Biomedical subjects
DL Olive
Publications and source records attributed to DL Olive.
Cryomyolysis in the Conservative Treatment of Uterine Fibroids
Conservative surgical options for uterine fibroids are abdominal myomectomy, laparoscopic myomectomy, and, more recently, myolysis. Another option for the conservative surgical treatment of fibroids is freezing the structures. This procedure, cryomyolysis, can be performed rapidly by laparoscopic or hysteroscopic access. We performed a pilot study of 14 women with uterine fibroids. All were pretreated with a gonadotropin-releasing hormone (GnRH) agonist for 3 months to reduce uterine and myoma size. Cryomyolysis was performed in each, and the GnRH agonist was discontinued. Magnetic resonance imaging scans were performed in 10 of the 14 women after GnRH agonist treatment before surgery and 4 months postoperatively. Total uterine volume ranged from 41.3 to 1134.8 ml preoperatively and 49.5 to 1320 ml postoperatively, for a mean increase of 22%. Normal uterine volume ranged from 35.6 to 548.7 ml preoperatively and 45.1 to 729.6 ml postoperatively, for a mean increase of 40%. Myoma volume showed a mean decrease of 6% (range 87-28%). Analysis of frozen fibroids revealed a mean volume decrease of 10%. We conclude that cryomyolysis is able to maintain (or slightly reduce) the uterine fibroid at its post-GnRH agonist size, whereas all other uterine tissues return to pretreatment size.
Optometric Testing in the Laparoscopic Surgeon
Teaching and credentialing for endoscopic surgery are highly desirable, but they used instructional methods and testing criteria that have not been scientifically validated. Furthermore, it is unclear whether performing inanimate endosurgical exercises in a repetitive manner is the most efficient means of developing skills. Optometric testing in elite athletes is a quantifiable method of assessing specific tasks involving hand-eye coordination. We hypothesized that such methods of testing and improving athletic performance are applicable to evaluating and teaching endoscopic surgery skills. The first phase of this research was to perform a wide range of 12 tests in 53 laparoscopic surgeons to determine which tests correlate with superior skill. Results indicated that contrast sensitivity (the ability to discriminate fine detail), speed of recognition, rapid eye tracking (fine ocular motor skill), near-far focus (ability to accommodate), and eye-hand cross-dominance all correlated with endoscopic skill. The implications of these and other findings should be explored further to improve teaching endoscopic surgery.
Office Microlaparoscopy Under Local Anesthesia
We assessed the utility, tolerance, and costs associated with office microlaparoscopy under local anesthesia using fiberoptic microlaparoscopes (<2 mm) and accessory instrumentation (<2 mm) for 100 of the following procedures: diagnostic laparoscopy to evaluate infertility including chromopertubation; diagnostic laparoscopy for chronic pelvic pain (CPP), including biopsy of endometriosis and conscious pain mapping; and early second-look laparoscopy including lysis of adhesions. A prospective nonselected cohort study was conducted on all women with CPP or infertility who consented to office microlaparoscopy under local anesthesia. A questionnaire was developed to follow all aspects of patient acceptance and tolerance of the procedures, and women were screened preoperatively, and 30 minutes and 1 week postoperatively. Pain was evaluated with modification of the McGill pain inventory relative intensity scale. A subset of questions evaluated the recovery period, and time and length of all aspects of the procedure and recovery were recorded. Second-look procedures were significantly more painful than diagnostic ones, and women with CPP experienced significantly greater pain than those with infertility. Virtually all expressed high satisfaction with the procedure. There were no complications, and no procedures required general anesthesia. Compared with traditional laparoscopy, there was a reduction in costs greater than 70%.
Decreased Performance of Skilled Laparoscopic Surgeons at Microlaparoscopy versus Traditional Laparoscopy
The skill requirements for microlaparoscopy are significantly higher than those for the traditional technique. This program was designed to meet the demands of compensated two-dimensional depth perception, instrument accuracy, and ambidexterity. Three specialized drills were constructed and 60 experienced laparoscopists with advanced operative skills were evaluated. The three skill-assessment tasks were first performed using traditional laparoscopic instrumentation (10-mm laparoscopes, 5-mm accessory instruments). The performance of the study group was compared with an extensive database of over 1000 laparoscopic surgeons from around the world and did not reveal any significant deficits with traditional-size equipment. Next, the tasks were performed using miniature 2-mm laparoscopes and accessory instruments. Performance levels for all tasks were significantly lower than with traditional-size equipment. These results demonstrate the increased difficulty of performing laparoscopy with 2-mm instruments and underscore the importance of formal training and objective skill assessment. The relationship of skill to credentialing must be considered.
Fluoroscopically Guided Cervical Dilatation in Patients with Infertility
Uterine cervical stenosis of either congenital or acquired etiology is a contributing factor in fertility. In such patients it is technically difficult to traverse the tortuous or stenotic cervical canal, precluding diagnostic procedures such as endometrial biopsy and hysterosalpingography, as well as therapies such as in vitro fertilization and embryo transfer (IVF-ET) or insemination. The standard method of dilatation with successively larger dilators may be difficult and traumatic, causing false channels or perforation of the uterus. Fifteen patients were referred for cervical dilatation because of inability to gain access to the uterine lumen. Under fluoroscopic guidance, the cervix was cannulated and the endocervical canal dilated with an angioplasty balloon. Five women had simultaneous fallopian tube recanalization. Only one woman had mild postoperative vaginal bleeding that subsided spontaneously at 48 hours. No patients experienced pain requiring narcotics, and no infections occurred. Five women conceived, one after IVF-ET, two with intrauterine inseminations, and two spontaneously. In those who did not conceive, the cervix was easily cannulated after the procedure. Cervical dilatation may provide options for treatment that would otherwise not be available to a select group of infertile women with cervical stenosis.