A Laparoscopic Bipolar Cutting Forceps Can Assist In A Case Of Difficult Vaginal Hysterectomy
difficult; hysterectomy; limited; obese; Obstetrics & Gynecology; vagina
Fenton B W; Hutchings T; Flora R F; Fanning J
Journal of Minimally Invasive Gynecology
2006
2006-07
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1016/j.jmig.2006.04.01" target="_blank" rel="noreferrer noopener">10.1016/j.jmig.2006.04.01</a>
Carboplatin and paclitaxel for the treatment of advanced or recurrent endometrial cancer.
Adult; Aged; Survival; Drug Administration Schedule; Human; Middle Age; Retrospective Design; Neoplasm Recurrence; Antineoplastic Agents; Combined; Kaplan-Meier Estimator; Drug Toxicity; Severity of Illness; Carboplatin – Administration and Dosage; Endometrial Neoplasms – Drug Therapy; Local – Drug Therapy; Paclitaxel – Administration and Dosage
OBJECTIVE: The purpose of this study was to determine the activity and toxicity of carboplatin and paclitaxel (taxol) in the treatment of advanced or recurrent endometrial cancer. STUDY DESIGN: This was a retrospective review of 18 consecutive patients with advanced (stage 4) or recurrent endometrial adenocarcinoma that had been treated with outpatient carboplatin and taxol. Taxol was delivered at 135 mg/m 2 over 3 hours, and carboplatin was delivery at an area under the curve of 5 over 1 hour. Cycles were repeated every 21 days. RESULTS: The overall response rate was 63% with 28% of patients who had a partial response and 35% of patients who had a complete response. Kaplan-Meier test was used to estimate the median survival time of 27 months and the median progression free survival time of 24 months. No patient had neutropenia, thrombocytopenia or grade 3 vomiting, neurosensory toxicity, or renal toxicity. CONCLUSION: Carboplatin and taxol for the treatment of advanced or recurrent endometrial cancer appear to be active regimens with minimal toxicity.
Akram T; Maseelall P; Fanning J
American Journal of Obstetrics & Gynecology
2005
2005-05
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/j.ajog.2004.12.032" target="_blank" rel="noreferrer noopener">10.1016/j.ajog.2004.12.032</a>
Cost-effectiveness analysis of the treatment of large leiomyomas: laparoscopic assisted vaginal hysterectomy versus abdominal hysterectomy.
Adult; Female; Aged; Hysterectomy; Costs and Cost Analysis; Human; Middle Age; Cost Benefit Analysis; Visual Analog Scaling; Health Facility Costs; 80 and Over; Leiomyoma – Surgery; Hysterectomy – Economics; Laparoscopy – Economics; Uterine Neoplasms – Surgery; Vaginal – Economics
OBJECTIVE: The purpose of this study was to perform a cost-effectiveness analysis comparing the treatment of large leiomyomas by laparoscopic assisted vaginal hysterectomy (LAVH) versus abdominal hysterectomy (AH). STUDY DESIGN: Twenty consecutive LAVH were compared to 20 consecutive AH for leiomyoma \textgreater or = 250 g. Hospital costs were obtained through Healthcare cost accounting system. The 6 principles of cost-effectiveness analysis were used. RESULTS: The groups were similar in respect to age, weight, race, medical comorbidities, blood loss, and operative time. Median uterine weight (513 g) was approximately 20% \textgreater for LAVH. Length of stay and pain was significantly less for LAVH. Total hospital cost for AH was approximately 12% less expensive ($4394 vs $5023, P = .18). CONCLUSION: Because of multiple benefits of LAVH versus AH and no significant difference in cost, we believe LAVH is an acceptable treatment for large leiomyoma.
Mittapalli R; Fanning J; Flora R; Fenton BW
American Journal of Obstetrics & Gynecology
2007
2007-05
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/j.ajog.2006.12.029" target="_blank" rel="noreferrer noopener">10.1016/j.ajog.2006.12.029</a>
Digital rectal fecal occult blood screening during gynecologic examination
cancer; Obstetrics & Gynecology; occult blood screening; pelvic examination
Objective: The purpose of this study was to test the feasibility of digital rectal fecal occult blood screening during pelvic examination. Study design: We reviewed the data for 232 consecutive women who underwent digital rectal fecal occult blood screening during routine pelvic examination and who had had at least 1-year of follow-up visits: 59% of the women were followed for gynecologic cancer, and 41% of the women were followed for benign gynecologic disease. The median age was 62 years. Patients with positive digital rectal fecal occult blood screening were sent for gastroenterologic examination. Results: Sixteen of 232 patients (7%) had a positive digital rectal fecal occult blood screening result. On gastroenterologic examination, 5 of the 16 patients (31%) were found to have disease (2 polyps, 1 diverticular disease, 2 radiation proctitis). At 1-year follow-up, no patient had colon cancer. Conclusion: Until better compliance can be obtained with home stool sample fecal occult blood testing, we recommend a larger study of digital rectal fecal occult blood screening during gynecologic examination to verify our results. (C) 2004 Elsevier Inc. All rights reserved.
Willis F L; Fanning J
American Journal of Obstetrics and Gynecology
2004
2004-05
Journal Article
<a href="http://doi.org/10.1016/j.ajog.2004.01.072" target="_blank" rel="noreferrer noopener">10.1016/j.ajog.2004.01.072</a>
FeasibiLity of laparoscopic debulking with electrosurgical loop excision procedure and argon beam coagulator at recurrence in patients with previous laparotomy debulking
2nd; debulking; laparoscopy; model; Obstetrics & Gynecology; ovarian-cancer; ovarian-cancer
Objectives: Our purpose is to assess the feasibility and success of laparoscopic ovarian debulking with electrosurgical loop excision procedure (LEEP) and argon beam coagulator (ABC). Methods: Thirty-six consecutive asymptomatic patients with chemosensitive stage III or IV ovarian cancer who had undergone prior laparotomy debulking and chemotherapy, underwent laparoscopic debulking at the time of elevated CA 125. Preoperative abdominal/pelvic computed tomography was negative. Operative laparoscopy was performed through an open technique in the left upper quadrant. Tumors were debulked laparoscopically by using the LEEP and the ABC. Results: Of 36 patients, 34 (94%) underwent successful laparoscopic debulking without requiring laparotomy. Of 34 patients, 32 (94%) had all visible disease resected at laparoscopy; 6% had surgical complications. Median time for surgery was 2.6 hours, median blood loss 70 mL, and median hospital stay 1 day. Seventy-four percent had a complete response after laparoscopic debulking and chemotherapy with a median progression free survival of 1.1 years. Conclusion: We present the first report of laparoscopic ovarian debulking using LEEP and ABC after elevation of CA 125 in chemosensitive, asymptomatic patients who had undergone prior laparotomy debulking. Laparoscopic debulking appears feasible (94%), successful (94%), and safe (6% complications). Prospective randomized trials are needed to determine the optimal management of asymptomatic, chemosensitive patients with elevated CA 125. (C) 2004 Elsevier Inc. All rights reserved.
Trinh H; Ott C; Fanning J
American Journal of Obstetrics and Gynecology
2004
2004-05
Journal Article
<a href="http://doi.org/10.1016/j.ajog.2004.02.034" target="_blank" rel="noreferrer noopener">10.1016/j.ajog.2004.02.034</a>
Findings From A Mineral Density Perimenopausal 10-year Follow-up Of Bone In Competitive Runners
bone mineral density; exercise; follow-up studies; hip; Obstetrics & Gynecology; osteoporosis prevention; perimenopause; postmenopausal women; running; spine
Fanning J; Larrick L; Weinstein L; Horrigan T J; Marcotte M P; Flora R F
Journal of Reproductive Medicine
2007
2007-10
Journal Article or Conference Abstract Publication
n/a
Initial Results Of A Modified Proximal Bladder Neck Sling In Patients At Higher-risk For Failure
Obstetrics & Gynecology
Flora R F; Miller D M; Babbitt T; Fanning J
Obstetrics and Gynecology
2006
2006-04
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1097/00006250-200604001-00246" target="_blank" rel="noreferrer noopener">10.1097/00006250-200604001-00246</a>
Robotic radical hysterectomy.
Adult; Female; Human; Treatment Outcomes; Robotics; Carcinoma – Surgery; Cervix Neoplasms – Surgery; Hysterectomy – Methods
OBJECTIVE: Advanced laparoscopic procedures are increasing being used in gynecologic surgery. The da Vinci robotic system (Intuitive Surgical Corporation, Sunnyvale, CA) can further augment laparoscopic surgery. We describe our initial experience using the da Vinci robotic system to perform radical hysterectomy. STUDY DESIGN: Twenty consecutive patients with primary stage IB-IIA cervical carcinoma underwent class 3 radical hysterectomy with the use of the da Vinci robotic system. Median age was 44 years, median weight was 69.9 kg, 65% of patients had medical comorbidity, and 40% had prior abdominal surgery. RESULTS: All 20 patients successfully underwent robotic radical hysterectomy. Median operative time was 6.5 hours (3.5-8.5 hours) and median blood loss was 300 mL. All patients were discharged on the first day after surgery. At median follow-up of 2 years (0.6-3 years), 90% of patients are alive and disease free. CONCLUSION: We report the first series of robotic radical hysterectomy for early stage cervical cancer. All cases were successfully performed robotically with minimal complications and all patients were discharged on postoperative day 1.
Fanning J; Fenton B; Purohit M
American Journal of Obstetrics & Gynecology
2008
2008-06
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/j.ajog.2007.11.002" target="_blank" rel="noreferrer noopener">10.1016/j.ajog.2007.11.002</a>
The Also Course For Use In Patient Safety And As A Competency-based Orientation For Interns
Obstetrics & Gynecology
Flora R F; Rich M; Siegfried J; Fanning J
Obstetrics and Gynecology
2006
2006-04
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1097/00006250-200604001-00185" target="_blank" rel="noreferrer noopener">10.1097/00006250-200604001-00185</a>