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L Kliment

Publications and source records attributed to L Kliment.

At least 19 recordsLinked to original sources
PubMed2003

Short-term results from laparoscopic dissection of uterine vessels in women with symptomatic fibroids.

OBJECTIVE: To assess the outcome, tissue trauma, clinical improvement and the reduction in size of fibroid following laparoscopic dissection of uterine vessels (LDUV). SETTING: Department of Obstetrics and Gynaecology, Endoscopic Training Centre, Baby Friendly Hospital, Kladno, Czech Republic. DESIGN: An uncontrolled case series of 17 consecutive women who underwent LDUV using ultrasonically activated shears for the treatment of fibroids over two years. Ultrasound imaging was carried out before and three and six months following treatment. The tissue markers (C-reactive protein (CRP), Interleukin-6 (IL-6), Creatin kinase (CK) and white blood cell count) were studied preoperatively, on the first and third postoperative day. RESULTS: All patients underwent successful LDUV without intraoperative complications. Tissue markers results show that the LDUV performed using ultrasonically activated shears is associated with insignificant tissue damage. Time of surgery ranged from 30 to 50min (mean 39min). Mean blood loss was less than 30ml and mean hospital stay was 2.3 days. Three and six months after surgery, respectively, average reduction in uterine volume was 23.6 and 36.8% and average reduction in dominant fibroid was 28.6 and 56.8%. 94.1% of women had improvement in menorrhagia or dysmenorrhoea, and 91.6% had improvement in bulk-related symptoms or pelvic pain six months after treatment. CONCLUSION: Uterine volume and dominant fibroid were reduced and symptoms were improved by LDUV. The procedure of laparoscopic dissection of uterine vessels can be completed within 30-40min with only minimal blood loss and short hospital stay if performed by experienced laparoscopists.

Abdominal Pain↗
PubMed2003

[Minimally invasive surgical treatment of symptomatic myomas using laparoscopic dissection of uterine vessels: prospective clinical study (part I)].

OBJECTIVE: To assess the clinical outcome, indication and operative technique of laparoscopic dissection of uterine vessels (LDUV) using ultrasonic technique in the treatment of symptomatic fibroids. DESIGN: Prospective case observational clinical study (Part I). SETTING: Department of Obstetrics and Gynecology, Hospital Kladno. METHODS: We analysed clinical outcome of laparoscopic dissection of uterine vessels in 46 symptomatic women with fibroids in the period 2000-2002. The operative technique and indication to surgery were studied especially in part I. RESULTS: All patients underwent successful LDUV procedure without intraoperative complications. Time of surgery ranged from 15-50 minutes (mean 37.3 minutes) in cases of LDUV only. In cases of laparoscopic dissection of uterine vessels combined with myomectomy the mean of surgery was 63.1 minutes (range 35-120). Mean blood loss was less than 25 ml and mean hospital preoperative stay 2.1 days. Only two minor febrile preoperative complications was found (4.3%). CONCLUSION: The procedure of laparoscopic dissection of uterine vessels can be completed within 25-35 minutes with minimal blood loss, short hospital stay and acceptable number of complications.

Adult↗
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↗
PubMed2002

Comparison of two procedures for sentinel lymph node detection in patients with endometrial cancer: a pilot study.

OBJECTIVE: The purpose of this study was to assess the feasibility and contribution of two intraoperative procedures of lymphatic mapping and sentinel node detection using a blue dye in surgically-staged patients with early stage endometrial cancer. METHODS AND MATERIALS: In 25 cases of endometrial cancer, patent blue-V was injected into the subserosal myometrium (13 cases, SM group) or cervico-subserosal myometrium (12 cases, CSM group) during a surgical staging procedure. Laparoscopically-assisted vaginal hysterectomy and pelvic lymphadenectomy were completed successfully in 23 women out of 24 laparoscopically-staged patients (95.8%). One patient with FIGO stage IIa was indicated for a radical abdominal surgery. RESULTS: A deposition of the blue dye was found in at least one pelvic lymph node (LN) in eight out of 13 cases (61.5%) in the SM group compared with ten out of 12 cases (83.3%) in the CSM group (p = 0.378). The mean number of dye-colored LN (DCLN) was 1.15 (SM group) and 2.5 (CSM group), respectively (p = 0.05). The rate of DCLN/LN was 15/188 (SM group) versus 30/190. respectively (p = 0.03). An uptake of the blue bye was observed in a total of 45 out of 388 LN. CONCLUSION: An intraoperative combination of cervico-subserosal myometrium application of the blue dye allows successful detection (83.3%) of sentinel LN in patients with endometrial cancer. Comparing SM and CSM groups the statistical significant difference was found in the DCLN/LN rate and mean number of sentinel lymph nodes (p = 0.03, p = 0.05, respectively). Clinical validity of this surgical procedure must be assessed prospectively.

Aged↗
PubMed2002

Laparoscopic ultrasonic dissection of uterine vessels in women with benign uterine pathologies.

Uterine artery dissection is a new minimally invasive surgical technique used for the treatment of leiomyomas and adenomyomas. Three women underwent laparoscopically-assisted bilateral uterine dissection using ultrasonically activated shears. Surgery was uneventful, and patients were discharged on the second day after. Reduction in tumor volume measured by ultrasound was impressive (36%-68%), and the women felt their symptoms had improved. A larger series and longer follow-up are required to evaluate which patients will benefit from this technique. To our knowledge, this is the first report in the literature of origin uterine artery dissection in the area of the off-going part from the hypogastric artery using ultrasonically activated shears in symptomatic leiomyomas.

Adult↗
PubMed2002

Inflammatory response and tissue trauma in laparoscopic hysterectomy: comparison of electrosurgery and harmonic scalpel.

OBJECTIVE: Our aim was to quantify and compare clinical outcome and surgical inflammatory response and tissue trauma after laparoscopic hysterectomy for a benign disorder which was performed by electrosurgery or harmonic scalpel. METHODS: Sixty patients scheduled for laparoscopic hysterectomy were selected according to patient preference to undergo either electrosurgery or an ultrasonic operative technique. Blood samples for assay of markers of tissue trauma (C-reactive protein, interleukin-6, creatine kinase, white blood cell count) were taken preoperatively, on the first and third postoperative day. Three patients with intraoperative complications or incomplete records were excluded from tissue analysis. RESULTS: No differences were present in the demographic characteristics and clinical outcomes (blood loss, uterine weight, operating time and hospital stay) in 57 uncomplicated laparoscopic hysterectomies. Both electrosurgery (n = 36) and use of the harmonic scalpel (n = 21) resulted in statistically significant changes in the inflammatory and systemic immune response in comparison with preoperative values. No significant differences were observed in the studied inflammatory and tissue markers (C-reactive protein, interleukin-6, creatine kinase and white blood cells) between the compared groups. CONCLUSION: The harmonic scalpel and electrosurgery in laparoscopic hystsrectomy were equally traumatic in terms of surgical inflammatory response and tissue trauma.

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↗
PubMed2001

Laparoscopic hysterectomy in obese women: a clinical prospective study.

OBJECTIVE: To compare perioperative and postoperative outcomes of laparoscopic hysterectomy (LH) in surgical management of gynecological conditions in two groups of different weight. METHODS: A prospective comparative clinical study of 271 LH performed for disease of female pelvic organs in a group of 54 obese patients (over 30 body mass index (BMI)) and in a group of 217 non-obese patients (less than 30 BMI). The following criteria were assessed: patient characteristics, indications for surgery, previous surgery, presence of adhesions, duration of procedure, blood loss, weight of specimen, hospital stay and complications. Statistical analysis was performed using the unpaired t-test and non-parametric Chi-square test when appropriate, with a significance level of P=0.05. RESULTS: Three non-obese patients were converted to laparotomy due to operative complications. Laparoscopy in the remaining 268 patients (98.89%) was completed successfully. There was no significant difference in estimated blood loss, presence and degree of adhesions, weight of specimen, length of hospital stay and postoperative complications between women with high BMI and those with low BMI. The rate of major operative complications (5.55% versus 3.22%) was higher in the obese group. The duration of the operation was longer in obese women. However, the significance of the difference was borderline (P=0.06).

Adult↗
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

Laparoscopic surgery in obese women with endometrial cancer.

STUDY OBJECTIVE: To analyze perioperative and postoperative outcomes of laparoscopic treatment of endometrial cancer in two groups of women of different weight. DESIGN: Prospective, multicenter clinical study (Canadian Task Force classification II-1). SETTING: Three laparoscopic oncology centers. PATIENTS: Sixty-five consecutive women with endometrial cancer, of whom 32 were not obese (weight <81. 7 kg) and 33 were obese (weight (3)81.7 kg, body mass index 30-40). INTERVENTION: Laparoscopic surgery. MEASUREMENTS AND MAIN RESULTS: Three patients (1 nonobese, 2 obese) in whom laparoscopy was converted to laparotomy were removed from data analysis. Laparoscopy in the remaining 62 (94.38%) was completed successfully. Hysterectomy and pelvic and paraaortic lymphadenectomies were performed based on tumor grade and depth of myometrial invasion. In both groups, 28 women underwent pelvic lymphadenectomy and 21 paraaortic lymph node dissection or sampling. Eight patients had metastases in pelvic or paraaortic nodes. Deep myometrial invasion over 50% was present in five obese and two nonobese women. Mean operating time was 166 and 172 minutes, respectively. The rate of major complications and conversions was higher in the obese group (8 vs 5). CONCLUSION: Laparoscopic surgery is feasible in obese women and may also be considered for endometrial cancer, which typically occurs in obese women.

Body Mass Index↗
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↗
PubMed2000

Hemostasis using tissue glue in laparoscopy: discussion and review.

OBJECTIVES: To discuss the usefulness of tissue glue and TachoComb (TC), a new hemostyptic agent which combines the advantages of two reliable hemostyptic products-collagen fleece and fibrin glue in local hemostasis during laparoscopy. SETTING: Department of Gynecology and Obstetrics, Endoscopic Training Centre, Hospital Kladno. DESIGN: Review. METHODS: Analysis of literary and clinical data. RESULTS: In recent years, collagen fibers, gelatin sponges, oxidized cellulose and fibrin glue has been developed, which are now widely used in postoperative hemostasis in laparoscopy. An efficient use of these preparations shortens the duration of intervention procedures and reduces patient strain. CONCLUSIONS: Clinical studies demonstrate that hemorrhage from damage tissue important pelvic structures can be successfully arrested and controlled using the laparoscope to apply tissue glue. At Czech study, sixteen patients have been effective treated with collagen-fibrin agent during laparoscopic operations. The elimination of hemorrhages after primary laparoscopic electrosurgery and the effectiveness of this drug have been successfully tested.

Aprotinin↗
PubMed2000

Does hysterectomy without salpingo-oophorectomy influence the reoperation rate for adnexal pathology? A retrospective study.

OBJECTIVE: The aim of this study was to assess if the abdominal, vaginal and laparoscopic approach to hysterectomy can affect the incidence of ovarian or adnexal pathology after hysterectomy without salpingo-oophorectomy. METHODS: In this study 17 cases out of 617 hysterectomies were found to have development of adnexal pathology; reoperation rate was 2.75%. RESULTS: The reoperation rate was significantly different (p < 0.006) in the observed approaches to hysterectomy (TAH 5.67%, VH 0.69%, LH 3.18%). The greatest difference was found between the abdominal and vaginal groups. CONCLUSION: Our study results have sufficiently shown that the relationship of a number of factors (age, primary histologic findings, smaller peritoneal trauma) had an important impact on a significant difference in reoperation rate between vaginal, laparoscopic and namely abdominal hysterectomies in female patients with preserved adnexa.

Adult↗
PubMed1999

The role of laparoscopic hysterectomy and lymph node dissection in treatment of endometrial cancer.

BACKGROUND: The development of new diagnostic and surgical methods has brought a differentiated approach to surgery of endometrial cancer. The aim of this study was to verify the peri-and postoperative differences between laparoscopic and open procedure and prepare protocol for a second phase follow-up multicentric study. METHODS: The study includes 133 women with indications for surgery of endometrial cancer. A prospective multicentric study was undertaken at four centres in the Czech Republic. We evaluated differences in the peri-and postoperative outcomes. Sixty-eight patients treated laparoscopically were compared with 65 patients treated by an open procedure of hysterectomy and lymphadenectomy. RESULTS: Three patients with conversion were withdrawn from the study and another 65 patients (97%) from the laparoscopic group successfully completed the procedures. Laparoscopic and abdominal hysterectomy with lymphadenectomy were performed based on the grade of the tumor and depth of myometrial invasion. Out of both groups, 75 patients underwent pelvic lymphadenectomy and 21 women underwent para-aortic lymph node dissection or sampling. Eleven patients had metastases in the pelvic or para-aortic nodes (11.7% versus 4.7% in the open procedure group). Deep myoinvasion over 50% was more frequently present in the group of abdominally-treated women. The rate of major complications (18 versus 14 cases) was higher in the laparoscopic group, but more wound infections were seen in the open procedure group. CONCLUSION: The study illustrates that the laparoscopic approach to surgery is feasible and it also may be considered for endometrial cancer which typically occurs in at risk and obese women. Recovery time is reduced by avoiding an abdominal incision. Laparoscopic surgery was performed successfully in 65 women and in 8 cases (11.7%) malignant spread outside to the regional lymph nodes was found. However, the selection of patients for laparoscopy should be done considering optimal benefit and safety.

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↗