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At least 199 records · Page 11Linked to original sources
PubMed1992

Combined laparoscopic and vaginal surgery for the management of two cases of stage I endometrial cancer.

Two postmenopausal patients with stage I adenocarcinoma of the endometrium who were managed with a combined laparoscopic and vaginal approach are presented. Surgical-pathologic staging was performed laparoscopically, with exploration of the abdomen and procurement of peritoneal cytology and pelvic and para-aortic lymph nodes. The adnexa were ligated and mobilized laparoscopically and removed with the vaginal hysterectomy. This approach offers decreased morbidity to the patient yet still obtains the same pathologic information and surgical goal as the traditional transabdominal approach.

Adenocarcinoma↗
PubMed1983

Surgical procedures for carcinoma of the rectum. A historical review.

A review of the development of surgical procedures for the treatment of carcinoma of the rectum is presented. There have been very few truly new techniques offered in recent years; instead many of the older methods have been revived. This brief review of some of the important contributions made in this field may be of interest to today's surgeons. This discussion will concern the various approaches including perineal, abdominoperineal, abdominal, sacral, abdominosacral, abdominoanal, and vaginal approaches and local resections.

Abdomen↗
PubMed1981

Modified Pereyra procedure for stress incontinence.

Results of the modified Pereyra cystourethropexy for stress incontinence are presented. The technique prevents a suprapubic suture from entering the bladder because of a vaginal approach into the space of Retzius. The surgeon's vaginal finger guides the suprapubic needle as it passes through the rectus. Thus, a non-absorbable suture may be used and the urogenital diaphragm is brought superiorly to raise and to support the floor of the pelvis. Results are continence in 97 to 100 per cent of 30 women.

Adult↗
PubMed2006

Laparoscopic repair of vesicovaginal fistula.

Vesicovaginal fistula (VVF) may be a complication of prolonged repair or urogynecologic surgery. Failing conservative management, it may be repaired using an abdominal or vaginal approach. We herein report laparoscopic repair of VVF following vaginal hysterectomy and detail the operative steps.

Adult↗
PubMed1996

[Anterior vaginal wall and pelvic floor sling for stress incontinence].

There is considerable doubt as to whether the intra-abdominal position of the urethra is the critical factor in maintenance of continence. Recent studies have suggested that a firm, supportive, suburethral layer is required for urethral closure during effort. The surgical procedure we describe is performed by vaginal approach and involves creation of a sling from the vaginal wall and underlying musculofascial layer, that provides compression and support for the urethra and resuspends the bladder neck. 20 women (37-70 years, mean 48.4) with severe stress incontinence (average of 5 wet pads per day) underwent the sling procedure between October 1994 and July 1995. 10/20 had had previous pelvic surgery (6 anti-incontinence procedures and 4 hysterectomies). 3/20 had intrinsic sphincter dysfunction and the rest a hypermobile urethra. The surgical technique was easily performed. Postoperative complications were minimal, and included blood transfusion in 3 and in 5 suprapubic pain which subsided spontaneously or after oral diclofenac. The cystostomy was closed after 10.5 days (range 3-49) when voiding resumed and urine residual became less than 60 ml. The median follow-up was 9.4 months (range 3-12). All patients were cured and satisfied. 2/20 reported onset of urge incontinence which was found urodynamically to be de-novo detrusor instability due to urethral obstruction. On the other hand, all 3 patients with associated urge incontinence reported its disappearance postoperatively. These results are encouraging and this surgical procedure seems to provide a good solution for all types and grades of stress incontinence. Long-term follow-up is required to determine persistence of the good results.

Adult↗
PubMed1995

Anterior vaginal suspension for vaginal vault prolapse.

Vaginal prolapse may occur following hysterectomy or may evolve with the uterus in place. Current treatment options for vaginal prolapse have a limited success rate or are associated with significant morbidity. In this retrospective review, we present our experience with a new procedure for repair of vaginal prolapse. This technique relies on anterior suspension of the vaginal vault to the anterior rectus sheath in a fashion similar to bladder neck suspension. Forty patients have undergone this procedure. All patients had vaginal prolapse, cystocele, and urinary incontinence. In addition, 34 patients had enterocele, six had uterine prolapse, 33 had rectocele, and two had urethral diverticula. All patients had anterior vaginal suspension (AVS), with cystocele repair and bladder neck suspension. Six patients had vaginal hysterectomy, 34 had enterocele repair, 33 had rectocele repair, and two had urethral diverticulectomy. The mean hospital stay was 2.5 days (range, 1-7 days), and their mean follow-up was 30 months (range, 12-54 months). Thirty-six (90%) patients have excellent support of the vagina with no evidence of recurrent cystocele, enterocele, or rectocele. Four (10%) patients have recurrent enterocele. Thirty-three (82.5%) patients are dry or have rare episodes of urinary incontinence (less than one episode/month), whereas four (10%) patients have recurrent stress incontinence and three (7.5%) have urge incontinence. Constipation and fecal incontinence were resolved in all patients. All patients who were sexually active preoperatively remained so postoperatively, and none reported dyspareunea. Vaginogram in 10 patients demonstrated that posterior angulation of the vaginal axis was retained in all patients. AVS is associated with an excellent success rate in terms of resolution of symptoms and correction of prolapse. Morbidity is minimal, and hospital stay is short. The technique is simple and relies on anatomy that is familiar to all urologists. In addition, the vaginal approach allows for simultaneous correction of all components of vaginal prolapse and any associated vaginal pathology.

Adult↗
PubMed1994

Vesicovaginal fistulas: the transperitoneal repair revisited.

The experience in surgical repair of 18 complex vesicovaginal fistulas following abdominal hysterectomy is reviewed. The technique consisted in a transperitoneal approach and bivalving of the bladder. The fistulous tract was excised widely and the vagina closed transversely and the bladder longitudinally. In 10 patients, however, the bladder was closed in a Y-shaped fashion to avoid tension on the suture line. In 4 patients 5 ureters had to be reimplanted. There was one recurrence which was closed in a second attempt. For simple fistulas a simple vaginal approach is recommended. In complex fistulas including recurrences after vaginal repair a transperitoneal approach following the principles outlined will provide a high rate of success.

Adult↗
PubMed1996

Laparoscopic Burch Cystourethropexy Compared with the Transperitoneal and Extraperitoneal Approaches

Twenty transperitoneal and 20 extraperitoneal Burch procedures were compared. All women had preoperative multichannel urodynamics documenting true urinary stress incontinence (USI) and normal urethral closure pressures (>20 mm Hg). Those with mixed incontinence were treated medically without resolution before surgical intervention. If hysterectomy was indicated and could be performed vaginally, total vaginal hysterectomy, necessary vaginal repairs, and culdoplasties were performed first. The Burch was then performed with a balloon system to dissect the space of Retzius. If not amenable to a vaginal approach, laparoscopic-assisted vaginal hysterectomy, laparoscopic culdoplasties, and transperitoneal Burch were performed. In all cases the cystourethropexy was performed with one to two permanent sutures bilaterally in the periurethral fascia 1 to 2 cm from the urethra, then passed twice through Cooper's ligament. Operating time averaged 55 minutes less and hospital costs averaged $1855 less in the extraperitoneal group than in the transperitoneal group when similar procedures were performed. Length of hospitalization, complication rates, return to normal activity, and long-term success rates did not differ significantly between the groups. Two cases were converted to a transperitoneal approach after attempts at extraperitoneal access were unsuccessful. Currently, all patients remain continent, with follow-up ranging from 1 to 4.5 years. When feasible, the extraperitoneal approach to laparoscopic Burch cystourethropexy is an excellent alternative to transperitoneal laparoscopic Burch.

Journal Article↗
PubMed1994

Evaluation of surgical options in menorrhagia.

Total abdominal and vaginal hysterectomy has been the standard treatment for intractable and unmanageable menorrhagia for many years. However, in the last few years, hysteroscopic treatment of menorrhagia through surgical resection and/or ablation of the endometrial cavity has gained success. Over 625,000 hysterectomies are performed each year in the USA alone. More than 30% are done for menorrhagia as a primary diagnosis. Three times more hysterectomies are performed using the abdominal route than the vaginal approach. Morbidity is higher using the abdominal route alone. Complications of abdominal and vaginal hysterectomies will be briefly discussed. Menorrhagia caused by submucous fibroids can be treated hysteroscopically. A review of methods, complications, advantages and long-term follow up will be presented. Laparoscopically-assisted vaginal hysterectomy (LAVH) is the latest surgical option offered for menorrhagia. The advent of a hysteroscopic approach to the treatment of menorrhagia and careful analysis of the advantages and disadvantages of LAVH will be discussed.

Endoscopy↗
PubMed2005

Transvaginal mesh technique for pelvic organ prolapse repair: mesh exposure management and risk factors.

Prosthetic reinforcement in the surgical repair of pelvic prolapse by the vaginal approach is not devoid of tolerability-related problems such as vaginal erosion. The purposes of our study are to define the risk factors for exposure of the mesh material, to describe advances and to recommend a therapeutic strategy. Two hundred and seventy-seven patients undergoing surgery due to pelvic prolapse with transvaginal mesh technique were included in a continuous, retrospective study between January 2002 and December 2003. Thirty-four cases of mesh exposure were observed within the 2 months following surgery, which represents an incidence of 12.27%. All the patients were medically treated, nine of whom were found to have completely healed during the check-up performed at 2 months. In contrast, 25 patients required partial mesh exeresis. Risk factors of erosion were concomitant hysterectomy [OR = 5.17 (p = 10(-3))] and inverted T colpotomy [OR = 6.06 (p = 10(-2))]. Two technical guidelines can be defined from this study as regards the surgical procedure required in order to limit mesh exposure via the vaginal route. The uterus must be preserved, and the number and extent of colpotomies needed to insert the mesh must be limited.

Adult↗
PubMed2003

Laparoscopic suburethral sling procedure.

STUDY OBJECTIVE: To describe the technique of laparoscopic suburethral sling and discuss patient satisfaction and subjective continence rates over 7 years. DESIGN: Retrospective analysis (Canadian Task Force classification III). SETTING: Private practice. PATIENTS: Sixty-three consecutive patients. INTERVENTION: Laparoscopic sling procedure using either autologous or donor fascia. MEASUREMENTS AND MAIN RESULTS: The space of Retzius is entered laparoscopically. Then from a vaginal approach, a small midline vertical incision is made below the urethra, and vaginal epithelium is dissected off underlying periurethral and paravesical fascia. Material for the sling is passed underneath the urethra and secured laparoscopically to Cooper's ligaments bilaterally. Over 7 years, 63 laparoscopic suburethral sling procedures were performed. Overall, patients reported 88.9% satisfaction rate and 81.0% subjective continence rate. CONCLUSION: The laparoscopic approach is an acceptable alternative to other suburethral sling procedures.

Aged↗
PubMed2000

Vaginal pedicled flap for closure of vesicovaginal fistula.

A 22-year-old woman presented with chronic urinary tract infections and was found to have an ectopic ureter. Repair involved ligation of the distal ectopic ureter via a vaginal approach. She developed an iatrogenic vesicovaginal fistula which was repaired with a vaginal pedicled flap.

Adult↗
PubMed2001

Radical vaginal hysterectomy with extraperitoneal pelvic lymphadenectomy in cervical cancer.

OBJECTIVE: The aim of this work was to examine three types of radical vaginal hysterectomy with different degrees of radicality, performed in order to reduce surgical complications and sequelae in different indications, and to test the feasibility of a new simple and quick technique for extraperitoneal pelvic lymphadenectomy to be used in combination with radical vaginal hysterectomy for treatment of cervical cancer. In this way the advantages of vaginal surgery (e.g.: unnecessary general anaesthesia, reduced surgical trauma, applicability to obese and poor surgical risk patients, fast time-saving procedure) can be preserved. METHODS: We compared retrospectively the long-term results of radical vaginal and radical abdominal operations in a large series of stage IB-IIA cervical cancer patients treated at our institution in Florence from 1968 to 1983. Furthermore, we analysed the results of our experience from 1995 to 1998, when we performed extraperitoneal pelvic lymphadenectomy, followed by radical vaginal hysterectomy, on 48 patients affected by cervical cancer. Extraperitoneal pelvic lymphadenectomy was performed through two small abdominal incisions (6-7 cm). Twenty-two patients (45%) were obese (BMI>30 kg/m2) and 20 were poor surgical risks. FIGO stage was: IB1 in 18 cases, IB2 in eight, IIA in six, IIB in 12, IIIB in four. Neoadjuvant chemotherapy was given in 12 cases and preoperative irradiation was given in ten. General and regional anaesthesia were used in 30 (62.5%) and in 18 (37.5%) cases, respectively. RESULTS: As for past experience, in stage IB the five-year survival of 356 patients who underwent radical vaginal hysterectomy and that of 288 who had radical abdominal hysterectomy with pelvic lymphadenectomy were 81% and 75%, respectively (p<0.05). Surgical complications were fewer with no mortality in the first group. In stage IIA, survival rates were 68% for radical vaginal hysterectomy and 64% for radical abdominal hysterectomy, in 76 and 64 cases, respectively (p=n.s.). As for the more recent experience, median operative time for extraperitoneal pelvic lymphadenectomy was 20 minutes for each side (range 15-36). In each patient a median of 26 lymph nodes were removed (range 16-48). Positive nodes were found in 12 cases (25%). Median operative time for radical vaginal hysterectomy was 40 minutes (range 30-65). Extraperitoneal pelvic lymphadenectomy complications included: lymphocyst, five cases (10%) and retroperitoneal hematoma, one (2%); all occurred at the beginning of the experience. Radical vaginal hysterectomy complications included: ureteral stenosis, one (2%) and uretero-vaginal fistula, one (2%). All complications occurred in patients who received radiotherapy or chemotherapy preoperatively. Median hospital stay was ten days (range 6-20). CONCLUSIONS: The results of our work demonstrate that our technique for extraperitoneal pelvic lymphadenectomy shows a good applicability to cervical cancer patients submitted to radical vaginal hysterectomy, which has a high rate of cure for stage IB and IIA as shown by our past experience. The procedure of extraperitoneal pelvic lymphadenectomy was quick, easy, and safe, and its realization was not detrimental to the advantages of radical vaginal hysterectomy. Our experience supports the continued use of this combined extraperitoneal and vaginal approach in the treatment of cervical cancer. Moreover, the three classes of radical vaginal hysterectomy allow tailoring the type of the operation to the clinical and physical characteristics of the patients.

Adult↗
PubMedDate not supplied

[Methods of female sterilization].

The author gives a short review and the development of sterilization techniques. According to data from the literature and his limited experience, he concludes that to the Yugoslav population of women minilaparotomy with Pomeroy and Uchida occlusion techniques, as well as the laparoscopic approach with electrocoagulation or the application of clips and rings can be used. Vaginal approach should be reserved only for exceptional cases. Ljubljana.

Electrocoagulation↗
PubMed1993

Artificial urinary sphincter for recurrent/severe stress incontinence in women. Urogynecologic perspective.

Eight American Medical Systems 800 artificial urinary sphincters were implanted in seven women with severe and/or recurrent stress urinary incontinence. The surgical approach to urethral cuff implantation consisted of both abdominal and combined abdominal and vaginal approaches. Indications, preoperative evaluations, surgical technique and complications are discussed. Postoperative follow-up for 6-24 months showed all the patients to be completely continent subjectively and objectively. The artificial urinary sphincter is a viable option in these difficult cases of urinary incontinence.

Adult↗
PubMedDate not supplied

Cost-reducing protein production and delivery for sexually transmitted disease prevention.

Table 2 summarizes our two approaches: vaginal delivery of antibodies to immunize passively and edible microspheres for active immunization. These approaches have different roles in disease prevention in communities and each may be most useful for different kinds of diseases. The passive approach could easily be extended to lots of different sexually transmitted diseases by just changing the specificity of the antibody incorporated into the device. The active immunization approach requires more specific development steps for each particular type of disease. Detailed analysis of the cost-reduction potential of these approaches is not yet available, but estimates of the cost to manufacture these products can be made, based on the initial laboratory studies (Table 4). The results to date suggest that both products are feasible and that they could be manufactured as cheaply as other products (such as condoms and oral contraceptives) that people currently use for sexual health. All products, once made available, could have a significant impact on the reduction of healthcare costs.

Administration, Intravaginal↗
PubMed1975

Repair of vesicovaginal fistulas: simultaneous transvaginal-transvesical approach.

The records of 91 patients with vesicovaginal fistulas at the Ochsner Clinic between 1942 and 1974 were reviewed. The fistulas were managed in several ways: spontaneous closure, palliative operation, urinary diversion, transvesical repair, transvaginal repair, and a combined transvaginal-transvesical procedure. The latter had a 100% success rate in the eight patients in whom it was used. The technic of this procedure is described and the indications are expanded to include (1) large fistulas, (2) fistulas near the ureteral orifice, (3) if other abdominal or urologic surgery is being done, (4) if transvesical approach is being used, (5) previous failed attempts at correction, (6) difficulty of access by vaginal approach, and (7) fistulas resulting from transurethral resection of the bladder neck.

Adolescent↗
PubMed1997

[Comparative study of three alternative surgical techniques for hysterectomy].

In conjunction with the introduction of laparoscopic hysterectomy into wider clinical practice significant changes take place in the evaluation of medical and economic aspects of alternate surgical techniques. In the investigated group the advantages of a minimally invasive and vaginal approach in the evaluation of perioperative parameters and time of convalescence were confirmed. Laparoscopically assisted vaginal hysterectomy by the simple coagulation technique reduces considerably the costs of the operation. Costs can be markedly cut by reducing the number of days in hospital and by an earlier return to work. After systemic problems associated with funding of the health services will be resolved it will be useful to implement further extensive prospective studies. The results of these studies along with medical findings can participate in a significant way to an optimal ratio of different alternate surgical techniques of hysterectomy.

Convalescence↗