Biosurgicals and the Minimally Invasive Gynecologic Surgery (MIGS) Surgeon.

Biosurgical materials (biosurgicals) have a wide array of uses for providing hemostasis, including decreasing the risk of postoperative bleeding and, intraoperatively, controling bleeding. These materials are especially useful in situations where electrocautery, sutures, or clips are not feasible. Biosurgicals have long been used in general surgery and surgical subspecialties to provide hemostasis; however, they still are not commonly used during obstetric and gynecologic procedures. Three commonly used classes of biosurgicals will be discussed in this article: oxidized regenerated cellulose, flowables, fibrin sealants, and fibrin sealant patches. Each of these agents has a different role to play during minimally invasive gynecologic surgery (MIGS), either singularly or in combination with each other. One unique fibrin product is a fibrin sealant patch, which is a combination of products used to treat bleeding of various intensities, including acute, severe hemorrhagic situations. It is important for the MIGS surgeon to understand the nature and use of each product to be able to use biosurgicals appropriately for hemostasis management. This article reviews biosurgical products, their composition, and application in minimally invasive gynecologic surgery. Included will be a few of the "on label" and "off-label" uses of biosurgicals-either singularly or in combination-and tips for introducing these materials during MIGS procedures.

An Update on the Use of Barbed Suture in Minimally Invasive Gynecological Surgery (MIGS).

The use of barbed suture has enabled general and minimally invasive gynecological surgery (MIGS) surgeons to close surgical wounds more efficiently with minimal complications. This article reviews developments in barbed (knotless) sutures and related devices.

Now You See It: Using Angled Laparoscopes in Minimally Invasive Gynecologic Surgery.

As minimally invasive gynecologic surgery (MIGS) becomes more complex, and cases more difficult, surgeons must adapt to the challenges not only by using innovative equipment but also using the lessons learned from other disciplines. Many years after general surgeons learned the "art of laparoscopy," it is clear that general surgeons in the United States-and those around the world-have surpassed the "masters of laparoscopy" (gynecologists) with their use of new techniques and new equipment. Surgeons are using less traumatic graspers and perform a higher percentage of surgeries laparoscopically than gynecologic surgeons. With the essential need for more integrated ergonomics and a suitable laparoscopic operating room environment, this article describes the benefits of using angled laparoscopes and includes basic techniques to enable gynecologic surgeons to master "driving" the angled laparoscope.