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J F Daniell

Publications and source records attributed to J F Daniell.

At least 19 recordsLinked to original sources
PubMed1992

Laparoscopic oophorectomy: comparative study of ligatures, bipolar coagulation, and automatic stapling devices.

OBJECTIVE: We assessed laparoscopic oophorectomy using three techniques. METHODS: From January 1989 to October 1991, 65 patients underwent laparoscopic oophorectomy using three techniques: bipolar coagulation, pretied ligature placement, and automatic stapling devices. The patients were aged 18-57 years and had the indications of pain, ovarian endometriosis, adhesions, unilateral blocked tubes, breast cancer, and recurrent benign ovarian cysts. The primary method of adnexal removal involved the automatic stapling device in 17, bipolar coagulation in 30, and pretied ligatures in 18. RESULTS: Total anesthesia time ranged from 45-123 minutes, with means of 77 minutes for pretied ligatures, 84 minutes for bipolar coagulation, and 84 minutes for automatic stapling devices. Sixty-two patients were discharged within 23 hours, two stayed two nights, and one stayed three nights. Rectus muscle bleeding and hematoma formation were the only complications in this series. CONCLUSION: All three methods of laparoscopic oophorectomy are effective, with similar operative times and uniformly good results for the patients.

Adult↗
PubMed1992

Hysteroscopic endometrial ablation using the rollerball electrode.

OBJECTIVE: To assess the efficacy of hysteroscopic endometrial ablation with the rollerball resectoscope. METHODS: From April 1989 to March 1991, 64 women underwent hysteroscopic endometrial ablation using electrosurgery. Telephone follow-up was obtained for 61 patients at least 6 months after the procedure. The majority of patients requested endometrial ablation because of irregular heavy menses, and two patients presented with postmenopausal bleeding. All patients had preoperative endometrial sampling that demonstrated benign endometrial histology. Five women had previous endometrial ablation with the Nd:YAG laser, with persistent bleeding. Eight patients had endometrial polyps and six had submucous fibroids that were resected at the time of hysteroscopic ablation. RESULTS: The average operative time was 31.6 minutes, and an average of 304 mL of distending medium was absorbed during the procedure. Complications included one uterine perforation in a patient who had a previous Nd:YAG ablation, and one epidural anesthetic complication. At follow-up, 18 women (29.5%) reported amenorrhea, 16 (26.2%) reported spotting, 21 (34.4%) reported decreased menstrual flow, four (6.6%) had no change, and two (3.3%) noted increased flow. Subjectively, 49 patients (80.3%) reported a satisfactory outcome. Of the 12 who were not satisfied, seven underwent a repeat ablation with satisfactory results, four chose hysterectomy, and one elected not to have further therapy. CONCLUSION: Endometrial ablation with the rollerball electrode is a safe, excellent method of management in women with excessive menstrual flow and provides a cost-effective, minimally invasive alternative to hysterectomy.

Adult↗
PubMed1991

Laser laparoscopic management of large endometriomas.

Forty-seven patients underwent laser laparoscopic management of endometriomas from 3 to 12 cm in diameter. Eighteen patients had infertility, 15 had pelvic pain, and 14 had both. The types of laser used were the carbon dioxide, argon, and potassium-titanyl-phosphate. There were no surgical complications. Twelve of 32 patients with infertility achieved pregnancy after the initial procedure. Subsequently, 2 patients conceived after a second-look procedure. Twenty-three of 30 patients with pelvic pain reported improvement or resolution. We confirm the efficacy of operative laparoscopy using lasers in the management of large ovarian endometriomas.

Adult↗
PubMed1991

The use of an automatic stapling device for laparoscopic appendectomy.

Laparoscopic appendectomy, for years performed only occasionally, is becoming more common with the increasing interest by both general surgeons and gynecologists in "minimally invasive surgery." A recently available automatic laparoscopic stapling system (the MULTI-FIRE ENDO GIA 30) claims to make laparoscopic appendectomy technically easier to perform. The technique of laparoscopic appendectomy using this automatic stapling device was evaluated in ten patients and compared with our previous laparoscopic techniques. The MULTI-FIRE ENDO GIA passes through a 12-mm trocar and allows placement of two triple-staggered lines of titanium staples with a simultaneous cut. Using this technique, operating time for laparoscopic appendectomy was reduced from an average of 30 to a minimum of 5 minutes. With this technique, no appendiceal contents leaked intraperitoneally. The larger trocar allowed easier removal of the separated appendix with minimal dissection of the mesoappendix. Indications for appendectomy included endometriosis of the appendix (three), fixation to the right tube or ovary (three), early acute appendicitis (two), and elective removal (two). There were no immediate or late complications. Our preliminary experience with the MULTI-FIRE ENDO GIA 30 stapler suggests that it is a safe, easy, and rapid method of removing the appendix laparoscopically.

Adult↗
PubMed1989

Catastrophic injury secondary to the use of coaxial gas-cooled fibers and artificial sapphire tips for intrauterine surgery: a report of five cases.

Five women undergoing endometrial ablation with the Nd-YAG laser developed sudden gas embolism. In each case laser intrauterine contact surgery was carried out utilizing coaxial fibers with (three cases) and without (two cases) artificial sapphire tips but commonly cooled by air or nitrogen. Four of the five women died in a sequence of sudden cardiovascular collapse followed by irreversible cardiac arrest. One woman was critically ill and following prolonged hospitalization survived with neurological deficits.

Adult↗
PubMed1989

Death caused by air embolism associated with neodymium:yttrium-aluminum-garnet laser surgery and artificial sapphire tips.

Two women undergoing intrauterine surgery with the neodymium:yttrium-aluminum-garnet laser delivered by the artificial sapphire tip had catastrophic cardiovascular collapse during operation. In each case the evolution of clinical events was consistent with the diagnosis of air embolus. Investigation of causative factors links the use of the sapphire tip and the gaseous cooling of the tip to the calamitous outcomes. Both women died.

Adult↗
PubMed1989

Polycystic ovaries treated by laparoscopic laser vaporization.

Eighty-five anovulatory women with polycystic ovaries were treated laparoscopically by argon, carbon dioxide (CO2) or potassium-titanyl-phosphate (KTP) laser vaporization. Ovulation occurred spontaneously postoperatively in 71%. Twenty of 38 (53%) women resistant to standard clomiphene citrate (CC) therapy ovulated spontaneously after laparoscopic laser vaporization of the ovaries. Seventeen of the remaining 18 patients responded to CC postoperatively. Of 47 patients ovulating preoperatively with CC, 40 (85%) ovulated spontaneously postoperatively. Postoperatively, 56% conceived within six months of laparoscopy. This included 58% of postoperative spontaneous ovulators and 52% of postoperative CC stimulated patients. The results suggest that selected patients with polycystic ovaries can be induced to ovulate and subsequently conceive by laparoscopically partially vaporizing their ovaries with laser energy.

Female↗
PubMed1989

Fibreoptic laser laparoscopy.

Many gynaecologist are now doing more aggressive operative laparoscopic surgery. We feel that procedures which in the past required open laparotomy to be successfully performed, can now be done with fibreoptic laser energy. This chapter reviews our experiences with argon, KTP and Nd-YAG lasers for advanced laparoscopic surgery. We feel that these fibreoptic lasers allow us to obtain good results with less risk, shortened operating room time and with reduced difficulty during surgery. In this time of concern for cost containment in medicine, it seems reasonable for interested physicians to reduce costs without cutting corners or compromising patient care. Careful, intelligent, selective use of fibreoptic lasers as well as non-laser laparoscopic techniques in gynaecology may help in cost containment by allowing compatible results while avoiding major surgery with its concomitant expense, increased risks, morbidity and discomfort for patients. All forward-thinking gynaecologists should investigate the potential for fibreoptic laparoscopic laser surgery in their practices.

Female↗
PubMed1987

Laparoscopic assessment of ovarian healing following CO2 laser microsurgery: Vicryl vs. Surgilon.

A prospective multicenter study was undertaken by the Intraabdominal Laser Study Group to assess the type and extent of ovarian adhesions formed following incisional ovarian surgery performed as part of a fertility-promoting procedure with the aid of the carbon dioxide laser. Ovarian healing with subsequent adhesion formation was evaluated by early second-look laparoscopy. Two suture closing materials were used--Surgilon (siliconized braided nylon, David and Geck, Wayne, NJ) and Vicryl (polyglactin 910, Ethicon, Somerville, NJ). Sixty-five ovaries were evaluated in 37 patients with subsequent adhesions found in 37% (18/49) of the Surgilon-closed ovaries and in 94% (15/16) of the Vicryl-closed ovaries. The adhesions were filmy in 83% (15/18) of the Surgilon group and 47% (7/15) of the Vicryl group. Dense/vascular adhesions were found in 17% (3/18) of the Surgilon group and 53% (8/15) of the Vicryl group. The subsequent conception rates were 68% (17/25) in the Surgilon group and 33% (4/12) in the Vicryl group, although the small number of patients and multitude of infertility factors made pregnancy rate comparisons difficult. One of the authors noted lack of tensile strength in the Vicryl-closed ovaries within 12 weeks postlaser laparotomy, which led to incisional dehiscence during laparoscopic lysis of ovarian adhesions. From this preliminary study, it is concluded that additional data are needed to more fully resolve the debate on whether absorbable or nonabsorbable suture is preferred for ovarian infertility surgery.

Female↗
PubMed1987

Adhesion reformation and de novo adhesion formation after reproductive pelvic surgery.

At second-look laparoscopy, 82 of 161 women (51%) were noted to have adhesions at at least one new location. Such adhesions occurred at 31% of available sites. Among 121 women with adhesions at the initial operative procedure, the rate and type of recurrence assessed on the ovaries, fimbriae, and other sites were independent of the initial type. Additionally, neither the rate nor the type of adhesion recurrence observed at the time of second-look laparotomy was determined by the variable amount of time between the initial and second-look operative procedures. We conclude that reproductive pelvic surgical procedures are frequently complicated not only by adhesion reformation but by de novo adhesion formation as well.

Female↗
PubMed1987

Hysteroscopic correction of cornual occlusion with resultant term pregnancy.

Hysteroscopic correction of proximal cornual occlusion is possible in some cases using a simple ureteral stent. This allows re-establishment of tubal patency in selected cases with the possibility for occurrence of intrauterine pregnancy without the need for major surgery. The case presented represents the first reported term pregnancy in a well-documented case of this type.

Adult↗
PubMed1986

Clinical results of terminal salpingostomy with the use of the CO2 laser: report of the Intraabdominal Laser Study Group.

Forty-eight women underwent terminal salpingostomies with a standard operative procedure with the use of the CO2 laser and microsurgical techniques at five centers. Early second-look laparoscopy was performed in all patients 1 to 12 weeks after the laparotomy. The tubal patency rate at the second look was 92% for these 48 patients, with a minimum of 6 months' follow-up study in all patients. Of these patients, ten became pregnant (21%), one with an ectopic pregnancy (10%). All pregnancies occurred within 12 months of the second-look procedure. It is preliminarily concluded from this series that use of the CO2 laser for neosalpingostomy at laparotomy with early second-look laparoscopy provides a term pregnancy rate similar to that previously achieved by nonlaser microsurgical techniques and shortens the time period between the surgical procedure and when conception would be expected to occur.

Adult↗
PubMed1986

Initial evaluation of the use of the potassium-titanyl-phosphate (KTP/532) laser in gynecologic laparoscopy.

A new surgical laser, the potassium-titanyl-phosphate 532 nm laser (Laserscope, Santa Clara, CA) has recently become available for investigative procedures in gynecology. This article reports initial investigation of this laser energy at laparoscopy with the use of a flexible fiberoptic delivery system in rabbits and patients with endometriosis. Tissue effects on peritoneal structures of rabbits with laparoscopic firing of this new laser demonstrated the ability to accomplish surface vaporization without bowel perforation or penetration greater than 2 mm. In ten patients with pelvic endometriosis and pain, effective laparoscopic vaporization of implants has been safely accomplished with ease. Early follow-up revealed symptomatic improvement in all patients. This new laser is easy to use laparoscopically, appears safe in early investigations, and effectively reduces early postoperative pain associated with pelvic endometriosis.

Animals↗
PubMed1986

Ureteral abnormalities in women with endometriosis.

High-volume intravenous urography was performed in 63 women with surgically proven endometriosis. Subtle abnormalities were found in 15.9% of these women. No patient had urologic symptoms, and there was no evidence of hydroureter or ureteral obstruction on the IVP. Long-term follow-up study will be required to determine whether or not these lesions will progress and cause ureteral obstruction.

Adult↗
PubMed1985

Ovarian surgery in an infertility patient as an indication for a short-interval second-look laparoscopy: a preliminary study.

The usefulness of a short-interval second-look laparoscopy (SLL) after ovarian surgery was examined. In 23 infertile women who had either bilateral wedge resection (BWR) of polycystic ovaries, an oophorocystectomy (OC), or resection of endometriomata (RE), adhesions were graded before and after surgery and before and after laparoscopic lysis for each ovary. At SLL, periovarian adhesions involving at least one ovary were observed in all women. Of the 22 women who wanted to become pregnant, 3 of 3 with BWR, 1 of 3 with OC, and 6 of 16 with RE conceived. In the women with residual adhesive disease in both or the only remaining adnexa after SLL, there were no pregnancies; whereas 67% of the women with at least one adnexa free of disease became pregnant (P = 0.005). This preliminary study indicates that ovarian surgery does result in significant adhesion formation and that SLL offers an opportunity to reassess the pelvis, to lyse adhesions, and to establish a postoperative prognosis.

Adult↗
PubMed1985

A new second-puncture probe for CO2 laser laparoscopy.

A new second-puncture probe system was designed for aiming and firing the CO2 laser under laparoscopic control. The probe allows simultaneous suction of the smoke from vaporization and insufflation of fresh CO2 for maintenance of an adequate pneumoperitoneum during use. A 200-mm focusing lens attaches the probe to any surgical CO2 laser with an articulated arm. The new probe is 10 cm shorter than standard probes, allowing the application of a wider range of power densities during laser laparoscopy and making surgery easier to perform. Our initial experiences with this new instrument have involved both laboratory animals and patients with endometriosis, adnexal adhesions and distal tubal obstruction.

Animals↗
PubMed1985

Prior cesarean section. A risk factor for adenomyosis?

Four hundred eighty-five cases of histologically proven adenomyosis were reviewed to determine if that condition might have been induced by transplanted endometrium at the time of cesarean section. The rate of cesarean section in the study group was 6.4%. Evidence of the cesarean scar was noted histologically in 13 of 31 patients (42%) who had undergone cesarean section, and 2 of the 13 (15%) had evidence of glands and stroma within the scar. Both patients had other pathology that could account for their symptoms. Prior cesarean section does not appear to be a risk factor for symptomatic adenomyosis.

Adult↗