Female sterilization Chapman, Lynne; Magos, Adam
Expert review of medical devices,
20/7/1/, Letnik:
5, Številka:
4
Journal Article
Recenzirano
There has been considerable development and implementation of new contraceptive methods over the last 15 years. However, sterilization has remained the most widely used method around the world. ...Ideally, the procedure should be safe, have a high efficacy, be readily accessible, and be personally and culturally acceptable. The cost for each procedure would be low and the method would be simple, quick, easily learned and be able to be performed in an outpatient setting without general anesthesia. A transuterine method of female sterilization has long been the ideal for the gynecologist. The Essure™ system fulfils many of the criteria, and is the first one to be approved by the US FDA. However, there is still a need for further research to find a device with the success rate of the Essure but without its irreversibility.
Uterine fibroids remain the most common benign gynaecological pathology and a frequent reason for gynaecological referral and treatment. The range of available treatments is currently undergoing a ...minor revolution with the introduction of nonsurgical therapies, but their role remains to be established.
Arguably the most significant change in recent years has been the availability of uterine artery embolization as a form of nonsurgical management. A survey of UK gynaecologists, however, has shown that the option of embolization is only utilized by just over half the respondents. Instead, conventional surgery such as hysterectomy and myomectomy remain the mainstay of nonsymptomatic treatment. In the absence of gross uterine enlargement, vaginal hysterectomy is feasible and safe. Fewer hysterectomies, however, are being done and more women are undergoing myomectomy, with almost 50% of UK consultant gynaecologists carrying out hysteroscopic myomectomy and just over 10% laparoscopic myomectomy.
Greater utilization of less invasive endoscopic or vaginal procedures for the management of uterine fibroids seems a reasonable target. In the longer term, it is likely that the various nonsurgical techniques which shrink fibroids and thereby reduce symptoms will have an increasingly important role in the treatment of this common condition.
Laparoscopic entry after previous surgery Magos, Adam; Frappell, Jonathan
The obstetrician & gynaecologist,
January 2013, 2013-01-00, 20130101, Letnik:
15, Številka:
1
Journal Article
Background. To determine under controlled conditions whether there are significant differences in the duration of hospitalization and recovery between abdominal and vaginal hysterectomy for ...indications other than uterovaginal prolapse.
Method. In a two‐center prospective, double‐blind randomized trial, 36 women with dysfunctional uterine bleeding, uterine fibroids or pelvic pain scheduled for hysterectomy were randomized to abdominal or vaginal hysterectomy. The primary outcome measure was the duration of hospital stay. Secondary outcome measures included analgesic requirements and return to normal health and function.
Results. There were no significant differences in peri‐operative patient or surgical characteristics. Vaginal hysterectomy was associated with a reduction in hospital stay compared to abdominal hysterectomy (median stay 3 days vs. 5 days, p = 0.01). In addition, patients undergoing vaginal hysterectomy had reduced analgesic requirements (mean 75.4 mg vs. 131.4 mg morphine equivalent, p = 0.002), shorter need for intravenous hydration (mean 25.3 h vs. 32.7 h, p = 0.05), and faster return of bowel action (median 3 days vs. 4 days, p = 0.002). They also returned to normal domestic activities (mean 4.6 weeks vs. 8.5 weeks, p = 0.01) and work (mean 7.0 weeks vs. 13.9 weeks, p = 0.005), and completed their recovery (mean 7.9 weeks vs. 16.9 weeks, p = 0.008) more quickly.
Conclusions. Vaginal hysterectomy was associated with significant benefits in terms of reduced hospital stay and improved patient recovery. Vaginal hysterectomy should be the route of choice not only for women with genital tract prolapse but also those without.
Intrauterine adhesions after open myomectomy: an audit Conforti, Alessandro; Krishnamurthy, Geeta B; Dragamestianos, Christos ...
European journal of obstetrics & gynecology and reproductive biology,
08/2014, Letnik:
179
Journal Article
Recenzirano
Abstract Objective To estimate the incidence of intrauterine adhesions after open myomectomy. Study design A prospective audit descriptive study was conducted involving thirty-six women who had ...undergone open myomectomy for symptomatic fibroids at a large undergraduate teaching hospital. A follow-up out-patient hysteroscopy was performed three months after surgery. Results At hysteroscopy, eighteen patients (50%) were found to have mild to moderate intrauterine adhesions. The number of fibroids removed was significantly higher in patient who developed adhesions (median value 22 versus 9.5, p < 0.05). Pre-operative GnRHa therapy, uterine size, opening of the uterine cavity during surgery, specimen weight, estimated blood loss, post-operative bleeding or pyrexia were similar whether or not adhesions were found. Conclusion Open myomectomy represents an important but currently underappreciated aetiological factor in the formation of intrauterine adhesions.
The purpose of this study was to compare the variability of operating times for some of the most common gynaecological procedures performed laparoscopically and by open surgery. The case notes of 60 ...women randomly selected from a cohort of 600 who had undergone laparoscopic surgery for ectopic pregnancy, ovarian cysts, leiomyoma and hysterectomy were reviewed. These patients were matched with an equal number of women who had been treated by open surgery for similar indications. Additional matching criteria included age (±2 years), size of the lesion in cases of ovarian cysts and fibroids (±3 cm), the period of amenorrhoea in ectopic pregnancies, and uterine size and pelvic pathology in women undergoing hysterectomy. Comparison of laparoscopy and laparotomy showed that the mean procedure times were similar for the two routes of surgery, with the exception of hysterectomy which took significantly longer if done laparoscopically. The duration of laparoscopic surgery for ectopic pregnancy, ovarian cystectomy and hysterectomy was significantly less predictable than at laparotomy. These data indicate that with the exception of hysterectomy, the average operating time for laparoscopic procedures is comparable to that for laparotomy. In contrast, the variability of duration of laparoscopic surgery tends to be much greater than with laparotomy for all procedures considered.
Background. Outpatient hysteroscopy has become well-established for the investigation abnormal uterine bleeding. Although "See and Treat" clinics have been widely introduced, the types of procedures ...offered are limited, and many patients with intrauterine pathology continue to be admitted as in-patients for hysteroscopic surgery. We wanted to investigate the feasibility and acceptability of surgery for small intrauterine lesions without the need for general anesthesia by using a miniature resectoscope. Methods. This was a prospective observational study on 30 women with abnormal uterine bleeding associated with endometrial polyps or small (<3 cm) type 0 or 1 submucous fibroids. Hysteroscopic polypectomy (n=26) or myomectomy (n=4) was carried out using a 16 Fr gauge mini-resectoscope. Results. Ten procedures were carried out in the outpatient clinic and 20 in the operating theatre. Sixteen procedures were done without any anaesthesia and 14 after intra-cervical local anesthetic injections. The polyps and fibroids ranged in size from 1 to 5 cm, and all procedures took less than 15 minutes from the time the vagina was instrumented to the end of surgery. All procedures were completed successfully and were well tolerated with little discomfort. There were no complications. Conclusions. The mini-resectoscope appears to be an efficient and acceptable instrument for hysteroscopic surgery and can be used without general anesthesia for minor procedure such as polypectomy and the resection of small submucous fibroids.
Hysteroscopic ablation of the endometrium has become an accepted alternative to hysterectomy in the treatment of menorrhagia.
1
More than 10,200 of these procedures were performed in England and ...Wales from April 1993 through October 1994,
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for instance, only four years after the use of the technique was first reported in the United Kingdom.
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The rapid acceptance of endometrial ablation, whether performed by laser photovaporization,
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,
5
coagulation with a rollerball electrode,
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,
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or electroresection,
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,
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follows the numerous reports that the operation reduces menstrual blood loss.
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In addition, endometrial ablation is less traumatic than hysterectomy, causes less postoperative morbidity, is associated . . .
Abstract Objective To analyse the efficiency of the H Pipelle endometrial sampler at “no touch” (vaginoscopic) diagnostic hysteroscopy in terms of biopsy adequacy for histological diagnosis. Study ...design Retrospective descriptive study of 200 premenopausal women including comparison with previously published data on traditional biopsy instruments. Results Biopsy was adequate in 82% of cases overall, rising to 87% in those without submucous fibroids or polyps. Comparison with published data on other biopsy instruments shows that the H Pipelle is at least as efficient. Conclusion The H Pipelle appears to be at least as effective as traditional endometrial samplers even after hysteroscopy but allows hysteroscopy and biopsy to be done using a purely “no touch” (vaginoscopic) technique.
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