Is laparoscopic treatment of endometriosis better?
Explore the source record for details and available documents.
Data Interpretation, Statistical↗
Biomedical subjects
G D Adamson
Publications and source records attributed to G D Adamson.
13CO2 isotopic laser used through the operating channel of laser laparoscopes: a comparative study of power and energy density losses.
OBJECTIVE: To evaluate the power transmission, spot size, power density, and energy density of a new isotopic carbon dioxide (13CO2) laser compared with a conventional CO2 laser. METHODS: Experiments were performed in a laboratory using a conventional CO2 laser and an isotopic 13CO2 laser. Two laparoscopes with 5-mm and 7.5-mm operating channels were connected to a standard coupler and to each of the lasers. Standardized measurements were made of power transmission and spot size using both nitrogen purge gas and CO2 purge gas at rates of 1-20 L/minute. Power density and energy density were calculated for continuous mode and ultrapulse mode transmission, respectively. RESULTS: The isotopic 13CO2 laser power transmission was higher and proportional to input power, while spot size was smaller compared with the conventional laser and was insensitive to power level or purge rate. Power density and energy density were markedly higher with the isotopic 13CO2 laser, reaching the threshold for complete ablation, and were much more predictable. The 7.5-mm operating channel generally had superior operating results compared with the 5-mm channel because of the smaller spot size and higher power transmission. CONCLUSIONS: The isotopic 13CO2 laser is associated with much higher power density and energy density capabilities than are conventional CO2 lasers. At surgery, we have noted less thermal injury, faster ablation, more precise and predictable tissue effects, and greater control of tissue effect with the isotopic 13CO2 laser than with other CO2 lasers. These results are attributed to the improved beam propagation through CO2 insufflation gas measured in the laboratory. Thermal injury can be varied according to the required surgical situation and can be kept to an absolute minimum at high-pulse energy.
Carbon Dioxide↗
A new wave guide for use with a CO2 delivery system for laparoscopic surgery.
This study assessed the performance of the Heraeus LaserSonics InfraGuide with the 250Z CO2 laser in 46 patients undergoing laparoscopic surgery. Procedures included vaporization of endometriosis, adhesiolysis, ovarian cystectomy, uterosacral ligament transection, salpingoplasty, fimbrioplasty, neosalpingostomy, ectopic linear salpingostomy and myomectomy. The InfraGuide system was effective in transmitting laser energy to the pelvis. Advantages and disadvantages of the accessory sheath, spot diameter, HeNe aiming beam and optical laser coupler are discussed. The InfraGuide offers the surgeon an additional useful laparoscopic instrument.
Carbon Dioxide↗
Myomectomy, GnRH analogs, and adhesions.
Explore the source record for details and available documents.
Female↗
Hysteroscopic treatment of ectopic intrauterine bone. A case report.
Hysteroscopic removal of ectopic bone in the uterus, using laparoscopic control and ultrasonographic confirmation, was used to treat a patient who presented with a diagnosis of osseous metaplasia of the uterus. Pathologic analysis revealed benign bony tissue consistent with a diagnosis of osseous metaplasia. Laparoscopy and hysteroscopy confirmed the presence of bone in the form of spicules perpendicular to the uterine endometrium. Most of the bone was present in the posterior portion of the fundus. Initial removal was performed with biopsy forceps followed by gentle curettage. The resectoscope was then introduced to visualize any remaining spicules and remove them by mechanical means with minimal use of electrosurgery. Transvaginal ultrasound assisted in identifying bone and confirming its removal during and after surgery. The hysteroscopic procedure was viewed laparoscopically to reduce the risk of uterine perforation. Dense right adnexal adhesions were also lysed. The patient received conjugated equine estrogens for five weeks post-operatively. Ultrasound showed an intrauterine pregnancy of 5 to 6 weeks plus two small calcifications approximately 1 mm each. The patient delivered a healthy infant and has had no recurrent problems. This case report demonstrates the successful use of multiple diagnostic and treatment modalities in the treatment of ectopic intrauterine bone.
Adult↗
Laparoscopic endometriosis treatment: is it better?
OBJECTIVE: To assess the hypothesis that pregnancy rates (PRs) after operative laparoscopy (Laparoscopy Group) for endometriosis treatment would be equal to or greater than diagnostic laparoscopy only (No Treatment Group), diagnostic laparoscopy with medical treatment (Medical Treatment Group), and laparotomy (Laparotomy Group). DESIGN: Prospectively recorded data were analyzed to identify significant variables affecting PRs. These variables were statistically controlled for using survival analysis with multiple fixed covariates to compare operative laparoscopy PRs versus other treatment PRs. SETTING: Treatment was performed by the senior author in a referral reproductive endocrinology and surgery private practice. PATIENTS: Five hundred seventy-nine infertile women were diagnosed with endometriosis. A subset (n = 258) considered to have endometriosis only was evaluated separately (Endometriosis-Only Subset). INTERVENTIONS: Treatment groups included: No Treatment Group, Medical Treatment Group, Laparoscopy Group, and Laparotomy Group. MAIN OUTCOME MEASURE(S): Pregnancy was used as the indicator of treatment success. RESULTS: Laparoscopy Group PRs were at least equal to all other treatment groups and were significantly higher than some other treatment groups in some comparisons. CONCLUSIONS: Operative laparoscopy is the treatment of choice for infertile women with endometriosis unless they have severe tubal and/or fimbrial disease.
Cohort Studies↗
Therapeutic donor insemination: a prospective randomized trial of fresh versus frozen sperm.
OBJECTIVE: We evaluated the efficacy of fresh versus frozen sperm in therapeutic donor insemination. STUDY DESIGN: Fifty-seven women underwent 72 courses of treatment (a maximum of six therapeutic donor insemination cycles--three fresh and three frozen) totaling 198 cycles. Each woman served as her own control and was prospectively randomized to receive a single, timed insemination of either fresh or frozen sperm. RESULTS: Fecundity was 20.6% for fresh sperm cycles and 9.4% for frozen (p less than 0.03, by chi 2 analysis). Fresh cervical cap insemination fecundity was 20.3%; frozen was 7.8% (p less than 0.03, by chi 2 analysis). Fresh intrauterine insemination fecundity was 21.2%; frozen was 15.8% (p = 0.63, by chi 2 analysis). Fresh 3-month life-table pregnancy rates were 48% +/- 10%; frozen rates were 22% +/- 8% (p = 0.05 by Breslow analysis). Survival analysis with fixed covariates showed a positive association with the use of fresh sperm (p = 0.04). CONCLUSION: Cycle fecundity was significantly greater with fresh sperm in women undergoing cervical cap insemination or intrauterine insemination and in women undergoing only cervical cap insemination. These results have important implications for contemporary management of patients undergoing therapeutic donor insemination with frozen sperm.
Adult↗
Treatment of uterine fibroids: current findings with gonadotropin-releasing hormone agonists.
The gonadotropin-releasing hormone agonists have potential benefit as presurgical adjuncts in the management of uterine leiomyomas or fibroids. Uterine fibroids contain estrogen receptors and are responsive to therapeutic hormonal manipulation; gonadotropin-releasing hormone agonists are effective by inducing a state of hypoestrogenism. Clinical trials with gonadotropin-releasing hormone agonists consistently have demonstrated efficacy for decreasing both myoma size and uterine volume. The advantages of the preoperative use of gonadotropin-releasing hormone agonists include a reduction in uterine and myoma size and vascularity and potentially improved operative technique and uterine cavity integrity. Ongoing clinical trials will be needed to confirm the role of gonadotropin-releasing hormone agonists in the treatment of uterine fibroids.
Analysis of Variance↗
Comparison of CO2 laser laparoscopy with laparotomy for treatment of endometriomata.
OBJECTIVE: To assess the effectiveness of laparoscopy versus laparotomy in the treatment of endometriomata. DESIGN: Controlled study using data prospectively tabulated. SETTING: Treatment performed by senior author in a referral reproductive endocrinology and surgery private practice. PATIENTS: One hundred infertile women were diagnosed with endometriomata. INTERVENTION: Forty-eight women were treated with CO2 laser laparoscopy (laparoscopy group) and 52 women were treated with CO2 laser or nonlaser laparotomy (laparotomy group). MAIN OUTCOME MEASURE: The hypothesis that laparoscopy group pregnancy rates (PRs) would be equal to or greater than laparotomy group was formulated before data analysis but after data tabulation. RESULTS: The 1 and 3-year life table estimated cumulative PRs +/- SE were 0.30 +/- 0.07 and 0.52 +/- 0.09 for laparoscopy group and 0.23 +/- 0.06 and 0.46 +/- 0.09 for laparotomy group (Breslow P = 0.48). Monthly fecundity over 3 years was 2.4% for laparoscopy group and 2.0% for laparotomy group. CONCLUSIONS: Laparoscopy with CO2 laser can be a safe and effective modality for treating endometriomata.
Adult↗
Failure of intrauterine insemination in a refractory infertility population.
Intrauterine insemination by itself for multiple and/or severe infertility factors had no benefit over cervical cap with whole ejaculate or coitus in this study. The PRs for IUI and cervical cap with whole ejaculate or coitus were similar and low, suggesting that IUI by itself has limited, if any, utility in enhancing PRs in this type of infertility population. Couples attempting IUI should be advised about the low probability of achieving pregnancy. Ovulation stimulation and/or heterologous donor insemination, IVF, or gamete intrafallopian transfer may be beneficial therapeutic options.
Adult↗
The choice of therapy for the operative treatment of endometriosis is endoscopic laser surgery. Pro.
Explore the source record for details and available documents.
Cost Savings↗
Diagnosis and clinical presentation of endometriosis.
Despite advances in diagnostic techniques, endometriosis remains an enigmatic condition. Clinical symptoms and signs often do not correlate with the anatomic stage of the disease, and morphologic characteristics very widely. A definitive diagnosis can be established only by direct visualization, usually by laparoscopy. In some cases biopsy may be necessary to confirm the presence of disease.
Endometriosis↗
Improved prediction of postovulatory day using temperature recording, endometrial biopsy, and serum progesterone.
The use of basal body temperature (BBT) recording and a single progesterone (P) level at the time of the endometrial biopsy in the late luteal phase improved our ability to predict the onset of the next menstrual period (NMP) and determine the postovulatory day (POD) in 124 regularly menstruating infertile women. We determined BBT shift using a microcomputer program, analyzed P levels by radioimmunoassay, and evaluated endometrial biopsies both prospectively (blinded) and retrospectively (with knowledge of the other variables). Serum P levels were within the normal range for the luteal phase and prospective and retrospective histological diagnoses closely agreed (82% within 2 days). The best correlation with the NMP was the BBT shift (r = 0.493) followed by P (r = 0.426) and prospective histologic dating (r = 0.390). Multiple regression analysis confirmed that use of all of the variables markedly improved the ability to estimate the POD (R2 = 0.51).
Biopsy↗
More on "misuse of statistics".
Explore the source record for details and available documents.
Clinical Trials as Topic↗
Three-day treatment of vulvovaginal candidiasis.
Butoconazole nitrate, a newer imidazole, is effective for the treatment of vulvovaginal candidiasis when administered as a vaginal cream. The microbiologic and clinical cure rates achieved with a 3-day course of butoconazole 2% cream have been comparable with those obtained with a 6-day course of miconazole nitrate 2% cream or a 3-day course of clotrimazole vaginal tablets (200 mg/day). Patients taking oral contraceptives have responded as favorably as those using other forms of birth control or none whatsoever. In addition, both microbiologic and clinical cures resulting from a 3-day regimen of butoconazole 2% cream have been sustained for at least 4 weeks. The high degree of efficacy and safety demonstrated by this short treatment regimen offers an advantage in the management of patients with vulvovaginal candidiasis, many of whom are likely to abandon any therapy as soon as their clinical symptoms have subsided. A clinical assessment of butoconazole vaginal suppositories (100 mg/day) and clotrimazole vaginal tablets (200 mg/day) found that the two therapies were comparably safe and effective when administered for 3 days. The suppository form of butoconazole may offer a valuable therapeutic alternative for patients who wish to use it instead of or in conjunction with vaginal cream.
Adult↗
Laparoscopic CO2 laser vaporization of endometriosis compared with traditional treatments.
This study reports on 108 infertile patients with endometriosis diagnosed at laparoscopy. Sixty-four patients had endometriosis and adhesions vaporized with a CO2 laser (LAS) and were prospectively compared with a control group (CON) of 44 patients who had laparoscopy. The 6- and 12-month estimated cumulative pregnancy rates for LAS were 0.32 +/- 0.07 and 0.55 +/- 0.09 respectively, and for CON 0.17 +/- 0.06 and 0.43 +/- 0.09 (Breslow P = 0.10). Monthly fecundity rates were 6.7% in LAS and 4.5% in CON. Survival analysis with fixed covariates showed that pregnancy rates were increased in patients with adhesions (P = 0.002) and other pelvic disease (P = 0.0001). Pregnancy rates were reduced by age (P = 0.02), previous adhesiolysis (P = 0.0000) and post-laparoscopy medical treatment (P = 0.0002). Our findings indicate that CO2 laser laparoscopy vaporization of endometriosis can be a safe, effective, and possibly improved modality for treating endometriosis.
Actuarial Analysis↗
Three-day treatment with butoconazole vaginal suppositories for vulvovaginal candidiasis.
Butoconazole is a new imidazole, effective as therapy for vulvovaginal candidiasis for women who prefer solid-type vaginal preparations. The efficacy of three-day administration of butoconazole vaginal suppositories, 100 mg/day, was compared to that of clotrimazole vaginal tablets, 200 mg/day. Patients with culture-proven vulvovaginal candidiasis were randomly assigned to either butoconazole (97 patients) or clotrimazole (88 patients). The percentage of patients with fungal cultures negative for Candida albicans was statistically significantly higher for butoconazole than for clotrimazole (92 vs. 74, P = .003) at the eight-day posttreatment examination. At the 30-day posttreatment examination the cure rate was still higher for butoconazole (63%) than for clotrimazole (56%), but the difference was not statistically significant. Complete clinical relief was achieved in 81% of patients in both treatment groups achieved in 81% of patients in both treatment groups at the first follow-up examination, while at the second follow-up examination the clinical cure rate was 77% for butoconazole and 69% for clotrimazole. No systemic side effects were reported.
Adult↗
Butoconazole vaginal cream in the treatment of vulvovaginal candidiasis. Comparison with miconazole nitrate and placebo.
A double-blind, parallel study was conducted comparing a new imidazole derivative, butoconazole nitrate, with placebo and miconazole nitrate for the treatment of vulvovaginal candidiasis. Patients were randomly assigned to six treatment regimens. Butoconazole was found to be an effective antifungal agent in both the six- and three-day treatment schedules. The incidence of local side effects from both tested imidazoles was low.
Adolescent↗