Journal of minimally invasive gynecology
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J Minim Invasive Gynecol · Nov 2011
Survey of robotic surgery training in obstetrics and gynecology residency.
To examine the status of resident training in robotic surgery in obstetrics and gynecology programs in the United States, an online survey was emailed to residency program directors of 247 accredited programs identified through the Accreditation Council for Graduate Medical Education website. Eighty-three of 247 program directors responded, representing a 34% response rate. Robotic surgical systems for gynecologic procedures were used at 65 (78%) institutions. ⋯ Most program directors believed the role of robotic surgery would increase and play a more integral role in gynecologic surgery. Robotic surgery was widely reported in residency training hospitals with limited availability of effective resident training. Robotic surgery training in obstetrics and gynecology residency needs further assessment and may benefit from a structured curriculum.
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J Minim Invasive Gynecol · Nov 2011
Monopolar electrosurgery through single-port laparoscopy: a potential hidden hazard for bowel burns.
Surveys indicate that up to 90% of general surgeons and gynecologists use monopolar radiofrequency during laparoscopy and 18% have experienced visceral burns. Monopolar electrosurgery compared with other energy sources is associated with unique characteristics and inherent risks and complications caused by inadvertent direct or capacitive coupling or insulation failure of instruments. These dangers become particularly important with the reemergence of single-port laparoscopy, which requires close proximity and crossing of multiple intraabdominal instruments outside the surgeon's field of view. ⋯ During single-port laparoscopy and use of monopolar radiofrequency, the proximity and crossing of multiple instruments generate capacitive or direct coupled currents, which may cause visceral burns.
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J Minim Invasive Gynecol · Nov 2011
Case ReportsLaparoscopic transection and immediate repair of obturator nerve during pelvic lymphadenectomy.
Radical pelvic surgery including pelvic lymphadenectomy in the obturator fossa has become a routine endoscopically performed procedure in patients with gynecologic cancer. Nerve injury during these procedures is rare. However, to choose the best surgical procedure, the surgeon must be aware of the anatomical landmarks of the obturator fossa and of various injury mechanisms. Herein is presented the case of obturator nerve transection during laparoscopic pelvic lymph node dissection, radical vulvectomy, and inguinal lymphadenectomy and its immediate laparoscopic repair in a 56-year-old patient.
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J Minim Invasive Gynecol · Nov 2011
Case ReportsMalignant hyperthermia during a laparoscopic operation.
Malignant hyperthermia (MH) is a life-threatening complication of general anesthesia, and early diagnosis and prompt treatment are important for successful management of this condition. Diagnosis of MH during a laparoscopic operation may be difficult because the early signs of the condition are similar to the expected physical changes that occur during laparoscopy. Herein is presented the case of a successfully treated 37-year-old woman without any pertinent surgical or medical history in whom MH developed during laparoscopic myomectomy. ⋯ Twenty minutes after the start of CO(2) insufflation, increased end-tidal CO(2) and tachycardia were observed, which did not improve even with increased ventilation and release of insufflation. The anesthesiologist strongly suspected MH, and dantrolene was immediately administered. The patient quickly recovered, and experienced no postoperative complications.