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Laparoscopic bladder neck suspension
Abstracts
pregnancies. It can cause severe hemorrhage requiring hysterectomy. In this woman, early diagnosis allowed successful conservative treatment. In fact, despite miscarriage of the intrauterine pregnancy, she required no further invasive procedures, medical therapies, or blood transfusions, and her fertility was preserved.
No bowel or vascular injuries occurred. Cosmetic results were excellent. Conclusion. Direct umbilical insertion of the primary cannula is safe, rapid, and cosmetic.
162. Our Experience with LAVH G Pregenzer, M Schwartz. Muhlenberg Regional Medical Center, Somerset Medical Center, Warren, New Jersey.
160. Laparoscopic Bladder Neck Suspension G Pregenzer, M Schwartz. Muhlenberg Regional Medical Center, Somerset Medical Center, Warren, New Jersey.
Objective. To describe our experience of LAVH using two or three cannula sites without exceeding 10 mm. Measurements and Main Results. We performed LAVH and laparoscopic hysterectomy in 150 women (age 24-74 yrs) using two or three ports, with the electric morcellator for the large uterus. Forty patients had a two-port operative procedure with the 10-ram operative laparoscope and a 5-ram secondary port; 110 women had a three-port procedure with 5-ram cannulas at all sites. When necessary, the 10-mm electric morcellator was inserted in the existing umbilical port. Bipolar coagulation was performed in all patients. Of the 150 uteri, 50 were over 200 g, the largest being 910 g. Blood loss typically less than 100 ml. Conclusion. Laparoscopic removal of even an extremely large uterus by these techniques is a safe and cosmetically appealing method of performing hysterectomy.
Objective. To determine the results of laparoscopic bladder neck suspension using polypropylene mesh graft and laparoscopic stapler. Measurements and Main Results. Fifty women (age 31-79 yrs) with hypermobile proximal urethra and GUSI underwent direct video laparoscopic, extraabdominal bladder neck suspension. Average blood loss was less than 25 ml (range 20-100 ml) and average operating time was under 30 minutes (range 17-45 min). Success was defined as a negative Q-Tip test and lack of involuntary loss of urine. Over average followup of 24 months, the procedure yielded satisfactory urethrovesical support in 49 women, with overall success greater than 98%. Conclusion. Laparoscopic Burch procedure offers a rapid and effective cure for genuine stress incontinence with low morbidity, and shorter hospitalization and recovery times compared with open technique.
163. The Value of Laparoscopy for Diagnosing Endometriosis in Infertile Patients N Purnaghschband, D Arnold, HH Riedel. CarlThiem-Klinikum, Cottbus, Germany.
161. Laparoscopy and Primary Cannula Insertion G Pregenzer. Muhlenberg Regional Medical Center, Somerset Medical Center, Warren, New Jersey.
Objective. To define the value of laparoscopy (with optimal technical equipment) for the diagnosis of endometriosis in infertile women. Measurements and Main Results. The influence of new techniques and improved equipment on the frequency of endometriosis and localizations of deposits was compared from 1991 to 1995 (group 1) and 1996 to 1998 (group 2). The number of laparoscopies done in the first group was 2371, with absolute frequency of endometriosis of 5.1% (121 patients), whereas in group 2, 776 (25.9%) patients of 2995 who underwent laparoscopy had the disease. Endometriosis was diagnosed more often in infertile women in group 2 (97/216 patients, 46.3%) than in those patients in group 1 (55/161 patients, 34.2%).
Objective. To describe experience with direct umbilical insertion of the primary cannula. Measurements and Main Results. Subjects were 900 women (age 14-89 yrs, weight 85-475 lbs) undergoing diagnostic or operative laparoscopy with direct insertion of a 5-mm cannula without the Veress needle. The umbilicus was everted with an Allis clamp and the base was grasped with two towel clips. A no. 11 scapel was used to make a 3-to 5-mm incision in the base of the umbilicus, and a hemostat was used to develop the wound and enter the peritoneal cavity. This allowed bowel and omentum to fall away from the site as room air entered the abdomen. Of the 900 procedures, only 4 had to be converted to open laparoscopy.
$46
pregnancies. It can cause severe hemorrhage requiring hysterectomy. In this woman, early diagnosis allowed successful conservative treatment. In fact, despite miscarriage of the intrauterine pregnancy, she required no further invasive procedures, medical therapies, or blood transfusions, and her fertility was preserved.
No bowel or vascular injuries occurred. Cosmetic results were excellent. Conclusion. Direct umbilical insertion of the primary cannula is safe, rapid, and cosmetic.
162. Our Experience with LAVH G Pregenzer, M Schwartz. Muhlenberg Regional Medical Center, Somerset Medical Center, Warren, New Jersey.
160. Laparoscopic Bladder Neck Suspension G Pregenzer, M Schwartz. Muhlenberg Regional Medical Center, Somerset Medical Center, Warren, New Jersey.
Objective. To describe our experience of LAVH using two or three cannula sites without exceeding 10 mm. Measurements and Main Results. We performed LAVH and laparoscopic hysterectomy in 150 women (age 24-74 yrs) using two or three ports, with the electric morcellator for the large uterus. Forty patients had a two-port operative procedure with the 10-ram operative laparoscope and a 5-ram secondary port; 110 women had a three-port procedure with 5-ram cannulas at all sites. When necessary, the 10-mm electric morcellator was inserted in the existing umbilical port. Bipolar coagulation was performed in all patients. Of the 150 uteri, 50 were over 200 g, the largest being 910 g. Blood loss typically less than 100 ml. Conclusion. Laparoscopic removal of even an extremely large uterus by these techniques is a safe and cosmetically appealing method of performing hysterectomy.
Objective. To determine the results of laparoscopic bladder neck suspension using polypropylene mesh graft and laparoscopic stapler. Measurements and Main Results. Fifty women (age 31-79 yrs) with hypermobile proximal urethra and GUSI underwent direct video laparoscopic, extraabdominal bladder neck suspension. Average blood loss was less than 25 ml (range 20-100 ml) and average operating time was under 30 minutes (range 17-45 min). Success was defined as a negative Q-Tip test and lack of involuntary loss of urine. Over average followup of 24 months, the procedure yielded satisfactory urethrovesical support in 49 women, with overall success greater than 98%. Conclusion. Laparoscopic Burch procedure offers a rapid and effective cure for genuine stress incontinence with low morbidity, and shorter hospitalization and recovery times compared with open technique.
163. The Value of Laparoscopy for Diagnosing Endometriosis in Infertile Patients N Purnaghschband, D Arnold, HH Riedel. CarlThiem-Klinikum, Cottbus, Germany.
161. Laparoscopy and Primary Cannula Insertion G Pregenzer. Muhlenberg Regional Medical Center, Somerset Medical Center, Warren, New Jersey.
Objective. To define the value of laparoscopy (with optimal technical equipment) for the diagnosis of endometriosis in infertile women. Measurements and Main Results. The influence of new techniques and improved equipment on the frequency of endometriosis and localizations of deposits was compared from 1991 to 1995 (group 1) and 1996 to 1998 (group 2). The number of laparoscopies done in the first group was 2371, with absolute frequency of endometriosis of 5.1% (121 patients), whereas in group 2, 776 (25.9%) patients of 2995 who underwent laparoscopy had the disease. Endometriosis was diagnosed more often in infertile women in group 2 (97/216 patients, 46.3%) than in those patients in group 1 (55/161 patients, 34.2%).
Objective. To describe experience with direct umbilical insertion of the primary cannula. Measurements and Main Results. Subjects were 900 women (age 14-89 yrs, weight 85-475 lbs) undergoing diagnostic or operative laparoscopy with direct insertion of a 5-mm cannula without the Veress needle. The umbilicus was everted with an Allis clamp and the base was grasped with two towel clips. A no. 11 scapel was used to make a 3-to 5-mm incision in the base of the umbilicus, and a hemostat was used to develop the wound and enter the peritoneal cavity. This allowed bowel and omentum to fall away from the site as room air entered the abdomen. Of the 900 procedures, only 4 had to be converted to open laparoscopy.
$46