Biomedical subjects

Hiroyuki Takeuchi

Publications and source records attributed to Hiroyuki Takeuchi.

41 records · Page 3Linked to original sources

PubMedDate not supplied

Pregnancy and delivery after laparoscopic myomectomy.

STUDY OBJECTIVE: To assess the factors influencing pregnancy outcome and evaluate vaginal birth after laparoscopic myomectomy (VBALM). DESIGN: Retrospective study (Canadian Task Force classification II-2). SETTING: University hospital. PATIENTS: One hundred eight patients who wanted a child after laparoscopic myomectomy (LM) and a follow-up of at least 6 months. INTERVENTION: Laparoscopic myomectomy. MEASUREMENTS AND MAIN RESULTS: Forty-seven pregnancies occurred in 40 patients. As for the factors considered to contribute to pregnancy after LM, COX regression analysis showed that pregnancy after LM correlated positively with the diameter of the largest myoma (OR 1.06, 95% CI 1.02-1.10, p = .004) and negatively with the age of the patient at the time of LM (OR 0.88, 95% CI 0.80-0.98, p = .02) and the number of enucleated myomas (OR l.17, 95% CI 1.01-1.37, p=0.04). Vaginal birth after LM was managed in accordance with the standard management of vaginal birth after cesarean section (VBAC) in our hospital. Delivery after LM was accomplished in 32 pregnancies. Vaginal birth after laparoscopic myomectomy was attempted in 23 pregnancies (71.9%) and vaginal birth successful in 19 (82.6%) of these 23 pregnancies. Vaginal birth after LM was unsuccessful in four patients, as labor did not occur during more than 2 weeks after the expected date of delivery in two patients, and cesarean section was performed to prevent fetal asphyxia during the course of delivery in two patients. In the 18 patients (19 pregnancies) with successful VBALM, the diameter of the largest myoma at LM was 68.7 +/- 18.4 mm, the number of enucleated myomas was 2.9 +/- 2.1, and the number of hysterotomies was 2.5 +/- 1.8. As for the depth of the largest myoma, this was intramural in 12 patients, submucosal in 2 patients and subserosal in 4 patients. None of the patients, regardless of whether they had a successful VBALM or not, suffered uterine rupture during or after delivery. CONCLUSION: Since nearly complete suturing is possible in LM as in laparotomy, vaginal delivery can be accomplished safely without uterine rupture even after LM, provided that delivery is managed as in VBAC.

Adult↗

PubMedDate not supplied

Laparoscopic adenomyomectomy and hysteroplasty: a novel method.

STUDY OBJECTIVE: To evaluate a novel method of laparoscopic adenomyomectomy. DESIGN: Prospective study (Canadian Task Force classification II-3). SETTING: University-affiliated hospital. PATIENTS: Fourteen women with adenomyosis. INTERVENTION: Laparoscopic adenomyomectomy and hysteroplasty. After local injection by diluted vasopressin solution, a transverse incision was made in the adenomyotic tissue down to the endometrium, and the adenomyotic tissue was surgically removed with a monopolar needle. The normal muscle layer on the serosal membrane side was left as an upper and lower serosal flap. The flaps were overlapped and sutured to counteract the lost muscle layer to reconstruct the uterus. MEASUREMENTS AND MAIN OUTCOME: The changes of symptoms were evaluated before and after the operation. The visual analog scale of dysmenorrhea was significantly decreased, and hypermenorrhea was improved after the surgery. Postoperative pregnancy was achieved in 2 patients, and vaginal delivery was performed in the first case. CONCLUSION: For specific cases, laparoscopic adenomyomectomy may be a suitable method to relieve symptoms with minimally invasive surgery while conserving the uteri.

Adult↗

PubMedDate not supplied

The effect of vasopressin on local and general circulation during laparoscopic surgery.

STUDY OBJECTIVE: To study local and general circulation after vasopressin administration during laparoscopic surgery. DESIGN: Prospective analysis (Canadian Task Force classification II-1). SETTING: University-affiliated hospital. PATIENTS: Nine patients who underwent laparoscopic myomectomy (LM) from March through December 2003. INTERVENTION: Transvaginal ultrasound and transesophageal ultrasound were performed to evaluate blood flow of the uterine artery and the descending aorta, respectively, during laparoscopic surgery. MEASUREMENTS AND MAIN RESULTS: Nine patients who had a low number (one to two) of uterine myomas in the anterior wall underwent LM with local administration of four units of 100-fold diluted vasopressin. We monitored blood flow of the ascending branch of the uterine artery and measured the resistance index (RI) value by transvaginal ultrasound. The decreasing reaction of diastole blood flow was fast, and the median time required until disappearance of signal was 4 minutes (range 1-8 minutes). We monitored blood flow of the descending aorta by transesophageal ultrasound and compared the results with eight control patients who did not receive vasopressin. Urine volume was measured during the surgery and postoperatively. No significant difference in descending aortic blood flow volume, and intraoperative and postoperative urine volume was found between the two groups. Systolic/diastolic blood pressure tended to increase immediately after vasopressin administration, but the increase was not significant. CONCLUSIONS: Local administration of vasopressin to the uterus is a safe and effective hemostatic technique for controlling regional blood flow from the uterine artery to peripheral vessels without having a significant effect on systemic circulatory dynamics.

Adult↗

PubMedDate not supplied

A new enucleation method for cervical myoma via laparoscopy.

Laparoscopic myomectomy was performed on five women suffering from hypermenorrhea. A new method was used which enucleated the cervical myoma from postcervical medial incision. The wound was sutured in 2 layers intracorporeally. Clipping of the uterine artery and injection of diluted vasopressin were performed to decrease bleeding during laparoscopy. This is a minimally invasive and safe procedure.

Adult↗

PubMedDate not supplied

The indications, surgical techniques, and limitations of laparoscopic myomectomy.

OBJECTIVE: To assess the indications and limits of laparoscopic myomectomies (LM). METHODS: We conducted a retrospective analysis of 89 consecutive cases of LM. Our LM procedures were as follows: Diluted vasopressin was injected into the myoma capsule, and a transverse incision was made by fine monopolar electrode. Traction was applied to the myoma with a myoma screw. The uterine wall was sutured with a curved needle. Fibrin glue spray was applied to prevent adhesion formation. Enucleated myomas were removed via trocar by using an electric morcellator. RESULTS: We enucleated 195 nodules with diameters > 2 cm; the mean size of the dominant myomas was 5.3 cm. The mean number of myomas removed from each patient was 2. The uterine wall was sutured in all cases with a mean of 9 sutures. The mean blood loss was 102 mL, and the mean operating time was 111 minutes. No patients were converted to laparotomy. The average hospital stay was 2.4 days. When the myomas were larger than 10 cm, the blood loss and operating time were increased. However, the number of myomas did not correlate with blood loss. CONCLUSION: LM appears to offer a number of advantages if the myoma is not larger than 10 cm.

Adult↗