusion. True intrafascial technique offers advantages of clear anatomic exposure of uterine arteries and ureter, minimizing injury to the ureter, and simple tacking of the uterine artery.
92. Beneficial Effect of Injecting Methotrexate on Achieving Intrauterine Pregnancy after Laparoscopic Management of Ectopic Pregnancy M Jain, N Jain, K Tyagi. Vardhrnan Infertility and Endoscopic Centre, Muzaffarnagar, India.
94. Occult Inguinal Hernias in Women with Chronic Pelvic Pain
Objective. To analyze of laparoscopic salpingectomy for ruptured ectopic pregnancy. Measurements and Main Results. Twenty women had ruptured ectopic pregnancy at about 7 to 9 weeks. Most had either infertility or history of abortions. They had significant amount of clots and adhesions of bowel and omentum in the pouch of Douglas and corresponding adenexa. All patients had unilateral salpingectomy and contralateral tubal patency, although the remaining tube appeared quite bad for future pregnaxmies, with adhesions and delayed or partial spill. The women were given methotrexate 75 mg intramuscularly. Over a period of 3 years 16 women (80%) achieved a live intrauterine pregnancy. Conclusion. We would like other centers to carry out similar studies before we can conclude that methotrexate has beneficial role in achieving intrauterine pregnancy after laparoscopic management of ectopic pregnancy.
1TI Janicki, 1R Onders, 2BJ Bloom, 2AE Green. 1Case Western Reserve University; 2University Hospitals of Cleveland, Cleveland, Ohio.
Objective. To assess efficacy of repair of occult inguinal hernias in patients with CPP. Measurements and Main Results. Twenty-one women with history of CPP and several laparoscopies underwent laparoscopic occult inguinal hernia repair with mesh. The diagnosis of hernia was made by reproducing pelvic pain by digital vaginal palpation of the intemal inguinal ring and/or pain mapping during laparoscopy under conscious sedation. Two women were lost to follow-up. At 6 weeks after surgery 15% showed no improvement, 20% showed some improvement, and 65% showed great improvement or no pain. At 6 months, 26% had persistent or recurrent pain and 74% had great improvement or no pain; figures at 12 months (some results pending) were 22% and 78%, respectively. Conclusion. Occult inguinal hernias are a possible cause of CPP and their repair treats pain in most women.
93. Simplified Intrafascial Technique of Total Laparoscopic Hysterectomy M Jain, N Jain, K Tyagi. Vardhrnan Infertility and Endoscopic Centre, Muzaffarnagar, India.
95. Some Patients with Chronic Pelvic Pain May Suffer from a Form of Reflex Sympathetic Dystrophy
Objective. To assess efficacy and safety of true intrafascial TLH. Measurements and Main Results. Indications for hysterectomy in 50 women were menorrhagia, pelvic pain, and dysmenorrhea. Uterus size ranged from bulky to 18 weeks. The round ligament was first coagulated and cut, and both leaves of broad ligament were laid open. Dissection continued anteriorly to the vesicouterine space. Then the posterior leaf of broad lig-
TI Janicki. Case Western Reserve University, Cleveland, Ohio.
Objective. To present a new theory of CPP in women with generalized hyperalgesia or organ-related pain who do not respond to usual treatment.
$28