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Biomedical subjects

M G Munro

Publications and source records attributed to M G Munro.

At least 19 recordsLinked to original sources
PubMed2000

Medical management of abnormal uterine bleeding.

Abnormal uterine bleeding occurs secondary to a wide variety of functional and structural abnormalities. Although there is clearly a place for surgery, medical therapy has enormous potential for most women, especially those with dysfunctional uterine bleeding. To provide women with appropriate options for therapy, the clinician must be prepared to distinguish abnormal bleeding that is associated with ovulation from that which is anovulatory and to use appropriate ancillary tests to identify structural and endocrinologic anomalies or lifestyle factors that may explain the bleeding. In undertaking such an investigation, it is important for the clinician to be able to distinguish lesions that may be asymptomatic and unrelated to the bleeding from those that truly are the source of the problem. With this information, a rationally determined set of medical and, if appropriate, surgical therapeutic options may be presented to the woman. Among these medical treatment options are a number of treatment options that have not seen widespread use in North America but are inexpensive, effective, and well tolerated. It is clear that medical therapy is not for everyone. Women deserve the opportunity to relieve their symptoms with nonsurgical options.

Androgens↗
PubMed1999

Incision characteristics associated with six laparoscopic trocar-cannula systems: a randomized, observer-blinded comparison.

OBJECTIVE: Laparoscopic trocar-cannula systems of different design but similar internal diameter result in incisions of varying dimensions. Such variations might affect the incidence of incisional complications, such as dehiscence and hernia. We developed a system to measure associated fascial defects and then used the techniques to compare the defects resulting from different trocar-cannula systems. METHODS: This was a randomized, observer-blinded study. Six laparoscopic trocar-cannula systems of similar diameter (12 mm) were tested (two pyramidal, two blunt conical, and two cutting-dilating) using a white swine model. All systems were inserted into each of 12 subjects, with location designated by random allotment (total 72 insertions). The fascial defects were exposed and then directly measured for incisional length and area by an observer blinded to the system used. Means of each outcome variable (incisional length and area) were compared using factorial analysis of variance. RESULTS: The values for mean incisional areas were as follows: cutting-dilating 28.73 mm2 and 31.09 mm2, pyramidal 18.25 mm2 and 26.75 mm2, and blunt conical 10.00 mm2 and 12.33 mm2. Mean maximal incisional lengths were similar among all trocar-cannula systems. CONCLUSION: Blunt conical trocar-cannula systems resulted in significantly smaller fascial defects compared with the widely used pyramidal and the two cutting-dilating trocar-cannula systems tested. These differences have potential clinical implications. For example, smaller fascial defects could reduce risk of incisional hernia and dehiscence.

Animals↗
PubMed1999

Entry force and intra-abdominal pressure associated with six laparoscopic trocar-cannula systems: a randomized comparison.

OBJECTIVE: In trocar-cannula systems, increased entry force could result in loss of operator control, a potential cause of serious visceral and vascular injuries. We developed a system to measure entry force and intraperitoneal pressure to evaluate and compare trocar-cannula systems. METHODS: Six laparoscopic trocar-cannula systems of similar diameter (12 mm) were tested (two pyramidal, two cutting-dilating, and two blunt conical) using a white swine model. All six systems were inserted into each of 12 subjects with location designated by random allotment (72 insertions). During each insertion, intraperitoneal pressure and entry force were measured using a system consisting of a gas-gas transducer, a 50-lb load cell, and a multichannel data acquisition board. Mean entry force and intraperitoneal pressure were compared using mixed-model analysis of variance. RESULTS: Mean entry force measurements were as follows: pyramidal 9.01 lb and 13.48 lb, cutting-dilating 9.94 lb and 16.46 lb, and blunt conical 19.15 lb and 31.91 lb. Intraperitoneal pressure changes generally reflected measured entry force. CONCLUSION: The system successfully measured both entry force and resultant intraperitoneal pressure. Pyramidal trocar-cannula systems required the lowest force for entry. These differences in entry force have potential clinical implications related to the risk of visceral and vascular injury. Intraperitoneal pressure measurement could be used as a surrogate for insertional force measurement.

Abdomen↗
PubMed1998

Endometrial ablation versus hysterectomy: STOP-DUB.

Dysfunctional uterine bleeding (DUB) is a common clinical condition that frequently leads to hysterectomy. Endometrial ablation --a "minimally invasive" surgical technique that removes or destroys the endometrial lining of the uterus -- is a conservative alternative to hysterectomy for DUB. While endometrial ablation has lower immediate costs and shorter recovery than hysterectomy, symptoms are not always resolved. Available data from studies with admittedly incomplete follow-up suggest that up to one quarter of patients treated with endometrial ablation require repeat ablation or subsequent hysterectomy to stop DUB. This suggests that the short-term advantages of endometrial ablation may be offset by possible longer-term disadvantages. The Surgical Treatments Outcomes Project for Dysfunctional Uterine Bleeding (STOP-DUB) is a randomized trial designed to compare endometrial ablation against hysterectomy. The primary outcomes address issues of importance to women, such as quality of life and resolution of symptoms that led to surgery. Other outcomes include subsequent surgery and cost-effectiveness of the procedures. The study's target enrollment is 800 women--400 in each treatment group -- from 20 clinical centers throughout the US. The women will be followed for 2 years after surgery. Part of the STOP-DUB is a parallel observational study that involves women who do not choose surgery or who are not eligible for the randomized trial but could become eligible with time. It is anticipated that the result of this research will provide important information to women and their health care professionals as they consider the relative merits of surgical treatments for DUB.

Catheter Ablation↗
PubMed1997

Supracervical hysterectomy: ... a time for reappraisal.

Supracervical or subtotal hysterectomy is a procedure that largely was discarded in the middle part of this century. This decision was made because of the reduction in morbidity and mortality associated with total hysterectomy, the only known and available method for the prevention of cervical cancer. This rationale, appropriate earlier in the century, has become somewhat undermined with the advent of Papanicolaou smear screening, colposcopic diagnosis, and simple outpatient therapy for preinvasive cervical neoplasia. Furthermore, some have argued that supracervical hysterectomy better preserves bladder and sexual function, and may be associated with reduced surgical and postoperative morbidity. Recently, laparoscopic supracervical hysterectomy has been introduced as another operative alternative with putative advantages over the procedure performed via laparotomy. However, for routine cases, the available literature does not confirm that one procedure is superior, regardless of the route of access. In selected cases, where benign conditions significantly distort the cervical anatomy complicating the dissection, supracervical hysterectomy would seem a prudent choice. It is clear that appropriately designed comparative studies are in order, to better determine the place for supracervical hysterectomy in the contemporary management of women with benign uterine disease.

Cervix Uteri↗
PubMed1996

Loop electrosurgical excision in the peritoneal cavity. Preliminary experience with the rat model.

OBJECTIVE: To evaluate a monopolar electrosurgical loop electrode designed for use at laparoscopy. STUDY DESIGN: A pilot, observational study of cutting effectiveness followed by a nonrandomized comparative study of thermal injury associated with the loop electrode and CO2 vaporization in the rat model. The observer evaluating thermal injury was blind to the energy source used. RESULTS: The loops cut most effectively with a continuous, sinusoidal, radiofrequency output at 40 W. The depth of coagulative necrosis was similar in the laser vaporization and loop excision groups of lesions when using outputs and power densities commonly attainable at laparoscopy. There was more necrotic debris in the lasered lesions. CONCLUSION: While a randomized comparison will be necessary to clarify these results, electrosurgical loop electrodes seem to have a role in a number of gynecologic laparoscopic procedures.

Animals↗
PubMed1995

Loop electrosurgical excision with a laparoscopic electrode and carbon dioxide laser vaporization: comparison of thermal injury characteristics in the rat uterine horn.

OBJECTIVE: Our purpose was to compare the thermal intraperitoneal injury in lesions resulting from a monopolar electrosurgical loop electrode designed for laparoscopic surgery with similar lesions fashioned by carbon dioxide laser vaporization. STUDY DESIGN: A randomized, observer-blinded comparison was made of histopathologically measured thermal injury in rat uterine horns. The primary outcome measure was the depth of necrotic debris and coagulative necrosis in the lesions created by the two methods. RESULTS: The depth of coagulative necrosis was similar in the laser vaporization (0.118 +/- 0.028 mm) and the loop excision groups (0.165 +/- 0.167 mm). However, the average amount of necrotic debris was greater in the lasered lesions (0.053 +/- 0.019 mm) compared with those made with the loop electrode (0.013 +/- 0.011 mm). CONCLUSIONS: The depth of coagulative necrosis in rat uterine lesions fashioned with a loop electrode is similar to that of lesions created by carbon dioxide vaporization at power densities comparable with those usually achieved at laparoscopic surgery. There is a greater amount of necrotic debris in the lasered lesions. This suggests that electrosurgical loops designed for laparoscopic surgery may have promise for the cost-effective excision of intraperitoneal tissue.

Analysis of Variance↗
PubMed1995

Review on laparoscopic hysterectomy.

An increasing number of data on laparoscopic hysterectomy has become available since the procedure was introduced in 1989. This article reviews all published series till June 1995, totaling 4502 cases. Prior to this procedural evaluating strategy is addressed to highlight the short-comings of such a review. Most data are collected retrospectively in a lunited number of centers, all dedicated to the procedure. Laparoscopy Assisted Vaginal Hysterectomy (LAVH) may cover a whole range of procedures, and a classification system is needed. It is suggested that classification systems based on the degree of anatomical dissection is clinically most relevant. During 76.1% of LAVH-procedures, the uterine artery is ligated laparoscopically, though the fraction of total laparoscopic hysterectomies is minimal (1.5%). Mean conversion rate is 2.5% and mean major complication rate is 3.24% (range 0-20%). Urinary tract lesions (1.42%), such as bladder perforation, and reintervention for haemorrhage (0.78%), are the most frequent complications. LAVH seems an efficacious procedure, more data on its effectiveness are urgently needed.

Female↗
PubMed1994

Incisional hernia following laparoscopy: a survey of the American Association of Gynecologic Laparoscopists.

OBJECTIVE: To estimate the risk factors for and incidence of post-laparoscopy incisional hernia. METHODS: A questionnaire was sent to all individuals on a mailing list from the American Association of Gynecologic Laparoscopists. Adequately completed responses were entered into a computer-based data bank for analysis. Of the 11,500 surveys mailed, 3293 were returned; of these, 3217 were evaluable. RESULTS: A total of 933 hernias was reported from an estimated 4,385,000 laparoscopic procedures (an incidence of 21 per 100,000); 167 (17.9%) were reported to have occurred despite fascial closure. Six hundred sixty-five patients (71:3%) had subsequent surgical repair. Seven hundred twenty-five (86.3%) of the 840 hernias in which the size of the original fascial defect was noted, occurred in sites where ports 10 mm in diameter or larger had been placed. The occurrence of hernias is a function of the number of laparoscopies performed (P < .0001) and is not related to the length of the surgeon's career (P = .41). In at least 157 instances (16.8%), the presenting symptom or morbidity of the hernia was directly related to the involvement of the large or small intestine. CONCLUSION: Post-laparoscopy incisional hernias occur at an approximate incidence of 21 per 100,000 and are associated with significant morbidity. These hernias are most likely to occur when large ports are used. As currently practiced, closure is not completely protective. Further methods or devices should be developed to minimize the risk of hernia formation.

Female↗
PubMed1994

Successful pregnancy following zygote intrafallopian transfer for congenital cervical hypoplasia.

BACKGROUND: Congenital cervical atresia and hypoplasia are rare abnormalities that generally require reconstructive or extirpative procedures to relieve outflow tract obstruction. Infertility is a common sequel, and only four previous pregnancies have been reported. In selected cases, zygote intrafallopian transfer (ZIFT) or other assisted reproductive techniques may offer alternatives for conception. CASE: A 21-year-old amenorrheic woman experienced a spontaneous gush of vaginal bleeding following an 11-year history of cyclic lower abdominal pain. Regular but prolonged and painful menses ensued. After another 8 years of primary infertility, transcervical and transfundal hysteroscopy demonstrated congenital cervical hypoplasia and a normal endometrial cavity. Conception was achieved during her third cycle of ZIFT. Delivery occurred by elective cesarean at 39 weeks for a persistent oblique fetal lie. CONCLUSION: A successful pregnancy was established following ZIFT in a woman with congenital cervical hypoplasia. The endometrial cavity was evaluated by a previously unreported technique, transfundal hysteroscopy. The use of appropriate surgical or assisted reproductive techniques in conjunction with individualized post-conception management may permit successful pregnancy and delivery in selected women with congenital cervical hypoplasia and atresia.

Adult↗
PubMed1993

Automated laparoscope positioner: preliminary experience.

A new automated laparoscope positioner was designed that is easy to use and provides the surgeon with an opportunity to perform most laparoscopically directed procedures efficiently and safely without the need for an assistant. Potential additional benefits are reduced cost of care, development of laparoscopic simulators suitable for training residents, and development of surgical procedures and devices.

Equipment Design↗
PubMed1993

Office sonography and office hysteroscopy.

Researchers involved in assessing technology and healthcare, including gynecologic care, have identified differences among the terms efficacy, effectiveness and efficiency. In order to assess the efficiency of procedures such as office sonography and hysteroscopy, it is first necessary to compare them with the alternatives in terms of patient-focused outcomes. Office sonography has been used to diagnose early pregnancy disorders such as ectopic gestations and evaluate other adnexal pathology, with mixed results. The use of office hysteroscopy to assess abnormal bleeding may replace procedures that are associated with greater risk and expense. More information regarding outcomes is needed for both procedures before they can be recommended as efficient alternatives for the diagnosis or treatment of gynecologic conditions.

Clinical Competence↗
PubMed1993

A classification system for laparoscopic hysterectomy.

The term "laparoscopic hysterectomy" has been applied to a variety of procedures, ranging from lysis of adhesions laparoscopically followed by vaginal hysterectomy, to removal of the entire uterus under endoscopic direction. These procedures vary in a number of ways, including cost, morbidity, operating time, and surgical skill required. To facilitate training, credentialing, and outcome evaluation, we present the following classification system: type I--division of one or both pedicles containing the ovarian arteries, type II--dissection including one or both uterine arteries, type III--type II plus separation of part of at least one cardinal-uterosacral ligament complex, and type IV--type II plus separation of the entire cardinal-uterosacral ligament complex on at least one side. Each of the types may be subclassified according to the degree of dissection of structures located anterior and posterior to the cervix. Supracervical hysterectomy has a separate system of classification. Operations are categorized by management of the ovarian and uterine arteries and subdivided according to treatment of the cervical canal.

Female↗