Glossary

1. On the morning before your scheduled procedure begin a clear liquid diet only (broths and light soups are fine) 
2. At 9:00 AM on the day before surgery, begin drinking your chilled Gavage solution (Golytely or Nulytely) 
3. Drink all of the solution by noon if you can. You will shortly experience the desired results. 
4. By 6 PM, your stools should be very clear.
5. You may drink clear liquids until midnight. 
6. Don't drink or eat anything after midnight on the day of surgery. 
7. Please arrive at the hospital at the prearranged time.

Colonoscopy: The visual examination of the inside of the colon (large bowel) to detect cancer, polyps, endometriosis, etc. Bowel preparation has to be done prior to Colonoscopy.

Colostomy: Temporary or permanent connection of the colon to the abdominal wall, allowing stool to be collected in a plastic bag attached to the opening in the abdominal wall.

CT scan (CAT scan): CT, or CAT, stands for "computerized axial tomography." Basically, CT scans consist of a highly sensitive x-ray beam that is focused on a specific plane of the body. As this beam passes through the body, it is picked up by a detector, which feeds the information it receives into a computer. The computer then analyzes the information on the basis of tissue density. This analyzed data is then fed into a cathode ray tube (the device responsible for producing pictures on your TV screen), and a picture of the x-rayed, cross-section of the body is produced. Bone shows up as white, gases and liquids as black, and tissue as varying shades of gray, depending on its density.

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Cystic structure: A cyst is a fluid filled structure.

Cystoscopy: A visual examination of the inside of the urinary bladder.

Danazol: Danazol is a derivative of testosterone (male hormone). It is an effective medication for the suppression of endometriosis, but it has been plagued by significant side effects. This drug suppresses endometriosis by two separate mechanisms. First it will decrease estrogen production in the ovaries, by suppressing FSH production and LH ovulatory surge. The second mechanism is a direct effect on the implants of endometriosis causing them to shrink (atrophy). Danazol will relieve pain in up to 90% of the women undergoing six months of therapy. After stopping the treatment there may be a recurrence of pain within one year in up to 35% of individuals. The side effects of Danazol include weight gain, acne, hot flushes, increased hair growth and decrease in breast size.

Danazol vaginal suppositories: Vaginal Danazol suppresses endometriosis without causing significant side effects. It gets absorbed directly into the pelvic tissues through the wall of vagina. The only side effects experienced by my patients using vaginal Danazol include some vaginal irritation and occasional constipation.

Diaphragm: The abdominal diaphragm separates the chest from the abdominal cavity, it is a rare site of endometriotic implants.

Electrocauthery: Method of sealing vessels and cutting tissue by use of high-energy electric current.

Electrocauthery Bipolar: Method of controlling bleeding by application of high-energy electrical current. Two very small paddles are applied to the bleeding vessel and electrical current is passed between the paddles (electrodes) creating heat and sealing the blood vessel. The thermal injury is usually limited to the area between the paddles.

Electrocauthery Unipolar: Method of controlling bleeding or cutting tissue by application of high-energy electrical current. The electrical current is delivered via one electrode (needle, scissors) cutting or coagulating tissue immediately adjacent to the electrode. The current than passes by the shortest possible route to another electrode (grounding pad) usually located on the patient's thigh, where it is removed from the body. The thermal injury is usually greater than that with bipolar electrocauthery.

Endometrioma: A cyst within the ovary containing old blood and tissue debris, the wall of the cyst is usually covered with implants of endometriosis.

Endometriosis: Presence of endometrium (the lining of the uterine cavity) outside the uterus.

Fallopian tubes: The tubes connecting the inside of the uterus with the abdominal cavity. The function of the fallopian tube is to pick the egg from the ovary and transport it in the direction of the uterus. At the same time, it provides a good environment for the sperm to fertilize the egg and to nourish the early embryo.

GnRH Agonists: GnRH agonists cause pseudomenopause by suppressing production of FSH and LH by the anterior pituitary gland. There are three commercial preparations available in the US: Lupron Depot (Leuprolide acetate) given in monthly injections, Zoladex (Goserelin acetate) inserted under the skin every 28 days, and Synarel (Nafarelin acetate) used as an intranasal spray twice a day. GnRH agonists provide effective pain relief for most of the women suffering from endometriosis by producing a menopause like state, causing endometrial implants to shrink (atrophy) secondary to the lack of estrogen. After stopping the treatment there may be a recurrence of pain within one year in up to 50% of individuals. The side-effects of GnRH agonists include hot flushes, vaginal dryness, decreased sexual desire, irregular vaginal bleeding, depression, sleep disturbances, joint stiffness and skin changes.

Harmonic scalpel: A laparoscopic instrument that uses energy created by sound waves to cut tissues and seal blood vessels.

Inflammatory reaction: Reaction of the body to trauma, infection, or foreign substances. The purpose of the reaction is to isolate, neutralize the substance and remove it from the body.

Irritable Bowel Syndrome: Irritable Bowel Syndrome (IBS) is part of a spectrum of diseases known as Functional Gastrointestinal Disorders which include diseases such as noncardiac chest pain, nonulcer dyspepsia, and chronic constipation or diarrhea. These diseases are all characterized by chronic or recurrent gastrointestinal symptoms for which no structural or biochemical cause can be found.

Laparoscopy: Minimally invasive surgical procedure. After anesthesia, the surgeon makes a small (less than one inch) incision in the skin just below the navel, gas is installed in the abdomen creating an air bubble. The telescope with the camera attached is inserted into the air bubble and the organs in the pelvis and the abdomen are evaluated. There is usually a need to insert additional smaller instruments through lateral punctures to manipulate the organs, remove ovarian cysts, adhesions and treat endometriosis. Because this surgery does not involve making a large abdominal incision there is much less pain and a quicker recovery. This kind of surgery may not be appropriate for all conditions, especially if malignancy is suspected.

Laparotomy: This is a traditional method of doing abdominal surgery. The incision is made in the abdominal wall vertically or horizontally (bikini incision). The surgery is performed through these incisions. Because of the larger size of the incisions the recovery is usually longer and associated with more pain than recovery from laparoscopy. However, this may be the appropriate approach for some of the conditions, especially if malignancy is suspected.

Laser: A laser is an instrument that uses a beam of light (energy) to cut, vaporize and coagulate tissues and seal the blood vessels. There are three major types of laser used in gynecology.

Argon Laser: This laser uses a mixture of argon gas to create the laser beam. The energy beam of an argon laser is especially well absorbed by red pigment (blood, red endometriosis). The thermal injury to surrounding tissue is less than YAG laser but greater than CO2 laser.

CO2Laser : This is the most commonly used laser. This laser uses mixture of CO2 to create a laser beam (energy beam). Energy of a CO2 laser is readily absorbed by water. This is a very precise laser, excellent for cutting and vaporization of tissues, but it is not very effective in sealing larger blood vessels.

YAG Laser: The Neodymium YAG laser produces a beam of energy that can be transported via a flexible fiber. The Yag laser cuts and vaporizes tissue and it is very effective in sealing blood vessels. However, the thermal injury to the surrounding tissue is quite extensive.

Lupron Depot: A GnRH agonist thet causes pseudomenopause by suppressing production of FSH and LH by anterior pituitary gland. Lupron provides effective pain relief for most of the women suffering from endometriosis by producing a menopause-like state causing endometrial implants to shrink (atrophy), secondary to the lack of estrogen. After stopping the treatment there may be a recurrence of pain within one year in up to 50% of individuals. The side-effects of Lupron include hot flashes, vaginal dryness, decreased sexual desire, irregular vaginal bleeding, depression, sleep disturbances, joint stiffness and skin changes. The other concern is that of possible osteoporosis associated with prolonged use. The problem was recently addressed by adding small dose of estrogen to the treatment regimen.This add-back therapy seems to also diminish other symptoms associated with pseudomenopausal state.

Mesothelial cells: These are the cells lining body cavities (e.g. peritoneum). They are also present in the retroperitoneal tissue; these "reserve" mesothelial cells are essential in reconstructing the peritoneal layer.

MRI scan: An MRI machine uses computer-controlled radio waves and very big magnets, which create a magnetic field roughly 25,000 times stronger than the earth's magnetic field. After the machine creates a magnetic field, it sends radio waves into the body and then measures the response of its cells (how much energy they release) with a computer. From these responses, the computer is able to create a three-dimensional picture of the inside of the body. MRI makes use of the fact that all living cells have a certain magnetic quality to them; because of this, MRI can provide a look at the biochemistry of living cells.

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Ovary: This is a main source of estrogen in premenopausal woman. The ovary consists of the capsule and the stroma. The eggs are located in the capsule of the ovary.

Peritoneum: Smooth lining covering all surfaces inside the abdominal cavity.

Sigmoidoscopy: Flexible sigmoidoscopy is a procedure that enables your physician to examine the lining of the rectum and a portion of the colon (large bowel) by inserting a flexible tube that is about the thickness of your finger into the anus and advancing it slowly into the rectum and lower part of the colon. The rectum and lower colon must be completely empty of waste material for the procedure to be accurate.

Ultrasound: Ultrasound is a technique used to obtain information about the inside of the pelvis and abdomen. The technique employs the use of sonar or high frequency sound waves that are far beyond the range of human hearing. The waves are transmitted from the skin's surface or the vagina through the pelvis. Depending on the density of the underlying structures, the sound waves are then returned, producing an image on a small screen. Sometimes having an ultrasound examination is referred to as having a "sonar" or "sonogram."

Ureters: Tubes carrying urine from kidneys to urinary bladder.