Biomedical subjects

Chyi-Long Lee

Publications and source records attributed to Chyi-Long Lee.

27 records · Page 2Linked to original sources

PubMed2002

Combined laparoscopic uterosacral and round ligament procedures for treatment of symptomatic uterine retroversion and mild uterine decensus.

STUDY OBJECTIVE: To evaluate the efficacy of a new modified technique to treat a symptomatic retrodisplaced uterus. DESIGN: Prospective clinical study (Canadian Task Force classification II-2). SETTING: Tertiary care university hospital. PATIENTS: Thirty-one women with symptomatic uterine retrodisplacement but without significant pelvic pathology. INTERVENTION: Laparoscopic shortening and plication of uterosacral ligaments with modified Gilliam suspension. MEASUREMENTS AND MAIN RESULTS: In average follow-up of 3.3 +/-1.0 years, all patients had an anteverted, anteflexed uterus. Mean +/- SD operating time was 24.1 +/- 4.7 minutes. There were no complications during or after surgery. Dyspareunia scores before and after surgery were 5.4 +/- 1.4 and 0.5 +/- 0.7, respectively (p <0.001). Chronic pelvic pain was satisfactorily relieved in seven of nine women. Vagina lengths before and after surgery were 5.9 +/- 0.7 and 7.0 +/- 0.3 cm, respectively (p <0.001). CONCLUSION: Our technique achieved long-lasting good results in suspending uteri in anteverted, anteflexed position and relieved symptoms caused by retrodisplacement.

Adult↗

PubMed2002

Laparoscopic ultrasonography for uterovaginal canalization of a didelphic uterus with agenetic cervix.

Mullerian duct anomaly is often characterized by any of a number of disorders of the outflow tract and uterus. A 17-year-old woman suffered from cyclic lower abdominal pain for 3 years. Pelvic examination showed a small uterus with blind-ended vaginal canal about 3 cm in length. Three-dimensional pelvic ultrasonography showed a compact uterine corpus with fundal notch regarded as bicornuate uterus, and no evidence of uterine cervix. The same features were also proved by magnetic resonance imaging. Intraoperative ultrasonography showed a small uterine cavity, and uterovaginal canalization was performed. The patient had regular menses without further low abdominal pain after 6 months of follow-up. Uterovaginal canalization with the aid of intraoperative ultrasonography may be effective in managing the difficult didelphic uterus with an agenetic cervix and hypoplastic vagina.

Adult↗

PubMed2002

Comparison of laparoscopic and conventional surgery in the treatment of early cervical cancer.

STUDY OBJECTIVE: To compare efficacy, results, and complications of laparoscopic-assisted radical hysterectomy (LARH) and pelvic lymphadenectomy with abdominal radical hysterectomy (ARH) and pelvic lymphadenectomy in management of early (stages 1a2, 1b) invasive cervical carcinoma. DESIGN: Prospective cohort study (Canadian Task Force classification II-2). SETTING: University-affiliated hospital. PATIENTS: Sixty women enrolled for radical hysterectomy as most appropriate primary treatment. INTERVENTION: Radical hysterectomy performed by laparoscopy or laparotomy. MEASUREMENTS AND MAIN RESULTS: Thirty patients each underwent LARH and ARH. The groups did not differ in terms of age, weight, disease stage, operating time, and hospital stay. Mean blood loss was 962 +/- 543 ml for ARH and 450 +/- 284 ml for LARH. No laparoscopic procedure was converted to laparotomy. There was no significant difference in intraoperative and postoperative complications. There was no significant difference in recurrence rates. CONCLUSION: LARH with pelvic lymphadenectomy does not increase recurrence rates and morbidity when performed by experienced endoscopists and oncologists.

Adult↗

PubMed2002

Trocar-assisted sling suspension for stress urinary incontinence.

STUDY OBJECTIVE: To introduce a new approach in trocar-assisted sling suspension (TASS) for genuine stress incontinence. DESIGN: Prospective, observational study (Canadian Task Force classification II-2). SETTING: University-affiliated hospital. PATIENTS: Twenty-four women with genuine stress incontinence. INTERVENTION: TASS. MEASUREMENTS AND MAIN RESULTS: After standard preparation and under general endotracheal anesthesia, the periurethral space and thicker part of pubocervical fascia was opened from the vagina. An 0.5-cm incision was made on both sides of the lower abdomen 4 cm lateral to the linea alba and 2 to 3 cm above the pubic bone. A trocar was used to penetrate the incision site to the space of Retzius. A folded polypropylene mesh, 2 cm wide and 30 cm long, inside the vagina was pulled outside the trocar with laparoscopic forceps. All procedures were completed as planned. Average blood loss was less than 50 ml and operating time was 20 to 90 minutes. One woman had voiding difficulty and two had detrussor instability, but no bladder injury occurred (overall complication rate 12.5%). At 2-year follow-up, 23 of 24 women were satisfied with the results. CONCLUSION: TASS is a feasible surgical procedure for managing stress incontinence. Since urinary incontinence surgery is usually combined with other gynecologic procedures, the laparoscopic trocar that is used during TASS can be used for concurrent surgery.

Adult↗

PubMed2002

Total laparoscopic radical hysterectomy using Lee-Huang portal and McCartney transvaginal tube.

A surgical approach to the treatment of invasive cervical carcinoma 1b1 may result in decreased mortality and morbidity as well as better functional quality of life. Laparoscopic-assisted radical vaginal hysterectomy (LARVH) is an alternative treatment for early cervical cancer, with parts of the procedures performed vaginally. We modified LARVH to total laparoscopic radical hysterectomy (TLRH) using Lee-Huang portal and McCartney transvaginal tube. The advantage of TLRH for cervical cancer is that the entire procedure is performed under direct observation. It may reduce the possibility of visceral organ injury during vaginal procedures and could minimize vaginal bleeding due to dissection. The Lee-Huang portal as primary laparoscopic port affords wide access to the abdominal cavity and proper visual angle, and increases the working distance. A plastic McCartney transvaginal tube placed inside the vagina maintains pneumoperitoneum and performs a circular incision on the vagina around the uterus with ease. Our preliminary experience with 12 patients suggests that this method of TLRH is feasible for selected patients and may be a useful alternative in treating early cervical cancer.

Biopsy, Needle↗

PubMedDate not supplied

Total laparoscopic radical parametrectomy.

Although the surgical approach to early invasive cervical carcinoma may result in a better functional quality of life, the majority of patients with occult cervical cancer posthysterectomy still are treated with radiation therapy. Obviously, a radical operation still is considered a technically difficult task. Recently, laparoscopic-assisted vaginal radical parametrectomy (LAVRP) has been reported as an alternative treatment for this situation. In laparoscopic-assisted vaginal radical hysterectomy (LARVH), parts of the procedure are performed vaginally. We modified LAVRP in treating cervical cancer as through the laparoscope completely total laparoscopic radical parametrectomy (TLRP). The major advantage of TLRP for occult cervical cancer is that the entire surgery is performed under direct observation. It may reduce the possibility of visceral organ injury during vaginal procedures and could minimize the vaginal bleeding from vaginal dissection. Our preliminary experiences suggest that TLRP is feasible for carefully selected candidates.

Endometrium↗

PubMedDate not supplied

Hysteroscopic management of cesarean scar pregnancy after unsuccessful methotrexate treatment.

Current management of cesarean scar pregnancy is conservative and consists of medical treatment with methotrexate (MTX). We present a report on a woman with this type of pregnancy who had continuous vaginal bleeding and persistent serum levels of beta human chorionic gonadotropin after undergoing curettage and MTX. Eventually, the remaining ectopic gestational tissue was removed by operative hysteroscopy.

Abortifacient Agents, Nonsteroidal↗

PubMedDate not supplied

A prospective comparison of morcellator and culdotomy for extracting of uterine myomas laparoscopically in nullipara.

We compare the removal of uterine myomas in 78 nulliparous women identified by ultrasound during laparoscopic myomectomy through culdotomy or by use of a power morcellator. Patients were divided into two groups. The culdotomy group was significantly longer. There were no significant differences in tumor size, total specimen weight, patient body weight, total operating time, blood loss, and postoperative stay between each group. Uterine myomas can be removed successfully through either port site in nullipara; however, because of reduced removal time, the power morcellator is preferred.

Adult↗

PubMedDate not supplied

Minilaparoscopic cystectomy and appendectomy in late second trimester.

BACKGROUND AND OBJECTIVES: Laparoscopic ovarian cystectomy and appendectomy during the early second trimester have been widely reported. However, the use of both procedures in advanced gestation is rare. We propose a minilaparoscopic approach for performing these 2 procedures in a woman 24-weeks pregnant. METHODS: We describe the case and laparoscopic management of acute abdominal pain at the 24th week of pregnancy. Microlaparoscopy under ultrasound guidance was used for the first trocar insertion to prevent injury to the uterus. It was followed by minilaparoscopic ovarian cystectomy and appendectomy. RESULTS: Premature contractions occurred after the operation, but they were controlled with a single tocolytic agent, and an apparently healthy female baby was born uneventfully via Cesarean delivery at 41 weeks of gestation. CONCLUSION: Minilaparoscopic ovarian cystectomy and appendectomy can be carried out in the late second trimester without serious sequela.

Abdominal Pain↗