Table Of ContentADVANCES IN
GYNAECOLOGICAL
SURGERY
GMM
Edited by
Peter J. O’Donovan
Ellis G. R. Downes
ADVANCES
IN
GYNAECOLOGICAL SURGERY
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To my wife, Carmel, and my children James, Olivia, Charles and Niamh
P. J. O’D.
To my wife, Louise, and my children George and Lily
E. G. R. D.
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ADVANCES
IN
GYNAECOLOGICAL SURGERY
Edited by
Peter J. O’Donovan
Consultant Gynaecologist, MERIT Centre, Bradford Royal Infirmary, UK
Ellis G. R. Downes
Consultant Gynaecologist, Chase Farm Hospital, Enfield, Middlesex, London, UK
Associate Editor
Paul McGurgan
Karl Stortz Research Fellow
The MERIT Centre
Bradford Royal Infirmiry
Bradford
LONDON ● SAN FRANCISCO
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© 2002
Greenwich Medical Media Ltd
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ISBN: 1 900 151 499
First Published 2002
Apart from any fair dealing for the purposes of research or private study, or criticism or review, as permitted under the UK
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terms stated here should be sent to the publishers at the London address printed above.
The right of Peter J. O’Donovan and Ellis G. R. Downes to be identified as editors of this work has been asserted by them in
accordance with the Copyright, Designs and Patents Act 1988.
The publishers make no representation, express or implied, with regard to the accuracy of the information contained in this book
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Printed by The Bath Press
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CONTENTS
LIST OF CONTRIBUTORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii
FOREWORD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix
Professor Christopher Sutton
PREFACE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi
ACKNOWLEDGEMENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xii
INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiii
E Downes
1
Microendoscopy in Gynaecology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1
P J O’Donovan, J K Gupta
2
Laparoscopy in Urogynaecology. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
A R B Smith
3
Decision Analysis in Surgery. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
J G Thornton
4
Current Advances in Surgery for Stress Incontinence . . . . . . . . . . . . . . . . . . . . . . . . . 33
L Cardozo, J Bidmead
5
Vaginal Surgery – what can’t we do?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
S S Sheth
6
Laparoscopic Colposuspension . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
S Pringle, R Hawthorn
7
Vault Prolapse – can it be prevented? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
D A Johns
8
Photodynamic Therapy in Gynaecology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
M J Gannon
9
Virtual Reality Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99
N McClure,A G Gallagher, J McGuigan
v
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10 New Surgical Techniques for the Treatment of Menorrhagia . . . . . . . . . . . . . . . . . . . . 105
N N Amso, E Tsakos
11 Laparoscopic myomectomy: techniques and results . . . . . . . . . . . . . . . . . . . . . . . . . . . 125
J B Dubuisson, C Chapron,A Fauconnier
12 Management of Vaginal Prolapse after Hysterectomy . . . . . . . . . . . . . . . . . . . . . . . . . 135
P Hogston
13 Recent Advances in Gynaecological Oncology Surgery . . . . . . . . . . . . . . . . . . . . . . 147
R A F Crawford
14 What is the Current Role of Endometrial Ablation and Resection? . . . . . . . . . . . . . . . 157
D E Parkin
15 Strategies to Avoid Complications in Laparoscopic and Hysteroscopic Surgery . . . . . . . 169
T C Li, P McGurgan, P J O’Donovan
16 Microwave Endometrial Ablation in the Outpatient Setting. . . . . . . . . . . . . . . . . . . . . 189
N Sharp
17 The Filshie Clip: current uses and future developments. . . . . . . . . . . . . . . . . . . . . . . . 199
S M F Ismail, G M Filshie
18 Recent Advances in Electrosurgery - VersapointTM technology. . . . . . . . . . . . . . . . . . . . 207
M Farrugia, P McGurgan, D L McMillan, P J O’Donovan
INDEX. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 217
CONTENTS
vi
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N N Amso
Senior Lecturer/Honorary Consultant
University of Wales College of Medicine
Department of Obstetrics and Gynaecology
Cardiff, UK
J Bidmead
Urogynaecology Research Fellow
King’s College Hospital
London, UK
L Cardozo
Professor of Urogynaecology
Kings College Hospital
London, UK
C Chapron
Service de Gynecologie Obstetrique II
A Orientation Gynecologique
Groupe Hospitalier Cochin
Paris, France
R A F Crawford
Consultant Gynaecologist
Addenbrooke’s Hospital
Cambridge, UK
Ellis Downes
The Kings Oak Hospital
Chase Farm
Enfield
J B Dubuisson
Service de Gynecologie Obstetrique II
A Orientation Gynecologique
Groupe Hospitalier Cochin
Paris, France
A Fauconnier
Service de Gynecologie Obstetrique II
A Orientation Gynecologique
Groupe Hospitalier Cochin
Paris, France
M Farrugia MRCOG
Research Fellow
Whipps Cross Hospital
London
G M Filshie MD FRCOG
Formerly Reader/Consultant
Queens Medical Centre
Nottingham
AJ Gallagher
Consultant
Department of Psychology
David Keir Building
Queens University
Belfast, UK
M J Gannon
Consultant Obstetrician and Gynaecologist
Gynaecology Out-Patients Department
Pinderfields Hospital
Wakefield, UK
JK Gupta MD MRCOG
Senior Lecturer
Birmingham Women’s Hospital
Edgebaston
Birmingham
R Hawthorn MD FRCOG
Consultant
Southern General Hospital
Glasgow
P Hogston
Consultant Gynaecologist
Saint Mary’s Hospital
Portsmouth, UK
S M F Ismail MRCOG
Research Fellow
MERIT Centre
Consultant Gynaecologist
MERIT Centre
Bradford Royal Infirmary
UK
vii
LIST OF CONTRIBUTORS
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D A Johns
Clinical Associate Professor
Texas Health Care
Fort Worth
Texas, USA
T C Li
Consultant Obstetrician and Gynaecologist
Jessop Wing
Royal Hallamshire Hospital
Sheffield, UK
N McClure
Senior Lecturer
Academic Dept of Obstetrics and Gynaecology
Queen’s University of Belfast
Belfast, UK
J A McGuigan
Consultant Thoracic Surgeon
Royal Victoria Hospital
Belfast, UK
P McGurgan MB BA MRCOG MRCPI
Karl Stortz Research Fellow
The MERIT Centre
Bradford Royal Infirmary
Bradford, UK
L McMillan FRCOG
Consultant
Whipps Cross Hospital
London
P J O’Donovan
Consultant Gynaecologist
MERIT Centre
Bradford Royal Infirmary
Bradford, UK
D E Parkin
Consultant in Obstetrics and Gynaeocology
Aberdeen Maternity Hospital
Aberdeen, UK
S Pringle
Specialist Registrar in Obstetrics and
Gynaecology
Southern General Hospital
Glasgow, UK
N Sharp
Consultant Obstetrician and Gynaecologist
Royal United Hospital
Combe Park
Bath, UK
S S Sheth
Consultant Gynaecologist
Breach Candy Hospital
Sir Hurkisondas Hospital
India
A R B Smith
Consultant Obstetrician and Gynaecologist
St Mary’s Hospital
Whitworth Park
Manchester, UK
J G Thornton
Research School of Medicine
Centre for Reproduction, Growth and
Development
University of Leeds
Leeds, UK
E Tsakos
Consultant Obstetrician and Gynaecologist
St Luke’s Hospital
Thessaloniki
Greece
LIST OF CONTRIBUTORS
viii
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FOREWORD
The final quarter of the last century witnessed a revolution in gynaecological surgery when the
traditional approach by laparotomy was replaced by minimal access surgery. After dramatic
improvements in safety in the final quarter of the preceding century, most pelvic operations
changed very little in the ensuing 100 years and most advances were due to extrinsic factors, such
as the introduction of fluid replacement and blood transfusion and the introduction of prophylaxis
with antibiotics and anticoagulants.The actual approach to the surgery remained static until the
introduction of laparoscopy and hysteroscopy, which enabled the inside of the abdominal cavity
and the inside of the uterus to be visualised with remarkable detail and visualisation.
That final quarter of the 20th Century was an exciting time to be involved in this particular
branch of surgery and scarcely a year went past without the introduction of some new technique
or energy source.Within a remarkably short space of time, it became possible to perform all pro-
cedures in the gynaecological repertoire, with the exception of operations for advanced malig-
nancy which were essentially palliative and of questionable benefit in the long term.
I recall a conversation I had with an expert in feto-maternal medicine in 1985, when we were try-
ing to get minimal access surgery accepted by the Royal College as a sub-specialty in its own right.
I was told in no uncertain terms that the literature on laparoscopic and hysteroscopic surgery was
scant, at best, and the quality was extremely poor with very little published in the form of ran-
domised,controlled trials.Little did he know that in the ensuing years there would be an avalanche
of publications, not merely addressing the technical minutiae, but also addressing safety issues and
increasingly using well-designed studies to justify the superiority of minimal access therapy,
according to the principles of evidence-based medicine.
This time has now come to look at ourselves in a mirror and ascertain our present strengths and
weaknesses and this is exactly what this book sets out to do. The Editors are both enthusiastic
young surgeons who learned minimal access techniques during their training and are therefore
able to look at these developments from a healthy distance. It has enabled them to produce an
excellent volume of essays which are largely written by the "Young Turks" in the battalion rather
than the “Old Guard”, although I am happy to see that the latter are well represented by Shirish
Sheth from India, who looks at his lifetime experience with vaginal surgery and Alan Johns from
Fort Worth in Texas who was one of the pioneers of laparoscopic hysterectomy and the laparo-
scopic repair of uterovaginal prolapse.
The volume looks at new methods of access with special emphasis on miniaturisation and also
endeavours to show the reader that many of the operations no longer need to be performed in
the hospital operating department and that the development of office-based procedures will cer-
tainly decrease the cost of minimal access surgery. Hysterectomy for menorrhagia will increasingly
be replaced by ablative procedures and the best of these are certain to be those that can be per-
formed in the out-patient setting with local anaesthesia and oral analgesia.The different methods
available for thermal ablation are well reviewed as well as newer techniques that might be avail-
able in the future, such as photodynamic therapy and virtual reality surgery.
ix
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