Operational improvement of gynecologic laparoscopic operating room services: an internal review.

BACKGROUND: To reorganize reusable laparoscopic instrumentation to promote instrument accessibility, minimize instrument breakage, eliminate infrequently used instruments on permanent trays, and help control maintenance costs. TECHNIQUE: The Robert Wood Johnson University Hospital Gynecologic Steering Committee evaluated during a 5-month period the storage, use, and maintenance of gynecologic laparoscopic instrument sets used in the surgical suite. Acting on this data, the committee oversaw the following changes. Infrequently used instruments were removed from permanent trays and separately packaged. Two types of gynecologic laparoscopy trays were prepared: one for laparoscopic bilateral tubal ligations and one for both diagnostic and operative laparoscopy. A double-decker compartmentalized tray in which instruments were sterilized and stored replaced the extant single-layer ones in which instruments were stacked on each other. To facilitate instrument identification and function, a surgical manual was compiled with photographs of each instrument and a description of its use. EXPERIENCE: After implementation of these changes, maintenance and sterilization costs for a 10-month period were compared with those for the previous 10 months. There was a savings of $13,889. The ratio of total costs divided by number of cases performed during the two study periods was also compared. There was a savings of $31 per case. CONCLUSION: Savings were achieved by reorganizing this operating room's handling of reusable gynecologic laparoscopy equipment. By eliminating infrequently used instruments from the permanent trays and by using a double decker compartmentalized tray that was used during surgery, sterilization, and storage, both sterilization costs and maintenance costs were reduced.

The correlation between HIV seropositivity, cervical dysplasia, and HPV subtypes 6/11, 16/18, 31/33/35.

Twenty-one human immunodeficiency virus (HIV) seropositive patients were studied to determine the prevalence of cervical dysplasia, the distribution of human papilloma virus (HPV) subtypes, and the utility of cytologic diagnosis in this population. The patients ranged in age from 18 to 41 years. HIV infection was diagnosed in all patients by ELISA method and confirmed by Western blot. Patients were interviewed to document risk factors for HIV infection and cervical dysplasia. All were examined colposcopically and identifiable lesions were biopsied. In patients with normal colposcopic findings four quadrant biopsies were performed. Cervical and endocervical smears were obtained on all patients at the time of colposcopy and blood was collected for T-cell studies. Eighteen patients (86%) had abnormal cytologic findings. The Pap smear was able to identify 10 of 13 biopsy-proven epithelial abnormalities. In 14 patients there was sufficient tissue for HPV typing by in situ hybridization; the HPV subtypes identified were 6/11 (10 patients), 16/18 (9 patients), and 31/33/35 (9 patients). Dysplasia was present in 11/14 (79%) of the specimens submitted for subtyping. The absolute CD4 cell counts were 342 per mm3 for the dysplasia group and 281 per mm3 for the patients without dysplasia. Patients with dysplasia did not differ significantly from patients without dysplasia in regard to risk factors for cervical dysplasia, including history of STD, tobacco use, multiple sexual partners, age at first coitus, and parity. In addition, history of medication use and risk factors associated with HIV infection were similar in both groups.(ABSTRACT TRUNCATED AT 250 WORDS)