Average Length Of Procedure Research Articles

Predictors of Outcome, Complications, and Recanalization of the Solitaire Device

The use of mechanical thrombectomy in the management of acute ischemic stroke is becoming increasingly popular. To identify notable factors that affect outcome, revascularization, and complications in patients with acute ischemic stroke treated with the Solitaire Flow Restoration Revascularization device. Eighty-nine patients treated with the Solitaire Flow Restoration Revascularization device (ev3/Covidien Vascular Therapies, Irvine, California) were retrospectively analyzed. Three endpoints were considered: revascularization (Thrombolysis In Cerebral Infarction), outcome (modified Rankin Scale score), and complications. Univariate analysis and multivariate logistic regression were conducted to determine significant predictors. The mean time from onset of symptoms to the start of intervention was 6.7 hours. The average procedure length was 58 minutes. The mean NIH Stroke Scale (NIHSS) score was 16 on arrival and 8 at discharge. Of the patients, 6.7% had a symptomatic intracerebral hemorrhage, 16.8% had fatal outcomes within 3 months post-intervention, and 81.4% had a successful recanalization. Thrombus location in the M1 segment of the middle cerebral artery was associated with successful recanalization (thrombolysis in cerebral infarction 2b/3) (P = .003). Of the patients, 56.6% had a favorable outcome (modified Rankin Scale score at 3 months: 0-2). In patients younger than 80 years of age, 66.7% had favorable outcome. Increasing age (P = .01) and NIHSS score (P = .002) were significant predictors of a poor outcome. On multivariate analysis, NIHSS score on admission (P = .05) was a predictor of complications. On univariate analysis, increasing NIHSS score from admission to 24 hours after the procedure (P = .05) and then to discharge (P = .04) was a predictor of complications. Thrombus location in the posterior circulation (P = .04) and increasing NIHSS score (P = .04) predicted mortality. The Solitaire device is safe and effective in achieving successful recanalization after acute ischemic stroke. Important factors to consider include age, NIHSS score, and location.

Report of a Mississippi Hospital’s Experience with Rapid Conversion to Robotic-Assisted Gynecological Surgery

The use of robotic-assisted gynecological surgery has grown at an unprecedented rate since its approval by the United States Food and Drug Administration in 2005. This rapid adoption of new technology has been demonstrated at Merit Health Woman's Hospital, a medical and surgical facility in Flowood, Mississippi, outside of Jackson. Woman's Hospital operates 60 patient beds with five operating rooms and began its robotic-assisted gyn surgical program in December 2010. The facility now has three fully functional daVinci Si robotic systems utilized by 27 gynecologists as well as by general surgeons and urologists. Through the end of 2014, a total of 1943 robotic-assisted total laparoscopic hysterectomies (with or without removal of the adnexa) were performed, nearly eliminating laparotomy procedures. Robotic-assisted surgery also replaced total laparoscopic surgical techniques performed straight-stick or rigid (i.e., without the utilization of wristed laparoscopic instruments) and has nearly replaced vaginal hysterectomies. Average length of procedure defined as skin-to-skin or start of first incision to complete skin closure was less for robot-assisted total laparoscopic hysterectomy (RATLH) than total abdominal hysterectomy (TAH), each with or without bilateral salpingo-oophorectomy (BSO). Physicians have found robotic-assisted techniques to be less physically taxing. Likewise, among Woman's Hospital patients surveyed, patient satisfaction remained high as minimally invasive robotic techniques replaced laparotomy. The surgical site patient infection rate has fallen from 3.9% of total hysterectomy cases performed in 2009 prior to initiation of our robotic program to an even lower 1.3% in 2014 after nearly all hysterectomies were performed using robot- assisted techniques. Quality control standards regarding operating times and surgical credentialing are enforced in the program.

Gaze and viewing patterns in microsurgery

Gaze disruptions in surgery have been associated with suboptimal surgical workflow, and human factor tools have been developed to quantify these events in cardiovascular and laparoscopic surgeries. Disruptions to workflow may be a particular concern in microsurgery because looking away from the microscope can cause the surgeon to lose view of delicate and precise tasks occurring at the surgical site. However, these viewing patterns in microsurgery have not been investigated. The purpose of this study is to quantify the gaze and viewing patterns during the microsurgery procedure. Event-based task analysis was performed for 14 surgeons performing microsurgery. Results found that average length of procedure was 70±33 minutes. Surgeons were observed to primarily interact with microscope 83±9% during microsurgery. Surgeons were observed to look away from the microscope in order to examine the tool area, patient site, and rest. Frequency of gaze away from the microscope was observed to be 11 disruptions per 10 minutes. Observed gaze demands of microsurgery and the limited opportunity for rests may impact surgeon performance and their risk for musculoskeletal fatigue.

Factors affecting the technical difficulty and clinical outcome of endoscopic submucosal dissection for colorectal tumors

Endoscopic submucosal dissection (ESD) for colorectal tumors is technically difficult due to the anatomy of the large intestine, with its narrow lumen, thin walls, and redundancy. Here, we assessed factors associated with incomplete resection and difficult colorectal ESD. Between November 2009 and April 2013, we performed ESD on 151 consecutive colorectal tumors in 147 patients. We evaluated the clinical outcomes of all cases and conducted multiple logistic regression analysis of the following factors related to incomplete resection and difficult procedure: age, gender, location (right colon, left colon or rectum), tumor size (diameter ≥40 or <40 mm), operation time, morphology [granular-type laterally spreading tumor (LST-G), non-granular-type laterally spreading tumor (LST-NG), or protruded type], fibrosis, and paradoxical movement during the procedure. A procedure that required more than 120 min was defined as a difficult colorectal ESD. Average tumor size was 32.1 ± 10.7 mm, and the average procedure length was 71.8 ± 49.5 min. The rate of en bloc resection was 94.7%, while that of en bloc curative resection was 86.8%. Perforation occurred in 1.3% of the ESD procedures. Multivariate logistic regression analysis revealed that only severe fibrosis [odds ratio (OR) 4.51; 95% confidence interval (CI) 1.36-14.91, p = 0.014] contributed to incomplete resection and that a tumor size exceeding 40 mm (OR 5.73 [95% CI 1.66-19.74], p = 0.006), severe fibrosis (OR 23.31 [95% CI 6.59-82.54], p < 0.001), and paradoxical movement (OR 4.26 [95% CI 1.11-16.44], p = 0.035) were independent factors exacerbating the difficulty of colorectal ESD. Severe fibrosis contributed to both incomplete resection and difficult colorectal ESD. Larger tumor size and paradoxical movement during the procedure were independent factors contributing to the difficulty of colorectal ESD. These factors might enable endoscopists to develop strategies for treating colorectal ESD.

Safety, efficacy, and feasibility of an ultra-low dose radiation protocol for CT-guided percutaneous needle biopsy of pulmonary lesions: Initial experience

To prospectively determine efficacy and complication rates following an ultra-low dose (ULD) protocol for computed tomography (CT)-guided percutaneous needle biopsy (PNB) of lung lesions. The use of an ULD protocol (100kV, 7.5mAs) for CT-guided lung biopsy was initiated, as a quality assurance initiative. All patients who underwent lung lesion biopsies under ULD were evaluated prospectively. For the purposes of comparison, a retrospective review was conducted to obtain data from patients who underwent the standard-dose protocol for CT-guided PNB of lung lesions. Total dose received, length of procedure, technical success, and complications were evaluated. The overall technical success rate using the ULD protocol was 95.8%. There was a statistically significant 57.5% reduction in radiation dose in the ULD group. There was no significant difference in average length of procedure between the two groups. Complication rates between the two groups were comparable, with 42% in the standard-dose group and 32% in the ULD group; no major complications occurred. Within the ULD group, smaller sized lesions were found to be correlated with higher complication rates, but lesion size had no effect on the total dose of radiation received. Radiation dose to the chest during CT-guided lung PNB is reduced significantly by 57.5% through the use of an ULD protocol. Reducing the CT radiation dose does not negatively impact patient safety or biopsy diagnostic rates in PNB.

Use of Antegrade Reverse-thermosensitive Polymer During Percutaneous Nephrolithotomy to Prevent Fragment Migration: Initial Experience

Our objective was to evaluate the feasibility and initial performance of Backstop reverse thermosensitive polymer to prevent antegrade stone fragment migration during percutaneous nephrolithotomy. Backstop was used during 5 percutaneous nephrolithotomy procedures to prevent stone migration into the ureter. Backstop was placed into the upper ureter under direct vision with a flexible nephroscope or with fluoroscopic guidance. Ultrasonic lithotripsy was then performed. Each patient was evaluated for the following: stone-free rate (postoperative computed tomography), rate of antegrade fragment migration, need for subsequent procedures, and complication rate. The average stone burden was 806 mm(2). Backstop was successfully deployed in all cases. Average procedure length was 106 minutes. Three patients were rendered stone free, 1 patient retained 2 1-mm fragments in the kidney, and 1 patient retained multiple fragments in the kidney, distal ureter, and bladder, all of which were <3 mm. No patient required a secondary procedure, and there were no adverse events. Backstop appears to be feasible, safe, and easy to use. Backstop should be administered every 45 minutes for longer cases, and warm saline should be used during the case to prevent dissolution. A randomized controlled trial with a larger study population is needed to further evaluate these initial findings.

Abstract TP417: Minimally-Invasive Video-Assisted Ligation of Left Atrial Appendage in Atrial Fibrillation: Stroke Prevention Strategy

Background: Non-valvular atrial fibrillation (AF) is a leading cause of embolic stroke, especially in the elderly population. The vast majority of thrombo-emboli in AF patients originate within the left atrial appendage (LAA). Effective and complete isolation of the LAA has been demonstrated to have a similar stroke-reduction effect as chronic anticoagulation. This study presents our initial experience with a novel minimally-invasive video-assisted (MIVA) thoracoscopic approach to epicardially isolate the LAA using the AtriClip device. Methods: Six consecutive AF patients (mean age 73.6 years, 3 of 6 male) with contra-indication to systemic anticoagulation underwent epicardial ligation of LAA using the AtriClip device. Procedure involved two 5mm ports and one 15mm port with application of the device at the base of the LAA under direct visualization. Immediate intra-operative confirmation of LAA isolation via trans-esophageal echocardiography (TEE) was obtained. Anticoagulation was not restarted post-operatively. Results: Average procedure length was 43mins and average length of stay was 72hours. All six patients had a non-complicated post-operative course. No stroke, myocardial infarction, renal failure or re-operation was encountered. No transfusions were needed. All patients were extubated in the operating room at conclusion of procedure and were ambulatory on the first postoperative day. 3 of 6 patients experienced excessive pleural drainage lasting 2-4 days postoperatively. TEE confirmation of complete LAA obliteration was achieved in all patients. Conclusions: MIVA LAA ligation appears to be a safe, effective and simple procedure to isolate the LAA in AF patients with contra-indication to anticoagulation. A multi-institutional trial to assess the efficacy of MIVA LAA ligation as a stroke prevention strategy is warranted and forthcoming.

Pose de chambre implantable par abord percutané échoguidé : à propos d’une série de 102 patients

Techniques of insertion of implantable venous devices have been widely described. The use of ultrasound guidance is part of the good practice recommendations of the SOR 2008 but there are few data in the literature and recommendations are based only on expert agreement. To this end we conducted a prospective, single-center study from January 2008 to August 2009 on percutaneous ultrasound-guided insertion of implantable devices. In addition to age, sex, the therapeutic indication and the site of implantation, we identified the operative time and number of venipunctures performed for each procedure. We then identified the infectious complications at three months and thromboembolic complications at 1 year and a half. Our study examined 102 consecutive patients. The mean age was 61.8 years (28-90); 71% of patients were men. For 101 patients, the internal jugular vein was punctured, the subclavian vein in one patient. In 86% of cases, the implantable venous device was inserted into the right vein. The average length of procedure was 30 minutes (18-60) for a single-vein puncture. Among the 102 patients, the overall morbidity was 7.8% with four infections (3.9%) and four thromboses (3.9%). There were no immediate perioperative complications (arterial puncture, hematoma, pneumothorax). In conclusion, percutaneous ultrasound-guided insertion of implantable venous devices in the internal jugular vein is a safe, minimally invasive technique which complies with the 2008 SOR recommendations by preventing the risk of venous thrombosis and avoiding repeated venous puncture. Less invasive than the open surgical approach, ultrasound-guided insertion is safer than puncture based solely on anatomical landmarks. In summary, this is a reliable, simple and easily reproducible technique which limits iatrogenic risks and improves patient comfort.

Same-day cervical preparation with misoprostol prior to second trimester D&E: a case series

BackgroundTraditionally, overnight cervical preparation with osmotic dilators has been used for second trimester dilation and evacuation (D&E) procedures. Misoprostol offers an alternative treatment that could shorten cervical preparation time. Study designThis study reports on a case series of patients who received only buccal or vaginal misoprostol for cervical preparation on the same day as the D&E procedure. Data were collected from charts of women undergoing second trimester D&E at an outpatient women's health clinic. Eligible cases included procedures performed between January 2001 and December 2010 at 17 0/7 to 23 0/7 weeks of gestation. ResultsChart review identified 1177 cases of D&E during the study period. After deletion of 96 multiple-day cases using laminaria, 1081 misoprostol-only cases remained for analysis. Two of the cases were not able to be completed in the same day (0.2%). Ninety-eight percent of cases were 17–20 weeks of gestation. The average time from either vaginal or buccal placement of the first misoprostol dose to procedure completion was 4.9 h (SD±1.7 h). The average procedure length was 13.0 min (SD±10.2 min). Complications were reported in 21 of 1079 same-day procedures (2%) and included resuction (n=4), hemorrhage (n=5), cervical laceration (n=4), endometritis (n=5), pulmonary embolus (n=1), disseminated intravascular coagulation (n=1) and perforation (n=1). ConclusionSame-day cervical preparation with misoprostol for second trimester D&E is both safe and effective. With the continuing shortage of D&E providers, the resulting increase in travel distance to obtain the procedure, mandatory waiting periods and the capability of having the procedure completed in a single day may increase patient access, reduce cost and improve patient satisfaction.

Chromoendoscopy in Community GI: A Single Physician Experience

Early detection of dysplastic tissue during colonoscopy allows early intervention and may decrease colon cancer and improve survival. Previous work from academic centers has demonstrated chromoendoscopy increases diagnostic yield for intraepithelial neoplasia in inflammatory bowel disease compared with white-light colonoscopy. However, the feasibility of this technique has not yet been adequately studied in the community setting. We evaluated a single physician's experience with chromoendoscopy in patients with IBD. We performed a retrospective review of surveillance colonoscopies (with & without chromoendoscopy) in patients with IBD between January 2005 & August 2012. Pathology and procedure reports were reviewed. We collected demographic data (age, gender), diagnosis (Crohn's, UC, IBDU), smoking and family history, history of polyps, length of colonoscopy, complications from procedure, location & number of biopsies, and final diagnosis from pathology. A total of 184 colonoscopies were evaluated, of these 64 were performed using chromoendoscopy with indigo carmine dye. Cases comprised of 118 individual patients, 64 males & 54 females, with a mean age of 51.6 years. There were no adverse events associated with colonoscopy in our study population. The average length of procedure was 38.8 [34.1, 43.4] minutes for chromoendoscopy, and 20.5 [18.1, 22.9] minutes without (P < 0.001). Chromoendoscopy yielded an average of 42.0 [38.0, 46.0] biopsies in 13.1 [12.4, 13.86] jars per case, while white-light averaged 34.9 [32.4, 37.3] biopsies in 10.0 [9.68, 10.44] jars (P < 0.001) per case. In the cases we reviewed, white light colonoscopy found 87 polyps and chromoendoscopy found 157 polyps. An average of 2.4 [1.9, 3.0] polyps were resected per case during chromoendoscopy while white-light yielded 0.7 [0.5, 1.0] polyps per case on average (P < 0.001). Chromoendoscopy led to discovery of 25 dysplastic lesions at a rate of 0.39 [0.23, 0.55] per case compared to 8 dysplastic lesions at a rate of 0.07 [0.02, 0.11] per case with regular colonoscopy (P < 0.001). Of all polyps discovered via chromoendoscopy, 31.25% were dysplastic lesions. With white light 6.67% (P < 0.001) of all polyps resected were dysplastic. In our study, there was only one case which found low grade dysplasia on a random biopsy; otherwise all remaining dysplastic lesions were found from resected polyps. Chromoendoscopy yields increased recognition of dysplastic polyps in patients with IBD. In our analysis colonoscopy time was prolonged by an average of 18 minutes per procedure with chromoendoscopy; however, the technique allowed for a five-fold higher rate of detection of dysplastic lesions compared to white light colonoscopy, similar to published data from academic centers. Random biopsy yielded low grade dysplasia in only one case, suggesting that the utility & cost effectiveness of random biopsies may be exceedingly low. Chromoendoscopy is an effective tool and should be utilized more frequently in patients with IBD undergoing surveillance colonoscopy. Our experience shows it can be done successfully and safely in the community practice setting.

Small cell lung cancer survival in elderly patients at UHSM UK

lower in the over 70 age category when compared to younger patients for both midazolam (2.5 (SD 0.9) mg vs. 3.3 (SD 1.1) mg; p=0.000001) and alfentanil (348.4 (SD 165.1) mcg vs. 519.4 (SD 200.7) mcg; pb0.00001). However there was no difference in the average procedure length between the two groups; 38.8 min in those aged over 70 and 39.3 min in those aged less than 70. Complications were reported in 7 patients in the over 70 age category and 12 in the under 70 age category (p=0.21) (detailed in Table 2). Conclusions: In our experience EBUS-TBNA can be performed safely in elderly patients. Average sedation requirement was lower in elderly patients consistent with the national guidelines for safe sedation practice. There was no difference in the tolerance of the procedure or the number of complications according to age. EBUSTBNA offers a safe and minimally invasive procedure that is well tolerated in elderly patients.

Leg Endoscopic Groin Lymphadenectomy (LEG Procedure): Step-by-Step Approach to a Straightforward Technique

BackgroundInguinofemoral lymphadenectomy can serve as a diagnostic and potentially therapeutic procedure in a variety of malignancies, including those of the genitalia and the skin. Historically, this procedure was associated with significant morbidity. ObjectiveWe hypothesized that both superficial and deep groin dissection (complete inguinofemoral lymphadenectomy) could be performed endoscopically, in a step-by-step manner, with low morbidity, including those patients with obesity and previously treated groins. Design, setting, and participantsTwenty-five groin dissections were undertaken in 16 patients, male and female, over a 12-mo time period. Surgical procedureThe femoral triangle was marked. An initial fingers’ breadth–sized incision was made 3cm below the apex of the femoral triangle. Finger dissection was used to develop the skin flaps at the apex of the triangle out to two additional 10-mm ports. The anterior space was dissected, and, following that, the saphenous vein was transected distally with an endoscopic stapler. The lateral planes on the adductor longus and sartorius muscles were developed, and, finally, the posterior plane was developed, lifting the packet off the fascia lata. Deep femoral nodes were removed as well. The saphenofemoral junction was transected and the packet was removed. A drain was placed. MeasurementsThe number of lymph nodes harvested was recorded. The development of skin complications, leg edema, and deep venous thrombosis was recorded as well. Results and limitationsThe average length of procedure was 147min. The mean number of lymph nodes harvested was nine. A groin seroma requiring further drainage was observed in one patient. Cellulitis was observed in two patients. ConclusionsLeg endoscopic groin lymphadenectomy (LEG procedure) is straightforward to learn, with operative times that parallel the open procedure. Less morbidity has been observed in our first group of patients compared to contemporary open series.

Is Gastrointestinal Endoscopy Safe in the Setting of Recent Coronary Artery Reperfusion Therapy? A Pilot Study

Purpose: To establish the safety of endoscopic procedures performed in patients who have undergone coronary artery reperfusion therapy via placement of a coronary artery stent or balloon angioplasty. Background: No specific guidelines exist for when and under what conditions it is safe to perform endoscopic procedures after a recent myocardial infarction(MI). Retrospective studies (Chin et al.) have addressed the role of endoscopy in the setting of recent MI. No studies have specifically addressed the safety of endoscopy in patients who have recently undergone reperfusion therapy. This population may have an additional risk of cardiopulmonary complications during or subsequent to endoscopy. Methods: A retrospective analysis of patients who underwent reperfusion therapy was performed at a tertiary care medical center in 2006. Subjects had undergone coronary artery reperfusion therapy via stent placement or balloon angioplasty after MI or unstable angina and within 30 days also underwent upper or lower gastrointestinal endoscopy. Indications, chronology, co-morbidities, anti-platelet drugs or anticoagulants, cardiac risk categories, type of procedure, findings, complications and their severity and mortality were recorded. Results: Of the 35 patients included in the study 57% (n = 20) were male, 43% (n = 15) were female. Average age was 77 (+/− 8) and BMI 26 (+/− 4). Indication included acute GI bleed (48%, n = 17), iron deficiency anemia (34% n = 12), abdominal pain (6% n = 2), dysphagia (6% n = 2), screening colonoscopy (3% n = 1) and PEG placement (3% n = 1). 14% (n = 5) had STEMI, 20% (n = 7) had NSTEMI and 66% (n = 23) had unstable angina. Procedures were done 7 (+/−7) days after stent placement. Comorbid conditions included hypertension (85% n = 30), dyslipidemia (80% n = 28), Arrhythmia (40% n = 14), chronic kidney disease (51% n = 18), CVA (8% n = 3). Patients were on ASA 325 mg, 28% (n = 10), ASA 81 mg, 31% (n = 12), clopidogrel 31% (n = 12), heparin or coumadin 20% (n = 7). Ejection fraction was normal 46% (n = 16), mildly (17 % n = 6), moderately (20 % n = 7), or severely (11% n = 4) reduced. Average length of procedure was 18 minutes (+/−10). NO post procedure bleeding was noted. One death was reported although it occurred greater than 30 days after endoscopy. No significant associations were found between the type of procedure, ejection fraction, anticoagulant/antiplatelet medication or length of time of procedure and bradycardia, tachycardia, hypoxia or mortality. Conclusions: Endoscopy after coronary artery stent placement or angioplasty is generally a safe procedure even in the post MI/unstable angina setting. Large scale studies are needed to further validate this conclusion.

4577 Physician resource utilization for endoscopic ultrasound vs. ercp.

INTRODUCTION: EUS and ERCP each represent hybrids of endoscopy and radiology that require special expertise and equipment. Despite these similarities, reimbursement for EUS is less than for ERCP. HYPOTHESIS: Physician resource utilization for EUS and ERCP as determined by procedure length is similar. AIM: Compare EUS and ERCP procedure lengths from a large multicenter database. METHODS: We performed a retrospective review of the CORI (Clinical Outcomes Research Initiative) database of all EUS (recorded 2/4/98 - 6/30/99) and ERCPs (recorded 6/30/97 - 6/30/99). Data were analyzed as to demographics and procedure length (minutes) of upper EUS vs ERCP, with subset analysis of EUS with fine needle aspiration (FNA) vs. therapeutic ERCP (ERCP with at least one therapeutic procedure: sphincterotomy, stent placement/replacement, stone removal, dilation). Statistical analysis was performed using the JMP module of SAS software. P-values were calculated using Student's T-test. RESULTS: 1452 upper EUS exams (65% male & 35% female) and 2110 ERCPs (57% male & 43% female) were recorded during the periods specified. EUS was performed by 42 endoscopists (60% University based, 40% VA based) at 19 sites (50% University, 50% VA). ERCP was performed by 103 endoscopists (60% University based, 28% VA based, 12% private practice) at 28 sites (69% University, 23% VA, 8% private practice). The mean age of patients undergoing upper EUS vs. ERCP was 61.0±13.6 yrs vs. 55.3 ± 17.5 yrs (mean ± SD, p<0.0001). Data on procedure length was available in 1073(74%) of upper EUS cases vs. 1380(65%) of ERCPs. The mean procedure length of upper EUS vs. ERCP was only 2 1/2 minutes different: 39.8 ± 22.7 min vs. 42.3 ± 26.2 min (mean ± SD,p=0.01). When comparing EUS with FNA (n=318) to therapeutic ERCP (n=615), data on procedure length was available in 215(68%) and 379(62%) cases, respectively. The mean procedure length of EUS with FNA vs. therapeutic ERCP was 61.2 ± 23.3 min vs. 47.7 ± 28.2 min (mean ± SD,p<0.0001). CONCLUSIONS:(1) Resource utilization as reflected in the average procedure length is similar for EUS and ERCP. (2)The average procedure length of EUS with FNA is substantially longer than therapeutic ERCP. (3) Given the complexity of both procedures, procedure lengths, need for additional specialized training, and demands on technical/nursing support, these data favor at least equal financial reimbursement for EUS procedures.

Office microlaparoscopy under local anesthesia for chronic pelvic pain

Study Objective. To investigate the utility, tolerance, and costs associated with a program of office laparoscopy under local anesthesia using fiberoptic microlaparoscopes (<2 mm) and accessory instrumentation (<2 mm) for the evaluation of patients with chronic pelvic pain (CPP). Design. Prospective, nonselected cohort study. Setting. Office-based free-standing faculty practice at a tertiary care referral center. Patients. All women with a history of CPP from February to June 1995 who required diagnostic laparoscopy were compared with a cohort of patients undergoing in office diagnostic laparoscopy for the evaluation of infertility during the same period. Interventions. All patients underwent diagnostic office microlaparoscopy under local anesthesia (OLULA) with supplemental intravenous sedation, as well as conscious pain mapping. Measurements and Main Results. A specific questionnaire was developed to follow all aspects of patient acceptance and tolerance of the procedures, and all patients were queried preoperatively, and 30 minutes and 1 week postoperatively. Pain was evaluated with a modification of the McGill pain inventory. A subset of questions evaluated the length of time until usual activities were resumed, anxiety level, and general acceptance of the procedure including set-up, operative time, and recovery time until discharge. Overall, there was a high degree of patient acceptance and satisfaction with OLULA; however, women with CPP experienced greater intraoperative and postoperative pain than those with infertility. Some patients with CPP had a generalized visceral hypersensitivity to pain; all areas of the pelvis and bowel were sensitive, and pain was not completely blocked with local anesthesia. Average procedure length was similar for the two groups. Patients with CPP required greater postoperative analgesia and took longer to return to work. Conscious pain mapping identified a focal source of pain in three patients and generalized visceral hypersensitivity in a majority of patients with CPP. Neither of these were found in patients with infertility. Compared with traditional laparoscopy there was almost an 80% reduction in costs. Conclusion. Office laparoscopy under local anesthesia is safe and effective for the evaluation of patients with CPP and is less expensive than traditional laparoscopy. Although the procedure is better tolerated by women undergoing infertility evaluation, it was well tolerated by both groups. Conscious pain mapping helps identify potential areas of pelvic pain and helps further characterize patients with CPP.