The Journal of Minimally Invasive Gynecology

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2009-01-01

Core Competencies for Gynecologic Endoscopy in Residency Training: A National Consensus Project

2009-01-01

Abstract: Residents and educators in obstetrics and gynecology have identified the need to improve endoscopic surgical education. The Canadian Endoscopy Education Project aims to create a national standardized endoscopy curriculum. The objective of the current project was to identify the core competencies for a gynecologic endoscopy (GE) curriculum in residency training programs. This expert consensus project (Canadian Task Force Classification III) included all 16 academic obstetrics and gynecology residency programs in Canada. Each university program selected their leading endoscopy educator to participate in the consensus process. Competencies for proficiency in GE were identified and then reviewed in 3 sequential rounds of consensus building using the Delphi technique. Overall, 213 objectives were reviewed and 199 (93%) of the items achieved consensus agreement. Competencies that were deemed outside the realm of general residency education were also collated and may represent a guide to subspecialty fellowship training in the future. The core competencies for GE training in obstetrics and gynecology residency were determined through national expert consensus. This provides the basis for a national standardized endoscopy curriculum for general obstetrics and gynecology training.

Laser Carbon-dioxide treatment of Complete Hydatidiform Mole Presenting as Bartholin Gland Cyst

2009-01-01

A 31-year-old woman underwent carbon-dioxide laser treatment for a 5-cm vulvar enlargement, suspected to be a Bartholin gland cyst. Two months earlier, a spontaneous abortion at 8 weeks with nonmolar histology was reported.

Narrow Band Imaging in Endometrial Lesions

Daniela Surico, Alessandro Vigone, Livio Leo — 2009-01-01

Hysteroscopy with directed biopsies has a key role in the diagnosis of intrauterine pathologies. In a series of 4054 patients, sensitivity of hysteroscopic view for endometrial cancer is 80%, suggesting that visual identification of morphologic changes in the endometrial mucosa is not always enough for a diagnostic conclusion .

Unmet Therapeutic Needs for Uterine Myomas

Charles E. Miller — 2009-01-01

Abstract: Uterine myomas may develop in many women, but only become clinically significant in about one third of the affected population. Although uterine myomas are most often benign, they are associated with debilitating symptoms and commonly result in hysterectomy. Current treatments for uterine myomas include pharmacologic therapies, delivery of focused energy, alteration of uterine vascular supply, or surgical procedures. Factors such as the woman's desire for future pregnancy, the importance of uterine preservation, symptom severity, and tumor characteristics direct the choice of therapeutic approach. The ideal treatment will have the following characteristics: easy to perform, minimally invasive, cost effective, preserves fertility, preserves the uterus, efficacious, acceptable tolerability and durability, and low incidence of myoma recurrence.

Trends in Sterilization since the Introduction of Essure Hysteroscopic Sterilization

2009-01-01

Abstract: Study Objective: To investigate trends in sterilization in women at the Detroit Medical Center, Michigan (DMC), since the introduction of Essure hysteroscopic sterilization.Design: Retrospective study (Canadian Task Force classification II-2).Setting: Outpatient surgery center and university teaching hospitals.Patients: Women who underwent interval sterilization procedures at the DMC (Hutzel Women's Hospital, Sinai-Grace Hospital, and the Berry Center) and postpartum sterilization procedures at Hutzel Women's Hospital between January 1, 2002, and December 31, 2007.Interventions: Permanent sterilization procedures including minilaparotomy tubal ligation, laparoscopic sterilization, Essure hysteroscopic sterilization, and postpartum tubal ligation performed at the time of cesarean section or after vaginal delivery.Measurements and Main Results: In all, 5509 permanent sterilization procedures were performed in the 6 years between January 1, 2002, and December 31, 2007, at the DMC facilities analyzed: 2484 interval sterilization procedures at Hutzel Women's Hospital, Sinai-Grace Hospital, and the Berry Center, and 3025 postpartum tubal ligations at Hutzel Women's Hospital. From 2002 through 2007, the decrease in laparoscopic sterilizations from 97.9% to 48.5% of all interval sterilization procedures corresponded significantly with the increase in Essure hysteroscopic sterilizations from 0.0% to 51.3% (p <.001). Postpartum tubal ligations performed after vaginal delivery also decreased significantly during the study period from 7.9% to 3.3% of all vaginal deliveries (p <.001) while the percentage of tubal ligations performed at the time of cesarean section remained constant (p =.051).Conclusion: At the DMC facilities analyzed from January 1, 2002, through December 31, 2007, a significant decrease occurred in the percentage of laparoscopic sterilizations and postpartum tubal ligations performed after vaginal delivery. Of the interval sterilizations performed, the percentage of Essure hysteroscopic sterilizations increased significantly from 0.0% to 51.3% of all procedures. Since the approval of Essure hysteroscopic sterilization in November 2002, this minimally invasive method of hysteroscopic sterilization has increased in popularity at the DMC.

Equipment Failure: Causes and Consequences in Endoscopic Gynecologic Surgery

2009-01-01

Abstract: Study Objective: To determine the incidence of equipment failure in gynecologic endoscopy and investigate causes and consequences.Design: A prospective observational single-center study between January and April 2006.Setting: Gynecologic surgery department of a university hospital.Interventions: In all, 116 endoscopic interventions were included: 62 laparoscopies, 51 operative hysteroscopies, and 3 fertiloscopies. Emergency and equipment testing procedures were excluded.Measurements and Main Results: Equipment malfunctions were divided into 4 categories with regard to imaging, transmission of fluids and light, the electric circuit, and surgical instruments. We also found cases with faulty connections between elements. Factors including human error, loss of time, and actual or potential consequences were analyzed. At least 1 equipment failure was noted in 38.8% of operative procedures, 41.9% of laparoscopies, and 37.3% of hysteroscopies. Fluid, gas, and light transmission was faulty in 36.2%, surgical instruments in 29.3%, the electric circuit in 22.4%, and imaging in 12.1%. Of malfunctions, 46.6% were a result of faulty connection between 2 elements. The most common cause for concern was bipolar forceps and cables in laparoscopy (42.3%) and the assembly of small parts in hysteroscopy (47.4%). Personnel were implicated in 43% of cases (nurses in 72%, surgeons in 12%, both in 16%). One equipment failure increased the total duration of laparoscopy by 7% and of hysteroscopy by 20%. The mean delay was 5.6±4.0minutes by equipment failure. Of the incidences, 19% could have led to serious complications for the patient; however, no morbidity or mortality actually occurred in this series.Conclusion: Equipment malfunction is common in endoscopic surgery and concerns both laparoscopy and hysteroscopy. Consequences are potentially serious. It is mandatory to identify and rectify causes of equipment failure so as to optimize the daily use of endoscopic instruments and improve patient safety. The implementation of systematic checklists is currently under evaluation.

Postoperative Long-term Maintenance Therapy with Oral Contraceptives after Gonadotropin-releasing Hormone Analog Treatment in Women with Ovarian Endometrioma

Hyun-Jung Park, Young-Ah Koo, Byung-Koo Yoon, DooSeok Choi — 2009-01-01

Abstract: Study Objective: The goal of this preliminary study was to assess the effect of cyclic monophasic oral contraceptives (OCs) as a postoperative long-term maintenance therapy (median 33.2 months) to suppress recurrence of endometrioma after conservative ovarian surgery followed by gonadotropin-releasing hormone (GnRH) analog treatment.Design: Retrospective clinical study (Canadian Task Force classification II-2).Setting: Adolescent and premarital clinic in a university hospital.Patients: The study was performed on 51 patients who underwent conservative surgery for endometrioma followed by GnRH analog treatment for 6 months.Interventions: We used cyclic monophasic OCs as maintenance therapy after surgical and medical treatment with GnRH analog for 6 months.Measurements and Main Results: Cyclic monophasic OCs were offered to young patients (n=51, age=24.1±2.8 years) who did not want to conceive immediately, to prevent the recurrence of endometrioma after conservative surgery with 6 cycles of postoperative GnRH analog treatment. During the long-term follow-up period (median 41.2; range 19–94 months), no recurrences of the endometrioma occurred in the current OC users. One patient showed a recurrence of endometrioma at 12 months after the discontinuation of the OCs. The median duration of OC administration was 33.20 months (range 12–86). In addition, 4 of 10 patients became pregnant within 12 months of discontinuing the long-term OC therapy.Conclusion: Postoperative long-term maintenance therapy with OCs can effectively suppress endometrioma recurrence in adolescent and young patients.

Rate, Type, and Cost of Invasive Interventions for Uterine Myomas in Germany, France, and England

2009-01-01

Abstract: Study Objective: The objective of our study was to quantify the rate, type, and cost of interventions for uterine myomas to payers in Germany, France, and England.Design: Computations using data from national hospital activity databases. Design classification: II-3.Setting: Hospital admissions in Germany, France, and England.Patients: Women admitted for a surgical or radiologic intervention for uterine myomas.Interventions: Surgical or radiologic interventions for uterine myomas.Measurements and Main Results: We identified the number and type of hospital admissions involving surgical or radiologic interventions for uterine myomas, through the analysis of national hospital activity databases from each country. We calculated the costs of these hospitalizations to payers in these countries using the diagnosis-related group reimbursement rates. In 2005, the number (rate) of hospital admissions involving interventions for uterine myomas was 64 299 (1.53/1000 women) in Germany, 37 787 (1.17/1000 women) in France, and 18 274 (0.71/1000 women) in England. The annual costs of these interventions to payers were €212 313 090 in Germany, €73 278 270 in France (excluding surgeon and anesthetist fees for interventions in the private sector), and €52 674 672 in England. The percentage of interventions for uterine myomas that included a hysterectomy was 84.9% in Germany, 59.7% in France, and 64.1% in England.Conclusion: The number of admissions and costs associated with interventions for uterine myomas are substantial in the 3 European countries studied. Hysterectomy is the most frequent surgical intervention used to treat uterine myomas. The results in this article provide useful information for policy makers wishing to evaluate the cost effectiveness and budget impact of new, less invasive interventions.

The Impact of Alternative Treatment for Abnormal Uterine Bleeding on Hysterectomy Rates in a Tertiary Referral Center

2009-01-01

Abstract: Study Objective: The purpose of this study was to estimate the influence of alternatives to hysterectomy for abnormal uterine bleeding (AUB) on hysterectomy rates.Design: Retrospective cohort study. Canadian Task Force II-2.Setting: University hospital.Patients: Premenopausal patients with AUB.Interventions: Medical records of all premenopausal patients treated for AUB in our university clinic between January 1, 1995, and December 31, 2004, were reviewed. Patients were identified based on (specific) diagnostic and therapy codes used in the registry system of the hospital. The total number of placements of levonorgestrel-releasing intrauterine device (LNG-IUD), hysteroscopic surgery, and hysterectomies performed/year was estimated. In addition, the course of treatment of each patient was assessed.Measurements and Main Results: A total of 640 patients received surgery and 246 LNG-IUDs were placed. The proportion of endometrial ablations decreased significantly over time (p <.001), whereas hysteroscopic polyp or myoma removal (p =.030) and insertion of LNG-IUD (p <.001) both increased. The proportion of patients receiving hysterectomy for AUB as their first therapy decreased significantly (p =.005) from 40.6% to 31.4%, although the total number of patients receiving hysterectomy remained similar (p =.449). The 5-year intervention-free percentage for LNG-IUD was 70.6% (SD = 3.3%), for hysteroscopic polyp or myoma removal 75.5% (SD = 3.3%), and for endometrial ablation 78.0% (SD = 4.3%; p =.067).Conclusion: Despite the introduction of alternative therapies, the total hysterectomy rate in the management of AUB did not decrease in our clinic.

What Determines the Need to Morcellate the Uterus during Total Laparoscopic Hysterectomy?

2009-01-01

Abstract: Study Objective: To identify factors associated with the need to perform uterine morcellation during total laparoscopic hysterectomy (TLH). A secondary aim was to establish new cut-offs based on uterine weight for the probability of morcellation.Design: Prospective observational study (Canadian Task Force Classification II-2).Setting: Tertiary referral laparoscopic unit.Patients: All women scheduled to undergo TLH in the study period were included.Interventions: Age, parity, operating time, estimated blood loss, and final uterine weight at histology were recorded. Logistic regression analysis was performed to determine the factors associated with the need to perform uterine morcellation at the time of TLH. Multiple imputation (MI) was used to impute missing values.Measurements and Main Results: A total of 112 consecutive women underwent TLH and were included in the final analysis. In all, 56 (50%) of 112 women underwent TLH without morcellation (i.e., it was possible to deliver the uterine specimen vaginally) and 56 (50%) of 112 women underwent TLH with morcellation (i.e., it was not possible to deliver the uterine specimen vaginally and, therefore, morcellation was performed). Median age in each group was 45 and 46 years, respectively. Sixteen (70%) of 23 nulliparous women underwent morcellation compared with 40 (45%) of 89 parous women. Multivariable logistic regression analysis revealed that nulliparity (OR = 6.45, 95% CI = 1.74–23.9) and uterine weight (OR/100-g increase = 4.97, 95% CI = 2.13–11.6) increased the odds of morcellation. All 20 women with a uterine weight of at least 350 g required morcellation. Based on the MI analysis results, uterine weight was at least 350 g in 1 of 5 patients, with 99.5% of the women having uterine weight of 350 g or more that required morcellation.Conclusion: Nulliparity and increasing uterine weight are associated with the need to perform uterine morcellation in TLH. Studies are needed to find a reliable method for estimating uterine weight preoperatively.

Nonsurgical Transurethral Collagen Denaturation for Stress Urinary Incontinence in Women: 12-Month Results from a Prospective Long-term Study

2009-01-01

Abstract: Study Objective: To assess efficacy of nonsurgical transurethral collagen denaturation (Renessa) in women with stress urinary incontinence (SUI) caused by bladder outlet hypermobility.Design: Continuing, prospective, 36-month, open-label, single-arm clinical trial. Twelve-month results from intent-to-treat (ITT) analysis are reported. Canadian Task Force classification II-2.Setting: Thirteen physician offices or ambulatory treatment centers.Patients: Women with SUI secondary to bladder outlet hypermobility for 12 months or longer who failed earlier conservative treatment and had not received earlier surgical or bulking agent therapy.Interventions: Women were treated as outpatients and received an oral antibiotic and local periurethral anesthesia before undergoing treatment with transurethral radiofrequency collagen denaturation.Measurements and Main Results: Voiding diaries and in-office stress pad weight tests yield objective assessments. Subjective measures include the Incontinence Quality of Life (I-QOL), Urogenital Distress Inventory (UDI-6), and Patient Global Impression of Improvement (PGI-I) instruments. In total, 136 women received treatment (ITT population). Patients experienced significant reductions versus baseline in median number of leaks caused by activity/day and activity/week (p <.0026 for both), with 50% of patients reporting 50% or more reduction. Pad weight tests revealed that 69% of women had 50% or more reduction in leakage (median reduction 15.2 g; p <.0001); 45% were dry (29% no leaks; 16% < 1-g leakage). Significant improvements occurred in median scores on the I-QOL (+9.5 [range –66.0 to 91.0]; p <.0001) and mean scores on the UDI-6 (–14.1 ± 24.7; p <.0001). Furthermore, 71.2% showed I-QOL score improvement, including 50.3% with 10-point or greater improvement, and 49.6% reported on the PGI-I that they were “a little,” “much,” or “very much” better.Conclusion: At 12 months, treatment of SUI with nonsurgical transurethral collagen denaturation resulted in significant improvements in activity-related leaks and quality of life.

Alexithymia–A Disorder of the Regulatory Mechanism of the Emotion Elaboration–and Quality of Life in Gynecologic Surgery

2009-01-01

Abstract: Study Objective: Alexithymia is a disorder of the regulatory mechanism of the emotion elaboration. To verify the influence of the personality trait in the evaluation of quality of life (QoL), we analyzed the effect of alexithymia on the outcome of gynecologic surgery. The purpose of this study was to investigate the presence of alexithymia by using the Toronto Alexithymia Scale (TAS)-20, and to examine the relationship between alexithymia and self-reported descriptors of QoL in a gynecologic population.Design: All patients were evaluated in a semistructured interview in which personal, medical, and social data were collected. They were provided with a set of questionnaires that included both measure of alexithymia (TAS-20) and QoL perception (the Medical Outcomes Study short-form general health survey-36 [SF-36]). The patients were assessed before the surgical procedure and 1 month postoperatively.Setting: Campus BioMedico Hospital in Rome, Italy.Patients: In all, 40 consecutive patients with benign gynecologic pathology were enrolled in the study.Interventions: A total of 20 of the patients underwent laparoscopy (LPS) and 20 underwent laparotomy (LPT).Measurements and Main Results: Patients were separated into 2 groups, with respect to the TAS questionnaire score: the high-level alexithymia (HA) group, with scores above 59, and the low-level alexithymia group, with scores below 59. The HA group represented 61% in patients who underwent LPS and 50% in patients who were submitted to LPT. Patients who underwent LPS showed a slight decrease in the QoL score after the surgical procedure. Patients who underwent LPT showed different QoL scores depending on the high or low TAS level: high-level TAS group showed higher SF-36 domain scores compared with the presurgical scores, whereas low-level TAS group showed lower scores compared with the presurgical scores.Conclusion: Our data show that the subjective QoL tested with SF-36 in patients with gynecologic conditions undergoing surgery is clearly influenced by the level of alexithymia. This influence is clearly detectable when a more invasive surgery is performed. In this case, patients with low-level alexithymia show a worsening of QoL. Contrarily, patients with HA have a better perception of QoL after more invasive surgery.

An Evaluation of Ureteral Flow after Doppler-guided Uterine Artery Occlusion Device Placement during Organ-preserving Gynecologic Procedures

2009-01-01

Abstract: We studied the use of color Doppler ultrasonography for ureteral patency after placement of a transvaginal Doppler-guided uterine artery occlusion device before organ-preserving surgery for leiomyomata uteri. Our case series involved 7 patients in whom ureteral flow was assessed using color Doppler sonography before and after placement of a Doppler-guided uterine artery occlusion device. Bilateral ureteral flow was assessed at the trigone using a grading system. Furosemide and additional intravenous hydration were administered if no flow was observed. Color Doppler ultrasonography can quantify ureteral flow before and after Doppler-guided uterine artery occlusion device placement during organ-preserving gynecologic procedures, facilitating safe placement and repositioning of the transvaginal device when necessary.

Impact of Laparoscopic Experience on Performance on Laparoscopic Training Drills among Obstetrics and Gynecology Residents: A Pilot Study

2009-01-01

Abstract: Study Objective: To assess whether volume of laparoscopic experience correlates with residents’ performance on laparoscopic training drills.Design: Residents performed 4 laparoscopic drills in the inanimate laboratory: peg transfer, bean drop, rope pass, and triangle transfer. Performance times were recorded. Laparoscopic experience as primary surgeon was determined from resident case logs. The resident data were divided according to volume of laparoscopic experience (0–19, 20–39, ≥40 cases). Performance times were compared among the groups according to volume of laparoscopic surgical experience. Design classification: II-3.Setting: This study was conducted in a university school of medicine surgical skills laboratory.Participants: Participants in this study were obstetrics and gynecology residents entering their second through fourth years of training.Interventions: Laparoscopic trainer drill performance times were recorded and correlated with amount of operative laparoscopic experience.Measurements and Main Results: In all, 25 residents participated. Only the peg transfer drill showed statistically significant correlation between faster performance time and increasing laparoscopic experience (p =.01). No significant association existed between laparoscopic experience and performance time on the bean drop, triangle transfer, or rope pass drills.Conclusion: Residents with more laparoscopic experience performed the peg transfer drill significantly faster than those with less experience.

Complete Bladder Gangrene Caused by Bilateral Hypogastric Artery Ligation during Laparoscopic Radical Hysterectomy

Myung Ki Kim, Byung Chan Oh, Hyung Jin Kim, Young Gon Kim, Young Beom Jeong — 2009-01-01

Abstract: Ischemic complications are extremely rare after radical pelvic surgery because of the collateral blood supply in the pelvis. We report a case of complete bladder gangrene 3 weeks after a laparoscopic radical hysterectomy with bilateral hypogastric artery ligation in a 70-year-old woman with cervical cancer.

Beware the Tarlov Cyst

Jane E. Hirst, Hugh Torode, William Sears, Michael J. Cousins — 2009-01-01

Abstract: Tarlov cysts are sacral perineural cysts. This case report describes the clinical course after biopsy of a very large Tarlov cyst via laparoscopy, which was thought preoperatively to be an adnexal mass. It serves as a warning against attempting biopsy or resection of these lesions.

Migration of an Intrauterine Contraceptive Device during the Course of Pregnancy: A Case Report

Tracy Glass, Teresa Baker, Robert P. Kauffman — 2009-01-01

Abstract: Uterine perforation by a contraceptive intrauterine device (IUD) is a relatively rare event. These events may result secondary to mechanical force applied during placement (primary perforation) or migration by uterine contractions or surgical manipulation after placement (secondary perforation). A 33-year-old woman with an IUD placed 9 years before admission visited the emergency department with an early pregnancy and a 3-day history of vaginal bleeding. Vaginal examination revealed IUD strings visible at the cervical os, and transvaginal ultrasound confirmed the presence of an IUD in the lower uterine segment and upper cervix. The IUD migrated spontaneously to the fundal myometrium at 15 weeks’ gestation. Premature rupture of membranes ensued at 20 weeks’ gestation, and, at delivery, the IUD could not be retrieved. Subsequent computed tomography confirmed that the IUD was incompletely embedded in the fundal myometrium and partially extending into the peritoneal cavity. At laparoscopic sterilization 6 weeks later, the IUD had perforated the small bowel, and the device was removed with concomitant bowel repair. This case documents spontaneous migration of a copper IUD from the lower uterine segment through the fundus during early pregnancy and supports removal of asymptomatic ectopic IUDs whenever possible.

Recurrent Thigh Abscess with Necrotizing Fasciitis from a Retained Transobturator Sling Segment

Charles R. Rardin, Richard Moore, Renee M. Ward, Deborah L. Myers — 2009-01-01

Abstract: A woman who underwent transobturator sling surgery for urinary incontinence experienced early vaginal mesh erosion, and underwent a partial sling removal. Several months later, she developed recurrent right thigh and groin abscesses and necrotizing fasciitis. The source of the infection, a retained segment of mesh in the obturator space, was identified only after several operative procedures and referrals. This case illustrates several of the areas of concern with the introduction of new surgical materials and techniques.

Hysteroscopic Removal of Gauze Packing Inadvertently Sutured to the Uterine Cavity: Report of 2 Cases

2009-01-01

Abstract: We report on 2 cases of successful hysteroscopic removal of uterovaginal packing, inserted during cesarean sections after uterine hemorrhage resistant to medical therapy. The packing, in both cases, could not be removed vaginally with sponge forceps because the packing had been sutured to the uterine cavity. A hysteroscopic approach enabled identification and cutting with 5F scissors of the stitches fixing the packing to the uterine walls, allowing straightforward removal in an outpatient setting and avoiding a repeated laparotomy. Some useful techniques to handle such a situation are described.

Laparoscopic–assisted Uterovaginal Anastomosis for Uterine Cervix Atresia with Partial Vaginal Aplasia

Emile Daraï, Marcos Ballester, Marc Bazot, Bernard–Jean Paniel — 2009-01-01

Abstract: This case report describes the surgical technique of laparoscopic–assisted uterovaginal anastomosis. At a tertiary university hospital, a girl with uterine cervix atresia and vaginal aplasia underwent laparoscopic–assisted uterovaginal anastomosis. We assessed feasibility and anatomic outcome. The operating time was 2 hours and 45 minutes. No perioperative or postoperative complications occurred. The hospital stay was 4 days. The surgical procedure resulted in adequate vaginal length (6 cm) and normal menstruation. Laparoscopic–assisted uterovaginal anastomosis without using a probe introduced by fundal incision is feasible with good anatomic results.

Isolated Extrapelvic Endometriosis of the Gluteal Muscle

2009-01-01

Abstract: A 33-year-old woman with a 2-year history of swelling and pain in her buttock and left thigh fluctuating with her menstrual cycle who was becoming progressively disabled was referred to the department of orthopedics. Magnetic resonance imaging (MRI) detected a left buttock lesion of 3 × 2 cm that was initially diagnosed as muscular-fiber laceration with associated hematoma. The worsening of her symptomatology required an ultrasound-guided biopsy of the lesion that revealed endometriosis. Laparoscopy showed the pelvis to be free of gross disease. Hormonal suppression by means of gonadotropin-releasing hormone analog therapy proved adequate in temporarily alleviating symptoms. A year later the patient underwent surgical excision of the buttock lesion, which was effective in alleviating her symptoms for a short period of 10 months. A 1-year follow-up MRI revealed several small endometriotic foci, located among piriformis and obturator internus muscle fibers, which were considered not suitable for surgical removal. The patient is currently on a drug regime for pain management. However, she has experienced permanent muscular damage on her left buttock including significant omolateral gluteus strength reduction, functional impairment (inability to rotate laterally or bend her left leg), and the assumption of an antalgic gait while walking. Because of impairment in her deambulation capability, total physical invalidity was agreed for her by the National Health Care Services.

The Sacral LION Procedure for Recovery of Bladder/Rectum/Sexual Functions in Paraplegic Patients after Explantation of a Previous Finetech-Brindley Controller

Marc Possover — 2009-01-01

Abstract: Study Objective: To report on our technique of sacral laparoscopic implantation of aneuroprosthesis-LION procedure–for recovery of bladder/intestinal/sexual function in paralyzed patients after spinal cord injury.Design: Prospective case series report.Setting: Academic community teaching hospital.Patients: Eight consecutive complete T-paralyzed patients after explantation of a previous dorsal implanted Brindley-Finetech controller with a sacral deafferentation.Interventions: Laparoscopic transperitoneal exposure of the sacral plexuse and bilateral implantation of Brindley-Finetech electrodes to the sacral nerve roots S2 to S4.Measurements and Main Results: Feasibility, complications, and outcome of the procedures. In 6 patients, recovery of electrically induced micturition and defecation could be obtained and in 2 men recovery of electrically induced erection. In 2 other patients, exposure and intraoperative stimulation of the sacral nerve roots showed irreversible destruction of the motoric vesical and rectal nerves. In one, the bilateral implantation of neuromodulation electrodes permitted complete control of the spasticity of the lower limbs and to the autonomic dysreflexia.Conclusion: The laparoscopic transperitoneal approach offers minimally invasive access for implantation of electrodes to the sacral nerve roots in paralyzed patients for recovery of pelvic visceral functions after failure of a previous implanted dorsal Brindley-Finetech controller with sacral deafferentation.

Delayed Iliac Artery Thrombosis after Blunt Trauma during Operative Laparoscopy

2009-01-01

Abstract: Major vascular injury during laparoscopic surgery is an uncommon but serious complication. A small number of earlier case reports describe delayed diagnosis of vascular lacerations. Herein we report a unique case of a robot-assisted laparoscopic resection of an obstructed uterine horn, complicated by delayed postoperative presentation of a common iliac artery thrombus without extravascular hemorrhage. The injury was likely caused by blunt trauma to the exterior of the vessel with damage to the vascular intima and subsequent dissection. Meticulous surgical technique, accurate diagnosis, and subsequent treatment are essential to decrease morbidity from such major vascular injuries at the time of laparoscopy.

Laparoscopic Management of an Isolated Ovarian Metastasis on a Transposed Ovary in a Patient Treated for Stage IB1 Adenocarcinoma of the Cervix

2009-01-01

Abstract: Transposition of the ovaries is performed frequently in young women with early-stage cervical cancer. This procedure is performed to preserve their quality of life. However, this must be balanced with the risks of ovarian metastases especially in patients with adenocarcinomas. We report the first case of laparoscopic management of an isolated metastasis to a transposed ovary that occurred 2 years after primary laparoscopic treatment of a stage IB1 adenocarcinoma of the cervix.

A Practical Manual of Laparoscopy and Minimally Invasive Gynecology, a Clinical Cookbook, 2nd edition

Amy Broach — 2009-01-01

A Practical Manual of Laparoscopy and Minimally Invasive Gynecology, a Clinical Cookbook, edited by Resad Pasic and Ronald Levine is a comprehensive overview of minimally invasive gynecology and laparoscopy, covering basic principles and advanced procedures. The editors and the collection of expert authors have amassed what should be considered one of the primary text resources for minimally invasive gynecology.

Capsule Summary

S.L. Corson — 2009-01-01

Cystic fibrosis (CF) is a pathology that historically had little direct relevancy to the practice of obstetrics and gynecology. But as treatment extended health and life, care of pregnant women with milder forms of CF became an issue. On the male side, CF is one of the few genetic diseases in which one copy of the mutant gene causes clinical changes, in this case, absence of the vas deferens. Fertility can be restored with IVF/ICSI, but sons stand a 50% chance of inheritance of the same problem.

Capsule Summary

Stephen L. Corson — 2009-01-01

Interviews and pelvic examinations were performed in 1961 nonpregnant women who had participated in the 2005 to 2006 National Health and Nutrition Examination Survey. Assessments were made of urinary and/or fecal incontinence and feeling or seeing a bulge in or outside of the vagina representing pelvic floor relaxation. The weighted prevalence of at least 1 disorder was 23.7% (95% CI, 21.2–26.2), urinary incontinence 15.7% (13.2–18.2), fecal incontinence 9.0% (7.3–10.7), and 2.9% (2.1–3.7) with prolapse. The proportion of at least 1 positive symptom increased with age from 9.7% (7.8–11.7) between ages 20 and 39 years to 49.7% (40.3–59.1) in those aged 80 years or older. As one would expect, parity had a similar deleterious effect starting at 12.8% (9.0–16.6) and becoming 32.4% (27.8–37.1) for zero through 3 or more deliveries, respectively. Obesity was another worsening factor but no racial or ethnic differences were found.

Capsule Summary

Stephen L. Corson — 2009-01-01

Colonoscopy data from both black and white asymptomatic patients (5464 and 80 061, respectively) taken from 67 adult gastrointestinal practice sites from 2004 through 2005 were prospectively collected. Both black men and women had a higher prevalence of polyps larger than 9 mm in diameter compared with their white counterparts. Compared with whites the OR for black women was 1.62 (95% CI, 1.39–1.89) and for men the results were 1.16 (95% CI, 1.01–1.34). The prevalence of 1 or more polyps larger than 9 mm was 7.7% in the black group and 6.2% in the white group. Differences in prevalence of proximal polyps were more pronounced in black patients older than 60 years. Based on previous studies that showed similar trends, the American College of Gastroenterology recommends initial screening at 45 years of age for black patients, although the American College of Radiology and the American Cancer Society do not make this distinction.

Meetings Calendar/Masthead

2009-01-01

Society Affiliations

2009-01-01

Editorial Board

2009-01-01

Board of Trustees

2009-01-01

The Journal of Minimally Invasive Gynecology

Cover 1

Core Competencies for Gynecologic Endoscopy in Residency Training: A National Consensus Project

Laser Carbon-dioxide treatment of Complete Hydatidiform Mole Presenting as Bartholin Gland Cyst

Narrow Band Imaging in Endometrial Lesions

Unmet Therapeutic Needs for Uterine Myomas

Trends in Sterilization since the Introduction of Essure Hysteroscopic Sterilization

Equipment Failure: Causes and Consequences in Endoscopic Gynecologic Surgery

Postoperative Long-term Maintenance Therapy with Oral Contraceptives after Gonadotropin-releasing Hormone Analog Treatment in Women with Ovarian Endometrioma

Rate, Type, and Cost of Invasive Interventions for Uterine Myomas in Germany, France, and England

The Impact of Alternative Treatment for Abnormal Uterine Bleeding on Hysterectomy Rates in a Tertiary Referral Center

What Determines the Need to Morcellate the Uterus during Total Laparoscopic Hysterectomy?

Nonsurgical Transurethral Collagen Denaturation for Stress Urinary Incontinence in Women: 12-Month Results from a Prospective Long-term Study

Alexithymia–A Disorder of the Regulatory Mechanism of the Emotion Elaboration–and Quality of Life in Gynecologic Surgery

An Evaluation of Ureteral Flow after Doppler-guided Uterine Artery Occlusion Device Placement during Organ-preserving Gynecologic Procedures

Impact of Laparoscopic Experience on Performance on Laparoscopic Training Drills among Obstetrics and Gynecology Residents: A Pilot Study

Complete Bladder Gangrene Caused by Bilateral Hypogastric Artery Ligation during Laparoscopic Radical Hysterectomy

Beware the Tarlov Cyst

Migration of an Intrauterine Contraceptive Device during the Course of Pregnancy: A Case Report

Recurrent Thigh Abscess with Necrotizing Fasciitis from a Retained Transobturator Sling Segment

Hysteroscopic Removal of Gauze Packing Inadvertently Sutured to the Uterine Cavity: Report of 2 Cases

Laparoscopic–assisted Uterovaginal Anastomosis for Uterine Cervix Atresia with Partial Vaginal Aplasia

Isolated Extrapelvic Endometriosis of the Gluteal Muscle

The Sacral LION Procedure for Recovery of Bladder/Rectum/Sexual Functions in Paraplegic Patients after Explantation of a Previous Finetech-Brindley Controller

Delayed Iliac Artery Thrombosis after Blunt Trauma during Operative Laparoscopy

Laparoscopic Management of an Isolated Ovarian Metastasis on a Transposed Ovary in a Patient Treated for Stage IB1 Adenocarcinoma of the Cervix

A Practical Manual of Laparoscopy and Minimally Invasive Gynecology, a Clinical Cookbook, 2nd edition

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Capsule Summary

Capsule Summary

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