Biomedical subjects

A Ostrzenski

Publications and source records attributed to A Ostrzenski.

30 records · Page 2Linked to original sources

PubMed1997

Method for diagnosing paravaginal defects using contrast ultrasonographic technique.

Thirty women with pelvic relaxation and genuine stress urinary incontinence were evaluated with a contrast ultrasonography technique developed for the diagnosis of paravaginal defects. Control subjects were continent women with vaginal prolapse and nulliparous asymptomatic women. Seventeen incontinent patients had unilateral right-sided paravaginal defects and 13 had bilateral paravaginal defects. All continent controls with vaginal prolapse had bilateral paravaginal defects. None of the nulliparous controls had paravaginal defects. The contrast ultrasonographic technique also was found to be useful for postoperative evaluation and documentation of the anatomic results achieved after laparoscopic paravaginal repair.

Adult↗

PubMed1997

A new laparoscopic technique for interstitial pregnancy resection. A case report.

BACKGROUND: The interstitial gestation prevalence ranges from 1 in 2,500-5,000 live births, with a mortality rate of 2-2.5%. Total abdominal hysterectomy is usually offered to clinically stable patients over 35 years old. For younger women who desire to preserve their child-bearing capacity, interstitial pregnancy excision with a salpingo-oopherectomy is offered. The case presented here differed from the classic approach in that the adnexal structures were preserved, the products of conception were excised laparoscopically, and myometrium reconstruction was performed by suturing and tying with a laparoscopic technique. CASE: A 34-year-old multipara presented with genital tract bleeding and gradual-onset, diffuse pelvic cramps progressively worsening and associated with nausea and vomiting. As expected, the regular, last menstrual period was 8 weeks prior to the patient's hospital admission. The serum beta-human chorionic gonadotropin level was 20,159 mIU/mL and the progesterone level 12.6 ng/mL. High-resolution transvaginal ultrasound revealed no intrauterine gestational sac. A 1.2-cm fluid collection was observed in the right uterine cornual area, and posterior cul-de-sac fluid was present. A hysteroscopic evaluation was inconclusive, and the endometrium frozen section histologic study failed to confirm the presence of chorionic villi. The patient underwent diagnostic and operative laparoscopic excision of the interstitial pregnancy with adnexa preservation. CONCLUSION: Laparoscopic resection of interstitial pregnancy with the preservation of the adnexal structures was a safe alternative to laparotomy in this case.

Adult↗

PubMed1996

Laparoscopic colposuspension for total vaginal prolapse.

OBJECTIVE: To present and evaluate a new technique of modified translaparoscopic colpopexy for total vaginal prolapse following hysterectomy as an alternative surgical mode of therapy to abdominal sacral suspension or transvaginal sacrospinous ligament vaginal vault suspension. A modest modification (Group II) of this author's initial surgical technique (Group I) and postoperative observations from 1989 to 1996 are presented. METHODS: Twenty-seven patients with iatrogenic total vaginal prolapse subsequent to hysterectomy enrolled in this clinical study, which was conducted from September 1989 through February 1996. Posteriorly, vaginal apex was suspended to the deep layer of the uterosacral ligaments. The latero-posteriors vaginal cuff was suspended to the cardinal ligaments. Anteriorly, the vaginal vault was approximated to the pubocervical fascia. These procedures were performed in both groups retroperitoneally. Additionally, and only in Group II, retrpubically, at the mid-pelvic level, the pubocervical fascia and lateral superior vaginal sulci were suspended to the tendinous arch and to the fascia covering the muscles of the pelvic sidewall. This additional part of the operation constituted a modification of the initial translaparoscopic colpopexy (Group I). RESULTS: In Group I, fifteen patients had good outcome of the operation. However, patient number 16 had a recurrent total vaginal vault prolapse within 6 months following the initial laparoscopic colpopexy. Preceding an initial laparoscopic colpopexy, sacrospinous ligament suspension was performed as one of multiple corrective surgeries. This patient was subjected to the modified laparoscopic colpopexy and has been observed for over three years. The vaginal vault remains well suspended in this particular case as well as in all remaining patients in Group II. There were neither intraoperative, immediate, nor delayed postoperative complications in all 27 patients, in both groups. CONCLUSIONS: (1) When Group I results are compared with Group II results, the new, modified translaparoscopic retroperitoneal-retropubic colpopexy appeared to be a superior technique and very promising, and offers: (a) vaginal cuff suspension by using natural neighbouring genital pelvic structures, (b) reconstruction of pelvic gross/functional anatomy, placement of the vagina adequately in midline position, and alignment of the vagina parallel to the rectum, and re-constitution of proper relationship between the newly suspended vagina and pelvic viscera. (2) It is a safe operation, simple to learn, and easy to execute; however, retroperitoneal-retropubic-mid-pelvis surgical experience as well as advanced operative laparoscopic skill is needed to meet technical demands of the operation.

Adult↗

PubMed1996

Laparoscopic total abdominal hysterectomy by suturing technique, with no transvaginal surgical approach: a review of 276 cases.

OBJECTIVE: To determine the effectiveness and safety of the new technique of laparoscopic total abdominal hysterectomy with prophylactic retroperitoneal rectovaginal-pouch of Douglas reconstruction and vaginal vault re-suspension by suturing method, with no transvaginal surgical approach. METHODS: The clinical prospective study included 276 women, and was conducted from July 1990 through December 1995. All women were subjected to a laparoscopic total abdominal hysterectomy with prophylactic retroperitoneal rectovaginal and pouch of Douglas reconstruction and vaginal vault suspension. The entire operation was executed via laparoscope with suturing and tying of extracorporeal sliding and intracorporeal two-turn flat square knot technique, and no transvaginal surgery was performed. The criteria for postoperative early (within 5 h) discharge plan were designed and assessed. RESULTS: All pre-planned instances of laparoscopic total abdominal hysterectomy with prophylactic retroperitoneal rectovaginal-pouch of Douglas reconstruction and vaginal vault re-suspension were completed; no technique failure was encountered. The average operating time for both hysterectomy and prophylactic surgery was 192 min. Intraoperative complications were two bladder injuries (0.72%); one case of inferior epigastric vessels injury (0.36%); one case of autologous, cells saver processed blood transfusion (0.36%). The immediate postoperative complications were four cases of voiding difficulty (1.45%) and five patients experiencing post anesthesia inordinate nausea and vomiting (1.81%). One patient required postoperative blood transfusion (0.36%). Delayed postoperative complications included 2 patients (0.72%) with superficial incisional skin infection. Estimated hemoglobin loss was from 0.5 g/dl to 5.0 g/dl, mean loss 1.5 g/dl. The extirpated uterine average weight 163 g. Postoperatively, within 24 h, 265 patients (96.01%) out of 276 were discharged home on the day of surgery, within 5 h, 110 patients (41.51%) out of 265 left the surgical unit. There was no single hospital post surgical re-admission. CONCLUSIONS: Laparoscopic total abdominal hysterectomy with prophylactic retroperitoneal rectovaginal-pouch of Douglas reconstruction and vaginal vault suspension by suturing method is a safe, well-defined operation, executed with no need for transvaginal surgical approach, and well accepted by patients.

Adult↗

PubMed1996

A new laparoscopic abdominal radical hysterectomy: a pilot phase trial.

The video laparoscopy, hydrodissection and laparoscopic scissors were used to develop adequate tissue planes in avascular pelvic areas. Haemostasis was accomplished by the laparoscopic suturing method and tying an extracorporeal sliding knot, enhanced by an intracorporeal two-turn flat square knot. Six patients with cervical carcinoma stage I B or II A were subjected to laparoscopic para-aortic, external iliac, obturator fosea, and hypogastric node dissection, followed by laparoscopic radical abdominal hysterectomy. The outcome of this pilot phase trial indicated that this operation can be executed laparoscopically with no transvaginal surgery. The integrity and principles of classic transabdominal radical hysterectomy with extended pelvic lymphadenectomy were honoured. Using the surgical technique of laparoscopic abdominal radical hysterectomy with extended pelvic lymphadenectomy eliminates laparotomy morbidity itself. This operation encouraged rapid post-surgical recovery, shortened recuperation time, and minimized post-operative discomfort.

Abdomen↗

PubMed1996

Seven-Year Experience with Office Microlaparoscopy and Hysteroscopy

Since 1989 more than 1200 office-based endoscopies have been performed at our facility. Visualization was initially achieved with 1.6-mm optical catheters, but recently, we have used larger-diameter fiber and glass rod endoscopes. Ancillary instruments progressed from 5- to 2-mm diameters, although occasionally we used up to 20-mm cannula punctures. Anesthesia remained consistent, with local infiltration followed by conscious sedation given by an on-site anesthesiologist. Lately, alternative methods of anesthesia including hypnosis and acupuncture have had some initial success. To date, we have performed 156 tubal ligations, 293 diagnostic laparoscopies, 151 treatments of endometriosis, 43 ovarian cyst aspirations, 29 adhesiolyses, 263 second-look procedures, 21 ectopic pregnancy removals, 198 diagnostic hysteroscopies, 64 endometrial biopsies, 20 fibroid resections, and 39 endometrial ablations. Patient response has been rewarding, thanks to decreased time off work, decreased cost of procedures to health insurance carriers, and immediate satisfaction from the diagnosis and treatment of their conditions.

Journal Article↗

PubMed1995

A new, simplified posterior culdoplasty and vaginal vault suspension during abdominal hysterectomy.

OBJECTIVE: A new surgical technique of creating a prophylactic, reconstructive posterior culdoplasty and vaginal vault suspension during abdominal hysterectomy is described. The procedure restores the pelvic topography and gross and functional anatomy after removal of the uterus. A systematic order of the operation, its safety and effectiveness are presented and illustrated. METHODS: This surgical technique has been studied for 10 years, from 1983 to 1993, in a group of 250 patients with ages ranging from 19 to 76 years, average age 43 years (Caucasian, n = 178; black, n = 61; and Asian, n = 11). The following new elements were introduced to achieve post-hysterectomy restoration of the posterior cul-de-sac and vaginal vault suspension: the deep layer of the uterosacral ligaments and pararectal-paravaginal fascia are incorporated for reconstructive posterior culdoplasty; the cardinal ligaments and the deep and superficial layers of the uterosacral ligaments are used for anatomical vaginal vault suspension from the latero-posterior aspect of the vaginal wall. RESULTS: This study has documented a good outcome and effectiveness of the operation as well as good postsurgical patient satisfaction, with no symptomatology or signs of dysfunctional vagina, vaginal prolapse or enterocele formation. CONCLUSION: This new prophylactic procedure is effective, safe, simple to learn, easy to carry out, and adds very little on to the overall surgical time. Restoration of the pelvic topography, functional anatomy, prevention of dysfunctional vagina, vaginal prolapse and pelvic hernia (enterocele) formation can be achieved by following this technique. Post-hysterectomy dysfunctional vagina, vaginal prolapse and pelvic hernia formation are preventable occurrences when a surgical operation is appropriately selected and properly executed.

Adult↗

PubMed1995

A new, laparoscopic full-thickness slice ovarian biopsy (from antimesenteric to mesenteric margin).

This article introduces a new laparoscopic surgical technique of full-thickness slice biopsy, from antimesenteric margin to mesenteric area, of the ovary. The uteroovarian ligament with mesenteric vasculature and the infundibulopelvic ligament with its artery and veins are transitionally obliterated with atraumatic 5-mm laparoscopic clamps. This part of the operation stabilizes and decreases the blood supply to the ovary. A desirable width of full-thickness slice in the middle part of the ovary is excised from antimesenteric to mesenteric region with 5-mm laparoscopic scissors. The full-thickness slice ovarian excision stops before the mesenteric vasculature to avoid surgical injury to that area that may compromise the ovarian blood supply or return. The presence of primordial follicles in the ovary differentiates the resistant ovary syndrome from premature ovarian failure. In hypergonadotropic hypogonadism, a classic minilaparotomy is performed to obtain enough ovarian tissue for the definitive histologic diagnosis of premature ovarian failure versus resistant ovary syndrome. Simplicity and good outcome make this laparoscopic technique suitable for many clinical predicaments when a deep lesion in the ovary must be removed.

Biopsy↗

PubMed1993

Endoscopic bladder repair during total modified laparoscopic hysterectomy. A case report.

Endoscopic repair was performed on a bladder laceration during total modified laparoscopic hysterectomy, with the vaginal cuff sutured to the cardinal and uterosacral ligaments. The patient underwent the hysterectomy for chronic pelvic pain. The endoscopic bladder laceration was repaired via laparoscopy, and the patient was discharged from the hospital on the second postoperative day with a catheter connected to a leg bag for drainage. Intravenous pyelogram with full bladder distention, which was performed two weeks after surgery, revealed no abnormality. The patient returned to her daily activities, including sex, within three weeks.

Adult↗

PubMed1992

[Video-laparoscopically modified hysterectomy with vaginal vault suspension].

Thanks to advanced operative techniques to traditional indications for operative laparoscopy, such as: adhesion lysis, endometriosis center coagulation, biopsy, myomectomy, hysteropexy, colpopexy, ovarian wedge resection and biopsy, pelvic herniorrhaphy, aspiration of cystic fluid it can be add laparoscopic treatment of ectopic pregnancy, adnexal tumors, polycystic ovary drilling and endoscopic hysterectomy. However, so complex a surgery necessitates in having an experienced surgical team and the state of art equipment. For the first time in Europe a 32 year old woman was subjected to video-laparoscopic modified hysterectomy with vaginal vault suspension, what was described in this paper.

Adult↗

PubMedDate not supplied

Endoscopic carbon dioxide laser ovarian wedge resection in resistant polycystic ovarian disease.

Clomiphene citrate therapy has been found to improve the infertility rate in women suffering from polycystic ovarian disease (PCOD). However, there still exists a group of women with PCOD who fail to respond to clomiphene citrate or human menopausal gonadotropin/human chorionic gonadotropin or urofollitropin/chorionic gonadotropin treatment, an ovarian wedge resection by laparotomy approach which has been known for 50 years. Within the last decade, translaparoscopic electrocautery and laser drilling techniques have been utilized. In 1986, a translaparoscopic carbon dioxide laser ovarian wedge resection was introduced for resistant PCOD. This paper describes the surgical principle of a translaparoscopic carbon dioxide laser ovarian wedge resection. This type of treatment results in a 75% crude conception rate, with a 67% rate of healthy live birth. There was an 8% postsurgical adhesion rate among 12 cases that were incorporated into the study. This mode of therapy may prove to be very useful, safe, easy to perform, and cost effective as a second-line therapy for resistant PCOD in cases where medical inductions fail to achieve ovulation.

Adult↗

PubMedDate not supplied

Resectoscopic cervical trauma minimized by inserting Laminaria digitata preoperatively.

OBJECTIVE: To examine the safety and efficacy of Laminaria digitata to dilate the cervix before resectoscopic surgery. DESIGN: Randomized, prospective. METHODS: A group of 30 patients who were dilated preoperatively with Laminaria tents were compared to a group of 30 patients in whom cervical dilatation was performed in the operating room without previously inserted Laminaria tents. Statistical analysis was done with Student's t test and the chi-square test. RESULTS: Statistically significant differences were documented between the two groups for three variables: bleeding, inability to reach desired cervical dilatation, and length of time required for cervical dilatation up to a #23 Pratt's dilator. CONCLUSIONS: This study strongly suggests the advantages of using Laminaria tents preoperatively in the nonpregnant patient population when more than 8-mm cervical dilatation is necessary. The very low cost of L. digitata tents makes this technique cost effective.

Cervix Uteri↗