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Biomedical subjects

A Ostrzenski

Publications and source records attributed to A Ostrzenski.

At least 19 recordsLinked to original sources
PubMed2001

Laparoscopic intestinal injury: a review and case presentation.

BACKGROUND: The incidence of laparoscopic primary trocar small-intestine injury is unknown. The case presented here differed from a typical clinical course in that only excessive periumbilical fluid leak was present postoperatively. Neither classic symptoms nor signs were present to justify laparoscopic trocar small-bowel perforations. CASE: A 42-year-old woman (G2 P1011, height 5'4", weight 132 lb) underwent elective, diagnostic, and operative laparoscopy with a lysis of extensive abdominal-pelvic adhesions for chronic pelvic pain. Preoperatively, the patient was classified as being at increased risk for intestinal laceration or perforation at the time of Veress needle or primary trocar insertion due to her surgical history. For this reason, mechanical bowel preparation with GoLYTELY was carried out. No intraoperative complications were noticed. After surgery, external, excessive fluid leak from the periumbilical incision only was observed (the three 5-mm incisions, in the lower part of the abdomen, were dry). Initially, this event was interpreted as residual irrigation fluid leakage. The patient was closely monitored for bowel injury, and neither medical condition nor laboratory tests changed from base within the initial 48 h, although excessive fluid drainage from periumbilical area was persistent. Enough time elapsed from laparoscopic surgery for CO2 and irrigation-fluid absorption; therefore, additional studies were ordered (an abdominal upright x-ray was inconclusive for viscous perforation and gastrointestinal x-ray with a water-soluble contrast medium documented small-intestine perforation). Exploratory laparotomy with partial bowel resection was executed. Postoperative clinical course was uneventful, and no long-term sequel was observed. CONCLUSIONS: 1) Persistent excessive external fluid leak from the periumbilical area after laparoscopic surgery with no drainage from other incisional sides may suggest small-bowel injury. 2) latrogenic, internal-external canalization between the small intestine and the skin masked clinical symptoms and signs of small-intestinal injury. 3) Lack of classic symptoms, signs, or changes in pertinent laboratory data did not rule out small-bowel perforation.

Adult↗
PubMed1999

Randomized, prospective, single-blind trial of a new parallel technique of Veress pneumoperitoneum needle insertion versus the conventional closed method.

OBJECTIVE: To evaluate the safety and effectiveness of a new closed parallel technique of Veress needle insertion and to compare this method with the conventional closed approach. DESIGN: Sequential, randomized, prospective, single-blind clinical trial. SETTING: University hospital. PATIENT(S): Women undergoing elective diagnostic and/or operative laparoscopy. Subjects (n = 200) were assigned randomly to undergo the conventional closed method (group 1; n = 100) or the new parallel technique (group 2; n = 100) of Veress needle insertion. INTERVENTION(S): Randomization of the patients was performed in the operating room. The investigator performed both diagnostic and operative laparoscopy in both study groups. MAIN OUTCOME MEASURE(S): Safety and effectiveness of the needle insertion technique. RESULT(S): There were no significant differences in demographics between the groups, or in the time required for Veress needle insertion to establish pneumoperitoneum. There were no nonlethal major or minor intraoperative complications associated with either laparoscopic approach. CONCLUSION(S): There is no significant disadvantage to the parallel technique of Veress pneumoperitoneum needle insertion compared with the conventional closed approach. This new technique avoids the anatomic location of large vessels during insertion and may serve as a safeguard to decrease the potential for lethal laceration of a major vessel.

Adult↗
PubMed1999

A new laparoscopic retroperitoneal posterior culdoplasty technique.

OBJECTIVE: To test the hypothesis that laparoscopic retroperitoneal culdoplasty executed with a CO2 laser is comparable to the same operation performed with mechanical laparoscopic instruments and to extend a previously reported series of laparoscopic posterior culdoplasties. STUDY DESIGN: A prospective, cohort, comparison, clinical study was conducted to determine relative risk on 30 subjects who met inclusion criteria for this trial. Group I patients (n = 15) were subjected to laparoscopic culdoplasty with a CO2 laser, group II subjects (n = 15) were exposed to the same intervention with 5-mm laparoscopic mechanical instruments. Both groups were observed for intraoperative, immediate postoperative and delayed complications. During the postoperative follow-up period, the following parameters were recorded: dyschesia, dyspareunia, sexual dysfunction, pelvic pain (preoperative and postoperative rating scale for pain used). RESULTS: There was no significant difference in clinical and demographic data between the two groups. All planned laparoscopic culdoplasties for symptomatic enterocele were successfully carried out, with no conversions to laparotomy or vaginal surgery. In group I, average operating time was 1 hour, 11 minures, and in group II it averaged 47 minutes (P = .03). There were no intraoperative complications or blood transfusions. During the early recovery period, 26% in group I vs. 6% in group II (P = .04) reported transitional urine retention. Two of those patients from group I developed symptoms of lower urinary tract infections. In group I, one patient (3%) (P = .10) developed a recurrence of enterocele, grade 2. In group II, one patient (3%) (P = .10) experienced difficulty during sexual intercourse following laparoscopic culdoplasty. In all patients but two, symptoms of dyschesia, dyspareunia and sexual dysfunction related to anatomy distortion and pelvic pain were cured. CONCLUSION: Laparoscopic retroperitoneal posterior culdoplasty executed with mechanical instruments yielded a clinical outcome similar to that of surgery performed with a CO2 laser. The operative time was statistically significantly longer when the operation was performed with a laser. Using a laser increases the potential for complications associated with the laser itself and increases the cost of the operation. Ninety-three percent of patients remained symptom free after surgery.

Carbon Dioxide↗
PubMed1999

Laparoscopic total abdominal hysterectomy in morbidly obese women. A pilot-phase report.

OBJECTIVE: To establish the consecutive steps in and evaluate the safety and effectiveness of laparoscopic total abdominal hysterectomy (L-TAH) (hysterectomy completed via laparoscopy, with no transvaginal approach by the suturing technique) in a group of morbidly obese women and to compare the results to a group of nonobese women with clinically similar characteristics and indications for hysterectomy. STUDY DESIGN: Eleven morbidly obese women were subjected to a L-TAH with no vaginal approach. The operation was executed by suturing and tying an extracorporeal sliding knot and by using intracorporeal two-turn flat square knot methods. The consecutive steps of the operation were changed from the original to facilitate this procedure. The group of morbidly obese women was compared to a group of nonobese women. RESULTS: All the subjects exceeded their ideal body weight by 100%. Their actual weight ranged from 118.9 to 139.8 kg, and their height ranged from 58 to 69 in. All the planned surgery was completed, and no intraoperative or postoperative complications were observed. There was no conversion from the laparoscopic approach to a laparotomy or transvaginal path. When compared to that in the control group, the mean operating time was significantly longer in morbidly obese subjects. CONCLUSION: L-TAH is safe and effective for morbidly obese women.

Adult↗
PubMed1999

A systematic arrangement of laparoscopic total abdominal hysterectomy: a new technique.

This sequential, prospective, observational clinical trial evaluated a systematic arrangement of laparoscopic total abdominal hysterectomy and prophylactic, retroperitoneal posterior culdoplasty with vaginal vault suspension surgical techniques by suturing method. The uterus was extirpated laparoscopically in 25 consecutive patients using an extra- and intra-corporeal two-turn flat square knot method. Upon completion of uterine excision, a new prophylactic laparoscopic technique of retroperitoneal posterior culdoplasty and vaginal vault suspension were initiated to prevent pelvic relaxation. Retroperitoneal culdoplasty was performed using the anterior rectal fascia, the posterior uterovaginal fascia, and the deep layer retroperitoneal of the uterosacral ligaments. Vaginal vault suspension was performed using posteriorly the deep layer of the uterosacral ligaments; from a lateroposterior aspect, the vaginal vault was suspended to the cardinal ligaments bilaterally, and anteriorly, the vesicouterine fascia provided support for the vaginal apex. A systematic arrangement of surgical steps was evaluated. All predetermined samples of laparoscopic total abdominal hysterectomy with posterior retroperitoneal culdoplasty and vaginal vault suspension were accomplished in a prearranged systematic order. Neither technical failure nor conversion to laparotomy or transvaginal approach was encountered. This technique expedites uterine extirpation and prophylactic pelvic reconstruction with a low complication rate, can be executed with no transvaginal approach, and eliminates the morbidity and mortality associated with laparotomy itself.

Adult↗
PubMed1998

Preoperative contrast ultrasonographic diagnosis of patent urachal sinus.

A patent urachal sinus, as well as other congenital urachal anomalies, may be at risk of injury during laparoscopy. Leakage of fluid at the midline site of trocar entry is the usual postoperative sign of injury to a patent urachal sinus. Pre-operative diagnosis of this anomaly can prevent injury during laparoscopy. We describe a contrast ultrasound technique for diagnosis of patent urachal sinus.

Female↗
PubMed1998

Ultrasonography as a screening tool for paravaginal defects in women with stress incontinence: a pilot study.

The aim of the study was to determine whether transabdominal ultrasonography can accurately identify paravaginal defects associated with genuine stress urinary incontinence. Sixteen women were diagnosed with genuine stress urinary incontinence (GSUI) following clinical evaluation, urethroscopy and urodynamic studies. They were then evaluated by transabdominal sonography and a full bladder and immediately following micturition. The ultrasound studies were also carried out in 8 women (5 nulliparous and 3 primiparous) who had no signs or symptoms of urinary incontinence. Paravaginal defects were detected in the 16 women with GSUI: 9 had unilateral defects and 7 had bilateral defects. Only right-sided defects were identified in women with unilateral lesions. Paravaginal defects were confirmed in all symptomatic women at the time of surgery, and corresponded with the defects identified with transabdominal ultrasound. Mild unilateral paravaginal defects were identified in 2 continent parous women. Five nulliparous women and 1 primiparous control had no ultrasound evidence of paravaginal defects. A transabdominal, transverse, suprapubic ultrasound scan with a full bladder is a promising screening technique for the diagnosis of paravaginal defect in women with GSUI. Transabdominal suprapubic longitudinal sections are not useful for the identification of paravaginal defects.

Case-Control Studies↗
PubMed1998

Extensive iatrogenic adenomyosis after laparoscopic myomectomy.

OBJECTIVE: To report a case of iatrogenic adenomyosis as a result of not reconstructing the uterine wall during a laparoscopic myomectomy. DESIGN: Retrospective case report. SETTING: University hospital. PATIENT(S): A 34-year-old woman, gravida O, had been referred to our institution for medical care. A laparoscopic penetrating leiomyomata uteri was removed 8 months before this hospital admission. Approximately 3 months after the initial laparoscopic myomectomy, she began experiencing pelvic pain in the middle low abdominal area, more accentuated in the second phase of the menstrual cycle, with peak pain during menstruation. The pain became progressively worse. Microcytic-hypochromic anemia secondary to menorrhagia was documented. Flexible office hysteroscopy, contrast ultrasonography, and magnetic resonance imaging (MRI) results suggested the presence of focal adenomyosis. INTERVENTION(S): Eight months after the initial laparoscopic myomectomy, the patient underwent a second-look laparoscopy to excise the visual uterine wall defect and reconstruct laparoscopically the layers of the uterine wall. MAIN OUTCOME MEASURE(S): Uterine wall histopathology and menstrual history. RESULT(S): Resolution of patient's pain, resumption of normal menses, and secondary anemia was ameliorated. CONCLUSION(S): Suturing the myometrium in layers during a laparoscopic myomectomy is necessary to prevent iatrogenic adenomyosis.

Adult↗
PubMed1998

Bladder injury during laparoscopic surgery.

The objective of this review is to present the incidence of latrogenic bladder injury associated with diagnostic and/or operative laparoscopic surgery; to determine the type of primary laparoscopic operation, the time at which the reported injuries occurred, the location of injuries, and the method(s) used to repair those injuries; to decide which laparoscopic procedure carries the highest risk for bladder injury; and to establish the most frequent surgical instruments with which injuries happened. World literature published between 1970 and 1996 was reviewed. The appropriate Medical Subject Heading (MeSH) terms were selected and used in a search of the MEDLINE, ACOGNET, OVID Compact Disk Version database. A total of 1372 articles on laparoscopic surgery complications were reviewed. Of that number, a total of 77 articles identified bladder injuries, and these were analyzed for the objectives of this study. There are a wide range of bladder injuries during laparoscopic procedures. In the studied articles, the incidence of bladder injury during laparoscopic procedures ranged from 0.02 to 8.3 percent of cases. Most frequently, these injuries occurred during laparoscopic-assisted vaginal hysterectomy. Sharp electrosurgical dissection was the leading instrument causing injury. An intraoperative diagnosis of bladder injury was made in 53.24 percent of all bladder injury cases. The bladder dome was the most commonly injured structure. Less than half (29.87 percent) of the bladder injuries were corrected laparoscopically.

Female↗
PubMed1998

Laparoscopic suturing technique for total abdominal hysterectomy.

The objective of this report is to present the laparoscopic technique for total abdominal hysterectomy executed with no transvaginal approach, and by suturing and tying an extracorporeal sliding and an intracorporeal two-flat square knot. The hysterectomy methodology itself was adapted from classic abdominal hysterectomy and completed via laparoscopy with necessary modifications to meet laparoscopic technology standards. Following uterine extirpation, prophylactic, retroperitoneal posterior culdoplasty (the retroperitoneal layer of the uterosacral ligaments, rectal fascia, and paravaginal fascia were incorporated into the reconstructive process), and vaginal vault re-suspension were executed posteriorly, to the deep layer of the uterosacral ligaments, laterally, to the cardinal ligaments, and anteriorly, to the vesicocervical fascia. Laparoscopic total abdominal hysterectomy with posterior culdoplasty and vaginal vault suspension by suturing method appeared to be a safe and effective operation.

Adult↗
PubMed1998

Laparoscopic retroperitoneal hysteropexy. A randomized trial.

OBJECTIVE: To assess the clinical applicability, safety and initial efficacy of a new laparoscopic retroperitoneal hysteropexy technique. STUDY DESIGN: A relatively homogeneous group of patients (N = 62) with symptomatic uterine retroflexion was randomly allocated to laparoscopic retroperitoneal uterine suspension (n = 32, group I) and diagnostic laparoscopy (n = 30, group II). Patients from both groups were followed for at least 24 months. The following clinical parameters were compared between groups I (treated) and II (untreated): deep dyspareunia, dysmenorrhea, sense of bladder pressure with frequent urination and sense of pressure in the rectum. RESULTS: Surgery was performed as an outpatient operation by the author. Intraoperative or postoperative complications were not observed in either group. A prospective, double-blind, controlled trial revealed that 87.5% of patients with symptomatic uterine retroflexion experienced relief from symptoms after the operation. Statistical analysis of the two groups documented that clinical symptoms improved (with P < .0001) in a statistically significant number of cases among patients subjected to hysteropexy. CONCLUSION: Laparoscopic retroperitoneal uterine suspension benefitted patients and was safe.

Adult↗
PubMed1998

Genuine stress urinary incontinence in women. New laparoscopic paravaginal reconstruction.

OBJECTIVE: To assess a new laparoscopic technique of paravaginal repair, adapted from a classic laparotomy procedure, for genuine stress urinary incontinence. STUDY DESIGN: From January 1992 to July 1997, 28 patients in a consecutive, prospective clinical case study were subjected to laparoscopic paravaginal repair. No concomitant surgery was performed. A clinical diagnosis of genuine stress urinary incontinence was documented by cystometry following a positive cough stress test. When indicated, a multichannel urodynamics study was performed. RESULTS: In 16 patients (57%) of 28, the right pelvic side was affected, and in 43% fascia damage was identified and repaired bilaterally. The average operative time was 2 hours, 45 minutes; average blood loss was 1.2 g hemoglobin. No intraoperative, immediate postoperative, delayed postoperative or anesthesia-associated complications were observed. Patients were discharged from the surgical units in an average of 5 hours, 15 minutes. There was no postoperative hospital readmission. CONCLUSION: Laparoscopic paravaginal repair is simple and safe and has a 93% cure rate. It is an attractive alternative to laparotomy.

Adult↗
PubMed1998

New retroperitoneal culdoplasty and colpopexy at the time of laparoscopic total abdominal hysterectomy (L-TAH).

BACKGROUND: After a laparoscopic total abdominal hysterectomy, the safety of the translaparoscopic, prophylactic, retroperitoneal pouch of a Douglas reconstruction and vaginal vault suspension was evaluated. METHODS: This operation was adapted from the laparotomy approach and has been investigated from July, 1992, to July, 1996. Modest modifications have been introduced to meet laparoscopic technology requirements. Observational clinical trials have been conducted on 112 women. The surgery was performed through laparoscopy by suturing and tying method, with no vaginal approach. RESULTS: This clinical trial showed positive results for the operation, with no complications observed in this group of patients. After the operation, there were no symptoms or signs of a dysfunctional vagina, or pelvic relaxation. CONCLUSION: This preventive operation is safe and it restores the pelvic topography, functional anatomy, and it prevents post-hysterectomy vaginal dysfunction disorders.

Adult↗
PubMed1997

An intraoperative method of localizing a missing piece of a broken laparoscopic instrument.

Missing a laparoscopic needle or a dislodged broken piece of a laparoscopic instrument presents a challenge in localizing it. A fragment of a broken instrument is often confined in an area remote from the primary operative side and entrapped in the bowel loop or in the omentum. An abdominal x-ray film identifies a missing part of the instrument intraabdominally; however, it is extremely difficult to find it with a laparoscope. A precise small area and a reference point are needed to establish where the dislodged missing fragment part is. The radiopaque threads from x-ray-detectable sponges were removed and placed on the abdominal skin, creating a net. With the target square determined by radiopaque threads, finding and removing the dislodged missing piece were achieved very expeditiously. This technique to localize a missing piece of a broken laparoscopic instrument intraabdominally is simple, inexpensive, and noninvasive, allowing expeditious removal and saving substantial operative time.

Equipment Failure↗
PubMed1997

Uterine leiomyoma particle growing in an abdominal-wall incision after laparoscopic retrieval.

BACKGROUND: As laparoscopic myomectomy gains acceptance among patients and pelvic surgeons, new laparoscopic techniques create a risk for complications that were not encountered in classic laparotomy myomectomy. Report of such complications will allow surgeons to undertake appropriate steps to prevent them. CASE: Fragments of uterine leiomyomas unintentionally implanted and growing in abdominal-wall incisions after laparoscopic myomectomy presented clinically with incisional pain and an abdominal-wall mass of increasing size. Diagnosis was confirmed by the histology, and treatment was achieved by excision. CONCLUSION: In the differential diagnosis of a progressively increasing incisional mass and pain after laparoscopic myomectomy, inadvertent implantation and growing particles of uterine leiomyomas should be considered when fragmented tumors are removed through a trocar sleeve.

Abdomen↗
PubMed1997

A new laparoscopic myomectomy technique for intramural fibroids penetrating the uterine cavity.

OBJECTIVE: To evaluate laparoscopic removal of intramural leiomyomata uteri penetrating the uterine cavity, with compression of the uterine isthmic vessels, repair of the endometrial defect, and reconstruction of the myometrium in three layers. STUDY DESIGN: 32 selected patients with penetrating intramural leiomyomata uteri were subjected to a new laparoscopic myomectomy technique. Conversion from laparoscopy to laparotomy, feasibility and safety of surgical technique, length of operation, hemoglobin loss, intra- and postoperative complications, and length of stay in hospital were evaluated. RESULTS: All laparoscopic myomectomy attempts were completed laparoscopically without blood transfusion. The operative time ranged from 127 min to 246 min, (mean 163 min). The mean hemoglobin fall was 0.74 g/ml and no intraoperative nor postoperative complication was observed. The average postoperative hospital stay was 7.5 h. CONCLUSION: This operation is safe, shows good reconstructive outcome, and offers an alternative approach to laparotomy, with all advantages of major surgery being executed through minimal access.

Adult↗
PubMed1997

Expression of an immunomodulatory protein known as progesterone induced blocking factor (PIBF) does not correlate with first trimester spontaneous abortions in progesterone supplemented women.

PROBLEM: An immunomodulatory protein known as the progesterone induced blocking factor (PIBF) has been found to positively correlate with early pregnancy beta human chorionic gonadotropin (B-hCG) levels. The study presented herein evaluated PIBF levels from conception to the end of the first trimester to determine if lower levels will correlate with first trimester spontaneous abortions (SAB). METHOD: Progesterone induced blocking factor expression by lymphocytes measured using an immunocytochemistry method was compared in pregnant women with ongoing vs. failed pregnancies. RESULTS: There were no differences in the proportion of women having lymphocytes expressing PIBF or in the median numbers when comparing ongoing vs. failed pregnancies. There was no B-hCG interval where failed pregnancies were found to have lower frequency of PIBF expressing lymphocytes. CONCLUSION: Inadequate PIBF expression independent of low P levels does not appear to be an etiologic factor for first trimester SABs; thus measuring this protein in pregnant women lacks practical usefulness.

Abortion, Spontaneous↗