While diagnosing abdominal adhesions, it is important to take a thorough clinical history in order to substantiate suspicions. This is crucial because a confident diagnosis will not be obtained by any other means, except intraoperatively.

Adhesions may occur anywhere in the body, but are most commonly found in the gastrointestinal tract, heart, and pelvis. Tissue injury due to surgery, trauma, infection, or radiation triggers cells in the body such as macrophages and fibroblasts to begin the process of healing.

This process results in the formation of bands of scar tissue or adhesions, which create an interface between tissues that are not usually joined together. While these adhesions themselves are painless, they generate adhesion-related complications that can cause pain and obstruction, which, in some instances, can be potentially life threatening.

The diagnosis of abdominal adhesions is typically done with the assistance of laparoscopy. This procedure involves using a camera to visualize the organs within the abdominal cavity. Routine tests such as X-rays, CT scans, and blood work are useless in diagnosing the adhesion itself. However, they are great choices in identifying adhesion-related complications like bowel obstruction, which restricts the movement of food, fluid, stool, and intestinal gases.

Management
Treating an abdominal adhesion depends widely on the adhesion-related problems, the location of the adhesion and the extent to which it is formed. There are two primary surgical techniques used to treat abdominal adhesions: laparotomy and laparoscopy. In laparoscopy, a small incision is made and with the help of the camera adhesions are cut and released.

This technique is known as adhesiolysis and is done under general anesthesia. It is indicated in patients who present with obstruction of the small bowel and no signs of inflammation of the peritoneum, hemodynamic instability, or bowel ischemia or perforation.

In laparotomy, a larger incision is made to directly see the adhesions and treat them. This technique is also known as open adhesiolysis and is associated with potential complications such as acute renal failure, sepsis, myocardial infarctions, respiratory failure, and wound infections. Moreover, the paradoxical relationship between treating adhesions surgically and surgery as the most common cause of adhesions makes the treatment of adhesions particularly difficult to manage.

Prevention
Preventing abdominal adhesions is not an easy feat. However, surgical techniques can effectively minimize the occurrence of abdominal adhesions. Laparoscopic surgery is great, because the incisions are smaller than that of laparotomy.

If, for whatever reasons, laparoscopic surgery cannot be done, and open adhesiolysis is required, a wax-like film is placed between the organs and the incisional area to help prevent the formation of new adhesions. The film is absorbed by the body within a week and it hydrates the organs in the process. This prevents dehydration, a strongly suspected cause of adhesion formation.

There have not been any studies published to support nutrition or diet as protective or causative factors in the development of abdominal adhesions. However, other steps that may be taken during surgery to reduce incidence are minimizing surgery time and intermittently moistening incisional area with saline, swabs, and drapes. Furthermore, latex- and starch-free gloves as well as the gentle handling of organs and tissues have shown promising results in terms of reducing the chances of developing post-operative abdominal adhesions.

A new study describes a safe way to remove the appendix following laparoscopic appendectomy in pediatric patients.

Developed by researchers at Ospedale Regionale Bellinzona e Valli (Switzerland) the technique uses the cut end of a sterile surgical latex glove to isolate and remove the resected appendix intact from the surgery site, so that surgeons can avoid the need for wide surgical incisions. The technique ensures that the patient’s abdominal wall is not exposed to the appendix’s inflamed tissue during the removal process.

For the study, the researchers retrospectively analyzed the files of 291 children (2–16 years of age) who were operated on by laparoscopic appendectomy between September 2004 and April 2015 using the technique. The results showed that the appendix was easily extracted in all the cases, no intraoperative complications related to the technique were observed, and overall, only one patient presented wound complications. The study was published in the January 2016 issue of the Journal of Pediatric Surgery.

“Avoiding wide surgical incisions and abdominal wall contaminations is essential during laparoscopic appendectomies in children. Our easy, safe and cheap technique allows these important goals to be achieved,” concluded lead author Mario Mendoza-Sagaon, MD, and colleagues of the department of pediatric surgery.

Following laparoscopic appendectomy the appendix should be removed from the peritoneal cavity as soon as it is transected, so that it does not contaminate surfaces or leak tainted fluids from its lumen. As wound protection is essential, the appendix must be extracted intact. If not, peritoneal defenses may not sufficient to control the extent of contamination, with the end result being more frequent postoperative abscesses.

Endometriosis is a painful uterine illness that is invisible to the naked eye, yet should never be minimized. Our friends at Your Tango are sharing the stuggles those with endometriosis endure, and what they want the public to know

Endometriosis is the illness that just keeps on giving.

On paper, we couldn't be more different, but for some reason, I strongly identify both with Lena Dunham and her Girls character, Hannah Horvath. I don't live in New York, I'm way older, and I'm not a tenth as comfortable with my body as both Lena and her character seem to be.

But besides a need to write and promote essay books, Lena and I have something else in common: we both have endometriosis and have both had our insides described as a mess.

Endometriosis happens when the cells from the lining of the uterus appear and continue to live outside the uterine cavity. They're outside the uterus, but are still under the influence of female hormones, which means they react the way they're supposed to if they were inside the uterus — thickening and shedding once a month. But the blood has no place to go, so cysts, adhesions and scar tissue are formed; everything becomes glued together and causes your insides to look like a mess.

I had the usual cramps and intense periods when I was growing up, but I didn't know I had endometriosis until I was diagnosed with a big cyst. They didn't immediately diagnose me with the cyst, but I was treated for a yeast infection a couple of times before I finally got the cyst diagnosis. When my doctor went in to remove the cyst, she found endometriosis everywhere — like a crime scene in my pelvic area.

Once we knew that I had endometriosis, that's when all the fun began with surgeries, treatments and pain. In some ways, this has become a curse to me and has made me very knowledgeable in the area of chronic pain, pain management, and the struggles of living with endometriosis.

Here's what women with endometriosis want you to know.

1. We aren't faking it to get out of doing something fun.

I know it can be annoying when we have to cancel our plans with you because we're not feeling well. It may seem like it happens too often to be real, but the pain of endometriosis can be debilitating. We want to do fun things and hang out with you, but there are times when getting dressed seems like an impossible task.

2. Endometriosis pain isn't just really bad cramps.

When you have endometriosis, it's not just like having a bad period — it's like having a bad period times a thousand. Everything is different. For me, the cramps are like someone shoving a hand up my vagina and squeezing. I have a lot of scar tissue and adhesions, so the pain feels like a hardening of my abdomen with kicks of pain. That sounds like I'm having a devil baby, and that's exactly what it feels like.

3. The pain isn't always brought on by PMS.

Sure, it's bad during that time of the month but it can be bad at any time. If I bend over a certain way or lie down — boom! Horrible pain. If I'm going to get my hair cut or my eyebrows waxed, I have to take three Advil as a cautionary device.

4. Endometrial cells have wanderlust.

Those badass cells like to travel, so while it's primarily in the pelvic cavity, on or under the ovaries, or behind the uterus, they can also grow to the bowel, bladder, lungs and other areas of the body.

5. The only way to remove it is with surgery.

The most common procedure to diagnose endometriosis is a laparoscopy. During this surgery, a thin, lighted tube is inserted into the abdomen through a small incision. In my case, they knew that there was already some kind of mass in my pelvic area, and so they had to go in and burn it off. Diagnosing endometriosis isn't as easy as just getting a blood test.

6. We aren't weak just because we can't always handle the pain.

It's actually pretty amazing the things that women with endometriosis manage to do. In an essay, Dunham talks about shooting her film Tiny Furniture and spending her first lunch break hiding on the toilet, "begging the lone female crew member to bring me Midol, heavy barbiturates or any combination thereof." Many women don't have the luxury to take off work when they're having a bad endometriosis episode and they have to keep going.

7. Sex can be superchallenging.

I don't know what position is going to set the pain-bomb off, and then there's always the issue of spotting. Here's another thing when you're writhing in pain: you might not be in the mood for sex. Though, if I'm careful body-position-wise, masturbation can sometimes help.

8. Treatments can be really hard on the body.

One of the first things a doctor may prescribe is birth control pills, and sometimes you have to be on them every day of the month so you miss periods. Another treatment is drugs, like Lupron, which is a medicine given to men with prostate cancer.

Since Lupron reduces the amount of testosterone in men and estrogen in women, when used as a treatment for endometriosis it can make you go through a false menopause. Yes, all the negatives of menopause (such as chin hair, hot flashes and night sweats), and none of the benefits.

9. Getting pregnant is complicated.

It used to be believed that if you got pregnant, your endometriosis would go away. However, while pregnancy may temporarily suppress the symptoms of the disease, it doesn't get rid of it permanently. Also, because of all the scar tissue, women who want to become pregnant may have a difficult time, though some women with endometriosis can still get pregnant.

10. There's no cure.

If you have a hysterectomy, you still may have the disease. Menopause may stop it, but if you go on estrogen, it will come right back. If your surgeon burns away the endometrial tissue, it will return.

If Lena Dunham can't promote the last season of Girls or is delayed in writing her next book, give her a break. Endometriosis is a very difficult disease to live with on a day-to-day basis and it's one that may cause her considerable pain through the foreseeable future.

SUNNYVALE, Calif., Feb. 29, 2016 (GLOBE NEWSWIRE) -- Intuitive Surgical, Inc. (Nasdaq:ISRG) today announced the published results from a new study1 titled, “Multicenter analysis comparing robotic, open, laparoscopic and vaginal hysterectomies performed by high volume surgeons for benign indication.” When evaluating comparable surgeon experience, the study found that women undergoing benign hysterectomies by robotic-assisted surgeons using da Vinci® Surgical Systems had better outcomes and experienced fewer complications compared to conventional abdominal, vaginal and laparoscopic hysterectomies outcomes.2

The study, which was published in the International Journal of Gynecology and Obstetrics, and led by Peter Lim, M.D. at Renown Regional Medical Center in Reno, Nevada, analyzed over 32,000 benign hysterectomy cases and compared the outcomes of high-volume surgeons across the four surgical approaches. The study compared 30-day outcomes from robotic-assisted hysterectomies performed by high-volume surgeons (≥60 procedures) with data from high-volume surgeons obtained from the Premier Perspective database for abdominal, vaginal, and laparoscopic hysterectomies. The data evaluated included: 2,300 robotic-assisted, 9,745 abdominal, 8,121 vaginal and 11,952 laparoscopic hysterectomies.

“It’s long been clear that minimally invasive hysterectomy can help reduce complications and speed recovery. But past studies comparing open and minimally invasive approaches compared less experienced robotic-assisted surgeons with colleagues in other approaches,” said Peter Lim, M.D., FACOG, The Center of Hope, Renown Regional Medical Center, Nevada. “This study is designed to compare only the outcomes of similarly experienced surgeons, regardless of surgical approach, which provides a much more accurate picture of comparative effectiveness.”

The study found subjects undergoing robotic assisted procedures with Intuitive Surgical’s da Vinci robotic surgical systems experienced significantly fewer intraoperative complications than patients who underwent abdominal or vaginal procedures and fewer than those who had a laparoscopic procedure. These better outcomes were observed despite the increased complexity of patients in the robotic-assisted group.

“Women in the robotic-assisted group had higher rates of obesity, adhesions and large uterus, suggesting that the robotic technology actually enables surgeons to perform surgery on more complex cases,” said Lim. “This study gives women and the surgeons who care for them important insights to inform their decision making.”

“This study provides compelling and valuable evidence on the advantages of robotic-assisted benign hysterectomy,” said Myriam Curet, M.D., Senior Vice President, Chief Medical Officer at Intuitive Surgical. “For women undergoing these procedures, the benefits of robotic-assisted surgery shown in this study carry real and tangible results for their recovery and return to everyday life.”

1 Intuitive Surgical Inc. provided funding for independent research and editorial support.

2 Lim PC, Crane JT, English EJ, Farnam RW, Garza DM, Winter ML, Rozeboom JL. Multicenter analysis comparing robotic, open, laparoscopic, and vaginal hysterectomies performed by high-volume surgeons for benign indications. International Journal of Gynecology and Obstetrics. 2016.

About Intuitive Surgical, Inc.

Intuitive Surgical, Inc. (Nasdaq:ISRG), headquartered in Sunnyvale, Calif., is the global leader in robotic-assisted, minimally invasive surgery. Intuitive Surgical develops, manufactures and markets the da Vinci® Surgical System.

About the da Vinci Surgical System

There are several models of the da Vinci Surgical System. The da Vinci Surgical Systems are designed to help surgeons perform minimally invasive surgery. da Vinci Systems are not programmed to perform surgery on their own. Instead, the procedure is performed entirely by a surgeon who controls the system. da Vinci Systems offer surgeons high-definition 3D vision, a magnified view, and robotic and computer assistance. They use specialized instrumentation, including a miniaturized surgical camera and wristed instruments (i.e., scissors, scalpels and forceps) that are designed to help with precise dissection and reconstruction deep inside the body.

Important Safety Information

Serious complications may occur in any surgery, including da Vinci Surgery, up to and including death. Risks include, but are not limited to, injury to tissues and organs and conversion to other surgical techniques. If your doctor needs to convert the surgery to another surgical technique, this could result in a longer operative time, additional time under anesthesia, additional or larger incisions and/or increased complications. Individual surgical results may vary. Patients who are not candidates for non-robotic minimally invasive surgery are also not candidates for da Vinci Surgery. Patients should talk to their doctors to decide if da Vinci Surgery is right for them. Patients and doctors should review all available information on non-surgical and surgical options in order to make an informed decision. Please also refer to www.daVinciSurgery.com/Safety for Important Safety Information.

Forward-Looking Statement

This press release contains forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995. These forward-looking statements are necessarily estimates reflecting the best judgment of our management and involve a number of risks and uncertainties that could cause actual results to differ materially from those suggested by the forward-looking statements. These forward-looking statements should, therefore, be considered in light of various important factors, including those under the heading "Risk Factors" in our annual report on Form 10-K for the year ended December 31, 2015, as updated from time to time by our quarterly reports on Form 10-Q and our other filings with the Securities and Exchange Commission. Statements using words such as "estimates," "projects," "believes," "anticipates," "plans," "expects," "intends," "may," "will," "could," "should," "would," "targeted" and similar words and expressions are intended to identify forward-looking statements. You are cautioned not to place undue reliance on these forward-looking statements, which speak only as of the date of this press release. We undertake no obligation to publicly update or release any revisions to these forward-looking statements, except as required by law.

© 2016 Intuitive Surgical, Inc. All rights reserved. Product names are trademarks or registered trademarks of their respective holders.

Intuitive Surgical, Inc. (Nasdaq:ISRG)
Corporate Communications
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INTRODUCTION: This study aimed to investigate asthma prevalence and severity in women with and without endometriosis. METHODS: Before laparoscopy, asthma prevalence was evaluated in 879 women of reproductive age, undergoing surgery because of benign gynaecological conditions. Diagnosis of bronchial asthma was based on the American Thoracic Society criteria; asthma severity was classified in four categories according to the 2002 Global Initiative for Asthma guidelines. Asthmatic patients completed the Living with Asthma Questionnaire (LWAQ). Endometriosis was confirmed histologically and classified according to the revised American Fertility Society criteria. RESULTS: There were no significant differences in age, smoking status, and other demographic and health characteristics between patients with endometriosis (n = 467) and controls (n = 412). Asthma prevalence was similar in women with (23/467, 4.9%; 95% CI, 3.1–7.3) and without (22/412, 5.3%; 95% CI, 3.4–8.0; P = 0.781) endometriosis. Asthma severity was similar in women with and without endometriosis, with 12 (52.2%) women with endometriosis and 13 (59.1%) controls being in the intermittent (mildest) degree of severity. No significant difference was observed between women with and without endometriosis in the LWAQ total score. CONCLUSIONS: Women with endometriosis do not have an increased risk of having asthma.