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Biomedical subjects

A L Magos

Publications and source records attributed to A L Magos.

At least 37 records · Page 2Linked to original sources
PubMed1996

A prospective study to evaluate oophorectomy at the time of vaginal hysterectomy.

OBJECTIVE: To assess the feasibility and safety of vaginal removal of ovaries at the time of vaginal hysterectomy. DESIGN: Prospective study. SETTING: London teaching hospital. POPULATION: Between March 1993 and March 1995, 40 women were admitted under the care of one consultant for vaginal hysterectomy and bilateral oophorectomy. METHODS: The success rate of removing the ovaries vaginally was calculated and the operative time, blood loss, intra- and post-operative complications and patient recovery were analysed and compared with 48 patients who had a vaginal hysterectomy but retained their ovaries during the same time period. RESULTS: Thirty-nine (97.5%) of the 40 women due to undergo removal of the ovaries were managed successfully via the vaginal route; one woman required laparoscopic removal of one of her ovaries containing an ovarian cyst which was not diagnosed pre-operatively. A variety of techniques were used for vaginal oophorectomy which included salpingo-oophorectomy, oophorectomy without salpingectomy, and transvaginal endoscopic oophorectomy utilising endoloop sutures or bipolar electrosurgery. Oophorectomy added a mean of 23.4 min (88.3 vs 64.9 min, 95% CI 10.2-36.7, P < 0.001) to the total operating time compared with vaginal hysterectomy alone. No laparotomies were required, and both the complication rate and post-operative inpatient stay were similar for the two groups. CONCLUSIONS: The need to perform oophorectomy should not be considered a contraindication to vaginal hysterectomy.

Adult↗
PubMed1996

Randomized studies in endoscopic surgery--where is the proof?

We have attempted to review the best available evidence for the commonest gynaecological endoscopic procedures. Controlled studies are the exception rather than the rule, and randomized studies are even rarer. Therefore, the results of large, uncontrolled series must be acknowledged. As a result, for most procedures, sufficient information is now available regarding indications, efficacy, and complications to determine their role in routine clinical practice.

Endoscopy↗
PubMed1995

Is laparoscopic hysterectomy a waste of time?

Laparoscopic hysterectomy (LH) is a way to avoid laparotomy. However, there is evidence that most women treated by abdominal hysterectomy are suitable for vaginal surgery. To test this hypothesis, and to determine the relative merits of laparoscopic and vaginal hysterectomy (VH) and the best technique for LH, we prospectively studied 98 women who had relative contraindications for vaginal surgery by traditional criteria. 75 underwent LH and 23 VH. The LH group included 22 women who had been assigned to this route of surgery as part of a prospective randomised controlled comparison with VH (23 women). Surgery was completed with the intended technique in 93.9% of cases. 5 women in the LH group (6.7%) and 2 in the VH group required laparotomy or additional procedures. In the prospective randomised study LH took longer than VH (mean duration 131 vs 77 min). VH was the faster procedure, irrespective of uterine size and need for oophorectomy. With LH, the operative time increased as more of the hysterectomy was carried out with laparoscopic rather than vaginal dissection. Complication rates, blood loss, analgesia requirements, and recovery were similar for the two techniques. Our study confirms that most hysterectomies could be performed vaginally, and that LH is a much slower procedure. If LH is done, it should be converted to a vaginal procedure as early as possible to reduce the overall operating time. LH does seem to be a waste of time for most patients.

Adult↗
PubMed1995

Transvaginal endoscopic oophorectomy.

Four women underwent transvaginal endoscopic oophorectomy during vaginal hysterectomy. The adnexa were visualized with a laparoscope inserted into the upper vagina. Bilateral salpingo-oophorectomy or oophorectomy was carried out with standard laparoscopic instruments introduced through the vagina without a pneumoperitoneum; Endoloop sutures and bipolar electrocoagulation were used for hemostasis.

Fallopian Tubes↗
PubMed1995

A series of 1000 consecutive out-patient diagnostic hysteroscopies.

OBJECTIVE: To review the success of out-patient diagnostic hysteroscopy. METHOD: Retrospective review of 1000 consecutive out-patient hysteroscopies. RESULTS: Hysteroscopy was successfully performed in 96%. Cervical dilatation was required in 15.0% and local anaesthesia was administered in 31.4%; 77.3% of those requiring cervical dilatation received local anaesthesia. Intrauterine pathology was noted in 49.3%. The procedure failed in 40 (4%) patients for the following reasons: pain or anxiety in 23, cervical stenosis in 11, equipment failure in 4, and extreme uterine retroversion and inadvertent false cavity formation in one case each. CONCLUSION: Out-patient diagnostic hysteroscopy is a safe, well tolerated and successful investigation procedure in the majority of patients and should be the procedure of choice for suspected intrauterine pathology.

Adult↗
PubMed1993

Liver transplantation during pregnancy.

We present a case of successful liver transplantation during the midtrimester of pregnancy, showing that pregnancy itself is not a contraindication to liver transplantation with life-threatening illness. Improvements in anaesthetic and surgical technique will enhance the possibility of foetal survival.

Adult↗