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Biomedical subjects

T L Lyons

Publications and source records attributed to T L Lyons.

16 recordsLinked to original sources
PubMed2001

Appendectomy in patients undergoing laparoscopic surgery for pelvic pain.

STUDY OBJECTIVE: To evaluate pathologic findings in appendixes of women undergoing laparoscopic surgery for pelvic pain. DESIGN: Retrospective study (Canadian Task Force classification II-2). SETTING: Private practice specializing in gynecologic endoscopic surgery. PATIENTS: One hundred ninety women. INTERVENTION: Prophylactic appendectomy. MEASUREMENTS AND MAIN RESULTS: On pathologic evaluation, 154 appendixes were diagnosed as having one or more abnormal findings, such as endometriosis, carcinoid, chronic appendicitis, periappendicitis, fibrous obliteration, and lymphoid hyperplasia. CONCLUSION: Women undergoing laparoscopic surgery for pelvic pain should be counseled on the high frequency of abnormal findings in the appendix, including endometriosis. Prophylactic appendectomy appears to be a worthwhile consideration in these patients.

Adolescent↗
PubMed2000

Laparoscopic supracervical hysterectomy.

Laparoscopic supracervical hysterectomy (LSH) provides an efficient, effective method of uterine extirpation for individuals with appropriate indications for the procedure. This article gives a rationale for the procedures and provides a step-by-step methodology for performing LSH. Data from existing literature are discussed, and suggestions for improving morbidity and mortality are presented.

Female↗
PubMed2000

Transvaginal hydrolaparoscopy, a new technique for pelvic assessment.

Transvaginal hydrolaparoscopy is based on classic culdoscopy. With alterations in equipment and method, the procedure holds promise for evaluation of pelvic pathology. We performed transvaginal hydrolaparoscopy in the operating room just before operative laparoscopy in 15 patients, to evaluate the feasibility of this procedure. Excellent images of the cul-de-sac, fimbriae, and caudal surface of the uterus, ovaries, and pelvic sidewall were obtained. We believe this is a practical and convenient office diagnostic procedure.

Adnexal Diseases↗
PubMed1998

Laparoscopic removal of a bladder leiomyoma.

Bladder leiomyoma is a rare tumor that is generally removed by transabdominal, vaginal, and transurethral approaches. We successfully removed a large, transmural, extravesical bladder leiomyoma by laparoscopy.

Adult↗
PubMed1998

Laparoscopic supracervical hysterectomy with a new disposable morcellator.

Laparoscopic supracervical hysterectomy (LSH) can be performed more easily with a powered morcellator for removal of the uterus. Available laparoscopic morcellators are expensive and may be difficult to use, but a new, powered, disposable instrument was developed (Diva; FemRx, Sunnyvale, CA) to morcellate the entire uterus for easy removal through a 15-mm cannula. Twelve consecutive women for whom subtotal hysterectomy was indicated underwent LSH by standard laparoscopic protocol and were monitored postoperatively for a minimum of 1 month. In the current trend of "less is more," LSH is an emerging option for less extensive hysterectomies and can be made more cost and time effective with a single-use powered morcellator.

Adult↗
PubMed1997

Laparoscopic supracervical hysterectomy.

Supracervical hysterectomy is a viable alternative for those individuals requiring uterine extirpation without indications for cervical removal. The laparoscopic approach to this procedure provides even lower morbidity and therefore can enhance clinical outcomes. The procedure is versatile in that most patients are amenable pathologically to this approach, particularly those individuals with large lieomyomata. Five year follow-up data is presented on 236 cases performed by the author including clinical outcomes and morbidity information. The procedure as performed by the author is presented in detail with illustrations of critical aspects of the technique of LSH.

Adult↗
PubMed1997

Laparoscopic rectocele repair using polyglactin mesh.

We assessed the efficacy of laparoscopic treatment of rectocele defect using a polyglactin mesh graft. From May 1, 1995, through September 30, 1995, we prospectively evaluated 20 women (age 38-74 yrs) undergoing pelvic floor reconstruction for symptomatic pelvic floor prolapse, with or without hysterectomy. Morbidity of the procedure was extremely low compared with standard transvaginal and transrectal approaches. Patients were followed at 3-month intervals for 1 year. Sixteen had resolution of symptoms. Laparoscopic application of polyglactin mesh for the repair of the rectocele defect is a viable option, although long-term follow-up is necessary.

Adult↗
PubMed1995

Clinical outcomes with laparoscopic approaches and open Burch procedures for urinary stress incontinence.

Laparoscopic minimally invasive approaches to urinary stress incontinence have been described in the literature since 1989. Technical advances have improved both access to the space of Retzius and the operator's ability to accomplish retropubic colposuspension. In addition to the traditional open Burch procedures, a new laparoscopic method of colposuspension is available. In one group of women, laparoscopically guided procedures were performed in the classic fashion using only sutures. In the second laparoscopic group the suspension was performed with a combination of sutures and endoscopic staples (Nolan-Lyons modification of the Burch). The third group was analyzed retrospectively by chart review and patient interview for surgical outcome data. All groups were similar demographically. Clinical outcomes were similar in the laparoscopic groups, and surgical morbidity was significantly decreased compared with traditional open procedures. Relief of symptoms was similar in all groups at 1-year follow-up. We conclude that a laparoscopic approach to retropubic colposuspension is an effective alternative with improved clinical outcomes. Additional modifications that can improve surgeons' accessibility to these techniques are feasible, with comparable clinical outcomes.

Adult↗
PubMed1995

Suggested set-up and layout of instruments and equipment for advanced operative laparoscopy.

Crucial elements that ensure the organization and smoothness of a laparoscopic procedure are clear communication among well-trained endoscopy team members, properly maintained equipment, and a sensible layout of the instruments. The team consists of the surgeon, surgical assistant, circulator, scrub nurse, laser nurse, and anesthesiologist. To promote continuity and interaction and to ensure a systematic, pleasant pace for laparoscopic procedures, the team should establish a specific routine, as well as set-up and layout of tables, equipment, and instruments. Key ingredients for advanced operative laparoscopy to be performed with optimum efficiency and effectiveness are the best organization and placement of the equipment, instrumentation, and team in a particular setting in the operating room.

Anesthesiology↗
PubMed1993

Laparoscopic supracervical hysterectomy. A comparison of morbidity and mortality results with laparoscopically assisted vaginal hysterectomy.

Laparoscopic applications in hysterectomy promise to be a factor in decreasing both economic and medical morbidity. However, with the need for both advanced laparoscopic skills and good vaginal surgical techniques, the meaningful conversion rate (total abdominal hysterectomy to laparoscopically assisted vaginal hysterectomy) appears to be low. A less morbid approach may be subtotal hysterectomy, in appropriate candidates, particularly if this procedure is readily accomplished by an increased number of physicians. A comparison of outcomes in 50 laparoscopically assisted vaginal hysterectomy patients versus 50 laparoscopic supracervical hysterectomy patients was made, demonstrating that the subtotal procedure was significantly less morbid.

Adult↗
PubMed1992

Tissue reconstruction with nonpenetrating arcuate-legged clips. Potential endoscopic applications.

A new system for tissue approximation consisting of a nonpenetrating arcuate-legged clip applied to everted tissue edges to form an elastomeric flanged joint is described. The flanged joint has unusual physical and morphologic properties. Novel systems for tissue eversion, clip application and clip removal have been tested at the micro scale in blood vessels and the rat vas deferens (vasovasostomy). Human applications have been successful (cerebrovascular reconstruction, free-flap transfer, skin grafting, A-V access). The system is biologically and technically equivalent to or superior to the needle-and-suture technique. Avoidance of intimal or mucosal penetration or intraluminal foreign body is associated with prompt wound healing and the reconstitution of tubular integrity. The system is readily adaptable for endoscopic surgical reconstructions, providing the surgeon with enhanced reconstructive abilities.

Anastomosis, Surgical↗
PubMed1987

Outcomes of twin gestations at the University of Colorado Health Sciences Center, 1973-1983.

A retrospective study was undertaken of 341 twin pregnancies over a ten-year period at the University of Colorado Health Sciences Center. The perinatal morbidity and mortality were higher than for singleton gestations, but no difference was found between the first and second twins. Bed rest was effective in prolonging gestation and decreasing perinatal mortality (P less than .05). Delivery of the second twin in noncephalic presentation was accomplished vaginally in 46.5%, with external version successful in five of six attempts. The interval between the birth of each twin did not affect outcome.

Bed Rest↗
PubMedDate not supplied

Vaginal vault suspension.

A laparoscopic approach to significant pelvic relaxation and vault prolapse, including technical aspects of the procedures involved and an anatomic rationale for the laparoscopic approach, are described. The results demonstrate good clinical outcomes in addition to low intraoperative and post operative morbidity. It is concluded that the laparoscopic approach to vault support has a superior result when compared to open vaginal alternatives.

Adult↗