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Laparoscopic burch colposuspension for stress incontinence
Abstracts
159. Predicting the Risk of Malignancy of Ovarian Masses in Premenopausal Women Based on Preoperative Findings and Correlation with Histopathologic Diagnosis
paraaortic nodal yields were 26 (range 1-56) and 17.3 (range 1-31), respectively. The only intraoperative complication was incidental transection of a distal branch of the inferior mesenteric artery controlled laparoscopically without adverse sequelae. One woman required blood transfusion during radical hysterectomy. There were no unplanned conversions to laparotomy. Two patients had postoperative fevers, and one had subcutaneous emphysema requiring observation. All resolved spontaneously. Conclusion. Laparoscopic pelvic and paraaortic lymph node removal using the harmonic scalpel appears both feasible and safe in the treatment of patients with gynecologic cancers. It is useful as a grasper, coagulator, disector, and cutting device, and avoids exchange of several instruments and clip application.
G Oelsner, L Eshet, A Kalter, G Artom, WH Gotlieb. Sheba Medical Center, Tel Aviv University, Tel Hashomer, Israel.
Objective. To describe a preoperative scoring system to predict the presence of malignancy in ovarian masses in premenopausal women, based on pelvic examination, ultrasonographic findings, and tumor markers. Measurements and Main Results. Premenopausal women not suspected of having malignancy underwent surgery for removal of ovarian masses after pelvic examination, vaginal ultrasound, and tumor markers. Resection of ovarian masses was performed by laparoscopy (309 patients) or laparotomy (81). Of 390 patients (mean age 29.2 + 6.8), 7 had a borderline tumor, 2 carcinoma, and 1 an immature teratoma. Only one malignancy was larger than 5 cm, two were simple cysts larger than 5 cm, and all had normal resistance index. Three of four women had CA 125 values within normal limits. Malignancy was missed by frozen section in 30% of cases. Conclusion. Our preoperative scoring system was successful in determining potentially malignant pelvic masses.
158. Importance of Histology before Endometrial Ablation A Niesel, U Neeb. Hospital of Peine, Peine, Germany.
Objective. To determine whether histology of endometrium before endometrial ablation protects against endometrial cancer. Measurements and Main Results. In addition to one woman in our own clinic, a MEDLINE search for articles about endometriaJ cancer after ablation yielded 16 cases between 1991 and 2001. Despite numerous D&Cs, endometrial biopsies, and hysteroscopies, early-stage endometrial cancers were not detected. Although contraindicated, women with adenomatous hyperplasia were treated with ablation. In no patient was carcinoma detected preoperatively. Most patients had high risk factors for developing endometrial cancer, such as marked obesity, diabetes mellitus, or hypertension. Thus far no endometrial cancer was reported after laser ablation, only after electrosurgical procedures. Regular cytobrush, ultrasound, and annual progesterone challenge are suggested to monitor high-risk patients after ablation. Conclusion. Endometrial cancer after ablation is a rare event. Not only normal histology but careful patient selection, excluding a33amnestic risk factors, normal vaginal ultrasound, and hysteroscopy, can help to avoid the disease after ablation.
160. Laparoscopic Burch Colposuspension for Stress Incontinence 1RT O'Shea, 1M Ritossa, 1E Seman, 2j Taylor. 1Flinders Endogynaecology, Flinders University and Flinders Medical Centre; 2Modbury Hospital, Adelaide, Australia.
Objective. To review outcomes and continence rates in women undergoing laparoscopic Burch colposuspension. Measurements and Main Results. One hundred seventy-five women underwent laparoscopic Burch colposuspension for urinary incontinence. Mean operating time was 112 minutes, mean blood loss was 119 ml, mean hospital stay was 5.1 days. Operative complications were conversion to laparotomy (4.8%) and cystotomy (9%). Average return to activity was 22 days. Based on results of an extensive questionnaire regarding urinary symptoms, 87% of women reported
$48
August 2001, Vol. 8, No. 3 Supplement
TheJournal of the American Association of Gynecologic Laparoscopists
Conclusion. Local damaging peritoneal alterations of increasing aridity, changes in hydrologic and morphodynamic processes, tissue desiccation, and peritoneal fluid alterations all occur due to dryness of laparoscopic gas.
improvement regardless of length of follow-up; 82% whose follow-up was less than 5 years were completely dry compared with 75% who were operated on more than 5 years ago. Conclusion. Long- and short-term continence rates after laparoscopic Burch colposuspension compare favorably with those of the open procedure.
163. Terminal Gas Velocity During Laparoscopy DE Ott, LW Lackey. Mercer University, School of Engineering, Macon, Georgia.
161. Total Laparoscopic Hysterectomy Using the McCartney Tube versus LAVH
Objective. To assess the effect of port size in relation to laparoscopic gas flow and deformation to determine the terminal velocity of gas flow during insufflation. Measurements and Main Results. We performed analytic calculations, including Bemoulli's equation and mass transfer analysis, and laboratory testing of gas flow velocity as it exits laparoscopic intraabdominal entrance sites. Mathematic modeling and anemometer analysis showed that a terminal velocity of gas entering the abdomen through needles or carmulas reaches a practical limit dependent on size and configuration of gas exit site, amount of turbulence, length of delivery port, and gas flow. Flow rate ranged from 1 to 10 L/minute for circles of 2, 5, and 10 mm, and annular slots of 0.1 to 0.01 mm thickness. Conclusion. Resistance to gas flow and gas exiting terminal velocity increase as the effective area of the gas exit site decreases. Depending on the configuration of variable parameters, gas flows can reach 70 miles/hour.
RT O'Shea, E Seman, J Cook, E Lombardi, S Gordon. Flinders Endogynaecology, Flinders University and Flinders Medical Centre, Adelaide, Australia.
Objective. To compare two groups of patients, one undergoing TLH (280) and the other LAVH (130). Measurements and Main Results. Patient characteristics were similar (mean age 47.5 yrs, mean weight 74 kg, parity 2). Indications for surgery were predominantly myomas and heavy menstrual bleeding (70%). Operative technique was mainly bipolar diathermy in each group, with concomitant high McCall culdoplasty in 50% of cases. Mean operating times were 120 minutes (TLH) and 119 minutes (LAVH). Mean estimated blood loss was 126 and 301 ml, mean uterine weight 146 g and 127 g, and mean hospital stay 3.3 and 4.6 days, respectively. Complications such as inferior epigastric injury, bladder laceration, bowel injury, and vault infection were equivalent in each group. Ureteric injury rates were 1.1% (TLH) and 0.8% (LAVH). Conclusion. Reduced blood loss and shorter hospital stay suggest that TLH is preferred over LAVH.
164. The Flexible Grasper and Cutter AC Pagedas. Rawson Medical Center, Franklin, Wisconsin.
162. Desertification of Peritoneum by Thin Film Evaporation During Laparoscopy
Objective. To describe a flexible instrument that grasps, cuts, coagulates, and can act as a needle holder if necessary. Measurements and Main Results. With assistance of the grasper guide, the instrument can reach many outof-the-way areas that at one time required the surgeon to perform awkward haaad-wrist maneuvers. Thus the surgeon is able to operate with greater safety and ease. The instrument activates each function like a multicolored ballpoint pen. The suture lock uses the cable-lock principle to simplify intracorporeal knot tying requiring one or two movements. Conclusion. The instrument performs a wide range of functions during laparoscopy.
DE Ott. Mercer University, School of Engineering, Macon, Georgia.
Objective. To assess effects of gas flow during insufflation on peritoneal fluid and peritoneal tissue with respect to transient thermal behavior and evaporation. Measurements and Main Results. Predicted analysis correlated with test findings showing that the laparoscopic high-velocity gas interface conditions result in surface temperature decreases up to 20 ~ C/second, and rapid evaporative effects that disrupt cell membranes and cause loss of peritoneal surface continuity and integrity.
$49
159. Predicting the Risk of Malignancy of Ovarian Masses in Premenopausal Women Based on Preoperative Findings and Correlation with Histopathologic Diagnosis
paraaortic nodal yields were 26 (range 1-56) and 17.3 (range 1-31), respectively. The only intraoperative complication was incidental transection of a distal branch of the inferior mesenteric artery controlled laparoscopically without adverse sequelae. One woman required blood transfusion during radical hysterectomy. There were no unplanned conversions to laparotomy. Two patients had postoperative fevers, and one had subcutaneous emphysema requiring observation. All resolved spontaneously. Conclusion. Laparoscopic pelvic and paraaortic lymph node removal using the harmonic scalpel appears both feasible and safe in the treatment of patients with gynecologic cancers. It is useful as a grasper, coagulator, disector, and cutting device, and avoids exchange of several instruments and clip application.
G Oelsner, L Eshet, A Kalter, G Artom, WH Gotlieb. Sheba Medical Center, Tel Aviv University, Tel Hashomer, Israel.
Objective. To describe a preoperative scoring system to predict the presence of malignancy in ovarian masses in premenopausal women, based on pelvic examination, ultrasonographic findings, and tumor markers. Measurements and Main Results. Premenopausal women not suspected of having malignancy underwent surgery for removal of ovarian masses after pelvic examination, vaginal ultrasound, and tumor markers. Resection of ovarian masses was performed by laparoscopy (309 patients) or laparotomy (81). Of 390 patients (mean age 29.2 + 6.8), 7 had a borderline tumor, 2 carcinoma, and 1 an immature teratoma. Only one malignancy was larger than 5 cm, two were simple cysts larger than 5 cm, and all had normal resistance index. Three of four women had CA 125 values within normal limits. Malignancy was missed by frozen section in 30% of cases. Conclusion. Our preoperative scoring system was successful in determining potentially malignant pelvic masses.
158. Importance of Histology before Endometrial Ablation A Niesel, U Neeb. Hospital of Peine, Peine, Germany.
Objective. To determine whether histology of endometrium before endometrial ablation protects against endometrial cancer. Measurements and Main Results. In addition to one woman in our own clinic, a MEDLINE search for articles about endometriaJ cancer after ablation yielded 16 cases between 1991 and 2001. Despite numerous D&Cs, endometrial biopsies, and hysteroscopies, early-stage endometrial cancers were not detected. Although contraindicated, women with adenomatous hyperplasia were treated with ablation. In no patient was carcinoma detected preoperatively. Most patients had high risk factors for developing endometrial cancer, such as marked obesity, diabetes mellitus, or hypertension. Thus far no endometrial cancer was reported after laser ablation, only after electrosurgical procedures. Regular cytobrush, ultrasound, and annual progesterone challenge are suggested to monitor high-risk patients after ablation. Conclusion. Endometrial cancer after ablation is a rare event. Not only normal histology but careful patient selection, excluding a33amnestic risk factors, normal vaginal ultrasound, and hysteroscopy, can help to avoid the disease after ablation.
160. Laparoscopic Burch Colposuspension for Stress Incontinence 1RT O'Shea, 1M Ritossa, 1E Seman, 2j Taylor. 1Flinders Endogynaecology, Flinders University and Flinders Medical Centre; 2Modbury Hospital, Adelaide, Australia.
Objective. To review outcomes and continence rates in women undergoing laparoscopic Burch colposuspension. Measurements and Main Results. One hundred seventy-five women underwent laparoscopic Burch colposuspension for urinary incontinence. Mean operating time was 112 minutes, mean blood loss was 119 ml, mean hospital stay was 5.1 days. Operative complications were conversion to laparotomy (4.8%) and cystotomy (9%). Average return to activity was 22 days. Based on results of an extensive questionnaire regarding urinary symptoms, 87% of women reported
$48
August 2001, Vol. 8, No. 3 Supplement
TheJournal of the American Association of Gynecologic Laparoscopists
Conclusion. Local damaging peritoneal alterations of increasing aridity, changes in hydrologic and morphodynamic processes, tissue desiccation, and peritoneal fluid alterations all occur due to dryness of laparoscopic gas.
improvement regardless of length of follow-up; 82% whose follow-up was less than 5 years were completely dry compared with 75% who were operated on more than 5 years ago. Conclusion. Long- and short-term continence rates after laparoscopic Burch colposuspension compare favorably with those of the open procedure.
163. Terminal Gas Velocity During Laparoscopy DE Ott, LW Lackey. Mercer University, School of Engineering, Macon, Georgia.
161. Total Laparoscopic Hysterectomy Using the McCartney Tube versus LAVH
Objective. To assess the effect of port size in relation to laparoscopic gas flow and deformation to determine the terminal velocity of gas flow during insufflation. Measurements and Main Results. We performed analytic calculations, including Bemoulli's equation and mass transfer analysis, and laboratory testing of gas flow velocity as it exits laparoscopic intraabdominal entrance sites. Mathematic modeling and anemometer analysis showed that a terminal velocity of gas entering the abdomen through needles or carmulas reaches a practical limit dependent on size and configuration of gas exit site, amount of turbulence, length of delivery port, and gas flow. Flow rate ranged from 1 to 10 L/minute for circles of 2, 5, and 10 mm, and annular slots of 0.1 to 0.01 mm thickness. Conclusion. Resistance to gas flow and gas exiting terminal velocity increase as the effective area of the gas exit site decreases. Depending on the configuration of variable parameters, gas flows can reach 70 miles/hour.
RT O'Shea, E Seman, J Cook, E Lombardi, S Gordon. Flinders Endogynaecology, Flinders University and Flinders Medical Centre, Adelaide, Australia.
Objective. To compare two groups of patients, one undergoing TLH (280) and the other LAVH (130). Measurements and Main Results. Patient characteristics were similar (mean age 47.5 yrs, mean weight 74 kg, parity 2). Indications for surgery were predominantly myomas and heavy menstrual bleeding (70%). Operative technique was mainly bipolar diathermy in each group, with concomitant high McCall culdoplasty in 50% of cases. Mean operating times were 120 minutes (TLH) and 119 minutes (LAVH). Mean estimated blood loss was 126 and 301 ml, mean uterine weight 146 g and 127 g, and mean hospital stay 3.3 and 4.6 days, respectively. Complications such as inferior epigastric injury, bladder laceration, bowel injury, and vault infection were equivalent in each group. Ureteric injury rates were 1.1% (TLH) and 0.8% (LAVH). Conclusion. Reduced blood loss and shorter hospital stay suggest that TLH is preferred over LAVH.
164. The Flexible Grasper and Cutter AC Pagedas. Rawson Medical Center, Franklin, Wisconsin.
162. Desertification of Peritoneum by Thin Film Evaporation During Laparoscopy
Objective. To describe a flexible instrument that grasps, cuts, coagulates, and can act as a needle holder if necessary. Measurements and Main Results. With assistance of the grasper guide, the instrument can reach many outof-the-way areas that at one time required the surgeon to perform awkward haaad-wrist maneuvers. Thus the surgeon is able to operate with greater safety and ease. The instrument activates each function like a multicolored ballpoint pen. The suture lock uses the cable-lock principle to simplify intracorporeal knot tying requiring one or two movements. Conclusion. The instrument performs a wide range of functions during laparoscopy.
DE Ott. Mercer University, School of Engineering, Macon, Georgia.
Objective. To assess effects of gas flow during insufflation on peritoneal fluid and peritoneal tissue with respect to transient thermal behavior and evaporation. Measurements and Main Results. Predicted analysis correlated with test findings showing that the laparoscopic high-velocity gas interface conditions result in surface temperature decreases up to 20 ~ C/second, and rapid evaporative effects that disrupt cell membranes and cause loss of peritoneal surface continuity and integrity.
$49