Abstracts SLS Annual Meeting 1997
نویسندگان
چکیده
Objective: To present a safe and sound strategy to perform Laparoscopic Assisted Vaginal Hysterectomy (LAVH). Presentation Highlights: The sole purpose of LAVH is the conversion of abdominal to vaginal surgery. Its only proven benefits over vaginal hysterectomy are the panoramic view afforded by the laparoscope and the ability to perform extensive adhesiolysis. Regardless of uterine size or conformation, the surgical conduct during LAVH should strictly follow a preemptive and strategic methodology. After normalization of the anatomy, the most fundamental and pivotal issue is whether there is safe and ready access to the uterine vessels. In fact, the "art" of performing a difficult LAVH is the ability to relinquish the panoramic view in favor of using magnification to incrementally dissect and mobilize tissue to access these structures. Lower segment distortion from myomata or dense posterolateral endometriosis should signal time for reassessment. After reduction of the adnexal attachments and the broad ligament tissues, adequate bladder reflection and thorough skeletonization of the uterosacral ligaments are paramount steps to maximize access to the uterine vessels and minimize the risk of bladder or ureteral injury. Adequate uterine torque with a reliable intrauterine manipulator is crucial for the tension-coun-tertension maneuvers required during this procedure. Since anterior vaginal dissection and bladder mobilization are usually the most difficult and morbid portion of vaginal hysterectomy, it behooves the surgeon to perform an anterior culdotomy prior to completing the procedure vaginally. In most cases, the hysterectomy should be completed vaginally as soon as it is feasible, thereby further reducing the risk of incomplete hemostasis and lower urinary tract injury. After securing the uterine vessels laparoscopically, large uteri and myomata can be laparoscopical-ly morcellated in situ before vaginal delivery. Conclusion: Success and the minimization of complications during LAVH are dependent on preemptive anatomic recognition and strategic surgical technique. Objective: To describe the three major new approaches to the treatment of stress incontinence: a) laparoscopic procedures, b) needle procedures with bone anchors, and c) biofeedback and office based neuromuscular conditioning procedures. Presentation Highlights: Laparoscopic bladder suspension can be accomplished in the following ways: 1) modified Burch procedure with suture, 2) modified Burch procedure with mesh, or 3) modified Gittes procedure. The success rate of these procedures has been demonstrated to be equal to that of the open surgical corrections. In addition, the laparoscopic approach, although requiring additional training on the part of the surgeon, provides the benefit of shorter hospitalization and faster …
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