Four year experience in laparoscopic dissection of intact ovarian dermoid cysts.

BACKGROUND: Intraperitoneal spillage of dermoid cyst content, if not followed immediately by abundant peritoneal lavage, can cause a chemical peritonitis with subsequent adhesion formation. STUDY DESIGN: We performed an open clinical study in a university hospital. Forty-four consecutive ovarian dermoid cysts were removed intact from 40 premenopausal women operated on between October 1993 and December 1997. The laparoscopic technique included: 1) creation of a cleavage plane between the cyst and the ovary; 2) dissection of the cyst by a combination of water, scissors, and gravity without direct traction on the cyst; and 3) extraction of the cyst after its placement inside a laparoscopic bag. RESULTS: The mean cyst diameter was 6.5 cm (range 3 to 12 cm). Mean operating time was 125 minutes (range 50 to 180 minutes). All patients were discharged within 48 hours. The cysts were dissected completely intact and were extracted without spillage in the abdominal cavity in all cases. Operative followup was available in 15 of the 40 patients; mild adhesions were found on the treated ovary in 3 (20%). CONCLUSIONS: It is always possible to prevent rupture and spillage of dermoid cysts during laparoscopic operations, but this approach is time consuming and needs expert surgical technique.

Experience of total wrist arthroplasty with silastic implants plus grommets.

The experience with radiocarpal joint reconstruction in rheumatoid arthritis using silastic implants and titanium grommets is reported. Forty-one implants were placed in 36 patients from 1986 to 1992, with a followup of 32 implants in 29 patients ranging from 2.5 years to 8 years. After a brief review of the crucial points of the procedure, including indications and surgical technique, the results were examined using a protocol derived from the one proposed in 1988 for an international multicenter study. The procedure, when correct indications are selected and correct surgical steps are performed, allows predictable results with a satisfying recovery of wrist function. Preservation of wrist function through the years seems enhanced by titanium grommets.