Diagnostic Laparoscopy Abstracts

Laparoscopic Ovarian Cystectomy During Pregnancy, Farr Nezhat, MD, Camran Nezhat, MD, Sheryl L. Silfen, MD, & Stephen H. Fehnel, MD; J Laparoendoscopic Surgery, Vol. 1, No. 3, 1991

A pregnant woman with a history of endometriosis and persistent bilateral adnexal masses underwent laparoscopic ovarian cystectomies at 16 weeks of gestation. There were no adverse sequelae, and the patient had an otherwise uneventful pregnancy and delivery. Operative laparoscopy should be considered to replace laparotomy in appropriate cases during pregnancy.

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.

Comparison of Direct Insertion of Disposables and Standard Reusable Laparoscopic Trocars and Previous Pneumoperitoneum With Veress Needle, Farr R. Nezhat, MD, Sheryl L. Silfen, MD, Debra Evans, LPN, & Camran Nezhat, MD; Obstet Gynecol 78:148, 1991

A randomized prospective study was conducted to evaluate the ease of use and safety of direct insertion of laparoscopic trocars. comparison of previous pneumoperitoneum by Veress needle insertion with direct insertion of the reusable conventional laparoscopic trocar and direct insertion of the disposable shielded trocar revealed minor complication rates of 22, 6 and 0%, respectively. No major complications occurred in this series of 200 patients.

Acute Pulmonary Edema Complicating Diagnostic Laparoscopy Preceded by Thoracotomy, Howard S. Brown, MD, Farr Nezhat, MD, Camran Nezhat, MD, Jeffrey S. Levy, MD, Michael Maffett, MD

We report the case of a patient with pelvic endometriosis and recurrent spontaneous pneumothoraces who had thoracotomy and diagnostic laparoscopy, with subsequent acute pulmonary edema. Potential causes are discussed. After a thorough literature search, we believe this to be the first case in which thoracotomy has been combined with diagnostic laparoscopy.

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.

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.