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Laparoscopic treatment of distal tubal occlusion—Reocclusion and pregnancy rate
August 1994, Vol. 1, No. 4, Part 2
The Journal of the American Association of Gynecologic Laparoscopists
1992 and 1993. Four patients presented with bilateral ovarian masses and one patient had two teratomas within one ovary. In the majority of cases (78.9%) the correct diagnosis was made preoperatively by pelvic examination and vaginal ultrasound. The average tumor size was 5.5 cm, ranging from 1 to 11 cm. Preservation of the ovary was achieved in most cases (40/81.6%). Uni- or bilateral adnexectomy was the treatment of choice in all postmenopausal women (5); in the remaining four patients salpingo-oophorectomy was performed due to torsion of a cyst (1), extensive adhesions (1) and large tumor size (2). CA 19-9 levels were elevated in 11 out of 20 patients, reaching a maximum value of 3,400 U/ml. No severe complications were encountered: two patients developed fever postoperatively, one of whom was suspected of having a chemical granulomatous peritonitis. We conclude that laparoscopic management of benign dermoid cysts is safe and effective and can therefore be highly recommended.
regarding tubal patency (66.6%) than the other eversion methods described (33.4%). The pregnancy rate could be assessed in 81 out of 161 laparoscopically treated cases. A total of 19 patients (23.3%) became pregnant. In 9.8% pregnancy was intrauterine and in 13.5% extrauterine. The highest intrauterine and lowest extrauterine pregnancy rate was seen in the group with "mild" distal tubal occlusion (according to AFS classification). In 84.2% of women who had conceived postoperatively, tubal wall eversion had been done by the Bruhat technique without suturing. Taking into account tubal wall pathology, tubal patency, eversion techniques, and rate of intrauterine pregnancies, it can be concluded that patients with thin-walled tubes allowing "perfect" or "good" eversion will benefit most from laparoscopic salpingostomy.
Laparoscopic Radical Hysterectomy: A Preliminary Report TV Sedlacek, MJ Campion, RA Hutchins, H Reich. The Graduate Hospital, Papour Pavilion, Philadelphia, PA.
Laparoscopic Treatment of Distal Tubal Occlusion Reocclusion and Pregnancy Rate
The Laparoscopic Assisted Surgery Program began in 1991 at The Graduate Hospital. Initially, traditional laparoscopic gynecologic procedures were performed including laparoscopic oophorectomy, hysterectomy, and adhesiolysis. We then began staging patients with ovarian and endometrial cancer laparoscopically. Next, a series of patients who underwent laparoscopic extrafascial hysterectomy with lymph node sampling for endometrial cancer was attempted. In June of 1992, we performed what we believe to be the first completely laparoscopic radical hysterectomy and bilateral pelvic and common iliac lymphadenectomy for a stage IB squamous carcinoma of the cervix. To date fourteen of these procedures have been performed with few complications. The complications encountered thus far include narrowing of a right ureter detected by an intravenous pyelogram obtained on postoperative day 10 and a small vesicovaginal fistula. The narrrowed right ureter had a retrograde stent placed as a precaution. It would appear that laparoscopic radical hyst e r e c t o m y in selected patients offers significant advantages in terms of hospitalization, incision size, and wound, pulmonary, and intestinal complications. In addition to the clinical advantages, laparoscopic radical hysterectomy appears to be more cost effective than traditional laparotomy.
V Sasse, E Karageorgieva, J Keckstein. Minimally Invasive Surgery, Frauenklinik Krusmann, Munich, Germany. There is still controversy about the question of which approach is best to treat tubal infertility: microsurgery, laparoscopic treatment, or in vitro fertilization. Our study comprised 161 patients with distal tubal occlusion. Various instruments (argon laser, CO2 laser, Nd:YAG laser, monopolar electrical needle, scissors) were used for laparoscopic salpingostomy, and a variety of techniques applied for tubal wall eversion (flowering technique according to Bruhat with and without suturing, suturing alone, or no eversion at all). Thirty-seven women with a total of 63 laparoscopically treated tubes were followed over a period of 2-72 months. Tubal patency was 38.9%. The reocclusion rate correlated with severity of tubal wall pathology and state of reduction of the tubal mucosa. After laser treatment tubal patency proved to be higher (41.1%) compared with treatment with conventional instruments. The Argon laser scored best results. The majority of patent tubes in the follow-up were found in the cohort with "perfect" and "good" eversion (95.8%), whereas none of the tubes where eversion was classed "insufficient" remained patent. The technique according to Bruhat without the use of additional suturing yielded better results
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The Journal of the American Association of Gynecologic Laparoscopists
1992 and 1993. Four patients presented with bilateral ovarian masses and one patient had two teratomas within one ovary. In the majority of cases (78.9%) the correct diagnosis was made preoperatively by pelvic examination and vaginal ultrasound. The average tumor size was 5.5 cm, ranging from 1 to 11 cm. Preservation of the ovary was achieved in most cases (40/81.6%). Uni- or bilateral adnexectomy was the treatment of choice in all postmenopausal women (5); in the remaining four patients salpingo-oophorectomy was performed due to torsion of a cyst (1), extensive adhesions (1) and large tumor size (2). CA 19-9 levels were elevated in 11 out of 20 patients, reaching a maximum value of 3,400 U/ml. No severe complications were encountered: two patients developed fever postoperatively, one of whom was suspected of having a chemical granulomatous peritonitis. We conclude that laparoscopic management of benign dermoid cysts is safe and effective and can therefore be highly recommended.
regarding tubal patency (66.6%) than the other eversion methods described (33.4%). The pregnancy rate could be assessed in 81 out of 161 laparoscopically treated cases. A total of 19 patients (23.3%) became pregnant. In 9.8% pregnancy was intrauterine and in 13.5% extrauterine. The highest intrauterine and lowest extrauterine pregnancy rate was seen in the group with "mild" distal tubal occlusion (according to AFS classification). In 84.2% of women who had conceived postoperatively, tubal wall eversion had been done by the Bruhat technique without suturing. Taking into account tubal wall pathology, tubal patency, eversion techniques, and rate of intrauterine pregnancies, it can be concluded that patients with thin-walled tubes allowing "perfect" or "good" eversion will benefit most from laparoscopic salpingostomy.
Laparoscopic Radical Hysterectomy: A Preliminary Report TV Sedlacek, MJ Campion, RA Hutchins, H Reich. The Graduate Hospital, Papour Pavilion, Philadelphia, PA.
Laparoscopic Treatment of Distal Tubal Occlusion Reocclusion and Pregnancy Rate
The Laparoscopic Assisted Surgery Program began in 1991 at The Graduate Hospital. Initially, traditional laparoscopic gynecologic procedures were performed including laparoscopic oophorectomy, hysterectomy, and adhesiolysis. We then began staging patients with ovarian and endometrial cancer laparoscopically. Next, a series of patients who underwent laparoscopic extrafascial hysterectomy with lymph node sampling for endometrial cancer was attempted. In June of 1992, we performed what we believe to be the first completely laparoscopic radical hysterectomy and bilateral pelvic and common iliac lymphadenectomy for a stage IB squamous carcinoma of the cervix. To date fourteen of these procedures have been performed with few complications. The complications encountered thus far include narrowing of a right ureter detected by an intravenous pyelogram obtained on postoperative day 10 and a small vesicovaginal fistula. The narrrowed right ureter had a retrograde stent placed as a precaution. It would appear that laparoscopic radical hyst e r e c t o m y in selected patients offers significant advantages in terms of hospitalization, incision size, and wound, pulmonary, and intestinal complications. In addition to the clinical advantages, laparoscopic radical hysterectomy appears to be more cost effective than traditional laparotomy.
V Sasse, E Karageorgieva, J Keckstein. Minimally Invasive Surgery, Frauenklinik Krusmann, Munich, Germany. There is still controversy about the question of which approach is best to treat tubal infertility: microsurgery, laparoscopic treatment, or in vitro fertilization. Our study comprised 161 patients with distal tubal occlusion. Various instruments (argon laser, CO2 laser, Nd:YAG laser, monopolar electrical needle, scissors) were used for laparoscopic salpingostomy, and a variety of techniques applied for tubal wall eversion (flowering technique according to Bruhat with and without suturing, suturing alone, or no eversion at all). Thirty-seven women with a total of 63 laparoscopically treated tubes were followed over a period of 2-72 months. Tubal patency was 38.9%. The reocclusion rate correlated with severity of tubal wall pathology and state of reduction of the tubal mucosa. After laser treatment tubal patency proved to be higher (41.1%) compared with treatment with conventional instruments. The Argon laser scored best results. The majority of patent tubes in the follow-up were found in the cohort with "perfect" and "good" eversion (95.8%), whereas none of the tubes where eversion was classed "insufficient" remained patent. The technique according to Bruhat without the use of additional suturing yielded better results
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