The Experts below are selected from a list of 10098 Experts worldwide ranked by ideXlab platform
A J Mccartney - One of the best experts on this subject based on the ideXlab platform.
-
total laparoscopic Hysterectomy versus total Abdominal Hysterectomy for obese women with endometrial cancer
International Journal of Gynecological Cancer, 2005Co-Authors: Andreas Obermair, Tom Manolitsas, Yee Leung, Ian Hammond, A J MccartneyAbstract:Obesity is common in endometrial cancer and surgery for these patients is challenging. We compared total laparoscopic Hysterectomy (TLH) with total Abdominal Hysterectomy (TAH) with respect to feasibility (operating time, estimated blood loss, length of hospital stay, and conversion to laparotomy) and safety (perioperative morbidity and mortality) in a retrospective analysis of 78 morbidly obese patients with endometrial cancer. Analysis is based on the intention to treat. The intention to treat was TLH in 47 patients and it could be successfully completed in 42 patients (89.4%). The mean weight for all patients was 118.7 kg, with patients in the TLH group weighing more and having higher ASA scores. Mean operating time and estimated blood loss were similar in both groups. Mean postoperative hospital stay was 4.4 (±3.9) days in the TLH group and 7.9 (±3.0) days in the TAH group (P < 0.0001). Wound infections occurred in 15 of 31 patients (48.4%) in the TAH group and in 1 of 47 patients (2.1%) in the TLH group. All other morbidity, as well as patterns of recurrence and survival were similar in both groups. These data justify a prospective randomized trial comparing TLH with TAH for the treatment of endometrial cancer. © 2005 IGCS
John G Laffey - One of the best experts on this subject based on the ideXlab platform.
-
the transversus abdominis plane block provides effective postoperative analgesia in patients undergoing total Abdominal Hysterectomy
Anesthesia & Analgesia, 2008Co-Authors: J Carney, John G Mcdonnell, Alan Ochana, Raj Bhinder, John G LaffeyAbstract:BACKGROUND:Patients undergoing total Abdominal Hysterectomy suffer significant postoperative pain. The transversus abdominis plane (TAP) block is a recently described approach to providing analgesia to the anterior Abdominal wall. We evaluated the analgesic efficacy of the TAP block in patients unde
Andreas Obermair - One of the best experts on this subject based on the ideXlab platform.
-
the cost effectiveness of total laparoscopic Hysterectomy compared to total Abdominal Hysterectomy for the treatment of early stage endometrial cancer
BMJ Open, 2013Co-Authors: Nicholas Graves, Monika Janda, Katharina Merollini, Val Gebski, Andreas ObermairAbstract:Objective: To summarise how costs and health benefits will change with the adoption of total laparoscopic Hysterectomy compared to total Abdominal Hysterectomy for the treatment of early stage endometrial cancer. Design: Cost-effectiveness modelling using the information from a randomised controlled trial. Participants: Two hypothetical modelled cohorts of 1000 individuals undergoing total laparoscopic Hysterectomy and total Abdominal Hysterectomy. Outcome measures: Surgery costs; hospital bed days used; total healthcare costs; quality-adjusted life years; and net monetary benefits. Results: For 1000 individuals receiving total laparoscopic Hysterectomy surgery, the costs were $509 575 higher, 3548 hospital fewer bed days were used and total health services costs were reduced by $3 746 221. There were 39.13 more quality-adjusted life years for a 5 year period following surgery. Conclusions: The adoption of total laparoscopic Hysterectomy is almost certainly a good decision for health services policy makers. There is 100% probability that it will be cost saving to health services, a 86.8% probability that it will increase health benefits and a 99.5% chance that it returns net monetary benefits greater than zero.
-
total laparoscopic Hysterectomy versus total Abdominal Hysterectomy for obese women with endometrial cancer
International Journal of Gynecological Cancer, 2005Co-Authors: Andreas Obermair, Tom Manolitsas, Yee Leung, Ian Hammond, A J MccartneyAbstract:Obesity is common in endometrial cancer and surgery for these patients is challenging. We compared total laparoscopic Hysterectomy (TLH) with total Abdominal Hysterectomy (TAH) with respect to feasibility (operating time, estimated blood loss, length of hospital stay, and conversion to laparotomy) and safety (perioperative morbidity and mortality) in a retrospective analysis of 78 morbidly obese patients with endometrial cancer. Analysis is based on the intention to treat. The intention to treat was TLH in 47 patients and it could be successfully completed in 42 patients (89.4%). The mean weight for all patients was 118.7 kg, with patients in the TLH group weighing more and having higher ASA scores. Mean operating time and estimated blood loss were similar in both groups. Mean postoperative hospital stay was 4.4 (±3.9) days in the TLH group and 7.9 (±3.0) days in the TAH group (P < 0.0001). Wound infections occurred in 15 of 31 patients (48.4%) in the TAH group and in 1 of 47 patients (2.1%) in the TLH group. All other morbidity, as well as patterns of recurrence and survival were similar in both groups. These data justify a prospective randomized trial comparing TLH with TAH for the treatment of endometrial cancer. © 2005 IGCS
A C Davidson - One of the best experts on this subject based on the ideXlab platform.
-
analgesic effects of parecoxib following total Abdominal Hysterectomy
BJA: British Journal of Anaesthesia, 2003Co-Authors: G Smith, A C DavidsonAbstract:Background Forty-eight ASA I–II patients undergoing total Abdominal Hysterectomy (TAH) were studied in a double blind, randomized placebo controlled trial of parecoxib for postoperative analgesia. Methods All patients were given propofol 2–4 mg kg−1 i.v., a non-depolarizing muscle relaxant, morphine 10 mg i.v. and prochlorperazine 12.5 mg i.m. intraoperatively. Their lungs were ventilated with nitrous oxide and isoflurane 1–1.5% in oxygen. Morphine was self-administered for postoperative analgesia via a patient controlled analgesia (PCA) device. Patients were allocated randomly to receive either parecoxib 40 mg i.v. or normal saline on induction of anaesthesia. Results Twelve patients did not complete the study. Of the remaining 36 patients, there was no significant difference between the treatment groups in age, weight, ASA status, duration of surgery, or intraoperative dose of morphine. However, mean (95% CI) 24 h morphine consumption of 54 (42–65) mg in the parecoxib group was significantly (P=0.04) lower than that of 72 (58–86) mg in the placebo group. Pain intensity scores on sitting up were significantly lower (P=0.02) in the parecoxib group compared with placebo. There was no significant difference between the treatment groups in pain intensity scores at rest and on deep inspiration, or in nausea, total number of vomiting episodes, median number of rescue antiemetic doses, and sedation scores. Conclusions Parecoxib 40 mg i.v. may be recommended in patients having TAH as it provides morphine-sparing analgesia.
-
the analgesic effects of intraperitoneal and incisional bupivacaine with epinephrine after total Abdominal Hysterectomy
Anesthesia & Analgesia, 2002Co-Authors: A Swami, G Smith, A C Davidson, J EmemboluAbstract:The objective of our study was to see if incisional and intraperitoneal bupivacaine with epinephrine produces analgesia after total Abdominal Hysterectomy. Forty-six ASA physical status I and II patients received a standardized anesthetic, patient-controlled analgesia (PCA) morphine, and rectal para
-
infiltration of the Abdominal wall with local anaesthetic after total Abdominal Hysterectomy has no opioid sparing effect
BJA: British Journal of Anaesthesia, 2000Co-Authors: J R Klein, A C Davidson, J P Heaton, J P Thompson, B R Cotton, G SmithAbstract:We have measured the effect of infiltration of the deep and superficial layers of the Abdominal wound on morphine consumption and pain for 48 h after operation, in 40 patients undergoing total Abdominal Hysterectomy, in a double-blind randomized study. Patients received wound infiltration with 0.9% normal saline 40 ml or 40 ml of 0.25% bupivacaine with epinephrine 1:200,000. There were no significant differences between groups in morphine consumption, linear analogue scores for pain at rest or on movement, nausea or sedation during the first 48 h after operation. We conclude that infiltration of the deep and superficial layers of the wound of a Pfannenstiel incision with local anaesthetic solution did not confer additional analgesia in patients undergoing major gynaecological surgery.
Gordon M Stirrat - One of the best experts on this subject based on the ideXlab platform.
-
randomised controlled trial comparing endometrial resection with Abdominal Hysterectomy for the surgical treatment of menorrhagia
British Journal of Obstetrics and Gynaecology, 1993Co-Authors: Nuala Dwyer, John Hutton, Gordon M StirratAbstract:Objective To evaluate the effectiveness of endometrial resection as a surgical treatment for menorrhagia. Design Randomised controlled trial. Setting Gynaecology department at a teaching hospital. Subjects Two hundred women needing surgical treatment for menorrhagia between January 1990 and May 1991. After withdrawal of four women 97 underwent Hysterectomy and 99 underwent endometrial resection. Main outcome measures Patient satisfaction 4 months after surgery; post-operative complications; length of hospital stay; duration of time before return to work, normal daily activities and sexual intercourse; change in premenstrual symptoms. Results The difference in patient satisfaction between endometrial resection (84 out of 99) and Abdominal Hysterectomy (89 out of 95) just reached statistical significance in favour of Abdominal Hysterectomy at 4 months after surgery (difference = 9%, 95% confidence intervals (CI) 1.1%–17.5%). Post-operative morbidity, length of hospital stay and time taken to return to work, normal daily activities and sexual intercourse were significantly less in the endometrial resection group. However, the premenstrual symptoms of dysmenorrhoea, bloating and breast tenderness were less frequent after Hysterectomy. Conclusion In the short term, endometrial resection was almost as satisfactory as Abdominal Hysterectomy for the surgical treatment of menorrhagia, and was associated with less morbidity. However, even at 4 months after surgery, there was a failure rate of at least 10% in those in whom endometrial resection appeared complete. Longer term comparative studies are necessary before the widespread introduction of endometrial resection as an alternative to Abdominal Hysterectomy for the surgical treatment of menorrhagia.
-
an economic evaluation of transcervical endometrial resection versus Abdominal Hysterectomy for the treatment of menorrhagia
British Journal of Obstetrics and Gynaecology, 1993Co-Authors: Mark Sculpher, Nuala Dwyer, John Hutton, Stirling Bryan, Gordon M StirratAbstract:OBJECTIVE: To evaluate the relative health service cost of endometrial resection versus Abdominal Hysterectomy for the treatment of menorrhagia and the value women attach to their health state before and after surgery. DESIGN: A prospective economic evaluation running alongside a randomised controlled trial. SETTING: The gynaecology department of a teaching hospital. SUBJECTS: 200 women requiring surgical treatment of menorrhagia between January 1990 and May 1991; after withdrawals, 97 women underwent Hysterectomy and 99 underwent endometrial resection. MAIN OUTCOME MEASURES: The total health service cost of managing women in the two arms of the trial until 4 months after their operation. The change in women's valuation of their health state a fortnight after and a minimum of 4 months after surgery relative to that 1 month prior to their operation. RESULTS: Total health service costs are significantly higher amongst Abdominal Hysterectomy patients (mean 1059.73 pounds) than amongst endometrial resection patients with a mean difference of 499.68 pounds (95% CI 432 pounds-567 pounds). This significant difference exists under alternative assumptions about the difference in lengths of stay in hospital between the two treatment groups and the hotel cost per in-patient day. On a scale of 0 to 100, relative to a month before surgery, there is a statistically significant difference in favour of endometrial resection between the two groups in the increase in value women attach to their health state at a fortnight after surgery (mean difference 11.2; 95% CI 0.6-21.7), but not at a minimum of 4 months after surgery (mean difference 7; 95% CI -17.4 to 3.4). CONCLUSIONS: On the basis of health service resource cost up to 4 months after surgery, endometrial resection has a cost advantage over Abdominal Hysterectomy. However, given the fact that a subgroup of women requires retreatment due to resection failure and that this study considers a relatively short period of follow up, the long term costs and benefits of endometrial resection need to be evaluated before widespread diffusion is justified.
-
an economic evaluation of transcervical endometrial resection versus Abdominal Hysterectomy for the treatment of menorrhagia
British Journal of Obstetrics and Gynaecology, 1993Co-Authors: Mark Sculpher, Nuala Dwyer, Stirling Bryan, John S Hutton, Gordon M StirratAbstract:OBJECTIVE To evaluate the relative health service cost of endometrial resection versus Abdominal Hysterectomy for the treatment of menorrhagia and the value women attach to their health state before and after surgery. DESIGN A prospective economic evaluation running alongside a randomised controlled trial. SETTING The gynaecology department of a teaching hospital. SUBJECTS 200 women requiring surgical treatment of menorrhagia between January 1990 and May 1991; after withdrawals, 97 women underwent Hysterectomy and 99 underwent endometrial resection. MAIN OUTCOME MEASURES The total health service cost of managing women in the two arms of the trial until 4 months after their operation. The change in women's valuation of their health state a fortnight after and a minimum of 4 months after surgery relative to that 1 month prior to their operation. RESULTS Total health service costs are significantly higher amongst Abdominal Hysterectomy patients (mean 1059.73 pounds) than amongst endometrial resection patients with a mean difference of 499.68 pounds (95% CI 432 pounds-567 pounds). This significant difference exists under alternative assumptions about the difference in lengths of stay in hospital between the two treatment groups and the hotel cost per in-patient day. On a scale of 0 to 100, relative to a month before surgery, there is a statistically significant difference in favour of endometrial resection between the two groups in the increase in value women attach to their health state at a fortnight after surgery (mean difference 11.2; 95% CI 0.6-21.7), but not at a minimum of 4 months after surgery (mean difference 7; 95% CI -17.4 to 3.4). CONCLUSIONS On the basis of health service resource cost up to 4 months after surgery, endometrial resection has a cost advantage over Abdominal Hysterectomy. However, given the fact that a subgroup of women requires retreatment due to resection failure and that this study considers a relatively short period of follow up, the long term costs and benefits of endometrial resection need to be evaluated before widespread diffusion is justified.
