Surgical Technology International
40th Anniversary Edition
May 2022 - ISSN:1090-3941
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Resectoscopic Surgery Part III: Advanced Resectoscopic Surgery
Morris Wortman, MD, FACOG, Associate Professor, University of Rochester Medical Center, Rochester, New York
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In this final section of our three-part series, we will apply the basic and intermediate skills described in the first two parts to advance the gynecologist’s skills to accomplish the most demanding of resectoscopic surgical challenges.
In Part I of this series, we reviewed the benefits of the continuous flow gynecologic resectoscope (CFGR) and how the motivated gynecologist can assemble an operative team and overcome the impediments to learning the use of this versatile and minimally invasive instrument. In this first section, we outlined and analyzed basic resectoscopic surgery—endometrial ablation, the resection of small submucous myomas and endometrial polyps, as well as the treatment of mild Asherman’s syndrome and the removal of retained products of conception.
In Part II—intermediate level resectoscopic surgery—we introduced procedures such as endomyometrial resection, the resection of intermediate-size submucous leiomyomas, hysteroscopic metroplasty, and endocervical resection. Though it is not considered an absolute requirement to accomplish procedures at this level, sonographic guidance was introduced in preparation for more challenging cases.
In Part III, the author reviews advanced resectoscopic procedures in which sonographic guidance is a requirement for the management of severe intrauterine adhesions and late-onset endometrial ablation failures, the management of FIGO Type 3 and 4 intramural myomas, as well as large submucous myomas.
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Robot-Assisted Surgery for Endometriosis Current and Future Perspectives
Emad Mikhail, MD, FACOG, FACS, Associate Professor & Director, Zoran Jason Pavlovic, MD, Maha Al Jumaily, MBBS , University of South Florida/Morsani College of Medicine, Tampa, Florida, Mira H. Kheil, MD, Wayne State University, Detroit, Michigan, Gaby N. Moawad, MD, FACOG, Clinical Associate Professor, The George Washington University School of Medicine, McLean, Virginia, Thiers Soares, MD, State University of Rio de Janeiro, Cardoso Fontes Hospital, Rio de Janeiro, Brazil
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Successful resection of all visible lesions may effectively treat endometriosis-related infertility and pelvic pain. Minimally invasive surgery provides significant advantages, with lower rates of surgical complications such as surgical trauma, infection, postoperative pain, and hospital stay. Robotic surgery is shown to have similar perioperative outcomes to conventional laparoscopy; however, complex stage III and IV endometriosis, especially cases requiring significant resection such as deep infiltrating endometriosis, widespread peritoneal implants, and urologic and intestinal involvement, may benefit most from a robotic approach.
There are certain aspects of endometriosis surgery where utilization of robotic technology might provide an additional benefit. These include (1) heterogeneity of lesions, and thus difficulty in identification; (2) difficulty in accurately predicting surgical complexity; and (3) prolonged operative time for complex cases. The objective of this review is to describe the current and future perspectives of robotic surgery as it pertains to endometriosis.
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Electrosurgery and Other Technical Advancements in Minimally Invasive Gynecological Surgery – An Update
Marcel Grube, Martin Weiss, MD, Junior Professor, Christina B. Walter, MD, Felix Neis, MD, Sascha Hoffmann, MD, Juergen Andress, MD, Stefan Kommoss, MD, Professor, Sara Y. Brucker, MD, Professor, Bernhard Krämer, MD, Professor, Department of Women’s Health, Tuebingen University Hospital, Tuebingen, Germany
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Electrosurgery in gynecology has changed over the past few decades. The use of energy-based devices, especially in minimally invasive procedures, is extremely important for preparation, short reconvalescence and patient safety. Recently, there have been major advances in energy-based surgical devices that have further shortened OR time and increased patient safety.
Although bipolar and monopolar electrosurgery is still very important, the introduction of high-frequency ultrasound in gynecologic surgery has improved cutting and coagulation by lowering thermal damage in the surrounding tissue. Furthermore, new technical inventions have fundamentally changed the treatment of specific diseases. The introduction of ablation in the therapy of uterine fibroids, for example, has made conventional myomectomy no longer necessary in some cases, as necrosis of fibroids can be induced by placing very small thermal probes into the fibroids.
Robotic surgery will change the face of gynecological surgery in the near future, as the initial studies could show lower surgical morbidity and faster recovery of patients after robotic-assisted laparoscopy.
In this article we provide a short overview of current technical advances, review possible indications as well as limitations, and take a look into the future of minimally invasive surgery in gynecology.
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Surgical Aspects of Adhesiolysis and Adhesion Barriers for Today’s Surgeon: A Call for More Robust Research
Alexandria Connor, MD, Hosam Hanna, MD, Resad Pasic, MD, PhD, Professor, Amira Quevedo, MD, Department of Obstetrics and Gynecology and Women’s Health, University of Louisville Hospital Louisville, Kentucky, Daniel Kruschinski, MD, Kruschinski Medical Center, Frankfurt, Germany
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Adhesions can cause symptoms of pelvic pain, infertility, and bowel obstruction in reproductive and postmenopausal women. The topic of adhesiolysis and adhesion barriers in gynecology has been studied in small, heterogeneous studies with very low to moderate quality. The efficacy for prevention and treatment strategies of adhesive disease in the gynecologic population will be reviewed here.
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