The Experts below are selected from a list of 312 Experts worldwide ranked by ideXlab platform
Veronica Lerner - One of the best experts on this subject based on the ideXlab platform.
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a novel porcine stomach tissue model for laparoscopic Colpotomy simulation
Obstetrics & Gynecology, 2019Co-Authors: Amanda Ulrich, Veronica LernerAbstract:BACKGROUND: Hysterectomies are the most common benign gynecologic surgical procedures performed in the United States. Currently, there are no tissue models that exist to teach trainees the techniques for Colpotomy during laparoscopic hysterectomy. To address this educational gap, we have created a laparoscopic Colpotomy model using a porcine stomach attached to a uterine manipulator. METHODS: A segment of a porcine stomach is secured onto a uterine manipulator to simulate the cervicovaginal junction. A uterus model created with craft materials and reused in subsequent sessions is placed above the porcine stomach onto the uterine manipulator tip. Porcine stomach was obtained from a local butcher or meat market costing less than $1.00 per model. The tissue can be refrigerated or frozen for storage, then thawed before each use. This model can be used with any energy device and any laparoscopic platform to teach and perform the Colpotomy. Usability survey showed that trainees responded positively to the model and attendings thought it was a useful teaching tool. EXPERIENCE: Trainees and faculty responded favorably to the model and stated that the use of actual tissue enhanced the realism of a Colpotomy simulation. CONCLUSION: The porcine stomach laparoscopic Colpotomy model is an innovative, low-cost teaching tool to add to a gynecologic surgical education simulation toolkit.
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a novel porcine stomach tissue model for laparoscopic Colpotomy simulation
Obstetrics & Gynecology, 2019Co-Authors: Amanda Ulrich, Veronica LernerAbstract:BACKGROUND: Hysterectomies are the most common benign gynecologic surgical procedures performed in the United States. Currently, there are no tissue models that exist to teach trainees the techniques for Colpotomy during laparoscopic hysterectomy. To address this educational gap, we have created a laparoscopic Colpotomy model using a porcine stomach attached to a uterine manipulator. METHODS: A segment of a porcine stomach is secured onto a uterine manipulator to simulate the cervicovaginal junction. A uterus model created with craft materials and reused in subsequent sessions is placed above the porcine stomach onto the uterine manipulator tip. Porcine stomach was obtained from a local butcher or meat market costing less than $1.00 per model. The tissue can be refrigerated or frozen for storage, then thawed before each use. This model can be used with any energy device and any laparoscopic platform to teach and perform the Colpotomy. Usability survey showed that trainees responded positively to the model and attendings thought it was a useful teaching tool. EXPERIENCE: Trainees and faculty responded favorably to the model and stated that the use of actual tissue enhanced the realism of a Colpotomy simulation. CONCLUSION: The porcine stomach laparoscopic Colpotomy model is an innovative, low-cost teaching tool to add to a gynecologic surgical education simulation toolkit.
K Semm - One of the best experts on this subject based on the ideXlab platform.
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comparative evaluation of classical intrafascial supracervical hysterectomy cish with transuterine mucosal resection as performed by pelviscopy and laparotomy our first 200 cases
Surgical Endoscopy and Other Interventional Techniques, 1995Co-Authors: Liselotte Mettler, K Semm, L Lehmannwillenbrock, A Shah, P Shah, R SharmaAbstract:A novel way of performing endoscopic intrafascial supracervical hysterectomy is presented. By using the endoscopic approach for dissection as well as uterine extraction using the serrated-edged macromorcellator, we avoid giving the patient a Colpotomy incision and its inherent post-operative discomfort. A further modification involves nearly complete excision (95%) of uterocervical mucosa using a calibrated resection tool, thus eliminating the possible subsequent development of cervical stump neoplasia. Sparing of the cardinal ligament insertion provides support to the cervical stump. Hemorrhage and genitourinary complications are prevented by avoiding dissection of the parametrium at the level of endocervix.
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intrafascial supracervical hysterectomy without Colpotomy and transuterine mucosal resection by pelviscopy and laparotomy
Diagnostic and Therapeutic Endoscopy, 1995Co-Authors: Liselotte Mettler, Erick Alvarezrodas, Enrique Lehmannwillenbrock, Jutta Luttges, K SemmAbstract:Between September 1991 and December 1993, 253 patients were operated on using the Classical Intrafascial SEMM (Serrated Edged Macro Morcellator) Hysterectomy (CISH) technique. One hundred fifty-two patients were assigned to pelviscopic CISH and 101 to laparotomic CISH. Uterine leiomyomas with menstrual disorders and pressure symptoms topped the list of indications with 61%. In all cases, initially transuterine mucosal resection and coring of the cervicouterine cylinder were carried out followed by the intrafascial supracervical dissection of the uterus. The size of the uterus played a decisive role in selecting the cases for CISH technique either by pelviscopy or laparotomy. The cervicouterine mucosal cylinders were cored using the Calibrated Uterine Resection Tool (CURT). Cervical thickness and diameters were measured preoperatively by transvaginal sonography for facilitating the use of a specific-sized CURT. After removal of this cylinder, hemostasis in the area was secured by coagulating with an endocoagulation device. The advantage of this technique is that the pelvic floor integrity remains intact, and because uterine arteries and ureters were not touched, the so called “complication zone” is thus avoided.The histological findings are in agreement with the indications, the leiomyomas and leiomyomas with adenomyosis being the most frequent pathology. The histologic analysis showed that in all cases the squamocolumnar transformation zone was totally removed. There were 11 (4.4%) complications, promptly identified and treated without further problems.The value of the Classical intrafascial supracervical hysterectomy without Colpotomy including the resection of transformation zone speaks for itself, because there is less physical stress and recovery is quick. However, it has yet to prove its value as compared with other techniques for hysterectomy for specific indications.
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8b endoscopic classic intrafascial supracervical hysterectomy without Colpotomy
Best Practice & Research in Clinical Obstetrics & Gynaecology, 1994Co-Authors: L Mettler, K SemmAbstract:The first reported abdominal (supracervical) hysterectomy was performed by Wilhelm Alexander Freund in 1878 in Breslau (Freund, 1878, 1879). From then on, supracervical hysterectomy was the leading technique in gynaecological surgery for over 80 years. Later a shift to total hysterectomy, performed either vaginally or abdominally, occurred because of the danger of cervical stump cancer (Tervilfi, 1963). Tervil~i (1963) reported the danger of cervical cancer to be 0.3-1.9% following supracervical hysterectomy. At the beginning of this century the Viennese and the Berlin schools carefully described the technique of hysterectomy in cancer cases. From about 1963 till 1990, all hysterectomies carried out in our department were total hysterectomies. In 1982, Semm began performing the laparoscopically assisted vaginal hysterectomy (LAVH), which he published details of in 1984 (Semm, 1984). In the Department of Obstetrics and Gynaecology, University of Kiel, the number of vaginal hysterectomies has increased over the last 10 years, with pelviscopy preceding vaginal hysterectomy in cases with many previous laparotomies, severe adhesions or benign adnexal tumours. However, we supported the use of vaginal hysterectomy performed with anterior Colpotomy to allow the adnexa to be separated from the pelvic wall. Dissection of the uterine arteries was never performed pelviscopically, as it is easily done during the vaginal hysterectomy. The international acceptance of this technique occurred in 1989 after Reich published details of the LAVH with dissection of the ureter and uterine arteries via laparoscopy. In 1991 this was followed by the classic intrafascial supracervical hysterectomy (CISH) without Colpotomy (Semm, 1991). The advantages of the CISH technique, which can be performed via pelviscopy, laparotomy or vaginal surgery, are: 1. Partial preservation of the integrity of the pelvic floor and no Colpotomy, with the exception of an anterior Colpotomy in an intrafascial vaginal hysterectomy. 2. Preservation of full blood supply to the pelvic floor. 3. Continuation of normal sexual function. 4. Protection against cervical cancer by coring out the transformation zone. Bailli~re's Clinical Obstetrics and G ynaecology
Amanda Ulrich - One of the best experts on this subject based on the ideXlab platform.
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a novel porcine stomach tissue model for laparoscopic Colpotomy simulation
Obstetrics & Gynecology, 2019Co-Authors: Amanda Ulrich, Veronica LernerAbstract:BACKGROUND: Hysterectomies are the most common benign gynecologic surgical procedures performed in the United States. Currently, there are no tissue models that exist to teach trainees the techniques for Colpotomy during laparoscopic hysterectomy. To address this educational gap, we have created a laparoscopic Colpotomy model using a porcine stomach attached to a uterine manipulator. METHODS: A segment of a porcine stomach is secured onto a uterine manipulator to simulate the cervicovaginal junction. A uterus model created with craft materials and reused in subsequent sessions is placed above the porcine stomach onto the uterine manipulator tip. Porcine stomach was obtained from a local butcher or meat market costing less than $1.00 per model. The tissue can be refrigerated or frozen for storage, then thawed before each use. This model can be used with any energy device and any laparoscopic platform to teach and perform the Colpotomy. Usability survey showed that trainees responded positively to the model and attendings thought it was a useful teaching tool. EXPERIENCE: Trainees and faculty responded favorably to the model and stated that the use of actual tissue enhanced the realism of a Colpotomy simulation. CONCLUSION: The porcine stomach laparoscopic Colpotomy model is an innovative, low-cost teaching tool to add to a gynecologic surgical education simulation toolkit.
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a novel porcine stomach tissue model for laparoscopic Colpotomy simulation
Obstetrics & Gynecology, 2019Co-Authors: Amanda Ulrich, Veronica LernerAbstract:BACKGROUND: Hysterectomies are the most common benign gynecologic surgical procedures performed in the United States. Currently, there are no tissue models that exist to teach trainees the techniques for Colpotomy during laparoscopic hysterectomy. To address this educational gap, we have created a laparoscopic Colpotomy model using a porcine stomach attached to a uterine manipulator. METHODS: A segment of a porcine stomach is secured onto a uterine manipulator to simulate the cervicovaginal junction. A uterus model created with craft materials and reused in subsequent sessions is placed above the porcine stomach onto the uterine manipulator tip. Porcine stomach was obtained from a local butcher or meat market costing less than $1.00 per model. The tissue can be refrigerated or frozen for storage, then thawed before each use. This model can be used with any energy device and any laparoscopic platform to teach and perform the Colpotomy. Usability survey showed that trainees responded positively to the model and attendings thought it was a useful teaching tool. EXPERIENCE: Trainees and faculty responded favorably to the model and stated that the use of actual tissue enhanced the realism of a Colpotomy simulation. CONCLUSION: The porcine stomach laparoscopic Colpotomy model is an innovative, low-cost teaching tool to add to a gynecologic surgical education simulation toolkit.
Liselotte Mettler - One of the best experts on this subject based on the ideXlab platform.
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comparative evaluation of classical intrafascial supracervical hysterectomy cish with transuterine mucosal resection as performed by pelviscopy and laparotomy our first 200 cases
Surgical Endoscopy and Other Interventional Techniques, 1995Co-Authors: Liselotte Mettler, K Semm, L Lehmannwillenbrock, A Shah, P Shah, R SharmaAbstract:A novel way of performing endoscopic intrafascial supracervical hysterectomy is presented. By using the endoscopic approach for dissection as well as uterine extraction using the serrated-edged macromorcellator, we avoid giving the patient a Colpotomy incision and its inherent post-operative discomfort. A further modification involves nearly complete excision (95%) of uterocervical mucosa using a calibrated resection tool, thus eliminating the possible subsequent development of cervical stump neoplasia. Sparing of the cardinal ligament insertion provides support to the cervical stump. Hemorrhage and genitourinary complications are prevented by avoiding dissection of the parametrium at the level of endocervix.
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intrafascial supracervical hysterectomy without Colpotomy and transuterine mucosal resection by pelviscopy and laparotomy
Diagnostic and Therapeutic Endoscopy, 1995Co-Authors: Liselotte Mettler, Erick Alvarezrodas, Enrique Lehmannwillenbrock, Jutta Luttges, K SemmAbstract:Between September 1991 and December 1993, 253 patients were operated on using the Classical Intrafascial SEMM (Serrated Edged Macro Morcellator) Hysterectomy (CISH) technique. One hundred fifty-two patients were assigned to pelviscopic CISH and 101 to laparotomic CISH. Uterine leiomyomas with menstrual disorders and pressure symptoms topped the list of indications with 61%. In all cases, initially transuterine mucosal resection and coring of the cervicouterine cylinder were carried out followed by the intrafascial supracervical dissection of the uterus. The size of the uterus played a decisive role in selecting the cases for CISH technique either by pelviscopy or laparotomy. The cervicouterine mucosal cylinders were cored using the Calibrated Uterine Resection Tool (CURT). Cervical thickness and diameters were measured preoperatively by transvaginal sonography for facilitating the use of a specific-sized CURT. After removal of this cylinder, hemostasis in the area was secured by coagulating with an endocoagulation device. The advantage of this technique is that the pelvic floor integrity remains intact, and because uterine arteries and ureters were not touched, the so called “complication zone” is thus avoided.The histological findings are in agreement with the indications, the leiomyomas and leiomyomas with adenomyosis being the most frequent pathology. The histologic analysis showed that in all cases the squamocolumnar transformation zone was totally removed. There were 11 (4.4%) complications, promptly identified and treated without further problems.The value of the Classical intrafascial supracervical hysterectomy without Colpotomy including the resection of transformation zone speaks for itself, because there is less physical stress and recovery is quick. However, it has yet to prove its value as compared with other techniques for hysterectomy for specific indications.
Frank Willem Jansen - One of the best experts on this subject based on the ideXlab platform.
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a new approach to simplify surgical Colpotomy in laparoscopic hysterectomy
Gynecological Surgery, 2016Co-Authors: L Van Den Haak, Johann P T Rhemrev, Mathijs D Blikkendaal, A C M Luteijn, J J Van Den Dobbelsteen, Sara R C Driessen, Frank Willem JansenAbstract:New surgical techniques and technology have simplified laparoscopic hysterectomy and have enhanced the safety of this procedure. However, the surgical Colpotomy step has not been addressed. This study evaluates the surgical Colpotomy step in laparoscopic hysterectomy with respect to difficulty and duration. Furthermore, it proposes an alternative route that may simplify this step in laparoscopic hysterectomy. A structured interview, a prospective cohort study, and a problem analysis were performed regarding experienced difficulty and duration of surgical Colpotomy in laparoscopic hysterectomy. Sixteen experts in minimally invasive gynecologic surgery from 12 hospitals participated in the structured interview using a 5-point Likert scale. The Colpotomy in LH received the highest scores for complexity (2.8 ± 1.2), compared to AH and VH. Colpotomy in LH was estimated as more difficult than in AH (2.8 vs 1.4, p < .001). In the cohort study, 107 patients undergoing LH were included. Sixteen percent of the total procedure time was spent on Colpotomy (SD 7.8 %). BMI was positively correlated with Colpotomy time, even after correcting for longer operation time. No relation was found between Colpotomy time and blood loss or uterine weight. The surgical Colpotomy step in laparoscopic hysterectomy should be simplified as this study demonstrates that it is time consuming and is considered to be more difficult than in other hysterectomy procedures. A vaginal approach to the Colpotomy is proposed to achieve this simplification.