Biomedical subjects

Mary Tsuang

Publications and source records attributed to Mary Tsuang.

2 recordsLinked to original sources

PubMed2004

Laparoscopic repair of vesicovaginal fistula.

PURPOSE: To describe a methodology for laparoscopic repair of vesicovaginal fistula (VVF), and to provide a comparison of results between a series of laparoscopic repairs, a series of transabdominal open repairs (TAORs), a series of transvaginal repairs (TVRs), and cases successfully managed without surgery. PATIENTS AND METHODS: A total of 16 patients were diagnosed with post-hysterectomy VVF. All patients were first managed conservatively with continuous drainage via a Foley catheter until dry. In 2 of the 16 cases (12.5%) the fistulae healed spontaneously with conservative management. After 4-12 weeks, the remaining 14 patients underwent surgical repair of their fistulas; 2 (14%) by laparoscopy, 6 (43%) by TAOR, and 6 (43%) by TVR. RESULTS: Fistula repair was successful in both laparoscopy cases, all 6 TAOR cases, and 5 of 6 TVR cases (86%). The failed transvaginal repair was repeated, with a successful outcome. Length of hospital stay was 7-10 days (mean, 8.3 days) for the open cases, 3-5 days (mean, 4.1 days) for the transvaginal cases, and 2-12 days for the laparoscopic cases. One patient who underwent laparoscopic repair had a 12-day hospital stay due to extended vaginal drainage lasting 3 weeks, which then resolved. Three of the 6 patients who underwent TAOR (50%) experienced postoperative complications, including 2 cases of ileus and 1 case of fever. One of 6 patients who underwent TVR (16%) experienced recurrent urinary tract infection. CONCLUSIONS: These data suggest that laparoscopic VVF repair is feasible and may result in lower morbidity, shorter hospital stay, and quicker recovery than the abdominal or transvaginal approaches. Additional controlled studies are warranted. The minimally invasive approach of laparoscopy may be a more attractive option for patients who experience VVF following hysterectomy.

Feasibility Studies↗

PubMed2004

Total laparoscopic hysterectomy using multifunction grasping, coagulating, and cutting forceps.

We describe the use of multifunction grasping, coagulating, and cutting forceps in total laparoscopic hysterectomy (LH) and compare surgery time, estimated blood loss, and costs for a series of 123 LH performed by the principal author at one of two community hospitals in Seattle between January 2001 and July 2002. The first 73 were performed using bipolar Kleppinger forceps (Richard Wolf Instruments, Vernon Hills, Illinois), endoscopic scissors (Karl Storz Endovision, Charlton, Massachusetts), and a monopolar spatula electrode (Jarit Surgical Instruments, Hawthorne, New York); the last 50 cases were performed using the PlasmaKinetic (PK) (Gyrus Medical, Maple Grove, Minnesota) multifunction cutting forceps and the monopolar spatula electrode. We were able to compare patient data in two surgery categories: LH alone (43 patients, 26 using the Kleppinger forceps and endoscopic scissors, 17 using the PK system), and laparoscopic hysterectomy with bilateral salpingo-oopherectomy (30 patients, 20 using Kleppinger forceps and endoscopic scissors, 10 using the PK system). In the remaining 50 cases, the addition of other secondary procedures precluded effective statistical comparisons. We found significantly lower estimated blood loss in both surgery categories when using the PK cutting forceps, but no differences in mean surgery time. Costs for disposable instrumentation parts and handling were approximately 70 dollars greater per procedure with the PK system. Using the PK cutting forceps eliminated some instrument exchanges and the requirement for a third instrument cannula. We also noted significantly less plume, quicker coagulation, and less tissue char when coagulating with the PK forceps compared to the Kleppinger forceps.

Adult↗