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Biomedical subjects

D Querleu

Publications and source records attributed to D Querleu.

At least 91 records · Page 5Linked to original sources
PubMed1998

[Comparison of laparoscopic and laparotomy colposuspension in the treatment of urinary stress incontinence. Comparative study of 72 matched cases].

The aim of this study was to compare the results of open retropubic (OC) and laparoscopic (LC) colposuspension to the Cooper's ligament (Burch operation). We matched retrospectively 72 LC and OC according to their ages, the type of associated operations and the clinical stages of their urinary incontinence. We excluded associated prolapsus, previous surgical procedure for urinary incontinence, maximal urethral closure pressure lower than 30 cms of water and instability of the detrusor. We estimated the comparability of our two series about the other criteria which have an effect upon the post operative results in literature. The mean follow up was 17 months for LC and 46 months for OC. LC operative time was longer than (Mean: LC: 89 minutes, OC: 42 minutes), women considered LC less aching than OC. They needed less postoperative analgesia, mostly given only just the day of the procedure. LC length of hospitalization and return to normal activity was shorter than OC (Mean: LC: 3 days--OC: 6, 7 days; LC: 15 days--OC: 21 days). The graphs of the subjective cure and improvement rates made according to the Kaplan-Meier method could be compared with the log rank test. (Cure after one year: LC 79%, OC 69%--Improvement after one year: LC 85%, OC 82%--Cure after two years: LC 68%--OC 64%--Improvement after two years: LC 80%--OC 75%).

Activities of Daily Living↗
PubMed1998

[SPIC: a training simulator for coelioscopic interventions with gynecologic purpose].

There is much demand for laparoscopy training. We have developed a training simulator for initial training in gynecological laparoscopy. The simulator includes a mannequin with 3 located trocars, a PC and software for managing the graphical part of the training protocol. The objective is to learn how to achieve spatial localization and handle tools within the abdominal cavity. A series of exercises are proposed with increasing degree of difficulty. The simulator can be customized to simulate many different scenarios. The trainer must be present to provide an ultimate assessment of the trainee's experience. This new training tool cannot replace traditional surgical training but can help make it more efficient. The simulator is now being used by residents. Further technical developments are in progress to add further indispensable mechanical interactions (force feed back) to visualize the organ deformations and organ dissections within the abdominal cavity.

Computer Simulation↗
PubMed1998

[Is vaginal hysterectomy important for large uterus of more than 500 g? Comparison with laparotomy].

OBJECTIVE: Vaginal hysterectomy is an advantageous surgical technique as compared with abdominal hysterectomy: operating time is shorter, it is safer and hospitalization stay and recovery time are shorter. However in France, 2/3 of all hysterectomies are still performed by laparotomy. Would the vaginal approach be reasonable if a difficult hysterectomy is expected? The purpose of our study was to compare the per- and postoperative complications and the period following vaginal hysterectomy versus the abdominal route in patients with a large uterus. PATIENTS AND METHODS: Forty-nine vaginal hysterectomies were compared retrospectively with 22 abdominal hysterectomies for fibroma during the period from 01.01.91 to 31.12.95. Uterine weight in all cases was between 500 to 1,000 g. RESULTS: The average uterine weight was significantly different between the vaginal and the abdominal groups (644 g vs 747 g, p = 0.02). Operating time, pre- and postoperative complications and analgesic use were not significantly different between the two groups. Operative bleeding was significantly higher in the abdominal group than in the vaginal group (659 ml vs. 359 ml, p = 0.006), as well as hemoglobin loss (2.49 vs. 1.82, p = 0.04). There was also a statistical difference between the vaginal group and the abdominal groups in terms of hospital stay (4 d vs. 6 d respectively, p = 0.0002). CONCLUSION: Vaginal hysterectomy with morcellation is advantageous in comparison with abdominal hysterectomy even when the uterine weight is over 500 g, since it offers better post-operative comfort than laparotomy without endangering the patients. The main contraindications for the vaginal route are uterus beyond the ombilicus and vaginal atresia. Excepting these cases, the indication for the vaginal approach depends on the patient's past surgical history, uterine mobility and vaginal access. In more difficult cases, these factors are assessed under anesthesia.

Adult↗
PubMed1997

[Treatment of rectovaginal endometriosis].

FREQUENT: The most frequent deep localization, endometriosis of the rectovaginal septum may penetrate into the vagina or rectum. MEDICAL TREATMENT: Hormone therapy suppresses menstruation if a short-term regimen is given, but the cost of long-term therapy with LHRH analogues and estrogen substitution may be high. SURGERY: Definitive treatment is difficult to achieve, but surgery may be required. The risks of surgery for this benign disease must be weighed against the expected benefit, particularly in drug-resistant cases where pain is severe or rectal symptoms predominant. ASYMPTOMATIC DISEASE: No specific treatment is required in asymptomatic patients or when unpainful disease is discovered at infertility explorations.

Endometriosis↗
PubMed1997

Accuracy and safety of laparoscopic lymphadenectomy: an experimental prospective randomized study.

INTRODUCTION: The goal of this study was to investigate the accuracy and safety of bilateral pelvic and paraaortic lymphadenectomy performed via transperitoneal laparoscopy (LS) compared to laparotomy (LT) in a porcine model. MATERIALS AND METHODS: Fifteen adult, female hogs underwent LS and 15 underwent LT. A complete pelvic and paraaortic lymphadenectomy was performed in each animal by an experienced surgeon. Lymph nodes were counted by a pathologist in each case. Operative times were reviewed and included all procedures performed. The intraoperative complications were noted. Four weeks after the lymphadenectomy, the animals underwent exploratory laparotomy, and intraperitoneal adhesions were quantified. RESULTS: Thirty animals were evaluable. The average total number of lymph nodes retrieved by LS was 16.9 +/- 3.8, which was not statistically (P = 0.77) different from 16.5 +/- 4.9 nodes in LT. The average operating time in LT was 60 +/- 16 min compared with 128 +/- 24 min in LS. Twenty-eight animals were evaluable for adhesion formation. The average adhesion scores observed in anterior abdominal wall (P = 0.0006), paraaortic (P = 0.0005), right (P = 0.015), and left (P = 0.0324) iliac areas after LS were uniformly lower than after LT. DISCUSSION: This study indicates that laparoscopic pelvic and paraaortic lymphadenectomy is a safe and effective procedure. The node yield is similar for both approaches. The transperitoneal laparoscopy pelvic and paraaortic lymphadenectomy may not induce the degree of adhesion formation associated with laparotomy.

Animals↗
PubMed1997

[What role should hysterectomy play in benign uterine lesions?].

Since the beginning of the nineties, we have seen an increase in the use of operative hysteroscopy in the surgical treatment of women with dysfunctional uterine bleeding. The aim of this article is to show that these new techniques are surgical acts subject to complications, failures, morbidity and indeed mortality. It seems therefore reasonable to ask whether vaginal hysterectomy represents a good alternative to endometrial ablation. We think so both in terms of functional or clinical results, and cost or quality of life. The endometrial ablation should be reserved to women who have strictly dysfunctional pathologies. In all cases, the difficulty in the diagnosis of adenomyosis, the high rate of failure of endometrial ablation, the degradation of its results with time and finally the better quality of life after hysterectomy must be exposed clearly to all patients. It will be with full knowledge of the facts, that women will be able to choose between radical surgical treatment represented by hysterectomy and so-called conservative surgical treatments.

Endometriosis↗
PubMed1997

Major vascular injuries during gynecologic laparoscopy.

BACKGROUND: This study was undertaken to report our experience with major vascular injuries in gynecologic laparoscopy in order to specify the circumstances under which they occurred, the means of diagnosis, the risk factors, and the means for prevention. STUDY DESIGN: Retrospective case review study. RESULTS: Seventeen patients with 21 major vascular injuries were identified. The average age of the patients was 33.8 +/- 11.6 years, and the mean body index mass was 21.6 +/- 3.08 kg/m2. Three of four of the accidents occurred during the set-up phase of laparoscopy (13 cases; 76.5%), and in 4 cases (23.5%) the accident occurred during the laparoscopic surgery procedure. Eleven (84.6%) of the complications occurring during the set-up phase were secondary to insertion of the umbilical trocar and 2 (15.4%) to insertion of the needle used to create the pneumoperitoneum (P-needle). Half (6 cases; 54.5%) of the major vascular injuries secondary to insertion of the umbilical trocar were observed when reusable trocars were used. In every case, the diagnosis was made during the operation. Two patients died, and two others presented a serious complication (phlebitis; acute ischemia requiring reoperation). CONCLUSIONS: Major vascular injuries are rare but serious complications of laparoscopic surgery. Prevention of these accidents relies on the surgeon's experience and scrupulous respect of the safety rules. In the vast majority of cases, it is necessary to convert to laparotomy immediately, calling in a vascular surgeon.

Adult↗
PubMed1997

[Laparoscopic surgical repair of surgical complication of laparoscopy in gynecology. Experiences at the Paul Gellé de Roubaix Center from 1992 to 1995].

UNLABELLED: From 1992 to 1995, 1565 laparoscopic operations were performed in Roubaix. We report on six complications. OBJECTIVE: To compare this figure with these of the French collaborative study done from 1987 to 1991 by seven departments known for their laparoscopic activity, including Roubaix. RESULTS: The trends are good. The rate of injuries was stable in spite of increasingly complex procedures. The largest portion of visceral and even vascular injuries were repaired by laparoscopy reducing by the same amount use of laparotomy. CONCLUSIONS: Strict adherence to safety guidelines and specific training of surgeons reduce the need of laparotomy for laparoscopic complication.

Blood Loss, Surgical↗
PubMed1996

The feasibility of vaginal hysterectomy.

OBJECTIVE: To assess the feasibility of vaginal hysterectomy for benign uterine disease and to assess how frequently laparoscopic assistance is necessary. METHODS: A prospective series of 806 hysterectomies for benign disease of the uterus without prolapse which were performed in our institution from 1 March 1991 to 28 February 1994 is discussed. The report is an evaluation of a planned approach for hysterectomy. Vaginal hysterectomy was performed whenever possible-laparoscopic hysterectomy was indicated for adnexal pathology, known or anticipated significant pelvic adhesions and for a narrow vaginal access with a moderately enlarged uterus-abdominal hysterectomy was chosen when both laparoscopic and vaginal surgery were judged to be impossible. RESULTS: Vaginal hysterectomy was performed in 80.6% of patients. Laparoscopic assistance was needed in 9.4% of cases. The need for laparotomy was reduced to 10% with an acceptable pre- or postoperative complications rate.

Feasibility Studies↗
PubMed1996

[Alternatives and access routes in hysterectomies. Are randomizations dangerous?].

Hysterectomy is a common gynaecological operation in Europe. Although the advantages of new minimally invasive procedures seem obvious, prospective randomised trials are essential for proper appraisal. We reviewed all randomised studies about routes for hysterectomy and comparison of conservative or radical surgery. This study points out the many deficiencies of such studies. Referred conclusions are then open to criticism. We concluded that new prospective studies should be performed, adapted to social, cultural and economic conditions in Europe.

Bias↗
PubMed1996

[Bowel complications in gynecologic laparoscopic surgery and their immediate repair without laparotomy. Four cases].

Laparoscopic surgical procedures are increasing throughout the world, and with this increase in its utilization, a renewed interest in its possible complications. We presented four case reports of bowels injuries and their repair by laparoscopy. We reviewed the literature and discuss common complications with suggestions to avoid such injuries and for management. We conclude that small and large bowel enterostomies can be repaired safely via the laparoscope with minimum morbidity in patients with a prepared bowel. More serious complications occur if visceral trauma is not handled immediately. There is no place for adopting a "wait and see" approach.

Adult↗
PubMed1996

[The advantage of an umbilical micro-laparotomy, "open laparoscopy", for laparoscopic surgery. Experimental study].

This study was carried out to evaluate the respective safety of standard introduction of the umbilical trocar after insuflation of the abdomen through a veress needle, direct trocar insertion, and the open laparoscopy approach. Abdominal adhesion were induced by standardized peritoneal trauma in 60 New Zeland white female rabbits. Three weeks later, the animals were randomly assigned to one of three techniques: group 1: standard approach; group 2: direct trocar insertion; group 3: open laparoscopy. Twenty-four bowel injuries occurred in group 1, thirty nine in group 2, and six in group 3. The differences between groups were statistically significant (group 1 vs group 2: p = 0.03; group 3 vs group 1: p = 0.004; group 3 vs group 2: p = 0.0001). These findings favor the use of the open laparoscopy approach when abdominal adhesions are suspected. The standard approach is safer than the technique without pneumoperitoneum, but would require an endoscopic visualization of the umbilical trocar insertion to reduce the complication rate.

Animals↗
PubMed1996

[Granulosa cell tumors: a case located in the broad ligament of the uterus with normal ovaries].

Granulosa cell tumours are relatively rare ovarian tumors. The incidence was 0.9 cases per 100,000 women per year. We describe a quite uncommon granulosa tumour found in the broad ligament. The patient was a 25-year-old, white woman, gravida 4, para 2. Surgical treatment was tumourectomy with homolateral salpingo-oophorectomy. From this observation, embryology, clinical and paraclinical aspects, treatment and prognosis of these tumours are reviewed.

Adult↗
PubMed1996

[Enterocele. Retrospective study of 134 cases: risk factors and comparison between abdominal and perineal routes].

OBJECTIVE: Our purpose was to assess etiological factors in enterocele and to compare abdominal sacral colpopexy with mesh and resection of the cul-de-sac of Douglas to transvaginal sacrospinous colpopexy. METHODS: A retrospective study, for 20 years, concerned 134 patients clinically proved enterocele confirmed during the operation. RESULTS: Etiological factors were: multiparity, perineal tear, foetal macrosomia, instrumental extractions, antecedents of gynaecologic operations, tissular and constitutional factors. The analysis of the anatomical and functional results did not distinguish between the two surgical procedures, each with its proper indications. CONCLUSION: For patients 60 years old or older, we propose the transvaginal sacrospinous colpopexy. Before 50 years, we prefer abdominal sacral colpopexy with mesh. Between 50 and 60 years, each case must be examined with the health status of the patients.

Adult↗
PubMed1996

[Endometrial cancer: total simple hysterectomy or radical hysterectomy? Abdominal or vaginal route?].

Total abdominal hysterectomy and bilateral salpingo-oophorectomy has long been the standard surgical treatment for endometrial cancer. Radical hysterectomy is not useful in stage I. in women with extreme obesity and medical risk factors, vaginal hysterectomy is recommended. Laparoscopy-assisted vaginal hysterectomy complete the oncologic treatment if lymphadenectomy is necessary.

Endometrial Neoplasms↗