Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Vaginal Approach”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 271 records · Page 15Linked to original sources
PubMed1998

An analysis of approaches to the management of endometrial cancer in North America: a CTF study.

OBJECTIVE: The aim of this study was to define the clinical-therapeutical approach to endometrial cancer now being followed in some of the most important centers of reference for gynecological cancer in North America by means of a questionnaire. STUDY DESIGN: The questionnaire focused on four principal areas: (1) surgical staging and therapy; (2) adjuvant treatment; (3) treatment modifications; and (4) management of advanced stages (FIGO III-IV). RESULTS: There were 48 evaluable responses (77%) received by the end of December 1994 which were considered for this analysis. Lymphadenectomy is utilized routinely in 26/48 centers (54.2%) and in selective clinical-pathological conditions in another 21/48 centers (43.5%). In the majority of centers (31/48; 64.6%) radical surgery is utilized for selected indications such as cervical involvement. Only 3/48 (6.2%) centers consider the vaginal approach totally inappropriate. The great majority (40/48; 83.3%) of the centers considered postsurgical adjuvant therapy to be necessary in FIGO Stage Ic. Brachytherapy is routinely performed in 3 centers (6.2%) in postsurgical management of Stage I endometrial cancer, while the majority of the centers (31/48; 64.6%) perform brachytherapy of the vaginal vault in certain clinical-pathological conditions. A wide variety of treatments are used for advanced stages (FIGO III-IV). CONCLUSIONS: It emerges that some controversial aspects exist on endometrial cancer treatment, and these conflicting data need a large-scale multicenter randomized clinical trial.

Adult↗
PubMed1989

[Endosonography in early pregnancy].

Vaginal sonography has brought tremendous advantages in the diagnosis of early pregnancy both for the patient and the physician. In the first place it is easier to perform than abdominal sonography, since a filled bladder is not a prerequisite for the examination. Secondly, the intrauterine location of the pregnancy can be diagnosed as early as the 37th day of gestation. Thirdly, diagnosis of a disturbed intrauterine or an extrauterine pregnancy is possible earlier than with the abdominal approach. Vaginal sonography thus frequently reduces the period of anxious waiting for the patient and, where necessary, enables the physician to operate early with the least possible traumatization.

Adult↗
PubMed1996

Adelaide Laparoscopic Hysterectomy Audit

After anecdotal reports of significant complications with laparoscopic hysterectomy, the Royal Australian College of Obstetricians and Gynaecologists, South Australian branch, instituted the Adelaide laparoscopic hysterectomy audit. All 760 cases performed in the city of Adelaide (population 1 million) from commencement in 1991 to 1994 were analyzed with specific attention to major complications such as hemorrhage, hematoma, laparotomy rates, and urinary tract injuries. Potential bias was carefully avoided by auditing independent of the surgeons involved. Eighty-nine percent of cases were performed with disposable endoscopic surgical staples. Surgical technique was a combined laparoscopic and vaginal approach. Mean operating time was 129 minutes, mean estimated blood loss was 263 ml, and average hospital stay was 4.9 days. Significant hemorrhagic complications occurred in 3% of women. Hematoma formation requiring reintervention was reported at 3.3%, with an overall laparotomy rate of 5.3%. Urinary tract injury overall totaled 2.4%, consisting of bladder laceration 0.9%, ureteric laceration 0.5%, and late diagnosis 1.1%. Hemorrhage, hematoma, and laparotomy rates were higher than published data suggest but compared favorably with appropriate abdominal and vaginal hysterectomy complication series. However, urinary tract injuries were significantly elevated in comparison with published data, raising the questions of learning curve and experience as factors.

Journal Article↗
PubMed2003

The management of old urethral injury in young girls: analysis of 44 cases.

BACKGROUND/PURPOSE: Traumatic urethral injury in girls is rare, and there is no consensus on its management. The authors report their 22-year experience. METHODS: Forty girls presented with urethrovaginal fistula. Twenty-six girls presented with cystostomy tube in place, whereas 17 girls presented with complete urinary incontinence. Incision and dilatation of the obliterated urethra was carried out in 7 patients. Vaginal repair of urethrovaginal fistula was performed in 4 patients. Transpubic reconstruction of the urethra using a modified Young-Dees-Leadbetter procedure with simultaneous repair of the urethrovaginal fistula was performed in 35 patients (once in 27, twice in 5, and 3 times in 3 patients). RESULTS: Follow-up in 40 girls averaged 3.5 years. Twenty-nine patients have regained normal urinary control, and 11 patients have mild stress urinary incontinence. Four patients were lost to follow-up. CONCLUSIONS: Simple dilation of the obliterated urethra can reestablish satisfactory urethral patency if the obliterated segment is short. The vaginal approach to urethrovaginal fistula may be successful in patients without concomitant urethral stricture or in those with stricture amenable to simple dilation. The transpubic approach remains the method of choice for repairing complete urethral disruption and severe urethral stricture, especially when associated with urethrovaginal fistula.

Adolescent↗
PubMed2006

[Use of prosthetic materials in reconstructive pelvic floor surgery. An evidence-based analysis].

Many surgical procedures for the repair of pelvic organ prolapse are used nowadays. Reconstructive pelvic surgery continues to evolve while surgeons continue to search the definitive surgical cure and have to choose the most appropriate procedures for their patients. Concerning the vaginal approach procedures, there is an increasing interest in the use of synthetic meshes which are at present widely used for surgical repair of pelvic organ prolapse. Prosthetic repair seems to be more reliable, especially when native tissues are of poor quality. The use of synthetic meshes may also simplify surgical procedures and reduce operative duration and morbidity. Material must be inert, permanent and resistant to infection. Based on authors' and other researchers' published experimental and clinical experience, polypropylene is assumed to be the most appropriate material for the vaginal repair of pelvic organ prolapse. However, since no standardized outcome measure is available, it is difficult to compare the results of surgical procedures. Only in recent studies, the subjective cure rates (patient satisfaction and outcome) have been assessed as well as the objective cure rates determined by the investigators. The subjective cure rate is probably more influenced by the functional outcome and sexual activity than by the anatomical result. Continuous evaluation is necessary to study replacement synthetic materials which should improve the rate of prolapse recurrence and reduce the risk of complications. Randomized controlled trials are required to determine which surgical procedures and type of prosthesis are most suitable. This review evaluates the properties of prosthetic materials, their complications and the most common procedures involved in the use of meshes for pelvic reconstructive surgery.

Evidence-Based Medicine↗
PubMed1998

Laparoscopic assistance for extended radicality of radical vaginal hysterectomy: description of a technique.

OBJECTIVE: We developed and standardized a surgical technique, which allows radical hysterectomy by a combined laparoscopic and vaginal approach with radicalness equivalent to a type III procedure according to Rutledge. METHOD: Thirty-six consecutive patients with cervical cancer stage IB1-IIIA with high risk for parametrial involvement were treated between May 1996 and March 1998. RESULTS: Bilateral para-aortic and pelvic lymphadenectomy and resection of the cardinal ligaments was performed laparoscopically using bipolar coagulation. Dissection of the ureters and resection of bladder pillars and uterosacral ligaments was performed transvaginally. On average 6.5 cm of cardinal ligament could be removed per side. CONCLUSIONS: With the laparoscopic-vaginal technique described a radical hysterectomy type III can be performed.

Adenocarcinoma↗
PubMed1988

Trachelectomy: a review of fifty-five cases.

A retrospective chart review was performed on all patients undergoing trachelectomy in the Roanoke Valley between January 1, 1975 and April 30, 1987. During this period a total of 55 trachelectomies were performed. Fifty-three of the 55 trachelectomies (96%) were performed by the vaginal approach. Forty-seven of the 55 patients (85%) had symptomatic genital prolapse as an indication for trachelectomy. Only seven of the patients had trachelectomy performed as a lone surgical procedure, whereas 48 of the 55 patients (87%) had additional surgical procedures performed at the time of trachelectomy. The most frequently performed concomitant operation was anterior and posterior colporrhaphy. Trachelectomy is an operation that should be performed only when clear indications exist and not on a prophylactic basis. With the use of sound surgical technique, trachelectomy can be performed with very acceptable morbidity. A technique for vaginal trachelectomy is described.

Adult↗
PubMed2000

A report on more than 10,000 vaginal hysterectomies performed without ligation of the paracervical ligaments.

OBJECTIVE: To review 10,016 cases of total vaginal hysterectomy (TVH) performed in our department by a method without ligation of the paracervical ligaments. METHODS: From 1955 to 1997, a total of 10,016 TVHs without ligation of the paracervical ligaments were performed at the Department of Obstetrics and Gynecology, Sapporo Medical University Hospital. RESULTS: Of all 22,509 gynecological operations, 44.5% were TVHs, and 8.7% were total abdominal hysterectomies (TAHs). The operative time of our TVHs ranged from 31-60 minutes in 44.1% of the cases, and from 61-90 minutes in 35.3% of the cases. Blood loss was less than 300 ml in 85% of the cases. Abdominal conversion from the vaginal approach occurred in 110 cases (1%). Operative complications also occurred only in 0.7% (69) of the cases. CONCLUSION: TVH without ligation of the paracervical ligaments is a safe and convenient method that has very few complications and that can be utilized by many gynecologists.

Blood Loss, Surgical↗
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↗
PubMedDate not supplied

[Urethrocystopexy with bone anchors: technical modification].

OBJECTIVE: To communicate a technical modification of urethrocystopexy which consist in the suspension of the urethropelvic ligaments to the posterior pubic bone with using bone fixations inserted with the In-Fast system. MATERIAL AND METHODS: Between August 2000 and January 2001, thirteen patients with an mean age of 56.1 years were operated with this technic. Using a transvaginal approach and after great opening of the endopelvic fascia we insert one fixation screw in each side of the symphisis pubic bone, later we give two or three stitches to the urethropelvic ligament with the polypropylene no. 1 suture that each screw have joined to their end. RESULTS: The mean stay has been 5.1 days. The cystostomy has been remained for a mean of the 10.1 days. We didn't observe any complication neither intra nor postoperatives. With a mean follow-up of 5.3 months all the patients present a disappearance of their stress incontinence. CONCLUSIONS: Lack of confirm with a larger following and more cases, the suspension of the urethropelvisc ligaments with screw fixations directly situated into the pubic bone per vaginal approach, has been a simple method, safe and highly comfortable for the patients.

Female↗
PubMed1991

Detection of retained products of conception following spontaneous abortion in the first trimester.

A retrospective analysis was performed to determine whether ultrasound could reliably rule in or out retained products of conception (POC) in women after first-trimester spontaneous abortions (miscarriages). Ninety-seven first-trimester pregnancies with pathologically proven results from dilatation and curettage (D&C) were studied within 7 days of ultrasound examination (60% within 2 days), either by the abdominal or a combination of abdominal and vaginal approaches. Cases were eliminated if there was clinical evidence of a spontaneous evacuation of POC during the interval between the ultrasound and the D&C. POC were diagnosed only if chorionic villi were evident pathologically. The pertinent ultrasound findings were related to the endometrium (thickness, echogenicity, a gestational saclike structure or a space-occupying collection). The results indicated that ultrasound could correctly diagnose POC in all of the cases by detecting a gestational sac or collection (77 cases), or a thickened endometrium of greater than 5 mm (6 cases). Ultrasound was less reliable in ruling out retained POC. When only a thin endometrial stripe of less than 2 mm was present, there was little likelihood of having POC (1 of 7 cases) with a moderately thick endometrium of 2 to 5 mm not diagnostic. Vaginal ultrasound added little new information and failed to change the ultrasound interpretation.

Abortion, Incomplete↗
PubMed2004

[Value of the transgluteal approach under CT-guidance for percutaneous interventional image guided procedures].

PURPOSE: To assess the CT-guided transgluteal approach for percutaneous interventional image guided procedures. MATERIALS AND METHODS: CT guided transgluteal approach through the greater sciatic foramen was used for diagnostic procedure (CT guided needle biopsy of presacral masses n=5) or percutaneous treatment (aspiration n=4, and drainage n=10) in 19 patients, mean age 58 years (age range 20-86). RESULTS: No technical failure occurred. A histological diagnostic was obtained in all diagnostic procedures. The success rate for therapeutic procedures was 87% and allowed to postpone surgery in 2 cases. In 2 patients a small pelvic hematoma occurred after catheter placement, but remained without consequence. Recurrences of collection occurred in 2 cases, one treated medically and the other surgically. Two patients suffered from transient deep pelvic pain, which resolved after catheter removal. CONCLUSION: CT-guided percutaneous transgluteal procedures may be successfully performed in patients who cannot undergo trans-perineal, trans-rectal or trans-vaginal approach and is a safe and effective diagnostic and therapeutic option.

Abdominal Abscess↗
PubMed2002

Modified radical vaginal hysterectomy with or without laparoscopic nerve-sparing dissection: a comparative study.

OBJECTIVE: Nerve-sparing dissection of the lateral portion of the cardinal ligament (paracervical lymphadenectomy) has been recently developed with the goal of reducing the late urinary adverse effects of radical hysterectomy without impairing the outcome. This work has been carried out in order to investigate the influence of additional paracervical lymph node dissection at the time of laparoscopically assisted modified radical hysterectomy on outcome and urinary sequelae. METHODS: A total of 95 patients underwent a modified radical hysterectomy using a combined laparoscopic and vaginal approach since 1991. In 47 of these patients treated since 1996 an additional laparoscopic paracervical lymphadenectomy was performed. The operative, postoperative, and survival outcomes were assessed. In 60 patients, 32 and 28 in the groups of patients with or without paracervical dissection, respectively, a careful interview on urinary symptoms was conducted by an independent investigator. RESULTS: Paracervical dissection involves no operative complication and lenghthens the postoperative urinary retention, but has no adverse influence on long-term urinary discomfort. The yield of paracervical dissection is negligible for small tumors: no positive node was found in 38 patients with tumors less than 2 cm in diameter. The outcome of patients after minimal access surgery for tumors less than 2 cm is excellent whether or not a paracervical dissection has been performed. CONCLUSION: Paracervical dissection does not worsen the late urinary symptoms after vaginal radical hysterectomy. It has a limited value in the surgical management of small-size (less than 2 cm) cervical cancers, although it may prevent long-term lateropelvic recurrences.

Female↗
PubMed2003

[Treatment of vesicovaginal fistulas using the musculofascial flap of the levator ani muscle: 26 case reports].

OBJECTIVE: The authors reported the preliminary results of levator ani muscle flap in the treatment of vesicovaginal fistula. MATERIALS AND METHODS: Twenty-six patients whose age varied between 13 and 18 years (mean: 30 years) are selected. All the patients are treated by the vaginal approach using the part of superficial rectal fibers of the levator ani muscle. RESULTS: Among the 26 patients, 14 are free after the first cure of vesicovaginal fistula (54%), and 4 patients (15%), after the treatment of some complications. CONCLUSION: The musculofascial levator ani flap with its vascular pedicle and its mobilisation can successfully close the vesicovaginal fistula. The preliminary results obtained (88%) tie up with that previously described in the literature.

Adolescent↗
PubMedDate not supplied

Surgical treatment of low stage cervical carcinoma: back to the old days?

Radical hysterectomies for the treatment of cervical carcinoma are being performed laparoscopically by some surgeons. Others combine the laparoscopic lymphadenectomy with a radical vaginal hysterectomy or a radical trachelectomy, like in the Schauta procedure. In this way the procedure resembles the AVRUEL-procedure (Abdominal Vaginal Radical Uterus Extirpation with transperitoneal Lymphadenectomy), as developed in 1957 by Sindram who combined the Wertheim and the Schauta procedure together with abdominal lymphadenectomy in one single operation. Because of the high complication rate in the form of voiding problems and sexual impairment caused by the Schauta part, this operation is no longer performed. In order to pay attention to the morbidity associated in the past with the combined abdomino-vaginal approach compared to the single abdominal approach, we reassembled the data of several large Dutch centers where patients were treated either by the AVRUEL or the abdominal radical hysterectomy. A total of 730 patients underwent an AVRUEL procedure, all carried out between 1957 and 1981. Fistulas occurred in 57 patients (7.8%), long-term urologic complications in 233 patients (32%), and sexual dysfunction in 71 (9.7%) were found. A total of 928 patients underwent an abdominal radical hysterectomy, of whom in 511 cases the complication rates have been described. Twelve fistulas occurred (2%), long-term micturition problems in 55 (10%), and sexual problems in 11 (2%). There was no difference in 5-year survival rates in both groups. From the above-mentioned data it is clear, that returning to the old days in terms of a re-introduction of the Schauta procedure is not to be preferred. In order to conclude if the laparoscopically assisted radical vaginal hysterectomy or the trachelectomy are an improvement, they should be carried out according to clearly defined prospective protocols in which data can be compared to those of other techniques with special attention to late complications including micturition and sexual sequelae.

Adult↗
PubMed1995

Validity of indications for transabdominal cervicoisthmic cerclage for cervical incompetence.

OBJECTIVE: Our purpose was to review the indications for transabdominal cervicoisthmic cerclage to determine whether it is a valid alternative to transvaginal cerclage. STUDY DESIGN: A retrospective review of transabdominal cerclage patients at one institution from 1978 to 1994, analysis of the indications for the transabdominal rather than the vaginal approach, and evaluation of fetal outcomes was performed. RESULTS: Twenty-three patients underwent 24 transabdominal cerclages. The primary indication for transabdominal cervicoisthmic cerclage was failed transvaginal cerclage in 14 patients and anatomic unsuitability for transvaginal cerclage in nine. Of the latter, five were a result of diethylstilbestrol exposure and four a result of cervical surgery. All patients were successfully delivered of one or more live babies (total 28, including two sets of twins). Two losses occurred, one after rupture of membranes at 21 weeks on the second pregnancy after cerclage placement and one intraoperative loss with herniation of the membranes. The live birth rate was 93%, compared with 18% salvage of pregnancies beyond the first trimester before the transabdominal cervicoisthmic cerclage procedure. Complications included blood loss requiring transfusion (four patients), although none of these occurred in the last 12 patients. CONCLUSION: We conclude that all the patients had a history compatible with incompetent cervix requiring a cerclage, and none were suitable candidates for a vaginal cerclage. We further conclude that with strict indications transabdominal cervicoisthmic cerclage offers a high rate of fetal salvage with a minimum of complications in patients with extremely poor obstetric histories because of cervical incompetence.

Abdomen↗
PubMed1996

The problem of post-partum fistulas in developing countries.

Postpartum fistulas are frequent in the tropical environment. They are mostly found in very young women who live in remote areas. Without treatment women with fistulas will be condemned to the disconsolate life of social outcasts. Good operative treatment is crucial. The different operative methods are discussed. The operation through vaginal approach can be performed in any hospital. It does not need special surgical skill. More important than surgery is prevention of postpartum fistulas through a well-organised primary health care program which reaches out into the villages and which includes adequate prenatal controls and competent midwifery.

Adolescent↗
PubMed2000

[Laparoscopic sacral colpopexy: short-term results and complications in 83 patients].

We retrospectively studied 77 laparoscopic sacral colpopexies performed from June 1996 to May 1998. Suspension was reinforced with two strips of synthetic mesh. Five patients had previously undergone hysterectomy and 4 others had experienced failure of surgery for prolapse of the uterus. Laparoscopy was performed in 83 women with symptomatic prolapse of the uterus. Six cases required conversion to laparotomy because of technical difficulties. All other 77 patients underwent laparoscopic sacropexy using anterior and posterior mesh reinforcement. Subtotal laparoscopic hysterectomy was associated in 60 cases, laparoscopic Burch colposuspension in 74 and levator myorraphy using the vaginal approach in 55. Operative time decreased from 292 to 180 minutes as the surgeon gained experience. The main operative complications were one rectal and two bladder injuries. Three patients required reoperations for haematoma or hemorrhage. One patient complained of chronic inflammation of the cervix and another experienced rejection of the posterior mesh 6 months after the operation. Mean follow up was 343 days. Three other patients required reoperation: one for a 3(rd) degree cystocele and two for recurrent stress incontinence. The conclusion of this study is that laparoscopic sacrocolpopexy is feasible. Operative time and postoperative complications are related to the surgeon's experience but remain comparable to those noted in laparotomy. Long term assessment is required to confirm the results of this procedure.

Adult↗