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Z Holub

Publications and source records attributed to Z Holub.

At least 37 records · Page 2Linked to original sources
PubMed2003

[Minimally invasive surgical treatment of symptomatic myomas using laparoscopic dissection of uterine vessels: prospective clinical study (part I)].

OBJECTIVE: To assess the clinical outcome, indication and operative technique of laparoscopic dissection of uterine vessels (LDUV) using ultrasonic technique in the treatment of symptomatic fibroids. DESIGN: Prospective case observational clinical study (Part I). SETTING: Department of Obstetrics and Gynecology, Hospital Kladno. METHODS: We analysed clinical outcome of laparoscopic dissection of uterine vessels in 46 symptomatic women with fibroids in the period 2000-2002. The operative technique and indication to surgery were studied especially in part I. RESULTS: All patients underwent successful LDUV procedure without intraoperative complications. Time of surgery ranged from 15-50 minutes (mean 37.3 minutes) in cases of LDUV only. In cases of laparoscopic dissection of uterine vessels combined with myomectomy the mean of surgery was 63.1 minutes (range 35-120). Mean blood loss was less than 25 ml and mean hospital preoperative stay 2.1 days. Only two minor febrile preoperative complications was found (4.3%). CONCLUSION: The procedure of laparoscopic dissection of uterine vessels can be completed within 25-35 minutes with minimal blood loss, short hospital stay and acceptable number of complications.

Adult↗
PubMed2003

Laparoscopically assisted modified radical vaginal hysterectomy (type II) with pelvic lymphadenectomy: ultrasonic operative technique.

OBJECTIVE: The aim of this study was to incorporate an ultrasonic operative laparoscopic technique to complete a type II laparoscopically-assisted modified radical vaginal hysterectomy (LARVH) and pelvic lymph node dissection (PLND) in early cervical cancer. METHODS AND MATERIALS: LARVH type II and PLND using a laparoscopic ultrasonic operative technique and conventional vaginal surgery were indicated in five cases of early cervical cancer (IA2). RESULTS: Complete pelvic lymphadenectomy and the laparoscopic phase of modified radical vaginal hysterectomy were successfully performed using ultrasonic instruments in all women. Uterine artery and ureteral dissection with resection of the cervicovesical fascia, cardinal and uterosacral ligaments were successful with ultrasonically activated instruments only. CONCLUSION: Our initial experience with laparoscopically assisted radical vaginal hysterectomy type II confirmed that the use of a minimally invasive ultrasonic technique is feasible. Further investigations into the indications of disease where laparoscopic surgery is appropriate in the management of early cervical carcinoma are required.

Adult↗
PubMed2002

Laparoscopic lymph node dissection using ultrasonically activated shears: comparison with electrosurgery.

PURPOSE: To assess and compare perioperative parameters in two groups of patients treated by different laparoscopic techniques of lymph node dissection (LND) for gynecologic cancer. PATIENTS AND METHODS: Between April 1996 and March 2001, 59 consecutive women with microinvasive cervical cancer (N = 5) or clinical stage I endometrial cancer (N = 54) underwent laparoscopic LND during a primary staging procedure using an electrosurgery (ELC) or ultrasonic (US) operative technique. The two groups were compared for perioperative outcomes. Differences between the two groups were determined by the Wilcoxon's rank-sum test. RESULTS: Laparoscopic LND and other staging procedures were completed successfully in 58 women (98.3%). There were no statistically significant differences between the groups with regard to perioperative outcomes (operation time, time for LND, blood loss, hospital stay, complications), but there was a significant difference (P = 0.0008) in the number of lymph nodes harvested: a mean of 13.7 in the ELC group and 17.5 in the US group. The pathologists found that the reading of histology slides was easier after US dissections because of the greater depth of thermal injury in the lymphatic tissue in ELC group. CONCLUSION: The US operative technique ensures efficient coagulation, cutting, dissection, and grasping for laparoscopic LND in patients with cervical and endometrial cancer.

Adult↗
PubMed2002

Comparison of two procedures for sentinel lymph node detection in patients with endometrial cancer: a pilot study.

OBJECTIVE: The purpose of this study was to assess the feasibility and contribution of two intraoperative procedures of lymphatic mapping and sentinel node detection using a blue dye in surgically-staged patients with early stage endometrial cancer. METHODS AND MATERIALS: In 25 cases of endometrial cancer, patent blue-V was injected into the subserosal myometrium (13 cases, SM group) or cervico-subserosal myometrium (12 cases, CSM group) during a surgical staging procedure. Laparoscopically-assisted vaginal hysterectomy and pelvic lymphadenectomy were completed successfully in 23 women out of 24 laparoscopically-staged patients (95.8%). One patient with FIGO stage IIa was indicated for a radical abdominal surgery. RESULTS: A deposition of the blue dye was found in at least one pelvic lymph node (LN) in eight out of 13 cases (61.5%) in the SM group compared with ten out of 12 cases (83.3%) in the CSM group (p = 0.378). The mean number of dye-colored LN (DCLN) was 1.15 (SM group) and 2.5 (CSM group), respectively (p = 0.05). The rate of DCLN/LN was 15/188 (SM group) versus 30/190. respectively (p = 0.03). An uptake of the blue bye was observed in a total of 45 out of 388 LN. CONCLUSION: An intraoperative combination of cervico-subserosal myometrium application of the blue dye allows successful detection (83.3%) of sentinel LN in patients with endometrial cancer. Comparing SM and CSM groups the statistical significant difference was found in the DCLN/LN rate and mean number of sentinel lymph nodes (p = 0.03, p = 0.05, respectively). Clinical validity of this surgical procedure must be assessed prospectively.

Aged↗
PubMed2002

Laparoscopic ultrasonic dissection of uterine vessels in women with benign uterine pathologies.

Uterine artery dissection is a new minimally invasive surgical technique used for the treatment of leiomyomas and adenomyomas. Three women underwent laparoscopically-assisted bilateral uterine dissection using ultrasonically activated shears. Surgery was uneventful, and patients were discharged on the second day after. Reduction in tumor volume measured by ultrasound was impressive (36%-68%), and the women felt their symptoms had improved. A larger series and longer follow-up are required to evaluate which patients will benefit from this technique. To our knowledge, this is the first report in the literature of origin uterine artery dissection in the area of the off-going part from the hypogastric artery using ultrasonically activated shears in symptomatic leiomyomas.

Adult↗
PubMed2002

Inflammatory response and tissue trauma in laparoscopic hysterectomy: comparison of electrosurgery and harmonic scalpel.

OBJECTIVE: Our aim was to quantify and compare clinical outcome and surgical inflammatory response and tissue trauma after laparoscopic hysterectomy for a benign disorder which was performed by electrosurgery or harmonic scalpel. METHODS: Sixty patients scheduled for laparoscopic hysterectomy were selected according to patient preference to undergo either electrosurgery or an ultrasonic operative technique. Blood samples for assay of markers of tissue trauma (C-reactive protein, interleukin-6, creatine kinase, white blood cell count) were taken preoperatively, on the first and third postoperative day. Three patients with intraoperative complications or incomplete records were excluded from tissue analysis. RESULTS: No differences were present in the demographic characteristics and clinical outcomes (blood loss, uterine weight, operating time and hospital stay) in 57 uncomplicated laparoscopic hysterectomies. Both electrosurgery (n = 36) and use of the harmonic scalpel (n = 21) resulted in statistically significant changes in the inflammatory and systemic immune response in comparison with preoperative values. No significant differences were observed in the studied inflammatory and tissue markers (C-reactive protein, interleukin-6, creatine kinase and white blood cells) between the compared groups. CONCLUSION: The harmonic scalpel and electrosurgery in laparoscopic hystsrectomy were equally traumatic in terms of surgical inflammatory response and tissue trauma.

Adult↗
PubMed2002

Impact of laparoscopic surgery on immune function.

OBJECTIVES: Endoscopic surgery, mostly studied during laparoscopic hysterectomy or cholecystectomy, has no important effects on classic endocrine responses when compared with similar open operations but may slightly reduce inflammatory responses and various immune functions. Preservation of both systemic and intraperitoneal immunity is particularly important in surgery for intra-abdominal sepsis or cancer and thus an understanding of the impact of laparoscopy on immune function is relevant. METHODS: Substantial recent studies on the topic of immune response in general and gynecologic surgery were identified from Medline. RESULTS AND DISCUSSION: The impact of laparoscopic surgery on the peri- and postoperative metabolic and systemic immune response is significantly less after laparoscopic hysterectomy or cholecystectomy than with an open approach. CONCLUSION: Laparoscopic surgery better preserves the postoperative immunological functions. However, prospective randomized studies are necessary to see whether these potential advantages can be employed in common clinical practice.

Cholecystectomy, Laparoscopic↗
PubMed2002

Laparoscopic surgery for endometrial cancer: long-term results of a multicentric study.

PURPOSE OF INVESTIGATION: Surgical treatment of endometrial cancer was traditionally done by laparotomy, however the laparoscopic approach has gained wider acceptance by gynecologic surgeons. The primary aim of the study was to report the perioperative and postoperative outcomes of laparoscopic surgery in a major group of patients with endometrial cancer. The second aim was to study the long-term results of laparoscopic surgery in patients with endometrial cancer. MATERIAL AND METHOD: A prospective multicentric study was conducted at three oncolaparoscopic centres; 221 women who had undergone laparoscopic (177 women) or abdominal (44 women) hysterectomy with bilateral salpingo-oophorectomy and lymphadenectomy were included in the study. Women with stage IA, grade I did not undergo lymphadenectomy unless they had a high risk histologic tumor type. Lymph node dissection was performed in 145 women with disease greater than IA or grades other than 1. RESULTS: The mean age and weight were similar in the compared laparoscopic and open groups. Perioperative blood loss was comparable in both groups (211.2 ml vs 245.7 ml, respectively) without any significant consecutive changes in serum hemoglobin values. Although the length of operating time for the laparoscopic surgery was significantly longer than the time for the laparotomy procedure (163.3 min vs 114.7 min, p < 0.0001), the laparoscopic patients were discharged from hospital much earlier at 3.9 days (range 2-16) after the laparoscopic procedure compared with 7.3 days (range 5-16) after the abdominal procedure (p < 0.0001). The difference in surgical complications between groups was statistically insignificant (p = 0.58). Similar long-term results were noted in both groups. With a median follow-up of 33.6 months for the laparoscopy group and 45.2 months for the open group, there were no significant differences in tumor recurrence (p = 0.99] or recurrence-free survival (p = 0.86) between the two groups. CONCLUSION: The study illustrates that laparoscopically assisted surgical staging of endometrial cancer is safe as an open procedure. The laparoscopic approach may also be considered for endometrial malignancy which typically occurs in obese and elderly, high-risk women. Our analysis showed no difference with respect to recurrence or survival between the compared laparoscopic and the open group.

Adenocarcinoma↗
PubMed2002

Clinical outcome, inflammatory response and tissue trauma in total laparoscopic hysterectomy: comparison to laparoscopically-assisted vaginal hysterectomy.

OBJECTIVE: Our aim was quantify and compare the clinical outcome and surgical inflammatory response and tissue trauma between the total laparoscopic hysterectomy (TLH) and laparoscopically-assisted vaginal hysterectomy (LAVH). DESIGN: Clinical study. SETTING: Departments of Gynaecology, Obstetrics and Biochemistry, Hospital Kladno, Department of Biochemistry, Faculty Hospital Motol-Prague. METHODS: Fifty-eight patients scheduled for laparoscopic hysterectomy were selected according patients or doctor preference to undergo either TLH or LAVH operative technique. Blood samples for assay of markers of tissue trauma (C-reactive protein, interleukin-6, creatine kinase, cortisol, cystatin C, serotonin and white blood cells count) were taken preoperatively, on the first and third postoperative day. One patient with intraoperative complication (ureteral injury) was excluded from tissue analysis. RESULTS: No differences were present in the demographic characteristics and clinical outcomes (blood loss, complications and hospital stay) in fifty seven laparoscopic hysterectomies. The statistically significant difference was found only in duration of surgery (70 min in TLH group vs. 90 min in LAVH group, P < 0.05). This difference can be related to difference in uterine specimen weight (185 g in TLH group vs. 289 g in LAVH group, P < 0.02). Both the LAVH (n = 37) and TLH (n = 20) resulted in statistically significant changes in the inflammatory and systemic immune response in comparison with preoperative value. No significant differences were observed in the studied inflammatory and tissue markers between the studied operative techniques of laparoscopic hysterectomy. CONCLUSION: The total laparoscopic hysterectomy and laparoscopically-assisted vaginal hysterectomy were equally traumatic in terms of surgical inflammatory response and tissue trauma.

Adult↗
PubMed2001

Laparoscopic staging of endometrial cancer using laparosonic instruments: comparison with electrosurgery.

OBJECTIVE: To compare perioperative parameters in two groups of women with different laparoscopic operative techniques in surgical staging of endometrial cancer (EC). STUDY DESIGN: Thirty randomly allocated and laparoscopically treated women with EC. Fifteen patients were operated by electrosurgery, 15 patients by laparosonic operative technique. Differences between the two groups were determined by the Wilcoxon rank-sum test. Probability (P) of less than 0.05 was considered significant. SETTING: Department of Gynecology and Obstetrics, Endoscopic Training Center, Baby Friendly Hospital, Kladno, Czech Republic. RESULTS: Laparoscopy was successfully completed in 29 patients. Laparoscopy-assisted surgical staging of EC was performed based on the tumor grade and the depth of myoinvasion. In both groups, in total 18 and 5 women underwent pelvic lymphadenectomy (PLN) and infra-aortic lymph node sampling (IALS), respectively. Three patients had metastases in pelvic lymph nodes. In the electrosurgical hemostasis and laparosonic group the mean total time required to finish the whole operative procedure were 132.1 and 138.3 min, respectively, with no statistically significant difference (P=0.96). There were no significant differences between the groups in any intraoperative or postoperative follow-up variables, except for the number of excised lymph nodes where the difference between electrosurgery and laparosonic group (12.7 versus 18) was statistically significant (P=0.05). In one patient with intraoperative venous bleeding the laparosonic hemostasis was ineffective (successful procedure rate 93.3%). One patient from the electrosurgery group was converted to laparotomy due to injury to the epigastric vessels. This complication had no connection with the surgical techniques studied. CONCLUSION: It is concluded that both operative technique variants in laparoscopy-assisted surgical staging appear to be feasible and effective for patients with EC.

Adenocarcinoma↗
PubMed2001

Laparoscopic hysterectomy in obese women: a clinical prospective study.

OBJECTIVE: To compare perioperative and postoperative outcomes of laparoscopic hysterectomy (LH) in surgical management of gynecological conditions in two groups of different weight. METHODS: A prospective comparative clinical study of 271 LH performed for disease of female pelvic organs in a group of 54 obese patients (over 30 body mass index (BMI)) and in a group of 217 non-obese patients (less than 30 BMI). The following criteria were assessed: patient characteristics, indications for surgery, previous surgery, presence of adhesions, duration of procedure, blood loss, weight of specimen, hospital stay and complications. Statistical analysis was performed using the unpaired t-test and non-parametric Chi-square test when appropriate, with a significance level of P=0.05. RESULTS: Three non-obese patients were converted to laparotomy due to operative complications. Laparoscopy in the remaining 268 patients (98.89%) was completed successfully. There was no significant difference in estimated blood loss, presence and degree of adhesions, weight of specimen, length of hospital stay and postoperative complications between women with high BMI and those with low BMI. The rate of major operative complications (5.55% versus 3.22%) was higher in the obese group. The duration of the operation was longer in obese women. However, the significance of the difference was borderline (P=0.06).

Adult↗
PubMed2001

Laparoscopically-assisted intraoperative lymphatic mapping in endometrial cancer: preliminary results.

OBJECTIVE: To analyse the results of a pilot study and determine the contribution of laparoscopically-assisted lymphatic mapping in patients with endometrial cancer. METHODS AND MATERIALS: In eight cases of early endometrial cancer, patent blue-V was injected laparoscopically into the uterine wall during a surgical staging procedure. RESULTS: A deposition of the blue dye was found in at least one pelvic lymph node in five of eight cases. Blue-colored nodes were observed in a total of 11 lymph nodes. Locations of these nodes included obturator, internal and common iliac sites. Only one blue colored node was positive for disease. An average of 15 lymph nodes were removed in the study group (range, 12-22). Uterine lymphatic vessels with bilateral drainage to the broad and infundibulopelvic ligaments were seen in all cases within 30-60 seconds. CONCLUSION: Our initial experience with laparoscopically-assisted lymphatic mapping confirmed that the use of a minimally invasive technique is feasible. Lymphatic channels in the pelvic areas were seen in every patient. A deposition of blue dye in laparoscopically identifiable lymph nodes was seen only in 62.5% of patients. However, we believe that the lymphatic mapping of the uterine corpus can improve the accuracy of surgical staging in patients with endometrial cancer.

Aged↗