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Arnold P Advincula

Publications and source records attributed to Arnold P Advincula.

14 recordsLinked to original sources
PubMed2006

Robot-assisted laparoscopic hysterectomy: technique and initial experience.

BACKGROUND: Our study objective was to develop a technique for robot-assisted laparoscopic hysterectomy and to evaluate feasibility of the technology to address the technical limitations of conventional laparoscopy. METHODS: The study design was a case series analysis in a university hospital. Sixteen consecutive patients underwent robot-assisted laparoscopic hysterectomy and were assessed for outcomes. Robot-assisted hysterectomy technique was refined and is described. RESULTS: There were no conversions to laparotomy. The mean uterine weight was 131.5 g (range 30 to 327 g). Median operating time was 242 minutes (range 170 to 432). Average estimated blood loss was 96 mL (range 50 to 300 mL). One patient experienced a delayed thermal bowel injury, 2 developed postoperative infections, and 1 developed a vaginal cuff hematoma that was managed expectantly. The median length of hospital stay was 1.5 days. CONCLUSIONS: Robot-assisted laparoscopic hysterectomy is a feasible and promising new technique that may overcome surgical limitations seen with conventional laparoscopy.

Adult↗
PubMed2006

Acute urinary retention caused by a large peritoneal inclusion cyst: a case report.

BACKGROUND: Pelvic masses have been known to cause bladder symptoms and compression. This is the first documented case of a large peritoneal inclusion cyst causing acute urinary retention from bladder outlet obstruction. CASE: A 36-year-old woman, gravida 2, para 2, presented to the gynecology clinic with an indwelling Foley catheter that was placed at an outside hospital secondary to acute urinary retention. Computed tomography, performed several days earlier for complaints of progressively worsening lower abdominal and pelvic pain, revealed a 10-cm, complex, cystic mass within the pelvis between the rectum and sigmoid colon, with anterior displacement of the bladder. The patient's past surgical history included a total abdominal hysterectomy as well as separate exploratory laparotomy for resection of a 20-cm peritoneal inclusion cyst and a prophylactic bilateral salpingo-oophorectomy. Due to the acute urinary retention and worsening pain, the decision was made to proceed with laparoscopic removal and drainage of the mass, which turned out to be consistent with a recurrent peritoneal inclusion cyst. Symptom relief was immediate. CONCLUSION: A large, recurrent, peritoneal inclusion cyst obstructed the bladder neck and presented as acute urinary retention. Laparoscopy relieved the symptoms.

Adult↗
PubMed2005

Adolescent chronic pelvic pain.

The presentation of chronic pelvic pain in the adolescent can at times be quite daunting. A careful and insightful approach to obtaining the history and physical examination must be implemented while maintaining an appreciation of the various stages of adolescent development. The etiologies can range from gynecologic to nongynecologic causes. The ability to render an early diagnosis and appropriate treatment in this population of patients can significantly improve future reproductive health outcomes. The following minireview will outline a systematic approach to the adolescent with chronic pelvic pain.

Adolescent↗
PubMed2004

Interstitial pregnancy.

A 20-year-old woman with an interstitial pregnancy who underwent ultrasonographic and laparoscopic imaging before surgical management is described.

Adult↗
PubMed2004

Laparoscopic robotic gynecologic surgery.

The first gynecologic procedure performed with a robot was a tubal anastomosis. This was performed in 1998 with the Zeus robot. Over the past several years other gynecologic procedures have been performed with other robots. Current robotic technology may not be universally applicable to many gynecologists' clinical practice. The field of surgical robotics is evolving at an ever increasing pace, however, and gynecologists need to participate in its development.

Female↗
PubMed2004

Preliminary experience with robot-assisted laparoscopic myomectomy.

The following retrospective case series evaluated the technique and feasibility of integrating robot-assisted technology in the performance of a laparoscopic myomectomy in order to overcome the limitations of conventional laparoscopy. We attempted 35 robot-assisted laparoscopic myomectomies in a university hospital setting with a conversion rate of 8.6%. There were a total of 48 myomas removed in 31 patients with completed robot-assisted laparoscopy. The mean number of myomas removed/patient was 1.6 (range 1-5). The mean diameter of myomas removed was 7.9 +/- 3.5 cm (95% CI 6.63-9.13), with the majority greater than 5 cm. The mean myoma weight was 223.2 +/- 244.1 g (95% CI 135.8-310.6). Mean operating time was 230.8 +/- 83 minutes (95% CI 201.6-260). The average estimated blood loss was 169 +/- 198.7 mL (95% CI 99.1-238.4). One patient experienced cardiogenic shock from vasopressin, two developed postoperative infections, and one was found to have adenomatous adenomyosis instead of a leiomyoma. The median length of hospital stay was 1 day. Overall, robot-assisted laparoscopic myomectomy is a promising new technique that may overcome many of the surgical limitations of conventional laparoscopy.

Adult↗
PubMed2004

Endoscopic management of leiomyomata.

Prior to the advent of modern minimally invasive surgery techniques, the primary surgical management of symptomatic leiomyomata for women desiring future fertility or uterine conservation was through laparotomy. Today, many cases of intramural and subserous leiomyomata are managed with laparoscopic myomectomy and selected cases of submucosal leiomyomata are managed with hysteroscopic myomectomy. The management of leiomyomata endoscopically is one of the more challenging procedures in minimally invasive surgery and requires a skilled surgeon. Despite its benefits, such as faster postoperative recovery and potentially less postoperative adhesions compared with laparotomy, many concerns still exist. Although pregnancy rates for women with leiomyomata managed endoscopically are similar to those after laparotomy, a major worry continues to be the risk of uterine rupture. The risk is essentially unknown. Lastly, the risk of recurrence seems higher after laparoscopic myomectomy compared with laparotomy.

Female↗
PubMed2003

Sexual activities and attitudes of women with vulvar dysesthesia.

OBJECTIVE: To assess the relationship between sexual activities and attitudes of women with and without vulvar dysesthesia. METHODS: Women with vulvar dysesthesia, 18-60 years old, and ethnically matched women without this disorder were enrolled in this cross-sectional study, completed a 27-page questionnaire, and had a physical examination. We compared sexual activities and attitudes between patients and controls using univariate and multivariable analyses. RESULTS: Between January 21, 2001, and December 12, 2002, we enrolled 63 women with vulvar dysesthesia and 62 controls who reported having a current sexual partner. Women with vulvar dysesthesia were less likely than controls to have had, during the previous month, intercourse (66.7% versus 83.9%, P =.03) and orgasms (57.6% versus 78.7%, P =.02), although the association with intercourse was no longer statistically significant after controlling for age, education, and smoking status (P =.07). Of those having had intercourse in the past month, the frequency of this activity was less among patients (3.0 +/- 2.7 versus 6.2 +/- 4.5 episodes, P <.001). Frequencies of orgasms, fellatio, cunnilingus, and masturbation did not significantly differ between patients and controls. Patients rated sex less important and rated themselves more negatively as sexual people than did controls (P <.001). CONCLUSION: Women with vulvar dysesthesia are similar to those without in many sexual activities but are less likely to have had an orgasm in the past month or to have had intercourse at the same frequency as controls. Although some attitudes were similar, sexual interest and self-concept were decreased among those with this disorder.

Adult↗
PubMedDate not supplied

A minimally invasive technique for management of the large adnexal mass.

STUDY OBJECTIVE: To describe our experience managing large pelvic masses through a minilaparotomy incision using a flexible, self-retaining wound retractor and exteriorized drainage by application of 2-octyl cyanoacrylate and a thin polyurethane membrane. DESIGN: Prospective nonrandomized trial (Canadian Task Force classification II-1). SETTING: Academic university hospital. PATIENTS: Ten women undergoing minilaparotomy for adnexal masses. INTERVENTIONS: After obtaining institutional review board approval, we identified 10 patients who underwent minilaparotomy for treatment of adnexal masses not thought to be amenable to laparoscopic surgical management and with clinical, radiographic, and laboratory evaluation consistent with a low probability of malignancy. Charts were reviewed and data collected. MEASUREMENTS AND MAIN RESULTS: The median mass size was 17.5 cm (range 9-30 cm), median incision length was 4.0 cm (range 3-5.5 cm), median patient age was 29.5 years (range 19-41 years), median body mass index was 24.7 (range 19.4-30.7), median duration of surgery was 85 minutes (range 53-141 minutes). Blood loss was minimal in all cases and all patients were discharged on the day of surgery. There were no diagnoses of ovarian malignancy. Pathologic diagnoses included mature cystic teratomas, cystadenomas, and cystadenofibromas. There were no instances of intraabdominal leakage of cyst fluid. One patient required readmission for a postoperative ileus. CONCLUSION: Minimally invasive management is a reasonable alternative to traditional laparotomy in the setting of a large adnexal mass with low probability of malignancy. This technique allows adequate access and exposure while minimizing the risk of intraabdominal contamination, speeding patient recovery, and optimizing cosmetic results. Further, this approach can be converted to a laparoscopic staging procedure if a patient is found to have ovarian cancer.

Adnexal Diseases↗
PubMedDate not supplied

Preliminary experience with robot-assisted laparoscopic staging of gynecologic malignancies.

OBJECTIVE: To evaluate the feasibility of integrating robot-assisted technology in the performance of laparoscopic staging of gynecologic malignancies. METHODS: Seven patients underwent robot-assisted laparoscopic staging procedures for gynecologic cancers. Data were collected and analyzed as a retrospective case series analysis. RESULTS: We attempted 7 robot-assisted laparoscopic staging procedures with no conversions to laparotomy. The median lymph node count for lymphadenectomy was 15 (range, 4 to 29). Mean operating time was 257 minutes (range, 174 to 345). The average estimated blood loss was 50 mL. One patient developed sinusitis and required intravenous antibiotics. The median hospital stay was 2 days. CONCLUSION: Robot-assisted laparoscopic staging is a feasible technique that may overcome the surgical limitations of conventional laparoscopy.

Adult↗
PubMedDate not supplied

The use of robot-assisted laparoscopic hysterectomy in the patient with a scarred or obliterated anterior cul-de-sac.

OBJECTIVE: The scarred or obliterated anterior cul-de-sac may pose a challenge to hysterectomy by any route. Conventional laparoscopic hysterectomy is fraught with technical limitations that limit the ability to compensate for the altered anatomy. This study will evaluate the feasibility of applying robot-assisted laparoscopy to managing these patients. METHODS: Six patients with suspected pelvic adhesive disease involving the anterior cul-de-sac underwent robot-assisted laparoscopic hysterectomy for benign indications. Data were collected and analyzed as a retrospective case series analysis. RESULTS: We attempted 6 robot-assisted laparoscopic hysterectomies with no conversions to laparotomy. The mean uterine weight was 121.7 g (range, 70 to 166.3). Mean operating time was 254 minutes (range, 170 to 368). The average estimated blood loss was 87.5 mL. One patient developed a delayed vaginal cuff hematoma. The average length of hospital stay was 1.3 days. CONCLUSION: Robot-assisted laparoscopic hysterectomy is a feasible technique in patients with a scarred or obliterated anterior cul-de-sac and may provide a tool to overcome the surgical limitations seen with conventional laparoscopy.

Adult↗