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Biomedical subjects

R Garry

Publications and source records attributed to R Garry.

At least 55 records · Page 3Linked to original sources
PubMed1995

Endometrial laser ablation.

With good techniques endometrial laser ablation can be a safe and effective treatment for dysfunctional uterine bleeding. For effective intrauterine surgery it is important to control the intrauterine environment during the procedure to ensure safe operating conditions. This can best be achieved by using a continuous flow hysteroscope and pressure-controlled fluid infusion pump. The laser energy should be applied with a direct dragging technique to produce a series of parallel furrows. Safe ablation will be achieved if the three golden rules are followed and the laser is activated only when the tip of the fibre is visible, only when it is being drawn towards the operator and only when the fibre is being moved across the endometrial surface. With a high power Nd: YAG laser at 80 W power, a treatment time of around 20 min should be regularly achieved. This approach can control menstrual flow in 90% of cases and result in an overall satisfactory outcome in around 85% of cases. Improved patient selection may further improve these results. These satisfactory results can be achieved with minimum morbidity but the potential for serious complications still exists so these techniques should not be undertaken without adequate training and good equipment.

Endometrium↗
PubMed1995

Initial experience with laparoscopic-assisted Doderlein hysterectomy.

OBJECTIVE: To assess the outcome of a modified laparoscopic-assisted Doderlein hysterectomy. DEFINE: A prospective clinical study. SETTING: Women's Endoscopic Laser Foundation, South Cleveland Hospital, Middlesbrough, Cleveland. SUBJECTS: Twenty consecutive women with indications for hysterectomy and unsuitable for vaginal approach. INTERVENTION: Laparoscopic-assisted Doderlein hysterectomy with modification to make the technique cost effective. MAIN OUTCOME MEASURES: Operative time, uterine weight, blood loss, hospital stay, intra-operative complications and post-operative complications. RESULTS: The median operative time was 93 minutes, the uterine weight was 168 g, blood loss minimal. The median hospital stay was three days. There were no intra-operative complications and minimal post-operative complications. CONCLUSIONS: The modified laparoscopic-assisted Doderlein hysterectomy is a safe, rapid procedure which allows the patient to achieve all the benefits of laparoscopic surgery with simple and inexpensive laparoscopic and vaginal techniques.

Adult↗
PubMed1995

Techniques of partial hysterectomy: an overview.

With the advent of endometrial ablation and resection, and the laparoscopic techniques for hysterectomy, there has been renewed interest in subtotal or partial hysterectomy. A number of unsubstantiated claims have been made for these new techniques and these are critically reviewed. There appears to be no reason to advocate a change from total hysterectomy to partial hysterectomy on the basis of the currently available evidence.

Cervix Uteri↗
PubMed1994

Factors Influencing the Outcome after Endometrial Laser Ablation: A Review of 600 Cases

A consecutive series of 524 patients who had undergone 600 endometrial laser ablations (ELA) were surveyed by mailed questionnaire to determine their response to the procedure. Five hundred one (96%) of the women replied. No major operative morbidity had occurred. The mean duration of follow-up was 15 months (range 6 to 42 months). The absolute amenorrhea rate was only 29%, but in 95% the volume of bleeding was significantly reduced. The frequency of menstruation was reduced in 37% of the patients and unaltered in the remainder. The majority (83%) expressed satisfaction with the medium term outcome. The principal reason for dissatisfaction was persistent menstrual pain. Reported success increased with increasing patient age but was not influenced by uterine size or operating time. ELA in correctly selected cases is a safe and effective treatment for menorrhagia.

Journal Article↗
PubMed1994

A Prospective Randomized Trial Comparing a GnRH Analog, Zoladex, and Danazol as Agents for Priming the Endometrium Prior to Endometrial Laser Ablation

A randomized controlled trial of 160 patients undergoing endometrial laser ablation (ELA) was performed. Patients selected for ELA were randomized to receive either danazol or the GnRH analog Zoladex. Eighty patients were allocated to each group. Each group was also randomized to receive either 1 or 2 months of treatment prior to surgery The major end points for the study were patient compliance and drug-related side-effects, operative time and complications, effectiveness of endometrial thinning as judged by ultrasound, histologic measurements, and clinical response at 6 months assessment. Significant differences in the effectiveness of the two preparations were noted.

Journal Article↗
PubMed1994

Factors influencing the outcome of endometrial laser ablation.

There have been more than 1000 endometrial laser ablations (ELA) performed at South Cleveland Hospital. The procedure has a high success rate in relieving the symptoms of dysfunctional uterine bleeding (83% sustained improvement over 1-4 years), and there has been no associated major morbidity. To identify factors that are associated with poor outcome, we have reviewed our data on women who progressed to hysterectomy after ELA. Twenty-nine of the first 524 women (5.5%) undergoing ELA have required subsequent hysterectomy. After excluding 3 cases where extensive endometriosis had been diagnosed at concomitant laparoscopy, these women were compared to 26 matched controls who had excellent outcomes. It was observed that young age, dysmenorrhea, and atypical pelvic pain at admission were factors associated with an increased chance of failure. Operative data, including uterine length and treatment times, were similar in both groups, and more than half the poor outcome group had entirely normal uteri. We conclude that good patient selection based on careful history and preoperative examination is of paramount importance in ensuring good treatment outcome.

Adult↗
PubMed1994

The use of syntocinon in the management of excessive fluid absorption during endometrial ablation.

Five cases of intravenous oxytocin use during endometrial laser ablations complicated by excessive fluid absorption are reported. In each of the 5 cases it was possible to measure the rate of fluid absorption before and after the administration of this medication. There was a marked reduction in fluid absorption in 4 of the 5 cases, although the small number in the study did not allow statistical significance to be reached. The clinical benefit observed supports earlier work at this institution which suggests that oxytocic agents may be of value in cases of excessive fluid absorption through their action in contracting the myometrium and thereby compressing myometrial veins.

Absorption↗
PubMed1994

Various approaches to laparoscopic hysterectomy.

The advantages of the laparoscopic mode of access for hysterectomy include shorter recovery time and less pain and scarring. The laparoscopic component of the hysterectomy is usually combined with a vaginal component. The relative proportions of the procedure, performed laparoscopically and vaginally, vary considerably between surgeons. The main problem associated with the laparoscopic approach is to ensure adequate hemostasis while avoiding damage to the urinary tract. A variety of differing techniques have been developed in attempts to ensure the safe and efficient removal of the uterus laparoscopically.

Female↗
PubMed1992

Fluid absorption during laser ablation of the endometrium in the treatment of menorrhagia.

Twenty-six women participated in a two-part study to determine the magnitude of absorption of irrigating fluid during endometrial laser ablation (ELA), and the effect on this absorption of controlling the intra-uterine pressure (IUP) during ablation. Six women participated in the first part of the study in which IUP was uncontrolled during surgery. The mean fluid deficit was 2027 ml. In the second part of the study, 20 women were allocated randomly to two groups. In the first group (nine women), IUP was uncontrolled during surgery. The mean IUP was 100 mm Hg, mean maximum IUP 136 mm Hg and mean fluid deficit 1255 ml. In the second group (11 women), the IUP was controlled during surgery. The mean IUP was 66 mm Hg, mean maximum IUP 70 mm Hg, and there was no fluid deficit in any of the women. The study demonstrates that control of IUP during ELA was effective in preventing absorption of irrigating fluid.

Adult↗
PubMed1991

A multi-centre collaborative study into the treatment of menorrhagia by Nd-YAG laser ablation of the endometrium.

OBJECTIVE: To determine the safety and clinical effectiveness of Nd-YAG laser ablation of the endometrium in the treatment of menorrhagia. DESIGN: A prospective 3-year observational multi-centre study. SETTING: Gynaecological units in the UK and USA with special interest in endoscopic laser surgery. SUBJECTS: 859 women with menorrhagia resistant to medical therapy. MAIN OUTCOME MEASURE: Duration of laser ablation, intra- and post-operative complications, amenorrhoea rate, oligomenorrhoea rate, and woman's subjective assessment of treatment. RESULTS: No major complications occurred in 859 treatments. Four (0.4%) cases of transient fluid overload, 4 (0.4%) of infection, and 3 (0.3%) of uterine perforation occurred. Each of the perforations occurred during insertion of the rigid instruments and none was produced by the laser. There were no major haemorrhages, no blood transfusions were needed, and no woman required a laparotomy. The mean duration of the laser ablation was 24 min, and the average stay in hospital was less than 24 h. Of the 479 women followed up for at least 6 months after treatment 288 (60%) developed complete amenorrhoea and 152 (32%) reported continuing but satisfactorily reduced menstruation; 39 (8%) failed to improve with the first treatment, but 26 of them responded to a second laser ablation. Overall 466 (97%) had a satisfactory response to laser ablation and only 13 (3%) required subsequent hysterectomy. CONCLUSION: Endometrial laser ablation would appear to be a popular, safe, effective and economical alternative to hysterectomy for the treatment of menorrhagia.

Adult↗