Surgical Technology International
32nd Edition
Contains 45 peer-reviewed articles featuring the latest advances in surgical techniques and technologies.
368 pages
May 2018 - ISSN:1090-3941
1 year Institutional Subscription
both electronic and print versions
Endometrial Ablation: Past, Present, and Future, Part I
Morris Wortman, MD, FACOG, Director, Center for Menstrual Disorders, Clinical Associate Professor Gynecology, University of Rochester Medical Center, Rochester, New York
987
Endometrial ablation (EA) is a commonly performed minimally invasive technique to manage intractable uterine bleeding that is unresponsive to medical therapy. It originated in ancient times when chemical astringents were used to control uterine hemorrhage associated with childbirth and a variety of other gynecologic conditions. In the late 19th century, the use of astringents and chemical cauterants gave way to the application of a variety of thermal energy technologies to cause selective destruction of the endometrium. These energy sources—steam, electricity, and even gamma rays—were applied blindly and were, by all accounts, quite effective at a time when hysterectomy was unsafe, infrequent, and generally unavailable.
With the emergence of improved optics and laser and video technology in the late 20th century, a resurgence of interest in endometrial ablation began—coinciding with a time when hysterectomy was commonly performed in developed countries. Endometrial ablation underwent a revolutionary change as physicians searched for new techniques to perform selective endometrial destruction under direct visual—hysteroscopic—control. In this first of a two-part series, we will explore the first and second generations of endometrial ablation to understand how this procedure has evolved into its present status and what issues remain to be solved.
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Total Laparoscopic Hysterectomy in the Setting of Prior Bilateral Renal Transplant, a Case Report and Review of the Literature
Nupur Tamhane, MD, Research Scholar, Entidhar Al Sawah, MD, Assistant Professor, Department of Obstetrics and Gynecology, University of South Florida, Tampa, Florida, Emad Mikhail, MB, ChB, MD, FACOG, FACS, Assistant Professor, Minimally Invasive Gynecologic Surgeon, Department of Obstetrics and Gynecology, University of South Florida/Morsani College of Medicine, Tampa, Florida
974
In recent years, more women are undergoing renal transplantation as a treatment for end-stage renal disease. Women with kidney transplants are prone to certain gynecologic issues which might necessitate hysterectomy. Laparoscopic hysterectomy can safely be performed in patients with prior unilateral or bilateral renal transplantation. Laparoscopy offers magnification of anatomy, decreased wound-related problems, and continuation of immunosuppression therapy. We present a case report and review of the literature for total laparoscopic hysterectomy and bilateral salpingectomy for a patient with prior bilateral renal transplant.
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Evaluation of the Safety and Efficacy of a Novel Radiofrequency Device for
Vaginal Treatment
Jeffrey C. Caruth, MD, Private Practice, Plano Aesthetics, Plano, TX
1000
Introduction: Vaginal laxity and atrophy are caused mainly by aging and vaginal childbirth, which lead to a loss of strength and flexibility within the vaginal wall. As a result, women may experience vaginal, pelvic, sexual and urinary symptoms that significantly affect their quality of life.
Objective: The aim of this study was to evaluate the safety and efficacy of a novel radiofrequency (RF) device for internal and external vaginal treatment.
Methods: Thirty women who had been diagnosed with symptoms of vaginal laxity and pelvic relaxation received a single treatment that consisted of continuous RF in the internal genitalia and continuous RF followed by fractional RF in the external vulva. Three different treatment conditions were examined. The results were evaluated by questionnaires and photos at two months post-treatment compared to baseline.
Results: For all parameters that were scored in the questionnaires, including vaginal symptoms, sexual matters, quality of life, pelvic floor impact and Stress Urinary Incontinence, significant improvements were found at a 2-month follow-up, compared to baseline (p<0.001). No significant or unexpected adverse events were noted.
Conclusions: The present results suggest that this novel RF-based device with continuous and fractional RF technologies is useful, safe and effective for treating vaginal relaxation and atrophy symptoms.
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Successful Treatment of Endometriosis-Related Hemorrhagic Ascites: A Report of Three Cases
Sofia Mendes, MD, Chief Resident, Catarina Carvalho, MD, Chief Resident, Gonçalo Rodrigues, MD, Clinical Assistant, Sónia Barata, MD, Clinical Assistant, Centro Hospitalar Lisboa Norte, Hospital Santa Maria, Lisboa, Portugal, Carlos Calhaz-Jorge, PhD, MD, Chief of Gynecology Department, Obstetrics and Gynecology Department, Centro Hospitalar Lisboa Norte, Hospital Santa Maria, Lisboa, Portugal, Faculdade de Medicina de Lisboa, CAML, Centro Académico de Medicina de Lisboa, Lisboa, Portugal, Filipa Osório, MD, Head of Minimally Invasive Surgery Unit, Hospital da Luz, Minimally Invasive Surgery Department/Obstetrics and Gynecology Department, Centro Hospitalar Lisboa Norte - Hospital de Santa Maria, Lisboa, Portugal
992
Endometriosis-related ascites is rare and is frequently confused with an ovarian malignancy. Since it affects women in reproductive age, its diagnosis and therapy are even more challenging. These patients usually present with abdominal distension, pelvic pain, and weight loss, but a careful questioning usually reveals the typical endometriosis symptoms—such as dysmenorrhea and dyspareunia. We present three cases of endometriosis-related ascites, one of them with pleural effusion. All cases were associated with extensive disease and required laborious laparoscopic surgery, medical therapy with gonadotropin releasing hormone analogs, and long-term follow-up. One of the patients delivered twins following an in vitro fertilization (IVF) cycle without recurrence of ascites. We aim to raise awareness toward the importance of considering endometriosis in a patient with ascites of unknown origin.
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Surgical Management After Hysteroscopic Sterilization: Minimally Invasive Approach Incorporating Intraoperative Fluoroscopy for Symptomatic Patients with >2 Essure® Devices
E. Scott Sills, MD PhD, Chairman and Medical Director , Reproductive Research Section, Center for Advanced Genetics, Carlsbad, California , Applied Biotechnology Research Group, University of Westminster, London, United Kingdom, Natalie S. Rickers, LVN, Director of Nursing , Reproductive Research Section, Center for Advanced Genetics, Carlsbad, California , Xiang Li, PhD, Director for Patient Services, Asia, Center for Advanced Genetics, Paralian Technologies, Inc., Mission Viejo, California
1016
Objective: To describe a non-hysterectomy surgical technique for symptomatic patients with >2 Essure® (Bayer Healthcare, Whippany, New Jersey) devices. Design: Patients (n=4) presented with sharp pelvic pain, irregular vaginal bleeding, dyspareunia, weight gain, hair loss, fatigue, and/or diffuse skin rash, all of which were absent before undergoing hysteroscopic sterilization (HS). Hysterosalpingogram obtained before surgical excision of contraceptive tubal implants confirmed more than two Essure® devices in all patients. Except for HS-associated complaints, all patients were in otherwise good general health and none had any history of prior pelvic pathology. Hysteroscopy was followed by 5mm triple-port laparoscopic cornual dissection, modified partial bilateral salpingectomy, and foreign body removal under fluoroscopy and/or radiographic guidance. Results: In this group, mean±SD patient age was 41±8yrs and interval between HS and device removal was 6.4±2.7yrs. At the conclusion of each case (mean±SD operative time=179±11min), imaging studies were reviewed by an attending radiologist and verified no retained metal in the abdomen. Conversion to laparotomy, hysterectomy, or blood transfusion was unnecessary for any patients, and all were discharged home within three hours. Their postoperative course continues to be satisfactory. Conclusion: Patients with more than two Essure® devices comprise an unusual group with a complex pelvic foreign body presentation. This is the first report on surgical management for such patients, underscoring the importance of localizing these contraceptive devices with careful imaging before, during, and after surgery. Moreover, hysterectomy is not absolutely mandatory in this setting and intraoperative fluoroscopy/radiography can facilitate complete, safe removal of all implants on an out-patient basis. Creation of ICD-10 modifiers for various post-HS complaints would allow for improved surveillance of the Essure® phenomenon.
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