The Journal of the American Association of Gynecologic Laparoscopists
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Accidental vascular placement of Veress needle or cannula during laparoscopic insufflation with carbon dioxide gas (CO2) may cause a fatal gas embolism. Deliberate CO2 injection into the vena cava of dogs did not define a safe flow rate or pressure to prevent mortality. We studied incremental increase in pressure at the same maximum rate of gas flow (corresponding to 2.5 L/mm in a 70-kg man, the maximum flow rate possible with a Veress needle) to define the pressure at which pigs did not reversibly tolerate intravenous CO2 insufflation. ⋯ However, a decrease in end tidal CO2 should alert the anesthesiologist to stop insufflation immediately. This will allow recovery. When insufflating pressures are in the middle (20 mm Hg) or high range (25 mm Hg), CO2 embolism can be fatal despite its early recognition.
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J Am Assoc Gynecol Laparosc · May 1996
Case ReportsHysteroscopic extraction of a vaginal foreign body in a child.
A 3.5-year-old girl had a persistent, foul-smelling, blood-tinged vaginal discharge. She was initially treated for recurrent and persistent vulvovaginitis, which resulted in no improvement. Vaginoscopy revealed an intravaginal foreign body, which was removed successfully by hysteroscopy. We believe hysteroscopy is safe, convenient, effective, and easy to perform, even in a child.
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Evaluating patients with chronic pelvic pain is complex. A detailed medical history should be ideally supplemented by psychologic evaluation and assessment of the woman's social background. At the time of physical examination, the location and intensity of the pain should be mapped. ⋯ Management should address the underlying cause(s) of pain; when this cannot be done, it should focus on treating the pain itself. When appropriate, empiric administration of antidepressants may be considered. In selected women, therapeutic goals may be achieved by electrical stimulation of nerves.
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We developed a simplified technique for closing laparoscopic cannula sites. Its advantages are simplicity, speed, reproducibility, and cost-effectiveness. It requires no laparoscopic assistance or specialized instruments.
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J Am Assoc Gynecol Laparosc · Nov 1995
Multicenter Study Clinical Trial100 laparoscopic hysterectomies in private practice and visiting professorship programs.
To evaluate 100 laparoscopic hysterectomies and their variations in private practice and visiting professorship programs. ⋯ Hysterectomy performed or aided by the laparoscope, whether LH, LAVH, or SLH, is effective and safe as long as at least one member of the surgical team is an experienced and appropriately trained laparoscopic surgeon. Further studies are necessary to determine if the credentialing process for advanced laparoscopic surgery would be facilitated by a visiting professorship program.