The Journal of the American Association of Gynecologic Laparoscopists
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J Am Assoc Gynecol Laparosc · Feb 1995
Case ReportsDilutional hyponatremia during hysteroscopic myomectomy with sorbitol-mannitol distention medium.
To determine the frequency of hyponatremic complications during hysteroscopic myoma resections using sorbitol-mannitol distending medium and its relationship to operative time, fluid balance, and myoma size, we reviewed all operative hysteroscopic procedures performed by the Section of Reproductive Endocrinology and Fertility at Yale-New Haven Hospital over a 1-year period during which that medium was used. Twenty-six cases were identified of which seven involved hysteroscopic myoma resections. Hyponatremia occurred in four of the seven patients, and in one it was associated with severe posttransurethral prostatic resection (post-TURP) syndrome. ⋯ No relationship was found between the degree of hyponatremia and operating time, estimated submucosal volume, and uterine volume. We conclude that dilutional hyponatremia and the post-TURP syndrome may occur with the use of sorbitol-mannitol distension medium during hysteroscopy. They occur more frequently during operative hysteroscopy to resect myomata, with myoma size and myoma volume expressed as a percentage of uterine volume possibly influencing the degree of hyponatremia.
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J Am Assoc Gynecol Laparosc · Nov 1994
Randomized Controlled Trial Comparative Study Clinical TrialThe effect of nitrous oxide and carbon dioxide pneumoperitoneum on operative and postoperative pain during laparoscopic sterilization under local anesthesia.
To compare carbon dioxide and nitrous oxide pneumoperitoneum with respect to intraoperative and postoperative pain during laparoscopic sterilization under local anesthesia. ⋯ There is no difference in intraoperative and postoperative pain between nitrous oxide and carbon dioxide pneumoperitoneum for laparoscopic sterilization when used in conjunction with a protocol such as ours.
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J Am Assoc Gynecol Laparosc · Nov 1994
Serum bupivacaine levels during laparoscopic sterilization using local anesthesia.
To determine the serum levels of bupivacaine during laparoscopic sterilization when bupivacaine 0.5% without epinephrine is used as the sole local anesthetic agent. ⋯ Serum bupivacaine levels during sterilization using bupivacaine 0.5% without epinephrine for local anesthesia are well below the threshold for serious toxicity.
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J Am Assoc Gynecol Laparosc · Aug 1994
Gasless Laparoscopic Assisted Hysterectomy with Epidural Anesthesia
Gasless laparoscopy is an evolving technique which can offer significant advantages to both patient and surgeon. A variety of major laparoscopic operations can be performed with gasless surgery including oophorectomy, myomectomy, and hysterectomy. The use of conventional instrumentation and open ports significantly improves the ease of surgery and greatly facilitates techniques such as endosuturing. ⋯ The surgery was completed without complication, and the patient expressed a high degree of satisfaction. Subsequently, three additional patients have successfully undergone major laparoscopic operations using a gasless technique and epidural anesthesia. With careful patient selection and attention to proper technique, gasless laparoscopy under regional anesthesia is a safe and viable alternative to conventional CO2 laparoscopy.
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J Am Assoc Gynecol Laparosc · May 1994
Control of intrauterine fluid pressure during operative hysteroscopy.
To evaluate the safety of a commonly used piston pump that controls the infusion pressure of low-viscosity fluids in a continuous-flow hysteroscopic system during operative hysteroscopy. ⋯ This controlled mechanical pump system with exact intrauterine pressure measurement reduced many technical difficulties associated with low-viscosity media, and created a safe environment for the media's use in operative hysteroscopy.