Carbon Dioxide Laser Laparoscopy for Endometriosis

Evaluation of an intuitive writing interface in robot-aided laser laparoscopic surgery

OBJECTIVE

The feasibility of the conceptual Intuitive Writing Interface (IWI) in robot-aided laser laparoscopic surgery has been demonstrated previously. This paper investigates the potential improvement of IWI by comparing conventional manipulation (CM) and IWI manipulation (IM) and conducting an animal experiment.

MATERIALS AND METHODS

Three tasks were designed that were considered to be representative of laser laparoscopic surgical procedures. All test participants used both CM and IM in all tasks. Completion time and error level of each task were taken as comparative indices and were integrated into a self-defined Index of Time and Error (ITE). Six sequential in vitro trials were carried out to investigate learning curves. In addition, nephrectomy was performed on a rabbit by employing IWI in robot-aided laser laparoscopic surgery.

RESULTS

The results showed significant advantages for IM, with shorter completion time, more successful shots, and smaller error length in the three tasks, as compared to CM. The learning curve showed a promising trend for IM. More than half of the participants performed better with IM. The animal model experiment demonstrated the clinical feasibility of IM, but at the same time revealed some limitations.

CONCLUSIONS

The new IWI interface definitely improved laser laparoscopic procedures by taking advantage of familiar writing skills. With its flexibility of implementation and ease of use, IWI has clear potential for use in laser laparoscopic procedures.

Hysterectomy for treatment of pain associated with endometriosis

The literature was searched for endometriosis and hysterectomy on PubMed and the individual search engines of the Journal of Minimally Invasive Surgery, Fertility and Sterility, BJOG, Obstetrics and Gynecology, the American Journal of Obstetrics and Gynecology, and Human Reproduction. Eighty references of interest were identified and included in this review. Analysis of hysterectomy for pain associated with endometriosis is difficult for many reasons. These include a lack of differentiation of various forms of cyclic pain from other forms of non-cyclic pain, the retrospective nature of much of the literature, and a low specificity for identifying pain. Hysterectomy for chronic non-specified pelvic pain associated with endometriosis is a successful approach in many women. It can not be determined whether this is due to intermingling of patients with and without cyclic pain or if both of these respond equally well. Focused prospective research is needed to determine whether symptoms, signs, or laboratory findings might be useful in determining more specific response patterns.

Excision of endometriosis with laparosonic coagulating shears

Excision of endometriotic lesions allows the diagnosis to be confirmed and may provide long-term relief of symptoms. Laparoscopic excision is generally accepted for treatment of all stages of disease and can be accomplished safely with laser, electrosurgery, or ultrasonic energy. Ultrasonic energy uses the 5-mm hook blade for excision and 5-mm harmonic scalpel ball electrode for coagulation. Disease was excised by laparosonic coagulating shears (LCS) in 14 women. All patients had an uneventful postoperative course, with 13 (93%) remaining pain free 7 to 18 months postoperatively. The LCS is easy to use and allows endometriosis to be excised with an adequate margin of safety. (J Am Assoc Gynecol Laparosc 6(2):195-199, 1999)