bluuebunny/crossref_metadata_2025_split huggingface dataset:
A survey of laparoscopic workshops
Authors: Chang Timothy , Maher Peter , Cooper Michael , Wong Felix 
Published: March 2003

ObjectiveTo assess the usefulness of workshops in basic laparoscopic skills in promoting the use of laparoscopy in gynaecological surgery.DesignProspective observational survey.SettingDepartment of Obstetrics and Gynaecology, Liverpool Hospital, Sydney, New South Wales and Department of Obstetrics and Gynaecology, Mercy Hospital, Melbourne, Victoria, Australia.ResultsBetween 1993 and 1996 12 laparoscopic workshops have been conducted, with eight participants in each course. Of the participants, 82.5% were male, and 72.3% were over the age of 45 years. Out of 62 respondents to a questionnaire, 60 (96.8%) were performing more laparoscopic procedures after the course, with 38/62 (61.3%) performing more complex procedures.ConclusionsLaparoscopic surgery does have a place in gynaecological practice, and laparoscopic workshops are useful for the introduction of laparoscopic techniques to the gynaecologist.
Conservative treatment of interstitial pregnancy
Authors: Broome Jonathan D. , Vancaillie Thierry G. , Torode Hugh 
Published: March 2003

ObjectiveTo report a case of interstitial pregnancy diagnosed and treated laparoscopically by cornual resection, and to review the literature in order to provide a perspective on alternative treatment options for this condition.Case reportA 42‐year‐old woman with persistent pelvic pain, elevated levels of beta‐human chorionic gonadotrophin (β‐hCG) and a negative ultrasound scan had an initial negative diagnostic laparoscopy. Symptoms continued and repeat ultrasound suggested an asymmetric fundal pregnancy. Repeat laparoscopy revealed an interstitial pregnancy and laparoscopic cornual resection was undertaken. Recovery was uneventful and she was discharged 2 days postoperatively.Current perspectiveWhen interstitial pregnancy is detected early, treatment options include expectant management, systemic methotrexate, or local injection of methotrexate, potassium chloride or prostaglandin into the gestational sac. Surgical intervention by hysteroscopic removal or laparoscopic cornual excision/cornuostomy can be employed in the case of failed medical treatment or advanced pregnancy.ConclusionThe early diagnosis of interstitial pregnancy should enable a conservative approach, whether medical or surgical, to be undertaken when treating this rare and potentially fatal condition.
A review of 2581 out‐patient diagnostic hysteroscopies in the management of abnormal uterine bleeding
Authors: Alexopoulos Evangelos D. , Fay Toby N. , Simonis Chantal D. 
Published: March 2003

ObjectiveTo evaluate the clinical efficacy, reliability and acceptability of out‐patient diagnostic hysteroscopy at a large teaching hospital.SettingThe Women's Endoscopy Unit at Nottingham City Hospital, Nottingham, UK.SubjectsBetween 1994 and 1997, 2581 women were referred for menstrual problems and abnormal uterine bleeding. The endocervical canal and 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. Endometrial biopsy was taken when indicated.ResultsThe main indications for referral for diagnostic hysteroscopy included menorrhagia (37.5%), postmenopausal bleeding (33.4%), intermenstrual bleeding (26.7%) and metrorrhagia (8.8%). Less common indications included treatment with tamoxifen, review of previous endometrial pathology or abnormal glandular cells on cervical cytology, and investigation for infertility. The mean age of patients referred was 49.3 years. Hysteroscopy was completed successfully in 96.8% of all patients, with pain being the main reason for failure to complete the procedure. Local anaesthesia with paracervical infiltration was used in 34% of all patients. Submucous fibroids were the commonest cause of intrauterine pathology (11.4%) with the highest incidence found in women referred for menometrorrhagia (17.2%). Endometrial polyps were detected in 10.6% of all the patients. The endometrium was characterized by the hysteroscopist as atrophic, thickened, polypoid, haemorrhagic or malignant. Endometrial Pipelle biopsies were taken in 48.6% of all cases. Abnormal histological findings were reported in 61 cases including 11 instances of endometrial adenocarcinoma. The concordance rate between hysteroscopic and histological findings for all abnormalities was 63.9%. Further medical treatment was offered to 406 patients (16.3%), while 185 patients (17.3%) needed additional surgery as in‐patients.ConclusionOut‐patient hysteroscopy is a safe, acceptable and well‐tolerated procedure that provides useful information about the uterine cavity. Endometrial biopsy improves the diagnostic accuracy of hysteroscopy in detecting endometrial pathology.
Laparoscopically assisted hysterectomy for the large uterus
Authors: Clayton Richard D. , Hawe Jeremy A. , Garry Ray 
Published: March 2003

ObjectiveTo assess the results of performing laparoscopically assisted hysterectomy on uteri greater in size than 12 weeks.DesignA prospective observational study.SettingSouth Cleveland Hospital, Middlesbrough, and St James' University Hospital, Leeds, UK.Subjects21 consecutive women undergoing wholly laparoscopic or laparoscopically assisted total or subtotal hysterectomy with or without bilateral salpingo‐oöphorectomy.Main outcome measuresThese included uterine size and weight, techniques used to perform hysterectomy, surgical outcome, operative time, additional pathological conditions found, blood loss, intra‐ and postoperative complications and duration of hospitalization.ResultsLaparoscopically assisted hysterectomy was completed in all cases. The mean uterine weight was 522 g with a range of 390–785 g. The mean operating time was 144 min with a range of 78–330 min. Four of the patients had additional pathological conditions. None of the patients required a blood transfusion. Three patients suffered complications: a functional ileus, a small port‐site haematoma and a ureteric injury. The mean hospital stay was 4.3 days (range 2–8 days).ConclusionLaparoscopic surgery can be used to avoid abdominal hysterectomy even with significant uterine enlargement, and allows the diagnosis and treatment of coexisting pelvic pathological conditions which cannot be adequately treated at vaginal hysterectomy. However the advantages must be weighed against the possible risk of increased complications.
Is routine preoperative preparation necessary for hysteroscopic endometrial resection?
Authors: Trivedi Prakash , Rocha Ivan , Padhye Asima 
Published: March 2003

ObjectiveTo assess whether routine preoperative preparation of the endometrium with danazol or GnRH analogues is really necessary for transcervical resection of the endometrium (TCRE).DesignA prospective open trial.SettingSpecialized arrangements in a private minimal access gynaecological centre and a research institute, in Mumbai, India.Participants665 women who presented with excessive menstrual bleeding.InterventionsRandom allocation into groups receiving either no preoperative preparation, or danazol or gonadotrophin‐releasing hormone (GnRH) analogues, or progesterones for preoperative preparation, followed by hysteroscopic resection of the endometrium.Main outcome measuresThese included assessment of relief of symptoms, failures and satisfaction rate. Total operating time, amount of fluid used and absorbed, as well as complications observed over a period of 7 years were also recorded.ResultsThe results of 665 TCRE procedures evaluated over a period of almost 7 years suggest that outcomes were not influenced by preoperative endometrial preparation. Lack of endometrial preparation was not associated with any increase in the complication rate, in procedures carried out by an experienced hysteroscopist. Routine endometrial preparation is not necessary, and it substantially increases the overall cost of the procedure, which is an important consideration in developing countries. Preoperative endometrial preparation is necessary only occasionally, when large submucous (>3 cm) fibroids are to be resected, as it may reduce the operating time and complication rate significantly. Relief from excessive menstrual bleeding occurred in 88% of patients, of whom 39% had amenorrhoea. Repeat TCRE was necessary in only 3% of patients, and 3% finally underwent hysterectomy.ConclusionsTCRE can be conveniently performed by an experienced hysteroscopist without routine endometrial preparation with danazol/GnRH analogues. Our study shows that the incidence of complications was low, with successful results in 88% of patients with excessive menstrual bleeding.
Peritoneal hyperdistention for trocar insertion
Authors: Reich Harry , Rasmussen Carsten , Vidali Andrea 
Published: March 2003

IntroductionMost laparoscopic complications occur at the time of Veress needle and trocar insertion. Although they are not very frequent, they increase the morbidity and mortality of both diagnostic and operative laparoscopic procedures. The currently recommended techniques of trocar insertion have not completely eliminated the risk of injury.TechniqueAfter Veress needle insertion we recommend creating peritoneal hyperdistention up to 25–30 mmHg pressure. At this point a short trocar is inserted in the deepest part of the umbilicus without elevation of the anterior abdominal wall. The result is a parietal peritoneal puncture directly beneath the umbilicus. As soon as safe abdominal entry is established, the pressure is lowered to 15 mmHg.ExperienceIn our large series utilizing peritoneal hyperdistention there was but one vascular bowel injury related to umbilical trocar insertion. Maintaining an increased intra‐abdominal pressure for the length of time required for trocar insertion did not result in patient morbidity.ConclusionPeritoneal hyperdistention at trocar insertion is safe and may reduce the rate of trocar‐related complications.
Laparoscopic management of ovarian cysts
Authors: Wong Yat‐May , Amer Saad , Li Tin‐Chiu , Cooke Ian D. 
Published: March 2003

Objective To review the various techniques of laparoscopic management of ovarian cysts and specimen retrieval. Design Medline search on topics related to ovarian cysts, ovarian endometrioma, medical and surgical management. Results Transvaginal scanning and measurement of CA 125 level are useful preoperative investigations. The value of preoperative Doppler ultrasound is yet to be established. In the absence of any features of malignancy, ovarian cysts of more than 5 cm may be safely removed laparoscopically. In ovarian endometrioma, drainage followed by ablation of the cyst wall is acceptable, although recent randomized data suggest that cystectomy produces better results. Rupture of stage 1a ovarian carcinoma does not worsen the prognosis if the laparoscopy is converted to laparotomy immediately. Conclusion The optimal outcome of laparoscopic management of ovarian cysts depends on careful patient selection and the ability to remove the cyst intact without spillage of its contents. A timely conversion from laparoscopy to laparotomy in cases of malignancy will not worsen the eventual prognosis.
Ovarian remnant syndrome
Authors: Richlin Spencer S. , Rock John A. 
Published: March 2003

ObjectiveTo review different diagnostic and surgical procedures for ovarian remnant syndrome and suggest that complete primary resection is the only method to avoid recurrence.Data sourcesSources include original articles and reviews on various ovarian remnant surgical techniques, on comparisons of laparotomy with laparoscopy and on the employment of possible medical methods for treatment, and reviews of methods and techniques for diagnosing ovarian remnant syndrome. The technical sources dated from 1953 to the present.Methods of study selectionStudies of methods and follow up of ovarian remnant techniques currently used. Review articles including surgical and medical techniques with long‐term outcomes and patient selection criteria were utilized to formulate a strategy for appropriate selection of ovarian remnant removal.Data extraction and synthesisThe methods reviewed include clinically applied surgical and medical techniques. Articles including surgical and nonsurgical treatment for ‘remnant removal’ were utilized with a review of laparotomy and laparoscopy data.ConclusionsComplete excision of ovarian remnants via exploratory laparotomy affords patients the best option for avoiding future corrective surgery for pelvic pain from persistent ovarian remnants.
Rectosigmoid integrity after excision of nodular endometriotic disease: do we test appropriately?
Authors: Gordon Simon J. , Maher Peter J. , Healey Martin 
Published: March 2003

ObjectiveTo highlight the necessity of adequately testing rectosigmoid integrity after resection of infiltrating endometriosis.SubjectA 25‐year‐old woman with a past history of ablative treatment for endometriosis, symptoms suggestive of disease progression, and a palpable anterior rectal nodule.Interventions and outcomesExcisional treatment of all visible disease, including the rectal nodule was carried out. Rectal integrity was confirmed intraoperatively via the ‘Betadine’ test. The patient presented again 3 days later with clinical findings suggestive of a bowel perforation. Repair of the defect and a de‐functioning colostomy were performed.ConclusionAlthough clinical bowel perforation is an uncommon event, the sequelae have far‐reaching consequences for the patient's quality of life. The use of electrosurgical dissection may have contributed to delayed tissue necrosis and the subsequent rectal perforation. Current methods for testing colorectal integrity are reviewed.
Initial training model for endometrial ablation
Authors: Dunkley M. Peta , Brown Lorna H. , Robinson Judith M. , Parkin David E. 
Published: March 2003

The development and evaluation of a model for use in the initial training of gynaecologists in endometrial ablation techniques.A series of prototypes, created according to theoretical specifications, were evaluated by practitioners experienced in endometrial ablation, and modified accordingly. The final model was evaluated by both trainers and trainees.An endoscopic training unit.The Faculty of the Scottish Diagnostic and Operative Hysteroscopy Course (12 consultants) and course participants (88), the majority being trainees from Scottish hospital trusts.A model was developed for use in laboratory training or for individual practice, which is inexpensive, made of readily available materials and easy to prepare.The materials, method of preparation and presentation of the model are reported and the advantages and disadvantages of its use are discussed.
Endoscopic treatment of advanced endometriosis with large endometriomata. Surgical technique
Authors: Milingos Spyros , Kallipolitis George , Loutradis Dimitris , Liapi Anthi , Drakakis Peter , Mavrommatis Konstantinos , Antsaklis Aris , Creatsas George , Michalas Stylianos 
Published: March 2003

Advanced endometriosis is a common cause of infertility. It has traditionally been treated surgically by laparotomy. The surgeon had to cope mainly with adhesions, endometriotic implants and, quite often, endometriotic cysts of various diameters. In this study, we report our laparoscopic technique for treating advanced endometriosis with large endometriomata, using conventional instrumentation, and we discuss our main problems and our results.The study population consisted of 68 subfertile patients with large endometriomata who underwent laparoscopic removal of the cysts.The Infertility Clinic at the Alexandra Maternity Hospital, Athens, Greece, between January 1990 and October 1997.Laparoscopic excision of endometriotic cysts in subfertile women.Success of treatment modality; postoperative complications; postoperative cumulative pregnancy rates.The technique is described. Postoperative complications were minimal. Of the patients, 32 (47%) became pregnant during the 2‐year postoperative follow‐up period. The estimated cumulative pregnancy rates at 6, 12, 18 and 24 months were 22%, 35%, 45% and 47%, respectively.Our experience favours the use of traditional laparoscopic tools over laser treatment for the management of extensive endometriosis with endometriomata, since the results are similar to those observed after laser treatment, and the training of a larger number of physicians and availability of equipment are more readily achieved for the former method. Postoperative pregnancy rates are high.
Normal saline field bipolar electrosurgery in hysteroscopy: report of the first 163 cases
Authors: Vleugels Michel P. H. 
Published: March 2003

To document the clinical and surgical experience of the first large series of hysteroscopic procedures performed with the new bipolar normal saline field electrodes.Prospective descriptive study.163 women scheduled for hysteroscopic surgery.All the scheduled operations could be done with the new device, and 69% of all lesions could be removed under local anaesthesia and 28% without anaesthesia at all. On average, 85 mL of distension fluid, i.e. normal saline, was resorbed. The amount of resorption was related to the operation time, which increased greatly in the case of polyps over 4 cm in size or fibroids larger than 3 cm in diameter. No complications were encountered.This new bipolar normal saline field device is easy to handle, and safe and effective in removing lesions by coagulation, cutting or vaporization. It can easily be used to perform most hysteroscopic procedures with or without local anaesthesia in daycase settings.
Endoscopically assisted vaginal sacrospinous colpopexy
Authors: Shafik Amina M. , Hefni Mohamed 
Published: March 2003

To describe an endoscopic technique which simplifies the transvaginal sacrospinous colpopexy operation for vault prolapse.Insertion of polydioxanone sutures was carried out under direct endoscopic visualization.The introduction of this new technique has changed the difficult blind step of the operation into a directly visualized endoscopic procedure and has decreased the likelihood of complications, especially injury to pudendal nerve and vessels and postoperative buttock pain. This could allow the majority of the gynaecologists to safely perform the operation.
Animal toxicities study of a promising new contraceptive device
Authors: Sterling Glenn M. 
Published: March 2003

ABSTRACTObjective Gore‐tex bags were placed over sheep ovaries and tissue reaction was assessed.Setting The study was conducted at The University of Queensland under the supervision of the School of Veterinary Science and The Wesley Research Institute.Design Gore‐tex bags were applied to ovaries at laparotomy and removed after 90 days. Photographs of the gross dissections and histological sections were utilized to document the findings.Results At repeat laparotomies, there were no adhesions between the ovarian bags and surrounding viscera. The ovaries were viable and surgical planes were easily established between the ovaries, the bags and the outer fibrous capsules. No detrimental tissue reaction was demonstrated in the animal model studied. The bags remained in place for the term of the study.Conclusion The laparoscopic placement of an inert bag over the ovary may be a method of reliable, reversible, barrier human contraception. The device should be amenable to application and removal using a minimally invasive technique. Other possible applications include oöcyte capture prior to egg collection in assisted reproductive technology and early detection and prevention of ovarian cancer.
Immunoadsorption for removal of inhibitors: update on treatments in Malmö–Lund between 1980 and 1995
Authors: Freiburghaus  , Berntorp  , Ekman  , Gunnarsson  , Kjellberg  , Nilsson  
Published: March 2003

Treatment of severe bleeding and the performance of surgery in Haemophilia patients with inhibitors creates severe problems. It is generally agreed that treatment is most effective if circulating levels of factor VIII/IX can be achieved long enough for control of heamostasis. Immunoadsorption with protein A for the removal of inhibitor has improved treatment for patients with initial inhibitor titres too high to neutralize by infusion alone. This is a summary of our experience in Malmö regarding immunoadsorption and heamostatis. A total of 19 applications with immunoadsorption in 10 patients were performed. On all occasions it was possible to eliminate totally the inhibitor or reduce it to low levels that could easily be neutralized with factor concentrate. Heamostatic levels of coagulation factors could be maintained for 5–9 days in all but one patient. This period was sufficient to stop ongoing heamorrhage or prevent excessive bleeding at surgical interventions.
Management of a premature infant with moderate haemophilia A using recombinant factor VIII
Authors: Gale  , Hird  , Colvin  
Published: March 2003

The birth of a very premature infant with haemophilia A is a rare event. In this case report the problems posed in the management of a child with a factor VIII level of 0.03 IU mL−1 born at 28 weeks of gestation and weighing 1590 g are considered.The value of recombinant factor VIII, the pharmacokinetics of factor VIII in this situation and the importance of close cooperation between paediatricians and haematologists are discussed.
Type 2B vWD: the varied clinical manifestations in two kindreds
Authors: Mathew P. , Greist A. , Maahs J. A. , Lichtenberg E. C. , Shapiro A. D. 
Published: March 2003

SummaryType 2B von Willebrand's disease (vWD) is associated with spontaneous binding of large von Willebrand factor (vWF) multimers to platelets in vivo, followed by clearance of both the large multimers and platelets resulting in thrombocytopenia, which may be intermittent, mild to severe, and may be exacerbated by stress such as infection or pregnancy. We report our experience in two kindreds (49 caucasian individuals) with type 2B vWD and discuss their varied clinical manifestations. The largest kindred (45 patients) was traced back five generations to a presumed index case. The genetic defect in this kindred was identified as a missense mutation, with a C to T transition at a CpG dinucleotide (nucleotide 3916) resulting in an amino acid substitution (Arg 543 to Trp) within the glycoprotein Ib binding domain of vWF. Ristocetin cofactor activity varied from < 10 to 28%, and factor VIII activity from 7 to 69%. Analysis of von Willebrand multimers consistently revealed loss of large molecular weight forms. Platelet counts in those with thrombocytopenia varied from 10 × 109 L−1 to 120 × 109 L−1. The severity of thrombocytopenia has also varied within the same individual during the period of follow‐up. The clinical manifestations were varied and ranged from mild to moderate spontaneous bleeding episodes, including epistaxis, menorrhagia and gastro‐intestinal haemorrhage. Severe bleeding episodes were observed in those undergoing surgery (both elective and non‐elective), and in a few patients despite aggressive replacement with exogenous source of intact vWF, antifibrinolytics when indicated, and a near normal platelet count. Thrombotic disease may be a rare and unusual sequela of this disorder as was noted in one of our patients. Obtaining a platelet count at birth in infants of mothers with type 2B vWD who exhibit thrombocytopenia, may help in the earlier detection of infants at risk for thrombocytopenia.