Biomedical subjects
JR Cohen
Publications and source records attributed to JR Cohen.
Laparoscopic Aortic Surgery.
With the success of laparoscopic cholecystectomy in decreasing postoperative pain, morbidity, hospital stay and costs, there has been much interest in applying minimally invasive techniques to other fields. Although endovascular stenting first emerged as a minimally invasive approach to vascular surgery, laparoscopic aortic surgery for both occlusive and aneurysmal disease has only recently been developed. Although technical feasibility has been demonstrated in animal and human studies, several issues still need to be resolved. These include the optimal surgical approach to the aorta, methods of maintaining a working cavity, technical issues specifically related to aortic surgery, and documentation of the exact benefits for patients. The purpose of this article is to review the current literature on laparoscopic aortic surgery and discuss them in the context of the above issues.
Sonohysterography for the Diagnosis of Endometrial Thickening in Postmenopausal Bleeding-A Preliminary Report
Sonohysterography or sonographic uterine cavity visualization by uterine cavity distension may help in distinguishing true endometrial thickening from other intracavitary pathologic conditions assuming the same appearance on conventional sonography. We examined 15 women with thickened endometrium (range 10-25 mm) on sonography performed for postmenopausal bleeding. Subsequent sonohysterography with saline revealed a polypoid structure in seven women, a normal uterine cavity in four, and thickened endometrium in four. All patients underwent hysteroscopic evaluation of the uterine cavity. Hysteroscopy confirmed the sonohysterographic findings in 14 patients (93.3%). Hysteroscopic resection of the polypoid structures was performed while the remaining patients underwent diagnostic curettage. Histologic examination of the seven polypoid structures revealed benign endometrial polyp in six and one pedunculated submucous fibroid. In patients undergoing diagnostic curettage, histologic examination revealed three cases of glandular hyperplasia, one case of cystic (atrophic) hyperplasia, one case of papillary endometrial adenocarcinoma, and two cases were inadequate for diagnosis. The advantage of sonohysterography in distinguishing endometrial thickening from intracavitary polyp or fibroid is clearly demonstrated. This technique can help in tailoring the correct treatment in various conditions presenting as postmenopausal bleeding.
Laparoscopic Conservative Cystectomy of Ovarian Benign Cystic Teratoma
Laparoscopic surgery has almost totally replaced laparotomy in the management of benign adnexal conditions. Benign cystic teratoma (dermoid cyst) is one of the most common ovarian neoplasms in young women. A prospective non-randomized clinical trial was conducted. To compare the efficacy of two different methods of removal of benign cystic teratoma enucleated laparoscopically. Between January 1991 and June 1993, 37 women, all reproductive-age and desiring future fertility, underwent resection of dermoid cysts between 4 and 8 cm in diameter via laparoscopy using the three-puncture-technique. The removal of the cysts from the abdominal cavity was carried out by traction through an extended incision of one of the puncture sites in the first 17 cases (group A), and the other 20 cases (group B) were managed by embedding the cyst in a plastic bag inserted through one of the trocars, aspirating its contents, and subsequent extraction of the bag without extension of abdominal wall stab wounds. The operating time in both groups was comparable (from 35-130 minutes in group A, and 45-120 minutes in group B. However, the time required for removal of the cyst from the abdominal cavity was significantly shorter in group B (10-15 minutes) compared with group A (20-35 minutes). Spillage of cyst contents occurred in six cases in group A, and in two cases in group B. The average hospital stay in both groups was similar (22.8 hours in group A and 23.4 hours in group B). Postoperative complications in group A included one case of excessive bleeding from the extended incision, and three cases of wound infection. None of the patients in group B had short- or long-term postoperative complications. Operative laparoscopy is a safe and effective method in the management of benign cystic teratoma. We found that removal of the enucleated cyst from the abdominal cavity using a plastic bag is advantageous in terms of operating time and postoperative complication as well as in the cosmetic results compared to extraction of the cyst through an extended abdominal incision.