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Biomedical subjects

L Mettler

Publications and source records attributed to L Mettler.

At least 19 recordsLinked to original sources
PubMed1999

Pregnancy: A contraindication?

According to David L. Sackett evidence-based medicine is the conscientious, explicit, and judicious use of current best evidence when making decisions about the care of individual patients. It means integrating individual clinical expertise with the best available external evidence from systematic research. On the basis of this idea in medicine the following communication summarizes and evaluates current statements and literature on laparoscopic surgery during pregnancy. The topic is an example for excellent individual clinical performance on one hand, as gynecologists have perform laparoscopic procedures during pregnancy for decades. On the other hand, pregnancy is considered to be a contraindication for laparoscopic surgery by clinicians, because no excellent external evidence from systematic research is available. To find an answer to the question of whether pregnancy is a contraindication for laparoscopic surgery we performed a literature search and gained information by conducting interviews with several experts in gynecology and endoscopic operations. We concluded that there are almost no "scientific" data about endoscopic surgery during pregnancy, but gynecologists representing the "real world" seem to have no fear of the procedure for their patients. Between the two extremes, performing laparoscopic operations during pregnancy might be advantageous for maximal patient-friendly surgery, but considering pregnancy as a contraindication for the laparoscopic approach might be the safer treatment. The reader may decide that the subject on endoscopic surgery in pregnancy is still open.

Appendectomy↗
PubMed1999

Immunohistochemical assessment of p170 provides prognostic information in endometrial carcinoma.

AIMS: To determine the significance of proliferative activity (PA) in endometrial carcinomas, we analysed the expression of cell cycle-related antigens in routinely processed tissue. METHODS AND RESULTS: Serial sections of 164 endometrial carcinoma specimens were immunostained with the monoclonal antibodies (MoAb) Ki-S4 (specificity for p170) and Ki-S5 (specificity for p320/350). The Ki-S4 PA (median value 18.3%) and Ki-S5 PA (median value 25.0%) in endometrial carcinomas showed a significant correlation (r = 0.89, P < 0.001). A significantly lower median value of Ki-S4 and Ki-S5 immunoreactivity was ascertained in endometrial carcinomas stage I vs. > I (P < 0.05), in tumours with myometrial invasion < or = 50% vs. > 50% (P < 0.03), and in grade 1 vs. grade 2 and 3 tumours (P < 0.001). Univariate analysis showed that age, FIGO stage and grade, histopathological subtype, myometrial invasion, Ki-S4 and Ki-S5 PA provided prognostic information on the adjusted overall survival, whereas FIGO stage (P = 0.002) and Ki-S4 PA (P = 0.008) were independent prognosticators for adjusted overall survival in multivariate analysis. CONCLUSIONS: The association with established prognosticators for endometrial carcinomas, and the results of uni- and multivariate analysis indicates that the additional evaluation of Ki-S4 PA is useful for classifying patients into subgroups with low and high risk of relapse which might help individualizing the therapeutic strategy in endometrial cancer patients.

Adult↗
PubMed1998

One year of experience working with the aid of a robotic assistant (the voice-controlled optic holder AESOP) in gynaecological endoscopic surgery.

The aim of the study was a comparison of robotic versus human laparoscopic camera control. Utilizing robotic technology a robot has been designed specifically for the purpose of holding and manoeuvring the laparoscope under the direct control of the surgeon. We tested AESOP (automated endoscopic system for optimal positioning) in 50 patients undergoing routine gynaecological endoscopic surgical procedures. The elimination of the camera holder allows two doctors to perform complex laparoscopic surgery faster than without the robotic arm. The timing of surgical procedures performed by surgeons using the voice control was compared to the timing of similar operations using the foot or hand control. The voice-controlled AESOP works more efficiently and faster than the hand or foot control.

Endoscopes↗
PubMed1998

Endoscopic lymphadenectomy and LAVH in the treatment of endometrial cancer.

This article describes the results of two and half years experience in laparoscopic treatment of patients with endometrial cancer stage I and II. Between January 1994 and October 1996, 25 patients were treated by laparoscopy procedures. All of them had performed LAVH and pelvic lymphadenectomy. The technique of the laparoscopic procedure was accurately described. No operative complications were observed and blood loss did not exceed 250 ml. In 7 patients (27.8%) nodal metastases were found. Mean 14 (range 7-25) lymph nodes were removed. After surgery some patients required radiotherapy. Up to now all patients are free of disease. We believe that laparoscopic assisted surgical staging of stage I and II endometrial cancer is an attractive alternative to the traditional surgical laparotomy approach.

Adenocarcinoma↗
PubMed1997

Subtotal versus total laparoscopic hysterectomy.

Between 1993 and 1994, 368 women underwent hysterectomy for benign disorders at the University of Kiel. Of these operations, 58.7% were performed either by pelviscopic or by laparotomic Classic Intrafascial Supracervical Hysterectomy, subtotal hysterectomy with coring of the inner cervix. Of the remainder, 14.8% were performed by total abdominal hysterectomy, 13.6% by Intrafascial Vaginal Hysterectomy, 12.2% by vaginal hysterectomy, and only 0.05% by Laparoscopic Assisted Vaginal Hysterectomy. Comparative data of these six surgical techniques concerning patients' characteristics, indications for operation, histological features, blood loss, operating time, hospital stay, uterine weights and postoperatively used analgesics are described.

Adult↗
PubMed1996

Proliferative activity of the endometrium throughout the menstrual cycle in infertile women with and without endometriosis.

OBJECTIVE: To assess whether changes in endometrial proliferation in patients with endometriosis contribute to ectopic endometrial implantation. DESIGN: Endometrial biopsies from patients with endometriosis were stained immunohistochemically and compared with endometrium of a control group (n = 111). The newly developed monoclonal antibody Ki-S3 was used as a marker of cellular proliferation in surface and glandular epithelia and in stromal cells. SETTING: Female Infertility Clinic, Research Centre of Obstetrics, Gynecology, and Perinatology, Moscow, Russia, and Institute of Pathology, Christian-Albrechts-University, Kiel, Germany. PATIENTS: One hundred thirty-nine women with endometriosis and 111 women without endometriosis, all being infertile. INTERVENTION: Collecting endometrial samples during diagnostic and therapeutic laparoscopy. MAIN OUTCOME MEASURE: Number of proliferating cells in endometrial stroma, glandular, and surface epithelia. RESULTS: Endometrial proliferation showed a characteristic cyclic dependency with greatest activity in the follicular phase. Although epithelial proliferation ceased completely during the luteal phase, the number of proliferating cells in the stroma increased again toward the end of the menstrual cycle after its maximum at ovulation. No significant differences could be found between both investigated groups. CONCLUSIONS: Endometriosis is not due to an altered proliferative activity in eutopic endometrium. Proliferating stromal cells at the end of the menstrual cycle may reflect increasing numbers of immunocompetent cells. Endometrium of patients with endometriosis reveals almost the same cyclical changes as endometrium of patients without endometriosis does. Further attention to cells and cell-mediated reactions in the extrauterine milieu is required to elucidate the pathogenesis of endometriosis.

Adult↗
PubMed1996

Enucleation of 482 Myomectomies

Of more than 800 women with uterine myomas, 60% underwent endoscopic myomectomy with uterine preservation and 40% conventional hysterectomy. Before endoscopic myomectomy, 3% of women were treated with gonadotropin-releasing hormone analogs for 3 to 6 months. Operating time was 30 to 60 minutes. No complications occurred. Histologically, the majority of myomas were fibromyomas.

Journal Article↗
PubMed1996

Lymphocyte subsets in the endometrium of patients with endometriosis throughout the menstrual cycle.

PROBLEM: Comparison and characterisation of different lymphocyte subsets in the endometrium of endometriosis patients and in healthy women on every day of the menstrual cycle with special emphasis on the CD4:CD8 ratio in the endometrium. METHOD: Immunohistochemical staining of 253 endometrial biopsies of infertile women with and without endometriosis with Anti-Leu4 (CD3), Anti-Leu3a (CD4), Anti-Leu2a (CD8), Anti-Leu7 and Anti-Human-B-cell (CD22) using the immune peroxidase reaction. Identification and counting of positive lymphocyte were performed on cryostat sections. RESULTS: Endometrial lymphocyte subsets show equal quantity and distribution in endometriosis patients and in the control group. After a peak in the early proliferative phase the absolute number of T lymphocytes decreases while a predominance of T-suppressor/cytotoxic T lymphocytes (CD8) compared to T-helper/inducer lymphocytes (CD4) occurs towards the end of the menstrual cycle. CONCLUSION: Endometrium as the potential parent epithelia of endometriosis lesions seems not to be altered in its lymphatic cell content compared to healthy women. Furthermore, endometrium is clearly characterised as part of the mucosa associated lymphatic tissue (MALT). T lymphocytes show specific quantitative changes due to different phases of the menstrual cycle.

Adult↗
PubMed1995

Comparative evaluation of classical intrafascial-supracervical hysterectomy (CISH) with transuterine mucosal resection as performed by pelviscopy and laparotomy--our first 200 cases.

A novel way of performing endoscopic intrafascial supracervical hysterectomy is presented. By using the endoscopic approach for dissection as well as uterine extraction using the serrated-edged macro-morcellator, we avoid giving the patient a colpotomy incision and its inherent post-operative discomfort. A further modification involves nearly complete excision (95%) of uterocervical mucosa using a calibrated resection tool, thus eliminating the possible subsequent development of cervical stump neoplasia. Sparing of the cardinal ligament insertion provides support to the cervical stump. Hemorrhage and genitourinary complications are prevented by avoiding dissection of the parametrium at the level of endocervix. Comparison of data of the pelviscopic CISH procedure with the laparotomy approach in our preliminary series (n = 190) confirms our claims as to its safety. Data on long-term postoperative evaluation are ongoing, but the initial reports deny any postoperative discomfort. Larger randomized studies are required to prove its value compared with the existing techniques. We believe that with its multitude of benefits, the classic intrafascial serrated-edged macro-morcellated (SEMM) hysterectomy (= CISH) may emerge as an attractive alternative to conventional hysterectomy.

Adult↗
PubMed1995

[Vaginal supracervical vs. laparoscopic supracervical hysterectomy, with resection of transcervical and transuterine mucosa].

Indications for the 346 hysterectomies performed in the Department of Obstetrics and Gynecology University of Kiel in the years 1991 till 1994 were myomas with pain, hypermenorrhoea, menorrhagia, recurrent bleedings and endometriosis. The applied hysterectomy technique consisted of supercervical hysterectomy without colpotomy including the resection of the transcervical and transuterine mucosa by laparotomy and via laparoscopy (pelviscopy). Histologically results were divided between fibromas, leiomyomas, adenomyosis and adenomatous hyperplasia. 42 patients where pretreated with hormones and showed a significantly reduced blood loss compared to the non treated patients during surgery. Intra- and postoperative complications were very low. The CISH-technique is an alternate method for vaginal and abdominal total hysterectomy via laparotomy or via laparoscopy. Gynecological indications for hysterectomies presents the following advantages. 1. CISH via pelviscopy: Prophylaxis against the development of cervical cancer, preservation of the pelvic floor, preservation of the pericervical vascular and nerve tissue and especially, avoiding the danger zone of the uterine arteria and ureter, reduced physical stress, short hospitalisation and recovery time of the patients. 2. CISH via laparotomy: Prophylaxes against cervical cancer, preservation of the pelvic floor, reduction of the pelvic trauma, simple technique. 3. CISH via vagina: The advances of the intrafascial vaginal hysterectomy are the same as those for laparoscopic intrafascial hysterectomy without colpotomy, no separation of cardinalia and sacrouterina ligaments, no cervical amputation. No search for the uterine artery, no change in sexual life. Ideal conditions for the preservation of pelvic floor to regain stability. 4. During the resection of the transcervical and transuterine mucosa the technique of mucosa ablation emerged, indications are dysfunctional bleeding.

Adult↗
PubMed1995

Microinjection of a single spermatozoon into the perivitelline space of bovine oocytes matured in vitro.

OBJECTIVE: To evaluate the outcome of a single sperm injection into the perivitelline space of bovine oocytes. STUDY DESIGN: Oocytes obtained from the ovaries of slaughtered heifers and cows were cultured in medium 199 supplemented with 20% fetal calf serum for 24 hours. Fresh or frozen spermatozoa were incubated for two hours in Ham's F-10 medium containing 0.75% bovine serum albumin for capacitation and kept for 30 minutes in culture medium containing 12 mM dibutyryl cyclic guanosine 3',5' monophosphate and 10 mM imridazole for the acrosome reaction. Only one motile spermatozoon was injected into the perivitelline space of each oocyte. RESULTS: The second polar body and the pronuclear stages were observed in 9.5% and 5.4% of oocytes, respectively. The cleavage rate of the oocytes over the two-cell stage was 4.1% (10 of 242). CONCLUSION: The results of this study suggest that microinjection may be a useful technique for studying sperm-oocyte interaction. However, one spermatozoon is not enough to achieve an acceptable fertilization rate.

Animals↗
PubMed1994

Histologic features of the CISH procedure.

STUDY OBJECTIVE: To evaluate the classic intrafascial SEMM (serrated-edge macromorcellated) hysterectomy (CISH) performed by pelviscopy and by laparotomy, and determine the histologic features of the procedures. DESIGN: The first 253 women who required hysterectomy were assigned to undergo the procedure by pelviscopy or laparotomy based on uterine size. PATIENTS: One hundred fifty-two women underwent CISH by pelviscopy and 101 by laparotomy. INTERVENTIONS: Between September 1991 and December 1993, the patients underwent the two procedures. Uterine leiomyomas with menstrual disorders and pressure symptoms were the principal indications (61%). MEASUREMENTS AND MAIN RESULTS: Histologic findings were in agreement with indications for the procedures. Leiomyomas and leiomyomas with adenomyosis were the most frequent findings. Histologic analysis revealed that the squamocolumnar transformation zone was totally removed in all cases, and all cervical glands were excised in 92%. CONCLUSION: Cervical dysplasia is not a contraindication to CISH, but emphasizes the importance of adequate preoperative screening. This is a conservative operation that my protect against some cervical cancers.

Adult↗
PubMed1994

Pelviscopic Therapy of Adnexal Tumors

Minimally invasive surgery after careful presurgical screening represents an accepted method of treatment for adnexal masses. Between 1990 and 1994, 1032 adnexal tumors were treated by ovarian cystectomy, ovarectomy, adnexectomy, and salpingectomy via pelviscopy. Ten borderline cancers were managed by placing the ovaries into tissue collection bags. In four cases of a preoperatively undetected ovarian cancer, the surgical procedure was changed to laparotomy. Compared with 325 laparotomies performed for ovarian malignancy in the same period of time, the surgical advantages of pelviscopy become evident.

Journal Article↗