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J B Dubuisson

Publications and source records attributed to J B Dubuisson.

At least 73 records · Page 4Linked to original sources
PubMed1997

EndothelinA receptors in human uterine leiomyomas.

OBJECTIVE: To determine if there are endothelin receptors on human uterine leiomyomas. METHODS: Samples of leiomyomas from eight patients were analyzed for [iodine (I)-125]endothelin-1 binding. Several subtype-selective ligands were used to determine the endothelin receptor population. RESULTS: Binding of [125I]endothelin-1 to uterine leiomyoma membranes was specific and saturable, with a mean +/- dissociation constant 85.5 +/- 8.4 pM. Competition binding studies showed that the order of potency was endothelin-1 > endothelin-3, which was consistent with the presence of the endothelinA receptor subtype. Binding of [125I]endothelin-1 was displaced by an endothelinA-selective antagonist, but not by sarafotoxin 6c, an endothelinB-selective agonist. An endothelins-selective ligand was not specifically bound to leiomyoma. CONCLUSION: These results indicate that only endothelinA receptors are present in human uterine leiomyomas. We speculate that endothelin-1 may act through these endothelinA receptors to influence the development or regulation of hypertrophy and proliferation of the human myometrium during pregnancy and in uterine disorders like leiomyomas.

Adult↗
PubMed1997

Salpingo-oophorectomy for adnexal masses. Place and results for operative laparoscopy.

OBJECTIVES: The aim of the study is to specify the place, modalities and results of operative laparoscopy when adnexectomy is indicated in a patient presenting with an adnexal mass. STUDY DESIGN: A retrospective analysis of the 186 patients who underwent adnexectomy for an adnexal mass between January 1, 1989 and December 31, 1994. RESULTS: The operation took place via laparotomy in 34.9% of cases (65 patients) and by laparoscopic surgery in 65.1% of cases (121 patients). All the patients presenting a malignant ovarian lesion (15 cases) were operated by laparotomy. For these patients the laparotomy was decided from the outset in 7 cases and there was a conversion to laparotomy decided during the diagnostic phase of laparoscopy in 8 cases. The preoperative workup (clinical examination, study of past history, trans vaginal ultrasonography, doppler, tumoral markers etc.) together with the diagnostic phase of laparoscopy provide 100% sensitivity, a positive predictive value of 50% and a negative predictive value of 100% for diagnosis of malignancy. CONCLUSION: These results demonstrate that provided a strict selection system is used, it is possible to carry out adnexectomy using laparoscopic surgery in 70.8% of cases (121/171) for patients with benign adnexal mass.

Adnexa Uteri↗
PubMed1997

Proximal tubal occlusion: is there an alternative to microsurgery?

Fertility outcome following microsurgical tubocornual anastomosis by laparotomy was evaluated. A total of 131 women presenting pure proximal occlusion, whether bilateral or in one tube only, were treated between January 1978 and December 1993. Subsequent fertility was studied in 120 patients, 11 being patients lost to follow-up. Cumulative intrauterine pregnancy (IUP) rate, evaluated by life-table analysis, was 68% at 24 months. The overall IUP rate, calculated from a group of 120 women with follow-up > or = 2 years, and including births and miscarriages, was 70% after 2 years. Comparisons of the cumulative IUP rates show that the fertility outcome is significantly better if the woman is aged < or = 36 years and if tubocornual anastomosis is carried out bilaterally. These results from our personal series confirm that microsurgical tubocornual anastomosis is still of prime importance in the treatment of pure proximal occlusions. Nevertheless, considerable progress in the fields of tubal catheterization, Falloposcopy and in-vitro fertilization techniques raises the question of the management of patients presenting with a proximal tubal occlusion. Here we define the indications for microsurgical tubocornual anastomosis.

Adult↗
PubMed1997

The role of laparoscopy in the diagnosis and management of heterotopic pregnancies.

The object of this report is to discuss diagnosis and treatment of heterotopic pregnancies. Thirteen consecutive cases referred to our institution are reviewed. In 54% of cases the heterotopic pregnancy was asymptomatic. The ectopic pregnancy was visualized prior to surgery in 69% of the cases. The treatment was surgical in every case and performed laparoscopically in 77% of cases. Ten patients underwent salpingectomy and three salpingostomy. In all, 60% of intrauterine pregnancies that were viable at the time of diagnosis of the heterotopic pregnancy had a favourable outcome. Diagnosis of heterotopic pregnancy is difficult. Laparoscopy allows both diagnosis and treatment, and the outcome of the intrauterine pregnancy is comparable to that obtained with laparotomy.

Adult↗
PubMed1997

Hysterectomy with adnexectomy. Can operative laparoscopy offer advantages?

OBJECTIVE: To investigate whether laparoscopic surgery has the advantage of reducing the rate of laparotomies when a patient with no genital prolapse needs a total hysterectomy associated with unilateral and bilateral adnexectomy. STUDY DESIGN: Retrospective study carried out between January 1993 and December 1995. All patients (96) with no prolapse, pelvic floor relaxation or stress urinary incontinence and scheduled for total hysterectomy with adnexectomy were included in the study. RESULTS: Laparotomy was required in 12.5% of cases (12 patients). For the 84 patients (87.5%) who underwent laparoscopic hysterectomy, the mean duration of the operation was 142.6 +/- 33.9 minutes, and the mean uterine weight was 209.7 +/- 129.4 g. The rate of laparotomy dropped steadily as the surgeon acquired experience. Whereas the rate of laparotomy was 30.5% (7 patients) in 1993, it was 10.8% (4 patients) in 1994 and fell to 2.8% (1 patient) in 1995. CONCLUSION: When adnexectomy needs to be performed with hysterectomy, in the majority of cases it should be carried out by laparotomy. Operative laparoscopy enables the rate of laparotomy to be reduced to < 15%. The existence of an adnexal mass not suspected to be malignant indicates operative laparoscopy.

Adnexa Uteri↗
PubMed1997

Laparoscopy for adnexal torsion in pregnant women.

OBJECTIVE: To report on six cases of adnexal torsion in pregnant women treated by operative laparoscopy. STUDY DESIGN: A retrospective study. Between January 1989 and March 1996, 26 patients with adnexal torsion were treated by operative laparoscopy. Of these patients, six were pregnant (23%). The types of operative procedure and outcome were studied. RESULTS: Adnexal torsion occurred between 6 and 13 weeks of amenorrhea. Two cases involved hyperstimulation, 3 cases a functional cyst and 1 case a dermoid cyst. In 4 cases laparoscopic treatment consisted of untwisting followed by puncture of the ovarian cyst; in 1 case it involved intraperitoneal cystectomy and in another simple untwisting of the adnexa. The immediate postoperative history was uncomplicated. In one patient with ovarian hyperstimulation, torsion recurred three weeks after the initial operation. No miscarriages occurred. CONCLUSION: In the hands of skilled surgeons, laparoscopy is well suited to the diagnosis and treatment of adnexal torsion occurring during the first trimester of pregnancy. Beyond 16 weeks or when there is any suspicion of torsion on a suspected tumor, it is preferable to use laparotomy.

Adnexal Diseases↗
PubMed1997

Laparoscopic myomectomy and myolysis.

The indications for operative laparoscopy have expanded greatly over the past decade as its many advantages over laparotomy have become recognized. Laparoscopic myomectomy as a technique is now clearly described. A monopolar hook is used for the uterine incision. After atraumatic enucleation of the myoma, the myometrium and serosa are usually sutured, especially if the incision is deep or more than 2 cm long. Myomas can be removed by posterior colpotomy. However, the development of an electrical cutting device permits easier and quicker removal of the myoma through the suprapubic puncture site. Only complicated myomas or those which give rise to persistent symptoms despite properly prescribed medical treatment, together with those which grow rapidly, require surgery. These satisfactory preliminary results must not mask the fact that laparoscopic myomectomy is lengthy and difficult, reserved for experienced surgeons with a thorough familiarity with endoscopic sutures. Under these conditions, laparoscopic myomectomy is possible, even for large myomas (5 cm and over) located purely intramurally. However, there are limits, and it is preferable to schedule myomas measuring over 8 cm and multiple myomectomy (over two) for laparotomy. Although the preliminary results are encouraging, the risk of adhesiogenesis on the uterine scar, the quality of the uterine suture and the fertility results need to be assessed in the near future.

Adult↗
PubMed1997

[Retroperitoneal endometriosis infiltrating the utero-sacral ligaments. Technique and results of laparoscopic surgery].

OBJECTIVE: The goal of this study is to assess the efficiency of laparoscopic surgical treatment of pain for patients presenting deep endometriosis located on the uterosacral ligaments. STUDY DESIGN: We analysed a continuous series of 36 patients treated by operative laparoscopy between January 1993 and April 1995. In all these cases treatment consisted of resection of all the uterosacral ligament(s) together with exeresis of all other endometriotic lesions. RESULTS: The results were assessed for all the patients with a minimum follow-up of one year. Patients who presented dysmenorrhea (29 cases) improved in 89.7% of cases (26 patients). Out of the 26 patients who presented deep dyspareunia, improvement was evident for 92.3% of cases (24 patients). The chronic pelvic pain suffered (17 cases) improved in 88.2% of cases (15 patients). Patients who benefited from an improvement rated it excellent or satisfactory in 80% of cases. CONCLUSION: These results demonstrate that provided the surgeon is highly skilled in laparoscopy, operative laparoscopy is efficient for the treatment of patients presenting painful symptoms related to deep endometriotic implants located on the uterosacral ligaments.

Adult↗
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

[Poor vaginal access: excellent indication for laparoscopic hysterectomy].

OBJECTIVE: The great majority of hysterectomies in patients without previous vaginal delivery have been carried out via laparotomy. The purpose of this study was to establish whether laparoscopic surgery can be of use in an attempt to reduce the number of laparotomies for patients with no previous vaginal delivery who underwent an hysterectomy indicated for benign pathologies. STUDY DESIGN: A retrospective study was carried out on 116 patients who had not had a previous vaginal delivery who underwent hysterectomy from January 1993 to December 1996. RESULTS: Laparotomy was required for only 20.7% of cases (24 patients). For the 92 patients (79.3%) who underwent laparoscopic hysterectomy, the average duration of the operation was 145 +/- 44 min (range: 60-290) and the mean uterine weight was 200 +/- 130 g (range: 30-840). CONCLUSIONS: These results demonstrate that laparoscopic surgery decreased significantly the number of laparotomies necessary for patients without previous vaginal delivery who require hysterectomy. When vaginal access is poor, simple laparoscopic preparation is inadequate and the only possibility of avoiding laparotomy is to carry out the hysterectomy entirely via laparoscopic route.

Blood Loss, Surgical↗
PubMed1996

Place and modalities of laparoscopy in surgical management of suspected adnexal masses.

Only benign adnexal masses are suitable for treatment by operative laparoscopy. Ovarian cancer must always be managed by midline laparotomy. In our experience the preoperative workup (clinical examination, study of past history, trans vaginal ultrasonography, doppler, tumoral markers etc.) together with the diagnostic phase of laparoscopy provide a sensitivity value of 100%, a positive predictive value of 50% and a negative predictive value of 100% for diagnosis of malignancy. Provided a strict selection, laparoscopy is reliable both for the diagnosis and the management of benign ovarian masses.

Adnexal Diseases↗
PubMed1996

Uterine fibroids: place and modalities of laparoscopic treatment.

Only fibroids which give rise to symptoms resistant to properly conducted medical treatment and/or complicated myomas require surgical treatment. The possibility offered by the new surgical approaches enables myomectomies to be now carried out via laparoscopy. We report our technique of laparoscopic myomectomy performed since 1989. Monopolar coagulation is used for the uterine incision, after myomectomy, myometrium and serosa are sutured. Myomas are removed through the suprapubic puncture site after fragmentation of large myomas, through a colpotomy or using the morcellator. Our results enable us to say that, although it is a difficult technique, laparoscopic myomectomy is a safe and reliable technique even for large intramural myomas.

Adult↗