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Total laparoscopic hysterectomy using the McCartney tube versus LAVH
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
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