ABSTRACT
Abnormal uterine bleeding (AUB) is a common problem that negatively impacts a woman's health-related quality of life and activity. Initial medical treatment includes hormonal and nonhormonal medications. If bleeding persists and no structural abnormalities are present, a repeat trial of medical therapy, a levonorgestrel intrauterine system, or an endometrial ablation can be used dependent on future fertility wishes. The levonorgestrel intrauterine system and endometrial ablation are effective, less invasive, and safe alternatives to a hysterectomy in women with AUB. A hysterectomy is the definitive treatment of AUB irrespective of the suspected cause when alternative treatments fail. Future studies should focus on detection of predictors for treatment outcomes.
Subject(s)
Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Contraceptive Agents, Female/therapeutic use , Endometrial Ablation Techniques , Hysterectomy , Intrauterine Devices, Medicated , Levonorgestrel/therapeutic use , Minimally Invasive Surgical Procedures/methods , Uterine Hemorrhage/therapy , Contraindications , Endometrial Ablation Techniques/methods , Female , Humans , Hysterectomy/statistics & numerical data , Outcome Assessment, Health Care , Quality of Life , United StatesABSTRACT
Major vessel injuries during laparoscopy most commonly occur during insertion of Veress needle and port trocars through the abdominal wall. This article reviews methods for avoiding major vessel injury while gaining laparoscopic access, including anatomic relationships of abdominal wall landmarks to the major retroperitoneal vessels. Methods for periumbilical placement of the Veress needle and primary trocar are reviewed in terms of direction and angle of insertion, and alternative methods and locations are discussed. Methods for secondary port placement are reviewed in terms of direction, depth, and speed of placement.
