bluuebunny/crossref_metadata_2025_split huggingface dataset:
Laparoscopic vs. laparotomic ovarian cystectomy in reproductive age women: an economic evaluation
Authors: Damiani  , Campo  , Dargenio  , Garcea  
Published: March 2003

ObjectiveThis study was carried out to assess both the efficacy and the economic advantages of two different surgical techniques in the treatment of ovarian cysts in women of reproductive age.DesignA prospective randomized clinical study.SettingEndocrinological Gynaecology Department of the Catholic University of S. Cuore, Rome.SubjectsThese were 68 women of reproductive age (16–39 years) who were hospitalized for ovarian cysts which had persisted for at least 3 months, or who were noted to have an increase in ovarian volume detected by consecutive ultrasound investigations.InterventionsOf these patients, 34 received laparotomic treatment using a Pfannewstiel incision and traditional techniques. The other 34 patients underwent a laparoscopic stripping of the capsule of the cyst with no sutures on the ovary.ResultsThe two techniques showed similar levels of safety and efficacy. The comparison of direct and indirect costs for the two procedures showed an average total cost of $4940 for laparotomic surgery and $3543 for laparoscopy.ConclusionsThe present study demonstrates that ovarian cysts can be as well treated using laparoscopic access as with laparotomy, but with an average cost reduction of 28% for the former.
Combined ovarian and uterine pregnancy
Authors: Astner Alois , Henrich Johann A. , Jonat Walter , Mettler Liselotte 
Published: March 2003

ObjectiveWe report a case of combined ovarian and intrauterine pregnancy successfully treated by pelviscopy after spontaneous abortion of the intrauterine pregnancy. We discuss the frequency, pathogenic aspects, diagnostic management and therapeutic possibilities of such a rare type of ectopic pregnancy.SubjectA 25‐year‐old primigravida, who had conceived after ovarian stimulation with clomiphene, came to our hospital 3 weeks after curettage of the uterine cavity for an incomplete abortion. An ovarian pregnancy was suspected on transvaginal sonography and this diagnosis was confirmed histologically after pelviscopic treatment.ConclusionMinimally invasive diagnostic and therapeutic management of ectopic pregnancy in early pregnancy should be employed for confirmation of the diagnosis of such a rare combination of intrauterine and ovarian pregnancy. We propose that our surgical management has a high degree of safety for the patient and involves lower hospitalization costs.
Patient recovery after laparoscopic colposuspension
Authors: Cutner Alfred , Rymer Janice 
Published: March 2003

ObjectiveThis short report aims to examine patient recovery after laparoscopic colposuspension.MethodAssessment of patient recovery after a laparoscopic colposuspension.ResultsWe found that return to activity was faster than that which would normally be expected after an open abdominal procedure.ConclusionWe feel that the data presented should encourage further research into the role of laparoscopic surgery for genuine stress incontinence.
A case report of vaginal injury with peritoneal perforation from a water‐jet accident: the first report of treatment by laparoscopic operation
Authors: Ishihara Yuki , Nabuchi Kaoru , Fukumoto Yumiko , Inoue Hiromi 
Published: March 2003

ObjectiveTo describe a unique case of vaginal injury with peritoneal perforation from a water‐jet accident that was treated by laparoscopic assisted operation.SubjectA woman was transferred to our unit with a vaginal laceration caused by impact of water flow to the perineum after falling off of the back seat of a Jet‐ski. A part of the appendix epiploica was seen in the vagina.InterventionsIn this particular case, by using a laparoscope and washing and draining the pelvic cavity, it was confirmed by the surgeon that there was no intestinal injury despite part of the colon having entered the vagina. The perforated vaginal wound was sutured transvaginally while draining the abdominal cavity. Compared with what would have been the case with laparotomy, the patient's need for pain killers and her recovery time were greatly reduced.ConclusionsPatients with vaginal lacerations are often encountered in the emergency room. In treatment it is necessary to stop the bleeding and prevent infection. In the case of vaginal perforation, it is also important to check for intestinal or pelvic injury. Usually, open surgery is performed for these reasons. However, the authors managed to treat the woman using a laparoscopically assisted approach, and therefore the treatment was minimally invasive.
Peritoneal seeding following hysteroscopic diagnosis of cervical adenocarcinoma
Authors: Wilson Hayley , Duncan Alistair 
Published: March 2003

ObjectivesThe purpose of this case report is to highlight the need for caution when investigating postmenopausal bleeding.DesignA retrospective analysis of the management of a case of postmenopausal bleeding.SettingNorthampton District General Hospital, UK.SubjectThe patient was a 77‐year‐old woman with two episodes of unexpected bleeding whilst on continuous combined hormone‐replacement therapy.InterventionsAfter diagnostic hysteroscopy and curettage, a total abdominal hysterectomy and bilateral salpingo‐oöphorectomywas performed.ResultsHistological diagnosis revealed a stage 1A2 adenocarcinoma of the cervix and peritoneal washings taken at the time of hysterectomy were found to contain adenocarcinoma cells.ConclusionsThese include advocating the use of hysteroscopy and directed curettage for the investigation of abnormal uterine bleeding, but with some caution as hysteroscopy may be associated with peritoneal seeding of carcinomatous cells. Cervical, ovarian and fallopian tube carcinomas should be also considered as possible causes of postmenopausal bleeding.
Audit of a new one‐stop menstrual disorder service
Authors: Uhiara Joseph E. , Dwarakanath Linga S. , Newton John R. 
Published: March 2003

ObjectiveTo evaluate the outcomes of a one‐stop menstrual disorder clinic and to determine its acceptability to patients.DesignA two‐part audit including a retrospective analysis of data from patients' records, and a prospective study of patients' views of the service.SettingThe Birmingham Women's Hospital, Birmingham, UK.Subjects and methodsAudit I involved a manual and computer‐assisted search of the records of patients who attended between 1 May and 31 October, 1996, for data collection and retrospective analysis. Audit II was based on the replies to anonymous printed questionnaires, completed after the consultation, by patients who attended the clinic between 1 January and 31 March 1997.ResultsAudit I: A total of 188 records (95%) were traced and audited. The mean waiting time to consultation was 5.5 weeks. The most common indication for patient referral was postmenopausal bleeding (PMB) (32.2%), followed by intermenstrual bleeding (30.5%) and menorrhagia (12.6%), a combination of which was most prevalent among women aged 41–50 years (90.7%). Out‐patient hysteroscopy was successful in 92.6% of patients. The most common pathology was an endometrial polyp. There were two cases of endometrial carcinoma. Additional procedures at a later stage under general anaesthetic were needed by 25 patients. The difference in costs over 6 months between the out‐patient one‐stop service and the traditional referral system following in‐patient treatment was £31 000. Audit II: Although nine out of every 10 patients experienced moderate discomfort, there was overwhelming patient satisfaction with all aspects of the service.ConclusionThe one‐stop out‐patient service is successful, rapidly accessible, safe and convenient, and is more cost‐effective than the service offered through the traditional referral system. Our study also indicates that the service is applicable to other gynaecological problems, such as assessment of the endometrium as part of the investigation for infertility.
Twin pregnancy in a rudimentary uterine horn diagnosed by ultrasound and managed laparoscopically before rupture
Authors: Morgans David , Scott Fergus 
Published: March 2003

ObjectiveTo describe a case of a pregnancy in a rudimentary horn, diagnosed by ultrasound and treated entirely with laparoscopic surgery.SubjectA 33‐year‐old multiparous patient, who had conceived after gamete intrafallopian transfer to the left fallopian tube.InterventionAt 9 weeks' gestation, because of mild right‐sided pain, pregnancy in a right rudimentary uterine horn, surrounded by very little endometrium, was diagnosed by means of ultrasound. At laparoscopy, the diagnosis was confirmed and the main body of the uterus was separated from the rudimentary horn containing the pregnancy. The tissue was then removed via one of the abdominal ports.ConclusionPregnancy in a rudimentary uterine horn diagnosed by ultrasound before rupture, can be treated using advanced laparoscopic surgery, with the associated benefits of this technique.
Simplified laparoscopic suturing: an acquired skill
Authors: Trivedi Prakash , Krishnamurthy Y. Niraj , Padhye Asima 
Published: March 2003

ObjectiveTo describe a simplified method of laparoscopic suturing for advanced or simple laparoscopic surgery by using our specially designed thread carrier, a simple knot and a special knot‐pusher, and to describe a method of making endosutures.DesignProspective study.SettingNational Institute of Laser and Endoscopic Surgery, Mumbai (Bombay), and Jaslok Hospital and Research Centre, Mumbai, India.InterventionsA simplified laparoscopic suturing technique was used in 352 laparoscopic surgery procedures, including laparoscopic hysterectomy, myomectomy, appendectomy, etc.ResultsThe simplified laparoscopic suturing technique designed and used by us is a skill that can be acquired; it is associated with adequate safety, no major complications, and an easy learning curve. It is a cheap technique and not dependent on a continuous supply of ready‐made endosutures.ConclusionThough laparoscopic surgery has progressed rapidly, suturing techniques still remain difficult and quite often confusing. We have designed a simplified suturing technique for various laparoscopic surgery procedures, which is elegant, secure and cheap, which is easy to learn and is associated with no major complications. Our technique is predominantly extracorporeal; however, the simplification of both extracorporeal and intracorporeal suturing will be of benefit to all endoscopists.
Combined vaginal and laparoscopic sacrofixation for genital prolapse using a tacking technique: a series of 45 cases
Authors: Godin Pierre Arnaud , Nisolle Michelle , Smets Mireille , Squifflet Jean , Donnez Jacques 
Published: March 2003

ObjectiveTo determine the efficacy and the safety of a combined laparoscopic and vaginal approach to the management of genital prolapse.DesignA retrospective case series.SettingGynaecological unit of a university hospital.Subjects45 women with total genital, cervical or vaginal prolapse examined between November 1995 and November 1997.InterventionsAll the patients underwent a simple combined vaginal and laparoscopic technique. A polypropylene mesh was attached to the posterior part of the cervix or the vaginal vault and the body of the first sacral or fifth lumbar vertebra. A tacking device (Origin Tacker System) was used.ResultsFollow up ranged from 6 to 30 months. Combined vaginal and laparoscopic surgery was faster than laparotomy and use of the tacking technique provided an easy, quick and effective fixation of the mesh to the vertebra in all cases but one. There was one recurrence due to inappropriate fixation of the mesh to the cervix. In another case, the vault was well fixed but an enterocele appeared 1 month later and required classical vaginal management. One serious complication (sciatic nerve compression) was caused by inappropriate tacking of one coil.ConclusionOur results suggest that a combined vaginal and laparoscopic sacrofixation approach can be an effective and quick alternative for prolapse therapy.
Evaluation of the endometrium in abnormal uterine bleeding associated with long‐term tamoxifen use
Authors: Bakour Shagaf H. , Khan Khalid S. , Newton John R. 
Published: March 2003

ObjectiveTo evaluate the underlying endometrial pathology in breast cancer patients receiving long‐term tamoxifen and presenting with abnormal bleeding.DesignProspective cohort study (1996–97).SettingMinimal access surgical training centre in a large teaching hospital.MethodsOutpatient ultrasound scan, hysteroscopy and endometrial sampling were carried out in 24 breast cancer patients with abnormal uterine bleeding who were receiving tamoxifen. If these outpatient procedures failed, inpatient hysteroscopy and endometrial sampling was undertaken. On diagnosis of an endometrial polyp, inpatient hysteroscopy, polypectomy and curettage were carried out.ResultsHysteroscopy revealed polyps in 17 of 24 patients (71%). Histologically, 13 polyps were benign, three polyps had hyperplasia (one simple and two complex), and one polyp was malignant. Endometrial thickness (ET) on ultrasound scan was associated with hyperplasia or cancer only at ET ≥ 10 mm.ConclusionIn breast cancer patients receiving tamoxifen and presenting with abnormal bleeding, a high rate of pathological endometrial lesions was observed. All the polyps were diagnosed hysteroscopically but prediction of premalignant/malignant lesions, which were confirmed by histological assessment, could not be done hysteroscopically. There is a need to assess the accuracy, acceptability and cost‐effectiveness of the various tests for evaluating endometrial pathology.
Falloposcopic investigation of tube pathology: correlation with histopathological findings
Authors: Déchaud  , Serres  , Picot  , Baldet  , Hédon  
Published: March 2003

ObjectiveTo compare the results of falloposcopic and histopathological examination of diseased fallopian tubes in order to assess the diagnostic quality of falloposcopy.SubjectsFive infertile patients with known, severe tubal pathology, which was considered to be irreversible and unsuitable for reconstructive surgery.InterventionsFalloposcopy followed by a bilateral salpingectomy, as preparation for in vitro fertilization. Serial cuts of the different segments of the 10 tubes were then prepared for histopathological examination. The histopathological findings were compared in blind fashion to the falloposcopic results. The pathomorphological criteria for both were the luminal geometry, status of the mucosal surface, fold architecture and intraluminal findings.ResultsThe sensitivity of falloposcopy was 100% for the evaluation of luminal geometry, the mucosa and fold architecture. For intraluminal pathology, the sensitivity was 75% and the specificity was 100%.ConclusionIn cases of severe tubal pathology, falloposcopy is an accurate diagnostic examination. However, its capacity to detect intraluminal pathology needs to be improved.
The value of outpatient hysteroscopy in the management of postmenopausal bleeding: a review of 862 cases
Authors: Alexopoulos Evangelos D. , Simonis Chantal D. , Kidsley Sally , Fay Toby N. 
Published: March 2003

ObjectiveTo evaluate the efficacy, reliability and acceptability of outpatient hysteroscopy in the investigation of postmenopausal bleeding in a major teaching hospital.DesignA retrospective descriptive study of 862 women referred with postmenopausal bleeding for outpatient hysteroscopy.MethodsBetween 1994 and 1997, 862 women were referred to the Women's Endoscopy Unit at Nottingham City Hospital for postmenopausal bleeding. Of these women, 171 were receiving hormone replacement treatment. The endocervical canal and the endometrial cavity were assessed using either a 4‐mm rigid or a 3.5‐mm flexible hysteroscope according to the preference of the operator. All hysteroscopies were performed by consultants or experienced registrars. Pipelle endometrial biopsy was taken when indicated.ResultsThe mean age of patients referred with postmenopausal bleeding was 58 years. Hysteroscopy was completed successfully in 97.2% of all patients. Cervical stenosis and pain were the main reasons for failure to complete the procedure. Local anaesthesia with paracervical infiltration was used in one‐third of all patients undergoing hysteroscopy. Intrauterine polyps were the commonest finding (13.9%) while submucous fibroids were detected in 10.7%. Endometrial biopsies were taken in 34.7%. Abnormal histological findings were reported in 28 cases, including eight instances of endometrial adenocarcinoma. After hysteroscopic assessment, 81% of patients were discharged while further surgical treatment was warranted in 14.6%.ConclusionOutpatient hysteroscopy is a reliable, safe and well‐tolerated diagnostic procedure for investigating endometrial and endocervical pathology in patients with postmenopausal bleeding. Whenever hysteroscopic findings appear suspicious an endometrial biopsy should be taken to exclude endometrial pathology.
Laparoscopically assisted segmental sigmoid resection (LASSR) for sigmoid endometriosis
Authors: Anaf V. , Sperduto N. , Simon P. , Noel J.‐C. , El Nakadi I. 
Published: March 2003

ObjectivesTo confirm the feasibility and safety of laparoscopically assisted segmental sigmoid resection (LASSR) for sigmoid endometriosis.SettingGynaecology and surgery departments at a university hospital.SubjectsBetween August 1997 and April 1999, five patients with symptomatic sigmoid endometriosis and concomitant pelvic endometriosis underwent LASSR. During that same period laparoscopic procedures for endometriosis involving the intestinal tract included: five anterior resections of the rectum with transanal end‐to‐end anastomosis for extensive rectosigmoid endometriosis, 26 resections of rectovaginal endometriotic nodules and one appendectomy.InterventionsThese included: laparoscopic dissection of the left large bowel from its adherent neighbouring structures, incision of the lateral and medial peritoneal reflections of the mesosigmoid, incision of the left paracolic gutter, identification of the left ovarian vessels and left ureter, extracorporeal resection of the sigmoid and lateroterminal handsewn anastomosis, and laparoscopic treatment of concomitant pelvic endometriosis.ResultsNeither intra‐ nor postoperative complications occurred. The mean operating time was 210 min. Postoperative ileus lasted less than 72 h in all cases (n = 5). The mean postoperative hospital stay was 6 days. There was no recurrence of sigmoid endometriosis symptoms over follow up for a mean of 15.2 months.ConclusionsLASSR is a feasible and safe technique which is indicated for symptomatic sigmoid endometriosis. It allows the simultaneous laparoscopic management of pelvic endometriosis. Better cosmesis is an immediately recognizable benefit of this technique. Reduced postoperative pain and shortened postoperative ileus represent presumed advantages of LASSR compared with open surgery. The use of LASSR can help to reduce the cost of the laparoscopic instrumentation that is necessary for total laparoscopic colectomy.
Complications of operative laparoscopy
Authors: Miranda Cristián S. , Carvajal Antonio R. , Escobar Paula 
Published: March 2003

Objective  To assess the incidence and type of laparoscopic complications. Design  A series of 1649 operative laparoscopies were reviewed in a retrospective study of patient records. Setting  A tertiary care university hospital. Interventions  Operative laparoscopy including minor procedures (minimal adhesiolysis, destruction of minimal endometriosis foci, ovarian biopsy, ovarian puncture, tubal sterilization); major laparoscopic surgery (extended adhesiolysis, tuboplasties, uterine suspension, treatment for ectopic pregnancy, salpingitis, ovarian cyst, moderate and severe endometriosis), and advanced laparoscopic surgery (hysterectomy, myomectomy, bladder neck suspension). Results  There was one major vascular complication, two intestinal injuries, one anaesthesiological complication and two urinary tract injuries. In addition there were two minor and five postoperative complications. The overall complication rate was 13/1649 (0.8%). The major complication rate was 6/1649 (0.36%). Conclusions  This review has been useful in helping surgeons to reduce the risk of injuries and to inform patients about possible complications. These rates were similar to those that have been previously reported.
Hysterectomy for benign uterine disease: the effect of the introduction of laparoscopic‐assisted hysterectomy on the selection of surgical access
Authors: Fernandez Hervé , Anquetil Christophe , Capella‐Allouc Sylvie , Frydman René , Gomel Victor 
Published: March 2003

Objective To investigate the effect of the introduction of laparoscopic surgery on the use of traditional techniques of hysterectomy. Design A retrospective study of hysterectomies performed for benign uterine disease, between August 1991 and July 1997. Setting University hospital. Subjects Patients requiring hysterectomy for benign uterine disease without prolapse or pelvic floor relaxation. Interventions 359 hysterectomies including vaginal (n = 211), laparoscopically assisted vaginal (n = 56), and abdominal (n = 92). Results The main indications for hysterectomy were profuse uterine bleeding and pelvic pain; uterine fibroids were a common occurrence (87%). There were no statistical differences between the mean ages of the patients in the three groups. The mean parity was significantly lower (P = 0.04) for patients undergoing abdominal hysterectomy
(AH) (1.3 ± 1.4) than for those whose surgery was either vaginal (2 ± 1.5) or laparoscopic (1.8 ± 1.6)
. Before the introduction of laparoscopic‐assisted vaginal hysterectomy (LAVH) (1989–90), the rates of vaginal hysterectomy (VH) and abdominal hysterectomy (AH) in our department were, respectively, 42% and 58%. In the initial 3 years of the study period, the rate of abdominal hysterectomy stayed stable around 30%, then dropped gradually to 18% (P < 0.05). The rate of LAVH stayed stable during the initial 4 years (between 22 and 24%) and declined thereafter to 7% (P < 0.05). The rate of VH stayed stable during the initial 4 years (between 46 and 56%) and then increased gradually to 75% (P < 0.05) and more specifically to 90% in patients who had no prior vaginal childbirth. During the last 2 years of the study there was a decrease in the use of the laparoscopic approach in favour of the vaginal route. Conclusion In our institution the introduction of LAVH led to expected changes during the initial 3 years of the study period, producing a major decline in the rate of AH in favour of LAVH. The unexpected development during the second 3 years of the study period was a further decline in the rate of AH along with a significant decline in the rate of LAVH, both in favour of VH.
Omental evisceration through 5mm umbilical laparoscopy port site
Authors: Negri John , Kuhn Raphael 
Published: March 2003

Objective To report the first adult female case of umbilical omental evisceration through a 5‐mm port site. Subject  A woman in whom evisceration occurred 6 h after an uncomplicated laparoscopic ovarian cystectomy. Intervention The umbilical port‐site incision was extended, the omentum reduced into the abdomen and the fascial defect closed. Conclusions Strategies for prevention of this complication are outlined.
Endoscopic transabdominal cervical cerclage
Authors: Ind Thomas , Mason Peter 
Published: March 2003

Objective To describe a case of endoscopic transabdominal cervical cerclage. Setting St Mary’s Hospital, Paddington, London, UK. Subject A 33‐year‐old lady with clinical cervical incompetence. Intervention Cervical cerclage was performed with zero gauge coated polyester at the level of the internal os. Results The duration of the operation was 50 min and was performed uneventfully. Prior to surgery the cervix admitted the largest dilator available (14 mm) without resistance. After the operation, the internal os did not admit a dilator of 9.5‐mm diameter. The patient was discharged 18 hours after completion of the procedure. Conclusion In this instance, laparoscopic cervical cerclage proved technically easy for a surgeon trained in laparoscopic suturing methods and resulted in discharge from hospital in the morning following an afternoon procedure.