Ultrasonic Surgical Techniques for the Pelvic Surgeon

This content does not have an Arabic version. Focused ultrasound surgery During focused ultrasound surgery, high-frequency, high-energy sound waves are used to target and destroy uterine fibroids. Request an Appointment at Mayo Clinic.

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References Zupi E, et al. Nonsurgical alternatives for uterine fibroids. Accessed March 20, Kong CY, et al. MRI-guided focused ultrasound surgery for uterine fibroid treatment: American Journal of Roentgenology. Jacoby VL, et al. A pilot, randomized, placebo-controlled trial of magnetic resonance guided focused ultrasound for uterine fibroids. Magnetic resonance imaging MRI: Kim HK, et al. Three cases of complications after high-intensity focused ultrasound treatment in unmarried women. Obstetrics and Gynecology Science. Mindjuk I, et al.

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Results from a single centre. New England Journal of Medicine. Coakley FV, et al. In this way, damage to healthy surrounding tissues is minimized. The system is currently used for liver and spleen resection, transplantation, and neurological surgery. Studies evaluating use of the CUSA in laparoscopic pelvic autonomic nerve-sparing radical hysterectomy indicate that the technique preserves the hypogastric nerve, which may be beneficial to the postoperative recovery of bladder function and bowel function.

However, CUSA is rarely used for laparoscopic pelvic autonomic nerve-sparing radical hysterectomy in China.

Diagnosing Endometriosis

Participation was voluntary, and subjects were allowed to drop out at any given time. The study was reviewed and approved by the local ethics committee. Patients were excluded from the study if they had received radiotherapy or chemotherapy before surgery. None of the patients had a history of chronic diseases of urinary system or intestinal tract before surgery and none had bowel or bladder dysfunction. Patients with complications likely to affect surgery were also excluded. Women with serious pelvic adhesions and those with heart conditions that contraindicated laparoscopic surgery were referred for laparotomy.

Cases where laparoscopic surgery was not nerve sparing because there was a close relationship between the tumors and surrounding nerves were excluded from the outcome evaluation. In this prospective study, sample size was calculated as described below, based on our previous experience. Patients were randomized at a ratio of 1: The patients were divided into 2 groups using a random number table. The laparoscopic nerve-sparing radical hysterectomy with pelvic lymphadenectomy was performed in 2 groups with or without the CUSA system. In all patients, the objective of the operation was to achieve Piver III radical hysterectomy surgery resection range.

The first step of the procedure was lymph node dissection. It was then used to isolate all associated structures and expose the nerves and major blood vessels. The procedure facilitated identification and preservation of the hypogastric nerve, the inferior hypogastric plexus pelvic plexus , and the bladder branch.

Surgery was undertaken by the same physicians 2 senior surgeons, 2 associate senior surgeons, and 2 attending physicians throughout the study. Postoperative indwelling catheter time was used to assess bladder function. After the catheter was removed, the onset of spontaneous voiding was recorded, and the postvoiding residual volume PVR was assessed. The catheter was inserted again if self-voiding did not occur or PVR was greater than mL. Bladder function was considered normalized when patients urinated to their satisfaction, reported spontaneous voiding, and had a PVR less than mL.

Postvoid residual urine volume in the sonolucent area of the bladder was measured by ultrasound. Operation time was assessed from the time of the first incision to the time of completing the final sutures. Other assessments included the number of harvested lymph nodes, evacuation time, and incidence of postoperative complications.

Patients were followed-up postoperatively every 3 months for 2 years, every 6 months for 1 year, and then once a year. Each follow-up visit included assessments to determine patient voiding after discharge, measure residual urine, and determine the recovery of bladder void function. The follow-up visit also included a physical and pelvic examination, vaginal cytology, ultrasound examination, chest x-ray, and squamous cell carcinoma antigen detection to determine the presence or absence of tumor recurrence and metastasis.

Statistical analysis was performed using SPSS version The quantitative data were presented as mean SD. The numeric data were presented as rate or ratio. Student t tests were used to compare the means in the 2 groups. A total of 54 patients were screened, and 48 patients were included in the study. Two of the 24 patients randomized to the non-CUSA required laparotomy.

Another subject had a close relationship between the tumor and surrounding nerve tissue. The mean SD operation was The mean SD intraoperative blood loss for was There were no cases of recurrence or metastasis. The mean SD number of lymph nodes was The other patient recovered their ability to void spontaneously within after 14 days. In the non-CUSA group, 18 patients There were no cases of damage to blood vessels or important organs during the procedure. All patients had negative surgical margins. I feel compelled to give you a bit of background so you can understand the significance of this surgery for me.

I am passionate about Endometriosis because it has affected me most of my life and I have a…. Goldstein radically changed my quality of life. This summer, I had a surgery with Dr. It was my first with them, but my 5th endo surgery. I couldn't believe the difference,…. I was in pain for 2 years. I was getting no answers, and because dr Goldstein and dr seckins were willing to see and treat me I'm finally feeling almost back to normal. They were very down to earth and helpful in my time of need. Dr Goldstein was easy to talk to and caring, she took care of me…. Seckin is one of the best endometriosis surgeon.

Every time I go to the office, he really listens to me and is always concerned about my issues. Dr Seckin's office staff are a delight and they always work with me. I feel I can leave everything to them and they will take care of it. Thank you to the…. Fast forward 5 years to find out incidentally I had a failing kidney. During this time, I was preparing all my documents to send to Dr.

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Our Approach

He quickly ascertained what needed to be done, laid out the options along with his recommendation and gave me the time to make the right decision for me. My surgery went without a hitch and I'm healing very well. Overview Endometriosis is often one of the most underdiagnosed, misdiagnosed and mistreated diseases in reproductive-aged women. What are the steps to diagnosing endometriosis? Diagnosing endometriosis requires 3 levels of diagnostic evaluation: The initial stage is a clinical examination and appropriate testing, this includes a pelvic examination and ultrasound.

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During this time, patients thoroughly recount their current complaints and symptoms, as their doctor intently listens in order to build trust that will facilitate long time care. Upon physical examination, such findings as the cervix, pelvic side and posterior thigh tenderness, which can radiate as far back to the cervix at the rectal wall, can all be key telling signs of endometriosis lesions and their possible location.

Cavitron Ultrasonic Surgical Aspirator in Laparoscopic Nerve-Sparing Radical Hysterectomy

Sonogram technology can help confirm the cause of this tenderness. Finally, a rectal exam may also be conducted if there is diffuse pelvic tenderness as the will want to determine if there is localized rectovaginal tenderness, a key sign of rectovaginal disease and possible nodules. Step 2 during surgery: The second stage is visual diagnosis by recognition of endometriotic lesions through laparoscopy.

This will be performed in the operating room, during laparoscopic surgery. In order for endometriosis to be confirmed, believed endometriosis scar tissue must be excised, collected and sent off to a pathology lab. Step 3 after surgery: The final formal diagnosis of endometriosis cannot be made without pathologic examination under a microscope, thus surgical specimens obtained through laparoscopic deep excision surgery must be sent off to the lab.

It usually takes a few days after surgery to assess. What are forms of testing performed pre-surgery? During this exam, a physician will look for any and all points of pelvic tenderness. Through a pelvic exam, your doctor will be able to gain a better understanding of your symptoms and any pain you may be experiencing. If your physician specializes in endometriosis, they may even be able to diagnose such conditions as the frozen pelvis. Ultrasound is a safe and painless technique that uses sound waves to create detailed images of inside the body. A small probe, called a transducer, is inserted into your vagina, much like a tampon.

Sound waves will then pass harmlessly through the skin from the transducer, bouncing off certain organs and tissue in the body creating "echoes". The echoes are reflected back to the transducer, which converts the echoes to electrical signals in order to produce an image. The images are viewed in real-time on a monitor and are also recorded and photographed for your physician to review. It is important to note, that this test can be performed during menstruation.

An image of the uterus using ultrasound technology Sonohysterography: During this imaging technique, fluid is injected through the cervix into the uterus. This procedure is done to find the underlying causes of abnormal uterine bleeding, miscarriage, and infertility , as it can detect: