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.

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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.

Adhesion Reformation After Reproductive Surgery by Videolaseroscopy, Camran Nezhat, MD, Farr R. Nezhat, MD, Deborah A. Metzger, PhD, MD, Anthony A. Luciano, MD; Fertil Steril 53:1008, 1990

After initial videolaseroscopy for the treatment of endometriosis-associated infertility, 157 patients underwent a second-look laparoscopy to evaluate and treat recurrence of disease and/or adhesions. The patients were divided into two groups. Group 1 consisted of 135 patients who underwent second-look laparoscopy for persistent infertility and/or recurrence of pain. Group 2 consisted of 22 patients who achieved a pregnancy after initial surgery and underwent second-look laparoscopy for evaluation of ectopic pregnancy or in association with uterine evacuation for first trimester spontaneous abortion. Both groups of patients demonstrated a significant reduction in adhesion scores involving the ovaries, tubes, posterior cul-de-sac, anterior cul-de-sac, and omentum/bowel. Although the initial mean adhesion scores were similar for both groups, at second-look laparoscopy the mean adhesion scores were significantly lower for group 2, particularly for ovarian and tubal adhesions. None of the patients formed de novo adhesions. From these results we may conclude that videolaseroscopy: (1) is effective in reducing peritoneal adhesions; (2) is associated with a low frequency of postoperative adhesion recurrence; and (3) appears to completely avoid de novo adhesion formation.

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; British Journal of Hospital Medicine, 1987.

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: The CO₂ Laser for Advanced Operative Laparoscopy, Camran R. Nezhat, MD, FACOG, Farr R. Nezhat, MD, FACOG, and Sheryl L. Silfen, MD, FACOG Obstetrics and Gynecology Clinics of North America, Vol. 18, No. 3, 9/1991

Advanced operative laparoscopy offers an appealing alternative to laparotomy for benign gynecologic disease. By eliminating a large abdominal incision, a laparoscopic surgical procedure generally requires short-stay hospitalization of less than 24 hours and allows full recovery in less than a week. Patients prefer laparoscopy intuitively because it is less painful and cosmetically acceptable; furthermore, patients perceive surgery done by laparoscopy as less invasive physically and less intrusive in their lives. Surgeons can visualize deep pelvic structures more easily and produce less de novo adhesions than with laparotomy, preserving patients’ future fertility. Health care costs are reduced, and workers return to full productivity rapidly. Thus, in the hands of a skilled, experienced operative laparoscopist, advanced operative laparoscopy is universally preferable to laparotomy for appropriately selected cases.

The Risk of Carbon Monoxide Poisoning After Prolonged Laparoscopic Surgery, Camran Nezhat, MD, Daniel S. Seidman, MD, Hendrik J. Vreman, PhD, David K. Stevenson, MD, Farr Nezhat, MD, and Ceana Nezhat, MD; Obstetrics & Gynecology, Vol. 88, No.5, p. 771-4, November 1996

To evaluate whether thermal energy produced by laser and bipolar electrosurgery during laparoscopic procedures significantly elevates blood carboxyhemoglobin levels.

Initial Report of the Carbon Dioxide Laser Laparoscopy Study Group: Complications, Nezhat et al, J Gynecologic Surgery, 5:269, 1989

Operative laparoscopy using the CO₂ laser is becoming increasingly common in reproductive pelvic surgery. However, to date, characterization of the safety of this technique has been limited. However, to date, characterization of the safety of this technique has been limited. To assess this issue, the reports of the 821 women in the database of the Carbon Dioxide Laser laparoscopy Study Group were reviewed. Procedures performed at laparoscopy included vaporization of endometriosis, adhesiolysis, transection of the uterosacral ligaments, fimbrioplasty, salpingostomy for ectopic pregnancy, ovarian cystectomy, and neosalpingostomy. Ninety (11%) were hospitalized overnight, and 22 (2.6%) were hospitalized two or more nights. Operative complication were limited and consisted of 9 cases of intraabdominal bleeding, 3 women with uterine perforation, 1 with trocar injury to the uterus, and 1 with an omental hemotoma. None of these women required laparotomy. One patient underwent laparotomy to rule out small bowel injury, but none was noted. Postoperative complications reported consisted of 2 women with urinary retention and 1 each with postconization bleeding, periumbilical hematoma, acute infectious colitis, and allergic reaction to i.m. Depo Provera. Thus, operative or postoperative complications attributable to performance of operative CO2 laser laparoscopy per se were rare and without clinically significant morbidity or mortality. It is concluded that in experienced hands, CO2 laser laparoscopy can be safely used in the performance of reproductive pelvic surgery.

Videolaseroscopy Camran Nezhat, MD, Farr Nezhat, MD, and Ceana Nezhat, MD; Clinical Practice of Gynecology:2, 137-145, 1990

Since the introduction of endoscopy in 1910, there has been a dramatic change of pattern and approach to the diagnosis and treatment of various diseases of the reproductive organs. Recent advances in the techniques of operative endoscopy and high-technology instrumentation (such as endoscopes, videocameras, and videomonitors) have made it possible to perform endoscopically almost all of the infertiltiy and noninfertility related procedures that previously required laparotomy.

Videolaseroscopy for Endometriosis, Camran Nezhat, MD, Wendy K Winer, RN, BSN, Farr R. Nezhat, MD Ceana Nezhat, MD; Lasers in Endoscopy, Chapter 9

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.

Vaginal Vault Evisceration After Total Laparoscopic Hysterectomy; Ceana H. Nezhat, MD, Farr Nezhat, MD, Daniel S. Seidman, MD, Camran Nezhat, MD; Obstet & Gynecol , 1996/87:868-70

Vaginal vault rupture with intestinal herniation, although rare, has been reported after vaginal and abdominal hysterectomies. We report three such cases, two postcoital and one spontaneous, after total laparoscopic hysterectomy.

Laparoscopic Excision of Ovarian Neoplasms Subsequently Found to be Malignant; Camran Nezhat, MD, Farr Nezhat, MD, Sheryl L. Stilfen, MD, Benedict Benigno, MD, Matthew Burrell, MD, Charles Welander, MD; Obstet Gynecol Vol 78, No. 2, Aug/1991

Letter to the editor in reference to article: "Laparoscopic excision of ovarian neoplasms subsequently found to be malignant", (Obstet Gynecol 1991:77:563-5), Maiman et al surveyed gynecologic oncologists to assess the quality of care and effect on the outcome of ovarian masses initially managed laparoscopically. We would like to suggest that the quality of laparoscopic care in the survey needs to be examined more carefully...

Laparoscopic-Assisted Myomectomy; Daniel S. Seidman, MD, Ceana H. Nezhat, MD, Farr Nezhat, MD, Camran Nezhat, MD; Infertility & Reproductive Medicine Clinics of N. America; Vol. 7, No. 1, Jan/1996

No Abstract.

Laparoscopic Radical Hysterectomy with Paraaortic and Pelvic Node Dissection; Camran R. NEzhat, MD, Matthew O. Burrell, MD, Farr R. Nezhat, MD, Benedict B. Benigno, MD, Charles E. Welander, MD; Am J of Ob/Gyn, Vol. 166, No.3, pp. 864-65, 3/1992.

We report the first case of a laparoscopic radical hysterectomy and paraaortic and pelvic lymphadenectomy to treat a stage IA2 carcinoma of the cervix. To our knowledge, a laparoscopic radical hysterectomy with laparoscopic paraaortic lymphadenectomy has note been previously described.

Adhesion Formation After Endoscopic Posterior Colpotomy; Farr Nezhat, MD, Andrew I. Brill, MD, Ceana H. Nezhat, MD, Camran Nezhat, MD; J. Reproductive Medicine; 0024-7758/93/3087-3534

Twenty-two women who had undergone laparoscopic posterior colpotomy at initial operative laparoscopy and later underwent a second laparoscopic procedure were evaluated for adhesion formation. Fifteen women(68%) had myomata removed, 3 (14%) had a dermoid cystectomy, 1 (5%) had a serous cystadenoma removed, and 3 (14%) who had large endometriomata and sever adhesions underwent salpingo-oophorectomy. Although filmy adhesions were noted in nine women, no adhesions were noted in the cul-de-sac. Based on our limited results, it does not appear that tissue removal via laparoscopic colpotomy predisposes reproductive-age women to post-operative adnexal adhesion formation.