MacGyveresque solutions.(CLINICAL PEARLS)

The year 2008 has been a tough one for some of us. Many companies are in financial trouble and the stock market has lost al most 50% of its value in the past year. Some of our colleagues have lost a large portion of their life savings. But as we come to the end of a rather nasty year, let's focus on the fact that there have always been cycles of good times and bad times. Things will certainly get better! Here are some pearls that may help you have a better time in 2009.

Laparoscopic-Assisted Hysteroscopy

Here's a pearl that even the extremely resourceful 1980s TV hero, MacGyver, would appreciate. Angus MacGyver was known for using such common objects as paper clips to do extraordinary things. During a hysteroscopy procedure, Dr. Brett Zimmerman of Holland, Mich., was having difficulty maintaining visualization because of a patulous cervix. The pressure bag was pumped up but fluid kept leaking, and he still couldn't see anything. A scrub nurse suggested that laparoscopy sheaths don't leak. So he asked for a 12-mm laparoscopy port (minus the trocar, of course) and slid it into the cervix. The hysteroscope was then inserted through the port as one would during a laparoscopy. The hysteroscopy was completed successfully Remember to keep the insufflation valve closed or the fluid will leak out.

The Painless Pipelle

Certain patients will experience unacceptable pain during an office endometrial biopsy when performed with a pipelle, such that the procedure cannot be completed. Dr. Douglas A. Levine of New York City has come up with a solution that even secret agent MacGyver would appreciate. Instilling lidocaine into the uterine cavity may ameliorate the pain associated with this procedure but it can be difficult to instill and maintain the lidocaine in the uterine cavity. Dr. Levine devised a system that has worked well for many patients. He uses a Potocky Needle (27 g ...