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Intraoperative management of ureteral injury during operative laparoscopy
12
Citations from the Literature
diminishing returns for power density above 40 W for the systems tested. Power densities obtainable at laparotomy were not possible. Clinically, this effect resulted in optimal cutting (vaporization) nying cutting Intraoperative
at low power settings and coagulation at higher settings. management
accompa-
of ureteral injury during operative
laparoscopy Gomel V; James C Department of Obstetrics and Gynaecology. University of British Columbia, 4490 Oak Street, Vancouver, BC V6H 3V5, CAN FERTIL STERIL 1991 55/2 (416-419) Injury to the ureter from operative laparoscopy is rare. The diagnosis is usually made radiologically, in the postoperative period, when the patient presents with symptoms and signs suggestive of ureteral injury. We report herein a case of ureteral injury resulting from operative laparoscopy for endometriosis. The injury was diagnosed and treated via laparoscopy during the same procedure. The increased utilization of operative laparoscopy to perform more complex procedures increases the potential for operative injury to the ureter. Prior visualization or retroperitoneal dissection of the ureter, in appropriate cases, will help reduce this complication and/or permit a prompt diagnosis in the event of such injury.
selected reference group of women matched for age. Registry data covering the entire Danish female population were used. Included in the study were all patients operated in the period 1977-1981. Patients were only included if no cancer was diagnosed and if no major co-surgery was performed (29 192 patients). Cancer patients were also excluded in the reference group (I6 I82 women). Mortality was studied according to characteristics of patients, their residential area, the surgical approach and operating hospital. Overall 47 patients died within 30 days of admission for hysterectomy (overall mortality 16. I per IO 000). Only seven deaths were expected on the basis of the population sample, and adjusted for age, the relative risk (RR) for hysterectomy patients was 6.38 (95% Cl 4.33-9.39). Early postoperative mortality increased with age, and the risk was elevated among emergency patients (RR = 3.22; I .72-6&l). Patients with more than one diagnosis at discharge (RR = 4.53; 2.12-9.70) were at high risk, but early postoperative mortality was independent of surgical approach. Causes of death are discussed. Compared to the general population, patients who undergo ‘simple’ hysterectomy are faced with a sixfold risk of dying within 30 days, but a complete assessment of the risks and benefits of hysterectomy requires prospective studies of survival and morbidity, including of life for longer periods of time following operations.
quality
The free-flap vaginoplasty; a new surgical procedure for the treatment of vaginal agenesis
Prolonged continuous acyclovir treatment of normal adults with
Johnson N; Lilford RJ; Batchelor A Department of Obstetrics and Gynaecology. St. James’s University Hospital, Leeds, GBR BR J OBSTET GYNAECOL 1991 98/2 (184-188)
P; J;
The ideal operation for a young woman born without a vagina would be a one stage procedure, creating a functionally normal vagina without cosmetically unattractive scars, without the need for subsequent dilatation, stents or obturators. This goal was achieved with a free flap vaginoplasty using a full thickness skin graft taken from the scapula region. The blood supply of the graft was maintained by microvascular anastomosis of the graft pedicles to vessels in the groin. The operation has been performed in three young women who were born with uterine hypoplasia and vaginal agenesis. We experienced no unexpected complications, the procedure was well tolerated and left our patients with a good length, fully functional vagina. However, the operation is a major undertaking and needs to be performed by those with expertise in plastic surgery as well as in gynaecology. Early postoperative mortality following hysterectomy. A Danish population based study, 1977-1981 Loft A; Andersen TF; Bronnum-Hansen H; Roepstorff C; Madsen M Department of Gynuecology and Obstetrics, Copenhagen County Hospital, Gentofte, DNK BR J OBSTET GYNAECOL 1991 98/2 (147-154) The main objective of this cohort study was to analyse the early postoperative mortality after ‘simple’ hysterectomy for benign indications and to compare it with that of a randomly
Int J Gynecol Obstet 37
frequently recurring genital herpes simplex virus infection Kaplowitz LG; Baker D; Gelb L; Blythe J; Hale R; Frost Crumpacker C; Rabinovich S; Peacock JE Jr; Herndon Davis LG
Division of Infectious Diseases, Virginia Commonwealth University, Box 49. MCV Station, Richmond, VA 23298-0049, USA J AM MED ASSOC 1991 26516 (747-751) In this 3-year study of suppressive acyclovir for recurrent genital herpes. patients with more than six recurrences per year were randomized initially to 400 mg of acyclovir or placebo orally two times per day, with recurrences treated with 200 mg of acyclovir five times per day for 5 days. In the second year of the study, all patients received acyclovir as a daily suppressive or intermittent acute therapy; in the third year, all received daily acyclovir. Among 525 patients completing 3 study years, 289 received 3 years of suppressive therapy and 236 received I year of acute therapy followed by 2 years of suppressive therapy. Of those who completed the third year, 61% were recurrence free that year; 25% of the suppressive therapyonly group were recurrence free for all 3 years. The annual recurrence rate dropped from more than I2 recurrences per year at baseline to I .O (suppressive therapy) and I .4 (acute and suppressive therapy) recurrences during the third year. No significant toxic effects were detected. Daily suppressive acyclovir therapy
was effective
Menstrual mythology menstruation
and well tolerated. and
sources
of
information
about
Cumming DC: Cumming CE; Kieren DK Walter Mackenzie Centre, University of Alberta. Edmonton. Alta. T6G 2R7, CAN
Citations from the Literature
diminishing returns for power density above 40 W for the systems tested. Power densities obtainable at laparotomy were not possible. Clinically, this effect resulted in optimal cutting (vaporization) nying cutting Intraoperative
at low power settings and coagulation at higher settings. management
accompa-
of ureteral injury during operative
laparoscopy Gomel V; James C Department of Obstetrics and Gynaecology. University of British Columbia, 4490 Oak Street, Vancouver, BC V6H 3V5, CAN FERTIL STERIL 1991 55/2 (416-419) Injury to the ureter from operative laparoscopy is rare. The diagnosis is usually made radiologically, in the postoperative period, when the patient presents with symptoms and signs suggestive of ureteral injury. We report herein a case of ureteral injury resulting from operative laparoscopy for endometriosis. The injury was diagnosed and treated via laparoscopy during the same procedure. The increased utilization of operative laparoscopy to perform more complex procedures increases the potential for operative injury to the ureter. Prior visualization or retroperitoneal dissection of the ureter, in appropriate cases, will help reduce this complication and/or permit a prompt diagnosis in the event of such injury.
selected reference group of women matched for age. Registry data covering the entire Danish female population were used. Included in the study were all patients operated in the period 1977-1981. Patients were only included if no cancer was diagnosed and if no major co-surgery was performed (29 192 patients). Cancer patients were also excluded in the reference group (I6 I82 women). Mortality was studied according to characteristics of patients, their residential area, the surgical approach and operating hospital. Overall 47 patients died within 30 days of admission for hysterectomy (overall mortality 16. I per IO 000). Only seven deaths were expected on the basis of the population sample, and adjusted for age, the relative risk (RR) for hysterectomy patients was 6.38 (95% Cl 4.33-9.39). Early postoperative mortality increased with age, and the risk was elevated among emergency patients (RR = 3.22; I .72-6&l). Patients with more than one diagnosis at discharge (RR = 4.53; 2.12-9.70) were at high risk, but early postoperative mortality was independent of surgical approach. Causes of death are discussed. Compared to the general population, patients who undergo ‘simple’ hysterectomy are faced with a sixfold risk of dying within 30 days, but a complete assessment of the risks and benefits of hysterectomy requires prospective studies of survival and morbidity, including of life for longer periods of time following operations.
quality
The free-flap vaginoplasty; a new surgical procedure for the treatment of vaginal agenesis
Prolonged continuous acyclovir treatment of normal adults with
Johnson N; Lilford RJ; Batchelor A Department of Obstetrics and Gynaecology. St. James’s University Hospital, Leeds, GBR BR J OBSTET GYNAECOL 1991 98/2 (184-188)
P; J;
The ideal operation for a young woman born without a vagina would be a one stage procedure, creating a functionally normal vagina without cosmetically unattractive scars, without the need for subsequent dilatation, stents or obturators. This goal was achieved with a free flap vaginoplasty using a full thickness skin graft taken from the scapula region. The blood supply of the graft was maintained by microvascular anastomosis of the graft pedicles to vessels in the groin. The operation has been performed in three young women who were born with uterine hypoplasia and vaginal agenesis. We experienced no unexpected complications, the procedure was well tolerated and left our patients with a good length, fully functional vagina. However, the operation is a major undertaking and needs to be performed by those with expertise in plastic surgery as well as in gynaecology. Early postoperative mortality following hysterectomy. A Danish population based study, 1977-1981 Loft A; Andersen TF; Bronnum-Hansen H; Roepstorff C; Madsen M Department of Gynuecology and Obstetrics, Copenhagen County Hospital, Gentofte, DNK BR J OBSTET GYNAECOL 1991 98/2 (147-154) The main objective of this cohort study was to analyse the early postoperative mortality after ‘simple’ hysterectomy for benign indications and to compare it with that of a randomly
Int J Gynecol Obstet 37
frequently recurring genital herpes simplex virus infection Kaplowitz LG; Baker D; Gelb L; Blythe J; Hale R; Frost Crumpacker C; Rabinovich S; Peacock JE Jr; Herndon Davis LG
Division of Infectious Diseases, Virginia Commonwealth University, Box 49. MCV Station, Richmond, VA 23298-0049, USA J AM MED ASSOC 1991 26516 (747-751) In this 3-year study of suppressive acyclovir for recurrent genital herpes. patients with more than six recurrences per year were randomized initially to 400 mg of acyclovir or placebo orally two times per day, with recurrences treated with 200 mg of acyclovir five times per day for 5 days. In the second year of the study, all patients received acyclovir as a daily suppressive or intermittent acute therapy; in the third year, all received daily acyclovir. Among 525 patients completing 3 study years, 289 received 3 years of suppressive therapy and 236 received I year of acute therapy followed by 2 years of suppressive therapy. Of those who completed the third year, 61% were recurrence free that year; 25% of the suppressive therapyonly group were recurrence free for all 3 years. The annual recurrence rate dropped from more than I2 recurrences per year at baseline to I .O (suppressive therapy) and I .4 (acute and suppressive therapy) recurrences during the third year. No significant toxic effects were detected. Daily suppressive acyclovir therapy
was effective
Menstrual mythology menstruation
and well tolerated. and
sources
of
information
about
Cumming DC: Cumming CE; Kieren DK Walter Mackenzie Centre, University of Alberta. Edmonton. Alta. T6G 2R7, CAN