ISSN:1077-2847    

出版商:OVID    

年代:1996

数据来源: OVID

ISSN:1077-2847    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

BackgroundIleocolic resection and creation of an ileal conduit can be associated with unexpected compromise of intestinal blood supply that can lead to major anastomotic complications. These problems can be anticipated and avoided.MethodsNine patients were identified who underwent a right colectomy with an ileal conduit urinary diversion between 1987 and 1994. The records were retrospectively reviewed for information on operative procedures, outcomes, and complications. Precautions taken in the performance of the operative procedures that related to the ileal conduit and colectomy were recorded.ResultsFive of the nine patients reported intestinal anastomotic complications isolated to the ileocolic area. These included two fistulae, one anastomotic leak with an abscess, one ischemic necrosis of the right colon, and one anastomotic stricture. Patients with an uncomplicated course had undergone resection of a previous ileal-ileal small bowel anastomosis done after ileal conduit creation, or had an extended small bowel resection to secure well-vascularized bowel for anastomosis. There were no complications related to preservation of the ileal conduit blood supply, its integrity, or its function.ConclusionsIleocolic resection with ileal conduit formation can result in a poorly vascularized anastomosis. This poor vascularity is caused by resection of the ileocolic artery during right colectomy and isolation of the superior mesenteric artery to supply the urinary conduit; any remaining ileum may be poorly vascularized. Re-resection of any previously done ileal anastomosis and extension of the proximal and distal resections to obtain well-vascularized bowel will prevent anastomotic complications.

ISSN:1077-2847    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

ObjectivesAim of surgery is not only the resolution of the pathologic conditions, but also the reduction of complications. Cesarean section, more than other operations, has not undergone significant modifications for a very long time. The Stark procedure, based on anatomical principles and the elimination of unnecessary surgical steps, is presented as an alternative to the traditional technique of Cesarean section.Study DesignIn this study, the surgical outcome of 57 patients who underwent a modified Stark procedure was compared with 57 traditional Cesarean sections. Total operating time, fetal extraction time, surgical material consumption, maternal blood loss, postoperative febrile morbidity, and recovery were compared in both groups and statistically analyzed.ResultsMean extraction time of the fetus in the modified Stark procedure was 3.1 minutes (range 1–7), whereas in the traditional procedure it was 7.3 minutes (range 2–19,P <0.001). Mean total operating time was 17 minutes (range 11–28) in the Stark cases and 53.9 minutes (range 33–80) in the control group(P <0.001). Among the Stark cases, a mean of 3.5 threads was used (range 3–6), whereas in the control group the mean was 9.2 (range 6–19,P <0.001). Maternal blood loss, postoperative febrile morbidity, and recovery were significantly improved in the group submitted to the modified Stark procedure.ConclusionsThe basic concept of this innovative technique is the elimination of unnecessary surgical steps and introduction of an alternative approach to the pelvis. The results of this study indicate significant reduction of morbidity and improved outcome.

ISSN:1077-2847    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

ObjectiveTo test the hypothesis that laparoscopic management of ovarian tumors did not decrease patient safety when those tumors were subsequently diagnosed as malignant.Material and MethodsA questionnaire was sent to 273 German departments of obstetrics and gynecology concerning the type of primary laparoscopic techniques used; the secondary cancer operation; cytotoxic treatment; time interval between laparoscopy and cancer operation; and follow-up in cases of ovarian cancer, dysgerrninoma, malignant teratoma, tubal cancer and borderline tumor of the ovary. A responses rate of 46% was obtained from 127 hospitals.ResultsIn the survey, the 192 ovarian malignancy cases managed laparoscopically seem to be an underestimate of the expected frequency in Germany. In the vast majority of these cases, laparoscopic techniques (capsule rupture, biopsy, tumor morcellation) were used that must be considered to be in violation of oncologic guidelines. For example, intact removal of the tumor using an endobag was implemented in only 6 of 81 (7.4%) cases of stage la ovarian cancer. The impact of the laparoscopic techniques used can be seen in the early follow-up of patients on whom secondary cancer surgery was performed 8 days later. Because of this delay, it could be seen that the spilling of tumor cells had already developed to implantations and metastases were macroscopically visible. In 50% (5/10) of cases of stage la borderline rumors and in 73% (26/36) of cases of stage la ovarian cancer, an early progression to stage Ic-III was noted; and in 53% of cases of stage la ovarian cancer (19/36), progression to stage II and III was observed. In 50 cases of laparoscopically managed stage Ic-III ovarian cancer, an early tumor spread to the laparoscopic trocar tract was evident in 52% (13/25) of patients when subsequent radical surgery was delayed more than 8 days. Patients who underwent adequate cancer surgery immediately or within 6 days of the laparoscopic management of ovarian malignancies showed no macroscopically visible signs of progression (metastases, implantations). Such “negative” findings in the German survey do not exclude later findings of iatrogenic progression.ConclusionAccurate preoperative definition of the existence of ovarian tumors is not possible. To thoroughly consider the safety of patients, every ovarian tumor should be considered

ISSN:1077-2847    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

ObjectiveThe objective of this study was to establish a learning curve as represented by operative time for laparoscopically assisted vaginal hysterectomy (LAVH).MethodsOne hundred seventy-five consecutive laparoscopically assisted vaginal hysterectomies performed by four experienced gynecologists were reviewed retrospectively. Changes in operating times were analyzed by a Lowess (smoothed) plot.ResultsFor three of four physicians, operating time reached a plateau at 22 cases. No significant difference was observed with respect to preoperative diagnosis, patient weight, estimated blood loss, or uterine weight, before or after the plateau for any physician. Seven of the ten bladder injuries occurred before the plateau in operating time.ConclusionsFor LAVH, physicians experienced in vaginal surgery may expect to achieve the most efficient operating time by the 22nd case. As expected, more intraoperative complications occur early in the learning curve.

ISSN:1077-2847    

出版商:OVID    

年代:1996

数据来源: OVID

ISSN:1077-2847    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

IntroductionThe ligaments and muscles of the pelvic floor are in the “position of function” in the standing position. This article describes 3 techniques that facilitate studying standing pelvic support anatomy and avoid the artifact induced by injection embalming.MethodsThe pelvic region of female cadavers is fixed by suspending them in formalin just above the flotation point. Once firmly fixed, the pelvis is held in the standing position by a specially designed apparatus consisting of two vertical posts fixed to a board, over which the marrow canals of the proximal femur may be placed. In this position, the structural mechanics of the fascial tissues can be observed while contraction and relaxation of the levator ani muscles are simulated by traction on a cord placed parallel to the fibers of the levator ani muscle.ResultsThese techniques allow the ligaments' orientation to be visualized as they resist gravity. Simulation of levator ani contraction is also possible and shows its relationship to fascial tissue tension. Perception of the structural relationships between the fascia and muscles is emphasized.ConclusionExamination of the supportive tissues of the pelvis in a standing position, fixed without the artifact caused by injection embalming, permits the structural logic of the pelvic organ support system to be appreciated properly.

ISSN:1077-2847    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

ObjectiveTo evaluate the role of preoperative autologous blood donation in gynecologic surgery.MethodsHospital A, a university hospital, and Hospitals B and C, community hospitals, in Gainesville, Florida were evaluated. Data pertaining to autologous blood donated, transfused, and discarded were obtained. The use and discard rates at the individual hospitals were compared with one another to determine if differences exist in the university versus community hospital setting. Statistical analyses were performed using the Fisher's exact test and the corrected chi-squared test with results considered significant whenP <0.05.ResultsOf the 253 units donated before gynecologic surgery, 26 were transfused compared with 1486 of the 2945 donated for surgeries in all specialties(P< 0.001). Comparisons within each of the individual hospitals revealed a statistically significant difference between overall use and use during gynecologic surgery (Hospital A,P <0.001; Hospital B,P= 0.04; Hospital C,P <0.001). Use of autologous blood during gynecologic surgery at Hospital A was not significantly different than that of Hospital B(P =0.3) or Hospital C(P =0.2).ConclusionPreoperative autologous blood donation is not indicated for most gynecologic surgery patients, regardless of the hospital setting.

ISSN:1077-2847    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

BackgroundHemorrhage is a known complication of presacral surgery. This is the first gynecologic case of presacral hemorrhage that was controlled with indirect coagulation through a muscle fragment.CaseA 29-year-old woman with central long-term pelvic pain underwent a presacral neurectomy. Presacral bleeding was encountered during dissection of the hypogastric plexus. Conventional hemostatic methods failed to control presacral hemorrhage. Hemostasis was finally achieved using indirect coagulation through a muscle fragment.ConclusionIndirect coagulation through a muscle fragment may be useful when conventional presacral hemostatic methods fail or when sterile thumbtacks or the applicator is not available.

ISSN:1077-2847    

出版商:OVID    

年代:1996

数据来源: OVID