A systematic arrangement of laparoscopic total abdominal hysterectomy: a new technique.
This sequential, prospective, observational clinical trial evaluated a systematic arrangement of laparoscopic total abdominal hysterectomy and prophylactic, retroperitoneal posterior culdoplasty with vaginal vault suspension surgical techniques by suturing method. The uterus was extirpated laparoscopically in 25 consecutive patients using an extra- and intra-corporeal two-turn flat square knot method. Upon completion of uterine excision, a new prophylactic laparoscopic technique of retroperitoneal posterior culdoplasty and vaginal vault suspension were initiated to prevent pelvic relaxation. Retroperitoneal culdoplasty was performed using the anterior rectal fascia, the posterior uterovaginal fascia, and the deep layer retroperitoneal of the uterosacral ligaments. Vaginal vault suspension was performed using posteriorly the deep layer of the uterosacral ligaments; from a lateroposterior aspect, the vaginal vault was suspended to the cardinal ligaments bilaterally, and anteriorly, the vesicouterine fascia provided support for the vaginal apex. A systematic arrangement of surgical steps was evaluated. All predetermined samples of laparoscopic total abdominal hysterectomy with posterior retroperitoneal culdoplasty and vaginal vault suspension were accomplished in a prearranged systematic order. Neither technical failure nor conversion to laparotomy or transvaginal approach was encountered. This technique expedites uterine extirpation and prophylactic pelvic reconstruction with a low complication rate, can be executed with no transvaginal approach, and eliminates the morbidity and mortality associated with laparotomy itself. (+info)
Culdolaparoscopy: a preliminary report.
OBJECTIVE: To introduce a surgical technique that combines culdoscopy with laparoscopy and microlaparoscopy. METHODS: This was a feasibility study conducted at The Mount Sinai Hospital of Queens. The technique is used when a larger port is required during laparoscopy or microlaparoscopy procedures. The additional port is placed in the vagina and, under laparoscopic surveillance, into the posterior cul-de-sac. RESULTS: This operation has been performed successfully in 5 oophorectomies, 4 myomectomies, 3 salpingoophorectomies, and 1 salpingectomy. CONCLUSION: This technique reduces the need for abdominal ports in excess of 5 mm. These ports can have a visual or operative function depending on the nature or stage of the procedure. The vaginal port can serve a visual function similar to that of culdoscopy or may be used for the introduction of operative instruments and the extraction of specimens. A principal benefit of using the larger vaginal port is derived from the capability of assisting laparoscopy and allowing the surgeon to use fewer and smaller abdominal trocars. (+info)
Investigation of the infertile couple: a one-stop outpatient endoscopy-based approach.
Transvaginal hydrolaparoscopy (THL) is a new culdoscopic technique for exploration of the pelvic cavity that takes advantage of micro-endoscopic technology and uses aquaflotation for inspection of the tubo-ovarian structures. In infertility patients, THL is systematically combined with mini-hysteroscopy, chromopertubation, fimbrioscopy and, when indicated, salpingoscopy. Mini-hysteroscopy in combination with the chromopertubation test allows accurate assessment of the uterine cavity and tubal patency. The transvaginal access combined with the aquaflotation during THL facilitates detailed inspection of the tubo-ovarian structures and detection of subtle pelvic disease. This combined transvaginal endoscopic approach allows complete evaluation of the reproductive tract. THL is better tolerated than hysterosalpingography, less invasive than standard laparoscopy, and can be used safely as a first line investigation of the female partner in a one-stop infertility clinic. (+info)
Laparoscopic sacrocolpopexy, hysterectomy, and burch colposuspension: feasibility and short-term complications of 77 procedures.
OBJECTIVE: To report our first cases of laparoscopic sacropexy and assess the feasibility and short-term complications. METHODS: We retrospectively studied 77 laparoscopic sacral colpopexies performed from June 1996 to May 1998. Suspension was reinforced with 2 strips of synthetic mesh. Five patients had previously undergone hysterectomy, and 4 others had experienced failure of surgery for prolapse of the uterus. RESULTS: Laparoscopy was performed in 83 women with symptomatic prolapse of the uterus. Six cases required conversion to laparotomy because of technical difficulties. All of the remaining 77 patients underwent laparoscopic sacropexy that included anterior and posterior mesh reinforcement. Subtotal laparoscopic hysterectomy was performed in 60 cases, laparoscopic Burch colposuspension in 74, and levator myorrhaphy via a vaginal approach in 55. Operative time decreased from 292 to 180 minutes as experience was gained. The main operative complications were 1 rectal and 2 bladder injuries. Three patients required reoperations for hematoma or hemorrhage. One patient complained of chronic inflammation of the cervix, and another experienced rejection of the posterior mesh 6 months after the operation. Mean follow-up was 343 days. Three other patients required reoperation, 1 for a third-degree cystocele and 2 for recurrent stress incontinence. CONCLUSION: Laparoscopic sacrocolpopexy is feasible. Operative time and postoperative complications are related to the surgeon's experience but remain comparable to those noted in laparotomy. Long-term assessment is required to confirm the results of this procedure. (+info)
Culdolaparoscopic cholecystectomy during vaginal hysterectomy.
BACKGROUND: Exploration of the abdominal cavity is routinely performed during abdominal and laparoscopic hysterectomies. The visualization of the abdomen during vaginal hysterectomy, however, is not usually done. During a vaginal hysterectomy, after the uterus is removed, an opening is present in the cul-de-sac, which offers a unique opportunity for the performance of not only exploratory but also concomitant surgeries, such as a cholecystectomy. METHOD: Culdolaparascopy is a culdoscopy assisted laparoscopic technique that utilizes a 12-mm trocar in the vagina as a multifunctional port in conjunction with laparoscopy and minilaparoscopy. A cholecystectomy was performed utilizing the vaginal trocar as an insufflation, visual, and extracting port during a vaginal hysterectomy. CONCLUSION: Culdolaparoscopy, when performed during vaginal hysterectomy, can be used for exploration and operation in the abdominal cavity. This case report illustrates the feasibility of a cholecystectomy performed using this surgical concept. (+info)
Sonographic demonstration of air in the myometrium. A complication of culdocentesis.
Six cases are presented in which air was seen in the myometrium in the distribution of the arcuate vessels during sonography performed after culdocentesis to exclude ectopic pregnancy. Three of these patients had viable intrauterine pregnancies; the others had an incomplete abortion, a complete abortion, and a right ectopic pregnancy. This relatively rare complication of culdocentesis should be kept in mind, especially when scanning patients with suspected inflammatory process of the uterus, so as not to confuse air in the arcuate vessels with a uterine abscess. (+info)
BACKGROUND AND OBJECTIVES: New technology has allowed us to perform major abdominal and pelvic surgeries with increasingly smaller instruments. The ultimate goal is surgery with no visible scars. Until current technical limitations are overcome, minilaparoscopy-assisted natural orifice surgery (MANOS) provides a solution. The aim of this study was to examine our clinical and experimental experience with MANOS. METHOD: Minilaparoscopic abdominal instruments were used together with a large vaginal port, which was used for insufflation, visual purposes, introduction of operative instruments, and specimen extraction. Minilaparoscopy-assisted intraperitoneal transgastric appendectomy was done in simulators (Lap trainer with SimuVision, Simulab Corp., Seattle, WA). RESULTS: Since 1998, we have used this technique in 100 cases including ovarian cystectomies, oophorectomies, salpingo-oophorectomies, myomectomies, appendectomies, and cholecystectomies. Some oophorectomies were performed after vaginal hysterectomy in cases where vaginal extraction was not possible. In this case series, we had only one complication, a case of postoperative fever after an ovarian cystectomy, which was diagnosed as drug-related fever. Our limited simulator experience showed that MANOS is a feasible technique for performing transgastric appendectomies. CONCLUSION: It may take several years for natural orifice surgery to become standard care. Meanwhile, MANOS could encourage and expedite this process. (+info)
Ultrasound-guided culdotomy for vaginal ovarian cystectomy using a renal balloon dilator catheter.