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Biomedical subjects

K Semm

Publications and source records attributed to K Semm.

213 records · Page 12Linked to original sources
PubMedDate not supplied

Pelviscopic uterine surgery.

About 15-20% of the time uterine surgery via laparotomy is replaced in our department by operative pelviscopy. Of these, in reference to myoma surgery, about 70% were tackled with operative pelviscopy and a laparotomy was avoided. This allows the preservation of the uterus, especially for those women who desire to bear children in the future. Organ-preserving, minimally invasive surgery is the current accepted operative ideal. Postoperative sequelae like adhesion formation, subacute intestinal obstruction, and chronic abdominal pain are thus decreased. The importance of correct and safely functioning equipment and instruments cannot be overstressed for optimal results. A closed drain, i.e., the Robinson drainage system, can be kept in place for at least 12-24 h to check the postoperative ooze. In two cases of extensive ooze, repeat pelviscopy was performed within 12 h and hemostasis was achieved by the use of endosutures and endocoagulation.

Adult↗
PubMedDate not supplied

Results of operative pelviscopy in 202 cases of ectopic pregnancy.

This study presents 202 cases of ectopic pregnancy treated by pelviscopy over 9 years, from 1978 to 1987. The tube was conserved in 177 patients, and a salpingectomy was performed in 25 cases. The former group includes 24 cases of tubal abortion. Longitudinal salpingectomy, to extract the products of conception, was performed in the remainder of cases (153), in 14 of which tubal rupture had already occurred. Postoperative bleeding demanded repeated pelviscopy in three cases, and laparotomy in two. Postoperative infection required salpingectomy in one case. One patient underwent laparotomy in another hospital, and in two cases, chorionic villi were found within a hematosalpinx at re-pelviscopy. The pregnancy rate in 74 patients desiring pregnancy was 57%. The recurrence rate of ectopic pregnancy in both the ipsi- and contralateral tube was 7%.

Adult↗
PubMedDate not supplied

[Typing of stored, hemolyzed blood samples by DNA fingerprinting].

DNA fingerprints were established from 3 months old hemolysed blood samples. In spite of partial degradation of the DNA, the hybridization with the oligonucleotide probe (GTG)5 allowed unequivocal identification of the source of the blood.

Accidents, Traffic↗
PubMedDate not supplied

Endoscopic subtotal hysterectomy without colpotomy: classic intrafascial SEMM hysterectomy. A new method of hysterectomy by pelviscopy, laparotomy, per vaginam or functionally by total uterine mucosal ablation.

The CISH-technique per laparotomiam, vaginam, or pelviscopiam which sometimes may be limited to a TUMA procedure should replace classic total hysterectomy is approximately 80% of the cases. Where hysterectomy is indicated CISH and TUMA reduce the feeling of disfiguration many women feel after total hysterectomy. The uterine artery is not ligated as is routinely performed at total hysterectomy where, thereafter, the vagina is supplied by collateral branches only. Atrophic tissue in the pelvic floor results. The CISH-technique preserves the full blood supply to the lower pelvis, and this is particularly important for older patients. Perhaps this is the first step in the prophylaxis against prolapse. With TUMA not only the sexual function of the vagina remains intact but through the preservation of the genital blood supply the endocrinological function of the ovaries remains unchanged. We are at the beginning of a new era of minimal invasive operative techniques in gynecology. This new era of surgery limits itself to removing only the diseased part of the affected organ. Radical operations such as oophorectomy, salpingectomy, hysterectomy etc. are reduced to a minimum and indicated only in cases of malignant disease in these organs. Experience will show whether IVH is the least physically traumatic hysterectomy technique or not. At the present IVH is the most minimally invasive hysterectomy technique.

Catheter Ablation↗
PubMedDate not supplied

Endoscopic management of adnexal masses.

BACKGROUND: The laparoscopic management of suspicious adnexal masses and early ovarian malignancies is discussed with the aim of maintaining accepted oncologic treatment principles. Comparative survival data of patients with gynecological malignancies managed by laparoscopy or laparotomy are still very scarce and the survival of cancer patients must not be compromised by new techniques. It is time to closely analyze laparoscopy and determine if it has a positive impact on the diagnosis and treatment of ovarian malignancies. In this paper we will address the following points: 1) Which ovarian cysts can be surgically treated by laparoscopy (pelviscopy)? 2) Is staging laparoscopy an accepted technique? 3) Is laparoscopy, as a second-look procedure, of benefit? 4) Is laparoscopic staging, together with histologic tissue sampling, adequate surgical technique in inoperable ovarian cancer with ascites and peritoneal carcinomatosis? 5) Does endoscopic biopsy of ovarian cancer stage Ia change the destiny of a patient into ovarian cancer Ic? DATA BASE: The above questions are analyzed based on our experience with the laparoscopic treatment of 1,225 patients with ovarian cysts and 165 ovarian cancer patients stage I to IV treated immediately by laparotomy during the years 1992-1995. CONCLUSIONS: Ovarian cystic tumors with no signs of malignancy can be dealt with by laparoscopic means with the option of immediate conversion to laparotomy or within one week if an ovarian malignancy is diagnosed. Today sampling laparoscopic lymphadenectomy of both pelvic and para-aortic is feasible and adequate. On a curative level, the number of lymph nodes to be resected has yet to be determined. The adnexa can be extracted from the abdominal cavity with bag extraction without the danger of spillage. The uterus can be removed transvaginally with laparoscopic assisted vaginal hysterectomy (LAVH). We must be cautious to advocate laparoscopy for ovarian cancer. However, it is an excellent tool when used as a staging procedure. A careful preoperative screening of the patient and an exact definition of existing cysts with imaging techniques allows us to frequently apply laparoscopic surgery for ovarian cysts, leaving only readily detectable cancer cases for laparotomy. Many gynecological oncologists employing staging and second-look procedures for ovarian cancer agree that initiating a case with laparoscopy may preclude laparotomy for many patients. Tumor propagation by performing a biopsy in FIGO stage Ia ovarian cancer patients does not occur if the patient receives adequate radical surgical treatment within one week. According to the reports of Sevelda et al. and Dembo et al., the degree of differentiation and the existence of ascites are more relevant to decreasing the five-year survival rate of patients with ovarian cancer stage I than the rupture of capsule or penetration of the tumor. A dependency on the first two parameters was found in these two large statistical studies. As the question of endoscopic operations for adnexal mass is predominantly put for the sanitation of small ovarian tumors (ovarian tumors with solid particles in the cysts can be put into the section of primary laparotomies) there remains a wide field of indications for the laparoscopic treatment of adnexal mass and ovarian cysts with benign indications. For many young patients with non-malignant ovarian lesions such as endometriosis, benign cysts, benign cystic proliferations and fibromas, a laparotomy can be avoided and these lesions treated by laparoscopy.

Adolescent↗