Surgeon preference when purchasing integrated laparoscopic theatres: a survey of British gynaecologists

This was a web-based survey of members of the British Society for Gynaecological Endoscopy to establish what features of integrated theatres are considered desirable to surgeons. A secondary aim was to assess if there are differences in preference between those surgeons who use these theatres regularly and those who have never used them. Respondents were asked to rank a list of 14 features of integrated theatres in terms of desirability with 1 being most desirable and 14 being least desirable. They were separately asked to rate each feature according to importance. The main outcome measures were the ranking and rating of each feature. In all 121/639 (18.9 %) surgeons responded, 83 (68.6 %) were male and 38 (31.4 %) were female. Ninety-two (76.0 %) were consultants and 29 (24.0 %) junior doctors. Sixty-six (54.5 %) had never used an integrated theatre, 24 (19.8 %) occasionally (one to six times/year) and 31 (25.6 %) regularly (greater than six times/year). There was significant regional variation in the usage of integrated theatres with the more affluent parts of the country (London and south of England) having a higher usage rate than more deprived areas (north of England). Some features of integrated theatres are consistently rated more highly than others. There were differences in preference between surgeons who use integrated theatres regularly and those who do not. It may be worth consulting with surgeons with experience of both purchasing and using these theatres in order to get the most appropriate system both in terms of cost and ergonomics.     

Lower urinary tract symptoms in women with vaginal agenesis

Introduction and hypothesis

Congenital vaginal aplasia is a condition with devastating implications for fertility and sexuality. However, little is known on whether urinary symptomatology is more common prior and following vaginal lengthening procedures in these women.

Methods

We performed a prospective observational study of 19 women with vaginal agenesis before and after vaginal dilation treatment or a laparoscopic Vecchietti procedure. All women completed the ICIQ FLUTS questionnaire before and after treatment in order to assess incidence and changes in urinary symptomatology.

Results

Urinary symptoms were present in 53% of women prior to treatment. The majority of bladder symptoms were not significantly altered by treatment, except for incomplete bladder emptying. Women following the Vecchietti procedure had increased urinary hesitancy and a poorer steam compared with those completing dilation treatment. The longer the vaginal length, the greater the urinary frequency.

Conclusion

Women with vaginal agenesis had significant levels of urinary symptoms and to our knowledge this has not been reported before. The majority of symptoms were not altered by treatment.     

Obstructive mullerian anomalies and modern laparoscopic management

STUDY OBJECTIVE: Congenital uterine anomalies are common, although the majority are asymptomatic. When an obstructed system exists, women may present with abdominal pain, or dysmenorrhea. Removal of the obstructed horn may be required in the symptomatic patient. In the past, surgical treatment necessitated a laparotomy. DESIGN: After preoperative diagnosis and planning using magnetic resonance imaging, laparoscopic removal of the obstructed uterine horn and tube was performed. Morcellation of tissue was used to permit removal through a 15mm port. SETTING: A central London tertiary referral teaching hospital. PARTICIPANTS: 15 women aged between 13 and 41. INTERVENTIONS: Between 1999 and 2005, all women underwent laparoscopic removal of the obstructed uterine horn and tube. MAIN OUTCOME MEASURES: Recovery, hospital stay, length of operation. RESULTS: All women recovered well, with an operation time of 80 to 300 minutes and an average hospital stay of 5 days. CONCLUSIONS: A laparoscopic approach is a safe and appropriate technique for the removal of an obstructed uterine horn.     

The new laparoscopic uterine sling suspension procedure: first year follow-up data

Ideally, any uterine conservation procedure for the treatment of prolapse should be effective, and yet, not significantly jeopardise subsequent surgery should a hysterectomy become a necessity in the future. We present our 1-year data on the new laparoscopic uterine sling suspension procedure. We have found significant anatomical improvements in points C and D on the pelvic organ prolapse quantification score, and improvements in vaginal, sexual and quality of life scores. We conclude that this technique is a promising new surgical method for treating uterine prolapse.     

Laparoscopic gonadectomy in paediatric and adolescent girls with intersex disorders

Gonadectomy is indicated in some children and teenagers with intersex disorders. Traditionally, this has been performed by laparotomy. This paper is a retrospective evaluation of laparoscopic gonadectomy in 10 girls (age range 8 to 17 years). Clinical records were reviewed for diagnosis, indication for surgery, complications and recovery period. Operative notes were reviewed for details of technique and complications. In all cases, the procedure was uncomplicated and the maximum hospital stay was two days. Laparoscopic gonadectomy is an effective and safe procedure for children and teenagers with these rare conditions.     

Laparoscopic colposuspension

Laparoscopic urogynaecology started to develop following the first report of a laparoscopic colposuspension in 1991. The place of laparoscopic treatment of urinary incontinence has yet to be established and, as for all new techniques, case reports, case series and small randomized studies have been reported. Larger randomized studies with adequate power have yet to be reported. Current opinion is divided as to the success of these new operations. Assessment of outcome is further clouded by large variations in technique, such that like is not always compared with like. The present review assesses the recent literature and the place of the traditional colposuspension performed via the laparoscopic route.     

Assessment of urinary symptoms in the second half of pregnancy

Twenty-eight pregnant women at 28 weeks gestation completed a urinary symptom questionnaire and then underwent uroflowmetry and subtracted provoked cystometry in order to correlate their urinary symptoms to their urodynamic assessment. Although a high incidence of urinary symptoms was found, there was poor correlation with the urodynamic findings.     

Growth of the normal human lower urinary tract from 12 to 21 weeks gestation.

Normal development of the human lower urinary tract was studied between the 14th and 20th week of gestation using 3 modes of fixation. Fixation by direct distension provides a high degree of reproducibility of parameters used to study the growth of the fetal bladder. Using this method, fetuses ranging from 12 to 21 weeks gestation were studied. Results obtained demonstrate that the length of the bladder, the inter-ureteric distance, and the distance between the apex of the trigone and the distal tip of the urethra occur in a linear mode. Furthermore, the rate of growth of the male urethra was evidently higher when compared to that of the female from the 12th week of gestation. Data from this work can be used for a more accurate assessment of cases with abnormal lower urinary tract development.     

Growth of the normal human lower urinary tract from 12 to 21 weeks gestation

Normal development of the human lower urinary tract was studied between the 14th and 20th week of gestation using 3 modes of fixation. Fixation by direct distension provides a high degree of reproducibility of parameters used to study the growth of the fetal bladder. Using this method, fetuses ranging from 12 to 21 weeks gestation were studied. Results obtained demonstrate that the length of the bladder, the inter-ureteric distance, and the distance between the apex of the trigone and the distal tip of the urethra occur in a linear mode. Furthermore, the rate of growth of the male urethra was evidently higher when compared to that of the female from the 12th week of gestation. Data from this work can be used for a more accurate assessment of cases with abnormal lower urinary tract development.© Willey-Liss, Inc.     

Endoscopic management of uterine fibroids

Uterine fibroids are very common, but their relationship to fertility is still controversial. Data in relation to fibroids and fertility mainly come from retrospective case series and prospective uncontrolled trials. Although some authors advocate prospective controlled studies, it is unlikely that an easy answer will be found due to considerable variations in location, size and number of fibroids, presence of additional infertility factors and variation of surgical techniques. Submucosal fibroids are more likely to be associated with menstrual disorders and subfertility, and hysteroscopic myomectomy has been accepted as the standard treatment for them. Treatment of submucosal fibroids may be associated with better reproductive outcomes. There is bigger controversy over the impact of intramural and subserosal fibroids on fertility. Laparoscopic myomectomy is now used by a large number of groups for removal of these fibroids in selected cases, but still remains a challenging procedure which requires advanced laparoscopic skills. Its advantages over open myomectomy include reduced postoperative pain, shorter hospitalization, quicker recovery, reduced febrile morbidity and blood loss. It may also reduce the risk of postoperative adhesion formation. There are now large numbers of pregnancies following laparoscopic myomectomy and the risk of uterine rupture in future pregnancies seems to be very low with good surgical technique.