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Background: Advanced vessel sealing devices are widely used in laparoscopic surgery. However, there remains a lack of adequately powered trials comparing laparoscopic advanced vessel sealing devices in the clinical setting, especially in gynaecology., Aims: This single-blinded randomised controlled trial aims to compare the surgical outcomes of total laparoscopic hysterectomy (TLH) using either the Gyrus PKS™ LYONS dissecting forceps or the LigaSure™ Maryland jaw vessel sealer/divider., Materials and Methods: Women who required TLHs for benign indications were randomised to having their surgeries performed using either Gyrus PKS™ or LigaSure™. Time to haemostasis (from initial skin incision to detachment of the uterus with secured haemostasis) was the primary outcome; a 20% difference in time was considered clinically significant. Secondary outcomes measured were intra-operative blood loss, complications, conversions, post-operative analgesia use, and length of stay. This study was registered with the Australia New Zealand Clinical Trials Registry ACTRN12615000639516., Results: Sixty-four women were included in the study - 33 and 31 in the Gyrus PKS™ and LigaSure™ arms, respectively. TLHs performed by LigaSure™ had statistically significantly shorter time to haemostasis compared to Gyrus PKS™ by 10.6 min (95% CI 1.3-2.0, P = 0.03). There were no differences in any of the other secondary outcomes measured., Conclusions: This trial suggests there is no difference between using either device. TLHs performed using LigaSure™ have statistically significantly shorter time to haemostasis than those using Gyrus PKS™; however, the difference is not considered clinically significant as it was only 14.2%. No other differences in surgical outcomes were detected., (© 2020 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.)

The anatomical position of the inferior epigastric artery (IEA) subjects it to risk of injury during abdominal procedures that are close to the artery, such as laparoscopic trocar insertion, insertion of intra-abdominal drains, Tenckhoff(®) catheter (peritoneal dialysis catheter) and paracentesis. This article aims to raise the awareness of the anatomical variations of the course of the IEA in relation to abdominal landmarks in order to define a safer zone for laparoscopic ancillary trocar placement. Methods of managing the IEA injury as well as techniques to minimise the risk of injury to the IEA are reviewed and discussed., (© 2015 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.)

Background: Recent evidence supports the fallopian tube as the site of origin for many pelvic serous cancers (PSC) including epithelial ovarian cancers (EOC). As a result, a change in practice with opportunistic bilateral salpingectomy (OBS) at the time of hysterectomy has been advocated as a preventative strategy for PSC in a low-risk population., Aims: The aim of this study was to assess current clinical practice in Australia with respect to OBS during gynaecological surgery for benign indications., Materials and Methods: An anonymous online survey was sent to all active Royal Australian and New Zealand College of Obstetrics and Gynaecology (RANZCOG) Fellows in Australia. Data regarding clinician demographics and the proportion of clinicians offering OBS were collected. Reasons for and against offering or discussing OBS were sought. A descriptive analysis was performed., Results: The response rate was 26% (280/1490) with 70% of respondents offering or discussing OBS to women undergoing gynaecological surgery for benign indications, usually at the time of abdominal (96%) or laparoscopic (76%) hysterectomy. The main reason for offering or discussing OBS was current evidence to suggest the fallopian tubes as the site of origin for most EOC. Main reasons for not offering OBS were insufficient evidence to benefit the woman (36%) or being unaware of recent evidence (33%)., Conclusions: The survey responses indicate that OBS is frequently discussed or offered in Australia, usually at the time of hysterectomy. Given the lack of robust evidence to suggest a benefit at a population-based level, a national registry is recommended to monitor outcomes., (© 2015 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.)

Background: A retrospective analysis of all women undergoing hysterectomy at Sydney West Advanced Pelvic Surgery Unit (SWAPS) was performed in the nine-year period from 2001 to 2009., Aims: To evaluate the incidence, timing and presenting symptoms of vaginal vault dehiscence after hysterectomy, especially via the laparoscopic approach to gain further understanding of patient risk factors and surgical factors that may predispose to this complication., Methods: Women who presented with vaginal vault dehiscence were identified and possible pre-operative, intra-operative and post-operative risk factors were assessed. A comprehensive literature search was performed to assess the current understanding and incidence of vault dehiscence after laparoscopic hysterectomy., Results: A total of 1224 hysterectomies were performed between 2001 and 2009. 989 (80.80%) were performed laparoscopically of which five women (0.42%) presented with vault dehiscence post-operatively. All had undergone total laparoscopic hysterectomy resulting in a vault dehiscence rate of 1.59% after total laparoscopic hysterectomy specifically. Baseline characteristics included a mean age of 42.8 years (37-51 years), mean BMI of 26.8 kg/m(2) (23.8-32.3 kg/m(2)) and a mean parity of two deliveries (1-3 deliveries). The main presenting symptom of vaginal vault dehiscence was vaginal bleeding. Women with confirmed vaginal vault dehiscence readmitted to hospital at a mean of 18 days (11-28 days) post-operatively., Conclusion: Vaginal vault dehiscence is a rare complication after hysterectomy, but more common after a laparoscopic approach. A delayed presentation with vaginal bleeding was the main presenting symptom in this study - a literature review has shown common presenting symptoms to include abdominal pain, vaginal evisceration and vaginal bleeding. Techniques specific to total laparoscopic hysterectomy seem especially important in the increased risk of vaginal vault dehiscence seen after laparoscopic hysterectomy., (© 2012 The Authors ANZJOG © 2012 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.)

Objective: To review the rate of inadvertent cystotomy during laparoscopic hysterectomy performed by the Sydney West Advanced Pelvic Surgery Unit (SWAPS). To compare this rate with other published data. To identify the risk factors for bladder injury at laparoscopic hysterectomy and to review the management and outcome following such injury., Method: This was a retrospective observational study. All hysterectomies where the SWAPS clinical fellow was involved were included. The study period was from January 2001 to June 2009. Simple statistical formulae were used to analyse data in this study., Results: There were 1223 hysterectomies performed during this period. Eighty-one percent of these were performed laparoscopically. There were 14 (1.1%) bladder injuries reported during this period. All bladder injuries occurred in the laparoscopic group. The majority were managed by laparoscopic repair or conservative management (86%). Two cases (14%) were converted to laparotomy. There were no short- or long-term sequelae. With increasing experience, a fall in the incidence of inadvertent cystotomy was noted during the study period., Conclusion: Inadvertent cystotomy is a recognised complication at hysterectomy. The rate in the SWAPS unit is comparable to that of other published series. Overall, there has been a decline in the rate of bladder injury, which appears attributable to more experience gained with an acquisition of increased skill levels and improved techniques., (© 2011 The Authors. Australian and New Zealand Journal of Obstetrics and Gynaecology © 2011 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.)

Background: Chronic pelvic pain (CPP) is a complex clinical scenario, which affects 15% of women. The published literature lacks a consistent definition of CPP. However according to Vercillini et al., CPP is defined by the duration and type of pelvic pain. CPP is present if the pelvic pain persists for more than 3 months duration and is constant or intermittent, cyclical or noncyclical in nature. Four types of pelvic pain have also been described and these include: cyclical pain during menstruation (dysmenorrhoea), deep dyspareunia, dyschezia and noncyclical pelvic pain. Therefore for the purposes of this study, CPP will be defined by these aforementioned types of pelvic pain and duration., Methods: Multi-centre randomised controlled trial comparing Mirena IUS versus expectant management in women with CPP and/or dysmenorrhoea who undergo laparoscopic surgery. All women aged 18 - 45 years with CPP scheduled for laparoscopy will be eligible for inclusion. Women with a non-gynecological cause of pelvic pain, contraindications to the use of Mirena IUS, previous hysterectomy, contraindications to laparoscopy and/or general anesthesia, use of hormonal treatment in the preceding three months, underlying gynaecological malignancies or known ovarian cysts other than endometriomata will be excluded. Importantly, all randomised women with endometriosis noted at the time of surgery will have the disease excised laparoscopically. Routine excision of endometriosis at laparoscopy will be performed according to the anatomical location and type (superficial or deep infiltrating endometriosis (DIE)). Women will be followed for up to 24 months after laparoscopic surgery., Results: The primary outcome measure is improvement of pelvic pain and/or of dysmenorrhoea post-laparoscopic surgery for women. Assuming a 30% reduction in pain for the expectantly managed group in order to detect a reduction in pain in the study group of 50% with an alpha of 0.05 and a beta of 0.20, the sample size was estimated at a minimum of 103 women per trial arm., Discussion: This trial will provide evidence to validate the effectiveness or otherwise of progestogen-releasing IUS in treating women with CPP who undergo laparoscopy surgery. The pros and cons of both trial arms will offer guidance to clinicians in making the right treatment choice.

The aim of this study was to estimate the prevalence and significance of hematuria during laparoscopic hysterectomy for benign uterine disease. The review assessed its incidence, risk factors, site of associated urinary tract injuries, methods of diagnosis, management strategies, and most likely intraoperative point at which hematuria occurred during laparoscopic hysterectomies. A retrospective review of 755 cases of laparoscopic-assisted and total laparoscopic hysterectomies from January 1998 through December 2006 was undertaken at Sydney West Advanced Pelvic Surgery, Sydney, Australia.

Data is presented from 1019 antenatal ultrasonic cardiographs performed on 391 patients; uterine contractions were not monitored concurrently with the fetal heart rate (FHR). No fetal deaths in utero or preterminal FHR patterns were seen within 24 hours of a normal trace. A comprehensive classification of FHR patterns is presented.

Papillomavirus infection (HPV) of the female genital tract is now recognized as a major risk factor for the development of neoplasia. With the combined investigative modalities of cytology, colposcopy and histopathology, it is clear that precancerous changes and HPV are closely associated. The differentiation of innocent HPV infection from progressive premalignant disease is not clear-cut in all situations. Despite various treatment modalities, close follow-up of these patients by cytology, colposcopy and histology reveals the presence of persistent genital tract infection by HPV.