Publications (17) View all
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Article: [Laparoscopic uterus sparing treatment of uterine fibroids].
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ABSTRACT: Objective: To report up-to date knowledge on laparoscopic, uterine sparing treatment of uterine fibroids.Study design: Review.Setting: Uterine Fibroids Center, Department of Obstetrics and Gynecology, Charles University, Prague.Methods: Analysis of our clinical experience and available literature resources.Results: The management of uterine fibroids depends on the symptoms, location, and size of fibroids and on the reproductive plans of the patient. The surgical treatment has changed from laparotomy to minimally invasive surgery. In general, laparoscopic myomectomy (LM) is considered the best option in symptomatic patients with pregnancy plans. The laparoscopic approach is associated with lower postoperative morbidity as well as lower incidence of massive postoperative adhesion formation compared to laparotomy. The limitation of laparoscopic myomectomy is the size and the number of fibroids but also the location and the accessibility for the laparoscopic suturing. Laparoscopic uterine artery occlusion (LUAO) represents one of the alternatives to LM in patients with multiple small myomas or in patients with fibroids in unfavorable location. LUAO may be advantageously used prior to LM in order to reduce peroperative blood loss or to prevent the persisting fibroids from growing. However there is no universal treatment of uterine fibroids in fertile patients and in each single patient the indication and surgical method should be thoroughly considered. Key words: uterine fibroid, myomectomy, laparoscopy, uterine artery occlusion.Ceska gynekologie / Ceska lekarska spolecnost J. Ev. Purkyne 08/2012; 77(4):326-30. -
Article: [Office hysteroscopy - management and results].
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ABSTRACT: Objective: Sum up the knowledge about office hysteroscopy.Type of study: Review of literature and our own experience.Setting: Department of Gynaecology and Obstetrics, First Faculty of Medicine, Charles University Prague and General Teaching Hospital Prague.Methods: Data from scientific literature and 10 years of our own experience with office hysteroscopy.Conclusions: Hysteroscopy provides optical evaluation of uterine cavity. Most of the benign intrauterine organics pathologies could be managed in a outpatient setting with a vaginoscopic approach without any anaesthesia and analgesia. Using that approach we can recommend to perform endometrial target biopsy, resection of endometrial polyps up to 1.5 cm and pedunculated submucous myomas up to 1 cm as well as resection of filmy intrauterine adhesions. Method is comfotable for well managed patients and practically complication-free. Key words: office hysteroscopy, vaginoscopic approach, endometrial biopsy, endometrial polyp, submucous myoma, intrauteine adhesions.Ceska gynekologie / Ceska lekarska spolecnost J. Ev. Purkyne 08/2012; 77(4):308-13. -
Article: [Laparoscopic lymph-node dissection in gynecological surgery].
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ABSTRACT: Objective: To analyze our experience with transperitoneal laparoscopic dissection of lymphatic nodes in women with gynecologic malignancies.Study design: Retrospective clinical study.Setting: Center of gynecologic endoscopy and minimally invasive surgery; Department of Obstetrics and Gynecology, General Faculty Hospital and 1st Medical Faculty in Prague.Methods: Analysis of data from our laparoscopic procedures in the years 2006-2011. The following procedures have been included: systematic pelvic lymphadenectomy (PLN), paraaortic lymphadenectomy (PALN), pelvic sentinel node excision, focused dissection of bulky lymphatic nodes from pelvis or paraaortic area.Results: We performed 177 primarily laparoscopic procedures pointed at dissection of pelvic and/or paraaortic lymph-nodes. The mean operating time and the mean number of lymph-nodes was 82 minutes and 26.5 nodes in patients with PLN, and 75 minutes and 12.5 nodes in patients with PALN. The overall rate of laparo-conversions was 4.5%; the incidence of major complications was 6.8% and of serious bleeding 5.6%. Laparoscopic lymphadenectomy could not be performed or completed in 2.3% of cases. Complications were more frequently associated with PALN than with PLN.Summary: Laparoscopic approach to PLN and PALN is feasible in vast majority of patients. It provides adequate earnings of the lymphatic nodes, tolerable operative time, and relatively low complication rate. The highly experienced operation team for especially high infrarenal PALN is necessary. Key words: laparoscopy, pelvic lymphadectomy, paraaortic lymphadectomy.Ceska gynekologie / Ceska lekarska spolecnost J. Ev. Purkyne 08/2012; 77(4):320-6. -
Article: [Genetic factors in etiology of uterine fibroids].
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ABSTRACT: Uterine fibroids are the most common pelvic tumors in women of reproductive age. The cause of development of uterine fibroids is still unknown, however recent cytogenetic and genetic studies led to advancement in understanding of etiology of these tumors. In accordance with the latest findings up to 40% of uterine fibroids bear some chromosomal abnormalities. The most common are aberration of chromosomes 6, 7, 12 and 14. Uterine fibroids have been linked to mutations of fumarate hydratase (FH) gene. Germline mutations in FH gene cause autosomal dominant syndromes MCUL1 (multiple cutaneous and uterine leiomyomata) and HLRCC (hereditary leiomyomatosis and renal cell cancer), characterized by multiple uterine and cutaneous leiomyomata and renal cancer. This paper reviews recent findings in the role of genetic in etiology of uterine fibroids.Ceska gynekologie / Ceska lekarska spolecnost J. Ev. Purkyne 02/2012; 77(1):58-60. -
Article: [Methods using ischemia in uterine fibroids treatment].
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ABSTRACT: To compare principle, advantages, disadvantages, and risks of conservative (i.e. uterus saving) methods of treatment of uterine fibroids, which are focused on elimination or reduction of their perfusion. To contribute to better understanding of this dynamic topic between gynecologists, especially in the field of appropriate indication criteria. Review article. Department of Obstetrics and Gynecology, Charles University and General Faculty Hospital, Prague. Analysis of literature and our clinical experience. Within the last decade the spectrum of treatment of uterine fibroids has broaden with methods causing ischemia of fibroids. These include the minimally invasive surgical therapy (laparoscopic occlusion of uterine arteries /LUAO/ and Doppler assisted laparoscopic myolysis) and radiological catheterization treatment (uterine artery embolization, UAE). Compared to foreign countries where UEA is mainly used in perimenopausal women, we focus on the group of patients with further fertility plans. It is necessary to stress that in spite of the number of affirmative experiences with the new techniques of uterine fibroid treatment in both the indication groups (women with or without further fertility plans) these methods still remain an alternative to standard surgical treatment, because both myomectomy and hysterectomy can be performed by minimally invasive techniques in the majority of women. This review is also focused on the specific risks of the particular methods as well as on their mechanism of action which may dramatically differ despite of some analogies.Ceska gynekologie / Ceska lekarska spolecnost J. Ev. Purkyne 08/2009; 74(4):262-8.
