Biomedical subjects

Pedram Ilbeigi

Publications and source records attributed to Pedram Ilbeigi.

7 recordsLinked to original sources

PubMed2006

Nonobstetric lacerations of the vagina.

Although obstetrically related trauma remains the most common cause of injury to the female genital tract, trauma of nonobstetric origin is not uncommon. Reports of traumatic injuries to the vagina, especially lacerations, have been infrequent in the literature and offer only a generalized approach to this problem. Severe vaginal lacerations may result in life-threatening blood loss. The authors report their recent experience with treating patients who have this type of trauma, review mechanisms of injury, and provide an organized treatment protocol for the nonobstetric patient with suspected vaginal laceration. Preparation for these emergencies circumvents dangerous delays and inadequate examination and treatment.

Adult↗

PubMed2005

Unusual cause of obstructive uropathy.

We report a case involving a 55-year-old healthy man that presented with urinary retention and a lower abdominal mass. His evaluation revealed a large mucocele arising from the appendix that caused severe bilateral ureteral obstruction and renal failure. Appendiceal mucoceles are rare and insidious entities that can present with urologic manifestation. Despite their rarity, this case highlights the importance of including mucoceles in the differential diagnosis in cases involving ureteral obstruction caused by external compression.

Appendiceal Neoplasms↗

PubMed2005

Retroperitoneal laparoscopic adrenalectomy.

Laparoscopic adrenalectomy is considered to be the standard of care for the surgical excision of the adrenal gland. Since the initial report of laparoscopic adrenalectomy in 1992, it has evolved into a feasible and reproducible minimally invasive procedure for benign adrenal tumors. Transperitoneal and retroperitoneal approaches are the two principal laparoscopic routes to the adrenal gland. Both have proven to be safe and effective when compared with open adrenalectomy, offering the benefits of decreased blood loss, less postoperative pain, shorter hospital stay, rapid convalescence, and improved cosmetic effect. Although the transperitoneal approach is used more widely, the retroperitoneal approach offers distinct advantages that make it a valuable alternative route to the adrenal gland. This article describes retroperitoneal laparoscopic adrenalectomy including indications, operative technique, and a review of the literature.

Adrenal Gland Neoplasms↗

PubMed2005

Open partial nephrectomy using saline-enhanced monopolar radiofrequency device: evaluation of novel surgical technique with TissueLink DS3.0 Dissecting Sealer.

INTRODUCTION: Nephron-sparing surgery has emerged as the preferred surgical management of select renal masses. Advancements in surgical and hemostatic techniques, together with long-term data on cancer-free survival, have led to greater use of these procedures. The TissueLink Dissecting Sealer is a new device that couples radiofrequency energy with low-volume saline irrigation to give improved hemostasis during dissection. We assessed this device as an alternative dissecting tool during open partial nephrectomy. TECHNICAL CONSIDERATIONS: A total of 32 consecutive patients underwent open partial nephrectomy during a 20-month period. These masses were resected using the TissueLink Dissecting Sealer or the surgeon's conventional method of dissection (needlepoint electrocautery). Perioperative parameters, including operative time, tumor size, blood loss, and hilar vessel occlusion times, were retrospectively reviewed and compared. The average age in the TissueLink group (n = 16) was 60 years (range 46 to 87) compared with 61 years (range 45 to 89) in the conventional group (n = 16). The average tumor size in the TissueLink group was 3.1 +/- 1.4 cm (range 1.2 to 7.0) compared with 2.5 +/- 1.3 cm (range 0.8 to 6.0) in the conventional group. The hilar vessels were clamped in select patients (with similar occlusion times) from both groups because of deep tumor penetration or a central location. The average blood loss was 126 +/- 40 mL (range 50 to 200) for the TissueLink group versus 194 +/- 105 mL (range 50 to 400) in the conventional group, a statistically significant difference (P = 0.027). No perioperative complications occurred. CONCLUSIONS: TissueLink-assisted open partial nephrectomy is a novel technique that couples radiofrequency energy with low-volume saline irrigation to provide excellent hemostasis during and after renal tumor dissection.

Aged↗

PubMed2005

Use of fourth arm in da Vinci robot-assisted extraperitoneal laparoscopic prostatectomy: novel technique.

INTRODUCTION: The da Vinci robot-assisted laparoscopic radical prostatectomy is a relatively new approach that is revolutionizing the surgical treatment of localized prostate cancer. Since its introduction, several improvements have been made in the robot design model, as well as in the surgical technique for prostatectomy. One of the more recent advances in this technology has been the introduction of a four-arm robot model. This modified system allows the operating surgeon to use the fourth arm for key steps and maneuvers during the operation, thereby decreasing the reliance on advanced assistant laparoscopic skills. In this report, we describe our modifications for the extraperitoneal approach for laparoscopic removal of the prostate using the four-arm da Vinci surgical system. TECHNICAL CONSIDERATIONS: During a 24-month period, 154 consecutive patients with clinically localized prostate cancer underwent extraperitoneal robot-assisted laparoscopic radical prostatectomy using the four-arm da Vinci robot system. All cases were videotaped and subsequently reviewed. Important factors regarding extraperitoneal access, patient positioning, port placement, and assistant role with or without the fourth arm were defined. CONCLUSIONS: Our experience has revealed that the extraperitoneal approach allows for a more natural patient position during the operation and avoids intraperitoneal organ injury. The addition of the fourth arm to the da Vinci robot provides the operating surgeon with a great deal of independence, which facilitates all aspects of robot-assisted laparoscopic prostatectomy. It allows the operating surgeon to retract tissue during critical steps in this challenging operation and reduces the reliance on highly trained laparoscopic assistants.

Equipment Design↗

PubMed2005

High incidence of vaginal mesh extrusion using the intravaginal slingplasty sling.

PURPOSE: The intravaginal slingplasty (IVS) is a tension-free vaginal tape variant that uses a multi-filament polypropylene tape to support the mid urethra for the treatment of female stress urinary incontinence. Numerous cases of defective vaginal wound healing have been described in the international urogynecological literature. We describe our experience of vaginal mesh extrusion using the IVS sling. MATERIALS AND METHODS: A total of 35 patients underwent suburethral sling procedures for anatomical stress urinary incontinence using the IVS system from November 2002 to September 2003. A retrospective chart review was performed to retrieve data on safety and efficacy, complications and outcomes using this product. RESULTS: Six patients (17%) to date have presented with defective vaginal healing manifested by extrusion of the sling material. Mean time to presenting symptoms was 9 months (range 2 to 15). All patients required surgical removal of the sling material. No urethral erosions were noted. CONCLUSIONS: Our experience suggests that the IVS sling system, which uses a multi-filament polypropylene suburethral mesh, incurs an unacceptably high rate of defective vaginal wound healing and mesh extrusion.

Aged↗

PubMed2005

Retained rear-tip extenders in redo penile prosthesis surgery: a case for heightened suspicion and thorough physical examination.

INTRODUCTION: Penile Prosthesis infection is a dreaded complication that can occur after primary inflatable penile implants. Redo prosthesis operations and salvage procedures have become increasingly popular after these inflections. These operations, however, have higher rates of re-infection as compared to primary implants. AIM: We describe a patient who was referred for repeat redo penile prosthesis surgery in whom retained rear-tip extenders harboring purulent fluid was discovered during physical examination. RESULTS: The patient underwent exploration and two rear-tip extenders were removed. He later underwent redo prosthesis insertion and the device remains fully functional and infection free at follow-up. CONCLUSION: This case conveys the importance of a thorough physical examination and raises the index of suspicion for retained prosthesis fragments in patients with recurrent penile prosthesis infections.

Aged↗