Laparoscopically assisted vaginal hysterectomy

The LAVH revolution beginning in the late 1980s is far from over. The overwhelming growth and, at times, overuse of the laparoscopic approach have waned somewhat as physicians reevaluate LAVH, adopt new techniques such as arterial embolization and myolysis, and rediscover old techniques such as uterine morcellation at vaginal hysterectomy. In addition, the cost of new procedures and instrumentation has come under intense scrutiny. As analysis of patient care moves from cost containment to improved outcomes, there will be renewed interest in minimally invasive approaches. The challenge to accumulate data, critically analyze each approach, and select the most appropriate procedure for each patient holds the greatest promise for improved patient satisfaction and outcomes.     

Laparoscopically assisted vaginal radical hysterectomy

Young patients affected by an early-stage invasive cancer of the cervix are usually treated by surgery. Abdominal radical hysterectomy with pelvic lymphadenectomy is the most widely used technique. With the advent of more conservative surgical approaches, laparoscopy has gained acceptance in gynecologic oncology, opening the way for radical vaginal surgery for cervical cancer. Before this technique becomes widely accepted, it has to be demonstrated that the results, in terms of safety and efficacy, are comparable with the 'standard' abdominal approach. In this chapter we review the technique of laparoscopically assisted radical vaginal hysterectomy and evaluate results of published series.     

Recent advances in uterine fibroid embolization

PURPOSE OF REVIEW: To summarize the literature on uterine embolization for fibroids published in 2004 and 2005. RECENT FINDINGS: During the last two years, our understanding of the outcome of uterine fibroid embolization has increased. The outcomes are comparable to those that occur after hysterectomy. Health-related quality-of-life studies have confirmed the positive impact of the procedure. Improvement in menorrhagia has been quantified using the alkaline hematin method, objectively confirming the outcome. Recovery is also better understood and quantified, with most patients experiencing only moderate pain over the first few days after embolization. In two pregnancy-outcome studies, an increased frequency of cesarean section occurred and possibly a greater likelihood of abnormal placentation, although the data are too few to draw conclusions at this time. Contrast-enhanced magnetic resonance imaging (MRI) has emerged as the primary tool for assessing the potential of complications following the procedure, and our understanding of vaginal discharge and uterine infarction has been increased as a result of its use. SUMMARY: Within the last few years, uterine embolization has become an accepted therapy for uterine fibroids. The increase in understanding gained in recent years has helped to confirm the effectiveness and relative tolerability of this therapy.     

Laparoscopically assisted vaginal hysterectomy: a novel method

This paper describes a novel method of facilitating laparoscopically assisted vaginal hysterectomy (LAVH) uniquely distinguished by commencing vaginally and finishing laparoscopically. For this technique a specially designed uterine manipulator has been developed.