bluuebunny/crossref_metadata_2025_split huggingface dataset:
Laparoscopic partial bladder resection for bladder endometriosis
Authors: Anaf Vincent , Vaessen Christophe , Zlotta Alexandre , Noël Jean‐Christophe , Simon Jacques , Simon Philippe 
Published: March 2003

ObjectivesTo confirm the feasibility and safety of laparoscopic partial bladder excision.SettingGynaecology department at a university hospital.SubjectsTwo patients with symptomatic bladder endometriosis.InterventionsUreteral catheterization, peroperative cystoscopy, laparoscopic adhesiolysis, bladder dissection, partial cystectomy, bladder closure with running sutures and simultaneous treatment of other endometriotic lesions.ResultsThe procedures were uncomplicated and, took 120 and 105 min, respectively. Bowel function recovery occurred within 24 h in both cases. The Foley catheters were withdrawn on days 10 and 7. Histological examination showed endometriosis. The patients are free of symptoms at 11 and 6 months of follow up.ConclusionsThis technique is feasible and safe and allows simultaneous treatment of other endometriotic lesions. Peroperative cystoscopy and ureteral catheterization are recommended to precisely define the lesion limits and to avoid trapping the ureters in the suture. In trained hands, this technique may become the treatment of choice for bladder endometriosis. Further evaluation will help to determine which instruments and types of sutures are best suited to laparoscopic bladder surgery.
Current status of management of ectopic pregnancy
Authors: Sau Ashis K. , Auld Barry J. , Sau Mita 
Published: March 2003

ObjectiveTo evaluate the relative safety and efficacy of conservative surgical, medical and expectant management.DesignRelevant studies were identified through a computer Medline search.ResultsLaparoscopy is not mandatory for diagnosis of ectopic pregnancy, which can be diagnosed by the use of transvaginal scan and estimation of quantitative βhCG. Laparoscopic salpingectomy or salpingostomy is preferred to laparotomy in a haemodynamically stable patient and should be used more frequently. The role of expectant management in ectopic pregnancy is very limited. Spontaneous resolution may occur only in a selected group of unruptured ectopic pregnancies with an initial βhCG of <200 mIU/ml and declining hCG level. Systemic methotrexate administration is a promising treatment in patients with early and unruptured ectopic pregnancy. Several prospective studies have shown success rates of 85–94% following single‐dose systemic methotrexate treatment. Single‐dose methotrexate is associated with fewer side‐effects but is as effective as multiple‐dose regimes. Recurrent ectopic pregnancy and intrauterine pregnancy rates following systemic methotrexate are comparable to those following laparoscopic salpingostomy.ConclusionSystemic methotrexate is a viable alternative to laparoscopic salpingostomy for women wishing to preserve their fertility. A large prospective randomized trial is needed to establish whether laparoscopic surgery or methotrexate should be the first‐line treatment.
Intraperitoneal bupivacaine vs. tramadol for pain relief following day case laparoscopic surgery
Authors: Darwish Atef M. , Zareh Hassan Zein E. A. 
Published: March 2003

ObjectivesTo record the severity of pain following operative laparoscopic surgery and to assess the effectiveness of either intraperitoneal infusion of bupivacaine or intravenous tramadol for postoperative pain relief.DesignA prospective randomized study.SettingGynaecologic Endoscopy Unit, Assiut University Hospital, Assiut, Egypt.Subjects90 patients undergoing day case laparoscopic surgery where a standard anaesthetic technique was used.InterventionsPatients were randomly allocated to one of three groups according to the analgesia provided in the postoperative period. Group B received intraperitoneal bupivacaine (20 ml, 0.25%) through the laparoscopic cannula and another 5 ml which was injected around the incision sites. Group T received intravenous tramadol hydrochloride slowly in a dose of 2 mg/kg, after the end of the procedure and group P received placebo saline, 20 ml intraperitoneally and 5 ml at the incision sites, and a placebo saline 2‐ml intravenous injection.Main outcome measuresEach patient recorded the site of pain, and its severity using a 4‐point verbal rating scale (0 = no pain to 3 = severe pain), at 30, 60, 120 and 240 min postoperatively. We also recorded the maximum pain score, the need for fentanyl and the time to first analgesia in minutes. The suitability for same‐ or next‐day discharge was also assessed in all patients.ResultsThe trial showed a statistically significant reduction in pain scores up to 4 h postoperatively in groups T and B compared with group P (P < 0.05). Also, the time to first analgesia was prolonged and there was less need for fentanyl and earlier discharge in groups T and B.ConclusionsWe concluded that both of the analgesic regimens used were satisfactory, but intraperitoneal bupivacaine showed better analgesic outcomes and is a useful contribution to analgesia in the immediate postoperative period after day‐case laparoscopic surgery.
Gynaecological endoscopy training simulators
Authors: Hadzimahmutovic Zorana , Healy David L. , Tsaltas Jim , Lawrence Anthony S. , Brown T. Ian H. , Flanagan Brendan 
Published: March 2003

ObjectiveTo introduce the concept of simulator training to gynaecological surgeons and to inform them of the current state of worldwide research into the development of a laparoscopic simulator.AttributesVirtual‐reality technology enables the surgeon not only to perform diagnostic procedures, but also to practice entire surgical operations on a mannikin, while observing and interacting with a realistic computer‐generated gynaecological environment on‐screen. The benefits of such simulator training are twofold: surgeons will be at a higher point on the learning curve before their first operation on a patient, and patients should enjoy better quality of care.ResearchGreat confidence in the potential of virtual‐reality technology in gynaecology, and medicine in general, has generated considerable international interest. As a result, much research and development effort is going into the creation of a gynaecological endoscopy simulator. Although several laparoscopic simulators are near their completion stage, there are no commercially available systems as yet.Medical educationA plan for the successful implementation of simulator training in gynaecology, through preceptorship and credentialling programs, is outlined. Use of simulator training in gynaecology, and other medical fields, is expected to become more popular with further advances in technology.
Laparoscopic hysterectomy and assisted Vecchietti procedure to treat congenital cervical and vaginal atresia
Authors: Broome Jonathan D. , Cerqui Anthony J. , Vancaillie Thierry G. , Bennett Michael J. 
Published: March 2003

ObjectiveTo report a case of complete cervical and vaginal atresia treated by laparoscopic hysterectomy and assisted Vecchietti procedure.SubjectAn 18‐year‐old woman requesting formation of a neovagina. The initial diagnosis of cervical and vaginal atresia had been made by ultrasound and confirmed by laparoscopy when the patient was aged 15 years.ResultsNo intra‐ or postoperative complications were recorded. A neovagina with a depth of 7 cm and width of 1.5 cm was created. Subsequent use of vaginal dilators produced a functional vagina at 6 weeks postoperatively.ConclusionThe use of laparoscopy to treat Müllerian anomalies, with the benefits of reduced postoperative morbidity and excellent cosmesis, should be supported.
Imaging leiomyomas prior to endoscopic surgery: the role of magnetic resonance imaging
Authors: Dover Richard W. , Powell Martin C. 
Published: March 2003

ObjectiveTo determine whether the use of scanning by magnetic resonance imaging (MRI) prior to endoscopic surgery for uterine fibroids gave an improved outcome compared with the use of ultrasound.DesignA retrospective analysis of the available literature.ResultsThe improved imaging afforded by MRI results in a better differentiation of fibroids from focal adenomyomas, and more accurate assessment of the size, number and location of fibroids within the uterus, when compared with the results obtained by ultrasound scanning.ConclusionsIn situations such as infertility where uterine conservation is paramount, the extra information provided by MRI allows better preoperative counselling and planning, and should be considered as an alternative to ultrasound scanning. However, it should not be considered as a first‐line investigation when patients are undergoing hysterectomy or when the diagnosis is thought to be diffuse adenomyosis.
Laparoscopic surgery of endometrial cancer. Preliminary results of a multicentric study
Authors: Holub Zdeněk , Bartos Pavel , Eim Josef 
Published: March 2003

ObjectiveTo analyse the results of laparoscopic management of women with endometrial cancer, and comparison with the open technique.DesignProspective multicentre study.SettingDepartment of Gynaecology, Hospital for Infants, Kladno, Czech Republic.Subjects76 women who underwent laparoscopic surgery and open procedures for endometrial cancer.Main outcome measuresThe differences between both the peri‐ and postoperative outcomes were evaluated.ResultsTwo patients whose surgery was completed by laparotomy were excluded from the study. The other 43 laparoscopic procedures were successfully completed. Laparoscopic hysterectomy and pelvic and para‐aortic lymphadenectomies were carried out, based on the grade of the tumour and the depth of myometrial invasion. Of the patients, 19 underwent pelvic lymphadenectomy and 14 women also had para‐aortic lymph node sampling dissection. Five of these patients had positive pelvic or para‐aortic nodes. The mean operating time was 178 min vs. 151 min in the control open group. There were no major complications.ConclusionsThe laparoscopic approach to surgery for early stage endometrial carcinoma is an attractive alternative to the conventional surgical approach. The advantages of laparoscopic surgery are patient related. Because an abdominal incision is avoided, recovery time is reduced. The major obstacle to incorporating operative laparoscopy into gynaecological oncology is the lack of controlled studies demonstrating its ability to improve current management.
Making the case for the radially expanding access system
Authors: Turner Duncan J. 
Published: March 2003

ObjectiveTo report data on the case of the radially expanding access device for laparoscopic surgery.DesignA narrative based on personal and industry‐wide evidence‐based outcome data on abdominal injuries caused by sharp trocars, compared with the safety associated with the radially expanding access system.SubjectsPatients undergoing laparoscopic gynaecological and general surgical procedures.ConclusionsUse of the radially expanding access device is associated with far fewer abdominal injuries, reduced pain and a much lower incidence of incisional hernia.
The role of microlaparoscopy for safer wall entry: incidence of umbilical adhesions according to past surgical history
Authors: Audebert Alain J. M. 
Published: March 2003

ObjectiveTo determine the incidence of umbilical adhesions related to previous surgical history.DesignA prospective single‐centre study with a single operator.SettingClinique Saint‐Sernin and Polyclinique de Bordeaux, Bordeaux, France.Subjects900 patients undergoing diagnostic or operative laparoscopy, classified into four groups: group I, 419 patients with no previous surgical surgery (control group); group II, 140 patients with previous major operative laparoscopy; group III 145 patients with previous laparotomy with a horizontal suprapubic incision; group IV, 96 patients with a previous laparotomy with a midline incision.InterventionInspection of the umbilical area for the presence of adhesions, with a microlaparoscope passed through a Veress needle at Palmer's point.Main outcome measuresIncidence and severity of umbilical adhesions and their potential risk in case of blind insertion of the umbilical trocar.ResultsUmbilical adhesions were noticed in 9.77% of the 900 patients. The incidence was different in the four groups: group I, 0.77%; group II, 1.42%; group III, 21.37%; group IV, 53.12%. Severe adhesions, with a potential risk in case of blind insertion of the umbilical trocar, were encountered in 0.38%, 0.71%, 6.89% and 31.25%, respectively, in the patients in the four groups.ConclusionsWomen with previous laparotomy have a higher incidence of umbilical adhesions, especially in the case of midline incisions. Preliminary inspection of the umbilical area with a microlaparoscope and insertion of the umbilical trocar under direct vision are recommended in these high risk patients, in order to reduce complications of trocar insertion.
Bilateral tubal pregnancy and laparoscopic bilateral salpingotomy
Authors: Herrero Rafael J. M. , Zafy Sylvie , Chitrit Yvon 
Published: March 2003

Objective To consider whether laparoscopic bilateral salpingotomy can be effective in the management of bilateral simultaneous tubal pregnancy. Design A case report. Subject A 24‐year‐old Indian woman, gravida 2 para 1, with pelvic pain at 5 weeks' gestation. Interventions The patient had conceived with an ovulation induction regimen. Pelvic examination and ultrasonography suggested an ectopic pregnancy. Laparoscopy revealed bilateral simultaneous tubal pregnancy. Conservative treatment through bilateral linear salpingotomy was carried out and pathological investigation confirmed the presence of chorionic villi in both tubes. Results The postoperative clinical course was uneventful and β‐human chorionic gonadotrophin levels dropped satisfactorily. The patient required no further treatment. Comment  Correctly performed laparoscopic bilateral salpingotomy can be effective in the management of bilateral simultaneous tubal pregnancy.
Hysteroscopic findings in postmenopausal patients with a thick endometrium after using implants of oestradiol and testosterone
Authors: Maia Hugo , Maltez Amélia , Fahel Paulo , Oliveira Mayta , Coutinho Elsimar M 
Published: March 2003

Objective  To evaluate the endometrial cavity of postmenopausal patients who developed a persistent increase in endometrial thickness, detected by transvaginal sonography, after using implants of oestradiol and testosterone. Design  This is a retrospective study. Results  23 patients with an endometrial echo >5 mm were evaluated by hysteroscopy. Of these, 18 patients had an endometrial polyp, two had proliferative endometrium and in the remaining three the uterine cavity was atrophic. There were three cases of complex hyperplasia within the polyp, two without atypia and one with moderate nuclear atypia. There was one case of endometrial carcinoma developing in a polypoid lesion. Conclusion  Endometrial polyps were the most frequent pathological finding detected in the uterine cavity of menopausal patients who had developed an increase in endometrial thickness after using implants of oestradiol and testosterone. There was one case of endometrial carcinoma in a polyp.
Laparoscopic management of genital prolapse: lateral suspension with two meshes
Authors: Dubuisson Jean‐bernard , Chapron Charles , Fauconnier Arnaud , Babaki‐Fard Katayoun , Dendrinos Spiros 
Published: March 2003

ObjectiveTo report our experience with a new laparoscopic technique to treat genital prolapse.SubjectsProspective longitudinal case study of 35 women with genital prolapse treated between June 1997 and January 1999.InterventionThe technique involves the use of two composite meshes, one of which is applied to the upper portion of the anterior wall of the vagina and the other to the upper portion of the posterior vaginal wall and posterior aspect of the cervix if present. The lateral ends of the two meshes are pulled trough a retroperitoneal tunnel and fixed to the aponeurosis of the external oblique muscle above the iliac crest. Depending on the patient's symptoms and clinical findings, ancillary procedures (i.e. urethropexy, repair of the pouch of Douglas) may be necessary.ResultsThe average operating time was 254 ± 45 min (range 180–360). The total rate of complications was 20% (seven cases). The mean duration of hospital stay was 4.8 ± 1.2 days (range 3–8). With regard to the anatomical results: the mean postoperative follow up was 5 ± 4.6 months; results were excellent in 80% of cases. The remaining 20% had moderate posterior vaginal wall defect. With regard to the functional results: the mean follow‐up was 10.5 ± 4.6 months; 90.9% of the patients were satisfied; the functional defects were persistent urinary stress incontinence in 6.6% cases, urgency in 6.6% cases, frequency in 6.6% cases, constipation in 9.1% cases; the rate of dyspareunia in patients who were sexually active was 10.3%.ConclusionThis technique presents the advantage of providing complete treatment for prolapse using laparoscopic surgery without having to approach the promontory or having to carry out extensive reperitonealization.
The effect of operator gender on patient satisfaction: does the ‘Y’ in outpatient hysteroscopy matter?
Authors: Mc Gurgan P. , O'Donovan P. , Jones S. E. 
Published: March 2003

Objective To evaluate the preconceptions and perceptions of patients having outpatient hysteroscopy, with emphasis on their attitudes towards the gynaecologist's gender.Design A prospective anonymous questionnaire used before and after the procedure. The operators were randomly allocated, and blinded to the results.Setting A district general hospital.Subjects 77 women referred to an outpatient hysteroscopy clinic.Main outcome measures How many patients expressed a preference concerning the gender of the hysteroscopist, and whether the hysteroscopist's gender influenced the patient's pain scores or satisfaction.Results Outpatient hysteroscopy was performed on 77 patients (38 by a male surgeon and 39 by a female surgeon).The two groups of patients were similar in age, parity, ethnicity, referral source and premedication use. Of the patients, 15 (39%) allocated to a male and nine (23%), of the patients allocated to a female would have preferred a female hysteroscopist; this was not statistically significant (P = 0.12). No patients expressed a preference for a male. Gender preference had no significant effect on preoperative anxiety (P = 0.58), procedure discomfort (P = 0.76), or satisfaction (P = 0.28). Patients treated by a male were more likely to state that the procedure would have been improved by having a female surgeon (P = 0.05).Conclusions The preference rates for gender are comparable to those of other published studies. Patients treated by operators of different genders do not have any difference in discomfort or satisfaction scores, but women treated by men perceive that the procedure would have been improved if a female hysteroscopist had treated them. For future practice, women should be given a choice of hysteroscopist gender where practical; however, this does not appear to have any effect on discomfort or satisfaction.
Evaluation of ultrasound in an outpatient hysteroscopy clinic: does it alter management in premenopausal women?
Authors: Taylor Sue , Jones Siân , Dixon Anne‐Marie , O'Donovan Peter 
Published: March 2003

ObjectiveTo assess the role of ultrasound with respect to management decisions in premenopausal women with abnormal uterine bleeding attending an outpatient hysteroscopy clinic.DesignRetrospective analysis of ultrasound and hysteroscopic findings, in 264 women referred with abnormal uterine bleeding.SettingOutpatient hysteroscopy clinic in a busy district general hospital.ResultsIn situations where hysteroscopy findings were normal, additional information gained from a preliminary ultrasound did not affect management decisions. No malignant adnexal pathology was detected, and ultrasound assessment of the endometrium did not correlate well with either hysteroscopic or histological findings.ConclusionUltrasound findings do not alter management decisions in this situation. The presence of irregular bleeding, and patients' prior expectations, are more significant determinants.
The application of hysteroscopy in diagnosis and treatment of missing intra‐uterine devices
Authors: Feng Zuan Chong , Shi Yong Peng , Wu Xue Zhe , Liu Su Ping 
Published: March 2003

ObjectiveTo evaluate the efficacy of hysteroscopy for diagnosis and treatment of missing intra‐uterine devices (IUDs).DesignA retrospective study of 274 patients.SettingShanghai Institute of Planned Parenthood Research, Shanghai Jiading District Gynaecological Endoscopy Centre and Shanghai First Maternity and Infant Health Hospital.Subjects274 patients with missing IUDs, who had previously undergone up to four unsuccessful attempts at IUD removal, were included in our study. Among them, 45 patients had been menopausal for more than 1 year.InterventionsHysteroscopy was used to detect and/or remove the missing IUDs or their broken pieces in all patients.ResultsIn 237 out of 274 patients with missing devices, the IUDs or their broken pieces in the uterine cavity were detected by hysteroscopy. In 236 out of these 237 patients, the IUDs or their broken pieces were removed successfully under hysteroscopic view or after hysteroscopic location. In one case only a small piece of the IUD remained in the uterine wall because of breakage during extraction. The IUDs of the remaining 37 patients were not found in the uterine cavity: in 13 patients there was expulsion of IUDs; in two there were broken pieces embedded in the uterine wall; 14 patients had IUDs removed by laparoscopy, and eight IUDs were removed by laparotomy.ConclusionOur study indicates that hysteroscopy, sometimes with an ultrasound B‐scan or laparoscopic guide, is of great value not only for precise locating of the IUD, but also for its removal under direct vision, particularly in the management of patients with broken and/or embedded IUD pieces.
Laparoscopic resection of deeply infiltrating endometriosis of the rectovaginal septum: effect on pelvic pain
Authors: Kwok Adrian , Lam Alan , Ford Robert 
Published: March 2003

ObjectiveTo compare pain scores for dysmenorrhoea, intermenstrual pelvic pain, dyspareunia and dyschezia before and after resection of endometriotic nodules from the rectovaginal septum.DesignRetrospective review of case records in 46 patients who had resection of deeply infiltrating endometriotic nodules from the rectovaginal septum. Adhesiolysis and treatment of endometriomas were performed where necessary. Two patients underwent laparoscopic uterosacral nerve ablation.ResultsThe average patient age was 32 years. The presenting symptoms were: severe dysmenorrhoea (70%), pelvic pain (65%), dyspareunia (28%), dyschezia (30%) and infertility (28%). Improvements in pain scores at follow up (mean 8.8 months) were 59%, 87%, 77% and 86%. Only one of the 13 patients with infertility conceived in the follow‐up period.ConclusionThis retrospective analysis suggests that the laparoscopic resection of rectovaginal endometriosis is effective in improving the different facets of pelvic pain. We believe that the development of a standardized scoring system to assess pain resulting from endometriosis would be helpful, as well as prospective studies to evaluate different treatment modalities.
Surgical management of endosalpingiosis with tubovaginal fistulization after hysterectomy by a combined laparoscopic‐vaginal route, and histological findings
Authors: Fleckenstein Georg , Heyl Wolfgang , Brinck Ulrich , Pauer Ulrich , Viereck Volker , Emons Günter 
Published: March 2003

BackgroundIsolated endosalpingiosis with vaginal fistulization after histerectomy is an extremely rare event.CaseWe present the interesting case of a female patient with persistent ‘menstrual bleeding’ after an abdominal hysterectomy. The cause was found to be an isolated endosalpingiosis with vaginal fistulization. Postoperative confirmation of the presumptive diagnosis was obtained by seamless histomorpholgical analysis of the tube and fistula and surrounding tissue. The situation was managed using a combined laparoscopic‐vaginal approach.ConclusionThe cyclic occurrence of vaginal bleeding after hysterectomy should by clarified endoscopically.