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J B Dubuisson

Publications and source records attributed to J B Dubuisson.

At least 109 records · Page 6Linked to original sources
PubMed1995

Laparoscopic tubal anastomosis (the one stitch technique): preliminary results.

We report a new laparoscopic technique of tubal anastomosis: the laparoscopic one stitch technique. After preparation and approximation of the two tubal segments, the anastomosis consists of one single suture placed at the '12 o'clock' site of the antimesenteric borders. Four patients have undergone this procedure. Bilateral tubal patency was confirmed in three cases. Hysterosalpingography was not performed on the fourth patient as she was already 1 month pregnant after tubal anastomosis.

Adult↗
PubMed1995

Uterine rupture during pregnancy after laparoscopic myomectomy.

A 31 year old patient presenting with primary infertility underwent an operative laparoscopy for the treatment of bilateral hydrosalpinges, during which a myomectomy was also performed. The uterus was repaired using interrupted sutures. At follow-up laparoscopy seven weeks later, a uterine fistula was diagnosed and was oversewn using a single 'figure of eight' suture. One year later the patient became pregnant through in-vitro fertilization. At 34 weeks gestation, she required an emergency laparotomy for acute abdominal pain and the presence of fetal bradycardia. The operative findings revealed a uterine rupture at the site of the previous myomectomy scar. This was then enlarged with a scalpel and a live baby was delivered. The uterus was repaired in two layers. The postoperative period for both mother and baby was satisfactory. This complication raises the problem of the quality of uterine repair following laparoscopic myomectomy, together with the question of how to prevent this type of life-threatening situation.

Abdominal Pain↗
PubMed1995

[Total hysterectomy for benign pathologies: why is laparoscopy of value?].

The majority of the hysterectomies are performed by laparotomy. With laparoscopic surgery it will be possible to perform only 10 to 20 per cent of the hysterectomies by the abdominal route. Even if laparoscopic hysterectomy is a feasible technique, all the hysterectomies should not be performed by the endoscopic route. Laparoscopic surgery is in no case an alternative to vaginal surgery. Laparoscopic surgery is not indicated for hysterectomy if the operation is feasible quickly and under good conditions via the vaginal route. Laparoscopic surgery is only indicated when vaginal surgery is difficult and/or contra-indicated. In these situations, laparoscopic surgery can be performed according two different modalities: laparoscopically assisted vaginal hysterectomy and total hysterectomy completely performed by laparoscopy.

Decision Trees↗
PubMed1995

[Total hysterectomy for benign pathologies. Conventional celiosurgical technique].

The standard technique for total laparoscopic hysterectomy is characterised by two essential points. The first is that all instruments are reusable and the second is that hemostasis is ensured by bipolar coagulation. It is a safe technique with a cost comparable to that of vaginal or abdominal hysterectomies. The routine use of disposable material and automatic disposable staplers for laparoscopic hysterectomies is debatable, as the considerable increase in cost is not accompanied by benefit for the patient or the community. Although laparoscopic hysterectomy is a feasible technique, all hysterectomies should not be performed by this route. If the operation is feasible quickly and under good conditions via the vaginal route, laparoscopic surgery is not indicated. Laparoscopic surgery is only indicated when vaginal surgery is difficult and/or contra-indicated. The elective indications for total laparoscopic hysterectomy are severe adhesions, deep endometriosis and especially a limited vaginal accessibility associated with a narrow vagina and a fixed or non prolapsed uterus. While a average of three quarters of hysterectomies (excluding cases of uterogenital prolapse) are currently performed via a laparotomy, laparoscopic surgery can reduce this rate to approximately 10 to 20 per cent.

Female↗
PubMed1995

[Complete hysterectomy for benign pathology and laparoscopy: respective indications of laparoscopic preparation and an exclusively laparoscopic approach].

According to whether uterine artery treatment takes place vaginally or laparoscopically, laparoscopy for hysterectomy can be considered according to two modalities: laparoscopically assisted vaginal hysterectomy (LAVH) and total laparoscopic hysterectomy (TLH). The indications for laparoscopy are defined by the limits and/or contraindications of the vaginal route. LAVH is indicated in the following situations: pelvic pain syndrome where diagnosis and treatment can be made at the same time as hysterectomy; minimal endometriosis; past surgical history favouring adhesions formation; necessity to perform an oophorectomy; existence of an ovarian pathology. The elective indications for TLH are the severe pelvic adhesions, deep endometriosis and especially a limited vaginal accessibility associating with a narrow vagina and a fixed or non prolapsed uterus. Laparoscopy thus allows to reduce the number of laparotomies. When on overage three quarters of the hysterectomies (excluding cases of uterogenital prolapse) were up till now performed abdominally, laparoscopy could reduce this rate to approximately 10%.

Elective Surgical Procedures↗
PubMed1995

[Laparoscopic tubal sterilization reversal: a technic using a single stitch].

We report our laparoscopic technique of tubal sterilization reversal. We perform a simple and atraumatic technique with a single point. After preparation and approximation of the two tubal segments, the anastomosis consists of one single suture placed at the "12 o'clock" site of the antimesenteric border. The feasibility, the advantages and the preliminary results are presented.

Anastomosis, Surgical↗
PubMed1995

[Laparoscopic surgery of large uterine fibromas. Operative technique and results].

OBJECTIVE. To describe the technique of laparoscopic myomectomy for large myomas (5 cm and more) and to evaluate the results. RESULTS. Only myomas which are complicated (and/or resistant to properly conducted medical treatment) require surgical treatment. Between October 1, 1990 and October 31, 1994, we carried out 72 laparoscopic myomectomies for intramural myomas measuring 5 cm or more, in 71 patients. The operations lasted 130 +/- 60 min (range: 40-330 min). We converted to laparotomy for two cases (2.7%). We observed no serious per or postoperative complications. We never needed a repeat operation, whether by laparotomy or by laparoscopy. CONCLUSION. Despite these encouraging results, it must be remembered that the operation is lengthy and difficult and is reversed for laparoscopic surgeons perfectly familiar with endoscopic knot tying. Although it is a difficult technique, laparoscopic myomectomy is possible even for large myomas and those that are completely intramural. These results need to be assessed over the long term especially with respect to the risk of adhesions and the quality of the laparoscopic suture.

Adult↗
PubMed1995

[Total laparoscopic hysterectomy. Operative technique, results and indications].

Total hysterectomy was performed via laparoscopy alone in 50 patients. In all cases, the operation was carried out using conventional, re-usable instruments (grasping forceps, laparoscopic scissors, bipolar coagulation). The mean duration of the operation was 163 min (range: 110-270 min). The mean drop in haemoglobin was 1.97 g/100 ml (range: 0-4 g/100 ml) and the average length of hospital stay was 3.9 days (range: 2-13 days). In one case (2%), we converted to laparotomy because a lateral myoma made it impossible to achieve haemostasis of the uterine pedicule under suitably safe conditions. No serious peri or post-operative complications were encountered. No second surgery was necessary and no transfusion was required. These results confirm that total laparoscopic hysterectomy via laparoscopy is a safe, feasable and reproductible technique. Future work will establish the exact place and methods for laparoscopic surgery for hysterectomy. Laparoscopic surgery is only indicated when vaginal hysterectomy is contraindicated or impossible. Laparoscopic hysterectomy constitutes an alternative to laparotomy rather than the vaginal hysterectomy. The combination of an immobile uterus and poor vaginal accessibility is the prime indication for total hysterectomy via laparotomy.

Adult↗
PubMed1994

Laparoscopic myomectomy. Operative procedure and results.

Myomectomy was performed by laparoscopy in 102 patients, according to a precise technique using the monopolar hook for the uterine incision and intraperitoneal sutures. Myomas were mostly removed through the suprapubic puncture site after fragmentation or by colpotomy. Conversion to laparotomy during the laparoscopic procedure was necessary in 2 cases. No complications were observed. A second-look laparoscopy was performed in 17 cases. Postoperative adhesions were noted in 2 cases. In our experience, operative laparoscopy has several advantages over laparotomy and the risk of complications is low in selected cases.

Female↗
PubMed1994

Treatment of ovarian dermoid cysts. Place and modalities of operative laparoscopy.

The purpose of this study was to discuss the place and the specific modalities of laparoscopic surgery in the management of ovarian dermoid cysts. This retrospective and noncomparative study was carried out in 65 patients who presented dermoid ovarian cyst between January 1986 and December 1990 in our institution. The surgical treatment was performed purely by laparoscopy in 86.2% of the cases (56 patients). The modalities of laparoscopic surgery were as follows: ovariectomy (8 cases; 14.3%), transparietal cystectomy (4 cases; 7.1%) and intraperitoneal cystectomy (44 cases; 78.6%). In 15 cases (15/44 = 34%) the intraperitoneal cystectomy was carried out without opening the cyst and the intact cyst was extracted using an endoscopic impermeable sack. We observed no cases of chemical peritonitis. The risk of recurrence after conservative treatment is 4% (two patients) and out of the ten patients for whom a second-look laparoscopy was performed only two (20%) presented adhesions. Laparoscopic treatment of dermoid ovarian cysts is feasible, safe, and effective. The treatment can be conservative in over 80% of the cases. The specific risk of chemical peritonitis can be countered by a change in the cystectomy technique. The use of an impermeable laparoscopic sack permits extraction of the cyst without any peritoneal contamination.

Adult↗
PubMed1994

[Uterine myoma: modalities and indications for coelioscopic treatment].

Only complicated fibromas refractory to medical treatment should be treated surgically. Two types of operations can be proposed for interstitial and subserosal fibromas: myomectomy and hysterectomy. The indication, based on a through preoperative assessment, depends on the patient's age and the size, number and sites of the fibromas and associated lesions. Preliminary series confirm the feasibility of these two operations performed by laparoscopy, as a result of the progress in this modality over recent years. In the future, larger series will determine the respective place of each of these surgical procedures in relation to others surgical possibilities.

Adult↗