Peter F. McComb

Operative laparoscopy versus open abdominal surgery: a comparative study on postoperative adhesion formation in the rat model.

The aim of this study was to compare the occurrence of adhesions after a standard uterine injury inflicted by laparoscopy or by laparotomy during which microsurgical principles were observed. The cross-sectional areas of adhesions involving the uterus were assessed and the 31 rats operated upon laparoscopically were compared with the 30 rats subjected to a laparotomy. The mean area of uterine adhesions formed in the laparotomy group was 4.29 mm2 and 8.88 mm2 in the laparoscopy group. The difference was not statistically significant. The results imply that a standard tissue injury to uterine tissue, whether conducted by laparoscopy or via laparotomy, carries the same potential to induce postoperative adhesions.

Plasma prolactin, human chorionic gonadotropin, estradiol, testosterone, and progesterone in the ovarian hyperstimulation syndrome☆

Plasma prolactin, estradiol, progesterone, and testosterone, but not HCG-beta levels, were higher in a patient who developed the ovarian hyperstimulation syndrome while undergoing ovulation induction with human gonadotropins than in two other women who also became pregnant after similar treatment without complications. These results suggest that hyperprolactinema, in association with elevated ovarian steroid levels, may be factors in the pathogenesis of this disorder.

Role of laparoscopic salpingostomy in the treatment of hydrosalpinx

OBJECTIVE To determine pregnancy rates after laparoscopic salpingostomy in occlusive distal tubal disease. To evaluate the relative impact of various historical, physical, and operative factors on pregnancy outcome using a multivariate statistical analysis. DESIGN Prospective cohort. SETTING University-affiliated tertiary care infertility clinic. PATIENT(S) One hundred thirty-nine infertile women with occlusive distal tube disease. INTERVENTION(S) Laparoscopic salpingostomy. MAIN OUTCOME MEASURE(S) The occurrence of intrauterine (IUP) and ectopic pregnancy (EP). RESULT(S) The overall IUP and EP rates were 24.5% and 16.5%, respectively. Analysis of historical variables, assessed independently, demonstrated a significantly higher IUP rate with a positive history of gonorrhea and a significantly higher EP rate with a positive history of pelvic inflammatory disease, lack of history of intrauterine device (IUD) usage, or the performance of a bilateral procedure. The logistic regression model to predict intrauterine pregnancy had an overall predictive value of 77.5% and included the following significant variables: secondary infertility, positive history of gonorrhea, and the operative finding of moderate periadnexal adhesions. The logistic regression model to predict ectopic pregnancy had an overall predictive value of 89.0% and included the following significant variables: previous ectopic pregnancy, negative history of IUD use, positive history of PID, a bilateral procedure, and perihepatic adhesions. CONCLUSION(S) Operative laparoscopy may be effective for the correction of hydrosalpinges in selected patients. The probability of achieving an intrauterine or an ectopic pregnancy can be predicted based on combinations of significant variables.

Predictors of success of reversal of sterilization

OBJECTIVE To determine the prognostic variables effecting the successful pregnancy outcome of reversal of sterilization. DESIGN Demographic and clinical history data were collected prospectively. SETTING Division of Infertility and Reproductive Endocrinology, Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, Canada. PATIENTS AND INTERVENTION Between 1981 and 1992, 217 consecutively referred patients underwent reversal of sterilization by a single surgeon using microsurgical techniques. MAIN OUTCOME MEASURES Prognostic variables associated with success were examined using logistic regression and expressed as odds ratios with corresponding 95% confidence intervals. RESULTS Age at reversal was a significant factor with the odds of a successful outcome for those < or = 35 years compared with those > 35 years being 2.3 with a 95% confidence interval of 1.3 to 4.1. There was some evidence that average tubal length as categorized in 2-cm intervals was a significant prognostic factor with the odds of a successful outcome for those with an average length of > 4 cm to those < or = 4 cm being 5.3 with a 95% confidence interval of 1.4 to 20.0. CONCLUSIONS Nonsubjective analysis of the prognostic variables of reversal of sterilization associates only age and tubal length of > 4 cm with intrauterine pregnancy.

A comparative histologic study on the healing process after tissue transection

In a previous study we have demonstrated that tissue transection with a carbon dioxide laser produces less carbon and less foreign body reaction than electromicrosurgery. The purpose of this study was to compare the healing process subsequent to transection of the rat uterine horn with carbon dioxide laser and microscissors. Incisions were histologically examined on postoperative days 0, 4, 10, 14, and 21. The following histologic parameters were assessed: scar width; amount of carbon and necrotic debris; number of polymorphonuclear leukocytes, lymphocytes, histiocytes, and giant cells; and extent of edema, exudate, and collagen in the scar. The results show that cutting with a carbon dioxide laser causes significantly more necrosis and hence more extensive foreign body reaction than cutting with microscissors.

Microsurgical tubocornual anastomosis for occlusive cornual disease: reproducible results without the need for tubouterine implantation

Microsurgical tubocornual anastomosis (TCA) and tubouterine implantation are the two primary operations used to treat proximal tubal occlusion (PTO). Tubouterine implantation usually has been reserved for cases of PTO in which the occlusion spans the entire intramural tubal segment. Yet TCA has proven to be more likely to lead to successful pregnancy than tubouterine implantation. 1-3 In this series, all PTO was treated by TCA. The article compares the reproducibility of results of TCA by two different operators and establishes the usefulness of TCA in all cases of PTO without resort to tubouterine implantation. Fifteen of 26 women achieved viable intrauterine pregnancies, a rate virtually identical to that published earlier by Gomel. Microsurgical TCA can be used to the exclusion of tubouterine implantation to achieve higher pregnancy rates, despite complete intramural occlusion.

Laparoscopic lateral ovarian transposition

OBJECTIVE To determine if the new technique laparoscopic lateral transposition of the ovaries before pelvic radiotherapy for anal canal carcinoma prevents radiation-related ovarian failure. DESIGN A case report. SETTING The operating room of a Canadian teaching hospital. PATIENTS A single patient with anal canal carcinoma, requiring pelvic radiotherapy, who desired preservation of ovarian function. INTERVENTIONS Laparoscopic ovarian transposition to the level of the pelvic brim. MAIN OUTCOME MEASURES Follow-up clinical and laboratory evidence of ovarian failure. RESULTS Initially ovarian failure was confirmed with the appearance of postmenopausal symptoms and the elevation of serum gonadotropins. These symptoms resolved by 8 months after radiotherapy, normal menstrual cycles resumed, and normal FSH levels were detected at that time. CONCLUSIONS The laparoscopic, lateral transposition of this patients ovaries was effective at preventing radiation-related ovarian failure.

Histologic reaction to four synthetic microsutures in the rabbit

Histologic reaction to nylon, polypropylene, polyglactin-910, and polydioxanone microsutures was assessed in the uterine horn of the rabbit. At 24 days after insertion of the microsuture, a marked infiltration of histiocytes was seen around the nylon, polypropylene, and polydioxanone microsutures, whereas the reaction to polyglactin-910 was characterized by the presence of giant cells. At 80 days after insertion of the microsutures, the polydioxanone was almost entirely absorbed and the reaction to polyglactin-910 was minimal. Moderate histiocytic infiltration persisted around the nylon and polypropylene sutures. Fibrosis was also detected around the nylon and polypropylene sutures at 80 days, but not at all around the polydioxanone and polyglactin-910 sutures. We conclude that polydioxanone leaves little or no tissue reaction at 80 days in the uterine horn of the rabbit.

The ascites in the ovarian hyperstimulation syndrome does not originate from the ovary

OBJECTIVE To evaluate the direct ovarian contribution to ascites formation in the ovarian hyperstimulation syndrome (OHSS) in a rabbit model. DESIGN Prospective experimental study. SETTING Research center of a university teaching hospital. PARTICIPANTS New Zealand White rabbits. INTERVENTIONS Both ovaries of the rabbits in the experimental group were enclosed within a pouch developed from the surrounding peritoneum and mesosalpinx by microsurgery. Animals in the control group did not undergo any surgical intervention. Ovarian hyperstimulation was induced by alternate day equine chorionic gonadotropin and intermittent human chorionic gonadotropin (hCG). MAIN OUTCOME MEASURES Degree of ascites formation and the morphological and endocrinologic signs of ovarian hyperstimulation. RESULTS The serial plasma estradiol and progesterone levels, ovarian weights, and ascites response were not statistically different between the two groups. CONCLUSIONS Isolation of both ovaries from the peritoneal cavity does not prevent ascites formation in the OHSS. Increased transudation across extraovarian serosal surfaces contributes to ascites formation in OHSS.

A comparative histologic study on the healing process after tissue transection: II. Carbon dioxide laser and surgical microscissors

In a previous study we have demonstrated that tissue transection with a carbon dioxide laser produces less carbon and less foreign body reaction than electromicrosurgery. The purpose of this study was to compare the healing process subsequent to transection of the rat uterine horn with carbon dioxide laser and microscissors. Incisions were histologically examined on postoperative days 0, 4, 10, 14, and 21. The following histologic parameters were assessed: scar width; amount of carbon and necrotic debris; number of polymorphonuclear leukocytes, lymphocytes, histiocytes, and giant cells; and extent of edema, exudate, and collagen in the scar. The results show that cutting with a carbon dioxide laser causes significantly more necrosis and hence more extensive foreign body reaction than cutting with microscissors.