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Biomedical subjects

W H Parker

Publications and source records attributed to W H Parker.

At least 19 recordsLinked to original sources
PubMed1995

The case for laparoscopic management of the adnexal mass.

Careful patient selection criteria can be used to identify patients who are appropriate for management of an adnexal masses via operative laparoscopy. Proper intraoperative assessment and liberal use of rapid frozen section are also important for optimal clinical outcome. Reported studies show that laparoscopic management of adnexal masses can be safely done. The short hospital stay and rapid return to normal activity combine to potentially reduce the overall cost of patient care. When cancer is unexpectedly found at the time of laparoscopic surgery for an adnexal mass, the surgeon should be prepared to proceed with staging laparotomy for appropriate treatment.

Adnexal Diseases↗
PubMed1994

A multicenter study of laparoscopic management of selected cystic adnexal masses in postmenopausal women.

BACKGROUND: The objective of this study was to determine the ability to predict benign adnexal masses in postmenopausal women and to evaluate the effectiveness of laparoscopic management in selected patients. STUDY DESIGN: Postmenopausal women found to have an adnexal mass were prospectively evaluated with clinical examination, sonography, and serum CA-125 levels. Women with cystic masses greater than 3 cm but less than 10 cm, with distinct borders, without solid parts or septations greater than 2 mm, without ascites or matted bowel, and with serum CA-125 levels less than 35 IU per mL were operated upon by laparoscopy. RESULTS: Sixty-one women gave consent for the study. Cyst size ranged from 3 to 10 cm. All masses were accurately predicted to be benign. Fifty-eight (95 percent) women were successfully managed by operative laparoscopy and three required laparotomy. For the patients managed by laparoscopy, the mean operative time was 63 minutes, the mean postoperative hospitalization period was 12 hours, and the mean return to normal activity was 5.6 days. CONCLUSIONS: The combination of clinical examination, sonographic appearance and serum CA-125 levels can accurately predict benign masses in postmenopausal women. Operative laparoscopy is acceptable for these patients and provides for a short period of hospitalization and a rapid recovery.

Adnexal Diseases↗
PubMed1994

Laparoscopic management of the adnexal mass.

Careful preoperative evaluation of women found to have an adnexal mass may select patients for whom operative laparoscopy is appropriate. The role of ultrasonography and serum tumor markers in patient selection is discussed. Operative techniques for the laparoscopic management of the adnexal mass are also presented.

Adnexa Uteri↗
PubMed1994

Uterine sarcoma in patients operated on for presumed leiomyoma and rapidly growing leiomyoma.

OBJECTIVE: To determine the incidence of uterine sarcoma in patients operated on for symptomatic uterine leiomyomas or "rapidly growing" leiomyomas. METHODS: We reviewed the medical records of 1332 women admitted to either of two community hospitals between 1988-1992 for hysterectomy or myomectomy for uterine leiomyomas. The incidence of leiomyosarcoma, endometrial stromal sarcoma, and mixed mesodermal tumor was calculated. Patient ages, admitting symptoms, and operative and pathologic findings were analyzed. The study included 371 women (28%) operated on for rapidly growing leiomyomas. All patients operated on during the same interval and found to have a uterine sarcoma were reviewed. RESULTS: One of the 1332 patients operated on for presumed leiomyoma was found to have a leiomyosarcoma. This women was the only patient found to have a sarcoma among 371 women operated on for rapid growth of the uterus. None of 198 patients who met a published definition of rapid growth had a uterine sarcoma. Two women (0.15%) had endometrial stromal sarcoma, but none had a mixed mesodermal tumor. During the same interval, nine additional patients were found to have uterine sarcomas, and for these women, the preoperative diagnosis was sarcoma in four, endometrial cancer in three, ovarian cancer in one, and prolapsed uterus in one. CONCLUSIONS: The total incidence of uterine sarcoma (leiomyosarcoma, endometrial stromal sarcoma, and mixed mesodermal tumor) among patients operated on for uterine leiomyoma is extremely low (0.23%). The incidence of sarcoma among patients having surgery for "rapidly growing" leiomyoma (0.27%) or among those who met published criteria for rapid growth (0%) does not substantiate the concept of increased risk of sarcoma in these women.

Adult↗
PubMed1993

A classification system for laparoscopic hysterectomy.

The term "laparoscopic hysterectomy" has been applied to a variety of procedures, ranging from lysis of adhesions laparoscopically followed by vaginal hysterectomy, to removal of the entire uterus under endoscopic direction. These procedures vary in a number of ways, including cost, morbidity, operating time, and surgical skill required. To facilitate training, credentialing, and outcome evaluation, we present the following classification system: type I--division of one or both pedicles containing the ovarian arteries, type II--dissection including one or both uterine arteries, type III--type II plus separation of part of at least one cardinal-uterosacral ligament complex, and type IV--type II plus separation of the entire cardinal-uterosacral ligament complex on at least one side. Each of the types may be subclassified according to the degree of dissection of structures located anterior and posterior to the cervix. Supracervical hysterectomy has a separate system of classification. Operations are categorized by management of the ovarian and uterine arteries and subdivided according to treatment of the cervical canal.

Female↗
PubMed1992

Management of ovarian masses. AAGL 1990 survey.

The American Association of Gynecologic Laparoscopists (AAGL) membership was surveyed on the use of laparoscopy in the management of persistent ovarian masses in 1990. A total of 13,739 laparoscopies were performed for this indication. Ninety-six percent of the respondents performed laparoscopy for this indication on premenopausal women only. Among respondents performing laparoscopy for suspected cancer, there was a 14% conversion rate to laparotomy, compared to 9% among those who performed direct laparotomies when cancer was suspected. An overall incidence of 4 per 1,000 cases of stage I ovarian cancer was found, and about 70% of women with persistent adnexal masses were managed by laparoscopy alone. The risks to women with cancer, as well as the benefits to those without, are discussed.

Female↗
PubMed1992

Management of adnexal masses by operative laparoscopy. Selection criteria.

The management of adnexal masses by operative laparoscopy is controversial. The application of strict criteria for preoperative patient selection and careful intraoperative assessment and management are critical to the appropriate use of this approach. Clinical examination, ultrasound imaging of the pelvis and the addition of the CA-125 tumor marker in postmenopausal women can aid in the selection of a population at low risk for malignancy that may be appropriate for operative laparoscopic adnexal surgery. Recommended procedures include careful intraoperative inspection of the pelvis and abdomen, liberal use of frozen sections, and conversion to immediate-staging laparotomy when malignancy is found.

Adnexal Diseases↗
PubMed1990

Management of selected cystic adnexal masses in postmenopausal women by operative laparoscopy: a pilot study.

Twenty-five postmenopausal patients were predicted to have benign masses by screening criteria that included ultrasonographic findings of a cystic adnexal mass less than 10 cm with distinct borders and no evidence of irregular solid parts, thick septa, ascites, or matted bowel, and a normal serum CA 125 value (less than 35 U/ml). All 25 masses were accurately predicted to be benign. The size of the cysts on ultrasonography ranged from 3 to 9 cm with a mean of 5 cm. Twenty-two patients (88%) were successfully managed by operative laparoscopy and adnexectomy. Mean operative time was 70 minutes and mean postoperative hospital stay was 12 hours. Mean time of return to normal activity was 5 days. Three patients required laparotomy. We conclude that removal of these cystic adnexal masses by operative laparoscopy is an acceptable alternative in carefully selected postmenopausal women.

Adnexal Diseases↗