The Journal of the American Association of Gynecologic Laparoscopists
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J Am Assoc Gynecol Laparosc · May 1998
Randomized Controlled Trial Clinical TrialPain control after microlaparoscopy.
To evaluate the efficacy of intraperitoneal subdiaphragmatic instillation of 0.5% lidocaine and 0.5% bupivacaine infiltration of cannula sites to control pain after diagnostic microlaparoscopy. ⋯ Postoperative intraperitoneal lidocaine and bupivacaine infiltration of cannula sites offered a detectable benefit to women undergoing diagnostic microlaparoscopy. The effect was temporary, but induced a significant decrease in the postoperative pain for approximately 6 hours.
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J Am Assoc Gynecol Laparosc · May 1998
Comparative Study Clinical TrialLaparoscopic appraisal of the anatomic relationship of the umbilicus to the aortic bifurcation.
To determine the cephalocaudal relationship among the umbilicus, aortic bifurcation, and iliac vessels by direct measurement during laparoscopy. ⋯ The cephalocaudal relationship between the aortic bifurcation and umbilicus varies widely and is not related to body mass index in anesthetized patients. Regardless of body mass index, the aortic bifurcation is more likely to be located caudal to the umbilicus in the Trendelenburg compared with the supine position. Its presumed location can be misleading during Veress needle or primary cannula insertion, and a more reliable guide is necessary for this procedure to avoid major retroperitoneal vascular injury.
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J Am Assoc Gynecol Laparosc · Nov 1997
Comparative Study Clinical TrialPreventing hyponatremic encephalopathy: comparison of serum sodium and osmolality during operative hysteroscopy with 5.0% mannitol and 1.5% glycine distention media.
To determine whether isotonic 5.0% mannitol is superior to 1.5% glycine in preventing development of hyponatremic encephalopathy. ⋯ We found that 5.0% mannitol distention fluid produces greater postoperative dilutional hyponatremia than 1.5% glycine, but hypo-osmolality does not occur with mannitol. Its use should lessen the risk of hyponatremic encephalopathy.
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J Am Assoc Gynecol Laparosc · Aug 1997
Transvaginal ultrasonography and hysteroscopy in the diagnosis of endometrial abnormalities.
To investigate the value of transvaginal ultrasonography, aspiration biopsy, and hysteroscopy combined with curettage or directed biopsy in detecting endometrial pathology in women with abnormal uterine bleeding. ⋯ Transvaginal ultrasound seems to be an excellent initial diagnostic method, with high sensitivity in diagnosing endometrial abnormalities. Its combination with aspiration biopsy seems to be safe in women with a thin endometrium. Hysteroscopy is necessary in postmenopausal women with an endometrium of 4 mm or more, as well as in premenopausal patients with endometrial thickness more than 5 mm (preovulatory phase of the cycle) and in those with suspected polyps or myomas.
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The world literature, including hospital and medicolegal case records, was reviewed to collate cases of venous air embolism resulting from the increasing number of operative hysteroscopies being performed. Seven women undergoing operative hysteroscopy for five different indications had clear-cut evidence of venous air embolism early in the course of the procedure. ⋯ This complication is rare but devastating, resulting from traumatic opening into large uterine sinuses, especially with the patient in the Trendelenburg position, when the heart is below the level of the uterus. Several steps can be taken to try to prevent this problem.