Dragging technique versus blanching technique for endometrial ablation with the Nd:YAG laser in the treatment of chronic menorrhagia

Endometrial ablation performed with the Nd:YAG laser was developed to treat patients with chronic menorrhagia as an alternative to hysterectomy. The original dragging technique may result in an obscured operating field and fluid overload. This study compares results of endometrial ablation performed in 62 patients. The first 17 procedures were performed by use of the dragging technique; the last 45 procedures were performed with a blanching technique. Both procedures were performed at the same institution and by the same surgeon. Sixty-five percent of patients undergoing the blanching technique became amenorrheic after the procedure versus 12% of those undergoing the dragging technique. Moreover, the blanching technique required less time, fewer joules of energy, and resulted in less fluid absorption by the patient. The blanching technique is apparently more effective, easier to accomplish, and safer for the patient than the dragging technique.     

阴式肌瘤剔除术30例的临床探讨及护理配合

目的:探讨经阴道子宫肌瘤剔除术的临床方法及护理配合。方法:对近三年来我院收治的30例经阴式子宫肌瘤患者的临床效果及术前护理、术中手术配合、术后护理进行分析。结果:术后所有患者恢复良好,月经正常,妇科检查无异常,B超未发现残余肌瘤。结论:阴道子宫肌瘤剔除术为微创手术,临床应用比传统经腹子宫肌瘤剔除更安全可靠,在整个治疗活动期间,护理作用巨大,患者配合治疗和护理,有利于身体恢复。     

Innovations of the Stark method for cesarean section. Comparison of techniques

BACKGROUND: The evolution of surgical techniques for cesarean section have improved the neonatal outcome as well as maternal morbidity and mortality. Aim of this study is to compare the conventional technique with a personally modified Stark's technique, in order to evaluate its effectiveness. METHODS: A prospective study has been carried out on a group of patients submitted to cesarean section by two different teams. A conventional technique for cesarean section was performed by a team, while the other carried out a modified Stark's technique, at the Obstetrics and Gynecology Department of the University of Parma from May 1997 to February 1998. A total of 105 cases underwent a modified Stark's technique, while 99 were submitted to cesarean section with the conventional technique. In order to get a better reliability of results, homogeneous cases for epidemiological characteristics and indications have been enrolled in the study. Statistical analysis was performed by using Student "t"-test, chi 2 test and Wilcoxon test. The Stark's technique for cesarean section, modified by the Authors, is described. RESULTS: The parameters concerning surgical procedure, postoperative course and neonatal outcome showed statistically significant differences in favour of the modified Stark's technique. CONCLUSIONS: The conclusion is drawn that this technique leads to a remarkable reduction of blood loss and urine bacteria. Surgical drainage was never required.     

Preincubation of human spermatozoa in test-yolk medium: Effect on penetration of zona-free hamster oocytes and correlation with other semen characteristics

Penetration of zona-free hamster oocytes by human spermatozoa after preincubation with BWW medium (standard technique) or a buffer system containing egg yolk (TESTY) was compared by applying both treatments to aliquots of 60 ejaculates from 34 patients. The TESTY-treated spermatozoa penetrated the oocytes much more successfully than the spermatozoa treated by the standard technique. Although the penetration levels achieved by the two methods were significantly correlated, the correlation coefficient was too low to predict the penetration outcome from one technique to the other. More consistent results were obtained when different ejaculates from the same donor were treated by TESTY than by the standard technique. Spermatozoan penetrating ability was more strongly correlated with sperm concentration, motility, and morphology after treatment by the standard technique than after TESTY treatment. Much larger differences in penetration were present between normal and abnormal ejaculates when the standard technique was used than TESTY.     

Endometrial biopsies using small-diameter hysteroscopes and 5F instruments: how can we obtain enough material for a correct histologic diagnosis?

STUDY OBJECTIVE: To evaluate the quantity of biopsy tissue obtained by hysteroscopic grasp technique compared with classic punch technique. DESIGN: Observational study (Canadian Task Force classification II-2). SETTING: University hospital. PATIENTS: One thousand two hundred seventy-six women. INTERVENTION: Targeted biopsies performed in an office setting using two biopsy forceps, classic spoon and crocodile, and two methods, classic punch and grasp technique. MEASUREMENTS AND MAIN RESULTS: With either biopsy forceps, the mean increase in amount of tissue obtained by grasp technique compared with punch technique was statistically significant (p <0.005). With grasp technique, the mean amount of tissue obtained was even larger with crocodile than with spoon forceps. CONCLUSION: Targeted biopsy, when performed with the appropriate instrument and applying correct technique, can provide the pathologist with a large amount of tissue (mean 5.7 mm2) that is invariably adequate for histologic examination.     

Comparison of the modified McIndoe and modified laparoscopic Vecchietti techniques for the creation of a neovagina in Rokitansky syndrome

The aim of this retrospective clinical study was to compare the effectiveness and long-term anatomic and functional results of the modified laparoscopic Vecchietti and modified McIndoe techniques used to treat Rokitansky syndrome. Neovaginas were created either with the modified laparoscopic Vecchietti technique or with the modified McIndoe technique in 21 patients with Rokitansky syndrome aged between 17 and 40 years (mean 23 years) who wished to begin sexual intercourse. Anatomic success was defined as a neovagina longer than 6 cm and the easy introduction of two fingers. Functional success was achieved if the patient reported satisfactory sexual intercourse starting from 6 months after surgery. The performance of both techniques was efficacious. However, the postoperative hospital stay and operation times of the modified laparoscopic Vecchietti technique were shorter than those of the modified McIndoe technique and the modified laparoscopic Vecchietti technique was less painful than the modified McIndoe technique.     

Why vaginal hysterectomy?

The article presents current view on vaginal hysterectomy. Arguments in favour of this miniinvasive, minimal access surgical technique are presented. In conclusion the authors underline that vaginal hysterectomy is a cheap, miniinvasive technique which doesn't require expensive, sophisticated equipment and, what is the most important, which is relatively easy to learn. Due to these advantages, if hysterectomy is necessary, vaginal route should be considered as a technique of choice. While taking a decision which technique to choose, a surgeon should rather look for contraindications for vaginal hysterectomy than indications for this technique.     

The effects of hands on and hands off/poised techniques on maternal outcomes: A systematic review and meta-analysis

BackgroundNegative maternal outcomes such as perineal trauma and related perineal pain may cause both long-and short- term morbidities. Hands on and hands off/poised technique are two kinds of techniques to protect perineum during the second-stage of labor. Hands on technique has been the routine midwifery practice for a long time; nevertheless, the effects of hands on technique on protecting perineum has been doubted. Hands off/poised as a promising technique seems prevalent in clinical practice. However, there is no consensus on use of hands off/poised technique and hands on technique. The effects of these techniques on maternal outcomes have not been fully investigated.ObjectiveTo evaluate the effects of hands on hands off/poised technique on maternal outcomes during the second-stage of labor.DesignSystematic review and meta-analysis of relevant quantitative studies.Data sourcesSeven databases: PubMed, EMBASE, The Cochrane Library, CINAHL, WanFang Data, China National Knowledge Infrastructure (CKNI), SinoMed were systematically searched from inception to July 23,2018 for relevant quantitative studies comparing the effects of hands on and hands off/poised technique on maternal outcomes.Review methodsQuantitative studies were retrieved for relevant studies. Two reviewers independently screened the studies, evaluated the methodological quality using JBI appraisal checklist tools and extracted the data. The included studies were divided into two groups for analysis according to study types.ResultsNine RCTs with a total of 7112 participants and eight non-RCTs with 37,786 participants were included for meta-analysis. Based on the results from RCTs, this study did not find difference between hands on and hands off/poised technique regarding the risk of 2nd perineal tears, 3rd /4th degree perineal tears, duration of second-stage labor and incidence of postpartum hemorrhage (PPH>500 ml). The results from 9 non-RCTs were similar with that of RCTs, except for showing less 2nd degree perineal tears in hands off/poised technique than in hands on technique.ConclusionEvidence in the present study indicated that hands off/poised technique may be a promising delivery technique to maintain intact perineum, and reduce perineal pain and episiotomy use among women with low-risk pregnancy undergoing vaginal delivery. In addition, hands off/poised technique might be safe to use as it did not increase the risk of severe perineal trauma, postpartum hemorrhage, and longer duration of second-stage labor when compared with hands on technique. More studies with stringent study design, especially large randomized controlled trial, should be conducted before strong recommendation of the hands off/poised technique.     

Laparoscopy: direct trocar insertion without pneumoperitoneum

This paper examines the technique of directly inserting the laparoscopic trocar without establishing a previous pneumoperitoneum. The technique is carefully described, and a series of 1002 patients in whom it has been used are reported. The advantages of this method are discussed. Use of the Surgiport Disposable Trocar with the shield enhances the safety of this technique. This technique merits further investigation as an easy and safer means of performing laparoscopy.     

How Are Effective Breastfeeding Technique and Pacifier Use Related to Breastfeeding Problems and Breastfeeding Duration?

Abstract: Background: Inconsistent findings leave uncertainty about the impact of pacifier use on effective breastfeeding technique. The purpose of this study was to investigate how breastfeeding technique and pacifier use were related to breastfeeding problems and duration of breastfeeding. Methods: Data were collected from the intervention group of a randomized trial in which health visitors followed up with mothers for 6 months after childbirth. The health visitors classified the breastfeeding technique at approximately 1 week after birth and repeated the observation if a correction was necessary. Effective technique included positioning, latch, sucking, and milk transfer. Data on breastfeeding problems and pacifier use were obtained from self‐reported questionnaires. The study population included 570 mother‐baby pairs with complete information on breastfeeding technique and pacifier use. The primary outcome was duration of exclusive breastfeeding. Results: One‐half of the mothers showed ineffective breastfeeding technique at the first\ observation, most frequently ineffective position (61%) and latch (52%). In the unadjusted analysis, only sucking and milk transfer were associated with breastfeeding duration. In the adjusted analysis, ineffective technique was significantly associated with mothers reporting early breastfeeding problems, which thereby influenced the breastfeeding duration. Pacifier use had an independent negative impact on duration of breastfeeding. A single correction of the breastfeeding technique was not associated with duration or occurrence of problems. Conclusions: Observation of breastfeeding technique may help mothers in the stage of when they are establishing breastfeeding to avoid early and later problems, but breastfeeding technique is less useful in predicting breastfeeding duration. Use of a pacifier should be avoided in the first weeks after birth. (BIRTH 36:1 March 2009)     

Complications of laparoscopy: an inquiry about closed- versus open-entry technique

OBJECTIVE: The purpose of this study was to determine the amount of complications and the incidence of open- versus closed-entry (either by Veress needle or first trocar) technique in gynecologic laparoscopy in The Netherlands. STUDY DESIGN: Questionnaire analysis of members of the Dutch Society for Gynaecological Endoscopy and Minimal Invasive Surgery was combined with a Medline literature search. Data related to complications on entry from January 1,1997, through December 31, 2001, were collected by questionnaire and were separated into group I (Veress needle or first trocar) and group II (open-entry technique). The number of laparoscopy procedures, years of experience, and indications to perform the chosen entry technique were collected. RESULTS: Response rate was 98%. The procedures were performed by 187 gynecologists in 74 hospitals (72%) in The Netherlands. Groups I and II were comparable to each other, with respect to type of clinic (teaching vs nonteaching hospital), the number of procedures, and the experience of gynecologists. One hundred six gynecologists (57%) used only the closed-entry technique. This group reported 31 complications (0.1%) in 31,532 procedures. Even in the case of patients who were at risk for entry-related complications (previous laparotomy, obesity), pneumoperitoneum was established by the closed-entry technique. However, most gynecologists used an alternative insufflation point (eg, Palmer's point). The remaining 81 gynecologists used both entry techniques. However, the open-entry technique was used on special indications and in only 2.0% of cases (range: 1-20%). These special indications were suspected adhesions or previous laparotomy (90%) and obese (7%) or very thin patients (3%). These 81 gynecologists reported 20,027 closed-entry procedures and 579 open-entry procedures and complication rates of 0.12% and 1.38%, respectively (P<.001). Significantly more visceral lesions were found (P<.001) at open-entry technique in group II. Our literature search showed a calculated average entry complication rate for the closed-entry technique for visceral and vascular lesions of 0.44 of 1000 procedures and 0.31 of 1000 procedures, respectively. CONCLUSION: Although 43% of the gynecologists in this study performed the open-entry technique in laparoscopy, Dutch gynecologists seldom use this technique. When it is performed in selected patients, the number of complications is not reduced necessarily. In contrast to published data of general surgeons' findings, the number of entry-related complications in the open technique was significantly higher than the closed-entry technique. There is no evidence to abandon the closed-entry technique in laparoscopy. However, the selection of patients for an open- or alternative-entry procedure is still recommended.     

Intra-operative diagnosis of lymph node metastases in gynaecological practice using imprint cytology

The technique of imprint cytology has been described for the assessment of malignancy and correlates well with histology. Despite the simplicity, speed and excellent cellular detail the technique has still not been fully appreciated. We describe the value of the technique applied to intra-operative diagnosis of lymph node metastases in gynaecological malignancy. Four hundred and seventy five lymph nodes were examined using imprint cytology followed by routine histology. The technique of imprint cytology was found to have a zero false negative rate, 0.6% false positive rate and an accuracy of 99.3%. We advocate the consideration of this technique for the evaluation of cases with gynaecological malignancy as an alternative to frozen section histology.     

Sucking Technique and Its Effect on Success of Breastfeeding

ABSTRACT: We investigated the prognostic value of sucking technique (faulty vs correct) during the first week after birth in relation to the long-term success of breastfeeding. At discharge from the maternity ward, 82 healthy mother-infant pairs were observed for assessment of breastfeeding technique and followed for four months by regular telephone checkups. Correct sucking technique was defined as the infant having a wide-open mouth, with the tongue under the areola, and expressing milk from the breast by slow, deep sucks; faulty technique was defined as superficial nipple sucking. The study population was divided into three groups: one in which faulty sucking technique was corrected when observed (n = 29), one with faulty but uncorrected technique (n = 25), and a control group with a correct technique (n = 28). At the four-month follow-up assessment, the faulty but uncorrected group was characterized by a greater proportion of mothers with breastfeeding problems and early cessation of breastfeeding than the other two groups. Regular use of a pacifier (>2 hrs/day) was more common among those with breastfeeding problems.     

Diagnosis and treatment of the cervical factor. I. Improvement with a short-course treatment of high-dose estrogen

A new technique for improving cervical factor is described. This technique employs the use of high-dose estrogen at the time that a mature follicle is determined by ultrasound in patients who have inadequate postcoital tests despite the use of low-dose estrogen, guaifenesin, and tetracycline. Previously, a technique based on high-dose estrogen early in the follicular phase was employed; this suppressed pituitary gonadotropins, thus requiring the concomitant use of hMG. Seventy-three percent of the patients for whom this more expensive and intricate technique would have been necessary were able to achieve a good postcoital test through this modified technique of merely using high-dose estrogen when the follicle has already matured. Thirty-three percent achieved a pregnancy within 6 months on this therapy.     

Simple and practical technique for hysterosalpingography: results obtained in 564 cases

About 5 years ago, we proposed a new technique for hysterosalpingography in order to make it simpler for the gynecologist and the radiologist and more readily acceptable for the patients. In our opinion, the technique is simple and practical; we have performed ISG's with it and have succeeded in 555 cases, that is, 98.4%; in 9 cases, 1.6%, we did not succeed. In 5 of these 9 cases, the failure was due to an error in the application of the technique. This technique, however, must not be used in patients with suspected didelphic uterus or septum or with an unsuitable portio. In none of the patients was the technique followed by complications.     

Sentinel lymph node detection in breast cancer. Experience of the Institut Curie

Sentinel lymph node biopsy is a recently developed, minimally invasive technique for staging the axilla in breast cancer. This new procedure of selective lymphadenectomy has been the subject of several studies, and a consensus of opinion is starting to form to define indications and methods of identification concerning the use of this technique. At the Institut Curie since 1996, we have been using the Patenté blue dye technique and from 1998 we have used the combination of blue dye and technetium labeled sulfur colloid. This article summarizes the principales aspect of this technique.     

Rapid hypnosis as an anaesthesia adjunct for evacuation of postpartum vulval haematoma

Hypnosis can be a useful therapeutic adjunct to pharmacological analgesia or anaesthesia in obstetrics. However, it is rarely considered a primary anaesthetic technique and is seldom employed in the acute surgical setting. Few obstetricians and anaesthetists currently utilise this technique in their clinical practice. We present a case report of a 34-year-old woman who successfully underwent evacuation of a large vulval haematoma using the simple hypnosis technique of 'believed-in imagination' as the principal anaesthetic technique with only minimal adjunctive pharmacological analgesia.     

A modified technique for lateral internal sphincterotomy

A technique for lateral subcutaneous internal sphincterotomy has been used in 300 patients. In 200, the blind method was used, and in 100, the open technique was used. Although the number of patients and the follow-up period were not matched, the early results were somewhat better with the group of patients who underwent the open technique than with those who underwent the blind procedure, particularly in regard to postoperative bleeding. We recommend this technique both to minimize bleeding and to afford the surgeon more technical control.