The new techniques of gynaecologic laparoscopy. Gasless, open Hasson, optic trocar.

BACKGROUND: New techniques of laparoscopy: gasless, open Hasson, optic trocars allow to avoid the risks of vessel and bowel injuries. The objective of this study was to evaluate the capability of a retractor system as an alternative to conventional technique without pneumoperitoneum and to assess if the system facilitates the use of conventional surgical instruments during gynaecological surgery. DESIGN: Prospective evaluation. SETTING: University-affiliated county hospital. PATIENTS: Gasless laparoscopy surgery was performed on 49 patients between December 1995 and July 1996 with a retractor system without pneumoperitoneum consisting of an intrabdominal retractor using conventional surgical and laparoscopic instruments and to enable a simultaneous vaginal approach. RESULTS: Gasless laparoscopy was successful in 44 (90%) of cases. A simultaneous vaginal approach was used in one third of indications including vaginal myomectomy and laparoscopic assisted hysterectomy. Conversion to laparotomy was required in 5% of cases. Mean procedure duration was 90 minutes and mean hospitalisation time was 5.7 days. CONCLUSIONS: The introduction of new techniques of laparoscopy: gasless, open Hasson, optic trocars has broadened the application of operative laparoscopy. Gasless technique in lieu of conventional laparoscopy can be performed reliably and safely for most gynaecological indications. The most outstanding benefit of this method is that it can be combined with a vaginal approach which is not possible using a pneumoperitoneum due to gas leakage. The place of gasless laparoscopy will depend on continuing development by instrument manufacturers, in order to achieve an instrument providing vision as good as that seen with the pneumoperitoneum.

[Celio-assisted vaginal surgery]. / La chirurgia vaginale celioassistita.

BACKGROUND: Remarkable progress has been made in laparoscopic surgery over the past few years. The evolution of laparoscopic techniques has enabled surgeons to undertake celio-assisted vaginal operations. In particular, the possibility of using mechanical retractors to lift the abdominal wall as an alternative to pneumoperitoneum now enables surgeons to operate simultaneously using a transvaginal and laparoscopic approach. Gas-free laparoscopy has introduced a new and very interesting concept of laparovaginal surgery. The uterus is in fact both an abdominal and pelvic organ and can therefore be reached more easily and with greater safety using a combined vaginal and laparoscopic technique. METHODS: A group of 17 patients underwent celio-assisted vaginal surgery. A prospective study was performed in patients with indications for vaginal operations who had given their informed consent to the use of this new surgical technique. Their mean age was 49.4 years. Mean parity was 1. RESULTS: Vaginal myomectomy was performed in 58.8% of cases, whereas 41.2% underwent vaginal hysterectomy. Laparoconversion was necessary in 17.6% of cases. Postoperative complications were rare (11.7%). The mean duration of surgery was 122.7 minutes. Mean hospital stay was 3.7 days. CONCLUSIONS: The considerable advantages of celio-assisted vaginal surgery using gas-free laparoscopy may be summed up as reduced operating time and reduced intra-abdominal pressure which significantly diminish the risk of thromboembolism. The disadvantages that were noted compared to pneumoperitoneum include: diminished lateral exposure of the abdominal cavity and paracholic grooves, reduced lifting of the rib margin and a greater presence of the intestinal ansae in the laparoscopic visual field in obese patients.

[Transvaginal echographic evaluation of myometrial invasion in patients with endometrial cancer]. / Valutazione con ecografia transvaginale dell'invasione miometriale in pazienti affette da carcinoma dell'endometrio.

Twenty-one patients with endometrial cancer who underwent laparotomy, were pre-operatively examined by transvaginal sonography. A deep myometrial invasion (> 50%) was noted sonographically in 9 patients (42.3%), with a superficial invasion (< 50%) in 12 (57.2%). A deep invasion was histologically seen in 10 patients (47.6%), with a superficial invasion in 11 (52.4%). In myometrial deep invasion evaluation, transvaginal sonography showed a 90% sensibility, a 73% specificity, a 75% positive predictive value and a 93% negative predictive value. In 3 cases (14.3%) the invasion depth was sonographically overestimated and in 1 case (4.8%) underestimated. These results make possible an important role of transvaginal sonography in staging endometrial cancer, to select patients needing for pelvic and lomboaortic lymphadenectomy over total abdominal hysterectomy with vaginal collar.

[Management of delivery in podalic birth: cesarean section or vaginal delivery?]. / Considerazioni sull'espletamento del parto podalico: taglio cesareo o parto vaginale?

Three hundred and thirty-six births with podalic presentation (3.15% of total deliveries) took place during the period 1978-89 in the Department of Obstetrics and Gynecology of Pinerolo Hospital. The nature of the delivery, the age of pregnant women, together with the length of pregnancy, the number of previous children, the number of days spent in hospital, complications, birth weight, and Apgar scores 1 and 5 minutes after birth were recorded. The most striking result is the increase in the number of caesarean section.

[Ovarian dysgerminoma. Report of a case with successive pregnancies]. / Disgerminoma ovarico. Descrizione di un caso con gravidanza successiva.

The case of a young woman is described who gave birth to two children following the removal of an ovarian dysgerminoma and currently enjoys good health eight years after the operation. The tumour was a pure dysgerminoma, with a diameter of 12 cm, which affected the left ovary. Surgical treatment alone was used.

[Congenital giant melanocytic mole and pregnancy. Report of a case and review of the literature]. / Nevi congeniti melanocitari giganti e gravidanza. Presentazione di un caso e revisione della letteratura.

Following a review of the literature on the topic, the paper reports the case of a young woman with a congenital giant pigmented mole who delivered a healthy male baby after a normal pregnancy. The subject has been followed up for 24 months but no variation of CGPM has been observed.

[The dosimetry of gynecological curietherapy by means of computed tomography]. / La dosimetria nella curieterapia endocavitaria ginecologica per mezzo della tomografia computerizzata.

The dosimetry of endocavitary curietherapy by means of CT in 15 patients, affected by cancer of the uterine cervix was studied. The results were compared with those obtained by the method of the European Group of Curietherapy. The authors measured the dimensions of the treated volume and the dose at critical points. The good relationship between the 2 methods is demonstrated, and the great possibilities opened by the new method are emphasized.

[Notes on the application of the law on voluntary interruption of pregnancy at a provincial general hospital]. / Observazioni sull'applicazione della legge per l'interruzione volontaria della gravidanza presso un Ospedale Generale Provinciale.

PIP: The Italian abortion law was passed in May 1978. Between June 1978 and April 1980, 1121 legal abortions were done at the general hospital "E. Agnelli" in Pinerolo, Italy. During the same period of time there were 1980 deliveries and 5350 hosptalizations for obstetric-gynecological reasons; legal abortions represented 29% of all types of hospitalizations. In certain month 60-69 abortions were done, while about 35 had been expected as the regular monthly load. Most procedures were done by curettage; there were 3 cases of uterine perforation and 1 case of hemorrhage. The majority of abortions were done between the 9th and the 12th week of pregnancy; age of patients was between 14 and 47, with the majority in the age group 26-35. 402 patients were at their 3rd pregnancy, and 351 declared to have had previous experience of spontaneous or induced abortion. Most requests for abortion were for social or economic reasons, followed by high parity, age and parity, and poor maternal health; only 28 requests were for fear of fetal abnormalities. Patients were kept only for 1 night and most were housewives. Because of the lack of personnel, lack of time and unsuitable hospital structures, it was impossible to give each patient adequate counseling on fertility control methods.^ieng