Journal of minimally invasive gynecology
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J Minim Invasive Gynecol · Jul 2009
ReviewPractical tips for office hysteroscopy and second-generation "global" endometrial ablation.
Hysteroscopy and endometrial ablation using the second-generation devices are safe, generally well tolerated, and effective when performed in the medical office as opposed to the ambulatory surgery center or hospital operating room. Not only does this benefit the patient and physician in terms of convenience and cost savings, and the overall economic benefit to the health care system is great. The availability of modern hysteroscopic and video equipment, the advent of second-generation "global"endometrial ablation devices, and use of minimal sedation combined with effective local anesthesia have made office procedures possible. ⋯ This review discusses each of the second-generation endometrial ablation devices in detail and some of the more pertinent issues related to office hysteroscopy and global endometrial ablation that were posted on the ListServ. Rollerball and transcervical resection of the endometrium are not discussed because the overwhelming majority of these procedures are performed in the operating room and there is little potential for their becoming office procedures. Practical clinical tips based on the evidence in the literature are discussed.
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J Minim Invasive Gynecol · May 2009
Laparoscopic posthysterectomy vaginal vault excision for chronic pelvic pain and deep dyspareunia.
To evaluate the outcome of posthysterectomy laparoscopic vaginal vault excision and its long-term effects on chronic pelvic pain, dyspareunia, quality of life, and patient satisfaction. ⋯ Laparoscopic vaginal apex excision is a safe and effective management option after carefully excluding other causes of deep dyspareunia and chronic pelvic pain. It also provides an opportunity to detect and surgically excise previously undiagnosed endometriosis and other disease.
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J Minim Invasive Gynecol · Mar 2009
Clinical TrialFeasibility of the use of novel matrix hemostatic sealant (FloSeal) to achieve hemostasis during laparoscopic excision of endometrioma.
To evaluate the use of FloSeal, a 2-component (collagen granules and thrombin) topical hemostatic agent for the control of minor bleeding of the ovarian wall at the end of the laparoscopic stripping procedure for endometriomas. ⋯ This preliminary series suggests that FloSeal may be used instead of bipolar electric coagulation after excision of ovarian endometriomas. Because the latter was identified by some authors as a possible cause of follicular damage, the use of FloSeal for bleeding control should be investigated in patients undergoing laparoscopic stripping of endometriomas.
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J Minim Invasive Gynecol · Jan 2009
Trends in sterilization since the introduction of Essure hysteroscopic sterilization.
To investigate trends in sterilization in women at the Detroit Medical Center, Michigan (DMC), since the introduction of Essure hysteroscopic sterilization. ⋯ At the DMC facilities analyzed from January 1, 2002, through December 31, 2007, a significant decrease occurred in the percentage of laparoscopic sterilizations and postpartum tubal ligations performed after vaginal delivery. Of the interval sterilizations performed, the percentage of Essure hysteroscopic sterilizations increased significantly from 0.0% to 51.3% of all procedures. Since the approval of Essure hysteroscopic sterilization in November 2002, this minimally invasive method of hysteroscopic sterilization has increased in popularity at the DMC.
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J Minim Invasive Gynecol · Jan 2009
Core competencies for gynecologic endoscopy in residency training: a national consensus project.
Residents and educators in obstetrics and gynecology have identified the need to improve endoscopic surgical education. The Canadian Endoscopy Education Project aims to create a national standardized endoscopy curriculum. The objective of the current project was to identify the core competencies for a gynecologic endoscopy (GE) curriculum in residency training programs. ⋯ Competencies that were deemed outside the realm of general residency education were also collated and may represent a guide to subspecialty fellowship training in the future. The core competencies for GE training in obstetrics and gynecology residency were determined through national expert consensus. This provides the basis for a national standardized endoscopy curriculum for general obstetrics and gynecology training.