The Journal of the American Association of Gynecologic Laparoscopists
-
J Am Assoc Gynecol Laparosc · Feb 2001
Multicenter StudyMajor complications of operative and diagnostic laparoscopy for gynecologic disease.
To compare complication rates of diagnostic and operative laparoscopy. Design. Retrospective study (Canadian Task Force classification II-2). ⋯ Laparoscopic surgery is appropriate for managing various gynecologic diseases and has an acceptable complication rate. However, operative laparoscopy should be performed carefully because its rate of complications is significantly higher than that of diagnostic laparoscopy, especially for laparoscopic-assisted vaginal hysterectomy. (J Am Assoc Gynecol Laparosc 8(1):68-73, 2001)
-
J Am Assoc Gynecol Laparosc · Nov 2000
ReviewAn evidence-based medicine approach to the treatment of endometriosis-associated chronic pelvic pain: placebo-controlled studies.
Use an evidence-based medicine (EBM) approach to evaluate the evidence regarding efficacy of treatment of endometriosis-associated chronic pelvic pain (CPP) in placebo-controlled randomized clinical trials (RCT). ⋯ Although either surgical or medical treatment of endometriosis in women with CPP is clearly indicated, pain relief of 6 or more months' duration can be expected in only 40 to 70% of women with endometriosis-associated CPP.
-
J Am Assoc Gynecol Laparosc · Aug 2000
Model to determine resistance and leakage-dependent flow on flow performance of laparoscopic insufflators to predict gas flow rate of cannulas.
To characterize insufflator CO2 gas flow performance to predict gas flow rate with standard cannulas. ⋯ Gas flow depends not only on maximum flow of insufflators but also on resistance of cannulas and leakage rate. With this model it is possible to predict the real, available flow of insufflator-cannula combinations for the first time. Improved resistance of all components can save insufflation time.
-
J Am Assoc Gynecol Laparosc · Nov 1999
Randomized Controlled Trial Comparative Study Clinical TrialComparison of anesthetic methods for microlaparoscopy in women with unexplained infertility.
To evaluate the effectiveness of ketamine compared with fentanyl as analgesia or sedation for microlaparoscopy. ⋯ Microlaparoscopy in infertile women was performed more effectively under sedation with ketamine than with fentanyl.
-
To evaluate the relationship between prevalence and severity of chronic pelvic pain (CPP) and stage, site, and type of endometriosis. ⋯ Ten women (11.1%) had no pain; 72 had dysmenorrhea (mild in 13, moderate in 37, severe in 22); 55 had CPP (mild in 11, moderate in 25, severe in 19); and 39 deep dyspareunia (mild in 5, moderate in 31, severe in 3). The severity of dysmenorrhea significantly correlated with the presence and extent of pelvic adhesions (p = 0.004); the severity of CPP correlated with deep endometriosis on the uterosacral ligaments (p = 0.0001) and extent of pelvic adhesions (p = 0.02); and deep dyspareunia correlated with deep endometriosis on the uterosacral ligaments (p = 0.04). Total pain score significantly correlated with deep endometriosis on the uterosacral ligaments (p = 0.0001), peritoneal adhesions (p = 0.01), and extent of adnexal adhesions (p = 0.01). No significant correlation was found among revised American Fertility Society stage of endometriosis; presence and size of ovarian endometriomas; extent, type, and site of peritoneal lesions; and pain scores. By logistic regression analysis, the presence and intensity of total pain could be predicted simultaneously by the presence of deep endometriosis (p = 0.0001) and presence and extent of adnexal adhesions without cystic endometriosis (p = 0.01), and by the presence of ovarian endometrioma with periovarian adhesions (p = 0.03). Chronic pelvic pain was predicted by both deep endometriosis (p = 0.0001) and ovarian endometriomas with adnexal adhesions (p = 0.03). Deep dyspareunia was predicted simultaneously by deep endometriosis (p = 0.01) and an ovarian endometrioma with periovarian adhesions (p = 0. 008). Conclusion. Deep endometriosis, pelvic adhesions, and ovarian cystic endometriosis were independent predictors of pelvic pain. These data strongly suggest that it is not the size of ovarian cystic endometriosis but the association with adhesions that causes pelvic pain.