Search PubMed⌕ Search

Biomedical subjects

M Nisolle

Publications and source records attributed to M Nisolle.

At least 73 records · Page 4Linked to original sources
PubMed1993

Laparoscopic supracervical (subtotal) hysterectomy (LASH).

The use of laparoscopically assisted vaginal hysterectomy with or without annexectomy has been widely discussed. We report the technique of laparoscopic supracervical (subtotal) hysterectomy (LASH), which was first performed in 1990. Laparoscopic supracervical hysterectomy was carried out in a series of 36 women. The duration time was 60 min in experienced hands. There were no major complications. The feasibility and low morbidity rate of this laparoscopic approach led us to propose LASH in certain indications, particularly in cases of a uterus with multiple submucosal myomas where hysteroscopic therapy is less successful.

Adult↗
PubMed1993

Laparoscopic myolysis with the Nd:YAG laser.

Laparoscopic myomectomy can be carried out in cases of subserosal and intramural fibroids. Laparoscopic myolysis can be proposed as an alternative to laparoscopic myomectomy in cases of large or multiple intramural fibroids in women aged over 40 or not desiring to bear more children but wishing to avoid a future hysterectomy. The authors report the technique and the long-term results in a series of 48 women with fibroids treated by myolysis. Because of the risk of bowel adhesions, further studies with another type of laser fiber are required.

Adult↗
PubMed1993

[The role of GnRH agonists in the endoscopic treatment of endometriosis and fibromyomas].

Uterine myomas and endometriosis are benign pathologies frequently encountered in women. Myomas are often associated with infertility and/or menorrhagia particularly if they are sub-mucosal. Endometriosis is diagnosed in more than 35% of infertile patients. These two common pathologies are oestrogen-dependent and the administration of a GnRH agonist has been proposed as a non-surgical approach to the treatment of myomas and endometriosis. GnRH agonists cannot, however, be considered as definitive medical therapy because most myomas and endometriotic cysts return to their initial size within 4 months following the cessation of treatment. Moreover, because of the menopausal-like state that they induce, GnRH agonists provoke bone demineralization and for this reason, their long-term use is not recommended. These agents should, therefore, be considered as an adjuvant preoperative therapy. The aim is, above all, to achieve a preoperative reduction of tumour size, thus facilitating the endoscopic surgery: either hysteroscopic resection in the case of sub-mucosal myomas, or vaporization of ovarian cysts in the case of cystic endometriotic lesions.

Adult↗
PubMed1993

Morphometric study of the stromal vascularization in peritoneal endometriosis.

To evaluate the stromal vascularization of different appearances of peritoneal endometriosis, biopsies were taken from peritoneal areas with endometriosis in a series of 135 infertile women and classified as typical (black), red, or white lesions. The number of capillaries per mm2 of stroma, their mean surface area, and the ratio of capillaries/stroma surface area, and the mitotic activity were analyzed in typical, red, and white lesions. Significant differences were found between the different subgroups. The higher vascularization and mitotic activity observed in red lesions suggested the hypothesis that such lesions are very active and probably the first stage of early implantation of endometrial glands and stroma. The poor vascularization and the absence of mitosis observed in white lesions suggested that these lesions are much less active than red lesions and are a quiescent stage of the disease. Our study proves that the "activity" of peritoneal endometriosis is related to the vascularity. This concept must be considered in the further discussion of American Fertility Society Endometriosis Classification. Typical, red and white lesions are three different stages of the peritoneal disease and their relative relation to infertility is also probably different.

Endometriosis↗
PubMed1992

Three-dimensional architectures of peritoneal endometriosis.

OBJECTIVE: To elucidate some biological characteristics of peritoneal endometriosis. DESIGN: A recently advanced stereographic computer technology was applied for the investigation of the three-dimensional (3-D) architectures of peritoneal endometriosis. SETTING: University Hospital of Gynecology. PATIENTS: Biopsies were taken from 42 women with peritoneal endometriosis. Twenty-six of them were in the luteal phase. Seventeen of them received Zoladex (ICI, Cambridge, United Kingdom) for 12 weeks before biopsy. RESULTS: Two different main types could be identified according to the presence or absence of ramifications. The apparently multifocal occurrence (in 2-D) of glandular epithelium was not confirmed by the 3-D study that showed that all epithelial glands are interconnected by luminal structures in each peritoneal lesion. Stereometric study suggests a stronger effect of gonadotropin-releasing hormone agonist therapy on the stroma than on the epithelium. CONCLUSIONS: The study evaluated the 3-D architectures of peritoneal endometriosis and identified two principal types of peritoneal endometriosis.

Biopsy↗
PubMed1992

Hysteroscopic surgery.

Because a wide variety of conditions can be diagnosed hysteroscopically, hysteroscopy has become a diagnostic gold standard. Through "operative" hysteroscopes, both the electrical current of the resectoscope and the energy of the neodymium:yttrium-aluminum-garnet laser have been effective tools in many cases and presented a new alternative to laparotomy and hysterectomy. The most frequent procedures are 1) endometrial ablation and partial endometrial ablation, 2) myomectomy for submucous myomas, 3) two-step myomectomy for large submucosal and intramural myomas, 4) hysteroscopic management of müllerian defects, and 5) hysteroscopic management of intrauterine adhesions.

Electrosurgery↗
PubMed1991

Laparoscopic management of large ovarian endometrial cyst: use of fibrin sealant.

In order to prevent postoperative adhesions often present after CO 2 laser vaporization of large endometriomas, 62 patients with endometriomas greater than 3 cm diameter were treated with a new procedure. Partial cystectomy was performed using the CO 2 laser. Residual endometrial cyst was then vaporized. After laparoscopic vaporization of the interior cyst wall, a fibrin glue (Tissucol) was injected onto the vaporized area to close laparoscopically the ovarian cyst cavity. When performed, second-look laparoscopy demonstrated healing of the ovary without any periovarian adhesions. The incidence of periovarian adhesions was significantly lower (p less than 0.01) than in the group of women treated by laparoscopy and in whom the glue was not used to close the ovarian cyst cavity.

Endometriosis↗
PubMed1990

Histologic study of peritoneal endometriosis in infertile women.

The present study included 118 patients undergoing a laparoscopy for infertility. In 86 patients with laparoscopically diagnosed endometriosis (group I), biopsies were taken from areas of apparent endometriosis (n = 86) and from a visually normal peritoneum (n = 52). Histology reveals the presence of endometriosis in 93% of positive sites and in 13% of negative sites. In 32 patients without endometriosis at laparoscopy (group II), biopsies were taken from normal uterosacral ligaments (n = 32). Endometriosis was observed in 6% of cases. Despite the increased ability to detect pigmented and nonpigmented endometriotic lesion, histological study revealed the presence of endometriosis in normal peritoneum in 13% (group I) and 6% (group II) of cases.

Biopsy↗
PubMed1990

Neodymium: YAG laser hysteroscopy in large submucous fibroids.

The preoperative use of a potent, subcutaneously injected gonadotropin-releasing hormone agonist (GnRH-a) was evaluated in a series of 60 women with large submucosal fibroids. Myomectomy by hysteroscopy and Nd:YAG laser was easily performed. In 12 cases, the largest portion of the myoma was not inside the uterine cavity and myomectomy was carried by a two-step hysteroscopy. In women who wished to become pregnant, a pregnancy rate of 66% was achieved. Advantages of preoperative use of a GnRH-a are (1) the significant decrease of the fibroid size, (2) a lower fluid absorption, and (3) the restoration of a normal hemoglobin concentration.

Adult↗
PubMed1990

Hysteroscopic sterilization with the Nd:YAG laser.

In 10 rabbits, ablation of the uterine horn endometrium and the fallopian tube was performed with the Nd:YAG laser at a power of 60 W using the touch technique. Eight weeks postsurgery, biopsies of the tissue site were obtained showing that the endometrium and tubal mucosa were completely destroyed. Thirty women were sterilized using a similar technique hysteroscopically. Tubal occlusion was demonstrated by hysterosalpingography in all cases at 3 months postoperatively.

Animals↗
PubMed1990

[Treatment of endometriosis. Evaluation of preoperative therapy with danazol, gestrinone and buserelin (nasal spray and implant)].

In order to adequately assess the effectiveness of danazol, gestrinone, buserelin-nasal spray (IN) and buserelin-implant (SC), a prospective non randomized study was initiated in 178 patients with laparoscopically confirmed ovarian endometriosis. After hormonal therapy, laparotomy with microsurgical resection of endometriotic cysts or laparoscopy laser was carried out. Regression (greater than 25%) of ovarian endometriosis was noted in 30, 34, 73 and 91% of cases after danazol, gestrinone and buserelin IN and buserelin SC respectively. Histological study proves that hormonal treatment leads to an incomplete suppression of ovarian endometriotic implants and this suggests the necessity to remove surgically invasive ovarian endometriosis. The pregnancy rate in moderate endometriosis (55%) differed significantly from the rate obtained in severe endometriosis (44%). The highest percentages were found after buserelin therapy. In conclusion, preoperative use of a potent GnRH agonist, administered subcutaneously, seems to be the best therapeutic approach when associated to surgery (CO2 laser or microsurgery).

Administration, Intranasal↗
PubMed1989

CO2 laser laparoscopic surgery. Adhesiolysis, salpingostomy, laser uterine nerve ablation and tubal pregnancy.

Used endoscopically, the CO2 laser offers some advantages over other operative techniques for endometriosis and adhesions but, in spite of the continuing development of new instrumentation there are still problems with the system. The technique needs specialized equipment requiring ongoing biomedical maintenance and specialized technical care in the operating room. Some problems such as the intraperitoneal accumulation of smoke, gas leakage, and difficulty with maintenance of proper beam alignment still occur. In spite of these problems the advantages are numerous: the system allows precise bloodless destruction of diseased tissue and eliminates the risks of cautery. In the hands of an experienced laparoscopist, it appears safe and effective in vaporization of endometriotic lesions, utero-sacral neurectomy, adhesiolysis and salpingostomy. The judicious use of these techniques, combined with carefully planned further investigations by well-trained and experienced laparoscopists and continuing improvements in the delivery systems, will soon reveal the true efficacy of the CO2 laser laparoscope. If studies continue to show pregnancy rates and pain relief to be equivalent to those patients treated by laparotomy, CO2 laser laparoscopy will become the preferred procedure for the management of pelvic endometriosis and its associated adhesions, distal tubal occlusion, pelvic pain and tubal pregnancy. With the exception of using the argon laser to treat endometriosis, the selective absorption characteristic of lasers has not been greatly utilized. While the CO2 laser is heavily absorbed by water and hence vaporizes most cells in a rather indiscriminate fashion, this is not true for other wavelengths, such as argon, Nd-YAG, KTP, krypton, xenon, copper and gold vapour lasers. The energy form of each of these lasers has different properties of penetration, absorption, reflection and heat dissipation. Many of these lasers have not yet been evaluated in human subjects. An exciting, although not new, area of possible laser application involves the use of photosensitizers and fluorescing agents (Dougherty et al, 1978). Some recent experimental studies (Schellhas and Schneider, 1986; Schneider et al, 1988) may lead to new therapeutic possibilities. The surgical laser is not, however, a panacea. Only controlled trials carried out carefully over the next few years will clearly define its potential. In the meantime it is incumbent upon all of us to investigate the clinical, gynaecological and surgical applications in a careful, methodical and scientific manner.

Female↗
PubMed1987

[Unruptured luteinized follicle syndrome and experimental endometriosis in the female rabbit].

To study the effect of endometriosis on follicular rupture, endometrial tissue was autografted to New Zealand White rabbits. Endometrium was surgically implanted into the peritoneal cavity. Human chorionic gonadotropin was administered to induce ovulation. The viability of the implants was demonstrated histologically during three subsequent laparotomies, the number of corpora lutea and stigmata were counted. Ovaries were then removed and ovarian serial sections were examined. In rabbits with peritoneal induced endometriosis, the percentage of stigmata per corpora lutea was significantly decreased. Macroscopic study was confirmed by histological examination. Indeed, a high incidence of entrapped oocytes was found in rabbits with peritoneal endometriosis. Our data demonstrated that endometriosis induced a failure of follicular rupture.

Animals↗
PubMedDate not supplied

Laparoscopic myolysis.

This review will focus on the different techniques and the long-term effects of the technique called myolysis on myoma growth. Indications for myolysis are essentially pelvic pain, compression symptoms and global uterine volume in order to avoid hysterectomy. In the late 1980s, myolysis was performed laparoscopically with the help of the neodynium: yttrium aluminium garnet (Nd:YAG) laser. Later, bipolar needles were developed as an alternative to the Nd:YAG laser. Diathermy and cryomyolysis were also proposed but series are small in the literature. Very recently, myoma interstitial thermo-therapy (MITT) was performed using the diode laser and a specific optical light diffuser that is designed to transmit laser light in all directions. Laparoscopic myolysis was proved to be effective in provoking myoma shrinkage, with a dramatic decrease in size and a marked devascularization of the myoma and this technique can be proposed as an alternative to myomectomy in selected patients: only those aged >40 years or those not desiring to bear any more children.

Cryosurgery↗