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C Chapron

Publications and source records attributed to C Chapron.

At least 91 records · Page 5Linked to original sources
PubMed1997

Hysterectomy with adnexectomy. Can operative laparoscopy offer advantages?

OBJECTIVE: To investigate whether laparoscopic surgery has the advantage of reducing the rate of laparotomies when a patient with no genital prolapse needs a total hysterectomy associated with unilateral and bilateral adnexectomy. STUDY DESIGN: Retrospective study carried out between January 1993 and December 1995. All patients (96) with no prolapse, pelvic floor relaxation or stress urinary incontinence and scheduled for total hysterectomy with adnexectomy were included in the study. RESULTS: Laparotomy was required in 12.5% of cases (12 patients). For the 84 patients (87.5%) who underwent laparoscopic hysterectomy, the mean duration of the operation was 142.6 +/- 33.9 minutes, and the mean uterine weight was 209.7 +/- 129.4 g. The rate of laparotomy dropped steadily as the surgeon acquired experience. Whereas the rate of laparotomy was 30.5% (7 patients) in 1993, it was 10.8% (4 patients) in 1994 and fell to 2.8% (1 patient) in 1995. CONCLUSION: When adnexectomy needs to be performed with hysterectomy, in the majority of cases it should be carried out by laparotomy. Operative laparoscopy enables the rate of laparotomy to be reduced to < 15%. The existence of an adnexal mass not suspected to be malignant indicates operative laparoscopy.

Adnexa Uteri↗
PubMed1997

Laparoscopy for adnexal torsion in pregnant women.

OBJECTIVE: To report on six cases of adnexal torsion in pregnant women treated by operative laparoscopy. STUDY DESIGN: A retrospective study. Between January 1989 and March 1996, 26 patients with adnexal torsion were treated by operative laparoscopy. Of these patients, six were pregnant (23%). The types of operative procedure and outcome were studied. RESULTS: Adnexal torsion occurred between 6 and 13 weeks of amenorrhea. Two cases involved hyperstimulation, 3 cases a functional cyst and 1 case a dermoid cyst. In 4 cases laparoscopic treatment consisted of untwisting followed by puncture of the ovarian cyst; in 1 case it involved intraperitoneal cystectomy and in another simple untwisting of the adnexa. The immediate postoperative history was uncomplicated. In one patient with ovarian hyperstimulation, torsion recurred three weeks after the initial operation. No miscarriages occurred. CONCLUSION: In the hands of skilled surgeons, laparoscopy is well suited to the diagnosis and treatment of adnexal torsion occurring during the first trimester of pregnancy. Beyond 16 weeks or when there is any suspicion of torsion on a suspected tumor, it is preferable to use laparotomy.

Adnexal Diseases↗
PubMed1997

Laparoscopic myomectomy and myolysis.

The indications for operative laparoscopy have expanded greatly over the past decade as its many advantages over laparotomy have become recognized. Laparoscopic myomectomy as a technique is now clearly described. A monopolar hook is used for the uterine incision. After atraumatic enucleation of the myoma, the myometrium and serosa are usually sutured, especially if the incision is deep or more than 2 cm long. Myomas can be removed by posterior colpotomy. However, the development of an electrical cutting device permits easier and quicker removal of the myoma through the suprapubic puncture site. Only complicated myomas or those which give rise to persistent symptoms despite properly prescribed medical treatment, together with those which grow rapidly, require surgery. These satisfactory preliminary results must not mask the fact that laparoscopic myomectomy is lengthy and difficult, reserved for experienced surgeons with a thorough familiarity with endoscopic sutures. Under these conditions, laparoscopic myomectomy is possible, even for large myomas (5 cm and over) located purely intramurally. However, there are limits, and it is preferable to schedule myomas measuring over 8 cm and multiple myomectomy (over two) for laparotomy. Although the preliminary results are encouraging, the risk of adhesiogenesis on the uterine scar, the quality of the uterine suture and the fertility results need to be assessed in the near future.

Adult↗
PubMed1997

[Retroperitoneal endometriosis infiltrating the utero-sacral ligaments. Technique and results of laparoscopic surgery].

OBJECTIVE: The goal of this study is to assess the efficiency of laparoscopic surgical treatment of pain for patients presenting deep endometriosis located on the uterosacral ligaments. STUDY DESIGN: We analysed a continuous series of 36 patients treated by operative laparoscopy between January 1993 and April 1995. In all these cases treatment consisted of resection of all the uterosacral ligament(s) together with exeresis of all other endometriotic lesions. RESULTS: The results were assessed for all the patients with a minimum follow-up of one year. Patients who presented dysmenorrhea (29 cases) improved in 89.7% of cases (26 patients). Out of the 26 patients who presented deep dyspareunia, improvement was evident for 92.3% of cases (24 patients). The chronic pelvic pain suffered (17 cases) improved in 88.2% of cases (15 patients). Patients who benefited from an improvement rated it excellent or satisfactory in 80% of cases. CONCLUSION: These results demonstrate that provided the surgeon is highly skilled in laparoscopy, operative laparoscopy is efficient for the treatment of patients presenting painful symptoms related to deep endometriotic implants located on the uterosacral ligaments.

Adult↗
PubMed1997

[Complications of laparoscopy caused by trocars. Preliminary study from the national registry of the French Society of Gynecologic Endoscopy].

OBJECTIVE: To describe laparoscopic complications due to trocar insertions and to define their prevention as well as their risk factors. STUDY DESIGN: The SFEG registry of laparoscopic complications was used for our study; 26 complications due to trocar insertions were recorded to this day by the register including 12 vascular injuries, 9 bowel injuries, 3 bladder perforations and 2 incisional herinas. In order to avoid accidents of this technique, patient profile, laparoscopy indications, trocar type, diagnosis and treatment of the complications as well as the outcome must be defined. RESULTS: Whatever the operator's experience, the indication of laparoscopy and the trocar type some patients seem to have complications at laparoscopy: 70% of studied group had prior surgical treatment and 50% were over weight. However, it appeared that safety rules were not been taken into account for one-third of the trocar injuries. Consequently, laparotomy was used by the same surgeons for these complications in 89% of cases, laparotomy was delayed in 27% of the cases. CONCLUSION: In order to prevent laparoscopic complications, the surgeon must (i) inform the patients about risks which may occur, (ii) be careful, and (iii) declare each complication to a national registry such as the SFEG registry.

Adult↗
PubMed1997

[Poor vaginal access: excellent indication for laparoscopic hysterectomy].

OBJECTIVE: The great majority of hysterectomies in patients without previous vaginal delivery have been carried out via laparotomy. The purpose of this study was to establish whether laparoscopic surgery can be of use in an attempt to reduce the number of laparotomies for patients with no previous vaginal delivery who underwent an hysterectomy indicated for benign pathologies. STUDY DESIGN: A retrospective study was carried out on 116 patients who had not had a previous vaginal delivery who underwent hysterectomy from January 1993 to December 1996. RESULTS: Laparotomy was required for only 20.7% of cases (24 patients). For the 92 patients (79.3%) who underwent laparoscopic hysterectomy, the average duration of the operation was 145 +/- 44 min (range: 60-290) and the mean uterine weight was 200 +/- 130 g (range: 30-840). CONCLUSIONS: These results demonstrate that laparoscopic surgery decreased significantly the number of laparotomies necessary for patients without previous vaginal delivery who require hysterectomy. When vaginal access is poor, simple laparoscopic preparation is inadequate and the only possibility of avoiding laparotomy is to carry out the hysterectomy entirely via laparoscopic route.

Blood Loss, Surgical↗
PubMed1996

Place and modalities of laparoscopy in surgical management of suspected adnexal masses.

Only benign adnexal masses are suitable for treatment by operative laparoscopy. Ovarian cancer must always be managed by midline laparotomy. In our experience the preoperative workup (clinical examination, study of past history, trans vaginal ultrasonography, doppler, tumoral markers etc.) together with the diagnostic phase of laparoscopy provide a sensitivity value of 100%, a positive predictive value of 50% and a negative predictive value of 100% for diagnosis of malignancy. Provided a strict selection, laparoscopy is reliable both for the diagnosis and the management of benign ovarian masses.

Adnexal Diseases↗
PubMed1996

Uterine fibroids: place and modalities of laparoscopic treatment.

Only fibroids which give rise to symptoms resistant to properly conducted medical treatment and/or complicated myomas require surgical treatment. The possibility offered by the new surgical approaches enables myomectomies to be now carried out via laparoscopy. We report our technique of laparoscopic myomectomy performed since 1989. Monopolar coagulation is used for the uterine incision, after myomectomy, myometrium and serosa are sutured. Myomas are removed through the suprapubic puncture site after fragmentation of large myomas, through a colpotomy or using the morcellator. Our results enable us to say that, although it is a difficult technique, laparoscopic myomectomy is a safe and reliable technique even for large intramural myomas.

Adult↗
PubMed1996

Fertility after laparoscopic myomectomy of large intramural myomas: preliminary results.

Fertility outcome following laparoscopic myomectomy was evaluated. A prospective clinical study was carried out between October 1990 and October 1993 in 21 infertile patients who underwent laparoscopic myomectomy for a myoma measuring > or = 5 cm in diameter. The overall rate of intrauterine pregnancy was 33.3% (seven patients). Out of 12 patients with infertility factors associated with uterine myomas, three (25.0%) became pregnant, whereas four (44.4%) out of nine patients with no other associated infertility factor became pregnant. No uterine rupture was observed. Out of the seven pregnancies, four were spontaneous and began within 1 year of the operation. The other three were achieved after in-vitro fertilization in patients with associated infertility factors. In the four patients who gave birth by Caesarean section, no adhesions were found on the myomectomy scar. From these preliminary results, laparoscopic surgery for myomas seems to offer comparable results with those obtained by laparotomy.

Adult↗
PubMed1996

Hysterectomy for patients without previous vaginal delivery: results and modalities of laparoscopic surgery.

The great majority of hysterectomies in nulliparous patients have been carried out via laparotomy. The purpose of this study was to establish whether laparoscopic surgery can be of use in an attempt to reduce the number of laparotomies when hysterectomy is indicated in patients without previous vaginal delivery. A retrospective study was carried out on 66 women who had not had a previous vaginal delivery who underwent hysterectomy from January 1993 to May 1995. Laparotomy was required for only 19.7% of cases (13 patients). For the 53 patients (80.3%) who underwent laparoscopic hysterectomy, the average duration of the operation was 152.24 +/- 45.7 min, and the average weight of the uterus was 238.3 +/- 154.1 g. The duration of the laparoscopic operation was correlated in a statistically significant fashion with the weight of the uterus (P = 0.0005), the necessity of associated procedures during the hysterectomy (P = 0.01) and the surgeons' experience (P = 0.01). These results demonstrated that laparoscopic surgery decreases the number of laparotomies necessary for patients with no previous vaginal delivery who require hysterectomy. When vaginal access is poor, simple laparoscopic preparation is inadequate and the only possibility of avoiding laparotomy is to carry out the hysterectomy entirely via the laparoscopic route.

Adult↗
PubMed1996

Laparoscopic treatment of deep endometriosis located on the uterosacral ligaments.

The goal of this study was to assess the efficiency of laparoscopic surgical treatment of pain for patients presenting deep endometriosis located on the uterosacral ligaments. To this end we analysed a continuous series of 21 patients treated by laparoscopic surgery between January 1993 and June 1994. In all these cases treatment consisted of resection of all the uterosacral ligament(s) presenting deep endometriotic lesions together with exercise of all other endometriotic lesions. No complications were observed per- or postoperatively. The results were assessed for all the patients with a minimum follow-up of one year. The efficiency of the treatment varied according to the symptoms. Patients who presented dysmenorrhoea (19 cases) improved in 84.2% of cases (16 patients). Out of the 17 patients who presented deep dyspareunia, improvement was evident for 94.1% of cases (16 patients). The chronic pelvic pain suffered improved in seven out of nine cases (77.7%). Patients who benefited from an improvement rated it excellent or satisfactory in over 80% of cases. These results demonstrate that, provided the surgeon is highly skilled in laparoscopy, laparoscopic surgery is efficient for the treatment of patients presenting painful symptoms related to deep endometriotic implants located on the uterosacral ligaments.

Adult↗
PubMed1996

Treatment of adnexal torsion using operative laparoscopy.

The aim of this work was to clarify the value and application of operative laparoscopic treatment for adnexal torsion. We included in our study all patients (n = 27) who presented with an intra-operative diagnosis of torsion of the adnexa between January 1989 and May 1995. A total of 28 adnexal torsions were treated. Treatment was carried out by laparoscopic surgery in 75% of cases (21 torsions): in one-half of the cases (14 torsions) it was possible to achieve conservative laparoscopic treatment. The nature of the lesions and the experience of the surgeons are two factors which closely govern the outcome of surgical treatment. For those patients presenting a benign pathology, laparoscopic surgery was used to treat 84% of cases in the series. All the patients presenting a benign pathology and operated upon since 1993 have received laparoscopic surgical treatment. No major complications (peritonitis, thrombotic emboli, coagulation problems) were observed after conservative laparoscopic surgery. These results demonstrate that, provided the surgeons are sufficiently experienced, treatment by conservative laparoscopic surgery for adnexal torsion is both safe and reliable. In the years to come more work must be done to assess the vitality of the adnexa so that as many patients as possible can benefit from conservative treatment.

Adnexal Diseases↗