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J F Daniell

Publications and source records attributed to J F Daniell.

At least 19 recordsLinked to original sources
PubMed1998

Evaluation of bipolar technology for laparoscopic supracervical hysterectomy.

One particularly controversial form of laparoscopic hysterectomy is subtotal hysterectomy (LSH). LSH was first described by Semm. Since that report, several authors have reported their initial experience with vanous methods for LSH. A recent clinical commentary by Munro discussed the pros and cons of LSH in an editorial entitled "Supracervical Hysterectomy: A Time for Reprisal. In a recently published report, we discussed our initial experience with laparoscopic subtotal hysterectomy. The article reported our experiences utilizing bipolar instruments, an electromechanical morcellator, and other modifications of LSH we feel simplify and reduce the procedural operaríve time and potential intraoperative and postoperative complications.

Journal Article↗
PubMed1998

Use of the PumpVac Plus Suction Irrigation System at Gynecologic Endoscopy.

At both laparoscopy and hysteroscopy, controlled movement of fluids is necessary. In addition, at laparoscopy, suctioning of accumulated smoke from lasers or electrosurgery is an essential venting technique to enhance visibility. This chapter will describe and discuss a unique, simple, cost-effective system that can be used for both hysteroscopy and laparoscopy to accomplish movement of fluids and management of smoke. Aquadissection or hydrodissection has been used for many years as an adjuvant to operative laparoscopy.' It has been found useful for operative laparoscopic treatment of conditions such as endometriosis, pelvic adhesions, and tubal obstructron. Most current systems are cumbersome, wastefully use large volumes of fluid, and often require a mechanical pump for pressurizing the fluid suction and irrigation systems. Usually, during combined laparoscopy and hysteroscopy, a separate system is used for accomplishing uterine distention when fluids are used for the hysteroscopic portion of surgery. The Pump Vac Plus can be used for both hysteroscopic distention and laparoscopic suction and irrigation. This article will describe our techniques for using the Pump Vac for both of these endoscopic approaches.

Journal Article↗
PubMed1996

Early outcomes of laparoscopic-assisted vaginal hysterectomy versus laparoscopic supracervical hysterectomy.

STUDY OBJECTIVE: To compare two different laparoscopic techniques for hysterectomy: laparoscopic-assisted vaginal hysterectomy (LAVH) and laparoscopic supracervical hysterectomy (LSH). DESIGN: A retrospective review of office and hospital charts, and a postoperative questionnaire completed by patients. SETTING: A private gynecology practice and private hospital in Nashville, Tennessee. PATIENTS: Forty women requiring laparoscopic hysterectomy between January 1993 and December 1994. Interventions. Twenty patients underwent LAVH and 20 LSH. Minimum follow-up was 3 months (range 3-27 mo). MEASUREMENTS AND MAIN RESULTS: The chart review focused on operating times, blood loss, length of hospital stay, complications, and total hospital costs to the patients. The operating times were shorter and the blood loss was less in the LSH group than in the LAVH group, but the difference did not reach statistical significance. Hospital stay was shorter (p = 0.0005) and hospital costs were less (p = 0.01) in the LSH group. Of women who were sexually active, those in the LSH group resumed intercourse earlier than those in the LAVH group (3.5 vs 5.9 wks), and reported better overall improvement in sexual function and ability to achieve orgasm. CONCLUSION: In certain patients, LSH is effective and associated with few complications.

Adult↗
PubMed1996

Early complications of laparoscopic hysterectomy.

Since Reich first described laparoscopic hysterectomy (LH) in 1989, a number of series have appeared in the literature detailing complications of this procedure. This review included all series obtained through a MEDLINE search from April 1989 through October 1994. Also included were series from the Journal of Gynecologic Surgery, Gynaecological Endoscopy, and the Journal of the American Association of Gynecologic Laparoscopists. Rates of various complications were calculated and compared with existing standards for abdominal and vaginal hysterectomy. Hemorrhage and injury to adjacent organs were fairly similar between traditional hysterectomy methods and LH. Infectious morbidity, however, was decreased in LH. Caution should be used in interpreting these data, as these initial reports come predominantly from leading experts in the field of endoscopic surgery. Whether these rates can be duplicated in a community hospital is debatable.

Abdominal Injuries↗
PubMed1995

Advanced laparoscopic procedures for pelvic pain and dysmenorrhoea.

The effective removal of endometriosis is the major aim of physicians treating patients with pelvic pain. This can now be accomplished long-term as effectively at laparoscopy as at laparotomy (Wheeler and Malinak, 1987; Redwine, 1991; Martin, 1994). All successful operative laparoscopists dealing with endometriosis-associated pain should be familiar with and consider offering their patients the operative procedures discussed in this chapter. Adhesiolysis is a well-accepted therapy but uterine suspension and the nerve separating techniques of LUNA and PSN are much more controversial. Pain, being subjective, is difficult to quantify and a poor end point to monitor scientifically. However, there is a significant body of published work to suggest that uterine suspension, LUNA and PSN, which have all been performed for decades, seem effective laparoscopically in reducing pelvic pain associated with endometriosis. Much more data are obviously needed to determine if endometriosis-associated pain can be effectively treated with laparoscopic procedures. Properly designed scientific prospective randomized studies to evaluate some of the laparoscopic operations discussed to treat endometriosis-associated pain have recently been reported (Sutton, 1994). Thoughtful gynaecologists dealing daily with patients with endometriosis should consider discussing with them the advantages and disadvantages of the techniques reviewed in this chapter. From our experience and that of others, it appears that adhesiolysis, uterine suspension, LUNA and PSN can all be safely and effectively accomplished by skilled laparoscopists and result in good patient outcomes. All gynaecologists involved in the care of patients with endometriosis and pain should consider learning and offering these operations to their patients with appropriate discussion of the potential risks and benefits.

Dysmenorrhea↗
PubMed1995

Combined laparoscopy and minilaparotomy for outpatient reversal of tubal sterilization.

This retrospective study determines risks, outcomes, and cost savings in microscopic tubal sterilization reversal done by minilaparotomy. From January 1992 to December 1993, 40 women, as outpatients, had combined laparoscopy and minilaparotomy for tubal anastomosis. The mean operating time was 1.7 hours, mean blood loss was 20 mL, and mean recovery time was 3.2 hours. Thirty-seven patients (93%) were discharged on the same day, two stayed for 23 hours, and one patient required hospitalization for 2 nights. There were no immediate or postoperative complications. Early crude pregnancy rate was 60%, with an 8% ectopic rate. Tubal patency was confirmed in 39 (98%). The average total cost to the patient was $5,200. Microsurgical tubal anastomosis can be done safely and successfully on an outpatient basis, reducing costs and morbidity and accelerating the patient's return to activity.

Adult↗
PubMed1994

Laparoscopic assisted vaginal hysterectomy: one group's experience.

Laparoscopic assisted vaginal hysterectomy (LAVH) has been reported worldwide. We report our experience with LAVH in 51 patients, 23 with the laparoscopic stapling device, 12 with a combination of stapler and bipolar coagulation, and 16 by bipolar coagulation exclusively. No operations were converted to laparotomy, and there were few minor complications. Average operating time was 1 h and 38 min. Hospital stay averaged 2.2 days. Average hospital costs were greater for the stapling devices ($7815.00) compared with bipolar coagulation ($7150.00). Postoperative patient satisfaction was high (96%), with high resolution of the symptoms (94%). We conclude that LAVH is a safe, effective operation in selected cases and may be a valid alternative to abdominal hysterectomy.

Adult↗
PubMed1993

Laparoscopic presacral neurectomy vs neurotomy: use of the argon beam coagulator compared to conventional technique.

Presacral neurectomy is effective treatment for dysmenorrhea and midline pelvic pain. Conventional laparoscopic techniques describe retroperitoneal dissection to excise retroperitoneal nerve tissue. The argon beam coagulator (ABC) can be used laparoscopically to hemostatically ablate and thus separate the presacral tissues down to the periosteum without dissecting or excising tissue. In 32 patients undergoing laparoscopic presacral neurectomy, 17 were performed with conventional methods, and 15 patients underwent ABC neurotomy only, without dissection or excision. Postoperative pain reduction was the same in both groups (73% vs 75%), with average anesthesia time 64 min for ABC neurotomy vs 92 min with conventional techniques. One major vascular complication requiring immediate laparotomy occurred in the ABC group. When properly applied laparoscopically, the ABC is an effective tool to rapidly coagulate and separate the presacral nerves with minimal smoke, excellent visualization, and no retroperitoneal dissection.

Adult↗
PubMed1993

Laparoscopic myomectomy using the argon beam coagulator.

Fourteen patients with symptomatic uterine fibroids underwent laparoscopic myomectomy using the argon beam coagulator (ABC). The ABC provides conventional unipolar coagulating current in a nontouch technique, which aids in dissection of the myoma in a hemostatic fashion. Minimal smoke production yields excellent visualization. Fibroids ranged from 2 cm to 6 cm, and eight of the patients had multiple fibroids removed. There were no intraoperative complications and there was minimal operative blood loss. The ABC is a safe and effective tool for laparoscopic removal of symptomatic uterine fibroids.

Female↗
PubMed1993

Laparoscopically assisted vaginal hysterectomy. The initial Nashville, Tennessee, experience.

It is now possible to begin a difficult hysterectomy via laparoscopy with or without adnexal removal and then complete the operation vaginally. We report our successful experience with laparoscopically assisted vaginal hysterectomy in 62 of 68 patients. Techniques used for hemostatic separation of the uterus and adnexal pedicles included an automatic laparoscopic stapling device (49 cases), bipolar coagulation with sharp transection (11) and combined techniques (2). Minor complications occurred in four patients. Six patients had their operations converted from laparoscopy to laparotomy because of significant adhesions (three), large fibroids (two) and poor access due to obesity (one). The use of a stapling device required less anesthesia time (1 hour, 57 minutes, vs. 3 hours, 43 minutes), a smaller blood loss (145 vs. 247 mL) and shorter hospital stays (2.53 vs. 2.75 days) than did laparoscopic bipolar coagulation. However, the average hospital costs were greater for disposable automatic stapling devices and trocars when compared to bipolar coagulation techniques ($9,310 vs. $6,227). Postoperative patient satisfaction with the operation was high (98%), with a high rate of symptom resolution (95%). Laparoscopically assisted vaginal hysterectomy is a safe, effective operation in selected cases and may soon become a common alternative to abdominal hysterectomy in certain cases.

Adult↗
PubMed1993

Incarcerated incisional hernia after laparoscopy. A case report.

A woman who had undergone operative laparoscopy with myomectomy, appendectomy and coagulation of endometriosis was readmitted on postoperative day 3 with a small bowel obstruction. At laparotomy she was found to have an incarcerated loop of small bowel through a 12-mm trocar site in the left midabdomen. A bowel resection was not required. The defect was closed, and the patient recovered without difficulty. Two points should be made about avoiding hernias, especially through a larger trocar site. First, the trocar sheath should be opened to room air during its removal to avoid creating a vacuum and pulling a loop of bowel into the incision. Second, the fascia should be closed after removal of larger trocars. This can be accomplished during direct visualization through the laparoscope prior to removal of the pneumoperitoneum to avoid placing the suture through the bowel.

Adult↗
PubMed1992

Laparoscopic oophorectomy: comparative study of ligatures, bipolar coagulation, and automatic stapling devices.

OBJECTIVE: We assessed laparoscopic oophorectomy using three techniques. METHODS: From January 1989 to October 1991, 65 patients underwent laparoscopic oophorectomy using three techniques: bipolar coagulation, pretied ligature placement, and automatic stapling devices. The patients were aged 18-57 years and had the indications of pain, ovarian endometriosis, adhesions, unilateral blocked tubes, breast cancer, and recurrent benign ovarian cysts. The primary method of adnexal removal involved the automatic stapling device in 17, bipolar coagulation in 30, and pretied ligatures in 18. RESULTS: Total anesthesia time ranged from 45-123 minutes, with means of 77 minutes for pretied ligatures, 84 minutes for bipolar coagulation, and 84 minutes for automatic stapling devices. Sixty-two patients were discharged within 23 hours, two stayed two nights, and one stayed three nights. Rectus muscle bleeding and hematoma formation were the only complications in this series. CONCLUSION: All three methods of laparoscopic oophorectomy are effective, with similar operative times and uniformly good results for the patients.

Adult↗
PubMed1992

Hysteroscopic endometrial ablation using the rollerball electrode.

OBJECTIVE: To assess the efficacy of hysteroscopic endometrial ablation with the rollerball resectoscope. METHODS: From April 1989 to March 1991, 64 women underwent hysteroscopic endometrial ablation using electrosurgery. Telephone follow-up was obtained for 61 patients at least 6 months after the procedure. The majority of patients requested endometrial ablation because of irregular heavy menses, and two patients presented with postmenopausal bleeding. All patients had preoperative endometrial sampling that demonstrated benign endometrial histology. Five women had previous endometrial ablation with the Nd:YAG laser, with persistent bleeding. Eight patients had endometrial polyps and six had submucous fibroids that were resected at the time of hysteroscopic ablation. RESULTS: The average operative time was 31.6 minutes, and an average of 304 mL of distending medium was absorbed during the procedure. Complications included one uterine perforation in a patient who had a previous Nd:YAG ablation, and one epidural anesthetic complication. At follow-up, 18 women (29.5%) reported amenorrhea, 16 (26.2%) reported spotting, 21 (34.4%) reported decreased menstrual flow, four (6.6%) had no change, and two (3.3%) noted increased flow. Subjectively, 49 patients (80.3%) reported a satisfactory outcome. Of the 12 who were not satisfied, seven underwent a repeat ablation with satisfactory results, four chose hysterectomy, and one elected not to have further therapy. CONCLUSION: Endometrial ablation with the rollerball electrode is a safe, excellent method of management in women with excessive menstrual flow and provides a cost-effective, minimally invasive alternative to hysterectomy.

Adult↗
PubMed1991

Laser laparoscopic management of large endometriomas.

Forty-seven patients underwent laser laparoscopic management of endometriomas from 3 to 12 cm in diameter. Eighteen patients had infertility, 15 had pelvic pain, and 14 had both. The types of laser used were the carbon dioxide, argon, and potassium-titanyl-phosphate. There were no surgical complications. Twelve of 32 patients with infertility achieved pregnancy after the initial procedure. Subsequently, 2 patients conceived after a second-look procedure. Twenty-three of 30 patients with pelvic pain reported improvement or resolution. We confirm the efficacy of operative laparoscopy using lasers in the management of large ovarian endometriomas.

Adult↗
PubMed1991

The use of an automatic stapling device for laparoscopic appendectomy.

Laparoscopic appendectomy, for years performed only occasionally, is becoming more common with the increasing interest by both general surgeons and gynecologists in "minimally invasive surgery." A recently available automatic laparoscopic stapling system (the MULTI-FIRE ENDO GIA 30) claims to make laparoscopic appendectomy technically easier to perform. The technique of laparoscopic appendectomy using this automatic stapling device was evaluated in ten patients and compared with our previous laparoscopic techniques. The MULTI-FIRE ENDO GIA passes through a 12-mm trocar and allows placement of two triple-staggered lines of titanium staples with a simultaneous cut. Using this technique, operating time for laparoscopic appendectomy was reduced from an average of 30 to a minimum of 5 minutes. With this technique, no appendiceal contents leaked intraperitoneally. The larger trocar allowed easier removal of the separated appendix with minimal dissection of the mesoappendix. Indications for appendectomy included endometriosis of the appendix (three), fixation to the right tube or ovary (three), early acute appendicitis (two), and elective removal (two). There were no immediate or late complications. Our preliminary experience with the MULTI-FIRE ENDO GIA 30 stapler suggests that it is a safe, easy, and rapid method of removing the appendix laparoscopically.

Adult↗