Re: Ob: Laparoscopic forceps for Vaginal Delivery
From: Andrew Folley (agfolley@hotmail.com)
Tue Jun 12 17:16:33 2007
I have been working with an engineer to develop laparoscopic forceps
(similar to a slender version of simpson leukarts) that could be used for a
laparoscopic vaginal forceps delilvery. I have attached the blue prints.
NOTE: They will have to be inserted through 12 mm port due to diameter of
11.5 mm.
andy
>From: "ghassan swaid" <ghassanswaid@gmail.com>
>Reply-To: ob-gyn-l@obgyn.net
>To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net>
>Subject: Re: Ob: After delivery inspection/exploration
>Date: Tue, 12 Jun 2007 13:07:18 -0500
>
>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.
>> >
>>--------------------------------------------------------------------------------
>> >
>>--------------------------------------------------------------------------------
>> > 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
_________________________________________________________________
PC Magazine’s 2007 editors’ choice for best Web mail—award-winning Windows
--
_________________________________________________________________
Live Hotmail.
http://imagine-windowslive.com/hotmail/?locale=en-us&ocid=TXT_TAGHM_migration_HM_mini_pcmag_0507
