Randomized trial comparing a radially expandable needle system with cutting trocars.

Sharp trocar insertion for laparoscopic procedures carries with it increased risk for vascular and visceral complications and incisional hernia. In a trial, which randomized 87 patients to treatment with either sharp trocars or a radially expanding needle system with blunt dilator, results showed that with the latter system there was statistically improved patient assessment of pain, a lower complications rate, and shorter procedure time. In the group of patients randomized to treatment with conventional trocars, there were a total of six instrument-related adverse events (6/42): four cases (five incidences) of abdominal wall injuries and one small bowel perforation caused by a Veress needle. Of the 45 patients randomized to the blunt dilator/cannula treatment, there was one adverse event (1/45) that was unrelated to the blunt dilator/cannula system: Veress needle injury to abdominal vasculature. The radially expanding access system demonstrates statistically improved patient postoperative comfort and improved patient safety.

Endometriosis ascites: a case report.

This is a case presentation of an usual nature, a 43-year-old Hispanic female, multigravida presenting with physical findings of massive ascites. In most instances, the presence of massive ascites is associated with malignancies, tuberculosis or perforated visous. In this case, the diagnosis of extensive endometriosis with ascites is reported as a very rare complication of the disease.

Is the standard of care what we think it is?

For the most part, gynecologists are actually unaware of the issues involving surrogate versus quality of life outcomes, the "deceptive practice of medicine" and the true incidence of complications as they relate to the standard of care. An anonymous survey of 1958 practicing gynecologists attending seven national symposia revealed a significant number of unreported complications. Clearly, the standard of care (at least with regard to complication risk) is markedly different than has been suggested by the medical literature. Concomitantly, we suggest that physicians need to take a more active role in the policing of our own specialties.

Initial experience with a physiologic morcellating resectoscope.

A new physiologic morcellating resectoscope allows operative hysteroscopy to be performed with a physiologic distention medium, thus reducing the risk of dilutional hyponatremia and cerebral edema secondary to excessive absorption of nonphysiologic fluid. To study this new technology, we gathered in vitro data with the SL resectoscope with dual-function electrode (FemRx, Sunnyvale, CA). Coupled to a standard monopolar electrosurgery unit and operating in normal saline or Ringer's lactate solution, extirpated uteri showed equivalent depth of tissue necrosis with this new physiologic morcellating resectoscope as with a conventional monopolar resectoscope used in an electrically nonconductive fluid.

Use of optical catheters for diagnostic office laparoscopy.

OBJECTIVE: To evaluate several small optical catheters (1.8-mm outer diameter) developed to allow access to the pelvic cavity for laparoscopic diagnosis in the operating room and in an office setting. STUDY DESIGN: Thirty-six procedures are reported, 20 performed in the operating room so that proper placement could be monitored and ensured, and the findings were compared with those obtained with a standard, 10-mm laparoscope. The remaining 16 procedures were performed in an office setting. The patients were women who were candidates for second-look laparoscopy, had pelvic pain and no physical findings, or were evaluated for possible tubal anastomosis. CONCLUSION: The small, rigid catheter, with its excellent optics, provided a clear view of the pelvis without the need for general anesthesia and associated costs. The procedure was performed easily and successfully with a local anesthetic and with minimal discomfort for the patient.

Endoscopic laser cholecystectomy: initial report.

With the recent advent of endoscopic laser cholecystectomy, gallbladder removal has been transformed into a minimally invasive operative procedure. To date, we have performed this technique in 12 patients (nine women and three men, aged 24 to 66 years). Early in our experience, one procedure was converted from the endoscopic technique to a standard open cholecystectomy after the gallbladder was accidentally punctured by the grasping forceps. The remaining 11 cases were completed endoscopically. Eight days postoperatively, one patient underwent reexploration because of bile leakage secondary to a fallen cystic duct (which was thickened from chronic inflammation). Compared with traditional methods, the endoscopic technique resulted in decreased morbidity and discomfort, a shorter hospital stay, minimal scarring, and a faster return to work.

Relationship between the results of sperm analysis and GIFT.

In vitro fertilization (IVF) and GIFT have been proposed as therapeutic approaches in infertile couples where a significant male factor is present. To date, few published data are available relating the success rate of GIFT to the severity of the male factor. In this report the results of the first 172 GIFT cases were analyzed. The overall pregnancy rate was 18.0%. The relationship between the occurrence of pregnancy and sperm count (millions/ml), total sperm count (millions/ejaculate), % motility, motile sperm count (millions/ml) and total motile sperm count (millions/ejaculate) were examined. Significant direct correlations were observed between the clinical pregnancy rate and sperm count, total sperm count, motile sperm count and total motile sperm count. Motile sperm count and total motile sperm count had the best correlations with clinical pregnancy rates, which were over 24.0% in groups with motile sperm counts exceeding 40 X 10(6) cells/ml or total motile sperm counts greater than 100 X 10(6)/ejaculate. The clinical pregnancy rates were 12.5% and 7.7%, respectively, for groups with motile sperm counts under 10 X 10(6)/ml and total motile sperm counts below 25 X 10(6)/ejaculate. No correlation was found between percent motile cells and pregnancy rate. Results of the sperm penetration assay using zona-free hamster eggs were available in a subpopulation of 27 patients. No significant correlation between this sperm penetration assay and pregnancy rate could be demonstrated. The incidence of chemical pregnancy showed a significant negative correlation with the total motile sperm count, indicating a higher incidence of early pregnancy wastage in cases of oligozoospermia.(ABSTRACT TRUNCATED AT 250 WORDS)

A new valving system for removal of laser plume during pelvic CO2 laser endoscopic procedures.

The large volumes of laser plume and char created during carbon dioxide laser endoscopy of the pelvis present a common problem to the gynecologic surgeon. Laser plume not only interferes with the view of the surgical field but also reduces the efficiency of emitted laser energy. A valving system has been designed and clinically tested that allows easy removal of laser-created debris while simultaneously maintaining control of the pneumoperitoneum. The system also removes these gas and liquid products without contaminating the operating room environment or hospital vacuum handling systems.

Laser laparoscopy. A new modality.

Assuming that a surgeon could have a laser available during every laparoscopic procedure, two pertinent questions would need to be addressed. First, how often can, or should, one use the laser laparoscope? Second, what are its advantages over the conventional techniques of operative laparoscopy? These and several other, related questions were answered partially by a study of pregnancy rates after vaporization and adhesiolysis with laser laparoscopy in cases of stage I and II endometriosis.