| Letter
to the Editor
OB/GYN April 2005
To the Editor:
Drs Colleen L. Casey, Arnold
P. Advincula, and William M. Burke wrote an excellent article, “Laparoscopy in the Obese Gynecologic Patient,” in the January 2005 edition of The Female Patient (2005;30(1):29-35). The authors provided insightful surgical techniques for performing minimally invasive surgery on obese gynecologic patients.
With regard to trocar site closure, definitely exposing the
fascia can be particularly challenging in the obese patient. I wanted to comment on the Carter—Thomason device not being long enough to traverse the abdominal wall of the very obese patient (mentioned on page 34). If this occurs with the standard device, there is a version of the Carter-Thomason trocar wound closure device, the Carter-Thomason CloseSure System XL (Inlet Medical, Inc, Eden Prairie, Minn), that has been specifically designed for use in the obese patient. Both of the instruments, the suture passer and Pilot guide, have been lengthened to extend through a thicker fat layer into the peritoneum. The XL system also includes a 15-mm guide for closing larger defects. Such a device allows direct visualization of the closure and would be an excellent addition to the physicians’ choices for fascial closure.
Congratulations again to our excellent laparoscopic colleagues from the University of Michigan for their outstanding work.
James E. Carter, MD, PhD
Mission Viejo, Calif
The Authors Respond
Drs Casey, Advincula, and I want to thank Dr Carter for his positive feedback on our article and for sharing the information on the Carter-Thomason CloseSure System XL (Inlet Medical, Inc, Eden Prairie, Minn). The gynecologic services at the University of Michigan have been extremely pleased with the performance and versatility of the Carter-Thomason device. We have recently had the opportunity to sample the Carter-Thomason CloseSure System XL, and look forward to adding the device to our surgical armamentarium. This type of surgical innovation helps overcome the challenge of operating on heavier patients and makes it possible to offer advanced laparoscopic procedures to a greater number of women while keeping safety a priority.
William M. Burke, MD
Ann Arbor, Mich
back to top
To the Editor:
After reading your Spanish special edition on women and contraception
by Drs Kaunitz, Sulak, Nelson, and Arias (La Opción Anti–conceptiva
Intrauterina: Seguridad, Conveniencia y Eficacia. The Female Patient.
2005;S49:1-12), I developed a better clinical understanding of what
is currently available to women in terms of intrauterine device (IUD)
methods. The articles are informative and present excellent and relevant
information to your readers. I also felt that I could better inform
my own female patients on what the market now has available.
I was impressed to learn that noncontraceptive options of the sistema intrauterino de liberación de levonorgestrel (SIU) include treatment of menopausal symptoms as well as endo–metriosis. The statistic provided by Dr Kaunitz that 25% of the female population feels remorseful post–tubal ligation was much higher than I anticipated. The suggestion of inducing amenorrhea through use of the SIU device is very appealing—not to mention that this office procedure is cost-effective as well, which will help to effectively market this device.
I agree with the authors that a poor impression was made on women secondary to the Dalkon Shield in relation to mortality and lack of alternative IUDs. In the article by Dr Nelson, I was made aware of a high worldwide IUD utilization versus only 2% usage in American women. I believe the SIU, with its lower side-effect profile, may allow physicians to revisit intrauterine contraceptive options and provide women with an inexpensive and long-term form of contraception.
Lastly, in your patient handout, I felt touched by the most salient points made for Spanish-speaking patients on the effectiveness, convenience, and most importantly, cost factor of the SIU. In the future, it is my hope that our office can provide this information to our Spanish-speaking clientele.
Joseph M. Alonzo, MD
Chino, Calif
back to top
|
