Is laparoscopy back?

Should surgical treatment of presumed endometriosis be advocated for all patients who fail to conceive after multiple IVF cycles? Without appropriately designed clinical studies, there is currently little evidence to support this approach.     

When will laparoscopy totally replace laparotomy?

This clinical opinion explores the current "zeitgeist" of minimally invasive gynaecological surgery (MIGS) as reflected in opinions expressed at the 40th AAGL conference held in Hollywood, Florida. It addresses concerns relating to the introduction of MIGS globally and the current position of robotic surgery in relation to conventional minimally invasive techniques like vaginal hysterectomy and minilaparotomy. It also explores challenges relating to MIGS in the healthcare environment of the 21st century.     

Diagnostic laparoscopy -- when and why?

Laparoscopy holds a key role in daignosing and treating endometriosis. The present paper aims at clarifying the correct indication for this procedure. To this end, relevant guidelines as well as considerations regarding incidence, pathogenesis as well as diagnostic and therapeutic alternatives are presented. An algorithm for clinical practice is presented.     

Gasless laparoscopy—Useless or useful?

Carbon dioxide (CO₂), pneumoperitoneum for advanced operative laparoscopy has well-documented inherent pathophysiologic risks. Problems are associated with creating and maintaining the pneumoperitoneum, lowering body temperature, infective particles in the insufflation gas, and ensuring hemostasis of port entry sites after intraabdominal pressure is reduced. When the vagina is opened to remove surgical specimens or at the time of hysterectomy, loss of vision occurs. In some patients general anesthesia and CO₂ pneumoperitoneum are contraindicated, and in them such problems could be avoided by gasless laparoscopy. Three types of mechanical anterior abdominal wall elevators have been used at the Melbourne Gynoscopy Centre for a variety of laparoscopic procedures, all of which have their advantages and disadvantages.     

旧貌换新颜塑料也SPA

塑料洗菜盆，塑料饭盒，塑料案板，塑料筷子，塑料漏网．塑料杯子，塑料勺子．塑料盘子……塑料制品在我们的生活中充当着各种各样的重要角色，但时间长了难免会由于清洗不勤或意外染色，导致很多塑料制品变得脏兮兮的。     

Entry techniques in gynecologic laparoscopy—a review

Laparoscopy is one of the most common surgical procedures in gynecologic medicine. Major complications associated with gynecologic laparoscopy are relatively rare, with up to 50% related to laparoscopic entry. Several entry techniques have been developed, all of which aim to provide a safe and easy entry to the abdominal cavity. In this article, we aim to review the available evidence on laparoscopic entry techniques in gynecologic surgery. We found no evidence that the Hasson (open) technique is superior to the Veress needle entry, the preferred method of most gynecologists all over the world. When entering the abdomen using the Veress needle, an intraperitoneal pressure <10 mmHg is a reliable predictor of correct intraperitoneal placement. Entry at Palmer’s point (left upper quadrant laparoscopy) is recommended for patients with suspected or known periumbilical adhesions, or a history or presence of umbilical hernia, or after three failed insufflation attempts at the umbilicus. Recently published trials suggest that direct trocar entry, especially when using optical trocar systems, might be superior to both the Hasson open technique and the Veress needle entry to avoid extraperitoneal insufflation and failed entry. Moreover, blood loss can be reduced and the mean entry time shortened. Laparoscopic entry techniques are still a controversial topic in gynecologic surgery. Many studies are underpowered in order to assess the risk for rare but life-threatening complications. In conclusion, there is no solid evidence proving the superiority of any method of laparoscopic entry.     

Is laparoscopy necessary before assisted reproductive technology?

PURPOSE OF REVIEW: Laparoscopy is widely used during infertility work-up, although it is sometimes unnecessary. This review highlights when laparoscopic intervention should be used in women undergoing assisted reproductive technology cycles. RECENT FINDINGS: There is no evidence for an increase in pregnancy rates in assisted reproductive technology cycles following surgical treatment of pelvic adhesions or endometriosis with laparoscopy. If the patient has bilateral visible hydrosalpinges, laparoscopy may be an option for evaluation of the tubes and treatment with salpingectomy in order to enhance the chance of pregnancy before commencing an assisted reproductive technology cycle. Laparoscopic ovarian drilling before assisted reproductive technology may be considered a therapeutic option in polycystic ovary disease patients who previously had severe ovarian hyperstimulation syndrome. Finally, laparoscopy may be useful in replacing the transposed ovaries to their original sites in the pelvic cavity in previously treated cancer patients so that monitoring of the controlled ovarian hyperstimulation and the oocyte aspiration would be much easier during the assisted reproductive technology cycles. SUMMARY: Laparoscopy should be considered before assisted reproductive technology cycles if the procedure diagnoses and treats a pelvic pathology at the same time and if laparoscopic intervention increases the chance of pregnancy following these cycles.     

快来做个SPA男人

SPA是希腊语SOLUSPARAQUA的缩写，意为健康在水中。是指人们利用天然的水资源结合沐浴、按摩和香薰来促进新陈代谢，满足人体视觉、味觉、触觉、嗅觉和思考，达到一种身心畅快的享受。这种由专业美疗师、水、光线、芳香精油、音乐等多个元素组合而成的舒缓减压方式，能帮助人们达到身、心的健康，是现代都市人追求身心健康的。种必然需求。特别是在职场打拼的男士们，确实需要用SPA来慰值一下。     

全新美丽方式：SPA

据考，关于SPA的起源，还有一种传说：在比利时，有一罗马帝国时代即闻名遐迩的小镇“SPA”，镇中有一温泉，因泉水中含有丰富的矿物质和芳香精油成分，经常在水中泡浴，人就会变得特别舒畅，皮肤变得雪白光滑，身材会变得匀称、丰满，且能消除很多疾病，用泉水洗脸，能消除色斑，增加皮肤弹性与光泽，使皮肤变得又白又嫩。一时间，     

旧貌换新颜,塑料也SPA

塑料洗菜盆，塑料饭盒，塑料案板，塑料筷子，塑料漏网．塑料杯子，塑料勺子．塑料盘子……塑料制品在我们的生活中充当着各种各样的重要角色，但时间长了难免会由于清洗不勤或意外染色，导致很多塑料制品变得脏兮兮的。     

在家中轻松享受SPA天堂

“您的肌肤接受了SPA的精心护理吗？”这是如今都市时尚女性间很流行的问候语。     

Can ultrasound-based investigations replace laparoscopy and hysteroscopy in infertility?

OBJECTIVES: To compare the use a simplified ultrasound based infertility investigation of the infertile couple with the current use of laparoscopy and hysteroscopy. STUDY DESIGN: Thirty-three infertile couples underwent transvaginal ultrasound and hystero-salpingo-contrast-sonography. A diagnosis was formulated based on the results of the ultrasound investigations, a semen analysis and endocrine parameters. The following day, all subjects underwent a laparoscopic chromotubation and hysteroscopy by a surgeon unaware of the ultrasound findings. A diagnosis based on the findings at laparoscopy and hysteroscopy, the same semen analysis and endocrine parameters, was then made. The two diagnoses were compared. RESULTS: A 90.9% agreement was found between the diagnoses made from the two methods used. When considering laparoscopic diagnosis the Gold Standard of tubal patency, the sensitivity to diagnose occluded tubes using hystero-contrast-sonography was 92.8%. The corresponding figures for specificity, PPV and NPV were 96.2%, 92.8% and 98.1%, respectively. CONCLUSIONS: A simple, ultrasound based approach to investigate the infertile couple, can be used effectively as an initial examination modality during the couple's work-up. However, there is a need for a larger study to confirm these results.     

Are borderline tumors of the ovary safely treated by laparoscopy?

OBJECTIVES: To evaluate the risk of the laparoscopic approach to patients with borderline ovarian tumors compared to the laparotomic management. METHODS: We treated or followed in our institution 479 women with borderline ovarian tumor. Sixty-two patients had fertility-sparing surgery followed by restaging or follow-up intervention: 30 operated by laparoscopy, 32 by laparotomy. Restaging surgery was performed in five cases and second-look surgery in 57. RESULTS: The diameter of the cyst is significantly lower in patients treated by laparoscopy, especially in women who underwent cystectomy (4.7 cm) compared to oophorectomy (10 cm, P = 0.008). Rupture of the cyst and stage IC were more frequent in the laparoscopic group. After a median follow-up of 61 months for the laparoscopic group and 77 months for the laparotomic group, we observed 11 patients (37%) with persistent disease after primary laparoscopy (adnexa, five cases; peritoneal implants, three cases; both patterns, three cases). After primary laparotomy, no patients showed early persistence of tumor, and ovarian relapses were diagnosed in seven women (22%) 33-138 months after laparotomy. The univariate analysis for the risk of neoplastic persistence after primary laparoscopy shows that patients with cysts greater than 5 cm have a higher risk (odds ratio 9.7, P = 0.02) compared to smaller cysts. No other factors proved significant, but the odds ratios for patients with serous tumor (5.8), stage IC (2.0), and those undergoing cystectomy (1.9) suggest a relationship to the probability of persistence. CONCLUSION: Laparoscopic treatment in borderline ovarian tumors should be reserved to masses not greater than 5 cm. When conservative therapy is desired, the entire affected ovary should be removed. If the neoplasia is bilateral, cystectomy could be allowed in women who wish to preserve fertility, although they are at high risk of relapse.