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J Vorácek

Publications and source records attributed to J Vorácek.

At least 19 recordsLinked to original sources
PubMed2001

Laparoscopically-assisted intraoperative lymphatic mapping in endometrial cancer: preliminary results.

OBJECTIVE: To analyse the results of a pilot study and determine the contribution of laparoscopically-assisted lymphatic mapping in patients with endometrial cancer. METHODS AND MATERIALS: In eight cases of early endometrial cancer, patent blue-V was injected laparoscopically into the uterine wall during a surgical staging procedure. RESULTS: A deposition of the blue dye was found in at least one pelvic lymph node in five of eight cases. Blue-colored nodes were observed in a total of 11 lymph nodes. Locations of these nodes included obturator, internal and common iliac sites. Only one blue colored node was positive for disease. An average of 15 lymph nodes were removed in the study group (range, 12-22). Uterine lymphatic vessels with bilateral drainage to the broad and infundibulopelvic ligaments were seen in all cases within 30-60 seconds. CONCLUSION: Our initial experience with laparoscopically-assisted lymphatic mapping confirmed that the use of a minimally invasive technique is feasible. Lymphatic channels in the pelvic areas were seen in every patient. A deposition of blue dye in laparoscopically identifiable lymph nodes was seen only in 62.5% of patients. However, we believe that the lymphatic mapping of the uterine corpus can improve the accuracy of surgical staging in patients with endometrial cancer.

Aged↗
PubMed2001

[Laparoscopic-assisted myomectomy--surgical technique and indications].

OBJECTIVE: To analyze perioperative outcomes of laparoscopically assisted myomectomy. DESIGN: Pilot study. SETTING: Department of Obstetrics and Gynaecology, Endoscopic Training Centre, Hospital Kladno, Czech Republic. MATERIAL AND METHODS: Eight consecutive women with fibromyoma were treated by laparoscopic assisted myomectomy. Laparoscopic surgery was performed based on size of fibromyoma over 6 cm. RESULTS: The application of the operative technique of laparoscopically assisted myomectomy was effective in all out exception. In the studied group the mean operative time and the mean of weight of the specimen were 76 min (range 50-90) and 151.7 g (range 45-220), respectively. In one patient the relaparoscopy for bleeding was necessary. CONCLUSION: Laparoscopic assisted surgery is feasible in women with fibromyoma and may also be considered for myomectomy.

Adult↗
PubMed2000

Comparison of two procedures for laparovaginal hysterectomy: a randomized trial.

OBJECTIVE: To compare peroperative parameters of two variants of a laparovaginal hysterectomy in surgical management of gynecological conditions. METHODS: A prospective randomized study of 70 laparovaginal hysterectomies performed by the same two surgeons for disease of female pelvic organs. The following criteria were studied: indication for surgery, previous surgery, duration of the procedure, recovery, hospital stay, blood loss, tissue damage markers, hysterectomy proportions and complication incidence. Statistical analysis was performed using the non-parametric chi(2)-test and non-parametric Fischer's exact probability test when appropriate, with a level of significance P=0.05. RESULTS: Totals of 38 (54.3%) laparoscopy-assisted vaginal and 31 (45.7%) vaginally assisted laparoscopic hysterectomies were performed for fibroma as the main indication. Conversion to laparotomy was applied in only one patient. The VALH group (P=0.01) showed both fewer procedures and shorter hospital stay with insignificant blood loss. CONCLUSION: The two variants of a laparovaginal hysterectomy appear to be safe and appropriate, effective procedures for women with gynecological conditions. Furthermore, vaginally assisted laparoscopic hysterectomy has been shown to be superior to laparoscopy-assisted vaginal hysterectomy in terms of shorter operating time and greater palliative effect upon the complex of uterosacral ligaments. Laparoscopic surgery can alter the relationship between vaginal and abdominal hysterectomy.

Adult↗
PubMed2000

[Hormone replacement therapy in women with surgical treatment of endometriosis and adenomyosis: prospective and follow-up study. Part I].

OBJECTIVE: To determine whether the initiation of estrogen replacement therapy (ERT) in the postoperative period increases the incidence of symptom recurrence following laparoscopic hysterectomy (LH) and/without bilateral salpingo-oophorectomy (BSO) for the treatment of endometriosis and adenomyosis. DESIGN: Prospective partially randomized patient preference follow up trial (PRPPT). SETTING: Department of Gynaecology, Endoscopic Training Centre, Kladno Hospital. METHODS: Chart review of 286 consecutive patients who underwent LH and/or without BSO for endometriosis or adenomyosis between April 1994 and June 1999 and who subsequently received ERT. The methods of second phase of trial was prepared. The symptoms of recurrence in patients who started ERT after surgery and in those who did not start ERT (control group) will be compared and adjusted. RESULTS: Seventy-three percent had preoperative pelvic pain. One hundred thirty two women (46.2%) had only endometriosis. Of the cases of endometriosis, 35.4% was stage I and 64.4% was stage II.-IV. One hundred fifty four women had adenomyosis, 60 with endometriosis. CONCLUSION: In the first phase of follow study the collection of clinical data was performed. Preliminary results from the PRPPT demonstrate that laparoscopic approach to surgery for endometriosis increased significantly the number of this disease.

Endometriosis↗
PubMed1999

[Perioperative hemorrhage associated with laparoscopic hysterectomy: retrospective study].

OBJECTIVE: To evaluate perioperative bleeding during laparoscopic hysterectomy. DESIGN: Retrospective clinical study. SETTING: Department Gynaecology and Obstetrics, Baby Friendly Hospital Kladno, Kladno, Czech Republic. METHODS: Clinical data and cases of perioperative complications and bleeding of patients after laparoscopic hysterectomy were summarized and assessed. The primary hemostatic treatment was electrosurgery. Patients were assessed to efficacy, safety, utility and applicability of vasoconstrictive and local hemostyptic agents. RESULTS: From all laparoscopic procedure were 97.6% successfully completed. There were of nine conversions (2.4%) and twenty-six (6.9%) of severe perioperative complications. The total number of perioperative bleeding was 16 (3.7%) from 376 laparoscopic hysterectomies. The mean order of blood loss was 201.6 ml (range 50-800 ml). CONCLUSION: Clinical retrospective study demonstrates that hemorrhage during and after laparoscopic hysterectomy is most perioperative complication. The laparoscopic approach to hysterectomy appears to be safe and is seen as a good, effective procedure for women with gynaecological conditions of female pelvis organs. Laparoscopic hysterectomy could potentially decrease morbidity historically associated with hysterectomy performed abdominally. Large prospective studies are needed to evaluate the surgical trauma and optimal number of perioperative complications. In conclusion, we think the oozing from the damage tissue during laparoscopic surgery can be successfully arrested and controlled using the laparoscope to apply of local hemostyptic agent.

Adult↗
PubMed1999

Laparoscopic ultrasonic operative technique in surgery of women with endometrial cancer: 2 case reports.

The aim of this study was to introduce a new laparoscopic ultrasonic technique in the laparoscopy-assisted surgical staging of endometrial cancer. The entire laparoscopic phase of the laparoscopic hysterectomy and pelvic lymph node dissection was performed using a 5 mm ultrasonic scalpel and shears. Ultrasonic activated technology was easy to use and allowed the surgeon to perform laparoscopic hysterectomy and lymphadenectomy close to important pelvic structures safer than in other operative techniques. This is only a case report and a larger study to confirm the advantages of the laparoscopic operative technique in surgery of women with uterine malignancy is needed.

Adenocarcinoma↗
PubMed1999

[Laparoscopic hysterectomy using ultrasonic surgical technics: prospective study].

OBJECTIVE: The use of the harmonic scalpel and Laparosonic Coagulating Shears (LCS) for laparoscopic hysterectomy (LH) was evaluated in thirty six women with other gynaecological conditions. DESIGN: Prospective clinical study. SETTING: Department Gynaecology and Obstetrics, Endoscopic Training Centre, Baby Friendly Hospital Kladno, Kladno, Czech Republic. METHODS: Clinical data and cases of hysterectomy performed via ultrasonic operative laparoscopy were summarized and assessed. The primary hemostatic treatment was harmonic scalpel and LCS. Patients were assessed to efficacy, safety, utility and applicability of laparosonic operative technique. RESULTS: From all laparoscopic procedure were 91.6% successfully completed. There were three cases which were finished electrosurgically. The mean order of total operating time was 86.03 min and the mean order of blood loss was 170 ml (range 50-400 ml). There were no major complications, only one case of postoperative bleeding from vaginal cuff. CONCLUSION: Clinical prospective study demonstrates that ultrasonic activated technology in laparoscopic hysterectomy is easy to use, cost effective, and affords the surgeon a greater margin of safety. The harmonic scalpel produces surgical incision with concomitant hemostasis. This is only a preliminary report, and further randomised study is needed.

Adult↗
PubMed1997

[The role of laparoscopic hysterectomy in the surgical treatment of premalignant and malignant diseases of the uterine cervix and uterus].

Laparoscopic hysterectomy is a suitable surgical method in women with premalignant changes of the uterine cervix and in premalignant and malignant endometrial diseases in a selected group of women with low or medium risk. The authors consider laparoscopic lymph-adenectomy in patients with endometrial carcinoma as technically feasible, provided careful selection and indication are made. Careful preoperative examination by biopsy, hybridization probes, tumour markers, sonography, computed tomography or magnetic resonance are essential. A minimal invasive approach can be applied not only in benign diseases of organs of the lasser pelvis. Favourable convalescence parameters are the reason for integration of surgical laparoscopy with gynaecological oncology. Multicentric control studies are needed which will provide evidence that endoscopy can improve the results of hitherto used surgical treatment. Training of the modern surgeon in the sphere of gynaecological oncology involves mastering of surgical techniques of open radical operations as well as perfect endoscopic surgery and strategy.

Adult↗
PubMed1996

[Present trends in surgical treatment of endometrial carcinoma].

Contemporary trends in the treatment of endometrial carcinoma are in favour of radical surgery, in particular when prognostic factors signalize possible failure of standard surgical treatment. When selecting a suitable operation it is important to respect the patient's general health status, age and anatomical conditions. High-standard evaluation of prognostic factors, proper surgical technique and tactics are further basic prerequisites of successful treatment.

Aged↗
PubMed1996

[Comparative prospective study of laparoscopic hysterectomy and abdominal hysterectomy].

Based on assembled findings, the authors assume that laparoscopically assisted vaginal hysterectomy is a real alternative of abdominal hysterectomy and extends the spectrum of indications to overcome contraindications of the vaginal approach in the treatment of benign diseases of organs of the lesser pelvis. In the investigated group of patients the advantages of the minimally invasive approach when evaluating convalescence parameters were confirmed. Introduction of LH had also a favourable impact on the interest in and extension of vaginal operations. It is essential to implement extensive prospective investigations which will evaluate objectively the contribution of endoscopic surgery and their effect on somatic, psychic, social and economic parameters.

Female↗