Teaching instrument: a laparoscopic training model.

A laparoscopic training model with female surface anatomy has been developed. This training model is made of a plastic boutique-showing model that is equivalent to normal-size female anatomy from the neck to the upper thigh. Four holes were made on the model's abdominal wall as puncture-sites to enter the cavity, the first is 80-mm diameter at the umbilical area, and the other three 38-mm diameter holes are located on both sides of the lower abdomen and suprapubic area. The umbilical hole can be covered with a simulated abdominal wall made from 6.5-mm insulation sheet, fixed to the model using a rubber band. The other three puncture-sites were plugged with a flexible rubber diaphragm as working ports. When used as video-laparoscopy, the auto-focus camcorder is used as a telescope and is connected to a regular television set as a monitor. This model can be used for training of abdominal entry by Veress needle or trocar, laparoscopic tubal ligation (LTL), and video-eye-hand co-ordination. This model has been a training medium in our Department for 1 year and was included in the OSCE for the Board Examination of the Royal Thai College of Obstetricians and Gynecologists in the year 2000 to assess the process of Veress needle insertion.

Songkla uterine manipulator.

The Songkla Uterine Manipulator (SUM) was developed for laparoscopic procedures. Its shaft consists of two stainless steel rods, which pivot a head and locking system. The obturator has a plate and is connected to the pivot head with a screw. The obturator has a diameter of 4.7 mm with three standard lengths of 6, 8, and 10 cm and there is a spring hook to retain it with the tenaculum. The SUM allows antevertion of the uterus up to 95 degrees and lateral motion of about 45 degrees bilaterally. From December 1996 to December 1999, the SUM was used successfully in 150 laparoscopic procedures, including 51 tubal sterilizations, 42 cases of adnexal surgery, 12 total laparoscopic hysterectomies and 45 laparoscopic assisted vaginal hysterectomies. The visualization of pelvic organs including both adnexae was good in all cases without trauma to the vagina, cervix or uterus. Conclusion: The simplified low cost uterine manipulator was developed. Early results were good but more modifications are needed, such as mechanism to retain it to the cervix without the tenaculum and sealing of gas leakage from the vagina during laparoscopic hysterectomy.

A clinico-pathologic study of ovarian tumors.

A series of 286 patients receiving surgical treatment for ovarian tumors at Song-klanagarind Hospital between January 1987 and June 1990 were reviewed. The most frequent diagnoses by age group were: cancer in 53 per cent of women > or = 50 yrs of age, endometrioma in 63 per cent of women 31-49 yrs of age and benign cystic teratoma in 49 per cent of women < or = 30 yrs of age. Mucinous ovarian tumors were the most common type of epithelial neoplasms. Abdominal pain was the symptom most frequently experienced in patients with benign ovarian tumors. The 95 per cent confidence interval for finding malignancy in women > or = 50 yrs, ascites > 500 ml and size of ovarian tumor > 10 cm was 47-99 per cent.

Ovarian neoplasms in childhood and adolescents in Songklanagarind Hospital, February 1983-March 1989.

Ovarian tumors in young females under the age of 20 years in Songklanagarind Hospital from February 1983 to March 1989 were evaluated. The total number of patients was 47, with a 4.0 per cent incidence of ovarian tumors in all age groups. Germ cell tumor was the most common tumor (59.6%) and 60.7 per cent were malignant. The chief presenting symptom was abdominal distention or mass, with 17.0 per cent of torsion. Ascites and solid consistency of tumors suggested its malignant potential. Surgery was the treatment for all patients with a conservative approach in the majority of cases and supplemented with chemotherapy and/or radiotherapy in malignant cases.