“Z” procedure for laparoscopy

864

NovemberlS, 1973 Am. J. Obstet. Gynecol.

Correspondence

better methods of detection ovaries and Fallopian tubes.

of cancer

Fred

E. Gilbert,

of the M.D.

Chief Clinical Chemistry and Hematology Training Unit Laboratory Training Section Center for Disease Control Atlanta, Georgia Martin Chief Pathology

Center

Section Disease

for

Atlanta,

D. Hicklin,

Control

Georgia

Stanley L. Inhorn, Director Wisconsin University Madison,

State

Laboratory

of

Hygiene

Wisconsin Leopold

University Rocheste’r,

M.

M.D.

Naib,

Hospital

M.

Stanley F. Patten, M.D., and Chairman of Pathology of Rochester School of Medicine New York Charles

Pathologist

and

P. Schwinn,

Medical

M. Head

Wilson

Ph.D.

Toll,

Obstetrics

and

M.D. M.D.

Gynecology

95128

Frangenheim, H.: Die Laparoskopie and die Culdoskopie in der Gynakologie, Stuttgart, 1959, Georg Thieme Verlag. Semm, K.: Geburtshilfe Frauenheilkd. 26: 1329, 1966. Steptoe, P.: J. Reprod. Med. 10: 211, 1973.

M.D.

M.D.

Hospital

Pathology of Chicago Lying-In Hospital Illinois of

of

Hospital California

James Whitelaw, Vincent F. Nola,

REFERENCES

of Cytopathology

General Maryland

Department O’Connor San Jose,

Center

George L. Wied, Professor University Chicago Chicago,

procedure for laparoscopy To the Editors: We noted with interest the article by Bishop and Halpin, “Dehiscence following laparoscopy: Report of an unusual complication,” which appeared in the JOURNAL (116: 585, 1973) and suggested a new method for an angulated “Z” tract in order to avoid the reported complication. This proposed procedure is about one decade tardy, as it has been used in Europe for over 10 years by Frangenheiml and Semm.2 A movie by Professor Semm depicting this “Z” procedure was shown by one of us (M. J. W.), at the annual meeting of the American College in San Francisco in 1971. It was made available to any gynecologist interested. It should be pointed out that as long as we have available a perfectly competent laparoscope of 5 mm., which will, to all intents and purposes, be just as efficient as the 11 mm. one for sterilization, a smaller puncture wound would automatically lessen the chances of dehiscence. In closing, we might quote the remarks of Steptoe,s in his key address to the first meeting of the American Association of Gynecological Laparoscopists in 1972, “It is appalling to me that anyone should attempt to think of training people in laparoscopy, particularly sterilization, in a course lasting a few days.”

Georgia

Associate Professor Department of Pathology Los Angeles County-USC Los Angeles, California

Associate Division Maryland Baltimore,

M.D.

Cytology

of

Grady Memorial

Professor Department

G. Koss,

Inc.

Zuher

Atlunta,

M.D.

of Wisconsin

Pathologist-in-Chief Sinai Hospital of Baltimore, Baltimore, Maryland

Director Division

M.D.

“Z”

M.D.

Bilateral

hypogastric

the Editors: In the AMERICAN GYNECOLOGY (116:

artery

ligation

To

JOURNALOF

OBSTETRICS

AND

493, 1973), there is an article entitled, “Bilateral internal iliac (hypogastric) artery ligation to control obstetric and gynecologic hemorrhage.” It was written by Dr. Robert A. Sack, Whittier, California, and he reported 4 cases of bilateral hypogastric artery ligation. I do not know the physicians that he queried, but I am absolutely astounded that he was able