AWARENESS OF PITFALLS DURING TRADITIONAL BIPOLAR ELECTROTHERMY METHOD OF TOTAL LAPAROSCOPIC HYSTERECTOMY.

Objectives: To report our experience on traditional electrothermal coagulation and cutting of uterine pedicles and vessels for total laparoscopic hysterectomy and its pitfalls

Measurements and Main Results: Between June 2001 and December 2004 we performed total laparoscopic hysterectomy in 358 patients for the indications of Fibroid uterus, Adenomyosis, DUB, Ovarian cyst, post-menopausal bleeding and stage I and II endometriosis. We excluded large fibroid and any genital malignancy and stage III – IV endometriosis. . Bipolar electrothermal coagulation and cutting of all uterine pedicles and vessels are used as the primary method of hemostasis. Uterine weight, operating time, blood loss, intra-operative and post-operative complications and hospital stay were recorded. Time required for the completion of operation was 70 to 120 minutes. Blood loss was 30ml – 400 milliliter. Hospital stay was 2 to 3 days. All instruments were reusable. Two patients needed conversion of total laparoscopic hysterectomy to total abdominal hysterectomy. One of them had previous caesarean section and leads to dense bladder adhesions and the second one for stage III endometriosis that had rectal adhesions. Operative complications were incomplete injury to the bladder wall, and inadequate coagulation of uterine vessels leading to difficult hemostasis. One patient has uretero-vault fistula which was corrected by reimplantation of ureter into the bladder after six weeks.

Laparoscopic Management of Atypical Ectopic Pregnancy

Abstract: To analyzes 22 ectopic pregnancies clinically presented as an atypical from for accuracy of diagnosis, operative details and post operative morbidity.

Design: Three year, retrospective analysis.

Setting: Victory Nursing and infertility management centre.

Patients: twenty two hemodynamically stable patients.

Intervention: Laparoscopic Surgery.

Measurement and Main results: Twenty two patients with atypical presentation of ectopic pregnancy were successfully managed Laparoscopically. All patients have dullache or severe pain in lower abdomen or any one iliac fossa. Regular and irregular menstrual pattern were 54.5% and 45.4% respectively ultrasound findings were complex heterogeneous mass without any free fluid 8 cases, definitive gestational sac 6, saclike 8 cases. Urimay ß – HCG was positive in 40.9% and negative was 59%. Pre-operative diagnoses were chronic ectopic pregnancy 11, ruptured corpers Luteum 6 and chocolate cyst 5. Operating diagnosis were chronicectopic pregnancy 14, unruptured tubal pregnancy 5, ovarian ectopic 3. Surgical procedure was salpingostomy, salpingectomy, salpingophrectomy and partial ovarian resection. Average operating time was 30 – 120 minutes. The average post-operative stay was 24 – 48 hours without any complications.

Conclusion: Ectopic pregnancy dose not present always typical form. In suspected cases these guidelines should help the gynaecologist’s decision making for best obstetric outcome and able them to understand diffident possibilities.