The morcellator knife: a new laparoscopic instrument for supracervical hysterectomy and morcellation.

BACKGROUND: Cutting the cervix, morcellation, and extraction of the uterus and myomata remain major problems in endoscopic surgery. We developed an efficient, safe, reusable, and inexpensive instrument to cut the cervix and morcellate the uterus and myomata: the morcellator knife. INSTRUMENT: The morcellator knife is a classic lancet with an interchangeable blade, transformed into an endoscopic instrument that can be inserted easily through a 10-mm-diameter trocar. The blade has an automatic retraction system and is set in the standby position, ensuring security. Cutting the cervix and uterine or myoma fragmentation are easy. The mass to be cut is held between two grasping forceps for easy cutting with the blade, under permanent visual control. After morcellation, extraction of the masses is performed through a posterior culdotomy. EXPERIENCE: We have used this morcellator knife in 54 subtotal hysterectomies and 16 myomectomies. There were no complications during the procedures. Morcellation lasted 3-14 minutes and involved the use of an average of two to three blades. CONCLUSION: The morcellator knife is a simple, safe, reusable, and inexpensive instrument with a low maintenance cost.

A new vaginal extractor for laparoscopic surgery.

We developed a new instrument specifically designed to facilitate the removal of large tissue masses through a vaginal incision during laparoscopic surgery without any loss of gas. It consists of a cannula fitted with a ball-shaped head at one end. After laparoscopic culpotomy, tissue is seized with a grasping forceps introduced vaginally through the cannula. To prevent dissemination and to facilitate passage through the incision, tissue masses may be placed in a tied plastic pouch prior to extraction. The entire procedure is safe because of continual endoscopic control. It was performed in 57 women to extract cysts, tubal pregnancies, adnexa, myomas, and ovaries. It took an average of 10 minutes, and no intraoperative or postoperative complications were observed. Preliminary experience suggests that this technique is safe, fast, inexpensive, and easy to perform under continuous endoscopic control.

[Value of penis endoscopy in sexual partners of women with condylomatous or dysplastic lesions]. / Intérêt de la péniscopie lors de lésions condylomateuses ou dysplasiques chez la femme.

TYPE OF STUDY: A retrospective study of 532 male sexual partners of patients who were examined for condylomatous or dysplasic lesions of the lower genital tract between January 1990 and June 1993. AIM: To evaluate the balanoscopy examination. The value of this examination for the follow-up of papilloma virus and dysplasic lesions in women. METHOD: Balanoscopy was performed after application of acetic acid (5%). Lesions were treated with viralytic agents or by CO2 laser destruction. Computer analysis of the data from the microscopic examination and treatment in partners was performed. MAIN RESULTS: Globally, peniscopy revealed a papilloma virus lesion in 43.3% of the cases. Nevertheless, for infectious lesions (condylomas) in women, 63% of the women had a papilloma virus lesions. CONCLUSION: Severe dysplasia of the penis is rare in our geographical area and balanoscopy is useful for the eradication of sexually transmitted diseases, sometimes for oncological examinations and to decrease the incidence of recurrent condylomatous or dysplasic lesions in women partners. Globally, the results are disappointing since the rate of recurrence was similar whether or not the male partner had been examined. The only difference was in case of rapid effective treatment in the partner which was obtained in 27% of the partners.

After potentials in nonmyelinated nerve fibers.

1. The sucrose-gap technique was employed to examine the different types of after potentials that follow, in desheathed rabbit vagus nerves, a single action potential (AP) elicited by a short (0.4 ms) supramaximal depolarizing pulse. 2. A fast and a slow hyperpolarizing after potential (fHAP and sHAP) as well as a depolarizing after potential (DAP) followed a single spike. Both the fHAP and the sHAP showed a dependence on the K+ electrochemical gradient, indicating that they are due to an outwardly oriented current of K+ ions. 3. The fHAP was sensitive to low concentrations of tetraethylammonium (TEA; 1 mM) and 4-aminopyridine (4-AP; 10 microM) and to millimolar concentrations of Ba2+. We conclude that the fHAP reflects the tail of the delayed rectifier K+ current. 4. The sHAP contained a Ca(2+)-sensitive component that showed a requirement for voltage-dependent Ca2+ entry during the AP. This component was completely blocked by low concentration of TEA (1 mM) and by Cd2+ (1 mM), but unaffected by 4-AP. These observations suggest that it reflects a current flowing through Ca(2+)-activated K+ channels. The remaining, apparently Ca(2+)-insensitive, component was insensitive to 4-AP and could be blocked by TEA only at concentrations greater than 50 mM. 5. The DAP usually appeared when the external concentration of K+ was increased to above approximately 8 mM, but sometimes it was clearly visible even at lower [K+]o. The DAP was TEA insensitive and entirely Ca2+ dependent. This latter property is inconsistent with the widely accepted hypothesis according to which the DAP reflect the accumulation of K+ in the extracellular space during the AP. 6. The origins of both the Ca(2+)-insensitive component of the sHAP and the DAP are not clear. However, in view of the fact that the sucrose-gap technique records not only the membrane potential of the nerve fibers but also of the surrounding glia, there is the possibility that these after potentials reflect changes in the electrical properties of the satellite Schwann cells.