ADVANCES IN LAPAROSCOPY AND HYSTEROSCOPY TECHNIQUES Preface Togas Tulandi xv Laparoscopy in the Pediatric and Adolescent Population 469 Suketu M. Mansuria and Joseph S. Sanfilippo The use of laparoscopy by gynecologists in treating pediatric and adolescent patients is a relatively new phenomenon. This article discusses the specialized instrumentation necessary for operating on these patients and preoperative considerations and generalized techniques unique to this population. Although laparoscopy has a myriad of uses, the main focus is on the diagnosis and treatment of pelvic pain, adnexal masses, and pelvic inflammatory disease. Incidental appendectomy in these patients is also discussed. Laparoscopy in the Second Trimester of Pregnancy 485 Kevin Stepp and Tommaso Falcone Advances in laparoscopic surgery have led to the development of methods to perform traditionally major abdominal surgery and reduce morbidity using minimally invasive surgery techniques. Because a growing number of reports in the literature have suggested its safe use, laparoscopy is being performed in pregnancy with increasing frequency in many centers. Any surgeon treating pregnant patients must have a thorough understanding of the physiology of the pregnant patient and risks and benefits of the surgical procedure. This article discusses the use of laparoscopy in pregnancy focusing on the physiologic changes induced by pregnancy relevant to laparoscopy. Strategies to reduce the risk of complications while performing laparoscopy on a pregnant patient are discussed. VOLUME 31 NUMBER 3 SEPTEMBER 2004 vii
Laparoscopic Abdominal Cerclage 497 Raedah Al-Fadhli and Togas Tulandi Cervical cerclage is an effective treatment of cervical incompetence. It is conventionally done by laparotomy approach. Laparoscopic abdominal cerclage is a less invasive technique that could replace the laparotomy technique. Laparoscopic abdominal cerclage does not require hospitalization, is associated with less pain, and leads to a faster recovery. Laparoscopic abdominal cerclage is equal to or may be better than abdominal cerclage by laparotomy. Laparoscopic Lymphadenectomy and Sentinel Node Biopsy in Uterine Cancer 505 Pierangelo Marchiolè and Daniel Dargent This article discusses laparoscopic lymphadenectomy and sentinel node biopsy in uterine cancer. Total Laparoscopic Hysterectomy and Laparoscopic Supracervical Hysterectomy 523 William H. Parker Laparoscopic hysterectomy was first performed in 1989 and has become one of the procedures that may be offered to women with significant gynecologic symptoms. This article describes alternatives to hysterectomy, indications for laparoscopic hysterectomy, and outcomes and complications of laparoscopic hysterectomy as compared with vaginal and abdominal hysterectomy. Surgical technique for both total and supracervical hysterectomy are described as well as the learning curve, training, and credentialing for these procedures. Laparoscopic Treatment of Urinary Incontinence 539 Rose C. Kung The optimal surgical management of stress incontinence in women remains a contentious issue. Retropubic urethropexies such as the Burch procedure are regarded as having excellent long-term success rates. The learning curve for transvaginal tape procedures is by far shorter and easier than for the laparoscopic Burch procedure. Data from the few randomized trials published thus far show that both procedures are associated with high success rates and patient satisfaction. Laparoscopic Pelvic Floor Repair 551 John R. Miklos, Robert D. Moore, and Neeraj Kohli Articles on laparoscopic approach to pelvic floor reconstruction continue to proliferate throughout the worldwide literature. Although procedures like laparoscopic Burch seem to be fading viii
fast, other procedures like the laparoscopic paravaginal repair and sacral colpopexy seem to be more common and visible in the literature. This article reviews the pertinent anatomy, surgical procedures, and literature concerning the laparoscopic approach to pelvic floor reconstruction. Laparoscopic Excision of Deep Endometriosis 567 Jacques Donnez and Jean Squifflet Deep endometriosis is essentially characterized by the presence of a rectovaginal or retrocervical nodule, which is a circumscribed, nodular aggregate of smooth muscle, endometrial glands, and, usually, endometrial stroma. The authors suggest that the retroperitoneal space should definitely be considered as the origin of this retroperitoneal adenomyotic disease. This article reviews the classification, the diagnosis, and the surgical treatment of deep endometriosis (adenomyotic disease). Laparoscopic Management of Ovarian Cysts 581 Ali Mahdavi, Bulent Berker, Ceana Nezhat, Farr Nezhat, and Camran Nezhat The role of operative laparoscopy in the management of patients with adnexal masses is expanding, offering distinct advantages of lower morbidity, improved postoperative recovery, and reduced cost. Although clinical examination and the results of preoperative work-up often indicate the benign or malignant nature of the cyst, only histology can provide the absolute diagnosis. Advanced operative laparoscopy for management of ovarian cysts, when performed by experienced endoscopic surgeons, is as safe and effective as open techniques. Laparoscopic Management of Ovarian Remnant 593 Ali Mahdavi, Bulent Berker, Ceana Nezhat, Farr Nezhat, and Camran Nezhat Ovarian remnant syndrome has become increasingly recognized as a cause of pelvic pain after extirpative surgery. Surgical removal of the ovarian remnant is the optimal treatment. Laparoscopy is safe and effective in managing ovarian remnant syndrome when performed by an experienced laparoscopist. Laparoscopic Robotic Gynecologic Surgery 599 Arnold P. Advincula and Tommaso Falcone The first gynecologic procedure performed with a robot was a tubal anastomosis. This was performed in 1998 with the Zeus robot. Over the past several years other gynecologic procedures ix
have been performed with other robots. Current robotic technology may not be universally applicable to many gynecologists clinical practice. The field of surgical robotics is evolving at an everincreasing pace, however, and gynecologists need to participate in its development. Laparoscopic Fertility Preservation 611 Togas Tulandi and Abdul Aziz Al-Shahrani Advances in cancer therapy have improved the long-term survival of young patients suffering from malignancies. The adverse effects of the treatment, however, are sterility and loss of gonadal function especially in females. If preservation of fertility in males by sperm freezing is already established, for young women undergoing cancer treatment the availability of preserving the gonadal function and fertility has just begun. Diseases commonly treated with radiation or chemotherapeutic agents in young women are breast cancer, lymphoma, leukemia, blood dyscrasia, glomerulonephritis, lupus erythematosus, and rheumatoid arthritis. The Role of Laparoscopy in the Diagnosis and Treatment of Conditions Associated with Chronic Pelvic Pain 619 Georgine Lamvu, Frank Tu, Sawsan As-Sanie, Denniz Zolnoun, and John F. Steege Laparoscopy is a useful tool for the diagnosis and treatment of conditions associated with chronic pelvic pain. In the evaluation of chronic pelvic pain, laparoscopic techniques vary from conservative procedures, such as pain mapping, excision, and nerve ablation, to more extensive procedures like oophorectomy and hysterectomy. Although useful for diagnosis, laparoscopy continues to have a controversial role in the treatment of chronic pelvic pain. Progress in Transvaginal Hydrolaparoscopy 631 Stephan Gordts, Ivo Brosens, Sylvie Gordts, Patrick Puttemans, and Rudi Campo Reproductive performance is now more than ever determining the choice of treatment for each individual couple. The easy access to ART treatments, their financial benefits, and the relative high success rate per cycle are at the basis of a liberal referral to these treatments without an accurate diagnosis. The easy and comprehensive investigation by a transvaginal endoscopy as a first-line diagnostic procedure allows for an accurate diagnosis and the choice of the most appropriate treatment. x
Office Hysteroscopy 641 Stefano Bettocchi, Luigi Nappi, Oronzo Ceci, and Luigi Selvaggi The indications for hysteroscopic procedures in gynecologic practice are ample and clearly charted: hysteroscopy is considered the gold standard not only for visualizing the cervical canal and the uterine cavity, but also for treating many different kinds of benign pathologies localized to that region. This article summarizes the authors experience with this technique during the last 14 years, which have been devoted to improving the procedure by creating new instruments and modifying the technique. The Technique and Overview of Flexible Hysteroscopy 655 Fiona Marsh and Sean Duffy Flexible hysteroscopy is a safe, successful, and reliable method of investigation for abnormal uterine bleeding. When compared with rigid hysteroscopy flexible hysteroscopy is associated with less pain both at introduction of the hysteroscope and during the procedure itself especially when the diameter of the scope is reduced. This article provides evidence of the benefits of flexible hysteroscopy to the health service provider, clinician, and patient. Flexible hysteroscopy is acceptable to most women when performed in the outpatient setting without analgesia and offers a suitable alternative to rigid hysteroscopy. Hysteroscopic Myomectomy 669 Neelam Batra, Athele Khunda, and Peter J. O Donovan Hysteroscopic myomectomy is a minimally invasive technique that eliminates the need for a laparotomy and is associated with lower morbidity than abdominal myomectomy. Its beneficial effects are reflected by the improvement in menstrual pattern, fertility rate, and overall patient satisfaction. It is usually performed as outpatient surgery but occasionally requires an overnight stay. Most patients return to full activity within 48 hours. To exploit the full potentials of this procedure, appropriate case selection and surgical expertise are essential. It should be considered as first-line conservative surgical therapy for the management of symptomatic intracavitary fibroids. Hysteroscopic and Nonhysteroscopic Endometrial Ablation 687 George A. Vilos Endometrial ablation is defined as the elimination of the endometrium by thermal energy or resection. It was introduced in the 1980s as an alternative to hysterectomy to those patients with abnormal uterine bleeding and benign pathology who are unable or unwilling to tolerate traditional therapies. This article explores various endometrial ablation techniques. xi
Hysteroscopic Tubal Sterilization 705 Adam Magos and Lynne Chapman This article provides an overview of the history of hysteroscopic sterilization including the current state of the art and future ideals. Unlike laparoscopic techniques, sterilization by hysteroscopy can be performed in an outpatient setting without general anesthesia. Many attempts have been made to develop a safe and effective method, but until recently, without success. The Essure system is the first one that seems to be a realistic alternative to laparoscopic sterilization, but is irreversible. The search is still on for the optimum method of hysteroscopic sterilization. Index 721 Subscription Information xii