Single-Port/Pneumovagina Technique for Two Further Applications.

OBJECTIVE: To demonstrate a novel technique to surgically treat certain vaginal conditions. DESIGN: Technical video demonstrating 2 cases in which the technique is used. SETTING: Gynecological Minimally Invasive and Robotic Surgery Unit at Clínica Universitaria (private clinic), Concepción, Chile. INTERVENTIONS: Local institutional review board was consulted, and this study was exempted from approval. Institutional ethics committee approved the study and publication of these data. A 35-year-old woman with a bicornuate unicollis uterus presented with dyspareunia. Her examination revealed an incomplete longitudinal vaginal septum. Her right hemivagina was slightly wider than the left one. With the patient under spinal anesthesia, we performed a complete resection of the septum using the single-port/pneumovagina technique (SPPT). A 36-year-old woman who was nulligravida presented with dyspareunia. On clinical exam she had a 3-cm leiomyoma in the proximal vaginal third. Doppler-powered pelvic ultrasound ruled out any vascular communication with the cervix. We performed a vaginal myomectomy using the SPPT under spinal anesthesia. In this particular case we used a fourth trocar in the gel cap to use a myoma screw. With this technique we created a pneumovagina occluding the introitus with the aid of a single-port device (GelPoint Path; Applied Medical, Rancho Santa Margarita, CA). We selected this particular device, designed for transanal surgery, because its access channel avoids gas leakage after applying gentle pressure on the cap. The working cannel is 4 × 4.5 cm, and up to 4 trocars can be inserted in the gel cap. We use 12 mm Hg of pressure to create the pneumovagina and 5 L/min flow to maintain it. Similar approaches have been described for treating eroded and/or infected sacrocolpopexy mesh [1-3]. One could question the utility of this approach over conventional vaginal surgery, and in this sense we believe it provides both the surgeon and surgical assistant a much more comfortable and ergonomic position while performing surgery. It also improves the view of anatomic structures for the surgical team, which in conventional vaginal surgery is limited only to the surgeon. Both procedures were uneventful. The operation time for the first patient was 5 minutes, and the patient was discharged 4 hours later. The operation time for the second patient lasted 35 minutes, and she was discharged 12 hours later. CONCLUSION: The creation of a pneumovagina with the application of a single-port device provides an excellent view of vaginal structures and allows the application of laparoscopic techniques to perform vaginal surgeries in a much more ergonomic fashion compared with conventional vaginal surgery.

Incontinencia urinaria de esfuerzo: evaluación de resultados con distintas técnicas urológicas / Urinary stress incontinence: effect of evaluation with different urologic techniques

Se analizan 50 pacientes portadoras de Incontinencia Urinaria de Esfuerzo (IOE), operados en el Servicio de Urología del Hospital Regional de Temuco, durante los años 1978-1988 (10 años). Se emplearon tres técnicas quirúrgicas diferentes, informándose los resultados exitosos obtenidos con cada una de ellas: Marshall-Marchetti modif.: 75%; Pereyra modif.: 56% y Lapides II: 90%. No se efectuó evaluación urodinámica previa a las intervenciones

Incontinencia urinaria de esfuerzo: resultados con distintas técnicas / Urinary stress incontinence: results with different technics

Se analizan 50 pacientes portadores de Incontinencia Urinaria de Esfuerzo (IOE) operados en el Servicio de Urología del Hospital Regional de Temuco entre 1978 y 1988. Se emplearon 3 técnicas quirúrgicas cuyos resultados exitosos son: Marshall-Marchetti mofif. 75%, Pereyra modif. 56% y Lapides II 90%. No se efectuó evaluación urodinámica previa a las intervenciones