laparoscopy Archives - Revista Brasileira de Ginecologia e Obstetrícia
Summary
Rev Bras Ginecol Obstet. 1998;20(2):105-109
DOI 10.1590/S0100-72031998000200008
The authors describe their experience with videolaparoscopic tubal anastomosis in 10 selected patients operated from June 1994 to February 1996. The time of the first surgery was 4 hours and 30 minutes and the last , 2 hours and 30 minutes. The time was different according to the change of auxiliary team. Half of the reanastomoses were isthmic- isthmic. The minimum size of the remaining tubes was 5cm on each side. We used 7-0 and 6-0 polyglycolic acid monofilament for suture. The tube patency was tested by hysterosalpingogram 3 months after surgery, and it was shown that 88.8% of the operated tubes were free. The patients considered able to become pregnant were followed up for a short period of time and 4 of them became pregnant. The hospitalization lasted 24 hours and there were no surgical or anesthetic complications.
Summary
Rev Bras Ginecol Obstet. 1998;20(2):105-109
DOI 10.1590/S0100-72031998000200008
The authors describe their experience with videolaparoscopic tubal anastomosis in 10 selected patients operated from June 1994 to February 1996. The time of the first surgery was 4 hours and 30 minutes and the last , 2 hours and 30 minutes. The time was different according to the change of auxiliary team. Half of the reanastomoses were isthmic- isthmic. The minimum size of the remaining tubes was 5cm on each side. We used 7-0 and 6-0 polyglycolic acid monofilament for suture. The tube patency was tested by hysterosalpingogram 3 months after surgery, and it was shown that 88.8% of the operated tubes were free. The patients considered able to become pregnant were followed up for a short period of time and 4 of them became pregnant. The hospitalization lasted 24 hours and there were no surgical or anesthetic complications.
Summary
Rev Bras Ginecol Obstet. 1998;20(9):537-540
DOI 10.1590/S0100-72031998000900008
Purpose: the laparoscope can be used to convert an abdominal into a vaginal hysterectomy when there are contraindications for the vaginal approach, and not as a substitute for simple vaginal hysterectomy. The purpose of the present study is to discuss the role of laparoscopy in vaginal hysterectomy. Methods: between February 1995 and September 1998, 400 patients were considered candidates for vaginal hysterectomy.Exclusion criteria included uterine prolapse, adnexal tumor and uterine immobility. The Heaney technique was used, and different morcellation procedures were employed for the removal of enlarged uteri. Results: the mean age and parity was 46.9 years and 3.2 deliveries, respectively. Twenty-nine patients (7.2%) were nulliparous, and 104 (26.0%) had never delivered vaginally. Three hundred and three patients (75.7%) had a history of previous pelvic surgery, the most common being cesarean section (48.7%). The most frequent indication was leiomyoma (61.2%), and the mean uterine volume was 239.9 cm³ (30-1228 cm³). Vaginal hysterectomy was successfully performed in 396 patients (99.0%), and 73 surgeries (18.2%) were done by residents. The mean operative time was 45 min. Diagnostic/operative laparoscopy was performed in 16 patients (4.0%). Intraoperative complications included 6 cystotomies (1.5%) and one rectal laceration (0.2%). There were four conversions (1.0%) to the abdominal route. Postoperative complications occurred in 24 patients (6.0%). Two hundred and eighty-one patients (70.2%) were discharged 24 h after surgery. Conclusions: the laparoscope does not seem to be necessary in cases were the uterus is mobile and there is no adnexal tumor. The main role of the laparoscope may be to increase the awareness of gynecologists to the possibility of a simple vaginal hysterectomy in the majority of cases.
Summary
Rev Bras Ginecol Obstet. 1998;20(9):537-540
DOI 10.1590/S0100-72031998000900008
Purpose: the laparoscope can be used to convert an abdominal into a vaginal hysterectomy when there are contraindications for the vaginal approach, and not as a substitute for simple vaginal hysterectomy. The purpose of the present study is to discuss the role of laparoscopy in vaginal hysterectomy. Methods: between February 1995 and September 1998, 400 patients were considered candidates for vaginal hysterectomy.Exclusion criteria included uterine prolapse, adnexal tumor and uterine immobility. The Heaney technique was used, and different morcellation procedures were employed for the removal of enlarged uteri. Results: the mean age and parity was 46.9 years and 3.2 deliveries, respectively. Twenty-nine patients (7.2%) were nulliparous, and 104 (26.0%) had never delivered vaginally. Three hundred and three patients (75.7%) had a history of previous pelvic surgery, the most common being cesarean section (48.7%). The most frequent indication was leiomyoma (61.2%), and the mean uterine volume was 239.9 cm³ (30-1228 cm³). Vaginal hysterectomy was successfully performed in 396 patients (99.0%), and 73 surgeries (18.2%) were done by residents. The mean operative time was 45 min. Diagnostic/operative laparoscopy was performed in 16 patients (4.0%). Intraoperative complications included 6 cystotomies (1.5%) and one rectal laceration (0.2%). There were four conversions (1.0%) to the abdominal route. Postoperative complications occurred in 24 patients (6.0%). Two hundred and eighty-one patients (70.2%) were discharged 24 h after surgery. Conclusions: the laparoscope does not seem to be necessary in cases were the uterus is mobile and there is no adnexal tumor. The main role of the laparoscope may be to increase the awareness of gynecologists to the possibility of a simple vaginal hysterectomy in the majority of cases.
Summary
Rev Bras Ginecol Obstet. 1998;20(10):571-576
DOI 10.1590/S0100-72031998001000005
Purpose: to evaluate the advantages of the laparoscopic approach for conversion of abdominal hysterectomies in vaginal hysterectomies in patients with indication of concomitant adnexectomy, being considered the safety and the additional costs of the procedure. Patients and Methods: cases: 9 patients submitted to Laparoscopically Assisted Vaginal Hysterectomy (LAVH) associated with adnexectomy. Controls:18 patients submitted to Abdominal Hysterectomy (AH) associated with adnexectomy. Both groups were compared regarding preoperative characteristics and the results of the procedure. The patients submitted to LAVH and AH are similar concerning age, parity, cesarean deliveries, previous surgeries and body mass index. Results: the average surgery time was 163.9 minutes for patients submitted to LAVH and 142.8 minutes for patients submitted to AH. No patient in the LAVH group presented postoperative complications, while in the AH group 2 patients presented suture deiscence and there was 1 case of incisional hernia. The median of hospital stay was 1 day in the LAVH group and 2 days in the AH group, those of convalescence periods were 2 and 4 weeks, respectively. 55.6% of the patients in the LAVH group and 100% in the AH group needed analgesics in the postoperative period. Conclusions: LAVH was shown to be advantageous in relation to AH in terms of better recovery and lower incidence of complications in the postoperative period. The procedure is feasible and safe in a University Hospital, and without additional costs.
Summary
Rev Bras Ginecol Obstet. 1998;20(10):571-576
DOI 10.1590/S0100-72031998001000005
Purpose: to evaluate the advantages of the laparoscopic approach for conversion of abdominal hysterectomies in vaginal hysterectomies in patients with indication of concomitant adnexectomy, being considered the safety and the additional costs of the procedure. Patients and Methods: cases: 9 patients submitted to Laparoscopically Assisted Vaginal Hysterectomy (LAVH) associated with adnexectomy. Controls:18 patients submitted to Abdominal Hysterectomy (AH) associated with adnexectomy. Both groups were compared regarding preoperative characteristics and the results of the procedure. The patients submitted to LAVH and AH are similar concerning age, parity, cesarean deliveries, previous surgeries and body mass index. Results: the average surgery time was 163.9 minutes for patients submitted to LAVH and 142.8 minutes for patients submitted to AH. No patient in the LAVH group presented postoperative complications, while in the AH group 2 patients presented suture deiscence and there was 1 case of incisional hernia. The median of hospital stay was 1 day in the LAVH group and 2 days in the AH group, those of convalescence periods were 2 and 4 weeks, respectively. 55.6% of the patients in the LAVH group and 100% in the AH group needed analgesics in the postoperative period. Conclusions: LAVH was shown to be advantageous in relation to AH in terms of better recovery and lower incidence of complications in the postoperative period. The procedure is feasible and safe in a University Hospital, and without additional costs.
Summary
Rev Bras Ginecol Obstet. 1999;21(2):85-90
DOI 10.1590/S0100-72031999000200005
Purpose: to present a profile of endometriosis, stages and results of treatment among the patients seen in our Service. Methods: the medical records of 155 patients with endometriosis treated during the period from 1991 to 1996 according to a preestablished protocol were examined. Results: mean patient age was 31 years, most patients were white, with regular menstrual cycles. The most frequently observed symptoms were dysmenorrhea, pelvic pain and infertility and were mild in most of the cases. The diagnostic methods utilized were laparoscopy or echography. There was agreement between echography and laparoscopy in 96% of cases. Laparotomy was required in 28% of cases for diagnostic elucidation and/or treatment. Endometrioma was detected in 37% of the cases and endometriosis was confirmed in only 74% of the biopsies from the lesion by anatomopathological examination. There was a significant improvement with clinical treatment regardless of the drug used, with improved symptoms in approximately 50% of the patients. Assisted fertilization was performed in 34 patients, consisting of in vitro fertilization (IVF) for 80% of them, with a 27% pregnancy/transfer rate. Conclusions: the diagnostic method of choice should be laparoscopy, although echography presented a high rate of agreement. Anatomopathological examination of the lesions should be used as an adjuvant method in the diagnosis since it is not confirmatory in all of the cases. Clinical treatment with assisted reproductive technologies is a good therapeutic option, especially with the use of IVF.
Summary
Rev Bras Ginecol Obstet. 1999;21(2):85-90
DOI 10.1590/S0100-72031999000200005
Purpose: to present a profile of endometriosis, stages and results of treatment among the patients seen in our Service. Methods: the medical records of 155 patients with endometriosis treated during the period from 1991 to 1996 according to a preestablished protocol were examined. Results: mean patient age was 31 years, most patients were white, with regular menstrual cycles. The most frequently observed symptoms were dysmenorrhea, pelvic pain and infertility and were mild in most of the cases. The diagnostic methods utilized were laparoscopy or echography. There was agreement between echography and laparoscopy in 96% of cases. Laparotomy was required in 28% of cases for diagnostic elucidation and/or treatment. Endometrioma was detected in 37% of the cases and endometriosis was confirmed in only 74% of the biopsies from the lesion by anatomopathological examination. There was a significant improvement with clinical treatment regardless of the drug used, with improved symptoms in approximately 50% of the patients. Assisted fertilization was performed in 34 patients, consisting of in vitro fertilization (IVF) for 80% of them, with a 27% pregnancy/transfer rate. Conclusions: the diagnostic method of choice should be laparoscopy, although echography presented a high rate of agreement. Anatomopathological examination of the lesions should be used as an adjuvant method in the diagnosis since it is not confirmatory in all of the cases. Clinical treatment with assisted reproductive technologies is a good therapeutic option, especially with the use of IVF.
Summary
Rev Bras Ginecol Obstet. 2006;28(12):733-740
DOI 10.1590/S0100-72032006001200008
Chronic pelvic pain is a debilitating and highly prevalent disease with a major impact on quality of life and work productivity, beyond significant costs to health services. The dilemma of managing patients with chronic pelvic pain continues to frustrate physicians confronted with these complaints, in part because its pathophysiology is poorly understood. Consequently, its treatment is often unsatisfactory and limited to temporary symptom relief. In the present revision, we discuss the adequate management of chronic pelvic pain. We point out that a comprehensive medical history and physical examination should include special attention to gastrointestinal, urological, gynecological, muscle-skeletal, neurological, psychiatric, and endocrine systems. Thus, a multidisciplinary approach is recommended. Additionally, we emphasize that, although useful, specific surgical procedures, such as laparoscopy, should be indicated only to selected patients, mainly after excluding irritable bowel syndrome and pain of myofascial origin.
Summary
Rev Bras Ginecol Obstet. 2006;28(12):733-740
DOI 10.1590/S0100-72032006001200008
Chronic pelvic pain is a debilitating and highly prevalent disease with a major impact on quality of life and work productivity, beyond significant costs to health services. The dilemma of managing patients with chronic pelvic pain continues to frustrate physicians confronted with these complaints, in part because its pathophysiology is poorly understood. Consequently, its treatment is often unsatisfactory and limited to temporary symptom relief. In the present revision, we discuss the adequate management of chronic pelvic pain. We point out that a comprehensive medical history and physical examination should include special attention to gastrointestinal, urological, gynecological, muscle-skeletal, neurological, psychiatric, and endocrine systems. Thus, a multidisciplinary approach is recommended. Additionally, we emphasize that, although useful, specific surgical procedures, such as laparoscopy, should be indicated only to selected patients, mainly after excluding irritable bowel syndrome and pain of myofascial origin.
Summary
Rev Bras Ginecol Obstet. 1999;21(1):41-45
DOI 10.1590/S0100-72031999000100007
Purpose: to demonstrate a new approach to treatment of endometrial cancer. Methods: Between February, 1996 and February, 1998, twelve patients with endometrial cancer, diagnosed by hysteroscopy and biopsy, were submitted to pelvic lymphadenectomy and hysterectomy with salpingo-oophorectomy by laparoscopy. The mean age was 58.1 years, the mean number of gestations was 2.3 and the mean body mass index was 28.6. Results: the mean length of anesthesia was 4.8 hours. The mean time of hospital stay was 3.3 days. The total of lymph nodes obtained was 176, 104 (59.1%) being from the right side and 72 (40.9%) from the left side. The mean of lymph nodes per patient was 18.5. We observed two complications: in one case the laparoscopic procedure had to be abandoned because the patient presented a dangerous increase in intratracheal pressure and in the other case a granuloma in the vagina was observed. Conclusions: the initial evaluation of the laparoscopic hysterectomy and laparoscopy shows that we achieved good results regarding the accuracy of staging, the number of nodes and a small number (3) of complications.
Summary
Rev Bras Ginecol Obstet. 1999;21(1):41-45
DOI 10.1590/S0100-72031999000100007
Purpose: to demonstrate a new approach to treatment of endometrial cancer. Methods: Between February, 1996 and February, 1998, twelve patients with endometrial cancer, diagnosed by hysteroscopy and biopsy, were submitted to pelvic lymphadenectomy and hysterectomy with salpingo-oophorectomy by laparoscopy. The mean age was 58.1 years, the mean number of gestations was 2.3 and the mean body mass index was 28.6. Results: the mean length of anesthesia was 4.8 hours. The mean time of hospital stay was 3.3 days. The total of lymph nodes obtained was 176, 104 (59.1%) being from the right side and 72 (40.9%) from the left side. The mean of lymph nodes per patient was 18.5. We observed two complications: in one case the laparoscopic procedure had to be abandoned because the patient presented a dangerous increase in intratracheal pressure and in the other case a granuloma in the vagina was observed. Conclusions: the initial evaluation of the laparoscopic hysterectomy and laparoscopy shows that we achieved good results regarding the accuracy of staging, the number of nodes and a small number (3) of complications.
Summary
Rev Bras Ginecol Obstet. 2006;28(7):403-409
DOI 10.1590/S0100-72032006000700005
PURPOSE: to compare in a retrospective way, 51 women who underwent tubal ligation, 30 through microlaparoascopy (Gmicrol) and 21 through minilaparotomy (Gminil). METHODS: the analyzed parameters were: total time for accomplishment of the procedure and the surgical technique, time of hospital stay and return to the habitual activities after the surgery, postoperative pain, morbidity, satisfaction degree and esthetic effect, considering values of p<0,05 as significant, and also standard cost. RESULTS: Gmicrol took less time to accomplish the surgery than the Gminil (43 against 57 minutes respectively, p<0,05), less time to accomplish the surgical technique (6.48 against 30.32 minutes respectively, p<0,05), and lower hospital stay (9,90 hours as against 41,7 hours respectively, p <0,05). There was no significant difference between the two groups regarding time to return to the habitual activities after surgery. To evaluate postoperative pain, a scale of 0-10 it was applied. Gmicrol present a lower pain score on the 1st and 2nd postoperative days (1.13 and 0.26 to Gmicrol and 4.52 and 1.14 to Gminil, respectively, p<0,05). There was no significant difference between immediate postoperative the most common complaint being pain at the site of pain and that on the 3rd postoperative day. Gminil presented a higher morbidity rate incision. To evaluate the satisfaction degree and esthetic effect, numeric values were attributed to as good, regular, poor and very bad as answered by the patiets. Gmicrol presented a higher satisfaction degree (p<0,05) and better esthetic effect as compared to Gminil (p <0,05). The microlaparoscopy standard cost was R$ 109.30 being lower than that of minilaparotomy. CONCLUSIONS: tubal ligation by microlaparoscopy, under local anesthesia and conscious sedation presented some advantages compared to minilaparotomy.
Summary
Rev Bras Ginecol Obstet. 2006;28(7):403-409
DOI 10.1590/S0100-72032006000700005
PURPOSE: to compare in a retrospective way, 51 women who underwent tubal ligation, 30 through microlaparoascopy (Gmicrol) and 21 through minilaparotomy (Gminil). METHODS: the analyzed parameters were: total time for accomplishment of the procedure and the surgical technique, time of hospital stay and return to the habitual activities after the surgery, postoperative pain, morbidity, satisfaction degree and esthetic effect, considering values of p<0,05 as significant, and also standard cost. RESULTS: Gmicrol took less time to accomplish the surgery than the Gminil (43 against 57 minutes respectively, p<0,05), less time to accomplish the surgical technique (6.48 against 30.32 minutes respectively, p<0,05), and lower hospital stay (9,90 hours as against 41,7 hours respectively, p <0,05). There was no significant difference between the two groups regarding time to return to the habitual activities after surgery. To evaluate postoperative pain, a scale of 0-10 it was applied. Gmicrol present a lower pain score on the 1st and 2nd postoperative days (1.13 and 0.26 to Gmicrol and 4.52 and 1.14 to Gminil, respectively, p<0,05). There was no significant difference between immediate postoperative the most common complaint being pain at the site of pain and that on the 3rd postoperative day. Gminil presented a higher morbidity rate incision. To evaluate the satisfaction degree and esthetic effect, numeric values were attributed to as good, regular, poor and very bad as answered by the patiets. Gmicrol presented a higher satisfaction degree (p<0,05) and better esthetic effect as compared to Gminil (p <0,05). The microlaparoscopy standard cost was R$ 109.30 being lower than that of minilaparotomy. CONCLUSIONS: tubal ligation by microlaparoscopy, under local anesthesia and conscious sedation presented some advantages compared to minilaparotomy.
Summary
Rev Bras Ginecol Obstet. 2005;27(7):401-406
DOI 10.1590/S0100-72032005000700006
PURPOSE: to evaluate the agreement between noninvasive methods - pelvic pain, transvaginal ultrasound and hysterosalpingography - and the gynecologic endoscopy approach for the diagnosis of tuboperitoneal factors responsible for conjugal infertility. METHODS: this is a cross-sectional study including 149 infertile patients who were submitted to clinical evaluation, transvaginal ultrasound, hysterosalpingography, hysteroscopy, and laparoscopy. In the evaluation of pelvic pain, the following complaints were considered to be abnormal: pelvic pain of the dyspareunia type, dysmenorrhea or acyclic pain, and pain upon mobilization of the cervix and palpation of the adnexa. Ultrasonographic examination was considered to be altered when adnexal or uterine morphological changes (hydrosalpinx, myomas or uterine malformations) were detected. Hysterosalpingography was considered to be abnormal in the presence of anatomical tubal changes and unilateral or bilateral obstruction. The agreement between noninvasive methods and endoscopy was evaluated by kappa statistics. RESULTS: the agreements between pelvic pain, transvaginal ultrasound, and hysterosalpingography and the endoscopic approach were 46.3% (kappa=0.092; CI 95%: -0.043 to 0.228), 24% (kappa=-0.052; CI 95%: -0.148 to 0.043), and 46% (kappa=0.092; CI 95%: -0.043 to 0.228), respectively. When at least one alteration detected by noninvasive methods was considered, the agreement with endoscopic approach was 63% (kappa=-0.014; CI 95%: -0.227 to 0.199). Sensitivity and specificity in predicting alterations on endoscopic approach were 39.5 and 80% in the presence of pelvic pain, 14.5 and 72% in the presence of alteration on transvaginal ultrasound, 39.5 and 80% in the presence of alteration on hysterosalpingography, and 70.2 and 28% in the presence of at least one alteration by noninvasive methods. CONCLUSION: there is a poor diagnostic agreement between the several noninvasive methods and endoscopy in the investigation of conjugal infertility secondary to tuboperitoneal factors.
Summary
Rev Bras Ginecol Obstet. 2005;27(7):401-406
DOI 10.1590/S0100-72032005000700006
PURPOSE: to evaluate the agreement between noninvasive methods - pelvic pain, transvaginal ultrasound and hysterosalpingography - and the gynecologic endoscopy approach for the diagnosis of tuboperitoneal factors responsible for conjugal infertility. METHODS: this is a cross-sectional study including 149 infertile patients who were submitted to clinical evaluation, transvaginal ultrasound, hysterosalpingography, hysteroscopy, and laparoscopy. In the evaluation of pelvic pain, the following complaints were considered to be abnormal: pelvic pain of the dyspareunia type, dysmenorrhea or acyclic pain, and pain upon mobilization of the cervix and palpation of the adnexa. Ultrasonographic examination was considered to be altered when adnexal or uterine morphological changes (hydrosalpinx, myomas or uterine malformations) were detected. Hysterosalpingography was considered to be abnormal in the presence of anatomical tubal changes and unilateral or bilateral obstruction. The agreement between noninvasive methods and endoscopy was evaluated by kappa statistics. RESULTS: the agreements between pelvic pain, transvaginal ultrasound, and hysterosalpingography and the endoscopic approach were 46.3% (kappa=0.092; CI 95%: -0.043 to 0.228), 24% (kappa=-0.052; CI 95%: -0.148 to 0.043), and 46% (kappa=0.092; CI 95%: -0.043 to 0.228), respectively. When at least one alteration detected by noninvasive methods was considered, the agreement with endoscopic approach was 63% (kappa=-0.014; CI 95%: -0.227 to 0.199). Sensitivity and specificity in predicting alterations on endoscopic approach were 39.5 and 80% in the presence of pelvic pain, 14.5 and 72% in the presence of alteration on transvaginal ultrasound, 39.5 and 80% in the presence of alteration on hysterosalpingography, and 70.2 and 28% in the presence of at least one alteration by noninvasive methods. CONCLUSION: there is a poor diagnostic agreement between the several noninvasive methods and endoscopy in the investigation of conjugal infertility secondary to tuboperitoneal factors.
