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D Raatz

Publications and source records attributed to D Raatz.

16 recordsLinked to original sources
PubMed2001

[Laparoscopy assisted radical vaginal hysterectomy (LAVRH) for cervical carcinoma--perioperative parameters and complications].

OBJECTIVE: Presently we note a standardization of techniques for laparoscopy assisted radical vaginal hysterectomy (LARVH). Altgassen et al. pointed to this fact with their evaluation of 108 operations for cervical cancer. They considered the necessity to perform 100 such operations before standardizing this method. In our survey we compare a similar number of operations performed in our department in order to prove whether Altgassen's thesis is correct, taking peri- and postoperative parameters as well as complications into consideration. For this purpose we analyzed the number of operations necessary to develop and standardize laparoscopic pelvic lymphadenectomy combined with radical vaginal hysterectomy in women treated for cervical cancer. PATIENTS AND METHODS: Between 1st August 1993 and 31st January 1999, 80 patients with cervical cancer FIGO stage Ia2-IIb were selected for laparoscopy assisted radical vaginal hysterectomy. We were able to perform this operation in 71 patients. The operation reports and records of the postoperative period were evaluated retrospectively. RESULTS: The average duration of the operation increased from 380 minutes in cervix carcinoma Ia2 to 530 minutes in cervix carcinoma IIb. The average blood loss remained the same at 1,000 ml for each operation. Correspondingly the average decrease of hemoglobin was 3.5% for all operations. The number of pelvic lymph nodes removed unilaterally varied between 6 and 13. If the group of 37 patients with cervical cancer FIGO stage Ib--particularly homogenous as far as the spread of the tumor and the course of the operation are concerned--is divided up into one group up to the 50th operation and another group after the 50th operation, the regression analysis after the 50th operation shows a statistically significantly higher number of lymphnodes (11 compared to 25; Mann-Whitney-U-Test, p = 0.00014). However no differences were found for mean blood loss (800 ml compared to 700 ml) or duration of operation (400 minutes compared to 420) (Mann-Whitney-U-Test, p > 0.05). 5% of serious complications were associated with the laparoscopic part of the procedure--a blood vessel lesion, a ureter lesion, two postoperative intraperitoneal secondary hemorrhages. 7.5% serious complications in the area of the bladder and the ureter were associated with the vaginal part of the procedure. In 6% of our procedures we observed lymphedema in the lower extremities. Deep Compartment Syndrome was observed in 5% of our patients and associated with the duration of the procedure. CONCLUSION: To implement and standardize our technique of laparoscopic pelvic lymphadenectomy and radical vaginal hysterectomy a learning phase of 50 procedures was necessary.

Adult↗
PubMed2000

[Renaissance of vaginal hysterectomy for cervical carcinoma. 100th anniversary of the first abdominal radical surgery of cervical carcinoma by Ernst Wertheim on November 16, 1898].

In the 100 year long history of the abdominal radical operation of collum carcinoma, due to the continued clinical surgical and scientific work of several generations of physicians, abdominal radical operation with standardized pelvic lymphonodectomy has become the method of choice for surgical treatment of collum carcinoma since 1970. Vaginal radical operation in its various forms has since played only a very restricted role in surgical treatment of collum carcinoma. According to the opinion of the majority of cancer surgeons vaginal radical operation had to be abandoned in view of discontinuous spreading of carcinoma into the regional pelvic lymph nodes. Because of its simplicity vaginal radical operation would still be useful today for very old high-risk patients and very young women with early invasive collum carcinoma detected in cancer screening. In view of our knowledge of the lymph node problem in collum carcinoma, however, this can no longer be the vaginal radical operation of past generations. In order to prevent critical objections to vaginal radical operation, the early attempts of Stoeckel, Suboth Mitra, Bastiaanse, Navratil, Inguilla, and Akashi were resumed. Since 1989 attempts have been made to combine vaginal radical operation of collum carcinoma with laparoscopic pelvic or para-aortic lymphonodectomy. The development has passed the following stages: the development of laparoscopic pelvic and para-aortic lymphonodectomy based on staging criteria the combination of laparoscopic lymphonodectomy with vaginal radical operation of collum carcinoma the combination of laparoscopic lymphonodectomy with complete laparoscopic radical hysterectomy and only subsequent vaginal removal of organs.

Austria↗
PubMed1998

[Endoscopic appendectomy in gynecology].

From 1987 to 1997 we treated 406 patients with appendicitis. 392 patients were treated by endoscopic appendectomy, 14 patients underwent laparotomy for appendectomy. Among these 406 patients we found 4 patients with primary pelvic inflammatory disease, 18 patients with endometriosis, 15 pregnant patients and 13 patients older than 60 year's. The difficulties during the laparoscopic operation were unimportant and we could keep them under control by laparoscopic. 13 patients developed severe complications during the postoperative period. For this reason we do not perform a prophylactic appendectomy during gynaecological laparoscopies. We present in this paper our results and indications for the endoscopic appendectomy.

Adolescent↗
PubMed1996

[Effect of surgical laparoscopy on prognosis of early and limited ovarian malignancies].

9375 laparoscopies were performed at our clinic between 1987 and 1993. In this patient group the incidence of early or localised stages of ovarial malignomas FIGO I and II is 0.9 per cent. 81 laparoscopies were performed on patients suffering from localised stages of ovarial malignomas. 32% (n = 26) of these laparoscopised patients suffering from ovarial malignomas were subjected to extended diagnostic-surgical laparoscopy. These 26 localised stages of ovarial malignomas on which tumour-aggressive laparoscopy had been performed, were followed up and the relevant literature studied and processed. In 23 of the patients thus subjected to tumour-aggressive laparoscopic surgery we did not observe any deterioration of the prognosis during the treatment period (1-8 years). Problematic postoperative courses were seen in 3 patients; the reasons for this are discussed in the present paper. Measures resulting in opening of the tumours during diagnostic-surgical laparoscopy are neither accidental nor unforeseen incidents, but are rather part of an overall surgical strategy. If safety techniques are adopted-as described in this paper-diagnostic-surgical laparoscopy can be performed even during localised stages of ovarial malignomas without any presently recognisable adverse effect on patient prognosis.

Adult↗
PubMed1995

[Risk of recurrence and rate of intrauterine pregnancy after endoscopic therapy of extrauterine pregnancies. 10 years experiences with the treatment of 709 extrauterine pregnancies].

709 ectopic pregnancies were observed from 1983-1992 in the Department of Gynaecology of the Neukölln Hospital, Berlin, Germany, 585 out of which underwent laparoscopic treatment. 169 of 372 patients treated from 1986-1991 still wished to conceive, and we found intrauterine pregnancies in 60% (102 patients) and recurrent ectopic pregnancies in 27% (46 patients). In 9% (11 patients) of these the recurrence occurred following a delivery. A long term follow-up of patients from 1986-1988 was carried out in 1989 and 1993. Compared to 1989, the data of 1993 show a remarkable increase in recurrences and a merely slight increase in intrauterine pregnancies. For representative results the duration of follow-up should be 5 years or longer. 37 cases were operated on while preserving the organ, on a solitary tube or on both tubes. This group with an intrauterine pregnancy rate of 33-47% and a recurrence rate of 49% is discussed later. The risk of recurrence is increased after organ-preserving treatment of a second tubal pregnancy and after severe pelvic inflammatory disease. The process of deciding between maintaining the organ versus salpingectomy, is also discussed.

Fallopian Tubes↗
PubMed1995

[The clinical picture of endoscopically treated extrauterine pregnancy. Postoperative follow-up of 677 endoscopically operated extrauterine pregnancies 1983-1993].

677 ectopic pregnancies were treated by laparoscopy from 1983-1993. Complications in 26 cases led to a second laparoscopic intervention; these complications are analysed to access the advantages and risks of this new procedure. The postoperative HCG blood levels were observed and salpingectomy vs. organ-preserving techniques compared. 30 cases of postoperative HCG-increases and 19 cases with operative treatment of residual trophoblast are also analysed. Endoscopic salpingectomy of tubal pregnancies is a safe procedure with a very low complication rate. Organ-preserving treatment of tubal pregnancies via laparoscopy has a critical complication range of 7-9%. This should be considered for the choice of the operating procedure and the patient should be informed of the risks and their frequency.

Adult↗
PubMed1992

[Endoscopic appendectomy in gynecology and obstetrics].

From 1987 to 1990, 99 patients were treated for appendicitis. 67 patients were treated by endoscopic appendectomy, 32 patients underwent laparotomy for appendectomy. Among these 67 patients we found 4 patients with endometriosis, 6 with pelvic inflammatory disease, and 4 pregnant patients. In no case did we have difficulties during the laparoscopic operation; only 4 patients developed severe inflammatory complications during the postoperative period. For this reason, we do not perform a prophylactic appendectomy during gynaecological laparoscopies. We recommend careful postoperative treatment after laparoscopic appendectomy.

Adolescent↗
PubMed1992

[Systematic aspects of depot peritoneal lavage in gynecology].

After 9 years of experience in gynaecology, the systematics of depot peritoneal lavage is now open for discussion. Intraoperatively, a liquid residual depot of 1.5-2.0 l Ringer's solution remains, while the abdominal cavity is continuously rinsed with varying amounts of liquid according to the indication. By maintaining the depot in all lavages, the formation of adhesions is therefore prevented. Forms and indications of the lavages: 1. "Postoperative Clear Lavage": a) Removal of blood and tissue residues must be removed b) Control/early diagnosis of secondary haemorrhage 2. "Adhesion Lavage": Prophylaxis 3. "Anti-septic Massive Lavage": In all cases of inflammatory diseases of the abdominal cavity, to prevent abscess and adhesion formation, and in peritonitis, to remove bacteria, endotoxins and detritus. In severe ascending infections, complete organ preservation was possible in 94% of 330 patients by combining early laparoscopy with an antiseptic massive lavage. Results of the first two indications will be published shortly.

Abscess↗
PubMed1992

[Laparoscopic diagnosis and therapy of cryptorchism].

Between May 1987 and December 1991, laparoscopy was performed in 33 selected children with 40 nonpalpable testes, to localize the testes. Of 40 testes sought, 16 were present (14 intra-abdominal and 2 inguinal), and in 24 cases testicular aplasia was verified. The authors describe the technique of laparoscopy for unilateral and bilateral undescended testes. Exact anatomical localization of the testes by laparoscopy facilitated accurate planning of operative repair. The advantages of laparoscopy compared with ultrasound and MR imaging in 14 selected patients are described. In 3 patients with an intra-abdominal hypoplastic testis we performed laparoscopic orchiectomy. This new operative procedure is described. Laparoscopic orchiectomy is minimally invasive, offering a practicable alternative to orchiectomy in the case of an atrophic or hypoplastic abdominal testis. No complications were noted.

Adolescent↗
PubMed1990

[Change in tubal pregnancy 1983-1989. 7-years experiences with surgical laparoscopy].

The authors report on the changing aspects in diagnostics and surgical treatment of tubal pregnancy during a period of 7 years (1983-89). In that period, 432 cases of tubal pregnancy were diagnosed and treated, 311 of which were treated by endoscopic abdominal surgery. Diagnosis of tubal pregnancy now depends on radioimmunology for identifying the presence of beta-HCG in the serum as well as on sonographic diagnosis. This may supply proof of tubal pregnancy in many cases as early as 3-4 weeks after conception. Surgery should not be initiated too early, but should also not be too late. We found that the 4th to 5th week after conception yields the best results. During 1986-88, 156 patients were surgically treated by laparoscopy because of tubal pregnancy. These operations and the subsequent fate of the patients are analysed. 66 patients continued to actively wish for a child. In 15% of these there was a recurrence of tubal pregnancy. 62% of these patients became again pregnant in utero.

Chorionic Gonadotropin↗
PubMed1990

[Endoscopic organ saving therapy of ascending infection--10 years experience at the Berlin-Neukölln Gynecologic Clinic].

In the treatment of ascending infection, a newly developed endoscopic surgery concept was combined with an intraoperative lavage and a 48-hour postoperative peritoneal lavage. 276 patients suffering from all grades of severity of disease were primarily treated between 1980 and 1989 by endoscopic surgery while preserving the genitalia. The primary therapy failed in 20 cases (7.2%) so that another surgical intervention became necessary. 4 patients were then treated finally by means of a second laparoscopy. The remaining 16 patients (5.8%) had to undergo laparotomy and partial or complete resection of the reproductive organ had to be performed. Early endoscopic therapy with peritoneal lavage enabled complete preservation of the genitalia in 259 cases (93.8%). The duration of in-patient treatment was reduced to two weeks.

Abscess↗
PubMed1989

[Organ-saving therapy of small ovarian cystomas and dermoids by surgical laparoscopy--a trial 1985-1987].

The article reports on the results of the removal of small benign ovarian tumors (teratoma, cystic adenoma) without oophorectomy. 10 patients were treated by laparotomy and 23 patients with operative laparoscopy. The laparoscopy procedure is limited to tumors not larger than 5 cm. In this procedure it is especially difficult to recognize the difference between a luteal cyst and a cystic tumor which is a already malignant. Careful preoperative and intra-operative attention must be paid to the differential diagnosis. So far, follow up of the 14 patients with cystic adenoma and the 19 patients with teratoma, has shown no recurrence of tumor in the remaining ovary.

Cystadenoma↗
PubMed1989

[Second-look laparoscopy in artificially-induced ascites].

Laparoscopy with artificial ascites creates a larger space between organs and makes an accurate inspection of the entire intra-peritoneal abdomen possible. Second-look laparoscopy with artificial ascites was performed 91 times on 63 tumour-patients. With the reliability of a second-look laparotomy, this method has the advantage of less stress for the patient, and an early discharge from hospital. The procedure can theoretically be repeated multiple times.

Ascitic Fluid↗
PubMed1987

Laparoscopy with artificial ascites.

Since September, 1985 we have performed laparoscopy with artificial ascites on 52 patients. First a laparoscopy with a pneumoperitoneum (2-31 CO2) is initiated, as usual under general anesthesia. After performing an orientating inspection, the CO2 is replaced by 2-31 warm physiological saline. The gas-containing intestinal loops, the air-containing stomach and the greater omentum float on the surface of the liquid, thus causing the mesenterium to spread out. By immersing the optical instrument in the liquid, accurate inspection of the intra-peritoneal organs becomes possible. By additionally inserting the optical instrument in the right upper quadrant, examination of the omental bursa can be performed. Tumors and adhesions in the posterior abdominal cavity and between neighboring organs can be seen, and with practice surgery is even possible. Further mastery of the new technique will provide additional diagnostic information. The indication for "second-look laparotomy" or "staging laparotomy" has now been made questionable by laparoscopy with artificial ascites.

Humans↗
PubMed1985

[Preoperative laparoscopy for determination of the surgical approach].

131 selected patients underwent preoperative laparoscopy directly before surgery and under the same anaesthesia during the period 1981-1984. In all 131 patients several findings were present in combined form that would have permitted abdominal surgery only, provided laparoscopy had not been performed. 49 patients were operated upon via the abdominal approach even though they had been subjected to laparoscopy. In 82 patients, the more favourable vaginal approach was rendered complicated by additional findings (in 22, antefixating preliminary operations on the uterus after Doléris or Baldy; in 29, cystic adnexal tumours; in 31, adhesions or unclear conditions of pain following known or unknown previous surgery). By preceding surgery by laparoscopy it became possible to treat these patients in such a manner that the subsequent vaginal operation was without risk and free from complications. Preoperative laparoscopy extends, enables and safeguards the indication for vaginal surgical approach if used with the necessary critical discrimination.

Aged↗