ADVANCES IN GYNAECOLOGICAL SURGERY GMM Edited by Peter J. O’Donovan Ellis G. R. Downes ADVANCES IN GYNAECOLOGICAL SURGERY 00Pre-cpp 14/11/01 2:14 pm Page i To my wife, Carmel, and my children James, Olivia, Charles and Niamh P. J. O’D. To my wife, Louise, and my children George and Lily E. G. R. D. 00Pre-cpp 14/11/01 2:14 pm Page ii ADVANCES IN GYNAECOLOGICAL SURGERY Edited by Peter J. O’Donovan Consultant Gynaecologist, MERIT Centre, Bradford Royal Infirmary, UK Ellis G. R. Downes Consultant Gynaecologist, Chase Farm Hospital, Enfield, Middlesex, London, UK Associate Editor Paul McGurgan Karl Stortz Research Fellow The MERIT Centre Bradford Royal Infirmiry Bradford LONDON ● SAN FRANCISCO 00Pre-cpp 14/11/01 2:14 pm Page iii © 2002 Greenwich Medical Media Ltd 4th Floor 137 Euston Road London NW1 2AA 870 Market Street, Ste 720 San Francisco CA 94109, USA ISBN: 1 900 151 499 First Published 2002 Apart from any fair dealing for the purposes of research or private study, or criticism or review, as permitted under the UK Copyright Designs and Patents Act, 1988, this publication may not be reproduced, stored, or transmitted, in any form or by any means, without the prior permission in writing of the publishers, or in the case of reprographic reproduction only in accordance with the terms of the licences issued by the Copyright Licensing Agency in the UK, or in accordance with the terms of the licences issued by the appropriate Reproduction Rights Organization outside the UK. Enquiries concerning reproduction outside the terms stated here should be sent to the publishers at the London address printed above. The right of Peter J. O’Donovan and Ellis G. R. Downes to be identified as editors of this work has been asserted by them in accordance with the Copyright, Designs and Patents Act 1988. The publishers make no representation, express or implied, with regard to the accuracy of the information contained in this book and cannot accept any legal responsibility or liability for any errors or omissions that may be made. www.greenwich-medical.co.uk A catalogue record for this book is available from the British Library. Designed and Typeset by Saldatore Limited and Phoenix Photosetting Ltd, Chatham Printed by The Bath Press 00Pre-cpp 14/11/01 2:14 pm Page iv CONTENTS LIST OF CONTRIBUTORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii FOREWORD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix Professor Christopher Sutton PREFACE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi ACKNOWLEDGEMENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xii INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiii E Downes 1 Microendoscopy in Gynaecology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 P J O’Donovan, J K Gupta 2 Laparoscopy in Urogynaecology. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 A R B Smith 3 Decision Analysis in Surgery. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 J G Thornton 4 Current Advances in Surgery for Stress Incontinence . . . . . . . . . . . . . . . . . . . . . . . . . 33 L Cardozo, J Bidmead 5 Vaginal Surgery – what can’t we do?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 S S Sheth 6 Laparoscopic Colposuspension . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 S Pringle, R Hawthorn 7 Vault Prolapse – can it be prevented? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79 D A Johns 8 Photodynamic Therapy in Gynaecology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87 M J Gannon 9 Virtual Reality Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99 N McClure,A G Gallagher, J McGuigan v 00Pre-cpp 14/11/01 2:14 pm Page v 10 New Surgical Techniques for the Treatment of Menorrhagia . . . . . . . . . . . . . . . . . . . . 105 N N Amso, E Tsakos 11 Laparoscopic myomectomy: techniques and results . . . . . . . . . . . . . . . . . . . . . . . . . . . 125 J B Dubuisson, C Chapron,A Fauconnier 12 Management of Vaginal Prolapse after Hysterectomy . . . . . . . . . . . . . . . . . . . . . . . . . 135 P Hogston 13 Recent Advances in Gynaecological Oncology Surgery . . . . . . . . . . . . . . . . . . . . . . 147 R A F Crawford 14 What is the Current Role of Endometrial Ablation and Resection? . . . . . . . . . . . . . . . 157 D E Parkin 15 Strategies to Avoid Complications in Laparoscopic and Hysteroscopic Surgery . . . . . . . 169 T C Li, P McGurgan, P J O’Donovan 16 Microwave Endometrial Ablation in the Outpatient Setting. . . . . . . . . . . . . . . . . . . . . 189 N Sharp 17 The Filshie Clip: current uses and future developments. . . . . . . . . . . . . . . . . . . . . . . . 199 S M F Ismail, G M Filshie 18 Recent Advances in Electrosurgery - VersapointTM technology. . . . . . . . . . . . . . . . . . . . 207 M Farrugia, P McGurgan, D L McMillan, P J O’Donovan INDEX. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 217 CONTENTS vi 00Pre-cpp 14/11/01 2:14 pm Page vi N N Amso Senior Lecturer/Honorary Consultant University of Wales College of Medicine Department of Obstetrics and Gynaecology Cardiff, UK J Bidmead Urogynaecology Research Fellow King’s College Hospital London, UK L Cardozo Professor of Urogynaecology Kings College Hospital London, UK C Chapron Service de Gynecologie Obstetrique II A Orientation Gynecologique Groupe Hospitalier Cochin Paris, France R A F Crawford Consultant Gynaecologist Addenbrooke’s Hospital Cambridge, UK Ellis Downes The Kings Oak Hospital Chase Farm Enfield J B Dubuisson Service de Gynecologie Obstetrique II A Orientation Gynecologique Groupe Hospitalier Cochin Paris, France A Fauconnier Service de Gynecologie Obstetrique II A Orientation Gynecologique Groupe Hospitalier Cochin Paris, France M Farrugia MRCOG Research Fellow Whipps Cross Hospital London G M Filshie MD FRCOG Formerly Reader/Consultant Queens Medical Centre Nottingham AJ Gallagher Consultant Department of Psychology David Keir Building Queens University Belfast, UK M J Gannon Consultant Obstetrician and Gynaecologist Gynaecology Out-Patients Department Pinderfields Hospital Wakefield, UK JK Gupta MD MRCOG Senior Lecturer Birmingham Women’s Hospital Edgebaston Birmingham R Hawthorn MD FRCOG Consultant Southern General Hospital Glasgow P Hogston Consultant Gynaecologist Saint Mary’s Hospital Portsmouth, UK S M F Ismail MRCOG Research Fellow MERIT Centre Consultant Gynaecologist MERIT Centre Bradford Royal Infirmary UK vii LIST OF CONTRIBUTORS 00Pre-cpp 14/11/01 2:14 pm Page vii D A Johns Clinical Associate Professor Texas Health Care Fort Worth Texas, USA T C Li Consultant Obstetrician and Gynaecologist Jessop Wing Royal Hallamshire Hospital Sheffield, UK N McClure Senior Lecturer Academic Dept of Obstetrics and Gynaecology Queen’s University of Belfast Belfast, UK J A McGuigan Consultant Thoracic Surgeon Royal Victoria Hospital Belfast, UK P McGurgan MB BA MRCOG MRCPI Karl Stortz Research Fellow The MERIT Centre Bradford Royal Infirmary Bradford, UK L McMillan FRCOG Consultant Whipps Cross Hospital London P J O’Donovan Consultant Gynaecologist MERIT Centre Bradford Royal Infirmary Bradford, UK D E Parkin Consultant in Obstetrics and Gynaeocology Aberdeen Maternity Hospital Aberdeen, UK S Pringle Specialist Registrar in Obstetrics and Gynaecology Southern General Hospital Glasgow, UK N Sharp Consultant Obstetrician and Gynaecologist Royal United Hospital Combe Park Bath, UK S S Sheth Consultant Gynaecologist Breach Candy Hospital Sir Hurkisondas Hospital India A R B Smith Consultant Obstetrician and Gynaecologist St Mary’s Hospital Whitworth Park Manchester, UK J G Thornton Research School of Medicine Centre for Reproduction, Growth and Development University of Leeds Leeds, UK E Tsakos Consultant Obstetrician and Gynaecologist St Luke’s Hospital Thessaloniki Greece LIST OF CONTRIBUTORS viii 00Pre-cpp 14/11/01 2:14 pm Page viii FOREWORD The final quarter of the last century witnessed a revolution in gynaecological surgery when the traditional approach by laparotomy was replaced by minimal access surgery. After dramatic improvements in safety in the final quarter of the preceding century, most pelvic operations changed very little in the ensuing 100 years and most advances were due to extrinsic factors, such as the introduction of fluid replacement and blood transfusion and the introduction of prophylaxis with antibiotics and anticoagulants.The actual approach to the surgery remained static until the introduction of laparoscopy and hysteroscopy, which enabled the inside of the abdominal cavity and the inside of the uterus to be visualised with remarkable detail and visualisation. That final quarter of the 20th Century was an exciting time to be involved in this particular branch of surgery and scarcely a year went past without the introduction of some new technique or energy source.Within a remarkably short space of time, it became possible to perform all pro- cedures in the gynaecological repertoire, with the exception of operations for advanced malig- nancy which were essentially palliative and of questionable benefit in the long term. I recall a conversation I had with an expert in feto-maternal medicine in 1985, when we were try- ing to get minimal access surgery accepted by the Royal College as a sub-specialty in its own right. I was told in no uncertain terms that the literature on laparoscopic and hysteroscopic surgery was scant, at best, and the quality was extremely poor with very little published in the form of ran- domised,controlled trials.Little did he know that in the ensuing years there would be an avalanche of publications, not merely addressing the technical minutiae, but also addressing safety issues and increasingly using well-designed studies to justify the superiority of minimal access therapy, according to the principles of evidence-based medicine. This time has now come to look at ourselves in a mirror and ascertain our present strengths and weaknesses and this is exactly what this book sets out to do. The Editors are both enthusiastic young surgeons who learned minimal access techniques during their training and are therefore able to look at these developments from a healthy distance. It has enabled them to produce an excellent volume of essays which are largely written by the "Young Turks" in the battalion rather than the “Old Guard”, although I am happy to see that the latter are well represented by Shirish Sheth from India, who looks at his lifetime experience with vaginal surgery and Alan Johns from Fort Worth in Texas who was one of the pioneers of laparoscopic hysterectomy and the laparo- scopic repair of uterovaginal prolapse. The volume looks at new methods of access with special emphasis on miniaturisation and also endeavours to show the reader that many of the operations no longer need to be performed in the hospital operating department and that the development of office-based procedures will cer- tainly decrease the cost of minimal access surgery. Hysterectomy for menorrhagia will increasingly be replaced by ablative procedures and the best of these are certain to be those that can be per- formed in the out-patient setting with local anaesthesia and oral analgesia.The different methods available for thermal ablation are well reviewed as well as newer techniques that might be avail- able in the future, such as photodynamic therapy and virtual reality surgery. ix 00Pre-cpp 14/11/01 2:14 pm Page ix