Biomedical subjects
Publications and source records attributed to H M Hasson.
Exploring means for tying a knot at the end of a continuous suture during laparoscopic surgery, it was found that formation of a single half-hitch over the last loop of the suture can secure the ending of the suture and protect against unraveling. This knot has been used successfully to complete running sutures in various endoscopic, gynecologic, and obstetric procedures.
Fifty-six patients presenting with infertility (17); bleeding, pain, and pressure symptoms (32); and pelvic mass (seven) associated with leiomyomas were managed with laparoscopic myomectomy. Twenty-four second-look procedures were performed to evaluate healing and adhesion formation. Operative time ranged between 45-443 minutes (mean 157), estimated blood loss varied from 10-400 mL (mean 75), and the mean length of hospital stay was 1 day. Traditional morcellation was used initially but was abandoned because of long operating time; vaginal or abdominal removal (depending on size) proved more satisfactory. Three patients developed subcutaneous emphysema and one had febrile morbidity due to upper respiratory tract infection. There were no other complications. In 24 second-look procedures, adhesions were present in 16 subjects (66%). Twelve of 17 in the infertility group conceived (71%); all 39 patients with other complaints experienced satisfactory relief. There were no reoperations. When myomectomy is indicated, the laparoscopic approach appears to offer an alternative to abdominal surgery in selected patients.
One hundred two women with ovarian cysts were managed laparoscopically over a 13-year period. Thirteen were treated with laparoscopic inspection followed by laparotomy, 6 with laparoscopic fine needle aspiration followed by laparotomy and 83 with laparoscopic fenestration and biopsy, with or without coagulation or removal of the cyst lining. Satisfactory results were noted in patients treated completely with laparoscopy. Only 1 of 56 functional, simple or paraovarian cysts recurred during the study period. Two of the 18 ovarian endometriomas treated with fenestration and coagulation or removal of the lining recurred, whereas 8 of 9 such lesions recurred when treated with fenestration alone. There were no surgical complications.
Three hundred thirteen women participated in an open, multicenter comparison of the incidence of intermenstrual bleeding (breakthrough bleeding and or spotting) associated with the use of three triphasic oral contraceptives. Triphasil (n = 107), containing levonorgestrel and ethinyl estradiol, and Ortho-Novum 7/7/7 (n = 97) and Tri-Norinyl (n = 109), both of which contain norethindrone and ethinyl estradiol, were administered over four cycles for a total of 1141 cycles. The total incidence of intermenstrual bleeding was significantly lower with Triphasil (17.2%) than with Ortho-Novum 7/7/7 (39.5%) or Tri-Norinyl (49.0%). The pattern remained the same when findings were analyzed cycle by cycle and for breakthrough bleeding and spotting separately. The incidence of other side effects was comparable for all regimens. Results of this study demonstrate superior cycle control with Triphasil compared with Ortho-Novum 7/7/7 and Tri-Norinyl during the first four cycles of use.
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Suture loop techniques have been devised to facilitate suture tying during microsurgical and laparoscopic procedures. The needle-through-the-noose technique involves making a knot by passing the needle of a suture through a noose loop formed near the distal end of the suture. This technique prevents inadvertant slippage of the suture's free short end through tissues, replaces the difficult first throw with simple passage of a needle through a noose and equalizes the amount of tension applied on the suture as it slides smoothly within the noose. The needle-through-the-noose knot can stand alone with continuous sutures but requires one more tie in interrupted sutures. The clock loop technique is based on turning the suture clockwise and counterclockwise for making square knots with instruments.
Clinical experience with intrauterine devices was evaluated, based on 627 insertions over a 14-year period in a private practice. Overall, there were few differences in the event rates leading to IUD discontinuation for the IUDs evaluated, principally Cu-7, Dalkon Shield and Lippes Loop. Pelvic infections were infrequent (0.7-2.2 cases per 100 woman-years of IUD use). The rate of PID in the study population appeared to be similar to that noted in the general population. IUD use did not appear to compromise future fertility, based on evaluations of patients after removal of their IUDs or from their return to fertility following IUD removal. IUD event rates (pregnancy, expulsion, displacement, removal for bleeding and/or pain) were related to the difference between endometrial cavity length and IUD length. A significant increase in the event rates was noted, regardless of the IUD type, when the endometrial cavity length exceeded IUD length by 2.0 cm or more, or when the difference between the endometrial cavity and IUD length was less than 0.5 cm.
Open laparoscopy was performed in 630 patients seeking permanent contraception for health reasons. Various electric and mechanical tubal occlusion methods were utilized. With few exceptions, uterine curettage was performed at the end of the laparoscopic procedure. Curettage revealed unexpected findings in 10 cases. Laparoscopic exploration of the peritoneal cavity showed pathologic findings in 10% of the patients. There were no intraoperative complications related to open laparoscopy. Fourteen patients (2%) underwent immediate laparotomy, to manage unexpected findings in six and to correct complications of unipolar tubal cautery technique in eight. Postoperative complications possibly related to open laparoscopy were limited to minor wound infection in 0.3% and febrile reaction of short duration in 0.1% of the cases. Two sterilization failures occurred in the series, both following unipolar techniques employing coagulation and resection. Many patients have now been followed for 5 or more years without noticeable increases in complaints of uterine bleeding and/or pelvic pain. The data indicate that open laparoscopy is a suitable means of performing tubal sterilization in the female.
The endometrial cavity is an isosceles trapezoid that changes in shape with the phase of the cycle. The distance from the fundus to where the cavity narrows to 12 mm is the effective length. This and the total length of the uterine cavity can be measured with the Wing Sound. IUCD complications are more frequent if the length of a device exceeds the effective length or the width of the uterine cavity. Devices must be designed to fit the uterine cavity and to conform to physiological changes in the shape of the organ.
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Twenty-eight patients presenting with initial complaints of infertility or chronic pelvic pain were found to have pelvic endometriosis at laparoscopy. Destruction of the endometriotic lesions by means of electrocoagulation was performed via laparoscopy in a group of 19 patients. The remaining nine patients did not undergo such management. In the treatment group, seven of the 11 patients with chronic pain experienced complete relief of their symptoms, and six of the eight patients with infertility became pregnant postoperatively. Patients in the control group had a less favorable outcome. Only one of five patients with chronic pain had relief and one of four patients with infertility became pregnant following laparoscopy without cauterization. Electrocoagulation of pelvic endometriotic lesions under laparoscopic control appears to be satisfactory for the management of selected patients with chronic pelvic pain or infertility.
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IUD design features that affect performance are reviewed and discussed. The use of a medicated device designed to be placed, retained and stabilized exclusively in the frontal plane of the upper uterine segment fulfills theoretical conditions of optimum performance.
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The instillation of 1 to 6 ml of 1% lidocaine was evaluated as a topical anesthetic method of reducing pain associated with uterine manipulations during gynecologic procedures. A plastic acorn cannula connected to a metal adapter and syringe was used to administer the topical anesthetic in 146 intrauterine device insertions, 16 cervical dilatations, and 18 dilatation and curettage procedures. Most patients reported satisfactory relief of pain. No complications were attributed to the topical anesthetic.