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Biomedical subjects

C Nezhat

Publications and source records attributed to C Nezhat.

At least 55 records · Page 3Linked to original sources
PubMed1994

Traumatic hypogastric artery bleeding controlled with bipolar desiccation during operative laparoscopy.

During multipuncture operative laparoscopy to excise peritoneal endometriosis involving the pelvic sidewall near the origin of the uterine artery, the lower portion of the hypogastric artery was perforated. The acute hemorrhage was controlled by immediately grasping the lacerated blood vessel with a 5-mm atraumatic grasping forceps. A Kleppinger bipolar forceps set at 25 W desiccated and sealed the artery successfully. As no further bleeding was noted, the procedure was terminated. The patient remained overnight for observation, and was discharged from the hospital the next day. She is doing well 18 months after the injury and repair.

Adult↗
PubMed1994

Life-threatening hypotension after vasopressin injection during operative laparoscopy, followed by uneventful repeat laparoscopy.

Vasopressin may be associated with systemic hemodynamic changes, including severe myocardial ischemia, even in healthy patients. A 36-year-old woman underwent laparoscopy for the treatment of a uterine leiomyoma. After intravascular injection of vasopressin, she experienced life-threatening hypotension, and the procedure was subsequently aborted. After she recovered, she underwent successful laparoscopy without the use of vasopressin, and no complications occurred. As endogenous vasopressin levels sometimes rise during laparoscopy, patients may become susceptible to the drug's effects, and appropriate precautions must be taken.

Adult↗
PubMed1994

The Incidence of Endometriosis in Posthysterectomy Women

One hundred consecutive patients, age 24-62, status post total hysterectomy with and without bilateral oophorectomy (BSO), presented with chronic pelvic pain. All underwent laparoscopy. Of those who did not have BSO, 30 had definite endometriosis found at laparoscopy and five had questionable endometriosis. Of the 30 patients found to have definite endometriosis, 24 had a positive history of endometriosis, five had a negative history and one had a questionable history. Sixty-four underwent total hysterectomy with BSO. Of these 64, definite endometriosis was found in 22 at laparoscopy, questionable endometriosis was noted in 3, and findings for 39 were negative. Of the 22 women with positive endometriosis, 19 had a positive history of endometriosis, 2 had a negative history and 1 had a questionable history. Of these 22 patients, 13 were on estrogen replacement therapy, 2 were on estrogen and progesterone, 2 were on testosterone estradiol pellets, 2 were on GnRH analogs, 1 was on danazol and 2 received no medication. In this group, the time between hysterectomy and our laparoscopy was eight months to 15 years. Twenty-four of the 100 patients had a positive history of endometriosis with negative findings at laparoscopy. Our findings support the view that endometriosis will be found at laparoscopy in a significant number of women with chronic pelvic pain status post hysterectomy with or without BSO, especially if the woman has a positive history of endometriosis.

Journal Article↗
PubMed1994

Laparoscopic repair of a vesicovaginal fistula: a case report.

BACKGROUND: Operative laparoscopy was performed for the management of ovarian remnant syndrome involving the bladder, bowel, vagina, and ureters, and requiring extensive dissection. A vesicovaginal fistula developed postoperatively. CASE: Because of the complexity and location of the fistula, a vaginal approach was not appropriate. Using techniques of videolaparoscopy, videocystoscopy, and operative laparoscopy, the fistula was repaired. CONCLUSION: In experienced hands, endoscopic management of complex vesicovaginal fistulas may be an alternative to the traditional abdominal approach.

Female↗
PubMed1994

Hospital cost comparison between abdominal, vaginal, and laparoscopy-assisted vaginal hysterectomies.

OBJECTIVE: To evaluate and compare the hospital charges for total abdominal hysterectomy (TAH), vaginal hysterectomy, and laparoscopy-assisted vaginal hysterectomy performed with the linear stapler. METHODS: Thirty cases of each of the three types of hysterectomies, performed at the same hospital by various surgeons, were selected at random. The authors did not participate in any of the cases evaluated. Operating room, postoperative hospitalization, and pharmacy costs were compared. Independent, two-tailed Student t test analysis was performed. RESULTS: The mean cost of performing laparoscopy-assisted vaginal hysterectomy with the linear stapler ($7161.66) was significantly higher (P < .05) than that of both vaginal hysterectomy ($4868.06) and TAH ($4926.80). The cost of vaginal hysterectomy was nonsignificantly lower (P > .05) than that of TAH. The mean operating room supplies and equipment charge for laparoscopy-assisted vaginal hysterectomy with the linear stapler ($2468.43) was, as expected, significantly higher (P < .05) than those for both abdominal ($716.65) and vaginal ($676.16) procedures. The average operating room time charge for laparoscopy-assisted vaginal hysterectomy ($1264.56) was also significantly higher (P < .05) than for the other two procedures (TAH $642.76, vaginal hysterectomy $955.66). The mean total pharmacy charges were similar for all groups ($1114.27 for laparoscopy-assisted vaginal hysterectomy, $1163.16 for vaginal hysterectomy, and $1098.71 for TAH). Reflecting the longer operating time for laparoscopy-assisted vaginal hysterectomy, the intraoperative pharmacy costs were significantly higher for this type ($417.00) than for the TAH patients ($290.62). The difference, however, was almost erased when postoperative pharmacy charges were included, reflecting the lower cost of a shorter hospital stay in the laparoscopy-assisted vaginal hysterectomy group. Some savings were realized by laparoscopy-assisted vaginal hysterectomy when postoperative hospitalization charges were considered. The average hospitalization time was 2.3 days for laparoscopy-assisted vaginal hysterectomy, 3.0 days for vaginal hysterectomy, and 3.3 for TAH. CONCLUSIONS: The cost savings expected with the advent of laparoscopy-assisted vaginal hysterectomy when performed with the linear stapler have not been realized at present. In most cost categories studied, the use of laparoscopy to perform a hysterectomy was associated with much higher costs. The predicted savings associated with the shorter hospital stay in these patients failed to offset the exorbitant intraoperative costs. However, when bipolar electrocoagulation with the CO2 laser and reusable instruments replace staplers and disposables, respectively, the projected savings are appreciated.

Abdomen↗
PubMed1994

Laparoscopic amputation of a noncommunicating rudimentary horn after a hysteroscopic diagnosis: a case study.

This report describes the diagnosis and management of a noncommunicating rudimentary horn complicated by severe pelvic pain and associated endometriosis. This condition was diagnosed by simultaneous laparoscopic and hysteroscopic examinations. The hysteroscopic evaluation was significant in the diagnosis, as the noncommunicating horn was not recognized during a previous laparoscopy. The laparoscopic removal of the horn afforded complete long-term resolution of pain coupled with speedy postoperative recovery.

Adult↗
PubMed1994

Complications of 361 Laparoscopic Hysterectomies

We evaluated the results and complications of 361 hysterectomies performed at operative laparoscopy to treat a variety of benign gynecologic conditions. The hysterectomies were classified according to the number of steps performed endoscopically. There were no conversions to laparotomy for the hysterectomy, although one required laparotomy for rectosigmoid resection and anastomosis due to severe stricture of the rectosigmoid colon. There were no cases of mortality during the hospitalization nor during 42 postoperative days. The overall complication rate was 10.23 per 100 women. Intraoperative complications included three inferior epigastric vessel injuries, two hemorrhages requiring blood transfusion, one small bowel injury and one bladder injury. The overall complication rate in this series is lower than that reported for abdominal or vaginal hysterectomy. Laparoscopically assisted hysterectomy allows the surgeon to directly visualize uterine artery pedicles, to clearly delineate ureteral paths, to accomplish immediate and precise hemostasis, to use hydrostatic lavage and irrigation to continuously disperse microclots and tissue debris, and to operate with accuracy. While this procedure seems to offer several advantages such as reduced devitalized tissue, near elimination of the potential for suture reaction, and diminished inflammatory responses during the healing phase, complications can be encountered.

Journal Article↗
PubMed1993

Adhesion formation after endoscopic posterior colpotomy.

Twenty-two women who had undergone laparoscopic posterior colpotomy at initial operative laparoscopy and later underwent a second laparoscopic procedure were evaluated for adhesion formation. Fifteen women (68%) had myomata removed, 3 (14%) had a dermoid cystectomy, 1 (5%) had a serous cystadenoma removed, and 3 (14%) who had large endometriomata and severe adhesions underwent salpingo-oophorectomy. Although filmy adhesions were noted in nine women, no adhesions were noted in the cul-de-sac. Based on our limited results, it does not appear that tissue removal via laparoscopic colpotomy predisposes reproductive-age women to postoperative adnexal adhesion formation.

Adnexal Diseases↗
PubMed1992

Four ovarian cancers diagnosed during laparoscopic management of 1011 women with adnexal masses.

OBJECTIVES: This study was conducted to assess the value of laparoscopic management of adnexal masses. Two concerns we wish to address are the failure to diagnose early ovarian cancer at laparoscopy and worsening the prognosis of stage I cancer by spilling fluid during surgery. STUDY DESIGN: The setting is a predominantly referral-based, private subspecialty practice. All operations were preformed in the outpatient surgical suite of a large suburban hospital. After extensive patient screenings, which included history and physical examination, preoperative serum CA 125 levels (since 1988), and pelvic ultrasonography, 1209 adnexal masses were managed laparoscopically. RESULTS: Of 1011 patients with surgical management, ovarian cancer was discovered intraoperatively in four. CONCLUSIONS: Our findings indicate that with consistent use of frozen sections of all cyst walls and suspicious tissue, laparoscopic management did not alter the prognosis. Neither CA 125 level, pelvic ultrasonography, nor peritoneal cytologic testing had sufficient diagnostic specificity to predict malignancy. Experienced surgeons using intraoperative histologic sampling may safely evaluate adnexal mass laparoscopically.

Adnexal Diseases↗
PubMed1992

Operative laparoscopy for the treatment of ovarian remnant syndrome.

OBJECTIVE: To present the technique and assess the efficacy of operative laparoscopy to manage ovarian remnant syndrome. DESIGN: Observational with a follow-up of 6 to 32 months. SETTING: Private subspecialty practice with a large referral base. PATIENTS: Thirteen women, 9 with previous bilateral salpingo-oophorectomy and 4 with previous unilateral salpingo-oophorectomy and pain on the ipsilateral side. INTERVENTIONS: Multipuncture advanced operative laparoscopy. MAIN OUTCOME MEASURES: Patient pain relief was assessed through return examinations, telephone interviews, or contact with referring physicians. RESULTS: Nine patients reported complete pain relief. One reported incomplete but satisfactory pain relief. Two required bowel resection by laparotomy to obtain pain relief, and one, despite subsequent laparotomy, had persistent pain. No intraoperative or postoperative complications were noted. CONCLUSION: Laparoscopy can be effective in managing ovarian remnant syndrome when performed by an experienced laparoscopist.

Adult↗
PubMed1992

Laparoscopic proctectomy for infiltrating endometriosis of the rectum.

Proctectomy for deep endometriosis of the rectal wall was performed without laparotomy. Although laparoscopic pelvic surgery and transperineal proctectomy with primary double-stapled anastomosis are established procedures in gynecological and gastrointestinal surgery, this is the first reported case in which these procedures are combined to mobilize the rectum and perform an extracorporeal transanal rectal resection and anastomosis.

Adult↗