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Biomedical subjects

C Nezhat

Publications and source records attributed to C Nezhat.

At least 73 records · Page 4Linked to original sources
PubMed1993

Adhesion formation after endoscopic posterior colpotomy.

Twenty-two women who had undergone laparoscopic posterior colpotomy at initial operative laparoscopy and later underwent a second laparoscopic procedure were evaluated for adhesion formation. Fifteen women (68%) had myomata removed, 3 (14%) had a dermoid cystectomy, 1 (5%) had a serous cystadenoma removed, and 3 (14%) who had large endometriomata and severe adhesions underwent salpingo-oophorectomy. Although filmy adhesions were noted in nine women, no adhesions were noted in the cul-de-sac. Based on our limited results, it does not appear that tissue removal via laparoscopic colpotomy predisposes reproductive-age women to postoperative adnexal adhesion formation.

Adnexal Diseases↗
PubMed1992

Four ovarian cancers diagnosed during laparoscopic management of 1011 women with adnexal masses.

OBJECTIVES: This study was conducted to assess the value of laparoscopic management of adnexal masses. Two concerns we wish to address are the failure to diagnose early ovarian cancer at laparoscopy and worsening the prognosis of stage I cancer by spilling fluid during surgery. STUDY DESIGN: The setting is a predominantly referral-based, private subspecialty practice. All operations were preformed in the outpatient surgical suite of a large suburban hospital. After extensive patient screenings, which included history and physical examination, preoperative serum CA 125 levels (since 1988), and pelvic ultrasonography, 1209 adnexal masses were managed laparoscopically. RESULTS: Of 1011 patients with surgical management, ovarian cancer was discovered intraoperatively in four. CONCLUSIONS: Our findings indicate that with consistent use of frozen sections of all cyst walls and suspicious tissue, laparoscopic management did not alter the prognosis. Neither CA 125 level, pelvic ultrasonography, nor peritoneal cytologic testing had sufficient diagnostic specificity to predict malignancy. Experienced surgeons using intraoperative histologic sampling may safely evaluate adnexal mass laparoscopically.

Adnexal Diseases↗
PubMed1992

Operative laparoscopy for the treatment of ovarian remnant syndrome.

OBJECTIVE: To present the technique and assess the efficacy of operative laparoscopy to manage ovarian remnant syndrome. DESIGN: Observational with a follow-up of 6 to 32 months. SETTING: Private subspecialty practice with a large referral base. PATIENTS: Thirteen women, 9 with previous bilateral salpingo-oophorectomy and 4 with previous unilateral salpingo-oophorectomy and pain on the ipsilateral side. INTERVENTIONS: Multipuncture advanced operative laparoscopy. MAIN OUTCOME MEASURES: Patient pain relief was assessed through return examinations, telephone interviews, or contact with referring physicians. RESULTS: Nine patients reported complete pain relief. One reported incomplete but satisfactory pain relief. Two required bowel resection by laparotomy to obtain pain relief, and one, despite subsequent laparotomy, had persistent pain. No intraoperative or postoperative complications were noted. CONCLUSION: Laparoscopy can be effective in managing ovarian remnant syndrome when performed by an experienced laparoscopist.

Adult↗
PubMed1992

Laparoscopic proctectomy for infiltrating endometriosis of the rectum.

Proctectomy for deep endometriosis of the rectal wall was performed without laparotomy. Although laparoscopic pelvic surgery and transperineal proctectomy with primary double-stapled anastomosis are established procedures in gynecological and gastrointestinal surgery, this is the first reported case in which these procedures are combined to mobilize the rectum and perform an extracorporeal transanal rectal resection and anastomosis.

Adult↗
PubMed1992

Laparoscopic treatment of symptomatic diaphragmatic endometriosis: a case report.

Extreme caution and meticulous surgery are imperative when treating the surface of the diaphragm. This procedure should only be performed by an experienced laparoscopic surgeon after appropriate consultation with a cardiothoracic surgeon. Proper care, a thorough understanding of surrounding anatomic structures, and familiarity with laparoscopic instrumentation including the CO2 laser are required for the safe laser vaporization or excision of any peritoneal surface using hydrodissection (7).

Adult↗
PubMed1992

Laparoscopic surgery with a new tuned high-energy pulsed CO 2 laser.

Although CO 2 lasers have gained popularity in operative laparoscopy, it has been suggested that they do not deliver sufficiently high power density at the distal end of a laparoscope. Heating of the insufflation gas inside the laparoscope by absorption of some of the laser power causes the gas density to change and creates distortion and defocusing, resulting in lower power density at the tissue as the laser power is increased. A new laser uses the carbon-13 isotope in the laser gas mix instead of the carbon-12 isotope, which is used in both conventional lasers and CO 2 insufflation gas. The new laser was found to have no noticeable effect on tissue attributed to distortion or power loss from absorption in the insufflation gas, and it allowed the surgeon to work with minimal thermal side effects, such as the formation of charred tissue. The laser was fitted with separate controls for adjusting pulse energy and average power, allowing the surgeon to control the laser-tissue response at different operating speeds.

Carbon Isotopes↗
PubMed1992

Laparoscopically-assisted hysterectomy for the management of a borderline ovarian tumor: a case report.

Borderline ovarian tumors account for 4% of ovarian neoplasms, an incidence which remains constant despite advancing age. Management for younger women can be unilateral oophorectomy, although simple hysterectomy with bilateral salpingo-oophorectomy is more appropriate for women beyond childbearing age. The authors report a laparoscopic approach to a case of borderline ovarian tumor.

Adult↗
PubMed1992

A simplified method of laparoscopic presacral neurectomy for the treatment of central pelvic pain due to endometriosis.

OBJECTIVE: To describe optimal procedures and preliminary results for videolaparoscopic presacral neurectomy as part of the surgical treatment of endometriosis associated with intractable dysmenorrhoea. DESIGN: Observational study with follow up for at least one year. SETTING: Subspecialty practice: Endometriosis Clinic and Centre for Special Pelvic Surgery. SUBJECTS: Eighty five women (18-45 years) with endometriosis and intractable pain, referred because medical and surgical management had failed. Subjects without a central (midline) component to their discomfort were excluded. INTERVENTIONS: Excision and vaporization of endometriotic pathology was followed by presacral neurectomy. OUTCOME MEASURES: During surgery, severity of endometriosis was assessed using revised American Fertility Society scoring. Overall pelvic pain and dysmenorrhoea relief were determined by office visit, telephone interview and questionnaire at a minimum of one year postoperatively. RESULTS: There were no operative complications and all women left hospital within 24 h of surgery. Overall pain relief was reported by 49 (94%) of 52 patients followed. The other three subjects noted no pain abatement. Dysmenorrhoea was reduced in 48 (92%) whereas four (8%) women claimed no relief. CONCLUSIONS: Laparoscopic presacral neurectomy is an option for treating dysmenorrhoea and pelvic pain in selected women, but is indicated only if medical management has failed. Videolaparoscopic presacral neurectomy using the CO2 laser is safe in trained hands. Pain relief achieved is within the range reported for laparotomy.

Adolescent↗
PubMed1992

Laparoscopic treatment of infiltrative rectosigmoid colon and rectovaginal septum endometriosis by the technique of videolaparoscopy and the CO2 laser.

OBJECTIVE: To present the technique and results of videolaparoscopy and the CO2 laser as a treatment for deep, infiltrative endometriosis of the rectovaginal septum, uterosacral ligaments, pouch of Douglas and anterior wall of the rectosigmoid colon. DESIGN: Observational study with 1-5 year follow up. SETTING: Sub-specialty practice: Endometriosis clinic and centre for special pelvic surgery. SUBJECTS: 185 women, aged 25-41 years. All had pelvic endometriosis and were referred because of the failure of previous medical and/or surgical treatment. INTERVENTIONS: Vaporization and excision of endometriotic implants and nodules, ureterolysis, ureteric stents, laparoscopic anterior rectal wall resection and reanastomosis, presacral neurectomy, laparoscopic hysterectomy, salpingo-oophorectomy and appendicectomy using the CO2 laser. MAIN OUTCOME MEASURES: 174 patients were followed for 1-5 years after surgery by office visit questionnaire or telephone interview. Eleven were lost to follow-up. RESULTS: 175 patients were discharged within 24 h. Nine with bowel perforations and one with a partial bowel resection were discharged 2-4 days postoperatively. Two patients required ureteric stents, which were removed 6 weeks postoperatively without sequelae. 162 women reported moderate to complete pain relief (145 after one procedure, 13 after two and four after three). 12 reported persistent or worse pain following the surgery. Seven eventually underwent total hysterectomy, four had bowel resections and one had a salpingo-oophorectomy. Of 61 with infertility, 25 achieved pregnancy. Postoperative complications included shoulder pain, anterior abdominal wall ecchymosis, urine retention and dyschezia for one to two weeks. CONCLUSIONS: Our experience suggests that rectosigmoid colon and infiltrative rectovaginal septum endometriosis can be effectively treated via videolaparoscopy in the hands of experienced endoscopic gynaecologists.

Adult↗
PubMed1992

Laparoscopic repair of ureter resected during operative laparoscopy.

Ureteral injury is a recognized complication of gynecologic surgery. During operative laparoscopy performed to treat extensive endometriosis of the pelvic sidewall, a 1.5-cm portion of the right ureter was resected and was repaired successfully. Repair of a resected ureter may be effectively accomplished endoscopically by experienced operative laparoscopists.

Adult↗
PubMed1992

Clinical and histologic classification of endometriomas. Implications for a mechanism of pathogenesis.

One hundred eighty-seven consecutive patients with persistent ovarian cysts and endometriosis underwent laparoscopic evaluation and ovarian cystectomy. All patients had been followed for a minimum of 6 weeks prior to surgery. The cysts were identified initially to be endometriomas based on their gross appearance and the presence of endometriosis at other pelvic sites. Presumed endometriomas were classified into three types based on size, cyst contents, ease of removal of the capsule, adhesions of the cyst to other structures and location of superficial endometrial implants relative to the cyst wall. After clinical laparoscopic classification, the cysts were evaluated histologically without knowledge of the clinical assessment. Histologically small (< 2 cm), superficial ovarian cysts were always endometriomas, and the cyst wall was very difficult to remove (type I). Large cysts with easily removed walls were usually luteal cysts (type II). Large cysts with walls adherent in multiple areas adjacent to superficial endometriosis were generally endometriomas but some also had histologic characteristics of functional (luteal or follicular) cysts (types IIIa and IIIb). These findings led to the conclusion that superficial ovarian endometriosis is similar to endometriosis in extra-ovarian sites in that the formation of superficial cysts is limited in size by fibrosis and scarring. In contrast, large endometriomas may develop as a result of secondary involvement of functional ovarian cysts by the endometriotic process.

Adult↗
PubMed1992

Laparoscopic versus abdominal hysterectomy.

The perioperative and postoperative courses of hysterectomy with or without bilateral salpingo-oophorectomy were compared for 10 women who underwent total abdominal hysterectomy and 10 who underwent laparoscopically assisted vaginal hysterectomy. Although laparoscopic hysterectomy took longer (160 versus 102 minutes), the women undergoing it had a shorter duration of hospitalization (2.4 versus 4.4 days), more rapid recuperation (3 versus 5 weeks) and fewer complications. These preliminary results suggest that in the hands of experienced operative laparoscopists, laparoscopically assisted vaginal hysterectomy is preferable to abdominal hysterectomy for selected candidates.

Adult↗