All gynecologic oncologists should learn the endoscopic surgical technique.
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Female↗
Biomedical subjects
Chyi-Long Lee
Publications and source records attributed to Chyi-Long Lee.
Inhibition of ovarian cancer growth and implantation by paclitaxel after laparoscopic surgery in a mouse model.
OBJECTIVE: We used an established experimental model to evaluate the influence of intraperitoneal chemotherapy on the generation of laparoscopy-associated metastases and the effectiveness of chemotherapy. STUDY DESIGN: Twenty-four nude mice underwent laparoscopy with carbon dioxide insufflation and the instillation of a tumor cell suspension with or without paclitaxel into the peritoneal cavity. Mice were allocated to 1 of the following groups (8 mice to each group): (1) controls; (2) paclitaxel given during the operation; (3) paclitaxel given after the operation. Mice were killed 30 days after the procedure, and the peritoneal cavity and port sites were examined for the presence of tumors. RESULTS: Tumor implantation and port-site metastases were reduced more by the intraoperative intraperitoneal administration of paclitaxel during the operation than by administration after the operation. CONCLUSION: Intraoperative intraperitoneal administration of paclitaxel may decrease significantly the occurrence of port-site metastasis and intraperitoneal dissemination in an animal study.
Abdomen↗
Use of laparoscopic cytoreductive surgery to treat infertile women with localized adenomyosis.
OBJECTIVE: We report on two infertile women with localized adenomyosis who had successful pregnancies after treatment with laparoscopic cytoreductive surgery. DESIGN: Case report. SETTING: Tertiary care university hospital. PATIENT(S): Two infertile women with localized adenomyosis. INTERVENTION(S): Laparoscopic excision of adenomyotic lesion with/without subsequent hypoestrogenic agent was performed. MAIN OUTCOME MEASURE(S): Pregnancy. RESULT(S): Hypoestrogenic agent with danazol was administered 3 months immediately after surgery in one woman. Both women conceived spontaneously at 30 and 21 months after surgery, respectively. The pregnancies were uneventful, and healthy infants were delivered via cesarean section at term. CONCLUSION(S): Laparoscopic cytoreductive surgery can be an alternative treatment to the use of hypoestrogenic agents or hysterectomy in women with localized adenomyosis, especially for those who want to maintain their fertility and achieve successful pregnancies. Patients may wait up to 21 months after surgery until a pregnancy occurs.
Adult↗
Endoscopic management of cesarean scar pregnancy.
OBJECTIVE: To describe our experiences with the diagnosis and endoscopic treatment of cesarean scar pregnancy. DESIGN: Prospective clinical study. SETTING: Tertiary care university hospital. PATIENT(S): Eleven women treated in our division between 1999 and 2004 who had been diagnosed with cesarean scar pregnancy. INTERVENTION(S): Transvaginal ultrasound was used for diagnosis, and endoscopy (laparoscopy and/or hysteroscopy) was used to treat cesarean scar pregnancy and preserve fertility. MAIN OUTCOME MEASURE(S): Operative blood loss, hospital stay, and time to resolution of serum beta-hCG were recorded. RESULT(S): The gestational age at diagnosis ranged between 6 and 11 weeks. Laparoscopic treatment was used in four women, hysteroscopic treatment in six women, and one woman underwent combined treatment with laparoscopy and hysteroscopy. The average blood loss during surgery was 110.9 mL (range, 20-300 mL), and average hospital stay was 1.7 days (range, 0.25-3 days). No complications occurred, and no blood transfusion was required. All patients' uteri were successfully preserved, and serum beta-hCG levels declined to a normal limit within 4 weeks postoperatively. CONCLUSION(S): When the diagnosis of cesarean scar pregnancy is made in the first trimester, endoscopy can be an alternative surgical treatment; the prognosis is good, and fertility can be preserved.
Adult↗
Laparoscopic-assisted vaginal subtotal hysterectomy.
BACKGROUND: A novel approach in combined laparoscopic and vaginal procedures through the posterior cul-de-sac for subtotal hysterectomy is introduced. PATIENTS AND METHODS: Twenty-one women with menometrorrhagia, symptomatic adenomyosis, or uterine myomas were enrolled in this study. After laparoscopic dissection of bilateral round ligaments and adnexa, a guiding suture brought the uterine fundus down through the posterior cul-desac into the vagina via a posterior colpotomy. Subtotal hysterectomy and hemostasis of the cervical stump were then performed transvaginally by conventional techniques and equipment. RESULTS: Mean operative time, blood loss, and length of hospital stay were 111.2 +/- 28.8 minutes, 252.4 +/- 147.9 mL, and 3.2 +/- 0.9 days, respectively. No patients developed serious complications, but 1 patient had a postoperative stump infection and was treated with 2 combined antibiotics, uneventfully. CONCLUSION: A combined laparoscopic and vaginal approach in performing subtotal hysterectomy through the posterior cul-de-sac is an alternative to a purely laparoscopic approach.
Anti-Bacterial Agents↗
Comparison of the efficacy of the pulsed bipolar system and conventional bipolar electrosurgery in laparoscopically assisted vaginal hysterectomy.
BACKGROUND: We compared the safety and effectiveness of the pulsed bipolar system (PlasmaKinetic; Gyrus Medical, Maple Grove, MN) and conventional electrosurgery (Kleppinger bipolar forceps; Richard Wolf Instruments, Vernon Hills, IL) in laparoscopically assisted vaginal hysterectomy (LAVH). PATIENTS AND METHODS: In this prospective, nonrandomized study, 62 women with benign gynecologic diseases scheduled for LAVH were divided into two groups: one group underwent LAVH with the pulsed bipolar system and the second group underwent LAVH with conventional electrosurgery. Outcome measures for both groups were compared in terms of length of operative time, amount of blood loss, requirement of blood transfusion, and length of hospital stay. RESULTS: The mean operative time (87.6+/-28.1 minutes vs. 93.4+/-20.2 minutes, P=0.368), blood loss (196.8+/-143.7 mL vs. 253.2+/-125.8 mL, P=0.105), and blood transfusion rate (3.2% vs. 6.5%, P=1.0) were slightly greater in the conventional electrosurgery group than those in the pulsed bipolar system group, although these differences were not statistically significant. The mean length of hospital stay was similar in both groups (3 days). No patients developed serious complications related either to conventional electrosurgery or to the pulsed bipolar system. CONCLUSION: Our findings indicate that the pulsed bipolar system is as safe and effective as conventional electrosurgery, and may offer an alternative option for patients undergoing LAVH.
Adult↗
Caesarean scar pregnancy successfully treated by operative hysteroscopy and suction curettage.
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Cesarean Section↗
[Evidence nursing of menopausal women: telephone intervention services].
With rapid innovation in medical techniques and continuous improvements in public sanitation, people now live much longer than they used to. According to the Department of Health, Executive Yuan, the average life expectancy of women increased from 60.26 years in 1952 to 78.48 years in 2002. As the average life expectancy of women increases, the population of menopausal women also tends to increase year by year. For that reason, the government sees the health care of menopausal women as an important aspect of healthcare policy. With the health care environment constantly changing, it appears that simply relying on traditional experiences and subjective beliefs to do such nursing work cannot satisfy the needs of patients. Consequently, effective methods to apply research results to clinical practice has become a crucial goal of current evidence nursing. Rosswurn and Larrabee (1999) proposed six steps of change in the clinical nursing model. In this paper, we used this model to evaluate the effects of telephone intervention services for menopausal women.
Interviews as Topic↗
A simplified method to decrease operative blood loss in laparoscopic-assisted vaginal hysterectomy for the large uterus.
UNLABELLED: STUDY OBJECTIVE. To evaluate the role of oxytocin in decreasing operative blood loss in laparoscopic-assisted vaginal hysterectomy (LAVH) for the large uterus (weight > or = 500 g). DESIGN: Prospective clinical study (Canadian Task Force classification II-2). SETTING: Tertiary care university hospital. PATIENTS: Eighty-eight women scheduled for a hysterectomy for large benign uterine tumors. INTERVENTION: Two ampules of oxytocin (10 u/mL/amp) were added to 1000 mL of saline solution running at the rate of 40 mU/min during the course of LAVH. MEASUREMENTS AND MAIN RESULTS: Blood loss and blood transfusion rate were significantly greater in the group without oxytocin infusion (group B) than in the group with oxytocin infusion (group A), with 485.7 +/- 321.6 mL versus 364.1 +/- 173.2 mL (p <.05) and 26.7% versus 6. 1% (p <.05), respectively. There was no significant difference in average age, body weight, and number of vaginal deliveries and cesarean sections between the two groups. There also was no significant difference in mean uterine weight, postoperative stay, and complications between the two groups. CONCLUSION: Oxytocin infusion can cause uterine contractions that decrease uterine perfusion. It is a safe and inexpensive method to help decrease operative blood loss during LAVH for the large uterus.
Adult↗
Trocar-assisted sling suspension for stress urinary incontinence: three-year follow-up.
STUDY OBJECTIVE: To evaluate 3-year outcomes of trocar-assisted sling suspension (TASS) for genuine stress incontinence. DESIGN: Retrospective review (Canadian Task Force classification II-2). SETTING: University-based, tertiary-level center for endoscopic surgery. PATIENTS: One hundred forty women with genuine stress incontinence with bladder neck hypermobility. INTERVENTION: After standard surgery preparation and general endotracheal anesthesia, TASS was performed. The periurethral space and thicker parts of the pubocervical fascia were opened from the vagina. A 0.5-cm incision was made on both sides of the lower abdomen and was measured 4-cm lateral to the linea album and 2-3-cm above the pubic bone. A trocar was used to penetrate the incision site to the space of Retzius. A 2-cm x 30-cm folded polypropylene mesh was placed inside the vagina and was then pulled out of the trocar sheath by a laparoscopic forceps. MEASUREMENTS AND MAIN RESULTS: All patients completed the procedures without exception. The average blood loss was less than 50 mL (range 10-200 mL). The operative time ranged from 20 to 90 minutes with a mean time of 32 +/- 12 minutes. Eleven patients had voiding difficulty. Six of them voided well after intermittent self-catheterization performed 28 days postoperatively. Seven patients had poor healing of the anterior vaginal wall; therefore, removal of mesh and wound repair were performed. One patient suffered from a retroperitoneal hematoma, and one patient had an intraoperative bladder injury. The overall complication rate was 14.3%. During 12-36 months of follow-up, 134 of 140 patients (95.7%) were satisfied with the surgery. CONCLUSIONS: Based on the results of our pilot study, TASS is quite feasible as a method of treatment for stress urinary incontinence. The surgery is not difficult to perform when compared with Burch colposuspension. Moreover, it encompasses the simplicity and effectiveness of tension-free vaginal tape surgery. In addition, TASS also can correct lateral wall defects such as cystocele.
Adult↗
Feasibility of human telomerase reverse transcriptase mRNA expression in individual blastomeres as an indicator of early embryo development.
PURPOSE: The study was undertaken to test whether human telomerase reverse transcriptase (hTERT) transcripts in an individual blastomere could be used as an indicator for embryo development. METHODS: Group A consisted of day 3 normal cleaving embryos at 4- to 8-cell stage, which were surplus and not allocated for uterine transfer. Group B consisted of arrested or fragmented embryos at the same stage, which were considered to be compromised. After blastomere dissociation, RNA purification, reverse transcription, and hTERT PCR amplification, the amplified product was separated by 3% gel electrophoresis. RESULTS: Eighty-six (90.5%) of the 95 intact blastomeres in group A and 78 (70.9%) of the 110 blastomeres in group B demonstrated hTERT mRNA expression. The difference was statistically significant (P < 0.05, chi-square). Eight (38.1%) of the 21 embryos in group A and 22 (62.9%) of the 35 embryos in group B had at least one blastomere that did not express hTERT mRNA under this procedure. The difference was not significant (P > 0.05, chi-square). CONCLUSIONS: General hTERT mRNA transcripts can be detected in most of the individual blastomeres but cannot be used as an indicator for early embryo development. Further investigations are necessary to elucidate its clinical application.
Blastomeres↗
Laparoscopic-assisted vaginal myomectomy through an anterior approach.
BACKGROUND: To evaluate the safety and efficacy of a combined laparoscopic and vaginal approach through the anterior cul-de-sac in dealing with fundal and/or anterior wall uterine myomata. PATIENTS AND METHODS: Seven women with symptomatic fundal and/or anterior wall uterine myomata were enrolled in this study. After laparoscopic identification of the location of the myomata, a guiding suture brought the dominant myoma down through the anterior cul-de-sac into the vagina via an anterior colpotomy. Resection and suturing were then performed transvaginally. RESULTS: Mean +/- standard deviation (SD) operative time, blood loss, and the length of hospital stay were 88.1 +/- 27.8 minutes, 278.6 +/- 131.8 mL, and 2.9 +/- 0.7 days, respectively. No patients developed serious complications, and only four transient macroscopic hematuria occurred intra- and postoperatively. CONCLUSION: Although transient hematuria may occur, a combined laparoscopy and vaginal approach in dealing with fundal and/or anterior wall uterine fibroids through the anterior cul-de-sac is an alternative to pure laparoscopic myomectomy.
Adult↗
Three-dimensional power Doppler ultrasound diagnosis and laparoscopic management of a pregancy in a previous cesarean scar.
An ectopic pregnancy developing in a previous Cesarean section scar is a rare event, and there is still a lack of information concerning the adequacy of management strategies. So far, no modality can guarantee the integrity of the uterus. We report the case of a 29-year-old woman with three Cesarean deliveries who was transferred to our hospital with a diagnosis of cervical pregnancy. Transvaginal three-dimensional power Doppler ultrasound revealed a well-encapsulated bulging mass displacing anteriorly over the lower anterior uterine wall sounding with an irregular course and branching vessels. The diagnosis of pregnancy in a previous Cesarean scar was made. Laparoscopic ligation of bilateral uterine arteries followed by excision of the ectopic pregnant mass was undertaken, and the patient's uterus was successfully preserved. Conservative management with the laparoscopic approach may be a safe and effective alternative to hysterectomy in patients with a pregnacy in a previous Cesarean scar.
Adult↗
Huge maternal hydronephrosis: a rare complication in pregnancy.
A huge maternal hydronephrosis is uncommon in pregnancy and might be mistaken as a pelvic mass. A 21-year-old primigravida was noted at 25th week of gestation to have a visible bulging mass on her left flank. The mass was originally mistaken as a large ovarian cyst but later proved to be a huge hydronephrosis. Retrograde insertion of ureteroscope and a ureteric stent failed, so we performed repeated ultrasound-guided needle aspiration to decompress the huge hydronephrosis, which enabled the patient to proceed to a successful term vaginal delivery. Nephrectomy was performed after delivery and proved the diagnosis of congenital ureteropelvic junction obstruction.
Adult↗
Randomized trial of surgical staging (extraperitoneal or laparoscopic) versus clinical staging in locally advanced cervical cancer.
OBJECTIVE: To define the role of pretreatment surgical staging for locally advanced cervical carcinoma. METHODS: A two-step randomized trial was conducted to compare clinical staging (arm A) versus surgical staging (arm B) and to compare the laparoscopic (LAP) with the extraperitoneal (EXP) approach in previously untreated locally advanced cervical carcinoma. After the first randomization, those in arm B were randomly allocated to either LAP or EXP. An interim analysis was planned to evaluate the feasibility of LAP versus EXP, which led to the current report. RESULTS: A total of 61 patients were eligible (arm A, 29; arm B, 32). The operation time, blood loss, and lymph node yield of LAP and EXP were not significantly different. Serious acute and late toxicity was not different between arm A and arm B, or LAP versus EXP. Para-aortic node metastasis was documented in 25% (95% confidence interval, 10% to 40%) of patients on arm B. An interim analysis was performed in January 2000. Patients on arm B had significantly worse progression-free survival than those on arm A. Hazard ratios of relapse/persistent or death were 3.13 (P = 0.005) and 1.76 (P = 0.150), respectively. Patient accrual was terminated according to the early stopping rules. With further follow-up till December 2001, the difference in progression-free survival remained significant (P = 0.003), and the difference in overall survival became significant (P = 0.024) as the data matured. CONCLUSION: The benefit of pretreatment surgical staging for cervical carcinoma remained unproven. The detrimental effects of surgical staging observed in this study must be considered in the design of clinical guidelines or future trials.
Adult↗
Laparoscopic radical trachelectomy for stage Ib1 cervical cancer.
Radical trachelectomy by vaginal approach is an alternative for young women with early-stage cervical cancer. We modified this procedure to treat two patients with stage Ib1 cervical cancer. With 100% laparoscopic pelvic lymphadenectomy and 80% laparoscopic approach, the technique is laparoscopic radical trachelectomy (LRT). Under direct enhanced vision of the laparoscope, it is easy to identify and preserve ascending branches of the uterine arteries and to divide ligaments surrounding the cervix and vagina. Vaginal procedures require only colpotomy, amputation of cervix, dividing caudal paracolpium, and corpus-vagina anastomosis. Short-term follow-up results of our first patients are satisfactory. Thus, LRT could be a useful alternative for women with early cervical cancer who want to preserve fertility.
Adult↗
Postlaparoscopic vulvar edema, a rare complication.
Two cases of unilateral labial edema occurred after laparoscopic presacral neurectomy and were associated with massive chylous ascites. One woman was cured by a second laparoscopy to repair the chylous leakage. In the other, vulvar edema subsided in 2 days and chyloperitoneum subsided spontaneously in 3 weeks. The mechanism of postlaparoscopic vulvar edema is believed to be similar to that of Conn's postparacentesis labial edema, in which the unhealed puncture tract permits ascites to travel through and accumulate in the labia majora.
Adult↗
Laparoscopic uterine artery ligation for treatment of symptomatic adenomyosis.
STUDY OBJECTIVE: To investigate the effect of laparoscopic uterine artery ligation on symptomatic adenomyosis. DESIGN: Prospective pilot study (Canadian Task Force classification II-2). SETTING: Tertiary care major teaching hospital. PATIENTS: Twenty women with symptomatic adenomyosis. INTERVENTION: Laparoscopic ligation of bilateral uterine arteries with hemoclips and electrocoagulation of bilateral uterine ovarian vessels. MEASUREMENTS AND MAIN RESULTS: Patients underwent sonographic measurement of uterine size, and recorded amount of menstruation and dysmenorrhea preoperatively and postoperatively. Six months postoperatively, mean uterine size had decreased by an amount ranging from 0.4% to 74.0%. Two of nine women achieved remission of the mass effect of an enlarged uterus. Thirteen of 16 patients achieved bleeding control and 5 returned to eumenorrhea or hypomenorrhea. Twelve of 16 patients achieved control of dysmenorrhea and 6 were analgesic free. However, nine women experienced nonmenstrual pain after surgery, three of whom underwent hysterectomy later. Treatment was rated as satisfactory by 15% of patients, but 45% were dissatisfied. Seventeen women would have refused to undergo the procedure if they could make the decision again. CONCLUSION: Poor satisfaction in this preliminary study suggests that symptomatic adenomyosis may not be effectively treated by laparoscopic uterine artery ligation.
Adult↗