Biomedical subjects

Ron Rowbotham

Publications and source records attributed to Ron Rowbotham.

6 recordsLinked to original sources

PubMed2004

Laparoscopic ureteroureteral anastomosis for repair of ureteral injury involving stricture.

We describe an approach to laparoscopic ureteroureteral anastomosis for surgical management of ureteral stricture, and review four cases in which this method was used. In these four cases, we observed no intraoperative complications. Patients' length of hospital stay was 1-2 days. Follow-up ranged from 12 to 14 months. All four patients have been asymptomatic, and their follow-up intravenous pyelograms (IVPs) have been normal. This surgical approach warrants further study with larger series and long-term follow-up.

Anastomosis, Surgical↗

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↗

PubMed2002

Laparoscopic uterine suspension by round ligament plication.

OBJECTIVE: To describe a method for laparoscopic uterine suspension by round ligament plication using standard suturing instruments. STUDY DESIGN: Forty-six women underwent uterine suspension for treatment of chronic pelvic pain due to uterine retroversion over a period of five years. All operations were performed by the principal author. RESULTS: Forty-six patients treated with this technique were selected from 388 who underwent clinical evaluation and diagnostic laparoscopy for chronic pelvic pain, defined as lasting more than six months. There were no intraoperative complications in this series. Mean follow-up was 23.6 months (range, 6-42). At each follow-up, patients were asked to rate their pain relative to preoperatively as unchanged, minor, moderate, significant or resolved. At six months, 44 of 46 patients (96%) reported at least some improvement, with 17 (37%) reporting significant improvement, and 18 (39%) reporting resolution of pain. Sixteen of 27 patients (59%) at 24 months' follow-up and 15 of 23 patients (65%) with 36 months' follow-up reported significant improvement in or resolution of their pain. CONCLUSION: For patients experiencing chronic pelvic pain associated with uterine retroversion, round ligament plication is an effective method of repositioning the uterus and reducing or eliminating the patient's symptoms.

Adult↗

PubMed2002

Laparoscopic myomectomy technique. Use of colpotomy and the harmonic scalpel.

OBJECTIVE: To describe the use of colpotomy and the harmonic scalpel in laparoscopic myomectomy and to compare estimated blood loss when using unipolar cautery versus the harmonic scalpel and surgical time for colpotomy versus morcellation. STUDY DESIGN: A retrospective, cohort study was performed on 168 patients who were diagnosed with and treated for uterine leiomyomata between January 1992 and January 2000. Patients presented with infertility, menometrorrhagia, dysmenorrhea, masses on ultrasound or a combination of these symptoms. Two patients required hysterectomy, and 1 required conversion to laparotomy due to bleeding, leaving 165 patients who underwent laparoscopic myomectomy, 143(87%) by colpotomy and 22 (13%) by morcellation. Unipolar cautery was used for uterine incision in 112 of the 165 myomectomies (68%) and the harmonic scalpel in 53 (32%). Surgery was performed at one of two community hospitals in the Seattle area or a general hospital in Taiwan. RESULTS: Mean estimated blood loss using the harmonic scalpel (243 mL, range 150-350) was significantly less (P < .01) than that using unipolar cautery (378 mL, range 203-800) for uterine incision. Mean surgical time for colpotomy (144 minutes, range 110-260) was less (P < .05) than that for morcellation (168 minutes, range 140-244) despite having removed a larger median number of myomata per patient of comparable or larger size (seven by colpotomy versus four by morcellation). CONCLUSION: These data suggest that the harmonic scalpel is effective for uterine incision during myomectomy and may result in less bleeding than unipolar cautery while offering some advantages in safety. Multiple leiomyomata can generally be extracted more quickly via posterior colpotomy than by morcellation. This difference is smaller and therefore less important in patients with only a few small to medium-sized (< 10 cm) fibroids. For these patients, the minimal invasiveness of morcellation may offer a more significant benefit.

Adolescent↗

PubMedDate not supplied

Use of a critical pathway for colon resections.

Tremendous variation in patient care exists, both among medical centers and among individual surgeons, in the field of colon and rectal surgery. Clinical or critical pathways based on "best demonstrated practices" from the medical literature have led to improved outcomes for many disease entities. The objective of this study was to develop a pathway for elective colon and rectal resections, and then determine whether this led to any improvement in measurable outcomes. A critical pathway was developed for the care of patients undergoing elective colon and rectal surgery, by reviewing best demonstrated practices in the literature and then developing standardized order sheets, nursing flow sheets, and patient educational material. A patient satisfaction survey was also included in the evaluation process. After being informed of the positive results from the pilot study, surgeons were encouraged to use the critical pathway order sheets, patient information sheets, and flow sheets for their patients undergoing elective abdominal colon or rectal surgery. Between January 1995 and October 1998, the critical pathway was used for 263 patients, whereas for 122 patients this pathway was not used. For those patients in the critical pathway group, the hospital length of stay was shorter (5.5 vs. 8.2 days, including the day of surgery, P = 0.001), the time until a regular diet was tolerated was shorter (3.5 vs. 4.4 days, P = 0.001), the percentage of patients discharged home was greater (90% vs. 82%, P = 0.038), and the average hospital charges were less (12,672 dollars vs. 16,665 dollars, P = 0.001). These advantages did seem to be correlated with efforts at postoperative ambulation, but were independent of the type of postoperative pain control (patient-controlled analgesia vs. epidural analgesia). Patient satisfaction in the subset surveyed was slightly better for those in the critical pathway group than in those for whom the critical pathway was not used. Elective colon and rectal surgery appears to lend itself to uniformity of postoperative order sheets and clinical expectations. Shortened lengths of hospital stay, earlier resumption of a regular diet, and diminished hospital charges were found with the use of this critical pathway, with no diminution of patients' perceptions of satisfaction with the hospital experience.

Adult↗