Journal of minimally invasive gynecology
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J Minim Invasive Gynecol · Nov 2005
Randomized Controlled Trial Comparative StudyMinimizing ancillary ports size in gynecologic laparoscopy: a randomized trial.
To evaluate the feasibility, safety, and effect on postoperative pain of laparoscopy for the management of adnexal masses by downsizing ancillary trocars from 5- to 3-mm. ⋯ Three-millimeter ancillary trocars can safely replace traditional-size equipment for the management of adnexal masses without a negative impact on the surgeon's ability to perform gynecologic laparoscopy and are associated with less immediate postoperative pain.
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J Minim Invasive Gynecol · Nov 2005
Endometriosis: what is the risk of hospital admission, readmission, and major surgical intervention?
To describe trends in hospital utilization and surgical rates for endometriosis and to estimate the probability of hospital readmission over 4 years among women with early-stage disease. ⋯ Fewer women are being hospitalized for minor surgical procedures for endometriosis with hospital-based care being reserved for more extensive procedures. Nonetheless, about a quarter of women hospitalized for initial surgical treatment for endometriosis will undergo additional surgical treatment within 4 years, and one in 10 will have a hysterectomy.
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Chronic endometritis is a subtle condition that is difficult to detect; however, it may cause abnormal uterine bleeding and infertility. Few data exist about the appearance of chronic endometritis at fluid hysteroscopy and about the value of diagnostic fluid hysteroscopy in the detection of this condition. In our experience, at fluid hysteroscopy chronic endometritis is characterized by consistent association of stromal edema and either focal or diffuse hyperemia; in some cases, this finding is associated with endometrial micropolyps (less than 1 mm in size). This study attempted to describe diagnostic criteria for chronic endometritis at fluid hysteroscopy and assess the diagnostic accuracy of fluid hysteroscopy in the detection of this condition. ⋯ Fluid hysteroscopy is very reliable in diagnosing no inflammation, while detection of micropolyps is a very reliable sign of inflammation. When performing hysteroscopy for abnormal uterine bleeding or infertility, signs of chronic endometritis should always be sought.
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J Minim Invasive Gynecol · Nov 2005
Case Reports"Silent" rupture of unscarred gravid uterus with subsequent pelvic abscess: successful laparoscopic management.
Intrapartum rupture of an unscarred uterus is rare in current times. However, it is still associated with significant maternal and fetal mortality and morbidity. Unlike rupture or dehiscence of a previous cesarean scar, which is occasionally bloodless, complete rupture of a gravid unscarred uterus frequently results in fetal jeopardy and significant maternal intraperitoneal bleeding, causes acute abdomen, and demands emergency surgical (laparotomy) intervention. ⋯ Successful vaginal delivery, even with normal lochia, good uterine contraction, and stable vital signs, does not preclude the possibility of uterine rupture. For patients with unusual postpartum pelvic pain, uterine rupture should be considered as one of the possible etiologic factors, and prompt survey should be performed. Laparoscopic intervention may be valuable in such situations.