ISSN:1040-872X    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Purpose of reviewVisual examination of the uterine cavity and contextual operative facilities have provided the gynecologist with the perfect ‘diagnostic’ tool, making it possible to examine the cavity and biopsy suspected areas under direct visualization.Recent findingsThe approach used to insert the scope, together with the diameter of the hysteroscope and the distention of the uterine cavity, are of extreme importance in reducing patient discomfort to a minimum during an outpatient examination. The vaginoscopic approach (without speculum or tenaculum) has definitively eliminated patient discomfort related to the traditional approach to the uterus. One of the major problems for endoscopists is passing through the internal cervical os; the new generation of hysteroscopes, with an oval profile and a total diameter between 4 and 5 mm, are strictly correlated to the anatomy of the cervical canal. Miniaturized instruments have enabled the physician not only to perform targeted hysteroscopic biopsies, but also to treat benign intrauterine pathologies, such as polyps and sinechiae, without any premedication or anesthesia. This has been defined as a ‘see & treat’ procedure: there is no longer a distinction between the diagnostic and operative procedures, but a single procedure in which the operative part is perfectly integrated in the diagnostic work‐up.SummaryDiagnostic hysteroscopy has long paid the price of being a purely visual method of investigation. Today, thanks to recent advances in instrumentation and to modified techniques related to the simultaneous use of the scope and of instruments, hysteroscopy is finally achieving the full accuracy that has been awaited for the last 20 years.

ISSN:1040-872X    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Purpose of reviewThe use of laparoscopic staging and/or surgery in the field of gynaecological oncology was pioneered in the early 1990s. The issue has been very controversial from the beginning, with some justification in view of the possible consequences of faulty cancer surgery. After more than 10 years, long‐term follow‐up and comparative studies, both of which are required in clinical oncological research, are now available.Recent findingsA number of papers have confirmed the absence of significant adverse effects on survival after laparoscopic diagnosis or surgery in gynaecological cancers. New developments cover virtually all the basic techniques in cancer surgery, excluding major exenterative surgery. The use of an extraperitoneal technique for aortic dissections is emerging. New indications, such as radical vaginal trachelectomy, pelvic sentinel node identification, interval debulking surgery of adnexal malignancies, or the liberal use of surgical staging of uterine cancers, have been developed as a direct result of the availability of laparoscopic techniques.SummaryContinuing worldwide interest clearly demonstrates that laparoscopic techniques are now part of the armamentarium of the gynaecological oncologist. Postoperative morbidity and recurrence risk do not seem to be affected. Cost‐efficiency of laparoscopic procedures is based on the reduction of hospital stay. Combined training in gynaecological oncology and in laparoscopic surgery is, more than ever, mandatory as a means of avoiding the risk of inadequate staging or the mismanagement of pelvic malignancies. The diversity of techniques, including laparotomy, laparoscopy, and vaginal surgery, allows the individualization of surgical approaches, whereby tumour size and local or general conditions can be taken into account.

ISSN:1040-872X    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Purpose of reviewCurrently, the two laparoscopic techniques available and described in the literature for the treatment of vaginal vault prolapse are uterosacral ligament vault suspension and sacrocolpopexy. These two techniques are opposing each other fundamentally. While the first is reconstructive, the second is essentially palliative.Recent findingsIn both methods the surgeon starts with the identification and dissection of the pubocervical and rectovaginal fascia. In the first technique however, the new vaginal vault, made by re approximation of the two fasciae, is attached to the uterosacral complex, while in the second one, each fascia is suspended from the sacral promontorium, using a mesh. In review of the existing literature, it seems that the palliative surgical approach is more successful in the long term, giving a cure rate of approximately 92%, probably as it involves using mesh instead of the native tissue.SummaryIn this article we discuss the laparoscopic techniques available currently, analyse their results, discuss their differences and compare them with other non‐laparoscopic techniques. Finally, we discuss the different options described, and offer some guidelines for the future of laparoscopic treatment of pelvic prolapse.

ISSN:1040-872X    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Purpose of reviewThis review analyzes the literature on ovarian endometrioma, examining the controversies on pathogenesis, malignant transformation and surgical therapy.Recent findingsRecent literature reflects the necessity of clearly defining the ethiologic and pathologic factors that determine the origin of ovarian endometriosis and explain the increase in the condition with the prospect of developing effective prevention therapy. The possibility that ovarian endometriomas undergo malignant transformation is widely reported in the literature. Recent studies underline the importance of detecting histological differences in endometriosis (hyperplasia and atypia) and several studies of molecular biology support the theory of genetic alterations interfering with malignant transformation of ovarian endometriosis.SummaryThe surgical approach must take into account all this information and, when the therapy is conservative, complete excision of the disease must be laparoscopically performed without affecting the healthy ovarian tissue.

ISSN:1040-872X    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Purpose of reviewAlthough endometrial ablation has now been accepted practice for more than 20 years, it continues to be a source of research, controversy and speculation. This is illustrated by the 175 articles found in PubMed between the years 2000 and 2003 under the search term ‘endometrial ablation’ commissioned as part of the preparation for this article.Recent findingsThe so‐called first‐generation methods (laser, resection, rollerball) have now got long‐term follow‐up data of up to 20 years. A few of the second‐generation devices have published long‐term follow‐up data of 5 years. All of the second‐generation devices assessed in randomized trials with the first‐generation methods compare favourably; however, there are few data on cost effectiveness. Similarly, there are few data comparing endometrial ablation with the Mirena intrauterine device.SummaryConventional endometrial ablation has been extensively validated; however, many of the newer techniques have inadequate patient numbers or lengths of follow‐up on which to evaluate their long‐term efficacy, safety or cost effectiveness fully. The anticipated decline in hysterectomy rates with the advent of endometrial destruction methods has not occurred, and this may indicate a lower threshold for surgical management.

ISSN:1040-872X    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Purpose of reviewSalpingoscopy is an endoscopic technique that allows direct evaluation of the ampullary tubal mucosa at the time of laparoscopy. It has been reported that the presence of ampullary mucosal adhesions can negatively affect reproductive outcome and increase the risk of ectopic tubal pregnancy. Various studies have suggested that the extent of intra‐luminal adhesions may not correlate with the nature and extent of periadnexal adhesions.Recent findingsFurther studies on salpingoscopic and laparoscopic correlations with regard to fertility outcome have been reported in the literature. Recently microsalpingoscopy has been introduced, with the number of nuclei stained by methylene blue dye employed as a prognostic factor of conception in women with infertility. As an alternative to salpingoscopy performed during laparoscopy, which requires hospitalization and general anesthesia, two groups have described salpingoscopy as an office procedure performed during transvaginal hydrolaparoscopy or in conjunction with fertiloscopy.SummaryThe prognostic value of salpingoscopy during operative laparoscopy for tubal factor infertility in terms of reproductive outcome has been confirmed. The prognostic significance of microsalpingoscopy needs further validation in large‐scale clinical trials. Transvaginal hydrolaparoscopy and fertiloscopy appear to be an alternative to hysterosalpingography as a first line procedure to investigate female infertility.

ISSN:1040-872X    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:1040-872X    

出版商:OVID    

年代:2003

数据来源: OVID