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Biomedical subjects

D B Redwine

Publications and source records attributed to D B Redwine.

At least 19 recordsLinked to original sources
PubMed1997

Data structuring.

Explore the source record for details and available documents.

Database Management Systems↗
PubMed1996

Laparoscopically assisted transvaginal segmental resection of the rectosigmoid colon for endometriosis.

OBJECTIVE: To compare three methods of segmental lower colon resection for treatment of symptomatic intestinal endometriosis. DESIGN: Retrospective case study. SETTING: Private practice patients in a rural community hospital. PATIENTS: Patients with nodular, invasive rectosigmoid endometriosis requiring segmental resection and anastomosis for treatment. Laparotomy patients were matched with laparoscopy patients for severity of intestinal endometriosis. INTERVENTIONS: Segmental resection of the rectosigmoid colon by laparotomy, by a laparoscopic Intracorporeal technique or by a laparoscopically assisted transvaginal technique. MAIN OUTCOME MEASURES: Length of surgery, length of hospital stay, operating room charges and total hospital charges corrected to 1995 dollars. RESULTS: Compared with laparotomy segmental colon resection for endometriosis, laparoscopic transvaginal segmental resection resulted in a shorter length of stay, equivalent operating room charges, and significantly lower total hospital charges. The laparoscopic transvaginal technique is much faster, safer, and less fatiguing to the surgeon than a total intracorporeal technique. CONCLUSIONS: Laparoscopically assisted transvaginal segmental rectosigmoid resection for endometriosis is a promising technique that is simpler than a laparoscopic intracorporeal segmental resection technique and is less costly than a laparotomy segmental resection technique.

Colon, Sigmoid↗
PubMed1996

Ovarian remnant syndrome after laparoscopic hysterectomy and bilateral salpingo-oophorectomy for severe pelvic endometriosis.

Ovarian remnant syndrome is a rare complication of total abdominal hysterectomy and bilateral salpingo-oophorectomy (BSO). Ovarian enlargement and dense periovarian adhesions are the predisposing factors. Recurrent ovarian remnant syndrome was associated with recurrence of symptomatic endometriosis in a woman who underwent laparoscopic supracervical hysterectomy and BSO for severe endometriosis and extensive pelvic adhesions. After primary surgery she required five additional procedures for complete resection of all ovarian remnants. Definitive surgery for advanced endometriosis with extensive periovarian adhesions may be complicated by ovarian remnant syndrome and reactivation of the disease. Careful retroperitoneal resection of all ovarian tissue is of paramount importance in preventing the syndrome. This, however, may be a limitation of laparoscopic surgery. The choice between laparoscopy and laparotomy in such cases should be individualized and based on the degree of surgical difficulty and the surgeon's level of experience.

Adult↗
PubMed1995

Laparoscopic surgery for intestinal and urinary endometriosis.

Intestinal and urinary tract involvement by endometriosis may be symptomatic, particularly when invasive disease is present. Even in expert hands, complete excision of all invasive disease cannot be accomplished laparoscopically in every case. The practitioner must balance enthusiasm for the advantages of a laparoscopic approach with limitations of time and skill. Laparoscopy should be abandoned in a particular case if a better job can be performed by laparotomy. Hysterectomy with castration may not relieve symptoms due to invasive disease.

Endometriosis↗
PubMed1995

Laparoscopic hysterectomy compared with abdominal and vaginal hysterectomy in a community hospital.

STUDY OBJECTIVE: To compare costs of laparoscopic hysterectomy with those of abdominal and vaginal hysterectomies in a community hospital. DESIGN: Retrospective review. Study cases were controlled for severity of pathology and extent of surgery performed laparoscopically. Charges were corrected for inflation. SETTING: Rural community hospital, fee for service practice. PARTICIPANTS: Women undergoing hysterectomy during the study period. INTERVENTIONS: Hysterectomy performed with or without laparoscopy. MEASUREMENTS AND MAIN RESULTS: Operating times, operating room charges, total hospital charges, uterine weight, length of hospital stay, and complications were tabulated for laparoscopic, abdominal, and vaginal hysterectomies, with and without bilateral salpingo-oophorectomy. The use of a video monitor and disposable instruments was associated with increased costs and longer operating times. With reusable instruments and a simple operating technique performed while looking down an operating laparoscope, laparoscopic hysterectomy was less costly than abdominal hysterectomy. Laparoscopy without treatment of concurrent pathology before vaginal hysterectomy was associated with increased costs. Vaginal hysterectomy was faster and less expensive than any other form of hysterectomy. Some abdominal hysterectomies could possibly have been performed vaginally. There was no advantage in studying patients undergoing hysterectomy with bilateral salpingo-oophorectomy separately from those undergoing hysterectomy alone. Complications were similar in all groups. CONCLUSIONS: Laparoscopic hysterectomy performed with a simple electrosurgical technique and reusable instruments, and without a video monitor was less expensive than abdominal hysterectomy. The video control and disposable instruments were associated with longer operating times and higher charges.

Disposable Equipment↗
PubMed1994

Remote recollection of preoperative pain in patients undergoing excision of endometriosis.

To determine the accuracy of postoperative recall of preoperative pain, this prospective, longitudinal study was conducted by a general gynecologist in private practice at a referral center. Before excision of endometriosis at laparoscopy or laparotomy and again at 6 to 18 months after surgery, 168 patients completed a 5-point scale assessing 11 symptoms that may be related to endometriosis. For 6 of the 11 symptoms, over 50% of patients had exact recall of pain level. For 10 symptoms, over 80% recalled their preoperative pain level within +/-1 point. Patients requiring reoperation were most likely to recall preoperative pain levels accurately. Those not requiring reoperation tended to inflate slightly their remote assessment of preoperative pain, indicating that successfully treated patients tend to forget how much they formerly hurt.

Endometriosis↗
PubMed1994

Endometriosis persisting after castration: clinical characteristics and results of surgical management.

OBJECTIVE: To identify the clinical characteristics and response to surgical treatment of endometriosis-associated pain in castrated women. METHODS: In a prospective, longitudinal observational study, 75 patients with previous castration had biopsy-proven endometriosis excised surgically. Anatomical characteristics of disease were studied using pelvic mapping and compared to the findings in non-castrated women with endometriosis. Preoperative and postoperative verbal analogue pain scales were used to gauge the response to excision of endometriosis. RESULTS: Patients treated surgically for endometriosis following castration were significantly older (37.8 +/- 8.1 versus 31.3 +/- 6.9 years, mean +/- standard deviation; 95% confidence interval [CI] 4.9-8.1) and slightly more likely to have intestinal involvement (risk ratio 1.3, 95% CI 0.94-1.8) than non-castrated endometriosis patients. Most had marked alleviation of pain after excision of endometriosis. CONCLUSIONS: Endometriosis can remain symptomatic after castration, with or without estrogen therapy. In such patients, there is a 33% frequency of intestinal involvement. At castration, consideration should be given to removal of invasive peritoneal and intestinal disease. Symptom improvement occurs in most patients after excision of endometriosis.

Adult↗
PubMed1993

Laparoscopic excision of endometriosis with 3-mm scissors: comparison of operating times between sharp excision and electro-excision.

To determine if laparoscopic excision of endometriosis by electrosurgery is more rapid than by sharp dissection, a retrospective comparative study was made of operative times for the two procedures. Median operating times for laparoscopic electro-excision of endometriosis were 26% to 49% faster than excision by sharp dissection. A chi2 analysis of the frequency counts of surgical intervals, and disease stage revealed this difference to be statistically significant and not due to acquired experience or differences in extent of disease in the two groups. The reduction in operating time achieved with monopolar electro-excision seems primarily associated with a more rapid cutting action with simultaneous coagulation of bleeders.

Dissection↗