Search PubMed⌕ Search

Biomedical subjects

T G Vancaillie

Publications and source records attributed to T G Vancaillie.

At least 19 recordsLinked to original sources
PubMed2003

Mechanical properties of urogynecologic implant materials.

Synthetic suburethral slings have recently become popular despite the risk of erosion commonly associated with synthetic implants. Some of these materials seem to have unexpectedly low erosion rates. Based on the hypothesis that erosion is due, in part, to biomechanical properties, we undertook an in vitro study. The biomechanical properties of eight non-resorbable synthetic implant materials, stiffness (slope, N/mm) and peak load (N) were determined from load vs. displacement curves. Open-weave Prolene mesh showed unique biomechanical properties compared to other tested materials. The tension- free vaginal tape had the lowest initial stiffness (0.23 N/mm), i.e. low resistance to deformation at forces below the elastic limit, whereas the stiffest implant tested, a nylon tape, reached 6.83 N/mm. We concluded that the TVT and other wide-weave Prolene tapes have unique biomechanical characteristics. These properties may be at least partly responsible for the apparent clinical success of the implants.

Biocompatible Materials↗
PubMed2003

Levator function in nulliparous women.

Pelvic floor muscle exercises are one of the main conservative options for the treatment of female urinary incontinence. Despite this widespread use, there is very little information on 'normal' pelvic floor function. In a prospective observational study the authors intended to define the spectrum of normality for pelvic floor function in women, assessing 206 nulliparous women recruited early in their first ongoing pregnancy. Levator function was evaluated using translabial ultrasound: cranioventral displacement of the bladder neck was utilized to quantify levator activity. The presence of a reflex contraction of the external perineal muscles and levator on coughing was registered, as was the strongest of at least three contractions. Only 41 of 206 women (20%) had ever been taught pelvic floor exercises by a health professional, and this had been exclusively verbal. Teaching had no influence on levator strength. Spontaneous contractions on request were obtained in 172 women (85%). Advice was necessary in 96 women (47%) in order to obtain an optimal contraction. Reflex muscle activation on coughing was documented in 118 women (57%) and was associated with a stronger contraction (P<0.001). Reported use of the levator muscle on intercourse was strongly associated with increased levator activity (P<0.001). Motivational factors mentioned were boyfriends, mothers, other female relatives and, most commonly, articles in popular magazines, e.g. Cosmospolitan and Cleo.

Female↗
PubMed2002

Female pelvic organ prolapse and voiding function.

It is accepted that pelvic organ prolapse impairs voiding, in particular as regards the anterior vaginal wall. The influence of central and posterior prolapse is more controversial. Mechanical effects, i.e. urethral distortion and compression, have been advanced as causative mechanisms. This study attempts to further elucidate the effect of prolapse on voiding. We investigated 228 patients with symptoms of lower urinary tract dysfunction and/or prolapse using independent flowmetry, clinical and ICS prolapse assessment and translabial ultrasound. As expected, age ( P<0.001), previous hysterectomy ( P = 0.002) and/or incontinence surgery ( P<0.001) negatively influenced flow. As regards prolapse, only enterocele had a consistently negative effect on flow ( P<0.001 for clinical staging, P = 0.002 for ICS assessment, P = 0.005 for ultrasound imaging). The relationship between anterior vaginal wall prolapse and voiding was complex: funneling and opening of the retrovesical angle on ultrasound was associated with improved voiding ( P<0.001), but a cystocele with intact retrovesical angle had the opposite effect ( P<0.001).

Female↗
PubMed2002

The assessment of levator muscle strength: a validation of three ultrasound techniques.

Levator ani muscle function is traditionally evaluated by palpation or perioneometry. Recently, three different techniques of performing this task by translabial ultrasound have been described. The authors intended to validate these new methods by correlating results with assessments performed by perineometry and palpation. One hundred consecutive women were evaluated prospectively by a physiotherapist and a gynecologist. The physiotherapist undertook an assessment by palpation (Oxford grading) and perineometry (Peritron). The gynecologist performed translabial ultrasound. Both were blinded against each other's results. Correlations between ultrasound and palpation were between 0.52 and 0.62, with displacement of the bladder neck agreeing most closely with palpation. As regards perineometry, correlations were 0.38 to 0.52, and again bladder neck displacement agreed best with the physiotherapeutic assessment. All correlations were highly significant. It appears that the assessment of levator function by ultrasound correlates strongly with vaginal palpation of muscle strength and perineometry.

Adolescent↗
PubMed2002

Vaginal childbirth and bladder neck mobility.

OBJECTIVE: Hypermobility of the bladder base is a predictor of stress urinary incontinence (SUI) in the female and at least partly due to pregnancy and vaginal childbirth. The purpose of this study was to quantify the effect of vaginal parity and birthweight on anterior compartment relaxation. DESIGN: Retrospective observational study. SETTING: Outpatient uroynaecological clinics. POPULATION: Five hundred and seventy three women seen for primary urogynaecological assessment. METHODS: Files of patients seen by the first author for assessment and translabial ultrasound imaging at urogynaecological units in Brisbane and Sydney, Australia, were reviewed for routinely-collected obstetric data and imaging results. MAIN OUTCOME MEASURES: Ultrasound parameters of anterior vaginal wall descent such as urethral rotation on Valsalva manoeuvre, bladder neck position on Valsalva, bladder neck descent and maximal descent of a cystocele on Valsalva. RESULTS: ANOVA analysis demonstrated a highly significant relationship between vaginal childbirth and bladder neck position on Valsalva (p < 0.001), bladder neck descent (p = 0.002) and maximal descent of a cystocele (p = 0.001). A large part of this effect was seen after one vaginal delivery. There was a trend towards increased bladder neck mobility (p = 0.065) with vaginal operative deliveries. Maximal recorded birthweight did not correlate with parameters of hypermobility. CONCLUSION: Vaginal childbirth is strongly associated with increased anterior vaginal wall descent, with most of this effect being due to the first vaginal delivery.

Adolescent↗
PubMed2000

Changes in hemostatic mechanisms associated with operative laparoscopy.

A 19-year-old woman underwent laparoscopic resection of extensive endometriosis of the cul-de-sac. At completion of surgery the abdomen was deflated for 3 minutes with the patient still in Trendelenburg position, before she was reexamined for intraoperative bleeding. The patient was taken back to surgery 7 hours postoperatively to arrest hemorrhage.

Adult↗
PubMed2000

One-year results of the vesta system for endometrial ablation.

STUDY OBJECTIVE: To compare a distensible multielectrode balloon for endometrial ablation with electrosurgical ablation performed by a combined resection-coagulation technique. DESIGN: Randomized, prospective trial (Canadian Task Force classification I). Setting. Eight centers. PATIENTS: Women with menorrhagia validated with a standardized pictorial blood loss assessment chart (PBAC), without intracavitary organic uterine disease, who failed or poorly tolerated medical therapy. Intervention. Results in 122 patients treated by Vesta and 112 treated surgically, evaluable at 1 year, were compared, with success defined as monthly blood loss of less than 80 ml and avoidance of additional therapy. MEASUREMENTS AND MAIN RESULTS: Pretreatment PBAC scores for patients treated by Vesta and resection or rollerball were 535+/-612 and 445 +/- 313, respectively; at 1 year they were 18+/-37 and 28+/-60, respectively. With PBAC below 75 as the definition of success, 86.9% of Vesta-treated patients were successful compared with 83.0% treated by rollerball or resection. Total amenorrhea, defined as no visible bleeding and no use of protective products, was 31.1% and 34. 8%, respectively. None of the outcome comparisons between treatments showed statistical difference. Complications in both groups were few and minor. Most (86.6%) Vesta procedures were carried out with paracervical block with or without intravenous sedation in an office or outpatient setting, compared with 79.7% epidural or general anesthesia for rollerball or resection. CONCLUSION: The Vesta system of endometrial ablation is equally effective and safe as classic resectoscopic methods. Potential advantages include avoidance of fluid and electrolyte disturbance associated with intravasation of distending media, and ability to perform the procedure under local anesthesia in an office setting with less total operating time.

Adult↗
PubMed2000

Unrecognized bladder perforation during operative laparoscopy.

During operative laparoscopy in a 42-year-old woman, 12-mm trocar lacerations occurred through anterior and posterior walls of the bladder but were not recognized. This case demonstrates important issues related to predicting, avoiding, detecting, and treating bladder trauma associated with laparoscopic surgery. It also indicates that some classic warning signs of accidental cystotomy may be absent or delayed in appearance.

Adult↗
PubMed1999

Fluoroscopically guided hysteroscopic division of adhesions in severe Asherman syndrome.

BACKGROUND: Severe Asherman syndrome that is stage III disease according to the American Fertility Society, with obliteration of the uterine cavity and the inability to visualize isolated pockets of the intrauterine cavity, makes safe and effective hysteroscopic division of adhesions difficult, if not impossible. TECHNIQUE: A 16-gauge, 80-mm Tuohy needle is introduced into the endocervical canal alongside a 5-mm diagnostic hysteroscope. The surgeon probes the area beyond the adhesion with the needle. Ultravist 76.9% is injected through the needle under fluoroscopic and hysteroscopic control. Hidden pockets of endometrium can be located radiographically, a passageway is created using the needle, and subsequent division of adhesions is performed under direct vision with hysteroscopic scissors. EXPERIENCE: Since 1984, approximately 55 women with severe Asherman syndrome have undergone this procedure. All patients required at least two procedures, and one woman required six. There have been two cases of uneventful perforation with the Tuohy needle, and all women resumed menstruation. No serious complications have occurred. CONCLUSION: This technique provides an intraoperative fluoroscopic view of pockets of endometrium behind an otherwise blind-ending endocervical canal in women with severe Asherman syndrome, allowing guided division of adhesions and reducing the likelihood of perforation and formation of false passageways.

Female↗
PubMed1999

Interim results of the American Vesta trial of endometrial ablation.

STUDY OBJECTIVE: To compare results of endometrial ablation using the Vesta system compared with resection and rollerball. DESIGN: Multicenter, prospective, randomized, controlled study (Canadian Task Force classification I). SETTING: Private practice and academic center. PATIENTS: Women with menorrhagia documented by menstrual diaries who failed or refused hormonal therapy and who had no major uterine organic lesions. INTERVENTIONS: Vesta endometrial ablation or traditional endometrial resection and rollerball ablation. MEASUREMENTS AND MAIN RESULTS: Both groups achieved excellent control of menorrhagia. CONCLUSION: Vesta is an attractive alternative to traditional methods of endometrial ablation. (J Am Assoc Gynecol Laparosc 6(1):45-49, 1999)

Adult↗
PubMed1998

Active electrode monitoring. How to prevent unintentional thermal injury associated with monopolar electrosurgery at laparoscopy.

BACKGROUND: In recent years, the use of minimally invasive surgery (MIS) has expanded to a wide variety of surgical specialties. The increased popularity of the procedure, however, has been accompanied by its share of complications, including trocar lacerations and inadvertent thermal injuries to nontargeted tissues during monopolar electrosurgery. METHODS: A survey on electrosurgical thermal injuries and three case studies are presented. The new technology of active electrode monitoring (AEM) is described. RESULTS: AEM eliminates stray currents generated by insulation failure and capacitive coupling. CONCLUSIONS: To reduce the incidence of injury by monopolar electrosurgery at laparoscopy, there is a need for advanced technology, such as AEM. In addition, laparoscopic surgeons should be encouraged to study the basic concepts of the biophysics of electrosurgery.

Adult↗
PubMed1998

Complications of fluid overload from resectoscopic surgery.

Excess absorption of liquid distending media is one of the most frequent complications of operative hysteroscopy. Although most women recover uneventfully, we are seeing cases of permanent morbidity or death resulting from this complication.

Female↗
PubMed1997

Laparoscopic colposuspension and pelvic floor repair.

True progress was achieved when the laparoscope was first used to explore the extraperitoneal space. Up to 25 reports on laparoscopic bladder neck surgery have been published in the past five years, and a few present prospective data. Laparoscopic surgery for the other aspects of pelvic floor reconstruction is still only timidly mentioned and in the case study stage.

Colposcopy↗
PubMed1996

Diagnosis and management of serious urinary complications after major operative laparoscopy.

OBJECTIVE: To evaluate the incidence, diagnosis, and management of serious urinary complications after major operative laparoscopy. METHODS: For this retrospective study of 953 consecutive cases of major operative laparoscopy from January 1, 1990, to December 31, 1994, we reviewed incidence, method of diagnosis, and management of complications. Urinary complications included bladder injuries, urinary fistulas, and ureteral injuries. Major operative laparoscopic procedures included hysterectomy, adnexectomy, treatment of tubal pregnancy, ovarian cystectomy, and ablation-fulguration of severe endometriosis (stage IV). RESULTS: Serious urinary complications were found during or after operative laparoscopy in 15 of 953 patients (1.6%, 95% confidence interval [CI] 0.8-2.4). Four ureteral injuries, three bladder fistulas, and eight bladder perforations were documented in this series. Eight cases of urinary complications were recognized during the original surgery (one ureteral injury and seven bladder injuries) and repaired at that time. Laparotomy or additional major surgery was performed in seven patients (three ureteral injuries, two bladder fistulas, and two bladder perforations). CONCLUSIONS: Serious urinary complications after major operative laparoscopy were discovered in 1.6% of patients. This incidence compares favorably to serious urinary complications after standard gynecologic surgery. Intraoperative recognition of these complications will likely avoid additional surgery.

Adolescent↗
PubMed1996

Endometrial ablation using a distensible multielectrode balloon.

The VestaBlate system uses a multielectrode intrauterine balloon as a device to create effective and safe endometrial ablation (EA). The surface of the distensible balloon is impregnated with thermistors and thin, platelike electrodes. It is designed to deliver low-power electroenergy to the endometrium. Unlike the resectoscope techniques that require nonelectrolytic fluids for uterine distention, moving electrodes at high power outputs, and other variables that are operator dependent, the VestaBlate is computer controlled using a standard type electrosurgical generator. A respiratory enzyme stain, nitroblue tetrazoleum, was used to determine the extent and depth of tissue necrosis to a myometrial depth of 2 to 4 mm with uniform destruction of tissue with power setting at 45 W for a 4-minute application of energy. Sixty-nine patients have been treated, with 45 followed for at least 3 to 9 months. The amenorrhea rate is 40%; the oligomenorhea-hypomenorrhea rate is 49%.

Electrodes↗
PubMed1996

Complications of major operative laparoscopy. A review of 452 cases.

OBJECTIVE: To evaluate complications of operative laparoscopy. STUDY DESIGN: Operative and postoperative complications in 452 consecutive cases from January 1, 1991, to August 31, 1993, were evaluated. The series was divided into three time segments--8, 12 and 12 months. Common and serious complications were classified and reviewed. RESULTS: Complications developed during and after major operative laparoscopy in 47 (10.4%) patients in the series; 24 (5.3% of cases, or 51% of total complications) were serious, such as hemorrhage, ureteral injuries and fistulas, and intestinal obstruction. Seventeen (3.8%) patients required unplanned surgery for management of complications. During the initial learning period of eight months, the rate of complications averaged 17.3%, decreasing to 7.7% and 10.1%, respectively, in the second and third periods in the series. There were no cases of death, postoperative ileus, thrombophlebitis or pulmonary complications. CONCLUSION: The overall incidence of complications in major operative laparoscopy was 10.4%. Serious complications accounted for half the complications. Surgical experience reduced the incidence of complications. Ovarian cystectomy produced the lowest rate of common complications and no serious ones. Laparoscopically assisted vaginal hysterectomy had the highest rate of serious complications.

Dysmenorrhea↗
PubMed1993

Laparoscopic approach to the seminal vesicles.

The seminal vesicles can be approached laparoscopically and completely dissected free via the rectovesical cul-de-sac. This approach may be helpful during a perineal prostatectomy or when treating primary seminal vesicle pathological conditions.

Humans↗