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J H Dorsey

Publications and source records attributed to J H Dorsey.

At least 19 recordsLinked to original sources
PubMed1995

Clinical indications for hysterectomy route: patient characteristics or physician preference?

OBJECTIVES: Our purpose was to compare the indications, characteristics, surgical management, and outcomes of patients undergoing total abdominal hysterectomy, total vaginal hysterectomy, and laparoscopically assisted vaginal hysterectomy and to assess whether patients who underwent abdominal hysterectomy might have been candidates for laparoscopically assisted vaginal hysterectomy and whether patients who underwent total abdominal hysterectomy or laparoscopically assisted vaginal hysterectomy might have been candidates for total vaginal hysterectomy. STUDY DESIGN: The hospital charts of 502 women who underwent elective inpatient hysterectomy at a single large general hospital between January 1992 and November 1993 were abstracted retrospectively by use of a structured data abstraction instrument. The study included patients operated on by 16 different experienced gynecologists. Data were collected regarding patient demographic characteristics, clinical history and preoperative physical examination, indications for surgery, route of hysterectomy, intraoperative findings, pathologic study results, and outcomes in the immediate postoperative hospitalization period. RESULTS: Patient age, race, weight, parity, and previous surgical history were significantly associated with hysterectomy type. Although no nulliparous patients and no patients with a uterine size estimated preoperatively to be > 12 weeks of gestation underwent total vaginal hysterectomy, 16.6% and 30.6% of laparoscopically assisted vaginal hysterectomy patients had these characteristics, respectively. A total of 6.6% of total abdominal hysterectomy cases and 16.7% of laparoscopically assisted vaginal hysterectomy cases lacked an obvious justification for an abdominal procedure. On average, surgical time was 23 minutes longer for laparoscopically assisted vaginal hysterectomy than for total abdominal hysterectomy and 30 minutes longer for total abdominal hysterectomy than for total vaginal hysterectomy. When uterine size or configuration impaired access to uterine vessels, laparoscopically assisted vaginal hysterectomy was difficult to perform. Postoperative morbidity was similar across the three procedures, but average length of hospital stay was 2.8 days, 3.5 days, and 4.4 days for laparoscopically assisted vaginal hysterectomy, total vaginal hysterectomy, and total abdominal hysterectomy, respectively. CONCLUSIONS: Although there are some consistent and statistically significant differences in the characteristics of patients undergoing total abdominal hysterectomy versus laparoscopically assisted vaginal hysterectomy versus total vaginal hysterectomy, laparoscopically assisted vaginal hysterectomy is enabling many patients to avoid total abdominal hysterectomy. However, many patients undergoing total abdominal hysterectomy and laparoscopically assisted vaginal hysterectomy could probably undergo total vaginal hysterectomy instead. Clinical outcomes were similar regardless of type of hysterectomy performed. Practice style and personal preference of the surgeon thus may be playing a significant role in selection of hysterectomy type. Laparoscopically assisted vaginal hysterectomy becomes technically difficult and conversion to total abdominal hysterectomy is more frequent when uterine size or configuration impairs access to uterine vessels.

Adult↗
PubMed1995

Laparoscopic knot strength: a comparison with conventional knots.

OBJECTIVE: To compare the strength of laparoscopic knots with those used at laparotomy. METHODS: Three types of laparoscopic knots commonly used (Roeder, extracorporeal sliding square, and intracorporeal two-turn flat square) and three widely used conventional knots (flat square, surgeon's square, and sliding square) were tied using seven suture materials. Each knot was tied five times in random order by a single surgeon in a pelvic training model. Knot strengths were scored by tensiometer readings. A two-way analysis of variance was performed to uncover differences in mean knot strength. Turkey multiple-comparisons test was performed to determine the variability in strength of different knot geometries. Knot strength was measured in newtons. RESULTS: Significant main effects for knot geometry (P < .05) and material (P < .05) as they contribute to differences in knot strength were identified, as well as an interaction for knot geometry with material (P < .05). The laparoscopic Roeder knot was significantly weaker than all other laparoscopic and conventional knots tested. The laparoscopic extracoporeal sliding square knot was significantly weaker than the conventional surgeon's square knot, and the conventional sliding square knot was significantly weaker than the conventional flat square knot and the surgeon's knot. The laparoscopic intracorporeal two-turn flat square knot was as strong as the strongest conventional knot. A significant main effect was discovered for knots with eight throws. CONCLUSION: When performing laparoscopic procedures that result in significant tension on suture lines, consideration should be given to using the stronger laparoscopic knots, such as the intracorporeal two-turn flat square knot and the extracorporeal sliding square knot, instead of the weaker Roeder knot.

Analysis of Variance↗
PubMed1991

The role of lasers in advanced operative laparoscopy.

Lasers, electrosurgery, and conventional pelviscopic techniques all provide the accomplished endoscopic surgeon with a sophisticated approach to advanced operative laparoscopy. The different lasers, as well as other energy delivery systems and conventional techniques, offer a wide choice of pathways through which a desired end result may be achieved. The sophisticated laparoscopic surgeon is able to choose the best instrument and technique to fit the purpose of the operation and skills of the surgeon. As in conventional surgery, different surgeons prefer different instruments and use different techniques. These various instruments and operative techniques should be considered synergistic rather than competitive, because they have greatly increased the scope and safety of laparoscopic surgery.

Carbon Dioxide↗
PubMed1991

Indications and general techniques for lasers in advanced operative laparoscopy.

Lasers are but one of the several energy delivery systems used by the operative laparoscopist in the performance of advanced operative laparoscopy. Safety is a key factor in the selection of a laser because the tissue damage produced by this instrument is absolutely predictable. The surgeon must be totally familiar with the chosen wavelength and its tissue reaction if this safety factor is to be realized. Other instruments complement the use of lasers in advanced operative laparoscopy, and without thorough knowledge of all available techniques and instruments, the operative laparoscopist will not achieve the full potential of this specialty. It is beyond the scope of this issue on gynecologic laser surgery to present all of the useful nonlaser techniques. Suffice it to say that we often use laser, loop ligature, sutures, hemoclips, bipolar electricity, hydrodissection, and endocoagulation during the course of a day in the operating room and sometimes during one case. As enthusiasm for advanced operative laparoscopy grows and endoscopic capability increases, more complicated and prolonged surgical feats are reported. Radical hysterectomy and lymphadenectomy have been performed by the laparoscopic route, and endoscopic management of ovarian tumors also has been reported. At this moment, these must be viewed as "show and tell" procedures unsupported by statistics to demonstrate any advantage (or disadvantage) when compared with conventional surgical methods. The time required of advanced operative laparoscopy for any given procedure is certainly an important factor. Prolonged operative and anesthesia time certainly can negate the supposed benefit of small incisions and minimally invasive surgery. What goes on inside the abdomen is certainly the most important part of advanced operative laparoscopy. Good surgeons must recognize their own limitations and the limitations of available technology. The operative laparoscopist must know when to quit and institute a laparotomy. In general, when the magnitude of the operative laparoscopy greatly increases the time required to perform the surgery or exceeds the capability of the surgeon, laparotomy is necessary. Patients should never be promised that an operation will be done by laparoscopy. In advanced operative laparoscopy, informed consent means that the patient has had a reasonable explanation of the method, its benefits and its dangers, and has also been told that laparotomy is always a possibility. In our large series, the laparotomy rate is about 3%. It is also wise not to promise the patient that advanced operative laparoscopy will be done by the laser.(ABSTRACT TRUNCATED AT 400 WORDS)

Computer Terminals↗
PubMed1991

Mini-laparoscopy and fiber-optic lasers.

The use of the Adair Verres needle and an optical catheter system has enabled us to perform both diagnostic and laser mini-laparoscopy. The prefix mini refers to the fact that the three incisions placed in the abdomen were 3 mm in diameter. There were no complications in our pilot series. Because initial inspections of the abdomen may localize abnormalities such as intestinal adhesions and may show the surgeon a safer approach to subsequent trocar placement, nothing is lost and much may be gained by routinely performing mini-laparoscopy. The picture produced on the video monitor is now of excellent quality and seems likely to improve. In the near future, a three-chip camera, which is able to produce even better resolution, will become available. The further development of 3-mm instrumentation promises additional expansion in operative capability. Although mini-laparoscopy will not replace conventional operative laparoscopy with the 10-mm telescope in the near future, a significant proportion of diagnostic and minimally to moderately involved operative procedures may be safely carried out by this method.

Female↗
PubMed1991

Laser surgery for cervical intraepithelial neoplasia.

The laser has provided a relatively easy and safe method for treating all types of CIN. The advantages of lasers include great conservatism due to tissue sparing, great precision because of microsurgical method, combination of excisions and vaporization possible, suitable for therapy of multifocal disease, uncluttered field, and good hemostasis. Although other modalities have also been used successfully in the therapy of this disease, it appears that none are so versatile as CO2 laser or possess its ability to accurately treat the multifocal disease that may involve large surface areas of the lower reproductive tract. It seems unlikely that any of the cervical ablation methods--chemical destruction, hot cautery, diathermy electrode, cryoprobe, laser, and diathermy loop--will completely disappear from use in the near future. Ablation is an attractive alternative to cold-knife excision in properly triaged patients, since it is almost always an outpatient procedure done without anesthesia or with only local anesthesia. Most importantly, a large number of patients have completely visible lesions of a severity less than that of in situ cancer; they really do not need excisional conization by any technique and benefit by quick ablation of the transformation zone. A conization, to be diagnostic and therapeutic, must remove the entire transformation zone to the proper depth. This procedure is almost always attended by a higher morbidity rate than is simple ablation. Laser excisional conization and the large loop excision of the transformation zone procedure are similar in a number of respects, because the operator must have certain capabilities and a through understanding of the disease to be treated to perform the operation correctly.

Carcinoma in Situ↗
PubMed1991

Endometrial ablation.

Both YAG ablation and resectoscopic ablation of the endometrial cavity produce good results in most patients. Most hysteroscopic surgeons choose the resectoscope because it is much faster and easier and the results are comparable or better. Newer, larger YAG fibers may make a great difference in technical ease and speed. These new series are just beginning.

Clinical Protocols↗
PubMed1991

Education and credentialing of the gynecologic laser surgeon.

Gynecologic laser surgery involves the use and understanding of a number of different wavelengths (lasers) and their delivery systems. The educated laser surgeon understands the pros and cons of all the practical wavelengths, their tissue reactions, and their safety features. The laser surgeon may use a colposcope, hysteroscope, laparoscope, or laser handpiece in surgery. Few gynecologists have acquired the necessary expertise to perform laser surgery during residency training. For this reason, attendance at courses that include hands-on laboratory experience has been mandatory. Hospitals, not course directors, credential surgeons to perform laser operations in their operating rooms. The credentialing committee of the hospital must decide which surgeons have been properly trained for laser surgery. Objective criteria have been offered in this chapter in the effort to make the task easier and more fair. As the number of laser surgeons grows, the need for training courses may decrease, because if laser surgery is learned during the residency years, the demand for postgraduate training will decrease. On the other hand, since surgical laser evolution continues, the training center will continue to offer a valuable educational experience.

Credentialing↗
PubMed1989

A ten-year experience treating cervical intraepithelial neoplasia with the CO2 laser.

Between 1977 and 1987, the CO2 laser was used to treat 4024 women who were diagnosed by cytology studies, colposcopy, and biopsy examination to have cervical intraepithelial neoplasia. On the basis of specific indications, these women were treated by vaporization, excisional conization, or combination conization procedure. The evolution of methodology for each laser technique was based on specific pathophysiology and long-term observation of results. A total of 3070 patients underwent vaporization, 2881 of whom had no evidence of disease after one laser exposure (93.8%). Of the 954 patients who had laser excisional procedures, 925 (97%) had no evidence of disease. The most common complications observed were intraoperative and postoperative bleeding; however, sutures were required in only 1.34% of the latter. The risks of cervical stenosis (1.1%), incompetent cervix (0%), and pelvic infection (0.05%) were very low. This 10-year study demonstrated that the CO2 laser was a highly effective method for treating cervical epithelial neoplasia and had the added benefit of preserving reproductive function and anatomic integrity.

Carbon Dioxide↗
PubMed1987

[Prevention of gram-negative and gram-positive infections with 3 intravenous immunoglobulin preparations and therapy of experimental polymicrobial burn infection with intravenous Pseudomonas immunoglobulin G and ciprofloxacin in an animal model].

Three immunoglobulin preparations for intravenous infusion were compared in vivo to determine their relative protective capacity against several gram-negative and gram-positive pathogens. Polyglobin N is a conventional IgG concentrate. Psomaglobin N is identical in formulation to Polyglobin N but is prepared from the plasma of donors who have naturally high levels of antibody to lipopolysaccharide antigens of Pseudomonas aeruginosa. IgGMA is a conventional IgG concentrate containing 12% IgG and 16% IgA. In a murine model of burn wound sepsis the three IgG preparations were similarly protective against three or ten strains of P. aeruginosa. Psomaglobin N and Polyglobin N were significantly (p less than or equal to 0.015) more protective than IgGMA against six of ten and three of ten strains of P. aeruginosa, respectively. In a murine model of Streptococcus pneumoniae type 3 pneumonia, the three Ig preparations were similarly protective. IgGMA was significantly more protective (p less than or equal to 0.025) than Psomaglobin N and Polyglobin N against Salmonella typhimurium in murine peritonitis. However, the mean protective dose (PD50) of the two later preparations was less than or equal to 20 mg/kg body weight. In models of peritonitis both Psomaglobin N and Polyglobin N were more protective than IgGMA (p less than or equal to 0.004) against Haemophilus influenzae b, Klebsiella pneumoniae, Serratia marcescens 06:H3 and group B Streptococcus types 1b and 1c. Psomaglobin N and ciprofloxacin were employed to treat established polymicrobial murine burn wound sepsis resulting from contamination of the burn site with mixtures of P. aeruginosa and Staphylococcus aureus.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1985

Carbon dioxide laser for combination excisional-vaporization conization.

Extensive cervical intraepithelial neoplasia may simultaneously involve large areas of the ectocervix, even extending to the vaginal fornices, as well as the endocervical canal. In such instances conventional sharp knife conization would result in virtual removal of the cervix if the surgeon wished to completely circumscribe the entire lesion. By combining a narrow carbon dioxide laser excisional conization with ectocervical vaporization, cervical intraepithelial neoplasia may be eradicated by a virtually bloodless surgical procedure and fertility may be preserved. Sixty-one combination conizations with 6 months to 4 years of follow-up are reported. In 95% of the cases biopsy demonstrated cervical intraepithelial neoplasia in three or more ectocervical quadrants, and 16% had extension of disease into the vagina. The technique of combination conization uses 20 to 30 W of power and 1/2 to 1 mm spots for excision and 10 to 15 W and 1 to 1.5 mm spots for vaporization. The average time to complete the entire procedure was 21 minutes. In three of 61 cases endocervical margins were positive; there were no instances of persistence of neoplasia at either the ectocervical or the vaginal margins. Four complications were observed, all related to delayed bleeding; however, only two patients required the placement of a suture. The volume of tissue removed by a large excisional conization is more than two times greater than that of a laser combination conization.

Adolescent↗
PubMed1984

Comparative anti-Pseudomonas aeruginosa activity of chemically modified and native immunoglobulin G (human), and potentiation of antibiotic protection against Pseudomonas aeruginosa and group B Streptococcus in vivo.

Immunoglobulin G intravenous is prepared by controlled reduction and alkylation of approximately four interheavy chain disulfide bonds per molecule. To determine if the protective activity of antibody modified by this process is diminished, mice were treated with identical doses of reduced and alkylated IgG and native IgG prepared from the same plasma pool. Three hours later mice were given a 10 percent body surface burn followed by challenge with the seven Fisher-Devlin-Gnabasik immunotypes of Pseudomonas aeruginosa. Against five of the seven immunotypes, the 50 percent protective doses were approximately 100 mg or less per kg body weight. Overall there was no significant difference in protection afforded to the mice by the two immunoglobulin preparations indicating that in vivo the activity of IgG against P. aeruginosa remains unimpaired by reduction and alkylation. In the second part of this study, immunoglobulin G intravenous significantly enhanced the activity of tobramycin and carbenicillin in the treatment of P. aeruginosa infection in burned mice and of penicillin G in the treatment of group B Streptococcus 1C infection in normal mice.

Animals↗
PubMed1982

Contact hysteroscopic evaluation of the endocervix as an adjunct to colposcopy.

A total of 66 women with cervical intraepithelial neoplasia extending into the endocervical canal were investigated by endocervical curettage, contact endoscopy, and conization biopsy of the cervix. Although atypical epithelium was obtained in only 8 women by blind endocervical curettage, contact endoscopy identified 42 instances of disease of equal or greater magnitude than determined by the original ectocervical colposcopic evaluation. These findings were subsequently confirmed by conization biopsy. As the 6-mm contact hysteroscope may easily be inserted into the pregnant cervix, sufficient reassurance may be gained to avoid endocervical curettage or cone biopsy and thus to avoid the hazard of major hemorrhage and/or pregnancy interruption.

Biopsy↗