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Tseng D, Hunter J. Surgery of the Biliary Tract. ZAKIM AND BOYER'S HEPATOLOGY 2006:1201-1217. [DOI: 10.1016/b978-1-4160-3258-8.50070-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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52
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Blum A, Tatour I, Monir M, Khazim K, Simsolo C. Gallstones in pregnancy and their complications: postpartum acute pancreatitis and acute peritonitis. Eur J Intern Med 2005; 16:473-6. [PMID: 16275538 DOI: 10.1016/j.ejim.2005.03.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2004] [Revised: 03/03/2005] [Accepted: 03/04/2005] [Indexed: 11/25/2022]
Affiliation(s)
- Arnon Blum
- Department of Internal Medicine A, Poria Medical Center, Lower Galilee 15208, Israel.
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Cohen-Kerem R, Railton C, Oren D, Lishner M, Koren G. Pregnancy outcome following non-obstetric surgical intervention. Am J Surg 2005; 190:467-73. [PMID: 16105538 DOI: 10.1016/j.amjsurg.2005.03.033] [Citation(s) in RCA: 234] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2004] [Revised: 03/15/2005] [Accepted: 03/15/2005] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To evaluate the effects of non-obstetric surgical procedures on maternal and fetal outcome. METHODS A systematic review of all English language literature. RESULTS Fifty-four papers met the inclusion criteria. The overall number of patients reported was 12,452. Reported maternal death was rare at .006%. The miscarriage rate was 5.8%; however, this number is difficult to interpret since matched controls were not available. The rate of elective termination of pregnancy following non-obstetric surgery was 1.3%. The rate of premature labor induced by non-obstetric surgical intervention was 3.5% and this was noted specifically following appendectomy versus other types of interventions (P<.001). A total of 2.5% of pregnancies resulted in fetal loss. The prematurity rate was 8.2%. The rate of major birth defects among women who underwent non-obstetric surgical intervention in the first trimester was 3.9%. Sub-analysis of papers reporting on appendectomy during pregnancy revealed a high rate (4.6%) of surgery-induced labor. Fetal loss associated with appendectomy was 2.6%; however, this rate was increased when peritonitis was present (10.9%). CONCLUSIONS Modern surgical and anesthesia techniques appear to diminish the rate of maternal death. Surgery in the first trimester does not appear to increase major birth defects and should not be delayed when indicated. Acute appendicitis with peritonitis is associated with higher risk to the mother and fetus.
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Affiliation(s)
- Raanan Cohen-Kerem
- Motherisk Program, Division of Clinical Pharmacology and Toxicology, Department of Pediatrics, University of Toronto, Hospital for Sick Children, Toronto, Ontario, Canada M5G 1X8
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54
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Abstract
The decision for surgical intervention during pregnancy should be interdisciplinary and include all aspects of prenatal care. The risk of surgery to mother and fetus must be calculated and weighed against the disadvantages of other, nonradical methods. If there is no danger to the mother, the highest priority in all therapeutic considerations is the fetus and its development. The greatest threat to the fetus exists during the first trimester. In case surgery cannot be postponed till after birth, they should be done if possible during the 4th to 6th months of pregnancy, not the first trimester. In case of danger to the mother, necessary surgery must be performed any time during the pregnancy. Once extrauterine fetal survival is possible (the 24th or 25th week of pregnancy), danger to the mother and the child's mortality and morbidity of the various options must be carefully weighed for both premature delivery and continued pregnancy. Due to the problems of prematurity, any surgery during pregnancy should be carried out only in perinatal clinics outfitted with neonatologic intensive care units.
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Affiliation(s)
- H Lang
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsklinikum Essen.
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55
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Jabbour N, Brenner M, Gagandeep S, Lin A, Genyk Y, Selby R, Mateo R. Major Hepatobiliary Surgery during Pregnancy: Safety and Timing. Am Surg 2005. [DOI: 10.1177/000313480507100416] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Hepatobiliary disease, although rare, may present during pregnancy with potential complications for mother and fetus. We present two cases of choledochal cysts and one case of a hepatic adenoma diagnosed in gravid patients. All three patients had acute events or failed medical management and were successfully treated with open resection, excision, or reconstruction during the second or third trimesters of pregnancy without requiring blood transfusions or tocolytic therapy. Although conservative treatment may be indicated in select patients due to the risk of underlying disease, we recommend surgical treatment preferably in the second trimester. With diligent intra- and postoperative management, pregnant patients can safely proceed with major hepatobiliary surgery.
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Affiliation(s)
- Nicolas Jabbour
- Division of Hepatobiliary/Pancreatic Surgery and Transplant Surgery, University of Southern California–University Hospital, Los Angeles, California
| | - Megan Brenner
- Division of Hepatobiliary/Pancreatic Surgery and Transplant Surgery, University of Southern California–University Hospital, Los Angeles, California
| | - Singh Gagandeep
- Division of Hepatobiliary/Pancreatic Surgery and Transplant Surgery, University of Southern California–University Hospital, Los Angeles, California
| | - Abe Lin
- Division of Hepatobiliary/Pancreatic Surgery and Transplant Surgery, University of Southern California–University Hospital, Los Angeles, California
| | - Yuri Genyk
- Division of Hepatobiliary/Pancreatic Surgery and Transplant Surgery, University of Southern California–University Hospital, Los Angeles, California
| | - Rick Selby
- Division of Hepatobiliary/Pancreatic Surgery and Transplant Surgery, University of Southern California–University Hospital, Los Angeles, California
| | - Rodrigo Mateo
- Division of Hepatobiliary/Pancreatic Surgery and Transplant Surgery, University of Southern California–University Hospital, Los Angeles, California
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Lu EJ, Curet MJ, El-Sayed YY, Kirkwood KS. Medical versus surgical management of biliary tract disease in pregnancy. Am J Surg 2005; 188:755-9. [PMID: 15619495 DOI: 10.1016/j.amjsurg.2004.09.002] [Citation(s) in RCA: 106] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2004] [Revised: 09/11/2004] [Accepted: 09/11/2004] [Indexed: 12/18/2022]
Abstract
BACKGROUND The management of symptomatic cholelithiasis during pregnancy remains controversial. We compared outcomes after medical versus surgical management of biliary tract disease in pregnant patients. METHODS We reviewed the clinical course of patients with symptomatic cholelithiasis during pregnancy from 1992 to 2002 at two university hospitals. RESULTS Seventy-six women with 78 pregnancies were admitted with biliary tract disease. Of the 63 women who presented with symptomatic cholelithiasis, 10 underwent surgery while pregnant. There were no deaths, preterm deliveries, or intensive care unit admissions. Fifty-three patients were treated medically. Their clinical courses were complicated by symptomatic relapse in 20 patients (38%), by labor induction to control biliary colic (8 patients), and by premature delivery in 2 patients. Each relapse in the medically managed group accounted for an additional five days in hospital. CONCLUSION Surgical management of symptomatic cholelithiasis in pregnancy is safe, decreases days in hospital, and reduces the rate of labor induction and preterm deliveries.
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Affiliation(s)
- Erika J Lu
- Department of Surgery, University of California-San Francisco, 533 Parnassus Avenue, Room U-372, San Francisco, CA 94143-0790, USA
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Rosa Junior A, Trindade MRM, Shemes TF, Tavares WC. Influência da abordagem cirúrgica (videolaparoscopia versus laparotomia) na gestação de coelhas prenhes. Acta Cir Bras 2003. [DOI: 10.1590/s0102-86502003000400014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Estudar a influência de duas abordagens cirúrgicas na gestação de coelhas. MÉTODOS: Sessenta coelhas prenhes, divididas em três grupos: controle (C), laparotomia(L) e videolaparoscopia (V) foram observadas durante a evolução de suas gestações (duração da gestação, mortalidade fetal e peso dos láparos).Amostras sangüínea foram colhidas para análise laboratorial. RESULTADOS: A duração da gestação (31,6 ± 0,99 vs. 31,8 ± 1,8 vs. 31,3 ± 2,24 dias), a mortalidade fetal (1,0 ± 2,5 vs. 1,9 ± 2,7 vs. 1,4 ± 2,0 láparos) e o peso dos láparos vivos no primeiro dia de vida (48,7 ± 11,3 vs. 51,5 ± 11,9 vs. 48,3 ± 8,2 g) nos grupos C, L e V, respectivamente, não apresentaram diferenças estatísticas significativas (p>0,05). Nas análises sangüíneas (pré e pós) dos grupos L e V, observou-se diferença estatística (p>0,05) em relação às medidas do hematócrito (34,4 ± 3,1 e 33,1 ± 2,8 vs. 34,2 ± 3,2 e 30,3 ± 3,7 g/dl), do pH (7,4 ± 0,1 e 7,4 ± 0,1 vs. 7,5 ± 0 e 7,3 ± 0,1), do paCO2 ( 30,8 ± 5,1 e 40,7 ± 8,2 vs. 32 ± 3,7 e 53,5 ± 18,4). CONCLUSÃO: A videolaparoscopia é um procedimento seguro no período gestacional de coelhas.
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Abstract
Gastrointestinal disorders during pregnancy that require surgery often mimic the symptoms and signs of conditions that do not require surgery. Anatomic and physiologic changes of pregnancy can alter the usual clinical presentation of gastrointestinal disorders that require surgery. These alterations can be a challenge to diagnosis. Prompt treatment is critical to successful management. Most elective and urgent operations can be performed during pregnancy with minimal maternal and fetal risk. The condition of the mother should always take priority because proper treatment of the mother usually benefits the fetus as well.
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Affiliation(s)
- Mark A Malangoni
- Department of Surgery, Case Western Reserve University, MetroHealth Medical Center Campus, 2500 MetroHealth Drive, H-914, Cleveland, OH 44109, USA.
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Affiliation(s)
- Mazen Bisharah
- Department of Obstetrics and Gynecology, McGill University, Montreal, Quebec, Canada
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Abstract
Numerous medical, surgical, psychiatric, gynecologic, and obstetric disorders can cause abdominal pain during pregnancy. The patient history, physical examination, laboratory data, and radiologic findings usually provide the diagnosis. The pregnant woman has physiologic alterations that affect the clinical presentation, including atypical normative laboratory values. Abdominal ultrasound is generally the recommended radiologic imaging modality; roentgenograms are generally contraindicated during pregnancy because of radiation teratogenicity. Concerns about the fetus limit the pharmacotherapy. Maternal and fetal survival have recently increased in many life-threatening conditions, such as ectopic pregnancy, appendicitis, and eclampsia, because of improved diagnostic technology, better maternal and fetal monitoring, improved laparoscopic technology, and earlier therapy.
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Affiliation(s)
- Mitchell S Cappell
- Division of Gastroenterology, Department of Medicine, Woodhull Medical Center, 760 Broadway Avenue, Brooklyn, NY 11206, USA
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Affiliation(s)
- Adrian A Indar
- Section of Gastrointestinal Surgery, University Hospital Nottingham, Nottingham NG7 2UH
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Abstract
PURPOSE OF REVIEW The purpose of this review is to evaluate the indications, and the safety and efficacy of operative laparoscopy in pregnancy with a particular attention to the pregnancy outcome. RECENT FINDINGS Hemodynamics changes during laparoscopic surgery in pregnancy are similar to those observed in the nonpregnant state. The procedure appears to be safe and reduces hospital admissions and frequency of premature labor. The safest time to perform laparoscopic surgery in pregnancy is at the second trimester. However, it can be complicated by injury to the gravid uterus and pregnancy loss. This is illustrated by a recent report of accidental gas insufflation into the amniotic cavity leading to the fetal loss. SUMMARY The most common indications of laparoscopy in pregnancy are cholelithiasis, appendicitis, persistent ovarian cyst and adnexal torsion. In general, it is associated with a good maternal and fetal outcome. The occurrence of a miscarriage, premature labor or fetal death appears to be related to the underlying pathology, independent of the operative intervention. Due to the displacement of the appendix by the gravid uterus and the physiologic elevation of white blood cell count in pregnancy, diagnosis of appendicitis in pregnancy can be delayed with its sequelle. In one report, the incidence of fetal loss is 1.5% in uncomplicated appendicitis and 35% in the presence of ruptured appendicitis. Similarly, the fetal loss rate in uncomplicated cholecystectomy is 4%, but the fetal mortality in gallstone pacreatitis could be up to 60%. Laparoscopy in pregnancy should be performed with utmost care. In the second trimester of pregnancy, open laparoscopic approach is strongly recommended.
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Affiliation(s)
- Haya Al-Fozan
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, McGill University, Montreal, Quebec, Canada
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Abstract
Minimally invasive surgery is being performed more frequently in pregnant patients. Numerous published reports have documented the safety and advantages of laparoscopic cholecystectomy and laparoscopic appendectomy during pregnancy. Pregnancy is associated with a variety of changes in the respiratory and cardiovascular systems, which make the parturient undergoing laparoscopic surgery particularly susceptible to hypoxia, hypercarbia and hypotension. This chapter provides a review of those physiological changes of pregnancy of particular concern for anaesthesiologists, and of the physiological responses to intra-abdominal carbon dioxide insufflation, not only in healthy patients, but also in the altered physiological state associated with pregnancy. We also describe our approach to anaesthetic management for minimally invasive surgery during pregnancy. With appropriate precautions, including vigilant monitoring and anticipation and treatment of the potential adverse effects of carbon dioxide pneumoperitoneum, anaesthesiologists may provide safe care for these patients, and pregnant women can benefit from the advantages of minimally invasive surgery.
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Affiliation(s)
- Richard A Steinbrook
- Department of Anesthesia and Critical Care, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA
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Visser BC, Glasgow RE, Mulvihill KK, Mulvihill SJ. Safety and timing of nonobstetric abdominal surgery in pregnancy. Dig Surg 2002; 18:409-17. [PMID: 11721118 DOI: 10.1159/000050183] [Citation(s) in RCA: 113] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND/AIMS Abdominal disorders occurring during pregnancy pose special difficulties in diagnosis and management to the obstetrician and surgeon. The advisability of nonobstetric abdominal surgery during pregnancy is uncertain. Our objective was to evaluate the safety and timing of abdominal surgery during pregnancy. METHODS We retrospectively reviewed 77 consecutive gravid patients undergoing nonobstetric abdominal surgery from 1989 to 1996 at an urban academic medical center and a large affiliated community teaching hospital. Medical records were evaluated for clinical presentation, perioperative management, preterm labor, and maternal and fetal morbidity and mortality. RESULTS The rate of nonobstetric abdominal surgery during pregnancy was 1 in every 527 births. Among the 77 patients, the indications for surgery were adnexal mass (42%), acute appendicitis (21%), gallstone disease (17%) and other (21%). There was no maternal or fetal loss or identifiable neonatal birth defect. Preterm labor occurred in 26% of the second-trimester patients and 82% of the third-trimester patients. Preterm labor was most common in patients with appendicitis and after adnexal surgery. Preterm delivery occurred in 16% of the patients, but appeared to be directly related to the abdominal surgery in only 5%. CONCLUSION Surgery during the first or second trimester is not associated with significant preterm labor, fetal loss or risk of teratogenicity. Surgery during the third trimester is associated with preterm labor, but not fetal loss.
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Affiliation(s)
- B C Visser
- Department of Surgery, University of California at San Francisco, San Francisco, Calif, USA
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65
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Abstract
BACKGROUND There are few reports about urinary retention rate after elective cholecystectomy. We designed a prospective study to assess the problem. METHODS A total of 121 female and 19 male patients were included in the study with a prospective study protocol. Laparoscopic cholecystectomy was performed in 107 patients and open cholecystectomy in 33 patients. RESULTS Neither gender nor age affected rate. Postoperative micturition difficulty developed in 10 patients. Of these patients, 9 could void with helping measures, and only 1 needed catheterization. Only 1 patient who underwent laparoscopic surgery required catheterization (0.7%). The open approach caused a higher incidence of postoperative micturition difficulty than did the laparoscopic approach (15.2% versus 4.7%; P = 0.04). Only large amounts of perioperative fluid administration and meperidine use had statistically significant effects on micturition problems. CONCLUSIONS Urinary retention is a rare complication after elective cholecystectomy. Helping measures are very effective and should be tried before inserting a urethral catheter.
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Affiliation(s)
- H Kulaçoğlu
- Department of Surgery, Ankara Numune Teaching and Research Hospital, Ankara, Turkey
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Edwards RK, Ripley DL, Davis JD, Bennett BB, Simms-Cendan JS, Cendan JC, Stone IK. Surgery in the pregnant patient. Curr Probl Surg 2001; 38:213-90. [PMID: 11296493 DOI: 10.1067/msg.2001.112768] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- R K Edwards
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Florida College of Medicine, Gainesville, Florida, USA
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Shay DC, Bhavani-Shankar K, Datta S. Laparoscopic surgery during pregnancy. ANESTHESIOLOGY CLINICS OF NORTH AMERICA 2001; 19:57-67. [PMID: 11244920 DOI: 10.1016/s0889-8537(05)70211-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Important factors in laparoscopic surgery during pregnancy are listed here: There is a risk of aspiration because of a hormonally induced decrease in lower esophageal sphincter tone and mechanical effects of a gravid uterus. Supine hypotensive syndrome because of aortocaval compression can be a major problem. Pneumoperitoneum during pregnancy results in more pronounced restrictive lung physiology. Avoid hypoxemia, hypotension, acidosis, hypoventilation, and hyperventilation. No anesthetic drugs have been proven to be teratogenic in humans. Surgery during pregnancy is associated with the delivery of low birth-weight, growth-restricted babies. Standard noninvasive monitoring could be sufficient for healthy parturients undergoing laparoscopic surgery. Fetal heart rate and uterine activity should be monitored pre- and postoperatively. Laparoscopic surgery during pregnancy is safe, has multiple advantages over open techniques, can be performed during all gestational ages, and does not require invasive or continuous fetal and uterine monitoring for routine cases; however, the anesthesiologist must be aware of the physiologic changes associated with pregnancy and the effects of positioning, and the consequences of CO2 pneumoperitoneum on the parturient and the fetus. Although no special monitoring is required in healthy parturients, each case must be assessed carefully, and invasive monitoring could be required in those patients with significant cardiovascular or pulmonary disease. Fetal heart rate should be assessed preoperatively and postoperatively. Surveillance with an external tocodynamometer should be instituted immediately preoperatively and postoperatively and tocolytic agents instituted if documented or perceived uterine activity is detected.
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Affiliation(s)
- D C Shay
- Department of Anesthesiology, Perioperative and Pain Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Curet MJ. Special problems in laparoscopic surgery. Previous abdominal surgery, obesity, and pregnancy. Surg Clin North Am 2000; 80:1093-110. [PMID: 10987026 DOI: 10.1016/s0039-6109(05)70215-2] [Citation(s) in RCA: 102] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Previous surgery, obesity, and pregnancy should no longer be considered contraindications to laparoscopic surgery. Surgeons should exercise good judgement in patient selection, use meticulous surgical techniques, and prepare thoroughly for the planned procedure. Patients and surgeons should be aware of increased conversion rates. With these caveats in mind, these patients can still experience the advantages of minimally invasive surgery without increased risks.
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Affiliation(s)
- M J Curet
- Department of Surgery, University of New Mexico School of Medicine, Albuquerque, USA
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Women's Health LiteratureWatch. JOURNAL OF WOMEN'S HEALTH & GENDER-BASED MEDICINE 1999; 8:999-1008. [PMID: 10534304 DOI: 10.1089/jwh.1.1999.8.999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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