http://www.gynecendoscopy.org/currentissue.asp Table of Contents:J Gynec Endosc Surg 2009 - 1(1) Pai Hrishikesh Editorial Journal of Gynecological Endoscopy and Surgery 2009 1(1):1-10974-1216 Pai Hrishikesh

Journal of Gynecological Endoscopy and Surgery 2009 1(1):1-1

]]> http://www.gynecendoscopy.org/article.asp?issn=0974-1216;year=2009;volume=1;issue=1;spage=1;epage=1;aulast=Pai Trivedi Prakash Editorial Journal of Gynecological Endoscopy and Surgery 2009 1(1):3-30974-1216 Trivedi Prakash

Journal of Gynecological Endoscopy and Surgery 2009 1(1):3-3

]]> http://www.gynecendoscopy.org/article.asp?issn=0974-1216;year=2009;volume=1;issue=1;spage=3;epage=3;aulast=Trivedi Krishnakumar S, Tambe P Review Article Journal of Gynecological Endoscopy and Surgery 2009 1(1):4-110974-1216 Krishnakumar S, Tambe P

Journal of Gynecological Endoscopy and Surgery 2009 1(1):4-11

Objective: To review the complications associated with laparoscopic surgery and provide clinical direction regarding the best practice based on the best available evidence. Options: The laparoscopic entry techniques and technologies reviewed include the classic pneumoperitoneum (Veress/trocar), the open (Hasson), the direct trocar insertion, the use of disposable shielded trocars, radially expanding trocars and visual entry systems. Evidence: Medline, Pubmed and Cochrane Databases were searched for English language articles published before December 2008. Conclusions: It is an evidence based fact that minimal access surgery is superior to conventional open surgery since this is beneficial to the women, community and the healthcare system.Over the past 50 years, many techniques, technologies and guidelines have been introduced to eliminate the risks associated with laparoscopic entry. No single technique or instrument has been proved to eliminate laparoscopic entry associated injury. Proper evaluation of the women, supported by surgical skills and good knowledge of the technology and instrumentation is the keystone to safe access and prevention of complications during laparoscopic surgery.]]> http://www.gynecendoscopy.org/article.asp?issn=0974-1216;year=2009;volume=1;issue=1;spage=4;epage=11;aulast=Krishnakumar Parihar Mandakini, Mirge Aparna, Hasabe Reshma Review Article Journal of Gynecological Endoscopy and Surgery 2009 1(1):12-160974-1216 Parihar Mandakini, Mirge Aparna, Hasabe Reshma

Journal of Gynecological Endoscopy and Surgery 2009 1(1):12-16

The first IVF baby, Louise Brown, was born in a natural cycle IVF of a woman who had bilateral tubal block making IVF the only option for having a child. The last 3 decades has seen astounding progress in the field of ART. Today thanks to ART, tubal disease and tubal factor infertility is easily overcome. The accepted theory today is that the hydrosalpinx fluid plays a causative role in the reduced pregnancy rate with ART. It is well known that the success of ART for patients with tubal disease with hydrosalpinx is reduced by half compared with patients without hydrosalpinx. Ideal would be removal of a hydrosalpinx by laparoscopic salpingectomy to improve pregnancy rates. However in some cases this is not feasible due to dense pelvic adhesions making access difficult. In such cases it is recommended that even de-linking the tube from the uterus would help in improving the ART outcome. There is suggestion that sonographically visible hydrosalpinges and those affected bilaterally have a poorer prognosis than those seen incidentally at laparoscopy. While there is clinical evidence supporting the causative role of the fluid itself, there is a lack of knowledge as to how the fluid exerts its negative effects. It is generally believed that the fluid holds a key position in impairing implantation potential. The aim of this review is to highlight the importance of identifying hydrosalpinges and its association with reduced fertility outcome using assisted reproductive technologies. Here we have discussed the different options available for the same, and highlighted the current modes of treatment.]]> http://www.gynecendoscopy.org/article.asp?issn=0974-1216;year=2009;volume=1;issue=1;spage=12;epage=16;aulast=Parihar Pai Hrishikesh D, Kundnani Manisha T, Palshetkar Nandita P, Pai Rishma D, Saxena Nidhi Original Article Journal of Gynecological Endoscopy and Surgery 2009 1(1):17-200974-1216 Pai Hrishikesh D, Kundnani Manisha T, Palshetkar Nandita P, Pai Rishma D, Saxena Nidhi

Journal of Gynecological Endoscopy and Surgery 2009 1(1):17-20

Background: There is enough evidence in the literature to support that removal of septum improves pregnancy rates in women with bad obstetric history. However, its role in patients with otherwise unexplained infertility is still not clear due to paucity of enough evidence. Objective: To assess reproductive performance in women with septate uterus and otherwise unexplained infertility after hysteroscopic metroplasty. Materials and Methods: 72 women with septate uterus and otherwise unexplained primary infertility were included in the study. All these women underwent hysteroscopic septal resection. Reproductive performance of these women within one year of surgery was studied and analysed. Result: 33 women (45.83%) conceived within one year of surgery. Only 4 women (12%) had spontaneous abortions and only 5 (15%) had preterm delivery. Conclusion: Hysteroscopic metroplasty in women with septate uterus significantly improves the reproductive performance.]]> http://www.gynecendoscopy.org/article.asp?issn=0974-1216;year=2009;volume=1;issue=1;spage=17;epage=20;aulast=Pai Tandulwadkar Sunita, Shah Amit, Agarwal Bhavana Original Article Journal of Gynecological Endoscopy and Surgery 2009 1(1):21-260974-1216 Tandulwadkar Sunita, Shah Amit, Agarwal Bhavana

Journal of Gynecological Endoscopy and Surgery 2009 1(1):21-26

Objective: 1) To determine if detorsion of the twisted adnexa is better than traditional adnexectomy to conserve the adnexa and preserve its function. 2) To determine the feasibility of detorsion in conservation of adnexa. Design: Prospective Study from September 2004 to September 2008 . Setting: Private IVF and Endoscopy Centre. Patients: 22 patients with twisted adnexa (15 non-pregnant and 7 pregnant) . Intervention: Surgical intervention and either detorsion of adnexa or adnexectomy . Main Outcome Measures: Ovarian preservation and conservation of ovarian function in 77.2% cases determined by: a) Follicular development on sonography (performed for one year after adnexectomy). b) Subsequent surgery for unrelated cause showing healthy ovaries. c) controlled ovarian hyperstimulation and successful oocyte retrieval subsequently. Results: We could conserve the adenexa in 77.2% cases. Laparoscopic detorsion was performed in 11/15(73.33 %) of non-pregnant women and adnexectomy done in four women 26.66%. Among the seven pregnant women, adnexa could be preserved in 6/7(85.7%) and only one woman required adnexectomy. Laparotomy was required in 2/22(9%) women both of which were in late second trimester of pregnancy. In one case (4.54%) we had recurrence of torsion. 88.23% of the women with conserved adnexa showed preservation of ovarian function. Conclusion: Our study showed that timely diagnosis and intervention could make the difference between ovarian loss and salvage- an outcome of great importance in population of reproductive age females. Laparoscopy with its many benefits proves to be superior to laparotomy.]]> http://www.gynecendoscopy.org/article.asp?issn=0974-1216;year=2009;volume=1;issue=1;spage=21;epage=26;aulast=Tandulwadkar Palshetkar Nandita, Pai Hrishikesh, Pisat Suchita Original Article Journal of Gynecological Endoscopy and Surgery 2009 1(1):27-300974-1216 Palshetkar Nandita, Pai Hrishikesh, Pisat Suchita

Journal of Gynecological Endoscopy and Surgery 2009 1(1):27-30

Background: There have been numerous advances in the area of assisted reproduction. Among the various reasons of implantation failure, intrauterine lesions play an important role. Objective: The aim of the present study is to evaluate the role of hysteroscopy prior to any assisted reproductive technique. Materials and Methods: It is a retrospective study of 292 women who attended our infertility clinic over a period of 18 months, who had a variable number of failed IVF cycles previously. Results: Out of the 292 women studied, in 74 women, that is 25%, intrauterine pathology was detected, which when rectified by hysteroscopy, gave a considerable increase in pregnancy rate. Conclusion: According to this study it can be concluded that evaluating the uterine cavity is an important step before any assisted reproductive procedures.]]> http://www.gynecendoscopy.org/article.asp?issn=0974-1216;year=2009;volume=1;issue=1;spage=27;epage=30;aulast=Palshetkar Pai Rishma Dhillon Original Article Journal of Gynecological Endoscopy and Surgery 2009 1(1):31-330974-1216 Pai Rishma Dhillon

Journal of Gynecological Endoscopy and Surgery 2009 1(1):31-33

Introduction: Dysfunctional uterine bleeding (DUB) affects a large number of women in the reproductive and perimenopausal age group. It significantly impairs the quality of life in otherwise healthy women. There are many different techniques for the conservative management of DUB. Medical management, LNG-IUD, hysteroscopic resection and various global ablation techniques. Materials and Methods: We did a retrospective analysis of 156 women with dysfunctional uterine bleeding who had completed childbearing and who underwent uterine balloon ablation therapy using the Thermachoice device. Majority of the women (72%) were done using short general anesthesia while in the others sedation or local anesthesia was used. Results: 49% women had amenorrhea while 41 % had oligomenorhoea or eumenorrhoea. 90% were satisfied with the procedure. There were no major complications during this study. Conclusions: Thermal balloon endometrial ablation is a simple, safe and effective technique for the permanent treatment of DUB in well selected cases.]]> http://www.gynecendoscopy.org/article.asp?issn=0974-1216;year=2009;volume=1;issue=1;spage=31;epage=33;aulast=Pai Sinha Rakesh, Sundaram Meenakshi, Lakhotia Smita, Mahajan Chaitali, Manaktala Gayatri, Shah Parul Original Article Journal of Gynecological Endoscopy and Surgery 2009 1(1):34-390974-1216 Sinha Rakesh, Sundaram Meenakshi, Lakhotia Smita, Mahajan Chaitali, Manaktala Gayatri, Shah Parul

Journal of Gynecological Endoscopy and Surgery 2009 1(1):34-39

Aim: In this review, we assessed the feasibility of total laparoscopic hysterectomy (TLH) in cases of very large uteri weighing more than 500 grams. We have analyzed whether it is possible for an experienced laparoscopic surgeon to perform efficient total laparoscopic hysterectomy for large myomatous uteri regardless of the size, number and location of the myomas. Design: Retrospective review (Canadian Task Force Classification II-1) Setting: Dedicated high volume Gynecological laparoscopy centre. Patients: 173 women with symptomatic myomas who underwent total laparoscopic hysterectomy at our center. There were no exclusion criteria based on the size number or location of myomas. Intervention: Total laparoscopic hysterectomy and modifications of performing the surgery by ligating the uterine arteries prior, myomectomy followed by hysterectomy, direct morcellation after uterine artery ligation. Results: 72% of patients had previous normal vaginal delivery and 28% had previous cesarean section. Average clinical size of the uterus was 18 weeks (10, 32). The average weight of the specimen was 700 grams (500, 2240). The average duration of surgery was 107 min (40, 300) and the average blood loss was 228 ml (10, 3200). Conclusion: Total laparoscopic hysterectomy is a technically feasible procedure. It can be performed by experienced surgeons for large uteri regardless of the size, number or location of the myomas.]]> http://www.gynecendoscopy.org/article.asp?issn=0974-1216;year=2009;volume=1;issue=1;spage=34;epage=39;aulast=Sinha Singhi Aditi Original Article Journal of Gynecological Endoscopy and Surgery 2009 1(1):40-460974-1216 Singhi Aditi

Journal of Gynecological Endoscopy and Surgery 2009 1(1):40-46

Study Objectives: (a) To find out the actual incidence of complications during endoscopic surgeries. (b) Comparison of complication rate between an experienced laparoscopic surgeon (> 10 years of experience in endoscopic surgery) and a clinical assistant (> 3 years of experience in endoscopic surgery). (c) How to manage complications in endoscopic surgery. (d) Concrete suggestions to reduce the complication rate. Design: Retrospective study (Canadian Task Force classification ii-2). Setting: Tertiary gynecologic endoscopic unit. Patients: A total of 3204 cases of gynecologic endoscopic surgery out of which 2001 were laparoscopic and 1203 were hysteroscopic surgeries. Interventions: Laparoscopic and hysteroscopic gynecologic surgeries in indicated cases. Measurements and Main Results: The study was carried out between April 2003 and October 2007 at a referral center for endoscopic surgery. A total of 3204 cases of gynecologic endoscopic surgery were studied. There were five significant complications in laparoscopic surgeries and four significant complications in hysteroscopic surgeries seen in four years and six months. All the complications could be managed with no mortality. Conversion to laparotomy was needed in eight cases of laparoscopic surgeries and none in hysteroscopic surgeries. Conclusion: The risk of complication reduces with the experience in endoscopic surgery. However, the proper grooming of a novice in experienced hands, for a sufficient period of time, can minimize the complication rate in the initial learning phase. The complication may be utilized as a stepping-stone to overcome any given situation without panic, but with adequate safety.]]> http://www.gynecendoscopy.org/article.asp?issn=0974-1216;year=2009;volume=1;issue=1;spage=40;epage=46;aulast=Singhi Trivedi Prakash, Abreo Mohini Original Article Journal of Gynecological Endoscopy and Surgery 2009 1(1):47-560974-1216 Trivedi Prakash, Abreo Mohini

Journal of Gynecological Endoscopy and Surgery 2009 1(1):47-56

Introduction: Fibroids are very common tumors affecting women for centuries, however surprising that no significant data is still available as to what could be the cause of fibroid? What could be the predisposing or risk factors? Does it has any impact on fertility? Outcomes of Laparoscopic myomectomy in infertility? Setting: Advanced Tertiary Gynecologic endoscopic unit. Aims and Objectives: 1) What are the predisposing factors to develop fibroids? 2) Do fibroids lead to infertility? 3) What are the indications for removal of fibroids in infertility? 4) Is laparoscopic surgery better than open surgery? 5) Is the risk of rupture uterus more after laparoscopic myomectomy? 6) What is the success in terms of pregnancy rate after myomectomy? 7) What are the chances of abortions with or without myomectomy? Materials and Methods: A retrospective research study was carried out on 2540 women at the National Institute of Laser and Endoscopic Surgery and Aakar IVF Centre, Mumbai, a referral centre in India. This study was done over a period of 14 years. Women varied in age from 23 to 51 years and infertility of at least more than three years. The woman had fibroids from one to seventeen in number and two centimeters to eighteen centimeters in size which were either submucous, intramural, serosal, cervical or broad ligament. The women requiring hysteroscopic myoma resection were excluded in this study and Laparoscopic myomectomy done in woman other than infertility are also excluded from the study. Results: During the course of our study we found that the diet, weight, hypertension, habits had a bearing on incidence of fibroid. In one of the most promising research fact we found that fibroids itself produce prolactin and due to three times high level of aromatase had higher level of estradiol locally compared to normal myometrium. This was detrimental to fertility. A mild elevation of blood levels of prolactin usually in the range of 40 - 60 ng/ml was noticed in nearly 42% of the cases. Fibroids with infertility as a major complaint along with excessive vaginal bleeding in 33%, pain abdomen and dysmenorhea 10%, pressure symptoms in 3%, accidental finding of a large mass in 5% were the major indications for laparoscopic myomectomy. The pregnancy rate after removal of fibroids with active fertility treatment was 42 % and in donor oocyte IVF was 50%, abortion rate was 5%, 64% LSCS, 31% vaginal deliveries. There was no scar rupture in all pregnancies post laparoscopic myomectomy. Conclusion: Presence of fibroids in first degree female relative, predominantly red meat eating women, excess weight and high Blood pressure increased incidence of fibroids. Pregnancies & oral contraceptives decreased chances of fibroids. In infertile patient fibroids of significant size, multiple, had high local prolactin & aromatase level affecting fertility. Laparoscopic removal of fibroids increased pregnancy rate to 37.2% & 50% in donor oocyte IVF.]]> http://www.gynecendoscopy.org/article.asp?issn=0974-1216;year=2009;volume=1;issue=1;spage=47;epage=56;aulast=Trivedi Sabharwal Malvika Case Report Journal of Gynecological Endoscopy and Surgery 2009 1(1):57-580974-1216 Sabharwal Malvika

Journal of Gynecological Endoscopy and Surgery 2009 1(1):57-58

Large bowel injuries are unfortunate complications of laparoscopic surgery, with an incidence of 0.62 to 1.6 per 1000 laparoscopies. One-third of these injuries can be diagnosed intraoperatively, with the rest going unnoticed and revealed later. Rectal injury, a very rare complication, may be caused during pelvic dissection of dense adhesions. Injury at the rectosigmoid junction due to traction with a rectal probe is extremely rare and highly underreported. We report a case of rectal injury during total laparoscopic hysterectomy in a case with dense pelvic adhesions.]]> http://www.gynecendoscopy.org/article.asp?issn=0974-1216;year=2009;volume=1;issue=1;spage=57;epage=58;aulast=Sabharwal Wahi Meenu, Trivedi Prakash Case Report Journal of Gynecological Endoscopy and Surgery 2009 1(1):59-620974-1216 Wahi Meenu, Trivedi Prakash

Journal of Gynecological Endoscopy and Surgery 2009 1(1):59-62

An unmarried girl with severe dysmenorrhea had laparotomy for bilateral endometriomas, later treated with danazol and GnRHa Depo injection for more than three years. On laparoscopy she had a large, noncommunicating, functioning rudimentary horn with ipsilateral renal agenesis. Laparoscopic excision of the rudimentary horn gave major relief from the suspected endometrioma, which was not the cause of her severe pain.]]> http://www.gynecendoscopy.org/article.asp?issn=0974-1216;year=2009;volume=1;issue=1;spage=59;epage=62;aulast=Wahi