Shortfalls in published neurosurgical literature.

Expenditure related to neurosurgery has increased unevenly since the early 1990s. In this study we explored the literature by which clinical evidence is obtained to better direct neurosurgical practice. We searched different types of neurosurgery literature and four major neurosurgical procedures (excision of brain lesion, cerebral aneurysm clipping/coiling, discectomy, spine fusion) written in English on PubMed from 1996, the year of its launch, using the keyword "cost". Only a small and static portion of the neurosurgical literature was indexed as level I clinical evidence (randomized controlled trials), with a lack of cost appraisal in the outcome analysis of neurosurgical interventions. By way of rectification, a major increase in funding of grade I studies with cost analysis, and the requirement by peer-reviewed journals of a cost-benefit analysis, would promote the quality of clinical research yielding unquestionable advantage on national healthcare practice.

The role of laparoscopic myomectomy in the management of uterine fibroids.

PURPOSE OF REVIEW: Laparoscopic myomectomy has been described as comparable to open myomectomy in terms of fertility and obstetrical outcome with decreased intraoperative bleeding and postoperative disability. Despite this, laparoscopic myomectomy is not widely used reportedly due to lack of experience. This article presents our technique for laparoscopic myomectomy and assesses the current evidence-based literature for the use of this minimally invasive procedure in benign gynecological practice. RECENT FINDINGS: Literature continues to support the safety and feasibility of laparoscopic myomectomy for symptomatic women desiring to preserve their fertility. Alternatively, laparoscopically assisted myomectomy has been suggested when wider access is needed to perform the procedure. This variant of the technique allows palpating the uterus and does not require laparoscopic suturing skills. Robotic-assisted laparoscopic myomectomy currently has limited advantage over conventional laparoscopy due to longer operative time, loss of tactile sensation necessary to detect intramural myomas and high cost. Single-port surgery is a new promising approach, but still requires extensive investigation to determine whether it has significant benefits over conventional techniques. SUMMARY: Laparoscopic myomectomy cases are mostly doable, but may become difficult if bleeding problems occur. Extended operative times may be required for morcellation and extensive laparoscopic suturing. Gynecologists need to improve their laparoscopic skills, as minimally invasive surgery is becoming the sine qua non of a modern surgeon.