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Biomedical subjects

P J Maher

Publications and source records attributed to P J Maher.

At least 19 recordsLinked to original sources
PubMed2001

Use of the CEEA stapler to avoid ultra-low segmental resection of a full-thickness rectal endometriotic nodule.

A woman with a history of numerous surgical episodes for treatment of aggressive endometriosis experienced rectal symptoms. She was prepared for the possibility of laparotomy with or without colostomy to relieve her symptoms. After extensive laparoscopic dissection of the rectovaginal septum, a circular stapling device (Premium Plus CEEA; Autosuture, Melbourne, Victoria, Australia) was used to excise completely an anterior rectal lesion that otherwise would have resulted in ultra-low rectal resection and anastomosis. Morbidity associated with the latter procedure was avoided; the patient was discharged within 72 hours and experienced no early or late complications. Postoperative barium enema was obviated by rapid return to normal bowel habits and complete resolution of dyschezia and dyspareunia.

Adult↗
PubMed1997

Laparoscopic hysterectomy.

The terminology of laparoscopically-assisted hysterectomies needs to be simplified and clarified. Laparoscopic hysterectomy should be used as a general term, whereas operative laparoscopy before hysterectomy, laparovaginal, laparoscopic total and subtotal hysterectomy should be used to describe the types of laparoscopic hysterectomy. The complication rates from laparoscopic hysterectomy, abdominal hysterectomy and vaginal hysterectomy are similar. The lower febrile morbidity after laparoscopic hysterectomy may be due to improved pelvic visualization compared to vaginal and abdominal hysterectomy. Controlled trials show that laparoscopic hysterectomy has advantages over abdominal hysterectomy which include reduced pain, reduced hospitalization time and earlier return to work. Most abdominal hysterectomies can be replaced by laparoscopic or vaginal hysterectomies. Whether this happens will depend upon adequate training facilities.

Controlled Clinical Trials as Topic↗
PubMed1997

Lost surgical specimens.

It is an unfortunate fact that surgical specimens can become lost in the peritoneal cavity. Several reparative actions may be required, including laparotomy. The preferred method to avoid this complication, however, is to prevent it from occurring.

Adult↗
PubMed1996

Direct cannula entry for laparoscopy.

The common blind puncture technique for inserting a cannula to establish pneumoperitoneum was first described by Veress in 1938 and carries several significant and specific complications such as gas embolism, subcutaneous inflation, failed pneumoperitoneum, and bowel or visceral insufflation. Direct cannula insertion is both safe and effective. No major complications using this technique occurred in a series of 550 consecutive laparoscopies. It would seem that the patient who is served safely by a Veress needle approach is equally served by direct cannula entry.

Catheterization↗
PubMed1995

Endoscopic minilaparotomy.

In a preliminary study the principles of standard gynaecological surgery, new operative laparoscopic techniques and mechanical elevation of the abdominal wall are combined. These early results indicate an advantage to both patient and hospitals from this approach. Further studies are required to verify our impressions that minilaparotomy combined with no insufflation laparoendoscopy will open up the concept of operative laparoscopic surgery to most gynaecologists.

Adult↗
PubMed1994

Instruments and equipment used in operative laparoscopy.

Successful operative laparoscopy is dependent on the proper use and knowledge of a variety of appropriate surgical equipment. This chapter describes cameras, light sources, videos, video positioning, operating tables, anaesthesia, insufflators, laparoscopes, trocars, irrigators, forceps, scissors, electrosurgical instruments, lasers, suturing, staples and uterine manipulators. Knowledge of the best choice and proper use of instruments has a more important role in performing operative laparoscopy than laparotomy.

Electrosurgery↗
PubMed1994

Laparoscopic hysterectomy.

Laparoscopic hysterectomy is a substitute for abdominal hysterectomy and not for vaginal hysterectomy. Most hysterectomies currently performed with an abdominal approach may be performed with laparoscopic dissection of part or all of the abdominal portion followed by vaginal removal, including fibroids of 1000 g. There are many surgical advantages, particularly magnification of anatomy and pathology, easy access to the vagina and rectum, and the ability to achieve complete haemostasis and clot evacuation during underwater examination. Patient advantages are multiple and are related to avoidance of a pain producing abdominal incision. They include a reduced period of hospitalization and recuperation and an extremely low rate of cuff infection and ileus. It must be emphasized that conversion to laparotomy when the surgeon becomes uncomfortable with the laparoscopic approach should never be considered a complication; it is rather a prudent surgical decision that will profoundly decrease patient risk. The laparoscope can be used in combination with hysterectomy in a variety of ways with significant surgical and patient advantages. With few exceptions, laparoscopic hysterectomy can replace abdominal hysterectomy. Surgical outcome is the same. In experienced hands, the complication rate is low. Patient benefits are related to avoidance of an abdominal incision and include improved cosmetics and more rapid recovery.

Endometriosis↗
PubMed1994

Complications of laparoscopic hysterectomy.

Although laparoscopic hysterectomy is now being performed worldwide, few reported data are available on the associated morbidity and mortality. Between December 1990 and September 1993, 220 women underwent laparoscopic hysterectomy at the Melbourne Gynoscopy Centre. Complications occurred in 35 (15.9%). Among these were anterior abdominal wall vessel injury in 5 patients, bladder injury in 5, febrile illness in 13, secondary hemorrhage in 4, temporary ureteral obstruction in 4, and Richter hernia in 1.

Abdominal Muscles↗
PubMed1994

Gasless laparoscopy--useless or useful?

Carbon dioxide (CO2) pneumoperitoneum for advanced operative laparoscopy has well-documented inherent pathophysiologic risks. Problems are associated with creating and maintaining the pneumoperitoneum, lowering body temperature, infective particles in the insufflation gas, and ensuring hemostasis of port entry sites after intraabdominal pressure is reduced. When the vagina is opened to remove surgical specimens or at the time of hysterectomy, loss of vision occurs. In some patients general anesthesia and CO2 pneumoperitoneum are contraindicated, and in them such problems could be avoided by gasless laparoscopy. Three types of mechanical anterior abdominal wall elevators have been used at the Melbourne Gynoscopy Centre for a variety of laparoscopic procedures, all of which have their advantages and disadvantages.

Carbon Dioxide↗
PubMed1992

Laparoscopically assisted hysterectomy.

OBJECTIVE: To determine the feasibility and effectiveness of laparoscopically assisted hysterectomy. DESIGN: A prospective study of the planned surgical procedure was carried out by two teams, each with two gynaecologists, who were experienced in operative laparoscopy. SETTING: The operations were carried out in a private hospital, where advanced operative laparoscopy equipment was available. PATIENTS: Seventeen patients were selected for the procedure, all of whom required hysterectomy for symptoms of pain or menorrhagia in association with uterine or other pelvic disease. Patients with carcinoma or uterine enlargement beyond 12 cm were excluded. PROCEDURE: Laparoscopically assisted hysterectomy was carried out by means of a video monitor, uterine manipulation by vaginal instrumentation, three or four abdominal punctures of less than 1 cm, and bipolar diathermy to secure vascular pedicles. The uterus was removed from the vagina by cutting vaginal skin and the cardinal ligaments. RESULTS: The operating time was 90-220 min, the blood loss was 30-200 mL, and the hospital stay lasted two to five days and convalescence two to four weeks. No serious complications occurred. CONCLUSIONS: Laparoscopically assisted hysterectomy may be valuable when adnexal or uterine abnormalities are present and vaginal hysterectomy is either contraindicated or more difficult. The procedure requires special equipment and may only be carried out by experienced gynaecological operative laparoscopists. Its acceptance will depend upon reducing the operating time to less than 90 min. It has the advantage of reducing the duration of hospital stay and the duration of convalescence when compared with abdominal hysterectomy.

Adult↗
PubMed1990

Treatment of vaginal agenesis with a new vulvovaginoplasty.

The correction of vaginal agenesis requires the creation of a canal that is in the correct axis and ideally of adequate size, texture, and secretion. A simple surgical technique is described which has a good anatomic and functional result with minimal morbidity. It combines the traditional dissection of the rectovesical space described by McIndoe with a significantly modified vulvovaginoplasty based on the Williams method. The technique has been performed with good results and no complications in three patients. Closely monitored vaginal dilatation is essential in the postoperative period. At this stage, only one patient has engaged in intercourse.

Adolescent↗