Laparoscopic treatment of ovarian dermoid cysts.
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Female↗
Biomedical subjects
J B Dubuisson
Publications and source records attributed to J B Dubuisson.
Fertility after laparoscopic myomectomy of large intramural myomas: preliminary results.
Fertility outcome following laparoscopic myomectomy was evaluated. A prospective clinical study was carried out between October 1990 and October 1993 in 21 infertile patients who underwent laparoscopic myomectomy for a myoma measuring > or = 5 cm in diameter. The overall rate of intrauterine pregnancy was 33.3% (seven patients). Out of 12 patients with infertility factors associated with uterine myomas, three (25.0%) became pregnant, whereas four (44.4%) out of nine patients with no other associated infertility factor became pregnant. No uterine rupture was observed. Out of the seven pregnancies, four were spontaneous and began within 1 year of the operation. The other three were achieved after in-vitro fertilization in patients with associated infertility factors. In the four patients who gave birth by Caesarean section, no adhesions were found on the myomectomy scar. From these preliminary results, laparoscopic surgery for myomas seems to offer comparable results with those obtained by laparotomy.
Adult↗
Hysterectomy for patients without previous vaginal delivery: results and modalities of laparoscopic surgery.
The great majority of hysterectomies in nulliparous patients have been carried out via laparotomy. The purpose of this study was to establish whether laparoscopic surgery can be of use in an attempt to reduce the number of laparotomies when hysterectomy is indicated in patients without previous vaginal delivery. A retrospective study was carried out on 66 women who had not had a previous vaginal delivery who underwent hysterectomy from January 1993 to May 1995. Laparotomy was required for only 19.7% of cases (13 patients). For the 53 patients (80.3%) who underwent laparoscopic hysterectomy, the average duration of the operation was 152.24 +/- 45.7 min, and the average weight of the uterus was 238.3 +/- 154.1 g. The duration of the laparoscopic operation was correlated in a statistically significant fashion with the weight of the uterus (P = 0.0005), the necessity of associated procedures during the hysterectomy (P = 0.01) and the surgeons' experience (P = 0.01). These results demonstrated that laparoscopic surgery decreases the number of laparotomies necessary for patients with no previous vaginal delivery who require hysterectomy. When vaginal access is poor, simple laparoscopic preparation is inadequate and the only possibility of avoiding laparotomy is to carry out the hysterectomy entirely via the laparoscopic route.
Adult↗
Is total laparoscopic hysterectomy a safe surgical procedure?
Total hysterectomy via laparoscopy is a recently developed technique. Assessment of a new surgical technique, once the operation has been shown to be feasible, requires an evaluation of the risks of complications. Here we report our cumulative 3 year experience with laparoscopic hysterectomy in a total of 222 patients. The overall complication rate was 10.0%. We did not observe any haemorrhage complications requiring another operation. Four patients (1.8%) were re-admitted to hospital but only two of them (0.9%) had to be operated upon again (one vesico-vaginal fistula and one vaginal cuff wound separation). These encouraging results mean that, provided the surgeons are experienced in laparoscopic surgery, total laparoscopic hysterectomy technique would appear not to have a higher rate of complications than hysterectomy via laparotomy or the vaginal route.
Female↗
Laparoscopic treatment of deep endometriosis located on the uterosacral ligaments.
The goal of this study was to assess the efficiency of laparoscopic surgical treatment of pain for patients presenting deep endometriosis located on the uterosacral ligaments. To this end we analysed a continuous series of 21 patients treated by laparoscopic surgery between January 1993 and June 1994. In all these cases treatment consisted of resection of all the uterosacral ligament(s) presenting deep endometriotic lesions together with exercise of all other endometriotic lesions. No complications were observed per- or postoperatively. The results were assessed for all the patients with a minimum follow-up of one year. The efficiency of the treatment varied according to the symptoms. Patients who presented dysmenorrhoea (19 cases) improved in 84.2% of cases (16 patients). Out of the 17 patients who presented deep dyspareunia, improvement was evident for 94.1% of cases (16 patients). The chronic pelvic pain suffered improved in seven out of nine cases (77.7%). Patients who benefited from an improvement rated it excellent or satisfactory in over 80% of cases. These results demonstrate that, provided the surgeon is highly skilled in laparoscopy, laparoscopic surgery is efficient for the treatment of patients presenting painful symptoms related to deep endometriotic implants located on the uterosacral ligaments.
Adult↗
Laparoscopic myomectomy today. A good technique when correctly indicated.
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Female↗
Treatment of adnexal torsion using operative laparoscopy.
The aim of this work was to clarify the value and application of operative laparoscopic treatment for adnexal torsion. We included in our study all patients (n = 27) who presented with an intra-operative diagnosis of torsion of the adnexa between January 1989 and May 1995. A total of 28 adnexal torsions were treated. Treatment was carried out by laparoscopic surgery in 75% of cases (21 torsions): in one-half of the cases (14 torsions) it was possible to achieve conservative laparoscopic treatment. The nature of the lesions and the experience of the surgeons are two factors which closely govern the outcome of surgical treatment. For those patients presenting a benign pathology, laparoscopic surgery was used to treat 84% of cases in the series. All the patients presenting a benign pathology and operated upon since 1993 have received laparoscopic surgical treatment. No major complications (peritonitis, thrombotic emboli, coagulation problems) were observed after conservative laparoscopic surgery. These results demonstrate that, provided the surgeons are sufficiently experienced, treatment by conservative laparoscopic surgery for adnexal torsion is both safe and reliable. In the years to come more work must be done to assess the vitality of the adnexa so that as many patients as possible can benefit from conservative treatment.
Adnexal Diseases↗
Salpingectomy - the laparoscopic surgical choice for ectopic pregnancy.
The aim of this study was to assess the fertility outcome after ectopic pregnancy (EP) treated by laparoscopic salpingectomy. Among the 375 patients who underwent this operation between January 1983 and December 1993, there were 145 patients who desired pregnancy and whose contralateral tube was not obstructed. The overall rate of intrauterine pregnancy (IUP) was 50.3%, with an EP rate of 15.2%. These results were analysed according to the patients' past history together with the condition of the contralateral tube at the time of the laparoscopy. We defined two groups. Group 1 included patients who had no previous history of tubal surgery and whose contralateral tube was normal. Group 2 comprised those patients who had a previous history of tubal surgery and/or those whose tube was pathological, but not obstructed. Postoperative fertility of the patients in group 1 was significantly higher than that of the patients in group 2, with IUP rates of 75 and 36.6% respectively (P < 0.001), and a risk of EP recurrence of 9.6 and 18.3% respectively. In group 1, the actuarial IUP rate at 24 months was significantly higher than that for the patients in group 2 (66.7 versus 36.9%; P < 0.001). The patient's past history and the condition of the contralateral tube were the two major factors related to fertility outcome after laparoscopic salpingectomy for EP. In patients with no past history of tubal surgery or infertility and whose contralateral tube was normal, the fertility results after laparoscopic salpingectomy appeared comparable to those observed after conservative laparoscopic treatment.
Adult↗
[Radical laparoscopic surgery of ectopic pregnancy: results from a continuous series of 383 interventions].
From January 1983 to December 1993, 375 patients underwent laparoscopic salpingectomy. Six complications (1.5 %) were observed. Among 145 patients with a patent contralateral tube who desired pregnancy, 73 had an intrauterine pregnancy (50.3 %) and 22 had ectopic pregnancy (15.2 %). These results are discussed according to the contralateral tube status and gynecologic past history.
Adolescent↗
[Genital bilharziasis and female infertility. Review of the literature and three case reports].
Genital schistosomiasis is an uncommon disease. Its responsibility in female infertility is controversial. We reported 3 cases of pelvic schistosomiasis and we debate about the pathogenic contribution of the bilharziosis in sterility.
Adult↗
[Laparoscopic surgery and benign diseases of the uterus].
Much progress has been made in gynecological surgery with the advent of laparoscopic techniques. Some benign diseases of the uterus can now be treated with laparoscopic myomectomy or hysterectomy. Patient selection is essential. There as still well-defined indications for the vaginal route and laparotomy.
Adult↗
[Trophoblast graft on the omentum. Failure of conservative celioscopic treatment of extra-uterine pregnancy].
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Adult↗
Laparoscopic myomectomy and myolysis.
The indications for operative laparoscopy have increased greatly over the past decades as its many advantages over laparotomy have become recognized. Laparoscopic myomectomy as a technique is now clearly described. A monopolar hook is used for the uterine incision. After atraumatic enucleation of the myoma, myometrium and serosa are usually sutured particularly if the incision is deep or more than 2 cm long. Myomas can be removed by posterior colpotomy. However, the development of an electrical cutting device permits an easier and quicker removal of the myoma through the suprapubic puncture site. Only complicated myomas and/or those which give rise to persistent symptoms despite properly prescribed medical treatment, together with those which grow rapidly, require surgery. In our experience of ablation of myomas measuring 5 cm and over the results were satisfactory in all 71 patients with more than one year of follow-up. In two cases (2.7%) we were obliged to convert to laparotomy. We were confronted with no serious per-operative or post-operative complications. These satisfactory results must not mask the fact that the technique is lengthy and difficult and should be carried out by experienced surgeons thoroughly familiar with endoscopic sutures. Under these conditions, laparoscopic myomectomy is possible, for large myomas (5 cm and over) even if they are located completely intramurally. However, there are limits and it is preferable to use laparotomy for myomas measuring over 10 cm and for multiple myomectomy (over 3). Finally, the risk of causing adhesions and the quality of the uterine suture need to be assessed in the near future.
Adult↗
Bladder injuries during total laparoscopic hysterectomy: diagnosis, management, and prevention.
Based on a series of 150 total hysterectomies carried out via laparoscopy between January 1993 and December 1994, we observed 2 bladder complications: 1 bladder injury and 1 vesicovaginal fistula. These two accidents form the basis of discussion on the risk factors for these complications, their diagnosis, treatment, and prevention.
Female↗
History of infertility.
Infertility has always been a constant preoccupation. The problems it raises today on medical, social, ethical, political and religious levels bear witness to this emphasis, but also to how complicated infertility is to deal with and understand. This study not only examines the history of infertility and the treatments applied but also the repercussions for infertile women socially. As we look through history, we find that the attitudes of physicians have often reflected the role of the woman and her image in society.
Arab World↗
Laparoscopic management of asymmetric Mayer-Rokitansky-Kuster-Hauser syndrome.
Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome is a partial or complete absence (agenesis) of the uterus with an absent or hypoplastic vagina. Until now, the recommended treatment, when resection of a rudimentary horn was indicated, was laparotomy. We report a case of MRKH syndrome in which the patient benefited from laparoscopic surgery for bilateral resection of rudimentary horns. Laparoscopy is not only useful for diagnosis of uterine malformations but can also be valuable for any treatment required for this type of malformation, this being carried out during the same operative procedure, thus avoiding laparotomy for the patient. The creation of an artificial vagina is performed during a second operation.
Adolescent↗
Sterilization reversal: fertility results.
Fertility outcome following sterilization reversal by laparotomy was evaluated. We studied all sterilization reversals performed between January 1978 and December 1991; a total of 226 women were treated. Tubal anastomosis was performed according to the rules for microsurgery. The microsurgical technique comprised two main phases: preparation of the healthy tube segments and the anastomosis carried out on two layers. It was possible to study the subsequent fertility of 206 patients in all, as 20 patients were lost to follow-up (8.8%). Cumulative pregnancy rates were evaluated by life-table analysis. The overall intrauterine pregnancy rate, including births and miscarriages, was 69.9% (144 patients) after 2 years. The cumulative intrauterine pregnancy rate was 62% at 18 months. Analysis of the fertility results demonstrated that age was the most significant predictive factor. The cumulative intrauterine pregnancy rate at 2 years was 83.5% (61 cases) for patients < or = 33 years, 70% (35 cases) for patients aged 34-36 years, 62.5% (30 cases) for patients aged 37-39 years, and 51.4% (18 cases) for patients aged > or = 40 years. Even for patients aged approximately 40 years, microsurgical repermeabilization can be retained as the first choice rather than in-vitro fertilization.
Adult↗