Biomedical subjects

J Voracek

Publications and source records attributed to J Voracek.

3 recordsLinked to original sources

PubMed2002

Laparoscopic lymph node dissection using ultrasonically activated shears: comparison with electrosurgery.

PURPOSE: To assess and compare perioperative parameters in two groups of patients treated by different laparoscopic techniques of lymph node dissection (LND) for gynecologic cancer. PATIENTS AND METHODS: Between April 1996 and March 2001, 59 consecutive women with microinvasive cervical cancer (N = 5) or clinical stage I endometrial cancer (N = 54) underwent laparoscopic LND during a primary staging procedure using an electrosurgery (ELC) or ultrasonic (US) operative technique. The two groups were compared for perioperative outcomes. Differences between the two groups were determined by the Wilcoxon's rank-sum test. RESULTS: Laparoscopic LND and other staging procedures were completed successfully in 58 women (98.3%). There were no statistically significant differences between the groups with regard to perioperative outcomes (operation time, time for LND, blood loss, hospital stay, complications), but there was a significant difference (P = 0.0008) in the number of lymph nodes harvested: a mean of 13.7 in the ELC group and 17.5 in the US group. The pathologists found that the reading of histology slides was easier after US dissections because of the greater depth of thermal injury in the lymphatic tissue in ELC group. CONCLUSION: The US operative technique ensures efficient coagulation, cutting, dissection, and grasping for laparoscopic LND in patients with cervical and endometrial cancer.

Adult↗

PubMed2001

Laparoscopic staging of endometrial cancer using laparosonic instruments: comparison with electrosurgery.

OBJECTIVE: To compare perioperative parameters in two groups of women with different laparoscopic operative techniques in surgical staging of endometrial cancer (EC). STUDY DESIGN: Thirty randomly allocated and laparoscopically treated women with EC. Fifteen patients were operated by electrosurgery, 15 patients by laparosonic operative technique. Differences between the two groups were determined by the Wilcoxon rank-sum test. Probability (P) of less than 0.05 was considered significant. SETTING: Department of Gynecology and Obstetrics, Endoscopic Training Center, Baby Friendly Hospital, Kladno, Czech Republic. RESULTS: Laparoscopy was successfully completed in 29 patients. Laparoscopy-assisted surgical staging of EC was performed based on the tumor grade and the depth of myoinvasion. In both groups, in total 18 and 5 women underwent pelvic lymphadenectomy (PLN) and infra-aortic lymph node sampling (IALS), respectively. Three patients had metastases in pelvic lymph nodes. In the electrosurgical hemostasis and laparosonic group the mean total time required to finish the whole operative procedure were 132.1 and 138.3 min, respectively, with no statistically significant difference (P=0.96). There were no significant differences between the groups in any intraoperative or postoperative follow-up variables, except for the number of excised lymph nodes where the difference between electrosurgery and laparosonic group (12.7 versus 18) was statistically significant (P=0.05). In one patient with intraoperative venous bleeding the laparosonic hemostasis was ineffective (successful procedure rate 93.3%). One patient from the electrosurgery group was converted to laparotomy due to injury to the epigastric vessels. This complication had no connection with the surgical techniques studied. CONCLUSION: It is concluded that both operative technique variants in laparoscopy-assisted surgical staging appear to be feasible and effective for patients with EC.

Adenocarcinoma↗

PubMed1998

A comparison of laparoscopic surgery with open procedure in endometrial cancer.

BACKGROUND: Laparoscopic hysterectomy and lymph node dissection have lately been reported as an alternative to an abdominal open procedure for the treatment of malignant gynaecological conditions. The laparoscopic operative technique has been evaluated and compared as to whether it is a safe, feasible and effective procedure. SUBJECTS: The study includes 78 women with indications for surgery for endometrial cancer stage I. A retrospective comparative study was undertaken at Baby Friendly Hospital, Kladno, in which 11 patients treated laparoscopically were compared with 26 patients treated by the open procedure of lymphadenectomy. We evaluated differences in the peri-and postoperative outcomes. RESULTS: All 11 procedures were successfully completed. The mean operating time was 153 min, and mean blood loss was 130 ml. The median hospital stay was 4.7 days. There were no major complications. CONCLUSIONS: Laparoscopic hysterectomy and lymphadenectomy seem to be the procedures which result in a shorter hospital stay and rapid recovery. This approach could potentially decrease morbidity historically associated with hysterectomy and lymphadenectomy performed abdominally. Only prospective randomised studies will be able to demonstrate the ability of operative laparoscopy to improve contemporary management of endometrial cancer.

Endometrial Neoplasms↗