Search PubMed⌕ Search

Biomedical subjects

A Magos

Publications and source records attributed to A Magos.

At least 19 recordsLinked to original sources
PubMed2001

The hysterectomy lottery.

We report a postal survey of consultant gynaecologists carried out to determine the pattern of current hysterectomy practice, to obtain views on indications and contraindications to vaginal hysterectomy, and to predict future practice. There was a 75% response rate. Approximately two-thirds of hysterectomies were performed abdominally, one-third vaginally and 3% laparoscopically by each gynaecologist, although there was significant variation between them. The most common factors limiting the use of vaginal hysterectomy were a lack of uterine prolapse, the presence of fibroids and the need for prophylactic oophorectomy. It was predicted that there would be a significant change in hysterectomy practice with the majority being performed vaginally but still with a large variation. Gynaecologists who currently perform laparoscopic hysterectomy have the highest vaginal hysterectomy rates and predict the greatest role for it in the future. The large variations in practice indicate that the route of surgery is more dependent on the clinical preference of the gynaecologist than the medical condition.

Journal Article↗
PubMed2001

Mass closure: a new technique for closure of the vaginal vault at vaginal hysterectomy.

A variety of methods of management of the vaginal vault have been described, all of which maintain certain principles. In techniques that advocate closure of the vault, the peritoneum and vaginal epithelium are treated with separate sutures. This leaves a potential space above the vaginal closure. We describe a simple technique of mass closure which obliterates this space and incorporates the pedicles to provide support for the vault. This method may hold potential advantages in terms of haemostasis, risk of vault haematoma, and post-operative vaginal cuff infections.

Adult↗
PubMed1999

The alternatives to hysterectomy.

Hysterectomy is one of the commonest major operations, with 72,362 procedures performed in England in 1993. However, for women with dysfunctional uterine bleeding other less invasive surgical options have been developed. In particular, hysteroscopic endometrial ablation has been shown to be an effective therapy. Prospective randomized trials have shown that hysteroscopic surgery is associated with a shorter operating time, fewer complications, less analgesic requirement, a faster resumption of normal activities and work and savings in treatment costs. Psychological and social functioning also improves with no significant differences compared to hysterectomy. There is, however, a tendency for women randomized to hysterectomy to report higher rates of satisfaction. Several non-hysteroscopic ablative techniques are currently being developed and tested. While attractive, as they do not require significant hysteroscopic skills and will probably prove to have fewer operative risks than hysteroscopic procedures, the results of these procedures are still in the evaluation phase.

Electrocoagulation↗
PubMed1999

Laparoscopic myomectomy.

Fibroids are common tumors that present with a variety of symptoms for whom medical treatment is generally unsatisfactory. Laparoscopic myomectomy was described nearly 20 years ago. Since then several hundred procedures have been described in the literature. With increasing experience it has become apparent that the technique is both technically demanding and time consuming. It is also not clear whether laparoscopic surgical outcome is improved compared with laparotomy. At present these factors limit the application of laparoscopic myomectomy.

Female↗
PubMed1999

Simple technique for rectus sheath closure after laparoscopic surgery using straight needles, with review of the literature.

The increasing use of laparoscopic surgery with more complicated procedures means that the use of multiple and larger ports is becoming commonplace. One well-known risk associated with the use of ports more than 10 mm in diameter is the development of an incisional hernia unless the deep fascia is closed adequately. This complication is estimated to follow 3% of major laparoscopic procedures. Closure of trocar incisions is therefore recommended for large sites. We have developed a closure technique using standard sutures with straight needles, a 5-mm laparoscopic grasper, and a 4-mm hysteroscope which we have found simple and fast, with the added advantage of low cost.

Fasciotomy↗
PubMed1999

Endometrial cell dissemination at diagnostic hysteroscopy: a prospective randomized cross-over comparison of normal saline and carbon dioxide uterine distension.

The incidence of pelvic spreading of endometrial cells at diagnostic hysteroscopy was studied comparing the two distension media carbon dioxide (CO(2)) and normal saline (N/Saline). Thirty patients requiring laparoscopy and hysteroscopy were included in this study, the main indication for surgery being subfertility. Hysteroscopy was performed using both CO(2) and N/Saline distension on each patient, the order of the distension media being randomly allocated. Samples of peritoneal fluid were aspirated from the pouch of Douglas before and after hysteroscopy with each distension medium, and the specimens were investigated cytologically for the presence of endometrial cells. Endometrium was present in 2/30 (6.7%) peritoneal aspirates before and in 15/60 (25%) collected after the hysteroscopies. There was no major difference between liquid or gaseous distension, transtubal reflux of endometrial cells occurring in 7/30 (23.3%) and in 8/30 (26.7%) hysteroscopies respectively. Positive peritoneal cytology was observed significantly more often in patients who were in the proliferative phase of the menstrual cycle [9/14 (64.3%) versus 0/11, P < 0.004]. In conclusion, transtubal dissemination of endometrium occurs in about one quarter of patients, irrespective whether N/Saline or CO(2) is used for uterine distension; there is no advantage to using gaseous distension for hysteroscopy when investigating high-risk cases for endometrial malignancy.

Carbon Dioxide↗
PubMed1999

Long term follow up of hysteroscopic myomectomy assessed by survival analysis.

OBJECTIVE: To identify patient characteristics which affect outcome after hysteroscopic myomectomy for submucous fibroids. DESIGN: Prospective observational study. SETTING: A university teaching hospital. SAMPLE: One hundred and twenty-two consecutive patients treated by hysteroscopic myomectomy for submucous leiomyoma over a period of almost eight years. METHODS: Hysteroscopic electroresection of the leiomyoama using a continuous flow resectoscope. MAIN OUTCOME MEASURES: The avoidance of further surgery and patient satisfaction. RESULTS: The average age of the patients at the time of their surgery was 42.8 years. A total of 194 fibroids were removed. The mean follow up period was 2.3 years (range 1-7.6). Of those asked, 71.4% were satisfied with the results of surgery. Sixteen women required further surgery for fibroids, and six ultimately underwent hysterectomy. Survival analysis showed that the risk of further surgery was 21% at four years after the myomectomy, and 0% thereafter. Univariate regression analysis suggested that outcome was significantly better in older women, and in cases where the uterus was equivalent in size to < or = 6 weeks of gestation, the fibroid was < or = 3 cm in diameter and mainly intra-cavitary, and the procedure time was < or = 20 minutes. The influence of hormonal pre-treatment and the number of fibroids excised was not statistically significant. After multivariate regression analysis, only overall uterine size and the position of the fibroid being removed were found to significantly influence the success of surgery. CONCLUSIONS: Hysteroscopic myomectomy is an effective way to manage patients with symptomatic submucous leiomyomata, particularly when the uterus is not grossly enlarged and the fibroid(s) are mainly inside the uterine cavity.

Adult↗
PubMed1998

How to increase the proportion of hysterectomies performed vaginally.

OBJECTIVES: The main purpose of our study was to identify the patient characteristics of women undergoing hysterectomy and to estimate the proportion of hysterectomies that could be done vaginally by recognized surgical techniques. STUDY DESIGN: The records of 500 women who underwent hysterectomy were reviewed. The characteristics of patients without an absolute contraindication to vaginal hysterectomy were analyzed. RESULTS: Overall, 96 (19.2%) of our study group underwent vaginal hysterectomy. A total of 382 (76.4%) women were judged not to have an absolute contraindication to this route. The most frequent characteristics of this group were lack of uterine prolapse (76.4%), a myomatous uterus (44.5%), and a need for oophorectomy (43.2%). We did not exclude women who did not have significant uterine prolapse or a history of pelvic surgery or pelvic tenderness and we included those requiring oophorectomy or with a uterine size up to that of 14 weeks' gestation; with these criteria more than two thirds of the entire study population could undergo vaginal surgery. CONCLUSIONS: To maximize the proportion of hysterectomies performed vaginally, gynecologists need to be familiar with surgical techniques for dealing with nonprolapsed uteri, uterine leiomyomas, and vaginal oophorectomy.

Adult↗
PubMed1998

Myometrial scoring: a new technique for the management of severe Asherman's syndrome.

OBJECTIVE: To describe a new hysteroscopic technique for the management of severe Asherman's syndrome. DESIGN: Prospective observational study. SETTING: Volunteers in an academic research environment. PATIENT(S): Seven patients with secondary infertility associated with amenorrhea or oligomenorrhea secondary to severe Asherman's syndrome. INTERVENTION(S): Six to eight longitudinal incisions were made into the myometrium extending from the uterine fundus to the isthmus with a resectoscope fitted with a Collins knife electrode. MAIN OUTCOME MEASURE(S): Restoration of menses, symptomatic relief, and postoperative reproductive performance. RESULT(S): The amount of menstrual bleeding increased in all cases, including two women who were amenorrheic before their surgery. Pelvic pain decreased in two of the four symptomatic cases. Three to four months after surgery, hysteroscopy showed a normal sized uterine cavity in five cases. After a median follow-up of 12 months, three women conceived four pregnancies, including a missed abortion, a tubal abortion, an ongoing pregnancy currently at 7 weeks' gestation, and one child delivered at 36 weeks gestation after premature rupture of the membranes. CONCLUSION(S): Hysteroscopic myometrial scoring enlarges uterine cavity size in cases of severe Asherman's syndrome and improves menstrual function. Reproductive performance seems to be improved also, but longer follow-up is required.

Adult↗
PubMed1998

Why do women choose endometrial ablation rather than hysterectomy?

OBJECTIVE: To determine why women choose endometrial ablation rather than hysterectomy for the treatment of menorrhagia. DESIGN: Observational study based on postal questionnaires. SETTING: A university hospital. PATIENT(S): One hundred eighty randomly selected patients from a cohort of 658 patients who underwent endometrial ablation for the treatment of menorrhagia during the past 7 years. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Patient attitude about endometrial ablation. RESULT(S): One hundred six questionnaires (58.9%) were completed satisfactorily. The average postoperative follow-up period was 45.1 months (range, 3-80 months). Eleven women (10.4%) had undergone repeated endometrial ablation and 8 (7.5%) had undergone hysterectomy. More than half the women indicated that they would find endometrial ablation acceptable even if there was no chance of amenorrhea, if the probability of menstruation becoming lighter was > or = 4:10, if the likelihood of menstrual pain decreasing was > or = 3:10, if the chance of requiring repeated endometrial ablation or hysterectomy was < or = 1:4, and if the risk of uterine cancer after surgery was < or = 1:200. The three most important advantages of endometrial ablation over hysterectomy were perceived to be the avoidance of major surgery, the fast return to normal functioning, and the short hospitalization. CONCLUSION(S): Most women who choose endometrial ablation rather than hysterectomy as therapy for menorrhagia are prepared to undergo hysteroscopic surgery even if the chance of success is relatively poor.

Cohort Studies↗
PubMed1998

The "remote control" laparoscopic bag: a simple technique to remove intra-abdominal specimens.

BACKGROUND: To facilitate extraction and avoid intra-abdominal spillage during laparoscopic removal of adnexal masses, various designs and sizes of endopouches (bags) have been used. We describe a simple technique using a special laparoscopic bag that requires no additional instruments to hold, open, or close the bag. TECHNIQUE: The laparoscopic bag can be prepared from the sterile wrapping of disposable surgical items (eg, suction tubing) and two long sutures. The bag is introduced through the cannula of the laparoscope and is unfurled. By manipulation of the two long sutures threaded through the neck of the bag, the surgeon can easily open and close it. EXPERIENCE: We have performed this procedure "in vitro" on many occasions to ensure that the drawstring technique works. The laparoscopic bag has been used successfully in three patients undergoing oophorectomy and salpingo-oophorectomy. Our experience shows that this type of laparoscopic bag is easy to use and safe, reduces operative time, and is cost effective. Because the bag can be large, operating inside the bag is also possible. CONCLUSION: Our drawstring design allows easy manipulation of a laparoscopic bag to facilitate its opening and closure.

Equipment Design↗