RESUMEN
IMPORTANCE: A range of energy sources are used in gynecologic laparoscopy. These energy sources include monopolar electrosurgery, bipolar electrosurgery (including "advanced bipolar" devices that incorporate tissue feedback monitoring), and various types of laser and ultrasonic technologies. Gynecologists using these tools should be aware of the potential benefits and potential dangers of these instruments. OBJECTIVE: This review provides an overview of the biophysics of these energy sources, their tissue effects, and the complications that may arise. It aims to highlight any potential advantages or disadvantages of various energy sources, as reported by clinical and laboratory studies. EVIDENCE ACQUISITION: Literature relating to energy sources used in gynecologic laparoscopy was reviewed. RESULTS: While laboratory-based studies have reported differences between various energy sources, these differences may not be clinically significant. The choice of instrumentation may depend on the nature of the surgical task being performed, but other factors, such as the surgeon's training/experience, cost, and industry marketing, may also influence the decision. CONCLUSIONS: TAn awareness of the pros and cons of each energy modality and their relative efficacy profiles is paramount. RELEVANCE: It is important that surgeons have an understanding of the biophysics of these technologies in order to understand their limitations and potential dangers and to utilize the most appropriate energy source(s) in the appropriate clinical setting, in order to both minimize the risk of inadvertent injuries during gynecologic laparoscopy and to maximize cost-efficient delivery of health care.
Asunto(s)
Electrocirugia/métodos , Procedimientos Quirúrgicos Ginecológicos/métodos , Laparoscopía/métodos , Animales , Electrocirugia/efectos adversos , Electrocirugia/instrumentación , Femenino , Procedimientos Quirúrgicos Ginecológicos/instrumentación , Humanos , Terapia por Láser , Terapia por Ultrasonido/instrumentaciónRESUMEN
Laparoscopic vessel sealing devices have revolutionized modern laparoscopy. These devices fall into 2 major categories: advanced bipolar and ultrasonic instruments. The range of tissue effects available with these technologies is more limited than with conventional monopolar electrosurgery; however, both advanced bipolar and ultrasonic devices efficiently seal vessels (≤7-mm and ≤5-mm diameter, respectively), and most also have built-in tissue transection capabilities. These technologies have been the subject of a range of comparative studies on their relative advantages and disadvantages, and, to date, neither advanced bipolar or ultrasonic devices has been proven to be superior.
Asunto(s)
Electrocirugia/métodos , Laparoscopía , Procedimientos Quirúrgicos Vasculares/métodos , Electrocirugia/instrumentación , Diseño de Equipo , Humanos , Técnicas de Cierre de Heridas/instrumentaciónRESUMEN
Energy sources incorporating "vessel sealing" capabilities are being increasingly used in gynecologic laparoscopic surgery although conventional monopolar and bipolar electrosurgery remain popular. The preference for one device over another is based on a combination of factors, including the surgeon's subjective experience, availability, and cost. Although comparative clinical studies and meta-analyses of laparoscopic energy sources have reported small but statistically significant differences in volumes of blood loss, the clinical significance of such small volumes is questionable. The overall usefulness of the various energy sources available will depend on a number of factors including vessel burst pressure and seal time, lateral thermal spread, and smoke production. Animal studies and laboratory-based trials are useful in providing a controlled environment to investigate such parameters. At present, there is insufficient evidence to support the use of one energy source over another.
Asunto(s)
Electrocirugia , Procedimientos Quirúrgicos Ginecológicos/métodos , Hemostasis Quirúrgica/métodos , Laparoscopía , Animales , Femenino , HumanosRESUMEN
OBJECTIVES: To assess women's perception of pain and acceptability of low vaginal swab (LVS) and anorectal swab (ARS) for antenatal screening for Group B Streptococcus (GBS), and to compare the detection rate between these tests. METHODS: Separate LVS and ARS were collected at the 36-week antenatal visit, either by the patient herself or by her clinician. Acceptability and pain were evaluated on a Likert scale using a standardised questionnaire. RESULTS: A total of 278 women were recruited, with a median gestation of 36.3 weeks (IQR 36-37). Of these women, 96% undertook specimen self-collection. The overall prevalence of colonisation was 64/278 (23%); 52 women had positive LVS results (18.7%), and an additional 12 (5.5%; 95% CI 2.5-8.5) were negative on LVS but positive on ARS. Most women rated LVS (99%) and ARS (92%) to be either 'pain-free' or causing 'mild discomfort', and found the LVS (90%) and ARS (84%) to be either 'totally acceptable' or 'somewhat acceptable'. CONCLUSIONS: The addition of an ARS resulted in an enhanced GBS positive rate, and most women found the test acceptable.
Asunto(s)
Tamizaje Masivo/psicología , Diagnóstico Prenatal/psicología , Infecciones Estreptocócicas/diagnóstico , Frotis Vaginal/psicología , Femenino , Humanos , Encuestas y CuestionariosRESUMEN
Laparoscopic subtotal/supracervical hysterectomy (LSH) is a surgical option when hysterectomy is indicated. Proponents of LSH suggest possible advantages including reduced recovery time, decreased risk of pelvic organ prolapse, and decreased risk of organ damage, in particular to the urinary tract. Opponents of LSH have suggested that the future risk of cervical malignancy, the possibility of ongoing cyclical bleeding, limited morbidity due to total laparoscopic hysterectomy, and similar clinical outcomes render this approach unnecessary. One study compared LSH with laparoscopically assisted vaginal hysterectomy in a randomized controlled trial that reported psychologic and sexual outcomes; however, no clinical data were published. The present review outlines techniques for subtotal hysterectomy and critically appraises the available evidence for outcomes including operative data, short- and long-term complications, and functional outcomes.