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Biomedical subjects

M A Bruhat

Publications and source records attributed to M A Bruhat.

At least 55 records · Page 3Linked to original sources
PubMed1996

[Limitations of laparoscopic management of pelvic static disorders in gynecology].

Laparoscopic treatment of urinary stress incontinence and urogenital prolapse is a recent development of endoscopic surgery. The aim of this study was to describe the operative techniques of colposuspension and of treatment of urogenital prolapse and to provide data of the results. Although, long-term follow-up data remains to be collected, 12 to 18 month results demonstrate appropriate success rates in correction of urinary stress incontinence using laparoscopic approach to the retropelvic space. An expanded laparoscopic approach is now possible for treatment of urogenital prolapse. It is imperative that the techniques continue in order to provide multicentered clinical data by which clinical investigators and practitioners should thoroughly evaluate these surgical techniques.

Female↗
PubMed1996

Laparoscopic management of adnexal abscesses: consequences for fertility.

OBJECTIVE: To study fertility of patients with adnexal abscesses treated by laparoscopy, antibiotic therapy, and second-look laparoscopy. DESIGN: A retrospective clinical study. SETTING: Department of Obstetrics Gynecology and Reproductive Medicine, University of Auvergne, University Hospital of Clermont Ferrand, France. PATIENT(S): Thirty-nine patients treated for adnexal abscesses between January 1983 and December 1992. INTERVENTION(S): Laparoscopic drainage of adnexal abscesses was performed in all patients; 35 patients underwent a second laparoscopy 3 to 6 months later. MAIN OUTCOME MEASURE(S): Immediate and long-term clinical results, anatomical data obtained at second-look laparoscopy, spontaneous fertility. RESULT(S): No immediate reoperation was necessary within the first 2 months after the initial laparoscopic surgery. At second-look laparoscopy, an adhesiolysis was necessary in all cases. A distal tuboplasty was performed in 17 patients and 6 patients were referred to IVF-ET. Subsequently, 12 of 19 patients not using any contraception obtained a spontaneous intrauterine pregnancy (63%). CONCLUSION(S): This study confirms that laparoscopic surgery is a safe and efficient technique for treating adnexal abscesses. Anatomical results observed at second-look laparoscopy suggest that this second surgical step is essential for patients desiring future pregnancy.

Abscess↗
PubMed1996

Laparoscopic treatment of symptomatic endometriosis.

From their experience and from data in the literature, the authors try to define the respective place of the different treatments for endometriosis, especially those of operative laparoscopy. In cases of endometriosis-associated infertility, operative laparoscopy is the first line treatment and assisted reproductive technology (ART) the second one. Gonadotrophin-releasing hormone (GnRH) analogues are only useful in cases of extensive endometriosis to render surgery easier, and for ART. The average pregnancy rate following laparoscopic treatment is approximately 50% (range 34-80%). It is poorly related to the type of endometriosis except in cases of large adhesions and tubal involvement. However, duration of infertility, age and sperm quality have a direct influence on it. Therefore the authors propose a scheme for the management of endometriosis-associated infertility. In cases of pain, laparoscopic surgery can also be used; however, drugs have a more important role in these cases, to avoid recurrent surgery.

Endometriosis↗
PubMed1996

[Laparoscopic hysterectomy. A series of 318 consecutive cases].

OBJECTIVE: To evaluate the place of laparoscopy in hysterectomy. DESIGN: A retrospective study. SETTING: Département de Gynécologie Obstétrique et Reproduction Humaine. Polyclinique de l'Hôtel-Dieu-CHU de Clermont-Ferrand. SUBJECTS: A 318 cases continuous series of laparoscopic hysterectomies performed from 1989 to 1993. Results were presented and compared to the largest series of vaginal or abdominal hysterectomies reported in the literature. RESULTS: Conversion to a vaginal route or a laparotomy was required in 11.3% of the cases. Operative duration was longer with laparoscopy than with the other technique. But hospital stay was shorter. The complications were extremely rare after laparoscopic hysterectomy. Urological complications rate was high. Operative route remains a controversial question. CONCLUSION: Laparoscopy has become the routine procedure for hysterectomy in our department.

Female↗
PubMed1996

Future endoscopic trends in gynecological oncology.

Using technological progress, laparoscopic lymphadenectomy is becoming the standard for staging of pelvic cancer. In the same way more extensive procedures such as para-aortic lymph nodes dissection and radical hysterectomy have been demonstrated to be feasible by laparoscopy. This new approach appears very promising. In the future, because of its well known advantages, laparoscopic surgery may appear as a way to decrease the consequences of oncologic treatments in patients with low risks tumors and to propose more aggressive treatments of patients with bad prognosis tumors.

Biopsy↗
PubMed1996

[Bowel endometriosis. Eight cases of colorectal resection].

Colo-rectal endometriosis requiring colon resection are reported in 8 patients to illustrated the diagnostic and therapeutic problems encountered in the management of this uncommon localisation. Pericatamenial or catamenial bowel symptoms associated with pelvic genital involvement were encountered in all cases. Clinical examination, barium enema and colonoscopy are essential to guide surgical management looking for multiple localisations. However their diagnostic value is low as endometriosis rarely involves the mucosa. Endosonography appears to be very promising in evaluating the depth of infiltration of the bowel. The treatment of bowel endometriosis is controversial and varies greatly according to the patient's complaints and clinical data. The indications and limits of all treatment modalities including abstention, medical, and surgical treatment are discussed. From the cases reported we conclude that symptomatic bowel endometriosis should be fully excised whenever possible, and the surgical procedure should be adapted to the depth of infiltration. A full thickness excision or bowel resection is mandatory in patients with deep muscularis involvement. These procedures, which are often difficult due to extensive fibrosis and adhesions, may be achieved by laparoscopy in selected patients.

Adult↗
PubMed1995

Laparoscopic radical hysterectomy for cervical cancer.

A laparoscopic approach for radical hysterectomy is described. The laparoscopic procedures are similar to those achieved previously by laparotomy, the extent of surgery being adapted to the volume of the tumour and to the associated treatments. From the results obtained in a preliminary study of 15 patients, this approach appears to be safe. This surgical treatment of cervical cancer which associates a radical procedure complying with oncological rules with a decreased morbidity seems very promising. However, laparoscopic radical hysterectomy should be considered investigational and reserved for oncology surgeons trained in extensive laparoscopic procedures. Large studies with long follow-up are necessary before this approach can be proposed as an alternative to conventional surgical approaches.

Adult↗
PubMed1995

[Treatment of endometrial clinical stage I adenocarcinoma by laparoscopic surgery. Seventeen cases].

AIM: Study and follow-up of laparoscopic surgical treatment of endometrial cancer, clinical stage I. METHOD AND MATERIALS: This retrospective study covering the period 01 February 1990 to 31 January 1994 on 17 patients presenting with endometrial cancer, clinical stage I, that is, 35.4% of endometrial cancers operated in our department during that period, and for which laparoscopy was the first step in surgical treatment. RESULTS: Of the 17 cancers assessed by laparoscopy, 12 were also operated by laparoscopy. Conversion to laparotomy concerned 5 cases (29.4%): one case of postoperative adhesions, 2 cases of laparoscopic complications (cardiac rhythm problems, sub cutaneous emphysema), 2 cases of peritoneal granulations giving rise to suspicious of stage III. The mean age of the patients operated via laparoscopy was 59.9 years (extremes: 34-74). Their weight varied from 52 to 94 kg with a mean of 68.1 kg. Two endoscopic surgical complications arose (one bladder injury and one cervico-vaginal bleeding), but did not require conversion to laparotomy. No postoperative complications were noted. The average follow-up for these patients treated by endoscopy is 22.3 months. There was regrettably one early recurrence of the disease 7 months postoperatively. CONCLUSION: Laparoscopic surgery can be used to treat clinical stage I cases of endometrial cancer. This surgical approach must be used only for favourable cases and is reserved for teams trained in endoscopic and cancer surgery.

Adenocarcinoma↗
PubMed1995

Laparoscopic hysterectomy.

We describe the use of laparoscopic techniques in hysterectomy, and the epidemiology of hysterectomy. We review the advantages and complications of total laparoscopic hysterectomy and subtotal laparoscopic hysterectomy. Finally, we discuss long-term outcomes and the cost of these techniques.

Female↗
PubMed1995

Laparoscopic procedures for stress incontinence and prolapse.

Laparoscopic treatment of urinary stress incontinence and urogenital prolapse is a recent development. We describe the progress of the ideas and techniques, in this field. However, the literature lacks prospective randomized studies with sufficient follow up. So there is a need for these techniques, which seem attractive at first glance, to be fully assessed before they can be adopted as standard practice.

Female↗
PubMed1995

[Laparoscopic treatment of adnexal abscesses. A series of 39 patients].

OBJECTIVE: Evaluate short- and long-term follow-up of patients treated by laparoscopy and antibiotherapy for tubo-ovarian abscess. METHODS: We report a retrospective study of 39 patients treated from January 1983 to December 1992. Clinical files were examined and a questionnaire was mailed to patients. RESULTS: None of the patients needed to be reoperated for failure of the first laparoscopic treatment. A laparoscopic control after 3 month was done in 35 cases, which allowed complete adhesiolysis in every patients. We performed distal tubal surgery in 17 patients at that time and oriented 6 patients directly towards IVF. Subsequent fertility, in 19 patients followed without contraception, demonstrated a rate of spontaneous intra-uterine pregnancy of 63%. CONCLUSION: This study confirms that laparoscopy remains the technique of choice in initial management of adnexal abscesses.

Abscess↗
PubMed1994

Introduction of gynecologic endoscopic surgery in an African setting.

The new operative endoscopic techniques have been fully tried in the industrialized world and have spread to all surgical specialities. These new technologies present an obvious advantage for certain gynecologic pathologies which are particularly common in Africa. For pelvic inflammatory diseases, ectopic pregnancies and tubal sterility, laparoscopic surgery enables an initial assessment of disease, a less traumatic treatment and therefore a better long-term prognosis for fertility and reduced postoperative morbidity. Recently, an operative endoscopic unit performing laparoscopic surgery and endoscopic resections was created at the Centre Hospitalo-Universitaire de Yaoundé in Cameroon. This facility is the result of close collaboration between the University of Yaoundé and the University Hospital of Clermont-Ferrand. This operative endoscopic unit has been functioning since April 1992. The authors discuss the difficulties involved in such projects, such as initial investment, maintenance of equipment and in particular training of the surgical team.

Cameroon↗
PubMed1994

[Insufflators for endoscopy].

Operative laparoscopy needs a space to be made inside the abdominal cavity. This can only be achieved by suspension or by positive pressure. The endoscopic insufflator makes it possible to create this positive pressure, and does indeed enable the operating space to remain open. But it would be too limiting to consider these devices from the visibility point of view only, for they can also be exploited for their action on hemostasis and dissection. With this in mind we feel that the endoscopic surgeon ought to be perfectly familiar with his apparatus and not simply limit himself to adjusting the pressure and flowrate at the beginning of the operation. This hyper pressure in the abdomen is not without consequences for the patients' homeostasis and can indeed require an operation to be halted or converted to laparotomy. So knowledge of the biomedical aspects of his equipment will also enable the surgeon to increase the safety of his operations.

Endoscopes↗