Managing gynaecological emergencies with laparoscopy.

Abstract

A consecutive series of 49 women (50 procedures), whose conditions were haemodynamically stable, presenting with acute lower abdominal pain, pelvic tenderness, and either a urine concentration of >50 U/l 3 human chorionic gonadotrophin or a pelvic mass shown by ultrasonography were treated with operative laparoscopy under video monitoring (videopelviscopy) as an alternative to laparotomy.Ectopic pregnancy, ovarian and non-ovarian cysts, pelvic adhesions, endometriosis, and fibroids were found, for which salpingotomy, salpingectomy and salpingo-oophorectomy, cystectomy, adhesiolysis, thermocoagulation, and myomectomy were carried out by laparoscopy. In one patient pelviscopy was repeated because of persistent tubal pregnancy after the fimbria was expressed. Laparotomies were carried out on three patients because treatment was not possible by laparoscopy and on a further patient two days after adhesiolysis had been attempted. These were the only serious complications. For the 46 cases (45 patients) in which operative laparoscopy was successful the mean stay in hospital was 1-9 days after operation, and this group of patients returned to normal activities and to work after an average of 2-3 and 2-6 weeks respectively.Most gynaecological emergencies that are managed by laparotomy can be treated by laparoscopy and benefit both patients and the health service.

The role of research in the training of an obstetrician and gynaecologist

“…This scanner was further used in the management of pain and bleeding in early pregnancy, resulting in reduced hospital stay and anxiety for many patients as they could either be directly placed on to an emergency operating list or discharged home. It improved clinical management of ectopic pregnancy as these cases were diagnosed earlier and could be managed conservatively often using laparoscopic surgery confirming previous findings (Magos et al 1989) and enabled us to use use the gynaecological operating theatres more effectively. Finally it benefited the registrars who were able to clock up several thousand scans as well as adequately inform and counsel patients about these procedures.…”

The Use of CO2 Laser for Reproductive Surgery

“…The experience in this area is still limited, and we are waiting to see the data and results of the technique. The use of laparoscopy for myomectomy was suggested by Gordon and Magos.68 A few cases were reported by Magoo et al 69 The laser beam is used to open the capsule of the myoma. The myoma is grasped with alligator forceps, and by traction and laser dissection, it is removed.…”

Diagnostic mini-video assisted thoracic surgery

“…Nowadays VATS has been established and calls for technological advancement [10]. Gynecologists first used the 2.0-mm instruments for endoscopic operations 7 to 9 years ago, with very good results [4,8,9]. In thoracic surgery the initial purpose is diagnostic accuracy, postoperative pain reduction, hospital stay limitation, and fast patient recovery.…”