- Email: [email protected]
Complications of multipuncture laparoscopic surgery
Selected Scientific Abstracts
compared 128 women in whom laparoscopic management was attempted with 157 who had a primary laparotomy. Our first laparoscopic oophorectomy was performed in 1989, and during 1995, 37 (73%) of 51 patients underwent the procedure. The failure rate for laparoscopy was 3.3% during the study period. The operating time was the same for both groups. With laparoscopy the mean size of the mass was 5.5 cm (range 3-16 cm). Complication rates were higher for laparotomy than for taparoscopy (29% vs 4%). In the laparoscopy group, two tumors of low malignant potential and one ovarian cancer were found (2.3%). With the increasing application of laparoscopy we reduced yearly average length of hospital stay for oophorectomy from 4.3 to 1.4 days. A cost analysis was completed comparing the two groups. Laparoscopic oophorectomy can be performed safely, with reduced morbidity and patient disability. By having a oncologist backup we have been able to convert most procedures to the laparoscopic approach.
malignancies. Because radiologic methods to detect occult paraaortic lymph node metastases are inaccurate and staging requires a major surgical procedure, we investigated the feasibility of laparoscopic paraaortic lymph node dissection in our preliminary series of five women (3 stage IIb cervical cancer, 1 stage Ib cervical cancer, 1 ovarian cancer). Three patients with stage Ib cervical cancer scheduled for primary radiotherapy underwent selective paraaortic lymph node biopsy only. We performed laparoscopic radical hysterectomy with pelvic lymphadenectomy in the patient with stage Ib disease, in addition to paraaortic lymph node dissection. The average operating time for lymph node dissection was 125 minutes and mean estimated blood loss was 250 ml. The average number of lymph nodes removed was 3.6. We conclude that this laparoscopic procedure is feasible and helps guide the management of these patients.
Complications of Multipuncture LaparoscopicSurgery M Hur, BH Kang. Chung-Ang University, Seoul, Korea.
Lateral Ovarian Transposition before Radiation Treatment of Hodgkin Disease
We analyzed the complications that occurred in 1813 laparoscopic operations performed in our institution from August 1989 to August 1995. The patients' mean age was 39.3 + 8.5 years and mean parity was 1.5 + 1.2. The most common indication for operative laparoscopy was uterine myomas (45.8%). After the procedure, 87 women (4.8%) developed complications. The most common was subcutaneous emphysema (42, 48.3%). Other complications were unintended laparotomies, 16 (18.4%); urinary complications, 11 (12.6%); and vascular injuries, 9 (10.3%). Understanding these complications and determining how to avoid them is the only way to reduce their frequency. Prompt recognition and treatment of complications results in the most favorable outcome.
FM Howard. Rochester General Hospital, Rochester, NY.
Preservation of ovarian function by repositioning the ovaries out of the irradiation field is suggested in women of reproductive age before pelvic radiotherapy for cervical cancer or Hodgkin disease. In women with Hodgkin disease this is usually done at the time of staging laparotomy. A 21-year-old woman with stage IIIa Hodgkin disease underwent repositioning of the ovaries during staging laparotomy, but before planned irradiation therapy it was noted that the ovaries were back in their normal anatomic position. Outpatient laparoscopic lateral transposition of the ovaries was performed without complication. Five years after pelvic irradiation she still has normal ovarian function. In selected women with malignancy and planned irradiation therapy, laparoscopy is an alternative to laparotomy to preserve ovarian function by lateral ovarian transposition.
Laparoscopic Hysterectomy JB Jaenisch. Mae de Deus Hospital, Porto Alegre, Brazil. Between April 1993 and November 1995 I performed 50 laparoscopic hysterectomies. The indications for surgery were chronic menometrorrhagia in 40 women, enlargement of the uterus in 8, and pelvic pain in 2. Bipolar coagulation was used in the first 20 cases exclusively and a combination of Endo GIA 30 and bipolar in the other 30. The operating time using only bipolar coagulation ranged from 90 to 120 minutes and with the Endo GIA 30 from 60 to 150 minutes.
Laparoscopic Paraaortic Lymph Node Dissection in Patients with Gynecologic Malignancies JY Hur, KW Lee, SY Chongh, KS Ju, PS Ku. Department of Obstetrics and Gynecology, Korea University, Seoul, Korea.
Accurate evaluation of the paraaortic lymph node is important in planning treatment of gynecologic
S18
compared 128 women in whom laparoscopic management was attempted with 157 who had a primary laparotomy. Our first laparoscopic oophorectomy was performed in 1989, and during 1995, 37 (73%) of 51 patients underwent the procedure. The failure rate for laparoscopy was 3.3% during the study period. The operating time was the same for both groups. With laparoscopy the mean size of the mass was 5.5 cm (range 3-16 cm). Complication rates were higher for laparotomy than for taparoscopy (29% vs 4%). In the laparoscopy group, two tumors of low malignant potential and one ovarian cancer were found (2.3%). With the increasing application of laparoscopy we reduced yearly average length of hospital stay for oophorectomy from 4.3 to 1.4 days. A cost analysis was completed comparing the two groups. Laparoscopic oophorectomy can be performed safely, with reduced morbidity and patient disability. By having a oncologist backup we have been able to convert most procedures to the laparoscopic approach.
malignancies. Because radiologic methods to detect occult paraaortic lymph node metastases are inaccurate and staging requires a major surgical procedure, we investigated the feasibility of laparoscopic paraaortic lymph node dissection in our preliminary series of five women (3 stage IIb cervical cancer, 1 stage Ib cervical cancer, 1 ovarian cancer). Three patients with stage Ib cervical cancer scheduled for primary radiotherapy underwent selective paraaortic lymph node biopsy only. We performed laparoscopic radical hysterectomy with pelvic lymphadenectomy in the patient with stage Ib disease, in addition to paraaortic lymph node dissection. The average operating time for lymph node dissection was 125 minutes and mean estimated blood loss was 250 ml. The average number of lymph nodes removed was 3.6. We conclude that this laparoscopic procedure is feasible and helps guide the management of these patients.
Complications of Multipuncture LaparoscopicSurgery M Hur, BH Kang. Chung-Ang University, Seoul, Korea.
Lateral Ovarian Transposition before Radiation Treatment of Hodgkin Disease
We analyzed the complications that occurred in 1813 laparoscopic operations performed in our institution from August 1989 to August 1995. The patients' mean age was 39.3 + 8.5 years and mean parity was 1.5 + 1.2. The most common indication for operative laparoscopy was uterine myomas (45.8%). After the procedure, 87 women (4.8%) developed complications. The most common was subcutaneous emphysema (42, 48.3%). Other complications were unintended laparotomies, 16 (18.4%); urinary complications, 11 (12.6%); and vascular injuries, 9 (10.3%). Understanding these complications and determining how to avoid them is the only way to reduce their frequency. Prompt recognition and treatment of complications results in the most favorable outcome.
FM Howard. Rochester General Hospital, Rochester, NY.
Preservation of ovarian function by repositioning the ovaries out of the irradiation field is suggested in women of reproductive age before pelvic radiotherapy for cervical cancer or Hodgkin disease. In women with Hodgkin disease this is usually done at the time of staging laparotomy. A 21-year-old woman with stage IIIa Hodgkin disease underwent repositioning of the ovaries during staging laparotomy, but before planned irradiation therapy it was noted that the ovaries were back in their normal anatomic position. Outpatient laparoscopic lateral transposition of the ovaries was performed without complication. Five years after pelvic irradiation she still has normal ovarian function. In selected women with malignancy and planned irradiation therapy, laparoscopy is an alternative to laparotomy to preserve ovarian function by lateral ovarian transposition.
Laparoscopic Hysterectomy JB Jaenisch. Mae de Deus Hospital, Porto Alegre, Brazil. Between April 1993 and November 1995 I performed 50 laparoscopic hysterectomies. The indications for surgery were chronic menometrorrhagia in 40 women, enlargement of the uterus in 8, and pelvic pain in 2. Bipolar coagulation was used in the first 20 cases exclusively and a combination of Endo GIA 30 and bipolar in the other 30. The operating time using only bipolar coagulation ranged from 90 to 120 minutes and with the Endo GIA 30 from 60 to 150 minutes.
Laparoscopic Paraaortic Lymph Node Dissection in Patients with Gynecologic Malignancies JY Hur, KW Lee, SY Chongh, KS Ju, PS Ku. Department of Obstetrics and Gynecology, Korea University, Seoul, Korea.
Accurate evaluation of the paraaortic lymph node is important in planning treatment of gynecologic
S18