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Biomedical subjects

J H Phipps

Publications and source records attributed to J H Phipps.

At least 19 recordsLinked to original sources
PubMed2000

Laparoscopic hysterectomy.

STUDY OBJECTIVE: To determine the soundness of laparoscopic hysterectomy compared with vaginal and abdominal hysterectomy Design. Nonrandomized, uncontrolled, retrospective study (Canadian Task Force classification III). SETTING: Medium-size community hospitals. PATIENTS: One thousand six hundred forty-eight women undergoing laparoscopic hysterectomy, including those with uterine size 17 weeks' gestation or less. INTERVENTION: Laparoscopic hysterectomy staged as level 4, which includes laparoscopic dissection of the uterine artery. MEASUREMENTS AND MAIN RESULTS: The median duration of surgery was 36 minutes (range 24-104 min), compared with the usual 115 minutes for laparoscopic-assisted vaginal hysterectomy. Complication rate was 0.66%. No complications occurred in the last 3 years when the procedures included transillumination of the ureters. Although the costs associated with disposable equipment are high, the technique is cost effective. CONCLUSION: With proper training and ureteral transillumination, laparoscopic hysterectomy is safe and effective, and with stents, ureteral injury is avoided.

Cost-Benefit Analysis↗
PubMed1995

Avoidance of complications of laparoscopic hysterectomy.

The laparoscopic approach to hysterectomy offers the patient very considerable advantages over the open surgical approach. Claims that operations can 'always be done vaginally' are false. Such claims are based on inappropriate patient selection. Comparisons between vaginal hysterectomy and the laparoscopic approach betray illogical thinking: they are two different operations for very different patients. For safe practice, the surgeon must be properly trained and experienced before attempting advanced laparoscopic surgery, including hysterectomy, and patients must be carefully selected for their suitability to undergo such operations. There are a number of specific precautions and manoeuvres detailed here which may greatly enhance the safety of laparoscopic hysterectomy and reduce complications to an absolute minimum in the hands of the trained laparoscopic surgeon.

Blood Vessels↗
PubMed1993

Laparoscopic hysterectomy and cancer.

Laparoscopic hysterectomy with or without oophorectomy is a procedure which is now gaining popularity in the UK. It has been clearly demonstrated that this technique is superior to abdominal hysterectomy and oophorectomy via laparotomy, and often replaces this procedure. In cases where vaginal hysterectomy is likely to prove difficult or impossible in the hands of most surgeons, the laparoscopic route is of value. In those cases where dense pelvic adhesions or poor vaginal access exist, or where oophorectomy is co-indicated, laparoscopic surgery converts operation via laparotomy to a less invasive procedure, with consequent benefits in terms of both patient care and bed occupancy. In the case of malignant disease, laparoscopic hysterectomy and oophorectomy is a viable alternative to open abdominal hysterectomy, but great care must be taken that patients with malignant disease are not under-treated.

Fallopian Tube Neoplasms↗
PubMed1992

Validation of a method of treating menorrhagia by endometrial ablation.

Menstrual blood loss was measured by intravenous injection of radioactive iron (59Fe) and whole-body counting in 19 women complaining of menorrhagia due to dysfunctional bleeding. Fifteen patients were then treated by radiofrequency endometrial ablation, after which blood loss was re-measured. The majority of the patients were bleeding excessively before treatment (mean 281 (SD 156) ml per cycle averaged over two cycles, range 49-665 ml, n = 19). In the 15 treated patients, average blood loss was reduced to 52 (SD 39) ml per cycle and the mean reduction in blood loss was highly significant (P < 0.001). These quantitative data correlate well with the patients' subjective reports.

Adult↗
PubMed1990

Treatment of functional menorrhagia by radiofrequency-induced thermal endometrial ablation.

42 patients were enrolled in a trial of radiofrequency-induced thermal endometrial ablation for the treatment of functional menorrhagia. The radiofrequency electromagnetic energy was delivered via a probe placed within the endometrial cavity. 10 patients received 330 kJ of energy, 10 received 445 kJ, and the other 22 received 660 kJ. 19 (87%) of those receiving the highest dose became amenorrheic or had a considerable reduction in menstrual flow. The procedure is simple and the heat induced in the endometrium does not penetrate much beyond the inner layers of the myometrium. There is no need for distension of the uterine cavity with flushing media.

Adult↗
PubMed1990

Experimental and clinical studies with radiofrequency-induced thermal endometrial ablation for functional menorrhagia.

A method of ablating the endometrium has been introduced into clinical practice that uses radiofrequency electromagnetic energy to heat the endometrium, using a probe inserted through the cervix. Preliminary studies suggest that over 80% of patients treated will develop either amenorrhea or a significant reduction in flow. The advantages of radiofrequency endometrial ablation over laser ablation or resection are the avoidance of intravascular fluid absorption, simplicity (no special operative hysteroscopic skills are required), speed of operation, and reduced cost compared with the Nd:YAG laser. In this paper, we describe the experimental studies performed during development of this new technique.

Adult↗
PubMed1990

Large loop excision of the transformation zone (LLETZ) compared to carbon dioxide laser in the treatment of CIN: a superior mode of treatment.

A series of 199 patients with histologically confirmed cervical intraepithelial neoplasia (CIN) grade II or III were allocated by hospital number to receive out-patient treatment by carbon dioxide laser vaporization or large loop excision of the transformation zone (LLETZ). All patients received local anaesthesia. The women in the LLETZ group experienced less post operative haemorrhage, less discomfort, operative time was greatly reduced, and histological material was available for confirmation of the diagnosis. There was no significant difference in recurrence of CIN after treatment between the two groups. At 6 month follow-up, recurrence rates of 8.2% (CIN II) and 7.5% (CIN III) were observed in the laser-group and 5% (CIN II) and 5.3% (CIN III) in the LLETZ group. Further advantages of LLETZ are reduced capital expenditure and no hazard to the eyesight of the surgeon, but laser treatment is preferable in patients with widespread vaginal involvement.

Adolescent↗