Journal of minimally invasive gynecology
-
J Minim Invasive Gynecol · Mar 2014
ReviewLaparoscopy in the morbidly obese: physiologic considerations and surgical techniques to optimize success.
The objectives of this review were to analyze the literature describing the benefits of minimally invasive gynecologic surgery in obese women, to examine the physiologic considerations associated with obesity, and to describe surgical techniques that will enable surgeons to perform laparoscopy and robotic surgery successfully in obese patients. The Medline database was reviewed for all articles published in the English language between 1993 and 2013 containing the search terms "gynecologic laparoscopy" "laparoscopy," "minimally invasive surgery and obesity," "obesity," and "robotic surgery." The incidence of obesity is increasing in the United States, and in particular morbid obesity in women. Obesity is associated with a wide range of comorbid conditions that may affect perioperative outcomes including hypertension, atherosclerosis, angina, obstructive sleep apnea, and diabetes mellitus. ⋯ Performing gynecologic laparoscopy in the morbidly obese is no longer rare. Increases in the heaviest weight categories involve changes in clinical practice patterns. With comprehensive and thoughtful preoperative and surgical planning, minimally invasive gynecologic surgery may be performed safely and is of particular benefit in obese patients.
-
J Minim Invasive Gynecol · Jan 2014
Can enhanced recovery pathways improve outcomes of vaginal hysterectomy? Cohort control study.
To assess the effect of enhanced recovery pathway implementation on patient outcomes after vaginal hysterectomy (VH) performed to treat benign indications. ⋯ The ERAS program in benign VH reduces length of stay by 51.6% and enables more women to be discharged within 24 hours, with no increase in patient readmissions rates.
-
J Minim Invasive Gynecol · Nov 2013
Analysis of adverse events with Essure hysteroscopic sterilization reported to the Manufacturer and User Facility Device Experience database.
The Manufacturer and User Facility Device Experience database may be useful for clinicians using a Food and Drug Administration-approved medical device to identify the occurrence of adverse events and complications. We sought to analyze and investigate reports associated with the Essure hysteroscopic sterilization system (Conceptus Inc., Mountain View, CA) using this database. ⋯ Sixty-one unintended poststerilization pregnancies were reported in the study period, of which 29 (47.5%) were ectopic gestations. Thus, ectopic pregnancy must be considered if a woman becomes pregnant after Essure hysteroscopic sterilization. Additionally, 44 women underwent hysterectomy after an adverse event reported to be associated with the use of the device.
-
J Minim Invasive Gynecol · Nov 2013
Randomized Controlled Trial Comparative StudyModular comparison of laparoscopic and robotic simulation platforms in residency training: a randomized trial.
To compare minimally invasive surgery (MIS) skills acquired using laparoscopic and robotic simulation training platforms. ⋯ Laparoscopic and robotic simulation platforms each demonstrated improved performance in the same and other platform. The robotic platform seems to have an edge over the laparoscopic platform. Larger studies are required in addition to studies to compare the effectiveness of both platforms in more advanced skills and to compare their effect on proficiency in the operating room.
-
J Minim Invasive Gynecol · Nov 2013
Intraocular pressure and steep Trendelenburg during minimally invasive gynecologic surgery: is there a risk?
Steep Trendelenburg position is frequently used during gynecologic minimally invasive surgery (MIS). However, little attention has been given to the potential impact of this nonphysiologic positioning on patients, specifically intraocular pressure (IOP). The purpose of our study was to evaluate IOP changes during laparoscopic or robotic hysterectomy conducted in the steep Trendelenburg position. ⋯ IOP increases significantly when patients are placed in the steep Trendelenburg position. Although further studies are needed to better characterize this process, given the aging population of our MIS patients in whom risk for glaucoma is significant, preoperative ocular health assessment should be considered in certain cases.