Re: Ob: After delivery inspection/exploration
From: ainsron (ainsron@sbcglobal.net)
Tue Jun 12 13:29:01 2007
Like Dan said, the article was written "tongue in cheek," it isn't really a
technique. It is simply one writer's attempt to poke fun at the tendency to
do all surgeries through minimally invasive surgeries.
Ronald E. Ainsworth, MD, FACOG
-----Original Message-----
From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of ghassan
swaid
Sent: Tuesday, June 12, 2007 11:08 AM
To: Multiple recipients of list OB-GYN-L
Subject: Re: Ob: After delivery inspection/exploration
Please I would like to know some images, video or drawing description
of this technic
on my e .mail
2007/6/12, R. Daniel Braun <rd.braun@gmail.com>:
> Come on yall, this was a farce.
>
> Dan
>
> On 6/12/07, Doc Peró <pero@fibertel.com.ar> wrote:
> >
> > Are we going to stand up, upon this, as an innovation/advancement/gold
> Standard in OB!!!!!!!!!!
> >
> > I myself absolutely refuse to accept this.
> >
> > Even more, statements like three hours operating time and transient
> hypotension and anemia that responded to transfusion of 14 units!!!! of
> packed red blood cells, reflects the weakness, to say the less of this
> "technique".
> >
> > Jorge.
> >
> > ________________________________
>
> > ________________________________
> >
> > De: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] En nombre de Cesar
> Molina
> > Enviado el: Martes, 12 de Junio de 2007 01:52 a.m.
> > Para: Multiple recipients of list OB-GYN-L
> > Asunto: Re: Ob: After delivery inspection/exploration
> >
> > Is it a fanatic attitud to laparoscopic¿¿¿ Please I would like to know
> some images, video or drawing description of this technic. Do you hava
somo
> to send me¿¿
> >
> > 2007/6/9, Efrain Ramirez <eramirezt@coqui.net >:
> >
> > Obstetrics & Gynecology 2000;95:163-165
> > (c) 2000 by The American College of Obstetricians and Gynecologists
> >
> > PubMed Citation
> > Articles by Barham, M.
> >
>
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> >
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> > AFTER OFFICE HOURS
> >
> > LAPAROSCOPIC VAGINAL DELIVERY: REPORT OF A CASE, LITERATURE REVIEW, AND
> > DISCUSSION
> > Mack Barham, MD
> > >From Monroe, Louisiana.
> >
> > Address reprint requests to: Mack Barham, MD, 3418 Medical Park Drive,
> > Suite 5, Monroe, LA 71203, E-mail: armadilo@bayou.com
> >
> > Abstract
> > Top
> > Abstract
> > Case
> > Comment
> > References
> >
> > I review the literature on laparoscopically assisted vaginal delivery,
> > present and discuss a case, and describe the technique.
Laparoscopically
> > assisted vaginal delivery will emerge as a triumphant obstetric
> > innovation that will radically transform operative obstetrics in the
> > 21st century.
> >
> > In recent years we have witnessed an expanding role of laparoscopy in
> > gynecology. Few operations, generally those involving the vulva, have
> > not been improved vastly by the addition of endoscopic technology. The
> > dearth of randomized controlled trials showing the benefit of such
> > technology dissuade only the most archaic troglodytes in our specialty.
> >
> > The final frontier of laparoscopy has now been reached. Laparoscopic
> > radical hysterectomy with pelvic node dissection,1 aortic node
> > dissection,2 and other radical pelvic and abdominal cancer operations3–5
> > are now commonly done endoscopically. Obstetrics is one of the few
> > remaining areas in our specialty that has not fully embraced the
> > manifest benefits of laparoscopically assisted operations, but that is
> > beginning to change. An article on endoscopic removal of adnexal masses
> > in pregnancy6 and a case report of an endoscopic uterine suspension
> > during pregnancy7 have been published recently. The logical extension
> > of the technology is into operative obstetrics.
> >
> > Recent debate about high cesarean rates and concerns about birth
> > injuries from vacuum extraction and mid forceps, combined with
> > inadequate resident training in operative vaginal delivery, have caused
> > thoughtful clinicians to consider alternative approaches to assisting
> > vaginal delivery. A review of the literature, including a MEDLINE
> > search, manual review of the Index Medicus back to 1974, and an Internet
> > search on PubMed, AltaVista, Yahoo, and Lycos found no reports of
> > laparoscopically assisted vaginal delivery. A search of E-Bay found no
> > related current auctions. Herein is reported the first case of
> > laparoscopically assisted vaginal delivery.
> >
> > Case
> > Top
> > Abstract
> > Case
> > Comment
> > References
> >
> > A 24-year-old woman, gravida 4, para 3-0-0-2, presented at 39 weeks'
> > gestation in active labor. Her first infant was delivered by midforceps
> > rotation and had a depressed skull fracture that required surgical
> > elevation in the neonatal period. That child is developmentally delayed
> > and has seziures. Her second infant was delivered by vacuum extraction,
> > had a severe subgaleal hemorrhage, and died at 2 days of age. Her third
> > infant was delivered by emergency low transverse cesarean because of a
> > prolapsed umbilical cord. Postoperatively, the mother had a pelvic
> > abscess and subsequent abdominal wall dehiscence that required
> > reoperation and 43 days of hospital care.
> >
> > In the current pregnancy there were no prenatal problems. Initial fetal
> > heart rate tracings were reassuring and epidural anesthesia was used.
> > She progressed to complete dilatation and pushed for 3 hours. The
> > vertex was at +1 station and was left occiput transverse. There had
> > been no descent during the previous 2 hours. Thick meconium was noted,
> > and there was decreased baseline variability on the fetal monitor strip.
> > After discussing the options of midforceps rotation, vacuum extraction,
> > and cesarean, the woman vehemently refused to consent to any of those
> > procedures. When she was offered an experimental laparoscopically
> > assisted vaginal delivery she eagerly consented, having had abysmal luck
> > with the available alternatives.
> >
> > After she was placed in modified lithotomy position, two 12-mm ports
> > were inserted above the umbilicus and four 12-mm ports were inserted in
> > the four quadrants of the abdomen using transillumination. The markedly
> > dilated vascular structures in the abdominal wall were easy to see and
> > several of them were successfully avoided. The video laparoscope was
> > used so everyone in the delivery suite could view the procedure. A
> > basketball net was inserted into the abdomen through one of the
> > supraumbilical ports. The bottom of the net was closed with a
> > purse-string suture. Half of the net's suspension loops were attached
> > to each of two dog leashes, creating an apparatus not entirely unlike a
> > two-legged macrame jellyfish.
> >
> > The open end of the net was guided over the top of the fundus with
> > grasping probes inserted through the upper ports. The ends of the
> > leashes were then exteriorized through the lower ports. Two crowbars
> > inserted through the upper ports were placed across the top of the
> > fundus under direct vision. Only 2 hours and 52 minutes after the
> > initial skin incision, all was in readiness. We are confident we can
> > reduce the operating time slightly as we gain additional experience. A
> > photograph of the apparatus applied to a uterine simulator is shown in
> > Figure 1.
> >
> > View larger version (99K):
> > [in this window]
> > [in a new window]
> > Figure 1. Crowbars and basketball net with attached leashes positioned
> > for laparoscopically assisted birth are shown applied to a uterine
> > simulator.
> >
> > With the next contraction the woman was instructed to push.
> > Simultaneous, vigorous caudad traction was applied to the leashes while
> > an assistant, using the abdominal wall as a fulcrum, directly applied
> > fundal pressure with the crowbars. The fetal head descended rapidly and
> > a viable 3800-g boy was delivered over an intact perineum. Apgar scores
> > were 9 at 1 minute and 10 at 5 minutes.
> > We saw the incidental rupture of the previous uterine scar that occured
> > just as the infant was delivered. It was easily repaired endoscopically
> > using standard techniques. Her postpartum course was uncomplicated,
> > except for transient hypotension and anemia that responded to
> > transfusion of 14 units of packed red blood cells. The neonate had a
> > transient checkerboard rash on his buttocks, lower back, and thighs that
> > resolved before discharge. He had an uneventful course in the nursery.
> >
> > Comment
> > Top
> > Abstract
> > Case
> > Comment
> > References
> >
> > This case illustrates the feasibility and desirability of
> > laparoscopically assisted vaginal delivery. The neonate had an
> > excellent outcome. We are convinced that the maternal complications
> > were in no way related to the laparoscopically assisted vaginal
> > delivery. We anticipate that she would have been ready for hospital
> > discharge the day after delivery had her uterus not ruptured. Much as
> > Richardson and O'Connor-O'Sullivan retractors have vanished on all
> > progressive gynecology services, forceps and vacuum extractors soon will
> > be relegated to museum shelves next to craniotomes, fetoscopes, and
> > other outdated obstetric accoutrements. Laparoscopically
> assisted
> > vaginal delivery will become the standard of care and emerge as the
> > triumphant obstetric innovation of the 21st century.
> >
> > Hospitals and physicians who do not promptly adopt this procedure will
> > be left standing by the wayside. Patients will demand it. The
> > marketability of laparoscopically assisted vaginal delivery will make it
> > mandatory long before pedantic, time-consuming, prospective randomized
> > clinical trials will confirm its superiority.
> >
> > The only marketing drawback to laparoscopically assisted vaginal
> > delivery is the unfortunate similarity of its acronym (which the reader
> > will have to infer as it is not yet a standard abbreviation and cannot
> > be used in this journal) to an abbreviation for certain urban southern
> > California sexually transmitted diseases. We are currently
> > contemplating terminology modification to laparoscopically assisted
> > birth. The acronym for laparoscopically assisted birth should make
> > marketing even easier as labrador retrievers are one of the most popular
> > breeds in America. I can see the ads now: "Let laparoscopically
> > assisted birth retrieve your baby without the danger of cesarean
> > delivery, forceps, or vacuum extraction!"
> >
> > The additional equipment necessary to implement laparoscopically
> > assisted vaginal delivery is inexpensive and can be found at most
> > sporting goods outlets, pet shops, and hardware stores. Physicians in
> > remote locations can find everything needed at any WalMart store.
> >
> > We are currently modifying our technique to allow laparoscopically
> > assisted cesarean delivery, but that will be the subject of a future
> > communication. I recently established The American Association of
> > Obstetric Laparoscopists to facilitate credentialing and exchange of
> > ideas among colleagues.
> >
> > In the 20th century the three factors that have most altered obstetrics
> > are safe blood transfusion, effective antibiotics, and trial lawyers.
> > Without a doubt, laparoscopically assisted vaginal delivery will
> > radically alter the practice of obstetrics in the 21st century. Modesty
> > forbids me from presupposing that my name will become as hallowed as
> > Chamberlen when the history of operative obstetrics is recorded. Only
> > time will tell. What is clear is that practioners who do not quickly
> > adopt this innovative advance will not thrive and flourish. The
> > transition from evidence-based medicine to marketing-based medicine has
> > never been more apparent. Early attendance of one of the economical
> > weekend laparoscopically assisted vaginal delivery courses offered at
> > various sites around the country in the near future is essential to your
> > professional survival. Do not be left behind. The millennium is upon
> > us.
> >
> > Footnotes
> >
> > PII S0029-7844(99)00512-8
> >
> > Received June 7, 1999. Received in revised form July 14, 1999.
Accepted
> > July 29, 1999.
> >
> > References
> > Top
> > Abstract
> > Case
> > Comment
> > References
> >
> > 1. Kim DH. Laparoscopic radical hysterectomy with pelvic
> > lymphadenectomy for early, invasive cervical carcinoma. J Am Assoc
> > Gynecol Laparosc 1998;5:411–7.[Medline]
> >
> > 2. Nezhat CR, Burrell MO, Nezhat FR, Benigno BB, Welander CE.
> > Laparoscopic radical hysterectomy with paraaortic and pelvic node
> > dissection. Am J Obstet Gynecol 1992;166:864–5.[Medline]
> >
> > 3. Ramshaw BJ. Laparoscopic surgery for cancer patients. CA Cancer J
> > Clin 1997;47:327–50.[Abstract]
> >
> > 4. Hatch KD, Hallum AV 3rd, Surwit EA, Childers JM. The role of
> > laparoscopy in gynecologic oncology. Cancer 1995;76:2113–6.[Medline]
> >
> > 5. Childers JM, Brzechffa PR, Hatch KD, Surwit EA. Laparoscopically
> > assisted surgical staging (LASS) of endometrial cancer. Gynecol Oncol
> > 1993;51:33–8.[Medline]
> >
> > 6. Soriano D, Yefet Y, Seidman DS, Goldenberg M, Mashiach S, Oelsner G.
> > Laparoscopy versus laparotomy in the management of adnexal masses during
> > pregnancy. Fertil Steril 1999;71:995–60.
> >
> > 7. Matsumoto T, Mutsumasa N, Yokata M, Masaharu I. Laparoscopic
> > treatment of uterine prolapse during pregnancy. Obstet Gynecol
> > 1999;93:849.[Free Full Text]
> >
> > At Sat, 09 Jun 2007, Dr Eberhard Lisse wrote:
> > >
> > >When can we expect delivery by laparoscopy :-)-O?
> > >
> > >el
> > >
> > >on 6/8/07 10:48 PM art fougner, md said the following:
> > >> OK this might be more than a little over the top ...
> > >>
> > >> JSLS. 2002 Apr-Jun;6(2):175-7.
> > >> "Endoview" project of intrapartum endoscopy.
> > >> Petrikovsky BM, Ravens S.
> >
> > --
> > " The greatest obstacle to knowledge is not ignorance,
> > it is the illusion of knowledge." Daniel J. Boorstin - Historian
> >
>
> --
> R. Daniel Braun, MD FACOG(L) CMT
> Professor Emeritus
> Dept. of Obstetrics and Gynecology
> Indiana U. School of Medicine
>
> R. Daniel Braun
>
> "Science without Religion is LAME; Religion without Science is
BLIND"
> Einstein 1941
--
Ghassan . R . Swaid , M.D
Arab Board Of Ob & Gyn
PO.BOX - 12761
Aleppo
Syria
Phone : 00963216653036
mobile : 0096394532648
