-Complications. Surgical endoscopy versus gynecologic minimal invasive surgery-.
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Female↗
Biomedical subjects
S Rimbach
Publications and source records attributed to S Rimbach.
[Tissue glue in endoscopic surgery].
Tissue-glue stands out by virtue of its ability to ensure non-traumatic tissue apposition and hemostasis, leading to a reduction in operative time. This explains the use of this technique in a wide range of indications in gynecological endoscopy. These include ovarian reconstruction after the extraction of cysts, tubal anastomoses and even closure of iatrogenic perforations of the uterus. In these indications, the application of tissue-glue can be considered as the method of choice because of its excellent long term results. In contrast, its effect in the sealing of peritoneal or serosal defects with the aim of avoiding adhesions has not yet been clearly demonstrated. Analysis of a sufficient number of cases with long follow-up is essential before any final assessment can be made. Among 75 instances of endoscopic use of tissue-glue up to now, we have never encountered any post-operative complications, nor during subsequent follow-up. In addition to its ability to stimulate tissue healing, tissue-glue offers a simple and non-traumatic alternative to the lengthy technique of endoscopic sutures, with a hemostatic action in parallel.
Dissection↗
The HysteroTrainer, a simulator for diagnostic and operative hysteroscopy.
Hysteroscopy has become an integral part of operative gynecology, with rates of major complications of 1%. To avoid serious, even lethal, complications, an intensive, well-structured training program for practicing surgeons is necessary. In response to these educational requirements. The HysteroTrainer was developed to provide in vitro simulation training for diagnostic and operative hysteroscopy, including laser and high-frequency electrosurgery.
Cervix Uteri↗
Operative Hysteroscopy: Results, Security Aspects, In Vitro Simulation Training (Hysterotrainer)
To date, hysteroscopy has become an integral part of the overall gynecologic surgical concept. In 156 women results of intrauterine hysteroscopic surgery are demonstrated to be at least comparable to those of conventional procedures. Moreover, a meta analysis of the literature (n = 10,000) as well as our own experience (n = 200) supports the view that complication rates may be minimized by a well-structured training program which includes the recently developed in vitro simulation trainer, the HysteroTrainer.
Journal Article↗
[Hysteroscopic endometrium ablation to avoid hysterectomy in "high risk" patients].
Hysteroscopic endometrial ablation under maximal anaesthesiological surveillance was performed in 34 high-risk patients to avoid hysterectomy. It was a collective of patients with heavy thrombo-embolic or thrombotic disease, either under permanent anticoagulation due to residual disease or multiple endoprosthetic treatment, or with endogenous coagulopathy. In all these women, hysterectomy was either a relative or an absolute contraindication. In 22 patients, treatment resulted in complete amenorrhoea or at least hypomenorrhoea (without menometrorrhagia) respectively cyclic spotting. In 6 further patients, amenorrhoea was achieved after a repeat procedure. Endometrial ablation was thus successful in 28 of 34 cases. In these patients, hysterectomy with the risk of major or even lethal complications, could thus be avoided. Hysterectomy, however, had to be performed in 2 women with extensive adenomyosis uteri interna. Within two respectively three years after endometrial ablation, two other patients died from causes unrelated to the surgical intervention (cardiac infarction, cerebral haemorrhage). Follow-up ranged from 1 to 5 years. Hysteroscopic endometrial ablation proved an effective therapeutic option in this selected group of patients. Other indications require further study.
Adult↗
[Incontinence operation by "Retzius-scopy"? An endoscopic modification of the Marshall-Marchetti-Krantz operation].
The operative treatment of stress incontinence with the Marshall-Marchetti-Krantz procedure has proved effective. A new, endoscopic modification of this procedure is presented here, based on the principle of vesico-urethral suspension with fibrin glueing. Open abdominal surgery is replaced by retziusscopy and a minimal invasive endoscopic intervention in the Retzius' cavity.
Female↗
[Surgical hysteroscopy: complications, safety aspects, education and training].
Hysteroscopy has become an integral part of the overall gynaecological surgical concept. On the one hand the experience of our study group as well as a literature survey have demonstrated that results of hysteroscopic metroplasty, resection of submucous myoma and synechiolysis are at least comparable to those of conventional procedures, the advantages of minimal invasive surgery being evident. However, increasing complications, even with a lethal outcome, due to deficient technical equipment or insufficient training of the surgeon are reported. Yet, a survey of complications in literature and in our own series of hysteroscopies (n = 200), shows a median complication rate below 1%. Knowledge of possible complications, symptoms and management alternatives is, however, a first requirement for application of these minimal access procedures. The second major precondition being a well structured training program for surgeon and assisting team. With the recently developed in-vitro-simulation trainer, the HysteroTrainer, training of the entire spectrum of hysteroscopic procedures, including laser and high frequency electrosurgical applications, is now feasible. The simulator may also be employed for security checking of the complex hysteroscopic equipment.
Equipment Safety↗
[New aspects in therapy of proximal tubal occlusion: hysteroscopic proximal tubal catheterization].
To date, the therapy of first choice in case of proximal tubal pathology is resection of the occluded segment and microsurgical reconstruction. Essential disadvantage of this rather successful method consists in the need of a laparotomy. According to the concept of minimal invasiveness a pilot study has been undertaken to evaluate hysteroscopic proximal tube catheterization (HPTC) and balloon dilatation for recanalization. This attempt has proven intraoperatively successful in more than 80% of the cases and the first pregnancy and birth following HPTC can yet be reported.
Adult↗
[The bipolar needle electrode in surgical laparoscopy. Initial technical experimental and clinical results].
To date the tremendous spread of operative laparoscopic procedures associated with monopolar high-frequency techniques has lead to an increase in complications caused by monopolar leakage currents. Experimental-surgical measurements on minipigs have shown no significant leakage currents in clinical relevant power range during laparoscopic application of a bipolar needle electrode as compared to monopolar electrodes. Practicability and safety of the bipolar electrode was proven in 100 operative laparoscopies for organ preserving or reconstructive surgery. In summary, with the new laparoscopic bipolar needle electrode a secure surgical instrument is available, with which finest tissue handling and minimal thermal damage feasible.
Electrodes↗
[Thermal preparation techniques in gynecologic endoscopy--technical, experimental and clinical results (n=2000)].
A comparative study on thermal, mainly laser and high frequency electrosurgical techniques, was conducted. Indications, handling and morphometric results were correlated. Morphometrical findings suggest that minimal thermal tissue damage is associated by a decrease in the hemostatic effect. Additional bipolar coagulation is necessary when using the carbon dioxide laser or high frequency electrodes. As thermal tissue lesion is concerned, the two techniques differ only slightly, by fractions of millimeters. Concerning clinical handling and practicability at our department, as well as in the centers participating at the European Consensus Study on Lasers in Gynaecology, high frequency electrosurgery has proven the method of choice for endoscopic ablative procedures. The carbon dioxide laser (at laparoscopy) and the Nd:YAG contact laser (at hysteroscopy) are preferentially employed for reconstructive surgery (e.g. the carbon dioxide laser for treatment of distal tubal pathology or endometriosis, the Nd:YAG contact laser for hysteroscopic synechiolysis).
Animals↗
[Chlamydia trachomatis: screening within the scope of prenatal care and rapid diagnosis in threatened premature labor].
Cervical infection with Chlamydia trachomatis during pregnancy is related to the incidence of preterm labour and preterm rupture of membranes, causing elevated neonatal morbidity and mortality. The present study reports our two-years-experiences with a general screening on Chlamydia infection in prenatal care as well as diagnostic possibilities in case of imminent preterm delivery. In the examined population of totally n = 263 pregnant women attended in our prenatal care unit, the prevalence of cervical Chlamydia infection was 3.4%. Among the screened asymptomatic women (n1 = 179) 2.8% had positive findings. Among n2 = 84 patients with preterm labour and/or preterm rupture of membranes 4.8% revealed cervical infection. Specially in the acute situation of imminent preterm delivery, an immunological bedside assay (Clearview Chlamydia, R) tested in 203 cases versus the tissue culture as reference method proved helpful. Its sensitivity was 0.8, specificity 0.99. The test allowed to prove or exclude chlamydial infection within only 30 minutes.
Adult↗
[Microsurgical heterotopic ovary transplantation. A preclinical study].
Free heterotopic autologous ovary transplantation might be a method to prevent iatrogenic radiocastration in case of Hodgkin's disease. Though first promising clinical case reports have been published, almost no experimental basic data are available. It was the aim of this study to develop a transplantation model in order to evaluate and improve operative technique and perioperative management preclinically. Whereas results in pilot transplantations on minipigs were impaired by the disposition to wound infections on the implantation site, transplantation on Beagle dogs proved to be a suitable model. Eleven transplantations have been performed (five in minipigs, six in Beagle dogs). The success rate of intact preserved transplants was 45% with an observation time of three months for the minipigs and 9 +/- 3.7 months for the dogs.
Anastomosis, Surgical↗
[Palliative laser therapy in gynecologic oncology].
Local recurrences of carcinomas of the breast and genitals are a severe psychic and physical strain on the patients. Continuous confrontation with an often visible and generally painful tumour manifestation is an indication for palliative treatment, if other oncological therapies can no longer be employed. In these cases, the possibility of laser use represents a new therapeutic approach. In a pilot study at the University of Heidelberg, Department of Obstetrics and Gynaecology, a palliative laser therapy was performed on 45 patients with locally recurrent carcinomas of the breast (n = 29) and genitals (n = 16). Carbon dioxide and Nd:YAG lasers were utilized for tumour resection, vaporisation and coagulation. This new concept, the combined application of both wavelengths has been proved to be most efficient.
Adult↗
Laser palliation of locoregional recurrences of breast cancer.
The paper reports on the use of carbon dioxide and Nd:YAG lasers for palliation of locoregional breast cancer recurrences. On the basis of three case reports, pros and cons of laser assisted treatment of loco-regionally recurrent breast cancer are discussed. A carbon dioxide--Nd:YAG combination therapy is proposed as the method best suited. The preliminary results indicate that laser palliation of local relapse and soft tissue metastases might enlarge the therapeutic spectrum.
Aged↗
Laser surgery in gynecological oncology. Part I: Experimental results. Relapse and metastatic behaviour of the Lewis lung carcinoma subsequent to CO2 laser surgery of the primary tumor. An experimental model to compare the effectiveness of various CO2 laser application techniques.
The influence of various CO2 laser surgical techniques on tumor behaviour was examined in an experimental model on C56BL/6 mice (n = 106) with Lewis Lung carcinomas and compared with that of scalpel excised tumors. Comparisons were made between the healing procedure, the local recurrence rate, metastatic behaviour and the survival rate (n = 86) of mice after laser surgical excision of tumors, using the superpulsed and continuous wave techniques, with and without additional vaporisation of the wound, as well as after general vaporisation only.
Animals↗
Identification and quantitation of cocaine and its metabolites, benzoylecgonine and ecgonine methyl ester, in hair of Bolivian coca chewers by gas chromatography/mass spectrometry.
Twenty hair samples obtained from Bolivian mine workers who chewed 3-8 g of coca leaves daily for several years were analyzed for cocaine and its main metabolites, benzoylecgonine (BZE) and ecgonine methyl ester (EME). A new method was developed for the detection and quantitation of cocaine and its metabolites, BZE and EME, from hair in a single procedure. The hair samples were washed, cut into 56 segments (2-cm length), pulverized, and incubated with phosphate buffer and the enzyme beta-glucuronidase-arylsulfatase. After solid phase extraction and derivatization with pentafluoropropionic anhydride/pentafluoropropanol, the drugs were identified and measured by gas chromatography/mass spectrometry (GC/MS) using deuterated cocaine, BZE, and EME as internal standards. The method is reproducible (cocaine, CV = 8%; BZE, CV = 14%) and the detection limit for cocaine and BZE was 0.1 ng/mg, for EME 1 ng/mg. In the different hair segments, cocaine was found to be present in concentrations between 1.4 to 50.6 ng/mg, benzoylecgonine from 0.4 to 17.6 ng/mg, and ecgonine methyl ester traces below the calibration curve of approximately 12.9 ng/mg. In 95% of the cases cocaine exceeded BZE and EME in concentration.
Adolescent↗
[Laser in gynecology. Palliative laser treatment in genital and breast cancers].
Local, so-called incurable, recurrences of breast or genital cancers were as therapeutic challenge in the past. The authors undertook a pilot trial of laser treatment in 45 patients, as a palliative measure, in view of the serious psychological and physical problems experienced by these women constantly confronted by the presence of painful, visible and often ulcerated tumor lesions. CO2 and Nd:YAG lasers were used for tumor vaporisation and coagulation, the combined use of these two wavelengths providing the new study concept which emerged from this pilot trial.
Adult↗
Endoscopic retropubic colposuspension: "Retziusscopy" versus laparoscopy--a reasonable enlargement of the operative spectrum in the management of recurrent stress incontinence?
The technical feasibility of the laparoscopic and extraperitoneal approach to the Burch colposuspension for treatment of grade II and III (moderate to severe) stress incontinence was examined in a randomised prospective study. Irrespective of the endoscopic access, two suspension techniques, namely conventional suture and stapler fixation of alloplastic materials, were compared. A total of 20 patients entered this preliminary evaluation. Three complications occurred; a bladder perforation (during laparoscopic dissection of the space of Retzius), a postoperative detrusor instability and transient urinary retention. Both the endoscopic approaches and the suspension procedures employed proved feasible and safe, and presented the advantages of a "minimal access" procedure, with short hospitalisation and rapid recovery. Short-term follow-up (6-12 months) showed subjective and objective results comparable to those of the conventional abdominal Burch colposuspension. Detailed evaluation of the subgroups is not yet feasible, as the number of patients in this preliminary evaluation was too small and follow-up too short. Final evaluation of the entire study population and long-term follow-up will be necessary before these procedures can be generally offered as a therapeutic alternative.
Adult↗