Book XXI - PrePrint Issue
STI XXI - Preview - Gynecology
Laparoscopic Management of Ovarian Cysts with Controlled Tissue Sealing - The "Cross Bag" Technique
James Dana Kondrup, MD, FACOG, Assistant Clinical Professor of Obstetrics and Gynecology, Upstate Medical Center, Binghamton, New York Campus and Syracuse, New York, Becky Quick, BSN, CNOR, Laparoscopic Team Leader, Operating Room, Our Lady of Lourdes Memorial Hospital, Binghamton, New York, Fran Anderson, PhD, RN, Research Coordinator, Our Lady of Lourdes Memorial Hospital, Binghamton, New York
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Abstract
- When ovarian preservation is desired, a minimally invasive laparoscopic surgical procedure using a "cross bag" technique is effective to consistently manage and remove ovarian cysts of concern. In addition to the standard preoperative preparation of patients, a bowel prep is critical, especially if the mass is large or the patient obese. Visualization of all internal structures is achieved using a multi-screen HD system and 5-mm laparoscope. Over 100 cases have been performed using the "cross bag" technique with no spillage of cysts.
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Don't Fear Adhesions: Safe Approaches for Reoperative Minimally Invasive Surgery
Rebekah S. Kim, MD, Fellow in Colon and Rectal Surgery, Orlando Health, Colon and Rectal Clinic, Orlando, Florida, Francisco P. Itriago, MD, Fellow in Minimally Invasive Surgery, Orlando Health, Colon and Rectal Clinic, Orlando, Florida, James C. Rosser, Jr. MD, FACS, Professor of Surgery, Morehouse School of Medicine, Atlanta, Georgia, Jay A. Redan, MD, Associate Professor of Surgery, Director of Minimally Invasive Surgery Celebration Hospital, Florida Hospital, University of Central Florida, Celebration, Florida
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Abstract
- Experience in minimally invasive surgery has increased at a rapid pace, and previous abdominal surgery with adhesion formation is no longer considered a contraindication for laparoscopic surgery. Therefore, surgeons across all specialties should be well equipped to approach a reoperative abdomen with minimal complications and satisfactory patient outcomes. Previous abdominal scarring and adhesions present distinct challenges for surgeons performing minimally invasive surgery, and postsurgical adhesions are considered one of the main reasons for conversion from laparoscopy to laparotomy. In this review article, we present the influence of previous abdominal surgeries and pathogenesis of adhesion formation. Methods of laparoscopic entry and technical aspects of adhesiolysis to the ventral abdominal wall, intestinal, and pelvic adhesions are reviewed. Surgeons should have a keen sense of awareness of adhesion-related complications to reduce the morbidity of laparoscopic reoperations.
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Sonographically Guided Hysteroscopic Endomyometrial Resection
Morris Wortman, MD, FACOG, Director, Center for Menstrual Disorders, Clinical Associate Professor of Gynecology, University of Rochester Medical Center, Rochester, New York
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Abstract
- Hysteroscopic endomyometrial resection (EMR) was first reported by this author in 1994.[1] Several refinements have been made through the years including the addition of sonographic guidance as well as its adaptation into an office-based environment. EMR has many outstanding benefits including its adaptability to a "see-and-treat" procedure appropriate to an office setting. Importantly, EMR has a very high rate of hysterectomy avoidance and provides a complete histologic specimen of the endometrium and superficial myometrium. Finally, EMR is a superior method of managing both resectoscopic and non-resectoscopic endometrial ablation failures.
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