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Surgical Technology International 30
$195.00
Surgical Technology International Vol. 30 contains 73 peer-reviewed articles featuring the latest advances in surgical techniques and technologies.
June-2017- ISSN:1090-3941
1 year Institutional Subscription
both electronic and print versions.
The Impact of a Topical Sexual Enhancement Cream on the Female Sexual Response and Its Relationship to Clitoral Blood Flow
Michael Pelekanos, MD, Vice Chair, Obstetrics and Gynecology Department, Female Pelvic Medicine and Reconstructive Surgery, West Penn Allegheny Health System, Pittsburgh, Pennsylvania, Guy M Stofman, MD, Chief Plastic Surgery, University of Pittsburgh Medical Center, Mercy Division, Clinical Professor of Plastic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, Neil Niren, MD, Clinical Instructor, Dermatology, University of Pittsburgh School of Medicine, Private Practice, Dermatology, Pittsburgh, Pennsylvania
796
19-Dec-2016
OBJECTIVE: The aim of this investigation was to determine, through two Investigational Review Board (IRB)-approved studies, if a new topical vasodilating cream (NTVC; Life Science Enhancement Corporation, Pittsburgh PA) could improve female sexual response. Study I subjectively evaluated sexual female response as accessed by a modification of the Female Intervention Efficacy Index (FIEI). FIEI was developed at the University of California as an immediate outcome measure of medical intervention to treat female sexual dysfunction.1 In Study II, 10 randomly selected positive responders from Study I were subsequently analyzed objectively with clitoral plethysmography in order to determine the effect of the NTVC and placebo on blood flow.2
RESULTS: In the subjective Study I (81 patients ranging in age from 18 to 63), a positive response trend for the NTVC was demonstrated compared to the placebo. In the objective Study II, 10 randomly selected patients who responded positive in Study I were objectively evaluated for response of increased blood flow in the clitoris after application of both the NTVC and placebo. The clitoral blood flow was shown to have increased with statistical significance for the NTVC in all 10 patients compared to the placebo, with the NTVC exhibiting an average 69% increase in clitoral blood flow.
CONCLUSIONS: The female sexual response is complex. In the subjective Study I, the NTVC demonstrated positive trends for enhanced lubrication, genital sensation, intercourse, and overall sexual experience. In the objective Study II, 10 of the positive subjective responders from Study I were randomly selected to evaluate their response to the NTVC compared to the placebo. This was done via Doppler plethysmography (DP). All 10 patients demonstrated a statistically significant response rate for increase in clitoral blood flow using the NTVC compared to the placebo, with an average blood flow increase of 69%. This portion of the investigation demonstrates a significant positive end organ response to the NTVC. The positive subjective trends combined with the significant and substantial increase in clitoral blood flow may result in enhanced female sexual satisfaction.
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The McCarus-Volker ForniSee®: A Novel Trans-illuminating Colpotomy Device and Uterine Manipulator for Use in Conventional and Robotic-Assisted Laparoscopic Hysterectomy
Melissa M. Gutierrez, MD, Assistant FMIGS Program Director, Minimally Invasive Gynecologic Surgery, Las Vegas Minimally Invasive Surgery/Women’s Pelvic Health Center, Las Vegas, Nevada, Jasmine D. Pedroso, MD, Assistant FMIGS Program Director, Minimally Invasive Gynecologic Surgery, Las Vegas Minimally Invasive Surgery/Women’s Pelvic Health Center, Las Vegas, Nevada, K. Warren Volker MD, PhD, FMIGS Program Director, Minimally Invasive Gynecologic Surgery , Las Vegas Minimally Invasive Surgery/Women’s Pelvic Health Center, Las Vegas, Nevada, David L. Howard, MD, PhD, Research Director, Minimally Invasive Gynecologic Surgery, Las Vegas Minimally Invasive Surgery and Women’s Pelvic Health Center, Las Vegas, Nevada, Steven D. McCarus, MD, Director of Gynecologic Surgery, McCarus Surgical Specialists for Women, Florida Hospital, Celebration, Florida
802
20-02-2017
Purpose: The purpose of this paper is to introduce a novel trans-illuminating culdotomy and uterine manipulator device.
Materials and Methods: The study was a prospective, non-randomized, non-blinded observational clinical study involving 50 female patients undergoing total laparoscopic hysterectomy (TLH) or laparoscopic supracervical hysterectomy (LSH) for benign indications. The surgeries were performed from March through May 2012 at two institutions. The primary study objectives were to demonstrate the safety and adequate clinical performance of the uterine manipulator device and to illustrate its potential widespread future use in minimally invasive gynecologic procedures.
Results: Average patient age was 45.1 years and, of the 50 patients, 33 had undergone previous intra-abdominal surgery. There were no reports of adverse events, difficulty with placement of the instrument, multiple attempts at placement, or difficulty with uterine manipulation. There was only one device-related uterine perforation, and pneumoperitoneum was maintained in all cases during culdotomy. Vaginal tissue left on subjects was less than 5mm. Overall, there were no ureteral injuries, there were two reported incidental cystotomies, and average blood loss was 99.0cc. Postoperative courses were normal for all patients, with only two reported postoperative complications: a possible vaginal cuff abscess and a 2cm vaginal mucosal cuff separation.
Conclusions: The McCarus-Volker ForniSee® (LSI Solutions, Inc., Victor, New York) is a novel trans-illuminating culdotomy device and uterine manipulator that is safe, efficient, functional, and easy to use. Trans-illumination additionally delineates and enhances identification of critical anatomic planes, such as the vesicovaginal junction and cervicovaginal junction.
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Pisat’s Visual Vasopressor Injection Needle: An Innovative Tool for Increasing Patient Safety in Laparoscopic Myomectomy
Dr Sanket Pisat, MS, DNB, Consultant/Gynaecological Endoscopic Surgeon, Department of Gynecology, Akanksha Hospital, Mumbai, India, Bruno van Herendael, MD, Professor/Consultant, Department of Gynecological Endoscopy, ZNA Stuivenberg Hospital, Antwerp, Belgium
815
14-02-2017
Introduction: The use of vasopressin and other vasoconstrictive agents to reduce blood loss during laparoscopic myomectomy significantly reduces blood loss and operative time. However, serious cardiovascular complications following the use of intramyometrial injection of vasopressin solution have also been reported. Most of these side effects are believed to be due to inadvertent intravascular injection of vasopressin solution.
Aims and Objectives: To describe a new design of an injection needle. Pisat’s visual vasopressor injection needle (VVIN) can be used during laparoscopic myomectomy to minimise the incidence of an inadvertent intravascular injection of a vasoconstrictor solution.
Results: A total of 53 patients who underwent laparoscopic myomectomy at various hospitals in Mumbai, India were studied over a period of two years. Out of these, 23 patients were operated upon using a standard 5 mm laparoscopic injection needle, and 30 patients were operated on by using a VVIN. Out of the 23 patients in whom a regular needle was used, four patients (17.39%) demonstrated a significant (over 20% of pre-injection value), but transient, elevation in pulse and blood pressure readings at one minute post injection. This gradually returned to baseline at 10 minutes after the injection. None of the 30 patients in whom VVIN was used after confirming a negative aspiration demonstrated any significant change in post-injection pulse or blood pressure recordings.
Conclusions: Using a VVIN during a laparoscopic myomectomy enables the surgeon to detect an inadvertent vascular puncture very early, even in a small calibre blood vessel, and with much more sensitivity than a regular needle. This increases patient safety during the intramyometrial injection of a vasoconstrictive agent during myomectomy and reduces the incidence of catastrophic complications.
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Pregnancy Complications After Hysteroscopic Metroplasty: A Ten-Year Case-Control Study
Alessandro Loddo, MD, Physician, Obstetrics-Gynecology Clinic and Pathophysiology of Human Reproduction Unit, Department of Surgical Sciences, University Hospital of Cagliari, Sardinia, Italy, Maurizio Nicola D’Alterio, MD, Physician, Obstetrics-Gynecology Clinic and Pathophysiology of Human Reproduction Unit, Department of Surgical Sciences, University Hospital of Cagliari, Sardinia, Italy, Manuela Neri, MD, Physician, Obstetrics-Gynecology Clinic and Pathophysiology of Human Reproduction Unit, Department of Surgical Sciences, University Hospital of Cagliari, Sardinia, Italy, Francesca Masala, MD, Physician, Obstetrics-Gynecology Clinic and Pathophysiology of Human Reproduction Unit, Department of Surgical Sciences, University Hospital of Cagliari, Sardinia, Italy, Fiorenza Lo Cane, MD, Physician, Obstetrics-Gynecology Clinic and Pathophysiology of Human Reproduction Unit, Department of Surgical Sciences, University Hospital of Cagliari, Sardinia, Italy, Gian Benedetto Melis, MD, Full Professor in Obstetrics and Gynecology, Obstetrics-Gynecology Clinic and Pathophysiology of Human Reproduction Unit, Department of Surgical Sciences, University Hospital of Cagliari, Sardinia, Italy
820
11-02-2017
Introduction: Septate uterus is one of the most common congenital uterine anomalies and it may effect female reproductive health causing different obstetric complications, in particular miscarriages and reduction of fertility.
Materials and Methods: We conducted a retrospective case-control (1:4) comparative study (Canadian Task Force Classification II-2) with the purpose to evaluate pregnancy complications (abnormal fetal presentations, preterm deliveries, and caesarean sections) and reproductive outcome after hysteroscopic metroplasty. We studied retrospectively two groups: 62 women that delivered after metroplasty (group A); and a control group of 248 women with no history of hysteroscopic metroplasty that delivered in the same period in our hospital (group B).
Results: The rate of abnormal fetal presentations was significantly higher in study group A versus control group B (22.58% [14/62] vs. 4.03% [10/248], p<0.0001). Caesarean section rate was significantly higher in group A versus group B (66.12% [41/62] vs. 35.08% [87/248], p<0.0001), and preterm deliveries rate was significantly higher in group A versus group B (14.51% [9/62] vs. 6.45% [16/248], p= 0.037). Furthermore, in group A, we observed a significant reduction of the abortion rate and an increase in the total number of live births after metroplasty.
Conclusions: In our series of cases, we have observed a high rate of some pregnancy complications after metroplasty compared to the general population, such as preterm deliveries and fetal malpresentations with a higher rate of caesarean sections. Hysteroscopic metroplasty has been proven to improve the overall reproductive outcome by reducing miscarriage rate and increasing live birth rate. In our opinion, benefits obtained after metroplasty must be considered greater than the adverse pregnancy outcomes observed with our series.
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Adnexal Torsion in the First Trimester of Pregnancy: Diagnosis, Laparoscopic Management, and Review of the Literature
Rafael Bras, MD, Department of Obstetrics and Gynecology, Centro Hospitalar do Porto, Porto, Portugal, Jorge Braga, MD, Professor, Department of Obstetrics and Gynecology, Centro Hospitalar do Porto, Porto, Portugal, António Tomé, MD, PhD, Full Professor, Department of Obstetrics and Gynecology, Centro Hospitalar do Porto, Porto, Portugal, Helder Ferreira, MD, PhD, Coordinator of Endoscopy Unit, Department of Obstetrics and Gynecology, Centro Hospitalar do Porto, Porto, Portugal, Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal, ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
840
15-04-2017
We report a case of an adnexal torsion in a 27-year-old woman in her 12th week of gestation. She presented with hypogastric and lumbar pain with biliary vomiting and nausea. Upon physical examination, tenderness in the right lower quadrant with rebound tenderness was apparent, and gynecological examination revealed right adnexal tenderness with absence of abnormal cervical discharge. The transvaginal ultrasonography demonstrated an enlarged cystic right ovary with no flow detected on color and power Doppler mode. We performed a laparoscopy and the diagnosis of adnexal torsion was confirmed. Detorsion of the right adnexa and cystectomy of the ovary was achieved without surgical or anesthetic complications.
The patient was supplemented with progesterone during pregnancy and gave birth to a healthy child at term.
Adnexal torsion is an unusual cause of abdominal pain in gestation with an incidence of 1–5:10.000, and it is more often observed during the first and early second trimesters of gestation. The clinical signs are often unspecific, and an ultrasound is the most commonly used imaging method for this diagnosis. The laparoscopy is the preferred method of diagnosis and treatment can be safely used in pregnancy if the guidelines are respected.
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Should We Abandon the Gynecologic Resectoscope in Favor of Hysteroscopic Morcellators?
Morris Wortman, MD, FACOG, Director, Center for Menstrual Disorders, Rochester, New York, Clinical Associate Professor, Department of Obstetrics & Gynecology, University of Rochester Medical Center, Rochester, New York
846
03-04-2017
The treatment of intrauterine masses, such as endometrial polyps and leiomyomas, has undergone a technological revolution in the past few decades. Gynecologists may now choose from a variety of unipolar and bipolar resectoscopes as well as an assortment of both mechanical and bipolar hysteroscopic morcellators. We present a comparison of these technologies to better practitioners understanding of the strengths and limitations of these devices.
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