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At least 127 records · Page 7Linked to original sources
PubMed2005

[Early prophylactic cervical cerclage for hypoplastic cervix following exposure to DES in utero].

AIM: Presentation of a prophylactic cerclage technique, placed in the beginning of second trimester of the pregnancy, derived from McDonald cerclage and adapted to hypoplastic cervix following exposure to DES in utero. MATERIALS AND METHODS: Prospective study including 20 pregnant patients exposed to DES in utero and presenting a hypoplastic cervix. Study of the location of the cerclage tape in the cervix and of changes in cervical length (before and after cerclage) assessed by physical examination of the cervix and by transvaginal ultrasonography. RESULTS: The cervix was longer after cerclage as shown by physical examination and by ultrasound. The tape was localized near the internal cervical os, its posterior portion nearer the internal cervical os than its anterior portion. CONCLUSION: This easy-to-perform technique of cerclage of hypoplastic cervix allows the tape to be localized near the internal cervical os without colpotomy and without use of the transabdominal approach, while allowing vaginal delivery.

Cerclage, Cervical↗
PubMed2005

[Prosthetic reinforcement by the vaginal approach after surgical repair of pelvic prolapse].

INTRODUCTION: Prosthetic reinforcement by the vaginal approach for surgical repair of pelvic prolapse is experiencing increasing popularity despite problems with tolerance. The most frequently described complication is prosthesis exposure, also known as erosion or granuloma. The mechanism is associated with defective vaginal healing and is independent of major infection such as pelvic cellulitis. OBJECTIVES: The purpose of our study was to define the course of this complication and the best therapeutic strategy for patients with prosthesis exposure. MATERIALS AND METHOD: Our continuous and retrospective study conducted over a period of 24 months between January 2002 and December 2003 recorded 34 files. These patients underwent prosthetic treatment via the vaginal approach of genital prolapse associated with prosthesis exposure. The procedure, known as TVM (Tension free Vaginal Mesh), involves the insertion without fixing of a synthetic prosthesis in areas of bladder-vagina and rectum-vagina detachment. RESULTS: In 33 cases out of 34, the exposure site was located on the anterior colpotomy scar (97%). These prosthesis exposures were managed in two stages, using antiseptic treatment first. This treatment cured 9 patients (26.47%). In the event of failure, a procedure was carried out under brief general anesthesia on an outpatient basis or during a 24-hour hospital stay. This single resection was sufficient for 20 patients (88%). Two patients nevertheless required a second removal procedure (8%) and one patient a third procedure (4%). To notice, one patient presented with a bladder-vagina fistula after resection. This observation of a bladder-vagina fistula following partial removal led us to recommend a blue test and/or cystoscopy as routine practice for each procedure. CONCLUSION: With this new vaginal approach for prolapse repair, it is important to monitor prosthesis exposure. To manage exposures, it is necessary to begin with antiseptic or estrogenic treatment. In the event of failure, a partial resection is warranted. We recommend careful prosthesis resection and systematic verification of the bladder.

Adult↗
PubMed2000

Dorsally recumbent female equine urogenital endoscopic surgery.

The ventral abdominal approach for laparoscopy is versatile. Reported techniques using a ventral approach in the mare include bilateral ovariectomy and granulosa cell tumor removal. Laparoscopic ovariectomy is performed by way of four instrument portals in the caudoventral aspect of the insufflated abdomen. The procedure has several advantages over the traditional approaches of colpotomy and celiotomy, including tension-free closure of all incisions and minimal invasiveness.

Animals↗
PubMed1995

Laparoscopic myomectomy and myolysis.

The indications for operative laparoscopy have increased greatly over the past decades as its many advantages over laparotomy have become recognized. Laparoscopic myomectomy as a technique is now clearly described. A monopolar hook is used for the uterine incision. After atraumatic enucleation of the myoma, myometrium and serosa are usually sutured particularly if the incision is deep or more than 2 cm long. Myomas can be removed by posterior colpotomy. However, the development of an electrical cutting device permits an easier and quicker removal of the myoma through the suprapubic puncture site. Only complicated myomas and/or those which give rise to persistent symptoms despite properly prescribed medical treatment, together with those which grow rapidly, require surgery. In our experience of ablation of myomas measuring 5 cm and over the results were satisfactory in all 71 patients with more than one year of follow-up. In two cases (2.7%) we were obliged to convert to laparotomy. We were confronted with no serious per-operative or post-operative complications. These satisfactory results must not mask the fact that the technique is lengthy and difficult and should be carried out by experienced surgeons thoroughly familiar with endoscopic sutures. Under these conditions, laparoscopic myomectomy is possible, for large myomas (5 cm and over) even if they are located completely intramurally. However, there are limits and it is preferable to use laparotomy for myomas measuring over 10 cm and for multiple myomectomy (over 3). Finally, the risk of causing adhesions and the quality of the uterine suture need to be assessed in the near future.

Adult↗
PubMed2003

Laparoscopic radical trachelectomy for stage Ib1 cervical cancer.

Radical trachelectomy by vaginal approach is an alternative for young women with early-stage cervical cancer. We modified this procedure to treat two patients with stage Ib1 cervical cancer. With 100% laparoscopic pelvic lymphadenectomy and 80% laparoscopic approach, the technique is laparoscopic radical trachelectomy (LRT). Under direct enhanced vision of the laparoscope, it is easy to identify and preserve ascending branches of the uterine arteries and to divide ligaments surrounding the cervix and vagina. Vaginal procedures require only colpotomy, amputation of cervix, dividing caudal paracolpium, and corpus-vagina anastomosis. Short-term follow-up results of our first patients are satisfactory. Thus, LRT could be a useful alternative for women with early cervical cancer who want to preserve fertility.

Adult↗
PubMed2003

Major complications associated with laparoscopic-assisted vaginal hysterectomy: ten-year experience.

STUDY OBJECTIVE: To describe our experience with major complications associated with laparoscopic-assisted vaginal hysterectomy (LAVH) and compare our results with those of the American Association of Gynecologic Laparoscopists (AAGL) membership survey and another similar study. DESIGN: Retrospective study (Canadian Task Force classification II-3). SETTING: University-affiliated hospital. PATIENTS: Two thousand seven hundred two women. Intervention. LAVH. MEASUREMENTS AND MAIN RESULTS: Demographic data and medical histories (age, parity, surgical indications, pathologic findings, major complications) were analyzed. Major complications were 11 bladder injuries, 4 ureter injuries, 11 bowel injuries, 2 vascular injuries, 2 cases of massive bleeding from the vaginal cuff or colpotomy wound with associated impending shock, 2 cases of postoperative ileus, and 2 pelvic abscesses. Our overall major complication rate was 1.3% compared with 2.7% in the AAGL 1995 membership survey (p <0.001). Similar rates of febrile morbidity (2.2% and 2.0%), bleeding requiring transfusion (0.05% and 0.06%), and bowel, ureteral, or bladder injury (1.0% and 1.0%) were noted between our study and the other 1995 study (all p >0.05). Of 34 major complications in our study, 24 occurred during hysterectomy performed by inexperienced general gynecologists and 10 by an experienced endoscopist (p = 0.005). CONCLUSION: The rate of major complications associated with LAVH can be reduced when the procedure is performed by a well-trained laparoscopic surgeon compared with a less-experienced general gynecologist.

Adult↗
PubMed1994

Supracervical Laparoscopic Hysterectomy (SCLH)

In 50 women without cervical pathology, a SCLH was performed with extraction of the uterus by means of a posterior colpotomy under endoscopic visual guidance. All cases were performed after a diagnosis of dysfunctional uterine bleeding or uterine leiomyomata and treatment with GnRH analogs for 3 months. Uterine fundal measurements ranged from 6-10 cm in greatest diameter. Results, including operating time, blood loss, subjective feelings of nausea, emesis, oral tolerance, and resumption of ambulation were all evaluated in the immediate postoperative period. All patients resumed their normal daily activities at 6 to 10 days postoperatively. A preliminary report addressing sexual function and satisfaction at 3 months postoperatively as compared with the preoperative period was developed. No difference in experience was noted. An economic evaluation was performed at the Clinica Ginemedex that revealed a 30% savings in terms of postoperative care and medication when performing a SCLH as opposed to the more conventional total laparoscopic hysterectomy (LH). SCLH appears to offer several advantages over total LH.

Journal Article↗
PubMed1996

Laparoscopic Myomectomy in Treatment of Large Myomas

Laparoscopic myomectomy was evaluated in 178 women, most of whom underwent the procedure for infertility or other gynecologic disorders associated with myomas (endometriosis, ovarian masses, genital malformations, tubal obstruction, etc.). In 28 (17.5%) patients the indication was the myoma itself, associated with pain, menorrhagia, miscarriage, or continued growth. The sizes of myomas ranged from 7 to 16 cm. Twenty-one women (75%) had only one myoma, but seven (25%) had two to eight (average 5). The myomas were prevalently interstitial and subserous. Myomectomies were performed with conventional techniques. No vasoconstricting preparations were used. All uterine wall defects were sutured with extracorporeal knot tying. Myomas were removed from the peritoneal cavity by morcellation or through a posterior colpotomy. Operating time ranged from 70 to 200 minutes (average 105 min); long cases were mostly due to the process of removing the myomas from the peritoneal cavity. Blood loss ranged from 20 to 250 ml (average 56 ml). We believe that laparoscopy is effective for myomectomy, even large myomas, but its advantages are still to be established based on long-term outcomes, especially with respect to adhesion formation and restoration of fertility.

Journal Article↗
PubMed1996

Total and Subtotal Laparoscopic Hysterectomy

The first laparoscopic hysterectomy was performed in our center in November 1990. From then until March 1994 I performed 107 procedures. The indications were the same as for abdominal hysterectomy, such as abnormal uterine bleeding (fibroids, adenomyosis), endometriosis, adhesions, and ovarian cysts, and to reduce uterine mobility. Concomitant surgery included vaporization or excision of endometriosis, unilateral or bilateral salpingectomy with or without oophorectomy, adhesiolysis, Burch procedure, and lymphadenectomy. Several techniques were used, including automatic stapling, bipolar coagulation, and suture of the uterine vessels. When the pathology was limited to the corpus uteri, a subtotal hysterectomy was performed with extraction through a posterior colpotomy. The mean uterine weight was 165 g. Operating time was 135 minutes, and hospital stay was 3.2 days. Perioperative complications were one bladder injury (Burch) and two conversions for difficult hemostasis; no ureteral or bowel injury occurred. Postoperative complications were seven urinary infections, two vaginal hematomas, and one vaginal abscess. No thrombosis or embolism occurred.

Journal Article↗
PubMed2000

New use of Argyle trocar catheter: treatment of pelvic abscess following transvaginal ultrasound-directed follicle aspiration (UDFA).

This report describes the use of an Argyle trocar catheter for the drainage of pelvic abscesses following transvaginal ultrasound-directed follicle aspiration (UDFA) for oocyte collection. Three patients treated with this technique recovered uneventfully. We conclude that the use of an Argyle trocar catheter for colpotomy in the management of pelvic abscesses appears to be simple and effective.

Abscess↗
PubMed2006

[Vaginal revision of irritation of the obturator nerve within colposuspension].

Irritation of the obturator-nerve within colposuspension is a possible complication because of topographic proximity between obturator-nerve and operating-field. The main symptoms are weakness of the adductor muscles, sensory disturbance of thigh till paralysis and pain in the operating- field early after surgery. Too lateral fixing of the sutures in the pectineal ligament above the obturator-channel can cause compression of the obturator-nerve. Precocious intervention is a precondition for complete remission of symptoms, retropubic revise of surgery is evident. The method outlined here describes vaginal access for re-surgery with lateral colpotomy and dissection of the proximal colposuspension s suture. In this way a recurrent laparotomy with additional trauma of the operating-field can be avoided. In the case described here, this method led to the patients complete remission.

Adult↗
PubMed1990

Cervical internal os cerclage: description of a new technique and comparison with Shirodkar operation.

Internal os cerclage for cervical incompetence was performed in 90 patients who had previous McDonald procedure failure (70 patients) or had unfavorable cervical anatomy (short or lacerated cervix) for primary McDonald type cerclage (20 patients). Two different techniques were used: the Shirodkar operation (n = 44) with Mersilene band, and a simpler new technique (n = 46). The new technique is characterized by anterior colpotomy for exposure of the internal os, and a 0.6 mm nylon suture encircling the cervix to be tied high in the posterior fornix. The pregnancy outcome for both groups was similar. Late abortions of 8.7 and 11% and premature deliveries of 13 and 18% occurred in the new technique and the Shirodkar groups, respectively. The removal of the suture was generally difficult in the Shirodkar group and in eight patients analgesia and sedation were required. In the new technique group, the removal was easier and in only one patient was sedation required (p less than 0.0001). Severe vaginal discharge was found in 52% of the Shirodkar patients and none in the other group. Apparently the monofilament nylon suture prevented this side effect. It seems that the new technique is simpler to perform, involves fewer side effects, the removal of the suture is easier, and it is as effective as the Shirodkar procedure.

Cervix Uteri↗
PubMed2000

Transrectal ultrasonographically guided drainage of gynecologic pelvic abscesses.

OBJECTIVE: This study assessed the feasibility of ultrasonographically guided transrectal aspiration of gynecologic pelvic abscesses to treat patients for whom intravenous antibiotic therapies failed and whose abscesses were not optimally amenable to colpotomy drainage or transabdominal or transvaginal ultrasonographically guided aspiration. STUDY DESIGN: This was a retrospective review of the first 15 women with pelvic abscesses that resulted from salpingitis or complications of gynecologic surgery who underwent transrectal pelvic abscess drainage after failure of antibiotic therapy. RESULTS: Purulent material was aspirated from the abscesses in 14 of the 15 women. All 14 women with aspirated material were successfully treated with real-time ultrasonographically guided transrectal drainage; only 4 of the 14 had indwelling catheter placement. CONCLUSION: Ultrasonographically guided transrectal drainage of gynecologic pelvic abscesses is a safe and effective treatment of pelvic abscesses for women who do not have an adequate response to antibiotic therapy.

Abscess↗
PubMed2004

Transuterine migration as a complication of intrauterine contraceptive devices: six case reports.

OBJECTIVES: We retrospectively analyzed six cases between 1986 and 2002 that had been operated within our unit with the diagnosis of migration of an intrauterine contraceptive device (IUD). Although an IUD is an effective contraceptive method, the migration of one is a rare but serious complication. The aim of this report is to emphasize the management and therapy of this complication. CASES: Out of six patients, three patients with occurring pregnancy, two with pelvic pain and one with a missing IUD incidentally diagnosed during a routine follow-up gynecological examination, were admitted to our clinic. The diagnosis of perforation and transuterine migration of the IUD was confirmed with a plain abdominal X-ray with a hysterometer placed in the uterus, hysterosalpingography and ultrasound. One patient was diagnosed as having a perforated rectosigmoid bowel intraoperatively and one presented with perforation of the bladder. In the remaining four cases, the IUD only migrated into the abdominal cavity without any organ perforations. One IUD was extracted laparoscopically, one was removed through the vagina by colpotomy and, in the other four cases, a laparotomy had to be performed. Patients were discharged without any complications. CONCLUSION: The most serious potential complication of IUD use is uterine perforation and this can cause severe morbidity. When an IUD is located in the abdominal cavity, it should be carefully managed and removed, even in an asymptomatic patient.

Adult↗
PubMed2003

Comparison of two methods of cervical cerclage by ultrasound cervical measurement.

OBJECTIVE: To compare the effects of cerclage performed with a modified Shirodkar procedure or with McDonald's technique using transvaginal ultrasound measurement of the distance between the external os and the suture. MATERIALS AND METHODS: We performed a retrospective study of all patients who underwent a prophylactic cerclage with either the modified Shirodkar procedure or the McDonald's technique over a 3-year period. Physicians chose the cerclage technique according to their own preferences. Transvaginal ultrasound examination of the cervix was performed 2 weeks after the cerclage to measure its functional length and the distance between the external os and the cerclage. RESULTS: During the study period, 14 patients had a cerclage with the modified Shirodkar procedure and 19 patients with the McDonald's technique. Twelve of these 33 patients (36.4%) delivered before 37 weeks. The obstetric characteristics of the patients in both groups were similar. There were no significant differences between the Shirodkar and McDonald groups as to the functional cervical length before (31.3 +/- 8.7 vs. 35.6 +/- 9.7 mm, respectively) or after (37.0 +/- 7.3 vs. 36.1 +/- 7.9 mm) cerclage, the distance between the external os and cerclage (16.7 +/- 3.8 vs. 14.0 +/- 5.2 mm), or the number of deliveries before 32 (0 vs. 2) and 34 (1 vs. 3) weeks. CONCLUSION: The anterior colpotomy of the Shirodkar procedure increased the distance between the external os and the cerclage by a mean of 2.7 mm. This slight gain does not justify exposing the patient to the risks related to this procedure. When cerclage is necessary, McDonald's technique seems preferable.

Adult↗
PubMed2004

Laparoscopic-assisted vaginal myomectomy through an anterior approach.

BACKGROUND: To evaluate the safety and efficacy of a combined laparoscopic and vaginal approach through the anterior cul-de-sac in dealing with fundal and/or anterior wall uterine myomata. PATIENTS AND METHODS: Seven women with symptomatic fundal and/or anterior wall uterine myomata were enrolled in this study. After laparoscopic identification of the location of the myomata, a guiding suture brought the dominant myoma down through the anterior cul-de-sac into the vagina via an anterior colpotomy. Resection and suturing were then performed transvaginally. RESULTS: Mean +/- standard deviation (SD) operative time, blood loss, and the length of hospital stay were 88.1 +/- 27.8 minutes, 278.6 +/- 131.8 mL, and 2.9 +/- 0.7 days, respectively. No patients developed serious complications, and only four transient macroscopic hematuria occurred intra- and postoperatively. CONCLUSION: Although transient hematuria may occur, a combined laparoscopy and vaginal approach in dealing with fundal and/or anterior wall uterine fibroids through the anterior cul-de-sac is an alternative to pure laparoscopic myomectomy.

Adult↗
PubMed1994

The benefits of using the loop ligature (Endoloop) laparoscopic sterilization procedure in a residency program.

This study was conducted to determine the impact of the addition of the loop ligation (Endoloop) technique on choice of sterilization surgery in our residency teaching program and to investigate significant differences between this technique and other methods performed at our hospital. A retrospective study of all patients undergoing interval tubal sterilization at Tampa General Hospital in 1989 and 1991 was undertaken. Data were analyzed to determine the frequency of sterilization methods and differences between the loop ligation method and the other procedures performed; p values of less than 0.05 were considered significant. Sixty-one patients in 1989 and 75 in 1991 qualified for the study. Five methods of interval sterilization were performed: loop ligation, minilaparotomy, colpotomy, laparoscopic bipolar fulguration, and Silastic ring application. The frequency of the loop ligature technique increased from 0% in 1989 to 40% in 1991. There were no significant differences in operative time and complication rate among the loop method and other procedures. The loop ligature (Endoloop) method of laparoscopic sterilization does not significantly change the length of surgery, blood loss, or complication rate compared to the other laparoscopic techniques used in our residency program. This method provides a definitive tissue diagnosis, eliminates the risk of thermal injury, theoretically provides an opportunity of later tubal reanastomosis, and subjectively helps develop laparoscopic skills.

Female↗
PubMed2005

Laparoscopic-assisted vaginal subtotal hysterectomy.

BACKGROUND: A novel approach in combined laparoscopic and vaginal procedures through the posterior cul-de-sac for subtotal hysterectomy is introduced. PATIENTS AND METHODS: Twenty-one women with menometrorrhagia, symptomatic adenomyosis, or uterine myomas were enrolled in this study. After laparoscopic dissection of bilateral round ligaments and adnexa, a guiding suture brought the uterine fundus down through the posterior cul-desac into the vagina via a posterior colpotomy. Subtotal hysterectomy and hemostasis of the cervical stump were then performed transvaginally by conventional techniques and equipment. RESULTS: Mean operative time, blood loss, and length of hospital stay were 111.2 +/- 28.8 minutes, 252.4 +/- 147.9 mL, and 3.2 +/- 0.9 days, respectively. No patients developed serious complications, but 1 patient had a postoperative stump infection and was treated with 2 combined antibiotics, uneventfully. CONCLUSION: A combined laparoscopic and vaginal approach in performing subtotal hysterectomy through the posterior cul-de-sac is an alternative to a purely laparoscopic approach.

Anti-Bacterial Agents↗