Endometriosis Abstracts
Dysmenorrhea is Related to the Number of Implants in Endometriosis Patients, Maria Menna Perper, PhD, Ceana H. Nezhat, MD, Farr Nezhat, MD, Camran Nezhat, MD, Harris Goldstein, MD, D.Med.Sc.; Fertility and Sterility, 1995;63:500-3
To determine whether the symptoms of endometriosis were related to the number and/or location of endometrial implants and the number and/or location of adhesions. Prospective, double-blind study. Seventy consecutive female surgical patients undergoing diagnostic and operative laparoscopy for pain, infertility, or both. Patients completed a self-administered questionnaire one day before laparoscopy. The number, type, and location of endometrial implants and the number, type and location of adhesions were evaluated during laparoscopy. These were compared with the type and severity of endometriosis symptoms as reported by patients. The total number of ectopic endometrial implants was associated directly with the intensity of dysmenorhea experienced by patients in the 60 days before operative laparoscopy (n=47). Patients with low pain scores had significantly fewer implants than patients with high pain scores. The intensity of menstrual pain is related to the number of endometrial implants in patients with endometriosis.
Videolaseroscopy for the Treatment Endometriosis Associated with Infertility, Camran Nezhat, MD, Scott Crowgey, MD, Farr Nezhat, MD; Fertility and Sterility, 51:237, 1989
Recent advances in laparoscopic surgery have enabled the gynecologic surgeon to treat an increased number of diseases of the reproductive organs by using the laser through the laparoscope. This article reviews the results or 243 patients with infertility associated with endometriosis ranging in severity from mild to extensive who were treated by the same surgeon using CO2 laser laparoscopically with videocamera augmentation and control. Of the 243 infertility patients, 168 (69.1%) achieved pregnancy. The pregnancy rates were 71.8% in 39 patients with stage I disease, 69.8% in 86 patients with stage II disease, 67.2% of 67 patients with stage III disease, and 68.6% in 51 patients with stage IV disease. The life table and two-parameter exponential model were used to calculate monthly fecundity, "cure" and "probability of pregnancy" rates. The results indicate that videolaserscopic treatment of endometriosis associated with infertility, in surgically experienced hands, is at least as efficacious as other forms of therapy for mild and moderate cases of disease, but appears to be more successful than laparotomy for the more severe and extensive stages of disease.
Videolaparoscopy and Videolaseroscopy: Alternatives to Surgery? Caran Nezhat, MD, Wendy K. Winerer, RN, Farr Nezhat, MD, Ceana Nezhat, MD; The Female Patient, Vol 13, 9/88
According to the authors, it has become possible for the gynecologic surgeon to treat an increasing number of reproductive organ diseases with laser and operative laparoscopy. Now, with the addition of a videocamera and videomonitor to the laser laparoscope, the physician can offer some patients an alternative to laparotomy. The following is a detailed report of one center’s experience with this new technology.
Urinary Tract Endometriosis Treated by Laparoscopy, Camran Nezhat, MD, Fariba Nasserbakht, MD, Farr Nezhat, MD, Maurizio Rosati, MD, Ceana H. Nezhat, MD, Daniel S. Seidman, MD; Fertility & Sterility, Vol 66, No 6 - 12/96
The surgical treatment of endometriosis has improved the results because of the introduction of new laparoscopic techniques. Involvement of the urinary tract with endometriosis is relatively uncommon, but it can be clinically significant. Endometriosis can involve the bladder or completely obstruct the ureter, resulting in the loss of kidney function. This report summarizes the laparoscopic management of 28 women who had severe endometriosis of the urinary bladder or ureter.
Surgical Treatment of Endometriosis Via Laser Laparoscopy, Camran Nezhat, MD, Scott R. Crowgey, MD, Charles P. Garrison, MD; Fertility & Sterility, Vol. 45, No. 6, 6/86
The carbon dioxide laser has been used laparoscopically for the removal of endometriotic implants, excision of endometrioma capsules, and lysis of adnexal adhesion in 102 patients. These patients were followed for a period ranging from 12 to 18 months, during which time there were 62 pregnancies including 9 spontaneous abortions and 1 elective termination. The rates of conception after surgery were as follows: 75% for patients with mild endometriosis, 62% for patients with moderate endometriosis, 42.1% for patients with severe endometriosis, and 50% for patients with extensive endometriosis. Of 102 patients presenting with infertility attributed to endometriosis, 60.7% conceived within 24 months after laser laparoscopy. In this patient group, no immediate or subsequent laparotomy was required before conception was achieved, nor was hormonal therapy enacted during the study period after surgery.
Surgery for Endometriosis, Camran Nezhat, MD, Sheryl Silfen, MD, Farr Nezhat, MD, & Dan Martin, MD; Obstetrics & Gynecology, 1991, 3:385-393
Advanced operative laparoscopy in general, and videolaseroscopy using CO2 laser via operative channel of the laparoscope and video, specifically, has revolutionized the management of endometriosis. Adhesion formation is reduced and subsequent fertility rates exceed those obtained with laparotomy. The most complicated cases of endometriosis, including involvement of the rectovaginal septum, gastrointestine, and urinary tract, can now be treated endoscopically by an experienced operative laparoscopist.
A Simplified Method of Laparoscopic Presacral Neurectomy for the Treatment of Central Pelvic Pain Due to Endometriosis, Camran Nezhat, MD, Farr Nezhat, MD; British Journal of Obstetrics & Gynaecology, 8/92, Vol 99, pp 659-63
To describe optimal procedures and preliminary results for videolaparoscopic presacral neurectomy as part of the surgical treatment of endometriosis associated with intractable dysmenorrhoea. Observational study with follow up for at least one year. Eighty five women (18-45 years) with endometriosis and intractable pain, referred because medical and surgical management had failed. Subjects without a central (midline) component to their discomfort were excluded. Excision and vaporization of endometriotic pathology was followed by presacral neurectomy. During surgery, severity of endometriosis was assessed using revised American Fertility Society scoring. Overall pelvic pain and dysmenorrhoea relief were determined by office visit, telephone interview and questionnaire at a minimum of one year postoperatively. There were no operative complications and all women left hospital within 24 h of surgery. Overall pain relief was reported by 49 (94%) of 52 patients followed. The other three subjects noted no pain abatement. Dysmenorrhoea was reduced in 48 (92%) whereas four (8%) women claimed no relief. Laparoscopic presacral neurectomy is an option for treating dysmenorrhoea and pelvic pain in selected women, but is indicated only if medical management has failed. Videolaparoscopic presacral neurectomy using the CO2 laser is safe in trained hands. Pain relief achieved is within the range reported for laparotomy.
Severe Endometriosis and Operative Laparoscopy, Camran Nezhat, MD, Farr Nezhat, MD, Ceana Nezhat, MD, & Daniel S. Seidman, MD; Current Opinion in Obstetrics in Gynecology, 1995, 7:299-306
Laparoscopic surgery offers the most effective form of treatment for women with sever endometriosis. The development of advanced laparoscopic techniques allows complete removal of deeply infiltrating lesions. Implants can be laparoscopically dissected from all anatomical locations, including severe involvement of the ureter, bladder and colon. When the endometriosis penetrates through the entire depth of the organ wall, complete resection and reanastomosis of the ureter or bowel can be safely performed laparoscopically by the experienced surgeon. However, optimal laparoscopic treatment requires not only surgical skill, but also comprehensive knowledge of pelvic anatomy and a good understanding of endometriosis and its progression.
Safe Laser Endoscopic Excision or Vaporization of Peritoneal Endometriosis, Camran Nezhat, MD, Farr R. Nezhat, MD; Fertility & Sterility, Vol. 52, No. 1, 7/89
Operative laparoscopy is being used with increasing frequency in the treatment of endometriosis. This technique requires skill and practice, and a formidable understanding of the nature of the disease. The risks of injuring sensitive areas such as bowel, ureter, bladder, and major blood vessels are great; therefore, these sites are often excluded from surgical intervention. This is detrimental to the patient, as endometriosis should be treated thoroughly wherever it is encountered if possible. We have used a technique that we believe makes treatment with the carbon dioxide laser in these high risk areas more safe. This technique, which we call hydrodissection, is successful because the CO2 laser beam does not penetrate fluid. Thus, treatment can be confined to the endometrial lesion, leaving adjacent normal tissue unharmed. By creating a bed of water beneath the peritoneum (or serosa of the bowel), the risk of laser beam penetration to underlying tissue is reduced.
Laparoscopically Assisted Anterior Rectal Wall Resection and Reanastomosis for Deeply Infiltrating Endometriosis, Camran Nezhat, MD, Earl Pennington, MD, Farr Nezhat, MD, Sheryl L. Silfen, MD; Surgical Laparoscopy & Endoscopy, vol. 1, No. 2, pp. 106-108
A 28-year-old woman, presented with a history of long-standing, severe pelvic and bowel endometriosis. Pronounced cul-de-sac tenderness and nodularity were noted on pelvic examination. Videolaseroscopy was undertaken, the rectum was mobilized, and the tumor was prolapsed to the level of the anus. Anterior rectal wall resection and reanastomosis were performed; the colon was returned to the pelvis under direct visualization via laparoscope.
Laparoscopic Vaporization of Diaphragmatic Endometriosis in a Woman with Epigastric Pain: A Case Report, Rakesh Mangal, MD, Omur Taskin, MD, Camran Nezhat, MD, & Robert Franklin, MD; J Reprod Med 1996, 41:64-66
Endometriosis has been observed in 8-15% of reproductive age women and is commonly found in pelvic and nonpelvic organs. Despite its widespread prevalence, the etiology remains obscure. A 22-year-old woman with intractable epigastric and pelvic pain who was treated previously by laser ablation for pelvic and diaphragmatic endometriosis was referred to our clinic. The patient received leuprolide acetate for six months, but the symptoms did not improve. Second-look laparoscopy revealed deep endometriotic spots involving both the diaphragms, exactly in the line of the left ventricle. With visualization, endometriosis was excised in total with the help of hydrodissection an CO2 vaporization. As in pelvic endometriosis, therapy for extrapelvic endometriosis consists of surgical and hormonal manipulation following the diagnosis. The importance of extreme caution, meticulous surgery and cardiothoracic consultation when treating the diaphragmatic surface cannot be overemphasized.
Case Report: Laparoscopic Treatment of Symptomatic Diaphragmatic Endometriosis; Farr Nezhat, MD, Camran Nezhat, MD, Jeffrey S. Levy, MD; Fertility & Sterility, Vol. 58, No. 3, Sept 1992
Several theories currently exist regarding the origin of endometriosis, but none of them have proven singly conclusive and the disease continues to be poorly understood. The location of endometrial implants varies widely and has been found to include such uncommon sites as the appendix, ureter, and lungs. To our knowledge, the following is the first case report describing the laparoscopic treatment of diaphragmatic endometriosis in the vicinity of the phrenic nerve. This type of endometriosis can be successfully treated with extreme caution by experienced laparoscopic surgeons, using CO2 laser vaporization and/or excision and hydrodissection.
Laparoscopic Treatment of Obstructed Ureter Due to Endometriosis by Resection and Ureteroureterostomy: A Case Report, Camran Nezhat, Farr Nezhat & Bruce Green; J of Urology, Vol 148, 865-868, September 1992
Partial ureteral resection and ureteroureterostomy were accomplished using operative laparoscopy in a 36-year-old woman with a long-standing history of endometriosis, left ureteral obstruction and nephrostomy.
Laparoscopic Treatment of Infiltrative Rectosigmoid Colon and Rectovaginal Septum Endometriosis by the Technique of Videolaparoscopy and the CO2 Laser, Camran Nezhat, Farr Nezhat, Earl Pennington; British J of Obstetrics and Gynaecology, August/1992, Vol. 99, pp. 665-667
To present the technique and results of videolaparoscopy and the CO2 laser as a treatment for deep, infiltrative endometriosis of the rectovaginal septum, uterosacral ligaments, pouch of Douglas and anterior wall of the rectosigmoid colon. Observational study with 1-5 year follow up. 185 women, ages 25-41 years. All had pelvic endometriosis and were referred because of the failure of previous medical and/or surgical treatment. Vaporization and excision of endometriotic implants and nodules, ureterolysis, ureteric stents, laparoscopic anterior rectal wall resection and reanastomosis, presacral neurectomy, laparoscopic hysterectomy, salpingo-oophorectomy and appendicectomy using the CO2 laser. 174 patients were followed for 1-5 years after surgery by office visit questionnaire or telephone interview. Eleven were lost to follow-up. 175 patients were discharged within 24 h. Nine with bowel perforations and one with a partial bowel resection were discharged 2-4 days postoperatively. Two patients required ureteric stents, which were removed 6 weeks postoperatively without sequelae. 162 women reported moderate to complete pain relief (145 after one procedure, 13 after two and four after three). 12 reported persistent or worse pain following the surgery. Seven eventually underwent total hysterectomy, four had bowel resections and one had a salpingo-oophorectomy. Of 61 with infertility, 25 achieved pregnancy. Postoperative complications included shoulder pain, anterior abdominal wall ecchymosis, urine retention and dyschezia for one to two weeks. Our experience suggests that rectosigmoid colon and infiltrative rectovaginal septum endometriosis can be effectively treated via videolaparoscopy in the hands of experienced endoscopic gynaecologists.
Laparoscopic Treatment of Endometriosis with Laser and Videocamera Augmentation (Videolaseroscopy), Camran Nezhat, Wendy K. Winer, RN, BSN, Farr Nezhat, MD, & Ceana Nezhat, MD; J of Gynecologic Surgery, 5:163, 1989
Recent advances in laparoscopic surgery have enabled the gynecologic surgeon to treat an increased number of diseases of the reproductive organs by using the laser through the laparoscope. This article reviews the results of 857 patients with endometriosis who were treated using the CO2 laser laparoscopically with videocamera augmentation (videolaseroscopy). Of 201 infertility patients followed for at least 18 months, 132 (66%) achieved pregnancy. Of 270 patients with pelvic pain, 210 (77%) patients experienced no pain after 1 year. We conclude that when surgical management of endometriosis is indicated, videolaseroscopy offers advantages over standard laser laparoscopy for the surgeon, including reduced back strain and increased magnification control. In addition, comparable, if not improved, results to the patients can be obtained through laser laparoscopy with video augmentation.
Laparoscopic Segmental Bladder Resection for Endometriosis: A Report of Two Cases, Camran R. Nezhat, MD, Farr R. Nezhat, MD; Obstet Gynecol, 1993, 80:882-4
The proper treatment of bladder endometriosis is unknown. Two women with endometriosis involving the full thickness of the bladder wall experienced persistent hematuria during menstruation. They had not responded to previous conservative medical or surgical therapy, so we performed laparoscopic segmental resection, with satisfactory results. Hematuria during menstruation due to endometriosis of the bladder is uncommon. In the two cases presented, good results followed laparoscopic segmental resection.
Laparoscopic Proctectomy for Infiltrating Endometriosis of Rectum, Farr Nezhat, MD, Camran Nezhat, MD, Earl Pennington, MD; Fertility & Sterility, Vol. 57, No. 5, 5/92
Five percent of cases of endometriosis involve the colon and 76% of these cases involve the rectum or rectosigmoid area. Deeply infiltrating rectal lesions traditionally required open laparotomy for bowel resection and reanastomosis, increasing morbidity and extending recovery. Recently, laparoscopic assisted bowel resections have been described, and the laparoscope’s use in gastrointestinal surgery is increasing . Techniques for laparoscopic assisted bowel resection have been limited to the anterior wall or areas for resection and anastomosis through a separate, smaller abdominal incision. The latter procedure is not recommended for rectal lesions because the rectum is not long enough to be brought up to the abdominal wall. We have previously reported on the technique of anterior rectal wall resection and reanastomosis. Now we have developed a technique for total rectal wall resection combining advanced operative laparoscopy to mobilize and cut the rectum so that it can be prolapsed through the anal canal, resected, replaced into the pelvis, and reanastomosed.
Laparoscopic Hysterectomy and Bilateral Salpingo-oophorectomy Using Multifire GIA Surgical Stapler, Camran Nezhat, MD, Farr Nezhat, MD, & Sheryl L. Silfen, MD; J Gynecol Surg 6:287, 1990
A laparoscopic hysterectomy and bilateral salpingo-oophorectomy was performed on a 42-year-old patient with pelvic pain and long-standing endometriosis. A prototype titanium Multifire GIA Stapler, which was designed for use in operative laparoscopy, was used for the first time on this patient, with excellent results.
Is Hormonal Treatment Efficacious in the Management of Ovarian Cysts in Women with Histories of Endometriosis? Ceana H. Nezhat, Farr Nezhat, Soheila Borhan, Daniel S. Seidman, & Camran R. Nezhat; Human Reproduction, Vol. 11, No. 4, p.874-77, 1996
In a controlled, randomized study, we evaluated the effectiveness of various hormonal regimens in treating 70 women (mean age 34.7 + 5.7 years) who had unilateral or bilateral ovarian cysts presumed to be physiological (functional) and a history of endometriosis. The patients were assigned randomly to one of the following groups: group I (control), no treatment; group II, oral contraceptives (35 ug ethinyl oestradiol and 1 mg norethindrone); group III, oral contraceptives (50 ug ethinyl oestradiol and 1 mg norethindrone); group IV, danazol 800 mg/day. Serum CA-125 concentrations were measured in 32 women. All medications were taken continuously for 6 weeks. Subjects were re-evaluated by pelvic examination and transvaginal ultrasound. Those with persistent cysts were offered diagnostic and possible operative laparoscopy. As 11 patients did not complete the study and five did not follow-up, the final study population comprised 54 women. At 6 weeks follow-up, complete resolution of cysts was found in: group I, 12 out of 18 (66.7%); group II, five out of nine (55.6%); group III, eight out of 14 (57l1%); and group IV, seven out of 13 (53.9%), Two of the 22 women with persistent cysts opted for 6 weeks further medical therapy and achieved complete resolution; 19 underwent laparoscopy, and one was lost to follow-up. All laparoscopic findings revealed benign masses. We found no statistically significant effect when hormonal treatment was compared with expectant management. There was no correlation between serum CA-125 concentrations and the persistence or resolution of cysts.
Incidental Appendectomy During Videolaseroscopy, Camran Nezhat, MD, & Farr Nezhat, MD; Am J Obstet Cynecol 1991; 165:559-64
One hundred incidental appendectomies were performed in patients undergoing operative laparoscopy (videolaseroscopy) for evaluating and treating various major diseases of the reproductive organs. Except for a fever resolving within 24 hours in one case and mild periumbilical ecchymosis, there were no intraoperative or postoperative complications. All patients were discharged within 24 hours of surgery. Average hospital stay was 14 hours. All cases have been followed up for a minimum of 8 months. We believe any risk associated with elective appendectomy as reported here is minimal and outweighed by the benefits of eliminating future emergency appendectomy, simplifying future differential diagnosis of pelvic pain and removing unsuspected abnormality found in the appendix.
A Fresh Look at Ovarian Endometriomas, Farr Nezhat, MD, Ceana Nezhat, MD, Camran Nezhat, MD, & Dahlia Admon, MD; Contemporary Ob/Gyn, Vol. 39, No. 11, 11/94
Endometriosis of the ovaries has unique manifestations. A new classification of endometriomas offers practical implications for diagnosis and treatment.
Laparoscopic Disk Excision and Primary Repair of the Anterior Rectal Wall for the Treatment of Full-thickness Bowel Endometriosis, C. Nezhat, F. Nezhat, E. Pennington, C. H. Nezhat, W. Ambroze; Surg Endosc, 1994, 8: 682-85
We used a new laparoscopic technique to treat infiltrative symptomatic intestinal endometriosis. Eight women, ages 29-38, with extensive symptomatic pelvic endometriosis were included in this series. All were diagnosed as having severe pelvic endometriosis and had not responded to previous conservative surgical and hormonal therapy. In a 5-18 month postoperative follow-up, six women have reported complete relief of the symptoms. Two have right lower quadrant pain and menstrual cramping. Second-look laparoscopy was offered to all patients and so far, two have accepted. these procedures were performed 6 weeks postoperatively. At that surgery, we found that the anastomotic site had healed completely with filmy adhesions between the posterior aspect of the uterus and the rectosigmoid colon in one patient. The second woman had undergone extensive adhesiolysis at the first surgery, and these adhesions recurred; however, the anastomotic site had healed completely. One of the two infertility patients has achieved pregnancy. The only complication was one patient with echymosis of the anterior abdominal wall. Sigmoidoscopy was performed 6 weeks postoperatively, and has been or will be performed at 6 months postoperatively. To date, all anastomotic sites have healed well wit no sign of stricture. Our results with this technique in a small series were positive, and it appears that, in the hands of experienced laparoscopists, it may prove useful in treating symptomatic infiltrative endometriosis.
Laparoscopic Amputation of a Noncommunicating Rudimentary Horn After a Hysteroscopic Diagnosis: A Case Study, Farr Nezhat, MD, Camran Nezhat, MD, Oleg Bess, MD, & Ceana H. Nezhat, MD; Surgical Laparoscopy & Endoscopy, Vol. 4, No. 2, p. 155-56
This report describes the diagnosis and management of a non-communicating rudimentary horn complicated by severe pelvic pain and associated endometriosis. this condition was diagnosed by simultaneous laparoscopic and hysteroscopic examinations. The hysteroscopic evaluation was significant in the diagnosis, as the noncommunicating horn was not recognized during a previous laparoscopy. the laparoscopic removal of the horn afforded complete long-term resolution of pain coupled with speedy postoperative recovery.
Fimbrioscopy and Salpingoscopy in Patients With Minimal to Moderate Pelvic Endometriosis, Farr Nezhat, MD, Wendy K. Winer, RN, BSN, & Camran Nezhat, MD; Obstet Gynecol 75:15, 1990
Fimbrioscopy and salpingoscopy were performed with a rigid salpingoscope during operative laparoscopy in 100 patients with minimal to moderate endometriosis and in 20 normal controls. Five women with endometriosis had perifimbrial adhesions, compared with none of the controls. No subject in either group had adhesion formation of the endosalpinx. These observations indicate that there is no association between endometriosis and intratubal disease.
Is Endoscopic Treatment of Endometriosis and Endometrioma Associated With Better Results Than Laparotomy, Camran Nezhat, MD, Wendy K. Winer, RN, BSN, Farr Nezhat, MD; Am J Gynecologic Health Vol. II, No. 3
Endoscopic treatment of endometriosis and endometrioma employing two different techniques was achieved on 20 infertility patients using the laser laparoscope with video augmentation or videolaseroscopy. Results of each technique are discussed.
Endometriosis of the Intestine and Genitourinary Tract, Camran Nezhat, MD, Farr Nezhat, MD, Ceana Nezhat, MD; Surgical Technology International 1994, Vol. 3, p. 343-974.
As with other organs, the etiology of bowel endometriosis is unknown. Its occurrence was reported as early as 1922 by Sampson. Following his investigation of nineteen cases, he proposed that "implantation adenoma of endometrial type of some portion of the intestinal tract may be present in at least one half of the cases of perforated ovarian hematoma of endometrial type with peritoneal implantations."
Comparison of Transvaginal Sonography and Bimanual Pelvic Examination in Patients With Laparoscopically Confirmed Endometriosis, Ceana Nezhat, MD, Joaquin Santolaya, MD, PhD, Farr R. Nezhat, MD, & Camran Nezhat, MD; J Am Assoc Gynec Laparoscopists Vol. 1, No. 2, p 127-30
To determine the usefulness of noninvasive clinical tests to diagnose symptomatic endometriosis, we retrospectively reviewed the medical records of 91 patients with chronic pelvic pain and laparoscopically confirmed endometriosis. Thirty-seven women (41%) had pelvic peritoneal endometrial implants with adhesions; in 44 (48%) the ovaries were also affected, and in 10 (11%) the disease involved both the uterus and ovaries. Seventy-nine (87%) women had dysmenorrhea, dyspareunia, or both. Forth-three (47%) had a normal bimanual pelvic examination and 37 (41%) an unremarkable transvaginal sonographic evaluation (no significant difference). The women were divided into two groups: group 1, in whom the disease extended to the ovaries and uterus, and group 2, those in whom only peritoneal implants and adhesions were present. In group 1, 48 women (89%) had an abnormal ultrasonographic evaluation compared with only 4 (11%) in group 2 (p <0.001). Our findings indicate that bimanual pelvic examination and transvaginal sonography are equally accurate in detecting endometriosis; however, when the uterine surface and ovaries are involved, the latter is more informative. Therefore, patients with chronic pelvic pain, especially pain related to menstruation or coitus, should be evaluated laparoscopically to diagnose mild endometriosis adequately.
A Comparison of the CO2, Argon, and KTP/532 Lasers in the Videolaseroscopic Treatment of Endometriosis, Camran Nezhat, Wendy K. Winer, and Farr Nezhat; Colposcopy & Gynecologic Laser Surgery, Vol. 4, No. 1; 1988
Several surgical lasers are available currently for laparoscopic use, including the carbon dioxide (CO2), argon, and potassium-titanyl-phosphate (KTP/532 nm) lasers. These lasers each have different properties that offer advantages and disadvantages in the treatment of endometriosis. In the present study, 120 patients with different stages of endometriosis were divided into three groups of 40 patients. Each group underwent videolaseroscopy using one of the three lasers listed above. All three lasers appear to be safe and effective for the laparoscopic treatment of endometriosis. There were no complications experienced, and satisfactory results were obtained in all three groups. This paper discusses and compares the properties of the CO2 , argon, and KTP/532 lasers and the results in each of the three groups of patients. Although the number of patients is too small to make a definite conclusion, it appears that the results of argon and KTP/532 lasers are identical. The outcome for pain relief and fertility appears to be better with CO2 lasers.
Clinical and Histologic Classification of Endometriomas: Implications for a Mechanism of Pathogenesis, Farr Nezhat, MD, Camran Nezhat, MD, Christopher J. Allan, MD, Deborah A. Metzger, PhD, MD, Donald L. Sears, MD; J Reproductive Medicine, 0024-7758/92/3709-0771
One hundred eighty-seven consecutive patients with persistent ovarian cysts and endometriosis underwent laparoscopic evaluation and ovarian cystectomy. All patients had been followed for a minimum of 6 weeks prior to surgery. The cysts were identified initially to be endometriomas based on their gross appearance and the presence of endometriosis at other pelvic sites. Presumed endometriomas were classified into three types based on size, cyst contents, ease of removal of the capsule, adhesions of the cyst to other structures and location of superficial endometrial implants relative to the cyst wall. After clinical laparoscopic classification, the cysts were evaluated histologically without knowledge of the clinical assessment. Histologically small (<2 cm), superficial ovarian cysts were always endometriomas, and the cyst wall was very difficult to remove (type I). Large cysts with easily removed walls were usually luteal cysts (type II). Large cysts with walls adherent in multiple areas adjacent to superficial endometriosis wee generally endometriomas but some also had histologic characteristics of functional (luteal or follicular) cysts (types IIIa and IIIb). These findings led to the conclusion that superficial ovarian endometriosis is similar to endometriosis in extraovarian sites in that the formation of superficial cysts is limited in size by fibrosis and scarring. In contrast, large endometriomas may develop as a result of secondary involvement of functional ovarian cysts by the endometriotic process.
Videolaseroscopy and Laser Laparoscopy in Gynaecology, Camran Nezhat/Joyce Hood/Wendy Winer/Farr Nezhat, Fertility and Endocrinologoy Center, Atlanta, Georgia, Scott R. Crowgey, Georgia Institute of Technology, Atlanta, Georgia, Charles P. Garrison, West Paces Ferry Hospital, Atlanta, Georgia
Laser laparoscopy has greatly expanded the potential applications of laparoscopy in gynaecology. Videolaseroscopy is a new refinement in the technique, which we believe is beneficial, not only to the patient, but also to the treating physician and the operating room staff. The clinical results of the beneficial application of this technique in the treatment of endometriosis and other diseases of the reproductive organs will be presented.
Laparoscopic Segmental Resection for Infiltrating Endometriosis of the Rectosigmoid Colon: A Preliminary Report; Camran Nezhat, MD, Earl Pennington, MD, and Wayne Ambroze, Jr., MD; Surgical Laparoscopy & Endoscopy, Vol. 2, No. 3, p. 212-16, 1992
The following is a description of the first series of laparoscopic partial proctectomies performed without a separate surgical incision. Sixteen women were treated for extensive endometriosis invading the rectal wall. This original series of patients tolerated the procedure well, with no major intraoperative or postoperative complications noted.
Videolaseroscopy for Endometriosis, Camran Nezhat, MD, Wendy K Winer, RN, BSN, Farr R. Nezhat, MD Ceana Nezhat, MD
Operative laparoscopy is a cost effective and clinically efficacious technique in the treatment of endometriosis. The CO2 laser is useful in situations requiring precise application, safety, and minimal tissue damage. The fine beam provides precise control for vaporization or dissection of endometriosis through the laparoscope. The use of the CO2 laser through the laparoscope was first reported by Bruhat, Mage and Manhes in 1979 and later by Tadir. Incorporation of the videocamera and laparoscope in human and animal studies has been described and the advantages have been noted. Previously, due to the weight of the cameras, low resolution of both cameras and monitors and high cost, videocameras had not been widely used in gynecology.