Designing an advanced laparoscopic surgery training center.

The explosive development of minimally invasive surgery has had a staggering impact on the hospital, operating room, and surgeon, as well as on the medical equipment industry and insurance carriers. As a result of (1) the overwhelming demand by the public, (2) the potential of future developments of this modality, and (3) the progressive geometric influence that has spread to the various surgical subspecialties, unprecedented pressure has been placed on our systems for training, credentialing, developing, supplying, and evaluating changes in surgical technique.

Laparoscopic presacral neurectomy for treatment of midline pelvic pain.

STUDY OBJECTIVE: To examine the efficacy and safety of laparoscopic presacral neurectomy (LPSN) as the initial surgical treatment of midline pelvic pain and dysmenorrhea; and to evaluate its effectiveness in conjunction with procedures to relieve lateral pelvic pain, such as excision of endometriosis and lysis of adhesions. DESIGN: A preoperative and postoperative self-rating with which patients classified pain on an ordinal scale of 0 to 5. A x^{2 analysis of the data was performed. SETTING: A private hospital in Savannah, Georgia. PATIENTS: Twenty-seven women, age 15 to 41 years, who experienced severe midline dysmenorrhea and/or pain; 12 also had significant lateral pain. INTERVENTIONS: Laparoscopic presacral neurectomy was the primary intervention. Other procedures, including lysis of adhesions, excision and vaporization of endometriosis, and appendectomy were completed as adjuncts to LPSN. MEASUREMENTS AND MAIN RESULTS: Ratings were completed by patients 5 to 35 months after surgery. Twenty-two women reported no midline pain, three had significant reduction of pain, and two had persistence of severe pain. Two of the 12 women with lateral pain reported that pain persisted. CONCLUSIONS: The LPSN is safe and effective as an initial surgical intervention for treating midline dysmenorrhea and pelvic pain, and when it is performed by experienced laparoscopic surgeons with adequate training.}

Laparoscopic tubotubal anastomosis: laparoscopic microsurgery in gynecology.

Tubotubal anastomosis technique dates back to the 1920's when large sutures were used to approximate proximal and distal ends of the fallopian tube. Direct vision, aided by overhead illumination, was used and stitches were placed superficially to avoid inclusion of the posterior wall. Delicate tissue handling was not stressed. No major breakthroughs in this area developed over the next half century. The 21% success rate for the conventional technique was disappointingly low although a clear explanation has never been established. Presumably it was caused either by the failure to reconstruct a patent lumenal channel or by causing extensive postoperative adhesion formation.

Laparoscopic presacral neurectomy.

Presacral neurectomy (PSN) has been successfully used to treat women experiencing midline premenstrual and menstrual dysmenorrhea along with mid line pelvic pain for almost 100 years. Recent developments in minimally-invasive surgical technique have allowed the gynecologic surgeon to perform laparoscopic presacral neurectomy (LPSN) as an isolated procedure or in conjunction with other conservative procedures for the treatment of pelvic pain and dysmenorrhea.

Maternal midtrimester sepsis in association with the intrauterine contraceptive device: early histopathologic findings.

PIP: A case study of sepsis of pregnancy associated with a shield-type intrauterine device (IUD) is reported. The patient presented with a 12-hour history of chills and fever, but no other complaints. A pregnancy of 14-16 weeks gestation, with the IUD in place, was confirmed. The fetus, placenta, and IUD were evacuated vaginally and curettage was performed. Histopathologic analysis revealed extensive bacterial colonization of the maternal side of the membranes. Microscopic sections of the placenta and fetal organs showed no remarkable characteristics. Possible explanations of the mechanism of severe maternal sepsis during pregnancy are briefly discussed.^ieng