Biomedical subjects

H Tintara

Publications and source records attributed to H Tintara.

9 recordsLinked to original sources

PubMed2004

Assessment of the physical properties of laparoscopic myoma-fixation devices.

BACKGROUND: The physical properties of three commercial 5-mm myoma-fixation devices available for clinical use (short-pitch corkscrew, long-pitch corkscrew, buttress-thread screw) and a standard wood screw were examined. METHODS: Fresh specimens of uterine leiomyoma masses were used to test the maximum traction force obtained from each device on 31 occasions. The myoma tissue at each traction site was evaluated histologically to determine its density. The maximal traction forces in each myoma density group were compared using a generalized estimating equations approach to linear regression based on repeated measures within each myoma. The bending strength also was determined for each device. RESULTS: A wide range of maximum traction forces with a mean of 130.8 +/- 71.5 N (range, 21.6-341.6 N) over all devices and tissue densities was recorded. The mean maximum traction force provided by the short-pitch corkscrew (159.2 +/- 12.2 N) was significantly higher (p < 0.01) than that of the other devices in medium-density myomas, and not significantly lower than that of other devices in low-density myomas. The mean maximum traction force provided by the buttress-thread screw was significantly lower than that of the short-pitch corkscrew only in medium density myomas, and did not differ significantly from that of the wood screw in any density group. The wood screw provided the highest bending strength (6.73 x 10(4) N/m) (whereas the short- and long-pitch corkscrew provided the lowest (9.70 x 10(2) N/m and 1.95 x 10(3) N/m, respectively) and the buttress-thread screw an intermediate (2.24 x 10(4) N/m) strength (p < 0.0005 for all comparisons except for the two corkscrews). CONCLUSIONS: Screw-type myoma-fixation devices can provide comparable traction force with high bending strength. A long-pitch corkscrew should not be used for laparoscopic myomectomy because of its low traction force and bending strength. When a commercial screw is not available, a standard wood screw can be used with acceptable traction force and very high strength for bending.

Biomechanical Phenomena↗

PubMed2004

Laparoscopic adnexectomy for benign tubo-ovarian disease using abdominal wall lift: a comparison to laparotomy.

OBJECTIVES: To evaluate the results of laparoscopic adnexectomy using an abdominal wall-lifting device compared to laparotomy. METHODS: From February 1997 to December 2001, laparoscopic adnexectomy was performed in 68 cases of benign diseases in a university hospital. Three cases (4.4%) were converted to laparotomy due to poor visualization. The control group was a similar cohort of 65 patients who underwent the same procedures using laparotomy. RESULTS: There were 59 ovarian cysts and six tubal pregnancies in each group. Mean analgesic used, hospital stay, recovery period and blood loss were 11.5 mg, 2.0 days, 1.0 week and 49 ml, compared with 151.8 mg, 4.0 days, 3.0 weeks, and 122 ml in the laparotomy group (P<0.0005). Mean operating times and hospital charges were 81.7 min and 293.9 dollars (US), compared with 77.1 min (P=0.108) and 272.7 dollars (US) (P=0.033) in the laparotomy group. No serious complications were found in either group. CONCLUSIONS: Gasless laparoscopic adnexectomy is a safe and effective technique to provide laparoscopic benefit with minimal increase in hospital charges.

Adnexa Uteri↗

PubMed2001

Teaching instrument: a laparoscopic training model.

A laparoscopic training model with female surface anatomy has been developed. This training model is made of a plastic boutique-showing model that is equivalent to normal-size female anatomy from the neck to the upper thigh. Four holes were made on the model's abdominal wall as puncture-sites to enter the cavity, the first is 80-mm diameter at the umbilical area, and the other three 38-mm diameter holes are located on both sides of the lower abdomen and suprapubic area. The umbilical hole can be covered with a simulated abdominal wall made from 6.5-mm insulation sheet, fixed to the model using a rubber band. The other three puncture-sites were plugged with a flexible rubber diaphragm as working ports. When used as video-laparoscopy, the auto-focus camcorder is used as a telescope and is connected to a regular television set as a monitor. This model can be used for training of abdominal entry by Veress needle or trocar, laparoscopic tubal ligation (LTL), and video-eye-hand co-ordination. This model has been a training medium in our Department for 1 year and was included in the OSCE for the Board Examination of the Royal Thai College of Obstetricians and Gynecologists in the year 2000 to assess the process of Veress needle insertion.

Clinical Competence↗

PubMed2000

Songkla uterine manipulator.

UNLABELLED: The Songkla Uterine Manipulator (SUM) was developed for laparoscopic procedures. Its shaft consists of two stainless steel rods, which pivot a head and locking system. The obturator has a plate and is connected to the pivot head with a screw. The obturator has a diameter of 4.7 mm with three standard lengths of 6, 8, and 10 cm and there is a spring hook to retain it with the tenaculum. The SUM allows antevertion of the uterus up to 95 degrees and lateral motion of about 45 degrees bilaterally. From December 1996 to December 1999, the SUM was used successfully in 150 laparoscopic procedures, including 51 tubal sterilizations, 42 cases of adnexal surgery, 12 total laparoscopic hysterectomies and 45 laparoscopic assisted vaginal hysterectomies. The visualization of pelvic organs including both adnexae was good in all cases without trauma to the vagina, cervix or uterus. CONCLUSION: The simplified low cost uterine manipulator was developed. Early results were good but more modifications are needed, such as mechanism to retain it to the cervix without the tenaculum and sealing of gas leakage from the vagina during laparoscopic hysterectomy.

Equipment Design↗

PubMed1998

Simplified abdominal wall-lifting device for gasless laparoscopy.

OBJECTIVE: To develop a simplified abdominal wall-lifting device for gasless laparoscopy. METHODS: The device is composed of an electric-power actuator, sliding arm and abdominal wall-retractor. All parts of the device are reusable. The device provides planar displacement of the anterior abdominal wall to enable space for laparoscopy. The valveless ports and conventional instruments, as well as laparoscopic instruments, were used without a gas leak problem. RESULTS: After preliminary success in the laboratory testing, a petition was made to the hospital's Ethic Committee. Since then we have performed 40 gasless laparoscopic procedures including 13 salpingo-oophorectomies, 10 diagnostic laparoscopies, five tubal ligations, five ovarian cystectomies, four salpingectomies, two removals of pelvic IUDs and one laparoscopic hysterectomy. There were no surgical complications, including no abdominal wall trauma. The operative field was almost the same as that of the pneumoperitoneum technique, with the exception of morbidly obese patients. CONCLUSIONS: This preliminary experience demonstrates the efficiency of the simplified abdominal wall-lifting device and the potential advantages of gasless laparoscopy. Continued modifications and applications are necessary to delineate the full range of benefits of this device and technique, especially in developing countries.

Abdominal Muscles↗

PubMed1996

A comparative study of outcome of laparoscopic salpingo-oophorectomy versus open salpingo-oophorectomy.

OBJECTIVE: To determine the effectiveness and appropriateness of laparoscopic salpingo-oophorectomy (LSO) versus open salpingo-oophorectomy (OSO) in developing country. METHOD: A clinical study with historical control consisted of 31 LSO cases of benign ovarian cysts were compared with 41 OSO cases matched by diagnosis and difficulty. RESULTS: The operative time of the LSO cases was higher (p < 0.001), but the morbidity was comparable (p = 0.22). The postoperative hospital stay of the LSO was shorter (p < 0.001). Patients who had LSO revealed meaningfully decreased postoperative use of analgesic (p < 0.05). The time to full recovery for LSO was shorter (p < 0.001), but the hospital charges were higher (p < 0.001). CONCLUSIONS: LSO is considerable safe and effective alternative to OSO but incurs higher hospital charges. The overall cost effectiveness of LSO, especially in the developing countries, need further evaluation.

Cost-Benefit Analysis↗

PubMed1995

Cost-benefit analysis of laparoscopic adnexectomy.

OBJECTIVE: To determine the economic feasibility (from the patient's viewpoint) of laparoscopic adnexectomy (LA) in a developing country. METHOD: Forty-four LA cases of benign ovarian cysts or tubal pregnancy were compared with 44 conventional open adnexectomy (OA) cases treated during the same period and matched by diagnosis, procedure and degree of difficulty. RESULT: The postoperative hospital stay was 1.3 +/- 0.6 days (mean +/- S.D.) and 5.3 +/- 1.1 days (P < 0.001) for the LA and OA groups, respectively. LA cases had a shorter recovery period (5.8 +/- 2.2 days vs. 27.2 +/- 6.6 days, P < 0.001), but higher hospital charges (US$463.3 +/- 84.9 vs. US$229.8 +/- 92.2, P < 0.001), caused mainly (89.2%) by disposable laparoscopic instruments. Incremental cost-benefit analysis revealed a possible saving with LA for higher income patients (US$9.2 per day). CONCLUSIONS: LA in Thailand may have economic benefit only to the higher income patients. Benefits to other patients in developing countries will depend on future cost reductions of disposable instruments and/or more effective use of reusable instruments.

Adult↗

PubMed1993

A clinico-pathologic study of ovarian tumors.

A series of 286 patients receiving surgical treatment for ovarian tumors at Song-klanagarind Hospital between January 1987 and June 1990 were reviewed. The most frequent diagnoses by age group were: cancer in 53 per cent of women > or = 50 yrs of age, endometrioma in 63 per cent of women 31-49 yrs of age and benign cystic teratoma in 49 per cent of women < or = 30 yrs of age. Mucinous ovarian tumors were the most common type of epithelial neoplasms. Abdominal pain was the symptom most frequently experienced in patients with benign ovarian tumors. The 95 per cent confidence interval for finding malignancy in women > or = 50 yrs, ascites > 500 ml and size of ovarian tumor > 10 cm was 47-99 per cent.

Adolescent↗

PubMed1990

Ovarian neoplasms in childhood and adolescents in Songklanagarind Hospital, February 1983-March 1989.

Ovarian tumors in young females under the age of 20 years in Songklanagarind Hospital from February 1983 to March 1989 were evaluated. The total number of patients was 47, with a 4.0 per cent incidence of ovarian tumors in all age groups. Germ cell tumor was the most common tumor (59.6%) and 60.7 per cent were malignant. The chief presenting symptom was abdominal distention or mass, with 17.0 per cent of torsion. Ascites and solid consistency of tumors suggested its malignant potential. Surgery was the treatment for all patients with a conservative approach in the majority of cases and supplemented with chemotherapy and/or radiotherapy in malignant cases.

Adolescent↗