bluuebunny/crossref_metadata_2025 huggingface dataset:
The effect of Calluna vulgaris cover on the performance and intake of ewes grazing hill pastures in northern Spain
Authors: Osoro K. , Oliván M. , Celaya R. , Martínez A.
Published: March 2003

The effect of the proportion of Calluna vulgaris cover on diet composition, intake and performance of sheep grazing hill vegetation communities in northern Spain is examined. A total of 591 non‐lactating Gallega ewes grazed for five consecutive grazing seasons (June to September) on replicated plots of hill pastures (1700 m.a.s.l.) composed principally of Festuca, Agrostis, Nardus and Calluna spp. but with different proportions of Calluna vulgaris cover, either 0·3 (C0·3) or 0·7 (C0·7) of the total area. In 1 year, twenty‐eight ewes suckling single lambs also grazed the plots. The mean stocking density over the 5 years was 8·7 ewes ha–1. On treatment C0·3, daily liveweight gains (33 g d–1) of non‐lactating ewes were significantly (P < 0·001) greater than on treatment C0·7 (12 g d–1). Likewise in lactating ewes the difference in mean daily liveweight change was 40 g d–1 (–5 vs. –45 g d–1 for C0·3 and C0·7 treatments respectively; P < 0·001). Liveweight gains of lambs were only 80–100 g d–1 from June to August and lambs only maintained live weight during August and September. The effect of lactational status on liveweight changes was not significant. Liveweight gains of non‐lactating ewes increased significantly (P < 0·001) from the first to the last year of the experiment on both treatments.

The composition of the diet was significantly affected by treatment (P < 0·001), with a higher proportion of grass species on the C0·3 treatment and a higher digestibility of the diet in the first half of the grazing season (P < 0·001). The proportion of C. vulgaris in the diet was significantly (P < 0·001) higher on the C0·7 treatment and increased significantly (P < 0·001) from July to September on both treatments. There were no significant differences in the composition of the diet selected by lactating and non‐lactating ewes.

The results demonstrate that on hill vegetation communities, in which the grass components (Festuca rubra, Agrostis capillaris, and Nardus stricta) cover at least 0·3 of the area and on which the preferred grass component (Festuca and Agrostis spp.) is maintained at a sward height of at least 2·5 cm, non‐lactating ewes can increase their live weight and body condition, but this increase is influenced by the proportion and quantity of species of grass in the diet, which is affected in turn by the species of grass available and their nutritive quality. However, ewes suckling lambs were not able to maintain their live weight and body condition except when Calluna cover was 0·3 and grass height was more than 3·5 cm.

It is concluded that these indigenous vegetation communities can be used in sheep production systems to complement the use of improved pastures at other times of year. In particular, they can be utilized during the non‐lactating period (summer) to increase body condition before the beginning of the mating period in autumn.
Leaf dynamics of timothy and meadow fescue under Nordic conditions
Authors: Virkajärvi P. , Järvenranta K.
Published: March 2003

Leaf production dynamics of timothy (Phleum pratense L. cv. Tarmo) and meadow fescue (Festuca pratensis Huds. cv. Kalevi) were studied in Finland under field conditions in mixed swards containing timothy, meadow fescue and red clover (Trifolium pratense L. cv. Björn) harvested by cutting. Fifteen randomly selected tillers of both species were marked and leaf number, leaf appearance rate (LAR), leaf elongation rate (LER), leaf senescence rate (LSR) and leaf live span (LLS) were followed through weekly observations. Concurrently another set of fifteen tillers of each species was dissected on each occasion to determine the number of unemerged leaves and development stage of the apex. The first observation period was between 26 April and 22 June and the second between 22 July and 22 September.

The species differed clearly for most of the measured parameters but most differences were dependent on the season. In spring, timothy started growth earlier, had higher LAR (+57%), produced more leaves (+83%) with higher LERgross (+58%), higher LSR (+61%), higher LERnet (+54%) and produced larger tillers (+193% in leaf area) than meadow fescue. In autumn, timothy still had a higher LAR (+80%), produced more leaves (+60%) with higher LERgross (+36%), but had also a higher LSR (+77%) and thus similar LERnet (0%) to meadow fescue. Timothy tillers were only slightly larger than meadow fescue tillers (+20% in leaf area). The consequences of these findings on competition in mixed swards and implications for grazing theories are discussed.
Integrating models of relative abundance of species with the dry‐weight‐rank method for the botanical analysis of forest understorey vegetation
Authors: González‐Estrada E. , Fawcett R. H. , Herrero M.
Published: March 2003

The objective of this work was to determine the applicability of the dry‐weight‐rank (DWR) method for evaluating the botanical composition of forest understorey vegetation. An analysis of plant species abundance was carried out, and instead of ranking the three most abundant species, as is commonly used, up to twelve ranks were scored. Concurrently, four models of relative abundance distribution (RAD) of species were compared for their ability to explain the abundance of species in the study area. The Power‐fraction model resulted in the best goodness‐of‐fit and it was subsequently used to produce the coefficients for the DWR method. Lin's concordance correlation coefficient, the adjusted coefficient of determination, the residual standard deviation and Spearman's rank‐order correlation coefficient indicated a good performance of the DWR method. Biomass data and the Shannon index for diversity were also considered. Further analyses showed that there was a trade‐off between the number of ranks scored and the accuracy of the botanical composition produced by the DWR method. It is concluded that, so long as the RAD model that explains the distribution of plant species is known, the DWR method can be applied to forest understorey vegetation.
Effects of the proportions of high or medium digestibility grass silage and concentrates in the diet of beef cattle on liveweight gain, carcass composition and fatty acid composition of muscle
Authors: Steen R. W. J. , Kilpatrick D. J. , Porter M. G.
Published: March 2003

Abstract An experiment was carried out over 2 years to evaluate the effects of increasing the proportion of cereal‐based concentrates in diets containing high‐digestibility and conventional medium‐digestibility grass silages on the dry‐matter (DM) intake, liveweight gain and carcass composition of beef cattle, and to examine the effects of grazed grass and the ratio of grass silage:concentrates in the diet on the fatty acid composition of selected muscle tissues. Late‐maturing steers (n = 231) were offered diets based on high‐digestibility (HD) (0·743 digestible organic matter (DOM) in DM) or medium‐digestibility (MD) (0·643 DOM in DM) grass silages supplemented with barley/soyabean meal‐based concentrates. The concentrates constituted 0·20, 0·40, 0·60 and 0·80 of total DM of the diets, which were offered ad libitum (AL). The two diets, which contained 0·80 concentrates, were also offered at 0·80 of AL intake. A further group of fourteen animals were given the medium‐digestibility silage only for 5 months and then grazed perennial ryegrass pastures for a further 5 months (silage/pasture treatment). For the diets containing HD silage and 0·20, 0·40, 0·60 and 0·80 concentrate, and 0·80 concentrate at 0·8 of AL intake, the DM intakes were 9·4, 10·2, 10·4, 10·2 and 8·1 (s.e. 0·16) kg d−1, respectively, and daily carcass gains were 0·67, 0·78, 0·77, 0·79 and 0·62 (s.e. 0·029) kg d−1, respectively; for those containing MD silage and 0·20, 0·40, 0·60 and 0·80 concentrate, and 0·80 concentrate at 0·8 of AL, the DM intakes were 8·2, 9·3, 10·1, 10·1 and 8·0 (s.e. 0·16) kg d−1, respectively, and daily carcass gains were 0·38, 0·48, 0·64, 0·77 and 0·56 (s.e. 0·029) kg d−1 respectively. Increasing the proportion of concentrates in silage‐based diets decreased the concentration of omega‐3 (ω‐3) polyunsaturated fatty acids (PUFA) (P < 0·001) and increased the concentration of ω‐6 PUFA (P < 0·001) in muscle. Cattle on the silage/pasture treatment had the highest concentration of ω‐3 PUFA in muscle (51 g kg−1 lipid), this value being over three times that for animals given diets containing MD silage and 0·80 concentrate in the diet. These results demonstrate the potential of HD silage made from perennial ryegrass relative to high concentrate diets. The consumption of pasture‐finished beef could make a significant contribution towards increasing the intake of ω‐3 PUFA in the human diet.
Fertility preservation in women with ovarian malignancy discovered at laparoscopy
Authors: Aharoni  , Levitan  , Condrea  , Zilberman  , Leibovitz
Published: March 2003

Objective

To assess the efficacy of deferred surgery on fertility preservation in women with early ovarian malignancy discovered at laparoscopy.

Methods

Over a 3‐year period, patients who had laparoscopic surgery for ovarian cysts underwent a defined protocol that included preoperative malignancy assessment, non‐spillage laparoscopic technique and frozen‐section histological determination. In a retrospective analysis, four cases of ovarian malignancy were found in reproductive age patients. Their staging laparotomy was deferred until after the final histological results were obtained. The avoidance of extensive surgery and achievement of pregnancy was considered to be a successful outcome.

Results

Deferring the staging laparotomy until after the final histological results informed us of the grading of the tumour and allowed us to avoid hysterectomy or removal of the contralateral ovary in cases of stage I, grade I tumours. Only one patient underwent hysterectomy. Two patients had wedge resection from the contralateral ovary, and one had bilateral ovariectomy. The latter three have already achieved pregnancy, including the patient with bilateral ovariectomy who had a successful IVF treatment with donor ova.

Conclusion

In cases of ovarian malignancy discovered at laparoscopy, deferring the staging laparotomy till after the final histological results may give the opportunity of preserving fertility as well as that of scheduling a gynaecological oncologist for the operation.
Pregnancy following rollerball endometrial ablation
Authors: Opperman  , Browning  , Child  , Laverty  , Fraser
Published: March 2003

Objective

To report a pregnancy occurring after rollerball endometrial ablation, and to review the literature in order to place this uncommon event in a clinical perspective.

Case report

An intrauterine pregnancy proceeded to a successful Caesarean delivery at term in a 43‐year‐old woman who conceived 33 months after a therapeutically effective rollerball endometrial ablation.

World perspective

Some 39 pregnancies following endometrial ablation have now been reported in the literature. Most (n = 27) of the known pregnancies have miscarried or been terminated. There has been one report of an ectopic pregnancy, and 11 pregnancies have proceeded beyond 20 weeks’ gestation. In the latter group the risk of obstetric complications is very high. Many pregnancies appear to have gone unreported.

Conclusion

Complete removal of the endometrium and complete obliteration of the tubal ostia cannot be guaranteed, and thus concurrent tubal interruption or continued contraception need to be considered for women proceeding to endometrial ablation.
Measurement of β‐hCG in cul‐de‐sac fluid vs. serum in the rapid detection of ectopic pregnancy
Authors: Bosteels Jan , Delattin Philippe , Van Boxelaer Jean Pierre , De Bruyn Marcel , Moerman Jan , De Vos Paul , Vermylen Paul
Published: March 2003

Objective

This study was designed to assess the value of measuring the cul‐de‐sac fluid to serum β‐hCG ratio as a rapid test for the detection of ectopic pregnancy.

Main outcome measure

The parameter chosen was the level of the β‐hCG in cul‐de‐sac fluid vs. that in serum (D/S ratio).

Design

This prospective controlled hospital‐based study included 53 patients. The control group was 25 patients, who were being treated with in vitro fertilization. Group A comprised 15 patients who had had an intra‐uterine miscarriage, histologically proven after suction curettage. Group B included 13 patients treated by laparoscopy for a histologically proven ectopic pregnancy. In each group β‐hCG was measured in both serum and cul‐de‐sac fluid and the appropriate D/S ratio was calculated.

Results

In the control group the mean D/S ratio was 0.49 (SEM = 0.03). The mean D/S ratio in group A was 0.78 (SEM = 0.14). In group B the mean D/S ratio was 8.47 (SEM = 2.53). The differences in D/S ratio between the control group and group A were statistically significant (P < 0.05).The differences in D/S ratio between the control group and group B were statistically highly significant (P < 0.00001). Of more interest is the fact that the difference in the D/S ratio between group A and group B was also statistically highly significant (P < 0.0005).

Conclusion

The D/S ratio for β‐hCG can be used as a rapid and reliable biochemical test to distinguish between eutopic and ectopic implantation in the pathological pregnancy.
Broken needle tip in Cooper's ligament: high occurrence rate with the EndostitchTM suturing device
Authors: Brölmann  , Ter Haar  , Scholten
Published: March 2003

Objective

To study the frequency of needle breakage with the EndostitchTM needleholder while performing Burch laparoscopic colposuspension, and its consequences for patient and doctor.

Design

A retrospective observational multicentred study, after selection of the centres by questionnaire.

Setting

Three general hospitals in the Netherlands with resident training facilities and special interest in endoscopic surgery.

Subjects

35 consecutive patients with genuine stress incontinence.

Intervention

Laparoscopic Burch colposuspension using the Endostitch needleholder.

Main outcome measure

Needle complications and postoperative recovery.

Results

In five patients (14%) six needles broke off in the Cooper's ligament. Four needle tips in three patients could not be located despite dissecting the ligament and intensive search, and were ultimately left in the patients. The recovery of all patients with and without needle complications was uneventful.

Conclusions

The Endostitch is designed for intracorporeal suturing and knot tying, but because of its shape it is not suited for suturing Cooper's ligament. Mesh stapling techniques save operating time, but result in foreign (mostly non‐absorbable) material being left in the patient and the stability of the suspension in the longer term is not yet established. At the present time, conventional suturing and knot tying seem to be preferable in laparoscopic suspension procedures, as they lead to more similarity between the laparoscopic method and the ‘open’ approach whose efficacy is well accepted.
Comparison between suction curettage, transvaginal sonography and hysteroscopy for the diagnosis of endometrial polyp
Authors: Maia Hugo , Maltez Amelia , Calmon Luis C. , Marques Dilson , Oliveira Maíta , Coutinho Elsimar
Published: March 2003

Objective

To compare the efficacy of suction curettage, hysteroscopy and transvaginal sonography in the diagnosis of endometrial polyps in both pre‐ and postmenopausal patients.

Setting

The study was carried out in a private hospital with facilities for endoscopic surgery.

Design

Comparative clinical study involving different techniques for the diagnosis of endometrial polyps in pre‐ and postmenopausal patients.

Subjects

74 patients with endometrial polyps.

Interventions

Patients with abnormal transvaginal sonograms were submitted to diagnostic hysteroscopy to confirm the presence of polyps. A suction curettage using a 4‐ or 5‐mm Karman curette was carried out after hysteroscopy to obtain fragments of polyps for pathological examination. Polypectomy followed by endometrial resection was performed using the 27F resectoscope after the uterine cavity was aspirated using an 8‐mm Karman curette.

Results

The percentage of positive histopathological diagnoses of endometrial polyps was low whenever suction curettage was performed with a 4‐mm curette. The value increased to 80% when the 5‐mm curette was used to sample the uterine cavity in patients with a hysteroscopic diagnosis of polyps. The 8‐mm suction curette was effective in removing large fragments of polyps prior to polypectomy in all cases.

Conclusion

Suction curettage can be used to diagnose endometrial polyps in over 80% of patients, if curettes with diameters equal to or greater than 5 mm are used. Use of suction cannulae of less than 4 mm in diameter leads to the diagnosis of endometrial polyps being missed in 90% of cases.
Finding of an unsuspected endometrial stromal sarcoma by hysteroscopic endometrial resection
Authors: Hansen Ulla D. , Lund Claus O.
Published: March 2003

Objective

Case report of unexpected finding of an endometrial stromal sarcoma.

Subject

A 34‐year‐old patient, admitted with irregular menstrual bleeding despite oral contraception.

Interventions

An ultrasonic scan showed an intrauterine fibroma‐like tumour. The finding was confirmed at hysteroscopic endometrial resection. Histological examination of the resected fragments showed low grade stromal sarcoma. Total abdominal hysterectomy was performed.

Conclusions

We draw attention to endometrial stromal sarcomas and stress the importance of histological examination of tissue resected from the endometrium.
Laparoscopic ilioinguinal nerve injury
Authors: Parker Jim , Hayes Chris , Wong Felix , Carter Jonathan
Published: March 2003

Objective

To report a case of laparoscopic ilioinguinal nerve damage due to direct trauma from a secondary trocar placed in the right iliac fossa.

Design

Case report and literature review.

Setting

Tertiary referral hospital in an Australian city.

Conclusion

Patients with ilioinguinal neuralgia present significant diagnostic and management problems. This report highlights the need for gynaecologists to have a knowledge of the anatomical relations of the inguinal nerves in the lower abdominal wall, so that iatrogenic injury can be avoided.
Laparoscopic lymph node dissection
Authors: Mettler Liselotte
Published: March 2003

Objective

Laparoscopic lymph node dissection in the treatment of endometrial, cervical and ovarian cancer, endoscopic axillary dissection in breast cancer and endoscopic inguinal dissection in vulval cancer are surgical techniques that have been developed over the last 10 years. The careful investigation of this endoscopic field in selected cases of gynaecological malignancy was attempted in a combined study. It is the aim of the present paper to assess the endoscopic possibilities of lymphadenectomy while observing the same oncological principles as the laparotomy approach. Endoscopic surgical techniques may give patients a better quality of life within the treatment of their malignant condition.

Design

Clinical retrospective evaluation.

Setting

The study was carried out at the Department of Obstetrics and Gynaecology, University of Kiel, Germany and at the Oncological Centre in Warsaw, Poland.

Subjects

60 patients were treated by endoscopic lymphadenectomy, and 38 of these were treated for endometrial cancer stages I and II according to the FIGO (International Federation of Obstetricians and Gynaecologists) classification.

Interventions

Endoscopic pelvic lymphadenectomies and laparoscopic‐assisted vaginal hysterectomies (LAVH) were performed.

Main outcome measures

Ease of performance of pelvic lymphadenectomies, and number of lymph nodes obtained compared with laparotomy.

Results

An average of 14 nodes per patient was removed. There were no complications.

Conclusions

The surgical approach to patients with endometrial cancer has changed. After laparoscopic surgical staging of endometrial cancer, the combined laparoscopic and vaginal surgical approach to treatment is possible, in properly selected patients by well‐trained surgeons. Lymphadenectomy and LAVH seem to be optimal surgical techniques for the treatment of endometrial cancer.
Case report of ovarian transposition and review of literature
Authors: Hart Roger , Sawyer Elinor , Magos Adam
Published: March 2003

Objective

Pelvic radiotherapy is frequently used to treat pelvic tumours in premenopausal women. As there is a high probability of premature ovarian failure in this situation, ovarian repositioning is often required. This can now be done laparoscopically. We aimed to develop a modified technique that maintained the relationship between the ovaries and the fallopian tubes for potential future conception without the requirement for further surgery.

Setting

A teaching hospital.

Subject

An 18‐year‐old girl with a medulloblastoma who after craniectomy required craniospinal irradiation. To avoid ovarian irradiation she was referred to our unit for ovarian transposition.

Intervention

At the time of laparoscopic surgery the utero‐ovarian ligaments were divided and the ovaries were sutured as a unit to the psoas muscle without distortion of the fallopian tube.

Result

After surgery, X‐ray examination revealed that the lateral displacement of the right ovary was insufficient and consequently the procedure was repeated on this side. The patient's gonadotrophin levels remained in the premenopausal range after surgery.

Conclusion

Ovarian transposition that maintains the relationship between the ovaries and fallopian tubes can be achieved by laparoscopic surgery.
Microlaparoscopy using an optical Veress needle inserted at Palmer's point
Authors: Okeahialam Majella G. , O'Donovan Peter J. , Gupta Janesh K.
Published: March 2003

Objective

To avoid vascular and visceral injury in a patient undergoing laparoscopic adhesiolysis and known to have extensive intra‐abdominal adhesions.

Design

An optical Veress needle was used to establish pneumoperitoneum under direct vision through Palmer's point. Safe sites were identified for the insertion of the secondary trocars.

Result

Satisfactory laparoscopic adhesiolysis was performed without any complications.

Conclusion

Microlaparoscopy using an optical Veress needle inserted through Palmer's point seems to be a safe technique for avoiding laparoscopic injury when extensive adhesions are suspected.
Gross bilateral haematosalpinges presenting 5 years following endometrial resection
Authors: Narayansingh Gordon V. , Parkin David E. , Dillon Philip
Published: March 2003

Objective

To report a case of large bilateral haematosalpinges presenting 5 years following transcervical resection of the endometrium (TCRE).

Methods

The clinical, radiological, biochemical, surgical and histopathological course of a 46‐year‐old woman who presented with a 3‐month history of colicky lower abdominopelvic pain 5 years after TCRE were reviewed.

Results

Clinical and sonographic findings demonstrated an immobile abdominopelvic mass with sigmoid colon compression. The CA125 was 567 U l−1. These features were highly suggestive of ovarian carcinoma. At laparotomy large bilateral haematosalpinges were found. The lower three‐quarters of the uterine cavity was obliterated with marked distension of both cornua superiorly.

Conclusion

The finding of haematosalpinges following TCRE resulted from retrograde cyclical bleeding of the spared cornual endometrium and was considered to be a long‐term complication of this procedure.
Laparoscopic partial bladder resection for bladder endometriosis
Authors: Anaf Vincent , Vaessen Christophe , Zlotta Alexandre , Noël Jean‐Christophe , Simon Jacques , Simon Philippe
Published: March 2003

Objectives

To confirm the feasibility and safety of laparoscopic partial bladder excision.

Setting

Gynaecology department at a university hospital.

Subjects

Two patients with symptomatic bladder endometriosis.

Interventions

Ureteral catheterization, peroperative cystoscopy, laparoscopic adhesiolysis, bladder dissection, partial cystectomy, bladder closure with running sutures and simultaneous treatment of other endometriotic lesions.

Results

The procedures were uncomplicated and, took 120 and 105 min, respectively. Bowel function recovery occurred within 24 h in both cases. The Foley catheters were withdrawn on days 10 and 7. Histological examination showed endometriosis. The patients are free of symptoms at 11 and 6 months of follow up.

Conclusions

This technique is feasible and safe and allows simultaneous treatment of other endometriotic lesions. Peroperative cystoscopy and ureteral catheterization are recommended to precisely define the lesion limits and to avoid trapping the ureters in the suture. In trained hands, this technique may become the treatment of choice for bladder endometriosis. Further evaluation will help to determine which instruments and types of sutures are best suited to laparoscopic bladder surgery.
Current status of management of ectopic pregnancy
Authors: Sau Ashis K. , Auld Barry J. , Sau Mita
Published: March 2003

Objective

To evaluate the relative safety and efficacy of conservative surgical, medical and expectant management.

Design

Relevant studies were identified through a computer Medline search.

Results

Laparoscopy is not mandatory for diagnosis of ectopic pregnancy, which can be diagnosed by the use of transvaginal scan and estimation of quantitative βhCG. Laparoscopic salpingectomy or salpingostomy is preferred to laparotomy in a haemodynamically stable patient and should be used more frequently. The role of expectant management in ectopic pregnancy is very limited. Spontaneous resolution may occur only in a selected group of unruptured ectopic pregnancies with an initial βhCG of <200 mIU/ml and declining hCG level. Systemic methotrexate administration is a promising treatment in patients with early and unruptured ectopic pregnancy. Several prospective studies have shown success rates of 85–94% following single‐dose systemic methotrexate treatment. Single‐dose methotrexate is associated with fewer side‐effects but is as effective as multiple‐dose regimes. Recurrent ectopic pregnancy and intrauterine pregnancy rates following systemic methotrexate are comparable to those following laparoscopic salpingostomy.

Conclusion

Systemic methotrexate is a viable alternative to laparoscopic salpingostomy for women wishing to preserve their fertility. A large prospective randomized trial is needed to establish whether laparoscopic surgery or methotrexate should be the first‐line treatment.
Intraperitoneal bupivacaine vs. tramadol for pain relief following day case laparoscopic surgery
Authors: Darwish Atef M. , Zareh Hassan Zein E. A.
Published: March 2003

Objectives

To record the severity of pain following operative laparoscopic surgery and to assess the effectiveness of either intraperitoneal infusion of bupivacaine or intravenous tramadol for postoperative pain relief.

Design

A prospective randomized study.

Setting

Gynaecologic Endoscopy Unit, Assiut University Hospital, Assiut, Egypt.

Subjects

90 patients undergoing day case laparoscopic surgery where a standard anaesthetic technique was used.

Interventions

Patients were randomly allocated to one of three groups according to the analgesia provided in the postoperative period. Group B received intraperitoneal bupivacaine (20 ml, 0.25%) through the laparoscopic cannula and another 5 ml which was injected around the incision sites. Group T received intravenous tramadol hydrochloride slowly in a dose of 2 mg/kg, after the end of the procedure and group P received placebo saline, 20 ml intraperitoneally and 5 ml at the incision sites, and a placebo saline 2‐ml intravenous injection.

Main outcome measures

Each patient recorded the site of pain, and its severity using a 4‐point verbal rating scale (0 = no pain to 3 = severe pain), at 30, 60, 120 and 240 min postoperatively. We also recorded the maximum pain score, the need for fentanyl and the time to first analgesia in minutes. The suitability for same‐ or next‐day discharge was also assessed in all patients.

Results

The trial showed a statistically significant reduction in pain scores up to 4 h postoperatively in groups T and B compared with group P (P < 0.05). Also, the time to first analgesia was prolonged and there was less need for fentanyl and earlier discharge in groups T and B.

Conclusions

We concluded that both of the analgesic regimens used were satisfactory, but intraperitoneal bupivacaine showed better analgesic outcomes and is a useful contribution to analgesia in the immediate postoperative period after day‐case laparoscopic surgery.
Gynaecological endoscopy training simulators
Authors: Hadzimahmutovic Zorana , Healy David L. , Tsaltas Jim , Lawrence Anthony S. , Brown T. Ian H. , Flanagan Brendan
Published: March 2003

Objective

To introduce the concept of simulator training to gynaecological surgeons and to inform them of the current state of worldwide research into the development of a laparoscopic simulator.

Attributes

Virtual‐reality technology enables the surgeon not only to perform diagnostic procedures, but also to practice entire surgical operations on a mannikin, while observing and interacting with a realistic computer‐generated gynaecological environment on‐screen. The benefits of such simulator training are twofold: surgeons will be at a higher point on the learning curve before their first operation on a patient, and patients should enjoy better quality of care.

Research

Great confidence in the potential of virtual‐reality technology in gynaecology, and medicine in general, has generated considerable international interest. As a result, much research and development effort is going into the creation of a gynaecological endoscopy simulator. Although several laparoscopic simulators are near their completion stage, there are no commercially available systems as yet.

Medical education

A plan for the successful implementation of simulator training in gynaecology, through preceptorship and credentialling programs, is outlined. Use of simulator training in gynaecology, and other medical fields, is expected to become more popular with further advances in technology.
Laparoscopic hysterectomy and assisted Vecchietti procedure to treat congenital cervical and vaginal atresia
Authors: Broome Jonathan D. , Cerqui Anthony J. , Vancaillie Thierry G. , Bennett Michael J.
Published: March 2003

Objective

To report a case of complete cervical and vaginal atresia treated by laparoscopic hysterectomy and assisted Vecchietti procedure.

Subject

An 18‐year‐old woman requesting formation of a neovagina. The initial diagnosis of cervical and vaginal atresia had been made by ultrasound and confirmed by laparoscopy when the patient was aged 15 years.

Results

No intra‐ or postoperative complications were recorded. A neovagina with a depth of 7 cm and width of 1.5 cm was created. Subsequent use of vaginal dilators produced a functional vagina at 6 weeks postoperatively.

Conclusion

The use of laparoscopy to treat Müllerian anomalies, with the benefits of reduced postoperative morbidity and excellent cosmesis, should be supported.
Imaging leiomyomas prior to endoscopic surgery: the role of magnetic resonance imaging
Authors: Dover Richard W. , Powell Martin C.
Published: March 2003

Objective

To determine whether the use of scanning by magnetic resonance imaging (MRI) prior to endoscopic surgery for uterine fibroids gave an improved outcome compared with the use of ultrasound.

Design

A retrospective analysis of the available literature.

Results

The improved imaging afforded by MRI results in a better differentiation of fibroids from focal adenomyomas, and more accurate assessment of the size, number and location of fibroids within the uterus, when compared with the results obtained by ultrasound scanning.

Conclusions

In situations such as infertility where uterine conservation is paramount, the extra information provided by MRI allows better preoperative counselling and planning, and should be considered as an alternative to ultrasound scanning. However, it should not be considered as a first‐line investigation when patients are undergoing hysterectomy or when the diagnosis is thought to be diffuse adenomyosis.
Laparoscopic surgery of endometrial cancer. Preliminary results of a multicentric study
Authors: Holub Zdeněk , Bartos Pavel , Eim Josef
Published: March 2003

Objective

To analyse the results of laparoscopic management of women with endometrial cancer, and comparison with the open technique.

Design

Prospective multicentre study.

Setting

Department of Gynaecology, Hospital for Infants, Kladno, Czech Republic.

Subjects

76 women who underwent laparoscopic surgery and open procedures for endometrial cancer.

Main outcome measures

The differences between both the peri‐ and postoperative outcomes were evaluated.

Results

Two patients whose surgery was completed by laparotomy were excluded from the study. The other 43 laparoscopic procedures were successfully completed. Laparoscopic hysterectomy and pelvic and para‐aortic lymphadenectomies were carried out, based on the grade of the tumour and the depth of myometrial invasion. Of the patients, 19 underwent pelvic lymphadenectomy and 14 women also had para‐aortic lymph node sampling dissection. Five of these patients had positive pelvic or para‐aortic nodes. The mean operating time was 178 min vs. 151 min in the control open group. There were no major complications.

Conclusions

The laparoscopic approach to surgery for early stage endometrial carcinoma is an attractive alternative to the conventional surgical approach. The advantages of laparoscopic surgery are patient related. Because an abdominal incision is avoided, recovery time is reduced. The major obstacle to incorporating operative laparoscopy into gynaecological oncology is the lack of controlled studies demonstrating its ability to improve current management.
Making the case for the radially expanding access system
Authors: Turner Duncan J.
Published: March 2003

Objective

To report data on the case of the radially expanding access device for laparoscopic surgery.

Design

A narrative based on personal and industry‐wide evidence‐based outcome data on abdominal injuries caused by sharp trocars, compared with the safety associated with the radially expanding access system.

Subjects

Patients undergoing laparoscopic gynaecological and general surgical procedures.

Conclusions

Use of the radially expanding access device is associated with far fewer abdominal injuries, reduced pain and a much lower incidence of incisional hernia.
The role of microlaparoscopy for safer wall entry: incidence of umbilical adhesions according to past surgical history
Authors: Audebert Alain J. M.
Published: March 2003

Objective

To determine the incidence of umbilical adhesions related to previous surgical history.

Design

A prospective single‐centre study with a single operator.

Setting

Clinique Saint‐Sernin and Polyclinique de Bordeaux, Bordeaux, France.

Subjects

900 patients undergoing diagnostic or operative laparoscopy, classified into four groups: group I, 419 patients with no previous surgical surgery (control group); group II, 140 patients with previous major operative laparoscopy; group III 145 patients with previous laparotomy with a horizontal suprapubic incision; group IV, 96 patients with a previous laparotomy with a midline incision.

Intervention

Inspection of the umbilical area for the presence of adhesions, with a microlaparoscope passed through a Veress needle at Palmer's point.

Main outcome measures

Incidence and severity of umbilical adhesions and their potential risk in case of blind insertion of the umbilical trocar.

Results

Umbilical adhesions were noticed in 9.77% of the 900 patients. The incidence was different in the four groups: group I, 0.77%; group II, 1.42%; group III, 21.37%; group IV, 53.12%. Severe adhesions, with a potential risk in case of blind insertion of the umbilical trocar, were encountered in 0.38%, 0.71%, 6.89% and 31.25%, respectively, in the patients in the four groups.

Conclusions

Women with previous laparotomy have a higher incidence of umbilical adhesions, especially in the case of midline incisions. Preliminary inspection of the umbilical area with a microlaparoscope and insertion of the umbilical trocar under direct vision are recommended in these high risk patients, in order to reduce complications of trocar insertion.
Laparoscopic conservative excision of a rare asymptomatic 11‐cm ovarian dermoid cyst containing a mandible with seven teeth
Authors: Campo Sebastiano , Marone Maria , Gambadauro Pietro , Garcea Nicola
Published: March 2003

A case is presented of conservative laparoscopic excision of a rare asymptomatic 11‐cm ovarian dermoid cyst which contained a mandible with seven teeth, found in a 22‐year‐old patient. To reduce spillage, the ovary was placed in a 15‐cm diameter endoscopic bag where the cyst was enucleated and then removed from the abdominal cavity. No intraoperative complications occurred. No signs or symptoms of peritonitis were observed. The patient was discharged on the first postoperative day. At 1 year of follow up by means of bimanual gynaecological examination and echography, the patient is well and free of disease.
Bilateral tubal pregnancy and laparoscopic bilateral salpingotomy
Authors: Herrero Rafael J. M. , Zafy Sylvie , Chitrit Yvon
Published: March 2003

Objective To consider whether laparoscopic bilateral salpingotomy can be effective in the management of bilateral simultaneous tubal pregnancy.

Design A case report.

Subject A 24‐year‐old Indian woman, gravida 2 para 1, with pelvic pain at 5 weeks' gestation.

Interventions The patient had conceived with an ovulation induction regimen. Pelvic examination and ultrasonography suggested an ectopic pregnancy. Laparoscopy revealed bilateral simultaneous tubal pregnancy. Conservative treatment through bilateral linear salpingotomy was carried out and pathological investigation confirmed the presence of chorionic villi in both tubes.

Results The postoperative clinical course was uneventful and β‐human chorionic gonadotrophin levels dropped satisfactorily. The patient required no further treatment.

Comment  Correctly performed laparoscopic bilateral salpingotomy can be effective in the management of bilateral simultaneous tubal pregnancy.
Hysteroscopic findings in postmenopausal patients with a thick endometrium after using implants of oestradiol and testosterone
Authors: Maia Hugo , Maltez Amélia , Fahel Paulo , Oliveira Mayta , Coutinho Elsimar M
Published: March 2003

Objective 

To evaluate the endometrial cavity of postmenopausal patients who developed a persistent increase in endometrial thickness, detected by transvaginal sonography, after using implants of oestradiol and testosterone.

Design 

This is a retrospective study.

Results 

23 patients with an endometrial echo >5 mm were evaluated by hysteroscopy. Of these, 18 patients had an endometrial polyp, two had proliferative endometrium and in the remaining three the uterine cavity was atrophic. There were three cases of complex hyperplasia within the polyp, two without atypia and one with moderate nuclear atypia. There was one case of endometrial carcinoma developing in a polypoid lesion.

Conclusion 

Endometrial polyps were the most frequent pathological finding detected in the uterine cavity of menopausal patients who had developed an increase in endometrial thickness after using implants of oestradiol and testosterone. There was one case of endometrial carcinoma in a polyp.
Laparoscopic management of genital prolapse: lateral suspension with two meshes
Authors: Dubuisson Jean‐bernard , Chapron Charles , Fauconnier Arnaud , Babaki‐Fard Katayoun , Dendrinos Spiros
Published: March 2003

Objective

To report our experience with a new laparoscopic technique to treat genital prolapse.

Subjects

Prospective longitudinal case study of 35 women with genital prolapse treated between June 1997 and January 1999.

Intervention

The technique involves the use of two composite meshes, one of which is applied to the upper portion of the anterior wall of the vagina and the other to the upper portion of the posterior vaginal wall and posterior aspect of the cervix if present. The lateral ends of the two meshes are pulled trough a retroperitoneal tunnel and fixed to the aponeurosis of the external oblique muscle above the iliac crest. Depending on the patient's symptoms and clinical findings, ancillary procedures (i.e. urethropexy, repair of the pouch of Douglas) may be necessary.

Results

The average operating time was 254 ± 45 min (range 180–360). The total rate of complications was 20% (seven cases). The mean duration of hospital stay was 4.8 ± 1.2 days (range 3–8). With regard to the anatomical results: the mean postoperative follow up was 5 ± 4.6 months; results were excellent in 80% of cases. The remaining 20% had moderate posterior vaginal wall defect. With regard to the functional results: the mean follow‐up was 10.5 ± 4.6 months; 90.9% of the patients were satisfied; the functional defects were persistent urinary stress incontinence in 6.6% cases, urgency in 6.6% cases, frequency in 6.6% cases, constipation in 9.1% cases; the rate of dyspareunia in patients who were sexually active was 10.3%.

Conclusion

This technique presents the advantage of providing complete treatment for prolapse using laparoscopic surgery without having to approach the promontory or having to carry out extensive reperitonealization.
The effect of operator gender on patient satisfaction: does the ‘Y’ in outpatient hysteroscopy matter?
Authors: Mc Gurgan P. , O'Donovan P. , Jones S. E.
Published: March 2003

Objective 

To evaluate the preconceptions and perceptions of patients having outpatient hysteroscopy, with emphasis on their attitudes towards the gynaecologist's gender.

Design 

A prospective anonymous questionnaire used before and after the procedure. The operators were randomly allocated, and blinded to the results.

Setting 

A district general hospital.

Subjects 

77 women referred to an outpatient hysteroscopy clinic.

Main outcome measures 

How many patients expressed a preference concerning the gender of the hysteroscopist, and whether the hysteroscopist's gender influenced the patient's pain scores or satisfaction.

Results 

Outpatient hysteroscopy was performed on 77 patients (38 by a male surgeon and 39 by a female surgeon).The two groups of patients were similar in age, parity, ethnicity, referral source and premedication use. Of the patients, 15 (39%) allocated to a male and nine (23%), of the patients allocated to a female would have preferred a female hysteroscopist; this was not statistically significant (P = 0.12). No patients expressed a preference for a male. Gender preference had no significant effect on preoperative anxiety (P = 0.58), procedure discomfort (P = 0.76), or satisfaction (P = 0.28). Patients treated by a male were more likely to state that the procedure would have been improved by having a female surgeon (P = 0.05).

Conclusions 

The preference rates for gender are comparable to those of other published studies. Patients treated by operators of different genders do not have any difference in discomfort or satisfaction scores, but women treated by men perceive that the procedure would have been improved if a female hysteroscopist had treated them. For future practice, women should be given a choice of hysteroscopist gender where practical; however, this does not appear to have any effect on discomfort or satisfaction.
Evaluation of ultrasound in an outpatient hysteroscopy clinic: does it alter management in premenopausal women?
Authors: Taylor Sue , Jones Siân , Dixon Anne‐Marie , O'Donovan Peter
Published: March 2003

Objective

To assess the role of ultrasound with respect to management decisions in premenopausal women with abnormal uterine bleeding attending an outpatient hysteroscopy clinic.

Design

Retrospective analysis of ultrasound and hysteroscopic findings, in 264 women referred with abnormal uterine bleeding.

Setting

Outpatient hysteroscopy clinic in a busy district general hospital.

Results

In situations where hysteroscopy findings were normal, additional information gained from a preliminary ultrasound did not affect management decisions. No malignant adnexal pathology was detected, and ultrasound assessment of the endometrium did not correlate well with either hysteroscopic or histological findings.

Conclusion

Ultrasound findings do not alter management decisions in this situation. The presence of irregular bleeding, and patients' prior expectations, are more significant determinants.
The application of hysteroscopy in diagnosis and treatment of missing intra‐uterine devices
Authors: Feng Zuan Chong , Shi Yong Peng , Wu Xue Zhe , Liu Su Ping
Published: March 2003

Objective

To evaluate the efficacy of hysteroscopy for diagnosis and treatment of missing intra‐uterine devices (IUDs).

Design

A retrospective study of 274 patients.

Setting

Shanghai Institute of Planned Parenthood Research, Shanghai Jiading District Gynaecological Endoscopy Centre and Shanghai First Maternity and Infant Health Hospital.

Subjects

274 patients with missing IUDs, who had previously undergone up to four unsuccessful attempts at IUD removal, were included in our study. Among them, 45 patients had been menopausal for more than 1 year.

Interventions

Hysteroscopy was used to detect and/or remove the missing IUDs or their broken pieces in all patients.

Results

In 237 out of 274 patients with missing devices, the IUDs or their broken pieces in the uterine cavity were detected by hysteroscopy. In 236 out of these 237 patients, the IUDs or their broken pieces were removed successfully under hysteroscopic view or after hysteroscopic location. In one case only a small piece of the IUD remained in the uterine wall because of breakage during extraction. The IUDs of the remaining 37 patients were not found in the uterine cavity: in 13 patients there was expulsion of IUDs; in two there were broken pieces embedded in the uterine wall; 14 patients had IUDs removed by laparoscopy, and eight IUDs were removed by laparotomy.

Conclusion

Our study indicates that hysteroscopy, sometimes with an ultrasound B‐scan or laparoscopic guide, is of great value not only for precise locating of the IUD, but also for its removal under direct vision, particularly in the management of patients with broken and/or embedded IUD pieces.
Laparoscopic resection of deeply infiltrating endometriosis of the rectovaginal septum: effect on pelvic pain
Authors: Kwok Adrian , Lam Alan , Ford Robert
Published: March 2003

Objective

To compare pain scores for dysmenorrhoea, intermenstrual pelvic pain, dyspareunia and dyschezia before and after resection of endometriotic nodules from the rectovaginal septum.

Design

Retrospective review of case records in 46 patients who had resection of deeply infiltrating endometriotic nodules from the rectovaginal septum. Adhesiolysis and treatment of endometriomas were performed where necessary. Two patients underwent laparoscopic uterosacral nerve ablation.

Results

The average patient age was 32 years. The presenting symptoms were: severe dysmenorrhoea (70%), pelvic pain (65%), dyspareunia (28%), dyschezia (30%) and infertility (28%). Improvements in pain scores at follow up (mean 8.8 months) were 59%, 87%, 77% and 86%. Only one of the 13 patients with infertility conceived in the follow‐up period.

Conclusion

This retrospective analysis suggests that the laparoscopic resection of rectovaginal endometriosis is effective in improving the different facets of pelvic pain. We believe that the development of a standardized scoring system to assess pain resulting from endometriosis would be helpful, as well as prospective studies to evaluate different treatment modalities.