Dr Ken Law has published extensively in well-respected peer reviewed Medical Journals. He has also delivered numerous presentations on minimally invasive gynaecology at various national and international meetings. He is currently a Reviewer for several peer-reviewed Medical Journals on Obstetrics, Gynaecology and Fertility.
Energy sources incorporating “vessel sealing” capabilities are being increasingly used in gynecologic laparoscopic surgery although conventional monopolar and bipolar electrosurgery remain popular. The preference for one device over another is based on a combination of factors, including the surgeon’s subjective experience, availability, and cost. Although comparative clinical studies and meta-analyses of laparoscopic energy sources have reported small but statistically significant differences in volumes of blood loss, the clinical significance of such small volumes is questionable. The overall usefulness of the various energy sources available will depend on a number of factors including vessel burst pressure and seal time, lateral thermal spread, and smoke production. Animal studies and laboratory-based trials are useful in providing a controlled environment to investigate such parameters. At present, there is insufficient evidence to support the use of one energy source over another.
Laparoscopic vessel sealing devices have revolutionized modern laparoscopy. These devices fall into 2 major categories: advanced bipolar and ultrasonic instruments. The range of tissue effects available with these technologies is more limited than with conventional monopolar electrosurgery; however, both advanced bipolar and ultrasonic devices efficiently seal vessels (≤7-mm and ≤5-mm diameter, respectively), and most also have built-in tissue transection capabilities. These technologies have been the subject of a range of comparative studies on their relative advantages and disadvantages, and, to date, neither advanced bipolar or ultrasonic devices has been proven to be superior.
Laparoscopic subtotal/supracervical hysterectomy (LSH) is a surgical option when hysterectomy is indicated. Proponents of LSH suggest possible advantages including reduced recovery time, decreased risk of pelvic organ prolapse, and decreased risk of organ damage, in particular to the urinary tract. Opponents of LSH have suggested that the future risk of cervical malignancy, the possibility of ongoing cyclical bleeding, limited morbidity due to total laparoscopic hysterectomy, and similar clinical outcomes render this approach unnecessary. One study compared LSH with laparoscopically assisted vaginal hysterectomy in a randomized controlled trial that reported psychologic and sexual outcomes; however, no clinical data were published. The present review outlines techniques for subtotal hysterectomy and critically appraises the available evidence for outcomes including operative data, short- and long-term complications, and functional outcomes.
Urinary retention is a recognised complication of laparoscopic surgery. Previous work showed an association with 4% icodextrin solution and urinary retention.
To determine the incidence of urinary retention following laparoscopic gynaecological surgery with or without the use of 4% icodextrin.
A prospective observational study of 147 women undergoing laparoscopic gynaecological surgery for benign pathology. Women had their planned laparoscopic procedure and either received icodextrin solution or nothing as determined by their treating surgeon at the time of the operation.
From May 2011 to February 2012, 147 women were approached to participate in the study; of whom, 124 women were included: 62 received icodextrin and 62 did not. The women in the non-icodextrin group were significantly older (P = 0.007) and had a higher BMI (P = 0.03) than those in the icodextrin group. Following surgery, 27/124 (21.8%) women had post-operative urinary retention. Icodextrin was associated with significantly more urinary retention (P = 0.017), but did not extend hospital admission significantly (P = 0.14). The administration of icodextrin was associated with resection of moderate- or severe-stage endometriosis involving multiple surgical sites, whereas women in the non-icodextrin group were more likely to be having a hysterectomy.
In this non-randomised study, there were significantly more women with post-operative urinary retention when icodextrin was used; however, this did not contribute to an extended hospital admission. While there may be confounding factors, women receiving icodextrin should be warned of the possibility of urinary retention post-operatively, but that this is unlikely to affect their stay in hospital.
To assess women’s perception of pain and acceptability of low vaginal swab (LVS) and anorectal swab (ARS) for antenatal screening for Group B Streptococcus (GBS), and to compare the detection rate between these tests.
Separate LVS and ARS were collected at the 36-week antenatal visit, either by the patient herself or by her clinician. Acceptability and pain were evaluated on a Likert scale using a standardised questionnaire.
A total of 278 women were recruited, with a median gestation of 36.3 weeks (IQR 36–37). Of these women, 96% undertook specimen self-collection. The overall prevalence of colonisation was 64/278 (23%); 52 women had positive LVS results (18.7%), and an additional 12 (5.5%; 95% CI 2.5–8.5) were negative on LVS but positive on ARS. Most women rated LVS (99%) and ARS (92%) to be either ‘pain-free’ or causing ‘mild discomfort’, and found the LVS (90%) and ARS (84%) to be either ‘totally acceptable’ or ‘somewhat acceptable’.
The addition of an ARS resulted in an enhanced GBS positive rate, and most women found the test acceptable.