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At least 145 records · Page 8Linked to original sources
PubMed2000

[Laparoscopic resection of rectovaginal endometriosis: a case report].

Two patients aged 35 i 40 years after extensive clinical evaluation were operated by means of combined approach--laparoscopy and vaginal resection of endometriotic tumors. First laparoscopy was performed in order to dissect rectovaginal septum and separate rectum from the vagina in order to facilitate complete vaginal resection of endometriotic lesions. The integrity of rectum was checked by means of bubble test and after the control of the haemostasis endoscope was removed. The post operative period was uneventful and the patients were discharged from the hospital on the 5th and 8th day of surgery. The combined laparoscopic and vaginal approach in order to dissect endometriotic rectovaginal tumor is in our opinion the treatment of choice for this peculiar localization of ectopic endometrium.

Adult↗
PubMed1994

Vaginal endosonography. New approach to image the undisturbed anal sphincter.

PURPOSE: Although anal endosonography provides clear images of anal sphincters, the probe in the anal canal may distort epithelial structures and sphincter muscles may be compressed, producing inaccurate muscle thickness measurements. The aim of this study is to describe a new approach using vaginal endosonography to image the anal canal undistorted. METHODS: Twenty females (10 healthy volunteers and 10 with fecal incontinence) had both anal and vaginal endosonography performed. RESULTS: The undisturbed anorectum, submucosa, anal cushions, and anal sphincter muscles were clearly visualized by vaginal endosonography, and anatomy was described. Although anal and vaginal endosonographic measurements of internal sphincter muscle thickness correlated (r = 0.83; P = 0.01), anal endosonography consistently underestimated the thickness (2.3 +/- 0.5 vs. 3.2 +/- 1.2 mm; mean +/- standard deviation). Anterior internal and external anal sphincter defects were identified accurately with both techniques. CONCLUSIONS: Vaginal endosonography is a new technique that enables accurate imaging of anal sphincters and epithelial structures at rest. In addition to making the diagnosis of anal sphincter defects, it has potential applications in the imaging of anovaginal sepsis and malignancy and possibly in understanding the pathogenesis of anal fissure and hemorrhoids.

Adult↗
PubMed2004

Total laparoscopic hysterectomy in obese versus nonobese patients.

OBJECTIVE: To estimate the risk of operative and postoperative complications for obese patients undergoing total laparoscopic hysterectomy compared with nonobese patients. METHODS: A retrospective cohort study was performed for patients undergoing total laparoscopic hysterectomy at Ochsner Clinic Foundation in New Orleans, Louisiana, for a period of 4.3 years. Rates of complications, successful laparoscopic completion, readmission, and reoperation were compared for those patients having a body mass index (BMI) of 30 kg/m(2) or greater with those whose BMI was less than 30 kg/m(2). RESULTS: Of 270 patients who met inclusion criteria, 106 (39.3%) women had a BMI of 30 kg/m(2) or greater. Procedures were completed by using endoscopic technique in 253 cases (93.7%), by using a combined vaginal approach (laparoscopically assisted vaginal hysterectomy) in 7 cases (2.6%), and via laparotomy (total abdominal hysterectomy) in 10 cases (3.7%). Neither the 2-fold risk of conversion to laparoscopically assisted vaginal hysterectomy (relative risk [RR] 2.2; 95% confidence interval [CI] 0.5, 10.1) nor the 4-fold risk of conversion to laparotomy (RR 3.9, 95% CI 1.0, 15.4) associated with obesity was statistically significant. Total laparoscopic hysterectomy for obese patients was 60% more likely to require at least 2 hours to complete (RR 1.6, 95% CI 1.2, 2.0) and was associated with a 3-fold risk of blood loss exceeding 500 mL compared with nonobese patients. Risks of major and minor complications, hospital readmission, and reoperation were similar for both groups. CONCLUSION: Total laparoscopic hysterectomy can be performed successfully in most obese patients, with complication rates similar to those for nonobese patients. LEVEL OF EVIDENCE: II-2

Adult↗
PubMedDate not supplied

Pudendal nerve latency time in normal women via intravaginal stimulation.

INTRODUCTION & OBJECTIVES: Studies of motor conduction for the efferent functional assessment of the pudendal nerve in women with pelvic dysfunctions have been conducted through researching distal motor latency times. The transrectal approach has been the classic approach for this electrophysiological examination. The objective of the present study is to verify the viability of the transvaginal approach in performing the exam, to establish normal values for this method and to analyze the influence of age, stature and parity in the latency value of normal women. MATERIALS AND METHODS: A total of 23 volunteers without genitourinary pathologies participated in this study. In each, pudendal motor latency was investigated through the transvaginal approach, which was chosen due to patient's higher tolerance levels. RESULTS: The motor response represented by registering the M-wave was obtained in all volunteers on the right side (100%) and in 13 volunteers on the left side (56.5%). The mean motor latency obtained in the right and left was respectively: 1.99 +/- 0.41 and 1.92 +/- 0.48 milliseconds (ms). There was no difference between the sides (p = 0.66). Latency did not correlate with age, stature or obstetric history. The results obtained in the present study were in agreement with those found by other researchers using the transrectal approach. CONCLUSION: The vaginal approach represents an alternative for pudendal nerve distal motor latency time, with similar results to those achieved through the transrectal approach. Normative values obtained herein might serve as a comparative basis for subsequent physiopathological studies.

Adult↗
PubMed1996

Laparoscopically assisted vaginal hysterectomy for non-malignant disease of the uterus. Report on a personal series of 126 cases.

OBJECTIVE: A report is given of a series of 126 laparoscopically-assisted vaginal hysterectomies (LAVH) for benign lesions, carried out between September 1990 and December 1995. MATERIALS AND METHOD: The mean age of the patients was 50.3 years, and the main indications for hysterectomy were metrorrhagia (88). The main reasons why LAVH was chosen from among other hysterectomy techniques were a large uterus (55), associated ovarian surgery (45), and a difficult vaginal approach (35). The surgical technique always began with a laparoscopic stage followed by a vaginal stage. The laparoscopic stage generally finished at the lower part of the broad ligament. The vagina was opened and the uterine arteries were ligatured by a vaginal approach (116). Only 10 total laparoscopic hysterectomies were performed. RESULTS: The mean duration of the operation was 72 +/- 28 min, mean blood loss was 1.89 g/dl, and mean uterus weight was 224 g (maximum = 1093 g). Operative complications consisted of two bladder wounds and two switches to abdominal hysterectomy. Postoperative complications were urinary infections (17), hemorrhages needing second-look operations [2] and abscess of the vaginal section requiring evacuation [3]. CONCLUSION: LAVH should never be carried out instead of vaginal hysterectomy (VH), since VH is the best procedure when it is easy to perform. The authors use LAVH when VH is difficult or contraindicated (the aim being to avoid laparotomy) and actually carry out less than 5% of hysterectomies for benign lesions by laparotomy.

Blood Loss, Surgical↗
PubMed2004

[Vesicovaginal fistula].

Urinary fistula to the vagina has been described since the beginning of the written record. In developed nations, these fistulas are usually unfortunate complications of gynecologic or other pelvic surgery and radiotherapy. Historically, birth trauma accounted for most vesicovaginal fistulas, and it remains the major cause of urinary fistulas in many underdeveloped nations. Once a vesicovaginal fistula is suspected, a thorough vaginal examination should be performed to identify its size and location, especially in relation to the trigone and eliminate a ureterovaginal fistula which can be associated in up to 10% of cases. Numerous methods for the treatment of vesicovaginal fistulae have been described. Abdominal, and vaginal approaches are used for the repair of vesicovaginal fistulae. The approach selected is dependent on many factors, but is probably best determined by the experience and training of the surgeon. The techniques of the vaginal approach involve tension-free closure of the fistula with or without excision of the tract, creation of an anterior vaginal wall flap and appropriate use of vascularized interposition grafts. The abdominal approach may be used to treat all types of vesicovaginal fistulae and is the preferred approach when concomittant ureteral reimplantation is required. Postoperative care is similar for both vaginal and abdominal vesicovaginal fistula repair. Adequate uninterrupted bladder drainage is the most critical aspect of postoperative management. A voiding cystourethrogram is performed at 10 postoperative days to confirm closure of the fistula.

Female↗
PubMed2002

Transurethral bladder eversion concurrent with uterovaginal prolapse.

BACKGROUND: Transurethral bladder eversion is rare. A case of transurethral bladder eversion with concurrent uterovaginal prolapse is presented. CASE: The patient was postmenopausal, had a long history of uterovaginal prolapse, and developed bladder eversion. Examination under anesthesia revealed full-thickness transurethral bladder eversion and complete uterine procidentia. Temporary reduction of the prolapse was done initially because of her unstable medical condition. After medical stabilization, definitive surgical reconstruction was completed by a vaginal approach. CONCLUSION: Full-thickness, transurethral bladder eversion can be surgically treated by a vaginal approach.

Bladder Exstrophy↗
PubMed2005

Vaginal repair of vesico-vaginal fistulas: our experience.

Vesico-vaginal fistula repair is feasible both with abdominal and vaginal approach. We report our experience in vaginal repair of 34 vesico vaginal fistulas. Twenty-eight out of 34 fistulas have been treated by vaginal repair (82.3%) (in 2 cases after an attempt of endoscopic repair), 4/34 (11.8%) by abdominal repair and 4/34 (11.8%) by endoscopic repair with good outcome in 2 cases. In 96% of fistulas treated by vaginal repair (27/28) we obtained a complete recovery; in one patient we observed fistula recurrence after 2 months from the operation. Four patients were treated by abdominal approach: in two complex patients with vesico-uretero-vaginal fistula, the repair was associated with entero-cystoplasty and ureteral reimplantation; in one case of huge fistula following cesarean section (7 cm) a vesical flap was used; in one case we repaired a recurrent fistula in orthotopic ileal neobladder: A good outcome was achieved in all cases. Vaginal approach is less aggressive, well accepted by patients and can lead to lower legal issues. Abdominal surgery is mandatory in complex situations, when the fistula is big (> 4 cm) or when ureteral orifices are involved.

Female↗
PubMed1996

Management of urinary bladder injuries in laparoscopic assisted vaginal hysterectomy.

BACKGROUND: To illustrate our experience and evolution in management of urinary bladder injury in laparoscopically assisted vaginal hysterectomy. METHODS: Four hundred and twenty-two women underwent laparoscopically assisted vaginal hysterectomy with or without adnexectomy during the period March 1991-September 1994. The indicators for hysterectomy included adenomyosis, myoma uteri, intractable menorrhagia, endometriosis and severe pelvic adhesion. There are six cases of urinary bladder injuries resulting from our 422 cases of laparoscopically assisted vaginal hysterectomy. RESULTS: The first two cases of urinary bladder injuries were repaired through exploratory laparotomy. The third case was repaired through laparoscopic intracorporeal suture. The technique of the automatic linear stapler through laparoscopy was used in case 4. The last two cases were repaired vaginally. All these patients recovered well after primary repair with an indwelling catheter for five to seven days regardless of the method of repair. The operation time for repairing the injuries is shortest in vaginal approach. CONCLUSIONS: The urinary bladder injury is one of the most common complications associated with laparoscopically assisted vaginal hysterectomy. Early detection and treatment enable complications to be overcome easily. As the laparoscopist acquires further experience in dealing with these complications, the urinary bladder injury may be managed laparoscopically. However, vaginal approach may be an easier way in dealing with this complication. Thus, most laparotomy or high technique laparoscopically repair could be avoided.

Female↗
PubMed1998

[Is vaginal hysterectomy important for large uterus of more than 500 g? Comparison with laparotomy].

OBJECTIVE: Vaginal hysterectomy is an advantageous surgical technique as compared with abdominal hysterectomy: operating time is shorter, it is safer and hospitalization stay and recovery time are shorter. However in France, 2/3 of all hysterectomies are still performed by laparotomy. Would the vaginal approach be reasonable if a difficult hysterectomy is expected? The purpose of our study was to compare the per- and postoperative complications and the period following vaginal hysterectomy versus the abdominal route in patients with a large uterus. PATIENTS AND METHODS: Forty-nine vaginal hysterectomies were compared retrospectively with 22 abdominal hysterectomies for fibroma during the period from 01.01.91 to 31.12.95. Uterine weight in all cases was between 500 to 1,000 g. RESULTS: The average uterine weight was significantly different between the vaginal and the abdominal groups (644 g vs 747 g, p = 0.02). Operating time, pre- and postoperative complications and analgesic use were not significantly different between the two groups. Operative bleeding was significantly higher in the abdominal group than in the vaginal group (659 ml vs. 359 ml, p = 0.006), as well as hemoglobin loss (2.49 vs. 1.82, p = 0.04). There was also a statistical difference between the vaginal group and the abdominal groups in terms of hospital stay (4 d vs. 6 d respectively, p = 0.0002). CONCLUSION: Vaginal hysterectomy with morcellation is advantageous in comparison with abdominal hysterectomy even when the uterine weight is over 500 g, since it offers better post-operative comfort than laparotomy without endangering the patients. The main contraindications for the vaginal route are uterus beyond the ombilicus and vaginal atresia. Excepting these cases, the indication for the vaginal approach depends on the patient's past surgical history, uterine mobility and vaginal access. In more difficult cases, these factors are assessed under anesthesia.

Adult↗
PubMed1995

Ureteral injury during laparoscopically assisted radical vaginal hysterectomy.

We report on a case of ureteral injury during laparoscopically radical hysterectomy to treat a patient with a stage IA2 carcinoma of the uterine cervix. The advantage of laparoscopically radical hysterectomy is the prevention of the identification and dissecting of the ureter from a vaginal approach, the main problem in the Schauta technique. However, ureteral injury may still occur while resecting the cardinal ligament without good visualization of the ureter during a vaginal procedure. Because the ureter was well identified and freed laparoscopically, a vaginal approach after uterine removal may be an option for treatment. Moreover, using the ureteral stent as a marker during a modified Schauta technique is helpful in the prevention of ureteral injury during laparoscopically assisted radical vaginal hysterectomy.

Adult↗
PubMed2006

[MRI evaluation of surgical pelvic floor repair].

OBJECTIVE: To bring to the fore the differences in terms of anatomical restoration between the abdominal and vaginal approach of pelvic floor repair. We compared the short-term anatomical results of the sacropexy and the sacrospinous fixation and paravaginal repair. PATIENTS AND METHODS: Magnetic Resonance Imagery (MRI) allowed us to obtain a reproducible and objective comparison of location of the various pelvic organs. Forty-three patients benefited from a MRI a pre- and postoperative evaluation according to the position of organs with regard to the pubo-coccygeal line. We noted cystocele, hysterocele or enterocele when the bladder, the uterine cervix, or the Douglas' cul-de-sac came under this line during efforts of push. We measured length modifications and lateral and anteroposterior vaginal axis. RESULTS: After the surgery, we noted that all pelvic organs were found above the reference line. On the other hand, bladders are significantly situated less high after vaginal pelvic floor repair. There is no postoperative difference as regards of the vaginal wall location. The lengths and vaginal axis are comparable in pre- and postoperative evaluation. DISCUSSION AND CONCLUSION: In our study, the anatomical results of pelvic floor repair performed by vaginal or abdominal route are short-term comparable and the vaginal approach is not responsible for decrease of length or vaginal reorientation. Standardized and longer term evaluated, the MRI can represent an objective and reproducible help to the staging of pelvic floor dysfunction.

Female↗
PubMed2001

Laparoscopic-assisted vaginal versus abdominal surgery in patients with endometrial cancer--a prospective randomized trial.

OBJECTIVE: We compared a laparoscopic-vaginal approach with the conventional abdominal approach for treatment of patients with endometrial cancer. METHOD: Between July 1995 and August 1999, 70 patients with endometrial cancer FIGO stage I-III were randomized to laparoscopic-assisted simple or radical vaginal hysterectomy or simple or radical abdominal hysterectomy with or without lymph node dissection. RESULTS: Thirty-seven patients were treated in the laparoscopic versus 33 patients in the laparotomy group. Lymph node dissection was performed in 25 patients by laparoscopy and in 24 patients by laparotomy. Blood loss and transfusion rates were significantly lower in the laparoscopic group. Yield of pelvic and para-aortic lymph nodes, duration of surgery, and incidence of postoperative complications were similar for both groups. Overall and recurrence-free survival did not differ significantly for both groups. CONCLUSION: The laparoscopic-vaginal approach for treatment of endometrial cancer is associated with lower perioperative morbidity compared with the conventional abdominal approach.

Aged↗
PubMed1996

Vaginal repair of rectocele after dynamic graciloplasty for fecal incontinence due to imperforate anus.

A 35-years-old woman developed obstructed defecation due to a large (6 cm) non-emptying rectocele one year after successful electrostimulated gracilis neosphincter operation for correction of fecal incontinence after surgery for imperforate anus. Surgical correction of the rectocele was performed by a trans-vaginal approach due to the poor elasticity of the neoanus and avoidance of possible damage to the neosphincter. After physiological investigations, including defecography, the patient had a resection of the posterior vaginal mucosal wall, a double layer plication of the muscular wall with non-absorbable suture and a longitudinal mucosal suture. The postoperative course was uneventful. Defecography, performed 3 and 6 months later, showed a marked reduction of the rectocele (2 cm) which corresponded to clinical improvement. Occurrence of disabling rectocele can be considered a possible long term complication after successful electrostimulated neosphincter procedure in patients at risk for developing a rectocele; a successful repair can be obtained using trans-vaginal approach without the risk of neosphincter damage. Transvaginal repair of rectocele in similar clinical situations may be recommended.

Adult↗
PubMed1994

Facilitating Vaginal Surgery for Residents and Veterans

With the increasing use of operative laparoscopy in gynecologic surgery, there is a rising concern that the use of the vaginal approach is decreasing and emerging gynecologic surgeons have reduced vaginal skills. Often the laparoscopic approach is initially used during a hysterectomy for purposes of oophorectomy or evaluation of pelvic pain and endometriosis. Elevation of the anterior abdominal wall and insertion of a laparoscope often allow initiation and completion of a hysterectomy totally by the vaginal approach. Avoidance of a pneumoperitoneum allows laparoscopic visualization of the entire procedure as well as the option of a regional anesthetic. The backlighting afforded by the laparoscope greatly enhances the vaginal view, and a concurrent laparoscopic view improves placement of clamps as well as upper pelvic dissection. This technique improves the safety and efficacy of the vaginal steps. Use of this technique can improve resident teaching as well as facilitate difficult vaginal dissections.

Journal Article↗
PubMed1992

Uterine torsion and uterine tear in a mare.

A 15-year-old Standard-bred mare was examined because of signs of abdominal discomfort in late gestation. Palpation per rectum revealed tight broad ligaments above and below the uterus, with the right broad ligament running across the top of the uterine body down toward the left, ventral side of the abdomen. A diagnosis of counterclockwise uterine torsion was made and surgical correction was approached via a left, flank laparotomy with the horse standing. The uterus was repositioned and a uterine tear encompassing 180 degrees of the uterine surface was found in the lateral, uterine body just cranial to the cervix. A live colt was delivered vaginally after uterine repositioning and the laparotomy incision was closed. The uterine tear was then repaired via a blind, vaginal approach. The mare was discharged 10 days after surgery. Repair per vaginum of a uterine tear is presented as an alternative treatment in cases for which the tear is recent, abdominal contamination is minimal, and the tear is easily accessible from the vaginal approach.

Animals↗
PubMed1982

Hysterectomy among women of reproductive age. Trends in the United States, 1970-1978.

An estimated 3.5 million women aged 15 to 44 years in the United States underwent hysterectomy (excluding radical procedures) between 1970 and 1978. Data from the National Center for Health Statistics were used to study the influence of age, race, and geographic region on hysterectomy rates, surgical approach, and concurrent oophorectomy. The number and rate of hysterectomies increased between 1970 and 1972 but remained stable thereafter. Hysterectomy rates increased with age, and rates for black women slightly exceeded the rates for whites. Rates were consistently highest for women in the South and lowest for women in the Northeast. Women undergoing hysterectomy in the Northeast had the lowest percentage performed by a vaginal approach and the highest percentage performed in conjunction with bilateral oophorectomy. Women having a hysterectomy in the West had the highest percentage performed by a vaginal approach.

Adolescent↗
PubMed2006

[Surgical treatment of prolapsed uterus and vagina using the RFV (reposition and fixation of the vagina) method R. Napierala].

OBJECTIVES: I am presenting a new and personal method of surgical treating a uterovaginal prolapses using vaginal approach. MATERIAL AND METHODS: From 30th July to 30th November 2004, 12 patients between the ages of 40 and 83 years were operated on using the RFV method. The RFV Surgical Method is a new, inexpensive and technically simple procedure with little risk of complications using vaginal approach. It involves repositioning a prolapsing vagina and uterus to their proper positions as well as stabilizing them with the use of circular, parallel, non-absorbent sutures on the vagina and then the formation of scar tissue around the sutures. RESULTS: After the surgical procedures, all 12 patients anatomical relations returned to normal. There was only one incident where absorbent sutures were used and 2 months after surgery the uterus once again began to prolapse. The patient was operated on once again using nonabsorbent sutures and to this day, four months after surgery, there is no evidence of the uterus or vaginal walls descending. CONCLUSIONS: The above named surgical procedure is recommended for older women who also suffer from other illnesses which might disqualify them from undergoing more traditional, extensive procedures. Preliminary results have been introduced at work of 12 patients operated on using this method.

Adult↗