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Mari Kitade

Publications and source records attributed to Mari Kitade.

17 recordsLinked to original sources
PubMed2006

A novel method of ninth-intercostal microlaparoscopic approach for patients with previous laparotomy.

BACKGROUND: To evaluate the availability of a primary laparoscopic approach for a patient with previous laparotomy and to assess postoperative adhesion to the abdominal wall.. METHODS: A total of 172 patients with a history of laparotomy who were undergoing laparoscopic surgery in our hospital were evaluated. The primary trocar insertion was performed via the ninth-intercostal microlaparoscopic approach for these patients. RESULTS: This procedure could be performed on all patients and there were no complications. Postoperative abdominal wall adhesion was found in 53 (30.8%) of 172 patients, and periumbilical adhesion was found in 16 patients (9.3%). Among the 172 patients, 150, 19, and three patients had undergone laparotomy once, twice, and thrice, respectively, prior to this study. Considering the number of previous laparotomies, the frequency of periumbilical adhesion was 5.3% (eight of 150 patients), 36.8% (seven of 19 patients), and 33.3% (one of three patients), respectively. Among 150 patients who had undergone laparotomy once, the type of laparotomy was an obstetric-and-gynecologic surgery in 126 patients and other surgeries in 24 patients. There was no significance in the frequency of adhesion between types of previous laparotomies. Surgical incisions were classified as median infra-umbilical incision (94 patients), median supra-umbilical incision (three patients), Pfannenstiel's incision (33 patients), para-rectal incision (15 patients), and peri-rectal incision (five patients). A high frequency of periumbilical adhesion was recognized in the all three median supra-umbilical incisions. CONCLUSION: Ninth-intercostal microlaparoscopic approach is safe for laparoscopic surgery in patients who have undergone laparotomy previously, and this procedure could prevent the risk of bowel injury.

Abdominal Wall↗
PubMed2006

Recurrence rate of endometriomas following a laparoscopic cystectomy.

BACKGROUND: The objectives were to observe the clinical course of patients who underwent laparoscopic cystectomy (LC) using transvaginal ultrasonography. METHOD: The definition of "recurrence" was to detect a diffuse, hypoechoic area whose long axis was at least 2 centimeters (cm) on the transvaginal ultrasonogram during the postoperative follow-up period. Using the Cox regression test, we analyzed each patient's background variables, namely, patient's age, the revised American Society of Reproductive Medicine score (r-ASRM score), use of gonadotropin releasing hormone analogues (GnRHa), and pregnancy during the observation period. Next, cyst size and multi-lobularity of each of the 417 cysts were also analyzed as recurrence risk factors per cyst. RESULTS: The mean postoperative observation period was 21.4+/-16.8 months. During the observation period, 50 (15.9%) out of 315 patients experienced recurrence and 51 (16.2%) out of 315 patients became pregnant. The cumulative recurrence rate per patient was 31.7% over 60 months. Among prognostic factors per patient, age and showed negative and r-ASRM scores positive correlations with cyst recurrence. On the other hand, we did not identify any cyst factors associated with recurrence. The patients who underwent hemilateral LC showed a 5.2% cyst recurrence rate in the ovary that appeared to be normal at the time of the initial surgery. CONCLUSION: Young age and severe endometriosis appeared to be the factors associated with high recurrence risk. Recurring ovarian endometrimas probably include cysts occurring spontaneously and those recurring from the cyst residues in the lesions where cystectomy has been performed.

Adolescent↗
PubMed2006

A novel instrument and technique for using Seprafilm hyaluronic acid/carboxymethylcellulose membrane during laparoscopic myomectomy.

Myomectomy is associated with the development of adhesions, and even when the patient is operated on laparoscopically, postoperative adhesions can often occur. Seprafilm is an effective and highly safe barrier to postoperative adhesions. However, it is vulnerable to tears and difficult to handle. We developed a device to introduce Seprafilm into the abdominal cavity during the laparoscopic procedure. Seprafilm is divided into 6 pieces and the pieces are rolled and inserted into the purpose-built introducer to be guided into the abdominal cavity. The inner syringe is pushed in and Seprafilm is applied onto the uterine wound with two grasping forceps. Of 117 patients in our study, we were able to use Seprafilm on 114 patients (97.4%). In total, 221 pieces of Seprafilm were used, and 87 pieces were damaged during the operation. Of these 87 pieces, 58 were damaged when inserted into the introducer, though this kind of loss tended to decrease with training, and 29 pieces were damaged during application to the wound. Seprafilm can be used safely and efficiently during laparoscopic surgery.

Carboxymethylcellulose Sodium↗
PubMed2006

Accurate preoperative diagnosis and laparoscopic removal of the cavitated non-communicated uterine horn for obstructive Mullerian anomalies.

Obstructive Mullerian anomalies cause severe dysmenorrhea following menarche as a result of disturbed menstrual outflow. Therefore, surgical management such as extirpation of the obstructive uterine horn is required for treatment of these patients. It is necessary to have a detailed understanding of the pathological conditions of the pelvic organs and urinary system prior to surgery. We report three cases of reproductive, nulligravid patients diagnosed as having obstructive Mullerian anomalies. Preoperative accurate diagnosis was obtained by magnetic resonance imaging (MRI) and 3-D computed tomography (CT) angiography. Laparoscopic resection of the rudimentary uterine horn was performed safely and completely, and resolved all problems. MRI and 3-D CT angiography are useful tools for diagnosing complex Mullerian anomalies, and operative laparoscopy may be an alternative treatment for these cases.

Adolescent↗
PubMed2006

Pathological study of Fitz-Hugh-Curtis syndrome evaluated from fallopian tube damage.

AIM: To analyze the causative pathogen, surgical indication and fallopian tube damages in Fitz-Hugh-Curtis syndrome (FHCS) cases diagnosed by laparoscopy. METHODS: Laparoscopic findings in 3568 cases at our hospital were reviewed retrospectively. Of these, 108 cases were diagnosed to have FHCS and examined for causative pathogens. Chlamydial infection was determined by both Chlamydia trachomatis (CT) antigens in the cervix and serum anti-CT antibodies. One hundred and four cases with chronic FHCS were divided into hydrosalpinx (H) and normal (N) groups based on the fallopian tube conditions, and were compared for patient profiles, tubal functions and perihepatic adhesion. RESULTS: Among surgical indications, tubal infertility and ectopic pregnancy were more often associated with FHCS than any other diseases. The primary causative pathogen of FHCS was CT. In 104 cases with chronic FHCS, there was no difference in CT antigen positivity between the H and N groups. The serum anti-CT IgG titer also did not differ between the two groups, although anti-CT IgA was slightly higher in the H group. The peritubal adhesion score was significantly higher in the H group, but it was not correlated with the degree of perihepatic adhesion. CONCLUSION: While some FHCS patients had severe fallopian tube dysfunctions, such as hydrosalpinx and tubal occlusion, 30% of FHCS cases did not show any abnormalities in the fallopian tube. Our study indicated that the severity of tubal dysfunctions associated with FHCS is determined by the host's reactivity to CT.

Adult↗
PubMed2005

A novel technique using magnetic resonance imaging jelly for evaluation of rectovaginal endometriosis.

OBJECTIVE: To evaluate the usefulness of the magnetic resonance imaging (MRI) jelly method as a preoperative diagnostic means for patients with rectovaginal endometriosis. DESIGN: Prospective study. SETTING: University hospital. PATIENT(S): Thirty one patients with suspected rectovaginal endometriosis based on clinical symptoms and the results of preoperative pelvic, rectal, and ultrasonographic examinations, who were scheduled to undergo laparoscopic surgery. INTERVENTION(S): Before surgery, jelly for ultrasonography was injected into the vagina and rectum for MRI. The MRI findings were compared with findings obtained through laparoscopic surgery and histopathologic examination of the removed tissues. MAIN OUTCOME MEASURE(S): The complete cul-de-sac obliteration and deep lesion confirmed at the time of the laparoscopic surgery were evaluated by the MRI jelly method. RESULT(S): For detecting the presence of complete obliteration of the cul-de-sac, the accuracy of the diagnosis of rectovaginal endometriosis attained using the MRI jelly method was sensitivity 90.9% and specificity 77.8%. For the presence of a deep lesion, the sensitivity was 94.1% and specificity 100%. CONCLUSION(S): The condition of the cul-de-sac could be imaged clearly via the MRI jelly method. Not only rectovaginal endometriosis presenting with deep lesions, but also complete cul-de-sac obliteration alone could be diagnosed preoperatively at a high rate.

Adult↗
PubMed2005

A case of simultaneous tubal-splenic pregnancy after assisted reproductive technology.

OBJECTIVE: To present a case of simultaneous splenic and tubal pregnancy following in vitro fertilization. DESIGN: Case report. SETTING: University hospital. PATIENT(S): A 37-year-old woman who had undergone in vitro fertilization and embryo transfer for unexplained infertility at another clinic. INTERVENTION(S): Laparoscopy and laparotomy. MAIN OUTCOME MEASURE(S): Serum concentration of human chorionic gonadotropin (hCG) after salpingosplenectomy. RESULT(S): After transfer of three embryos following fertilization by intracytoplasmic sperm injection (ICSI) at another clinic, the patient was referred to our hospital with suspicion of ectopic pregnancy. Because tubal pregnancy was suspected, laparoscopic right salpingectomy was performed. Although villi were detected in the resected fallopian tube, the serum hCG concentration did not decrease after the operation and a new intraabdominal hemorrhage was detected. We then suspected abdominal pregnancy in the epigastric region, and performed magnetic resonance imaging, computed tomography, and ultrasound examinations, which revealed implantation at the inferior pole of the spleen. Splenectomy was performed, with the resulting disappearance of intraabdominal hemorrhage and rapid fall of the serum concentration of hCG. CONCLUSION(S): Assisted reproduction sometimes results in heterotopic pregnancy, but an abdominal pregnancy involving the upper abdominal organs is considered extremely rare. Particularly, splenic pregnancy is usually overlooked and may only be discovered after a sudden intraabdominal hemorrhage. If hemorrhaging is present in the abdominal cavity but pregnancy is not detected within the pelvis, it is advisable to examine patients using imaging techniques to detect any upper abdominal pregnancies.

Adult↗
PubMed2005

Disposable laparoscopic surgical instruments and the economic effects of repackaging.

The purpose of this study was to evaluate the economic effects of repackaging disposable laparoscopic surgical instruments. We repacked a total of 28 disposable instruments for gynecologic laparoscopic surgery into one package. The time of preparation of surgical instruments, the amount of medical waste, and other economic effects were compared before and after the repackaging of disposable instruments. The time required for the preparation of surgical instruments was shortened by 22 minutes per operation, and medical waste decreased by 400 g, by repackaging the instruments, resulting in an estimated direct economic saving of $10,000 per year. Indirect economic effects might include savings due to a reduced inventory of surgical instruments and simplified cost-accounting for each operation. It is likely that preparation for surgery can be significantly improved and the cost reduced by repackaging the laparoscopic surgical instruments.

Disposable Equipment↗
PubMed2005

[Laparoscopic surgery for gynecologic malignancy].

The gynecologic laparoscopic surgery that has developed in the reproductive field is performed for most cases of benign disease. Introduction of laparoscopic surgery for a gynecologic malignancy is relatively late in comparison with other surgical regions and does not qualify for insurance. An operation for a gynecologic malignancy is classified roughly into a surgery of internal pelvic organs and lymph nodes. The techniques which extensive technology is pursued involve radical hysterectomy and paraaortic lymph node excision. In the surgeons who performed many laparoscopic surgeries, it seems that a surgical procedure other than these can be performed at present. The experienced laparoscopic techniques and the particular knowledge of pelvic anatomy were necessary to perform laparoscopic surgery for gynecologic malignancy.

Female↗
PubMed2005

Adhesion-prevention effects of fibrin sealants after laparoscopic myomectomy as determined by second-look laparoscopy: a prospective, randomized, controlled study.

OBJECTIVE: To examine the adhesion prevention effects of 2 types of fibrin sealant after laparoscopic myomectomy (LM). STUDY DESIGN: A prospective, randomized study (Canadian Task Force I) was conducted at a University-affiliated hospital. A total of 91 patients showing a minimal myoma > 5 cm, excluding pedunculated myomas, underwent LM alone: 32 patients in the control group, 29 in the fibrin gel group and 30 patients in the fibrin sheet group. After LM, postoperative adhesions were evaluated by second-look laparoscopy. The frequency of postoperative adhesions was the main outcome. RESULTS: The frequency of postoperative adhesions of the uterus was significantly lower (p < 0.05) in the fibrin gel group, with 20/32 (62.5%) in the control group, 10/29 (34.5%) in the fibrin gel group and 20/30 (67.7%) in the fibrin sheet group. Although no significant differences were found in the incidence of de novo adnexal adhesions, the lowest rate was found in the fibrin gel group, with 4/32 patients (12.5%) in the control group, 2/29 patients (6.8%) in the fibrin gel group and 5/30 patients (16.7%) in the fibrin sheet group. No bilateral adnexal adhesions were observed in the 3 groups. CONCLUSION: After LM for myomas as large as > or = 5 cm, postoperative adhesions were observed in > or = 50% of patients. The use of fibrin gel after LM is recommended.

Adult↗
PubMedDate not supplied

Pregnancy and delivery after laparoscopic myomectomy.

STUDY OBJECTIVE: To assess the factors influencing pregnancy outcome and evaluate vaginal birth after laparoscopic myomectomy (VBALM). DESIGN: Retrospective study (Canadian Task Force classification II-2). SETTING: University hospital. PATIENTS: One hundred eight patients who wanted a child after laparoscopic myomectomy (LM) and a follow-up of at least 6 months. INTERVENTION: Laparoscopic myomectomy. MEASUREMENTS AND MAIN RESULTS: Forty-seven pregnancies occurred in 40 patients. As for the factors considered to contribute to pregnancy after LM, COX regression analysis showed that pregnancy after LM correlated positively with the diameter of the largest myoma (OR 1.06, 95% CI 1.02-1.10, p = .004) and negatively with the age of the patient at the time of LM (OR 0.88, 95% CI 0.80-0.98, p = .02) and the number of enucleated myomas (OR l.17, 95% CI 1.01-1.37, p=0.04). Vaginal birth after LM was managed in accordance with the standard management of vaginal birth after cesarean section (VBAC) in our hospital. Delivery after LM was accomplished in 32 pregnancies. Vaginal birth after laparoscopic myomectomy was attempted in 23 pregnancies (71.9%) and vaginal birth successful in 19 (82.6%) of these 23 pregnancies. Vaginal birth after LM was unsuccessful in four patients, as labor did not occur during more than 2 weeks after the expected date of delivery in two patients, and cesarean section was performed to prevent fetal asphyxia during the course of delivery in two patients. In the 18 patients (19 pregnancies) with successful VBALM, the diameter of the largest myoma at LM was 68.7 +/- 18.4 mm, the number of enucleated myomas was 2.9 +/- 2.1, and the number of hysterotomies was 2.5 +/- 1.8. As for the depth of the largest myoma, this was intramural in 12 patients, submucosal in 2 patients and subserosal in 4 patients. None of the patients, regardless of whether they had a successful VBALM or not, suffered uterine rupture during or after delivery. CONCLUSION: Since nearly complete suturing is possible in LM as in laparotomy, vaginal delivery can be accomplished safely without uterine rupture even after LM, provided that delivery is managed as in VBAC.

Adult↗
PubMedDate not supplied

Laparoscopic adenomyomectomy and hysteroplasty: a novel method.

STUDY OBJECTIVE: To evaluate a novel method of laparoscopic adenomyomectomy. DESIGN: Prospective study (Canadian Task Force classification II-3). SETTING: University-affiliated hospital. PATIENTS: Fourteen women with adenomyosis. INTERVENTION: Laparoscopic adenomyomectomy and hysteroplasty. After local injection by diluted vasopressin solution, a transverse incision was made in the adenomyotic tissue down to the endometrium, and the adenomyotic tissue was surgically removed with a monopolar needle. The normal muscle layer on the serosal membrane side was left as an upper and lower serosal flap. The flaps were overlapped and sutured to counteract the lost muscle layer to reconstruct the uterus. MEASUREMENTS AND MAIN OUTCOME: The changes of symptoms were evaluated before and after the operation. The visual analog scale of dysmenorrhea was significantly decreased, and hypermenorrhea was improved after the surgery. Postoperative pregnancy was achieved in 2 patients, and vaginal delivery was performed in the first case. CONCLUSION: For specific cases, laparoscopic adenomyomectomy may be a suitable method to relieve symptoms with minimally invasive surgery while conserving the uteri.

Adult↗
PubMedDate not supplied

The effect of vasopressin on local and general circulation during laparoscopic surgery.

STUDY OBJECTIVE: To study local and general circulation after vasopressin administration during laparoscopic surgery. DESIGN: Prospective analysis (Canadian Task Force classification II-1). SETTING: University-affiliated hospital. PATIENTS: Nine patients who underwent laparoscopic myomectomy (LM) from March through December 2003. INTERVENTION: Transvaginal ultrasound and transesophageal ultrasound were performed to evaluate blood flow of the uterine artery and the descending aorta, respectively, during laparoscopic surgery. MEASUREMENTS AND MAIN RESULTS: Nine patients who had a low number (one to two) of uterine myomas in the anterior wall underwent LM with local administration of four units of 100-fold diluted vasopressin. We monitored blood flow of the ascending branch of the uterine artery and measured the resistance index (RI) value by transvaginal ultrasound. The decreasing reaction of diastole blood flow was fast, and the median time required until disappearance of signal was 4 minutes (range 1-8 minutes). We monitored blood flow of the descending aorta by transesophageal ultrasound and compared the results with eight control patients who did not receive vasopressin. Urine volume was measured during the surgery and postoperatively. No significant difference in descending aortic blood flow volume, and intraoperative and postoperative urine volume was found between the two groups. Systolic/diastolic blood pressure tended to increase immediately after vasopressin administration, but the increase was not significant. CONCLUSIONS: Local administration of vasopressin to the uterus is a safe and effective hemostatic technique for controlling regional blood flow from the uterine artery to peripheral vessels without having a significant effect on systemic circulatory dynamics.

Adult↗
PubMedDate not supplied

A new enucleation method for cervical myoma via laparoscopy.

Laparoscopic myomectomy was performed on five women suffering from hypermenorrhea. A new method was used which enucleated the cervical myoma from postcervical medial incision. The wound was sutured in 2 layers intracorporeally. Clipping of the uterine artery and injection of diluted vasopressin were performed to decrease bleeding during laparoscopy. This is a minimally invasive and safe procedure.

Adult↗