Biomedical subjects
Publications and source records attributed to H M Hasson.
Exploring means for tying a knot at the end of a continuous suture during laparoscopic surgery, it was found that formation of a single half-hitch over the last loop of the suture can secure the ending of the suture and protect against unraveling. This knot has been used successfully to complete running sutures in various endoscopic, gynecologic, and obstetric procedures.
Fifty-six patients presenting with infertility (17); bleeding, pain, and pressure symptoms (32); and pelvic mass (seven) associated with leiomyomas were managed with laparoscopic myomectomy. Twenty-four second-look procedures were performed to evaluate healing and adhesion formation. Operative time ranged between 45-443 minutes (mean 157), estimated blood loss varied from 10-400 mL (mean 75), and the mean length of hospital stay was 1 day. Traditional morcellation was used initially but was abandoned because of long operating time; vaginal or abdominal removal (depending on size) proved more satisfactory. Three patients developed subcutaneous emphysema and one had febrile morbidity due to upper respiratory tract infection. There were no other complications. In 24 second-look procedures, adhesions were present in 16 subjects (66%). Twelve of 17 in the infertility group conceived (71%); all 39 patients with other complaints experienced satisfactory relief. There were no reoperations. When myomectomy is indicated, the laparoscopic approach appears to offer an alternative to abdominal surgery in selected patients.
One hundred two women with ovarian cysts were managed laparoscopically over a 13-year period. Thirteen were treated with laparoscopic inspection followed by laparotomy, 6 with laparoscopic fine needle aspiration followed by laparotomy and 83 with laparoscopic fenestration and biopsy, with or without coagulation or removal of the cyst lining. Satisfactory results were noted in patients treated completely with laparoscopy. Only 1 of 56 functional, simple or paraovarian cysts recurred during the study period. Two of the 18 ovarian endometriomas treated with fenestration and coagulation or removal of the lining recurred, whereas 8 of 9 such lesions recurred when treated with fenestration alone. There were no surgical complications.
Three hundred thirteen women participated in an open, multicenter comparison of the incidence of intermenstrual bleeding (breakthrough bleeding and or spotting) associated with the use of three triphasic oral contraceptives. Triphasil (n = 107), containing levonorgestrel and ethinyl estradiol, and Ortho-Novum 7/7/7 (n = 97) and Tri-Norinyl (n = 109), both of which contain norethindrone and ethinyl estradiol, were administered over four cycles for a total of 1141 cycles. The total incidence of intermenstrual bleeding was significantly lower with Triphasil (17.2%) than with Ortho-Novum 7/7/7 (39.5%) or Tri-Norinyl (49.0%). The pattern remained the same when findings were analyzed cycle by cycle and for breakthrough bleeding and spotting separately. The incidence of other side effects was comparable for all regimens. Results of this study demonstrate superior cycle control with Triphasil compared with Ortho-Novum 7/7/7 and Tri-Norinyl during the first four cycles of use.
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Suture loop techniques have been devised to facilitate suture tying during microsurgical and laparoscopic procedures. The needle-through-the-noose technique involves making a knot by passing the needle of a suture through a noose loop formed near the distal end of the suture. This technique prevents inadvertant slippage of the suture's free short end through tissues, replaces the difficult first throw with simple passage of a needle through a noose and equalizes the amount of tension applied on the suture as it slides smoothly within the noose. The needle-through-the-noose knot can stand alone with continuous sutures but requires one more tie in interrupted sutures. The clock loop technique is based on turning the suture clockwise and counterclockwise for making square knots with instruments.
Open laparoscopy was performed in 630 patients seeking permanent contraception for health reasons. Various electric and mechanical tubal occlusion methods were utilized. With few exceptions, uterine curettage was performed at the end of the laparoscopic procedure. Curettage revealed unexpected findings in 10 cases. Laparoscopic exploration of the peritoneal cavity showed pathologic findings in 10% of the patients. There were no intraoperative complications related to open laparoscopy. Fourteen patients (2%) underwent immediate laparotomy, to manage unexpected findings in six and to correct complications of unipolar tubal cautery technique in eight. Postoperative complications possibly related to open laparoscopy were limited to minor wound infection in 0.3% and febrile reaction of short duration in 0.1% of the cases. Two sterilization failures occurred in the series, both following unipolar techniques employing coagulation and resection. Many patients have now been followed for 5 or more years without noticeable increases in complaints of uterine bleeding and/or pelvic pain. The data indicate that open laparoscopy is a suitable means of performing tubal sterilization in the female.
Twenty-eight patients presenting with initial complaints of infertility or chronic pelvic pain were found to have pelvic endometriosis at laparoscopy. Destruction of the endometriotic lesions by means of electrocoagulation was performed via laparoscopy in a group of 19 patients. The remaining nine patients did not undergo such management. In the treatment group, seven of the 11 patients with chronic pain experienced complete relief of their symptoms, and six of the eight patients with infertility became pregnant postoperatively. Patients in the control group had a less favorable outcome. Only one of five patients with chronic pain had relief and one of four patients with infertility became pregnant following laparoscopy without cauterization. Electrocoagulation of pelvic endometriotic lesions under laparoscopic control appears to be satisfactory for the management of selected patients with chronic pelvic pain or infertility.
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IUD design features that affect performance are reviewed and discussed. The use of a medicated device designed to be placed, retained and stabilized exclusively in the frontal plane of the upper uterine segment fulfills theoretical conditions of optimum performance.
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The instillation of 1 to 6 ml of 1% lidocaine was evaluated as a topical anesthetic method of reducing pain associated with uterine manipulations during gynecologic procedures. A plastic acorn cannula connected to a metal adapter and syringe was used to administer the topical anesthetic in 146 intrauterine device insertions, 16 cervical dilatations, and 18 dilatation and curettage procedures. Most patients reported satisfactory relief of pain. No complications were attributed to the topical anesthetic.
The relationship of endometrial cavity length to intrauterine contraceptive device (IUD) performance was evaluated in 319 patients wearing three types of devices. The rate of events, defined as pregnancy, expulsion, or medical removal, increased significantly when the length of the IUD was equal to, exceeded, or was shorter by two or more centimeters than the length of the endometrial cavity. Total uterine length was found to be a less accurate prognostic indicator of IUD performance than endometrial cavity length alone.
A sutureless wound-closure device was used in 150 patients. The average time spent to effect skin closure was reduced; removal was easy; skin apposition was satisfactory; and patient response was favorable. Sutureless tape closures eliminate the disadvantages of invasive skin closures. The device described provides secure tape adhesion to the skin and does not cover the wound. It can be easily applied, adjusted, and removed, in addition to serving as a protective splint to the healing wound. This method can reduce operative time of skin closure with highly satisfactory cosmetic results.
Endometriosis is a common finding at laparoscopy. In order to make a correct diagnosis and institute appropriate management it is recommended that laparoscopy be performed on all patients with chronic pelvic pain and on most patients with infertility or acute pelvic pain.
Use of conventional two-pronged forceps in laparoscopic surgery can be problematic. Fallopian tubes tend to slip and ovaries are difficult to grasp securely. In addition, when removing the forceps to obtain an ovarian biopsy specimen prior to cauterization of the biopsy site, the ovary must be released; it is the often difficult to regrasp promptly. Spring-loaded laparoscopic instruments that are provided with multiple prongs offer certain advantages. These instruments hold tissue more securely and with even tension, and with them it requires a minimal effort to maintain tissue in a stable position. The author designed multipronged forceps, which were used for tubal sterilization and ovarian mobilization and biopsy in a series of more than 125 cases. No complications were noted from the use of the forceps.
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