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Aruparayil N, Bolton W, Mishra A, Bains L, Gnanaraj J, King R, Ensor T, King N, Jayne D, Shinkins B. Clinical effectiveness of gasless laparoscopic surgery for abdominal conditions: systematic review and meta-analysis. Surg Endosc 2021; 35:6427-6437. [PMID: 34398284 PMCID: PMC8599349 DOI: 10.1007/s00464-021-08677-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 08/07/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND In high-income countries, laparoscopic surgery is the preferred approach for many abdominal conditions. Conventional laparoscopy is a complex intervention that is challenging to adopt and implement in low resource settings. This systematic review and meta-analysis evaluate the clinical effectiveness of gasless laparoscopy compared to conventional laparoscopy with CO2 pneumoperitoneum and open surgery for general surgery and gynaecological procedures. METHODS A search of the MEDLINE, EMBASE, Global Health, AJOL databases and Cochrane Library was performed from inception to January 2021. All randomised (RCTs) and comparative cohort (non-RCTs) studies comparing gasless laparoscopy with open surgery or conventional laparoscopy were included. The primary outcomes were mortality, conversion rates and intraoperative complications. SECONDARY OUTCOMES operative times and length of stay. The inverse variance random-effects model was used to synthesise data. RESULTS 63 studies were included: 41 RCTs and 22 non-RCTs (3,620 patients). No procedure-related deaths were reported in the studies. For gasless vs conventional laparoscopy there was no difference in intraoperative complications for general RR 1.04 [CI 0.45-2.40] or gynaecological surgery RR 0.66 [0.14-3.13]. In the gasless laparoscopy group, the conversion rates for gynaecological surgery were high RR 11.72 [CI 2.26-60.87] when compared to conventional laparoscopy. For gasless vs open surgery, the operative times were longer for gasless surgery in general surgery RCT group MD (mean difference) 10 [CI 0.64, 19.36], but significantly shorter in the gynaecology RCT group MD - 18.74 [CI - 29.23, - 8.26]. For gasless laparoscopy vs open surgery non-RCT, the length of stay was shorter for gasless laparoscopy in general surgery MD - 3.94 [CI - 5.93, - 1.95] and gynaecology MD - 1.75 [CI - 2.64, - 0.86]. Overall GRADE assessment for RCTs and Non-RCTs was very low. CONCLUSION Gasless laparoscopy has advantages for selective general and gynaecological procedures and may have a vital role to play in low resource settings.
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Affiliation(s)
- N Aruparayil
- Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK. .,NIHR Global Health Research Group, Surgical Technologies, Clinical Sciences Building, Level 7, Room 7.19, Leeds, LS9 7TF, UK.
| | - W Bolton
- Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK.,NIHR Global Health Research Group, Surgical Technologies, Clinical Sciences Building, Level 7, Room 7.19, Leeds, LS9 7TF, UK
| | - A Mishra
- Maulana Azad Medical College, Delhi, India
| | - L Bains
- Maulana Azad Medical College, Delhi, India
| | | | - R King
- Nuffield Centre for International Health and Development, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.,NIHR Global Health Research Group, Surgical Technologies, Clinical Sciences Building, Level 7, Room 7.19, Leeds, LS9 7TF, UK
| | - T Ensor
- Nuffield Centre for International Health and Development, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.,NIHR Global Health Research Group, Surgical Technologies, Clinical Sciences Building, Level 7, Room 7.19, Leeds, LS9 7TF, UK
| | - N King
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - D Jayne
- Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK.,NIHR Global Health Research Group, Surgical Technologies, Clinical Sciences Building, Level 7, Room 7.19, Leeds, LS9 7TF, UK
| | - B Shinkins
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.,NIHR Global Health Research Group, Surgical Technologies, Clinical Sciences Building, Level 7, Room 7.19, Leeds, LS9 7TF, UK
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A different technique in gasless, laparoendoscopic, single-site myomectomy. Surg Endosc 2020; 35:5508-5514. [PMID: 33315132 PMCID: PMC8437916 DOI: 10.1007/s00464-020-08044-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 09/22/2020] [Indexed: 11/18/2022]
Abstract
Background The aim of this study was to introduce a novel technique for gasless, laparoendoscopic, single-site (GLESS) myomectomy and to evaluate its feasibility and safety. Methods A retrospective observational study was performed at a hospital from Sep 2017 to Nov 2018. 15 patients with symptomatic subserosal or intramural myomas underwent GLESS myomectomy. Results The mean age and body mass index were 41.73 ± 8.58 years and 22.72 ± 2.27 kg/m2, respectively. 5 patients had a history of abdominal surgery, including four caesarean deliveries and one myomectomy. The mean operative duration, blood loss volume, time to specimen removal, time of bowel activity and postoperative hospitalization duration were 156.47 ± 62.19 min, 57.33 ± 72.35 ml, 29.87 ± 13.6 min, 27.67 ± 10.06 h, and 3.4 ± 0.74 days, respectively. The operation was successful in all patients, there were no surgical or wound complications in any patient, and the histopathological result was leiomyoma in all 15 patients. Conclusion The procedure is feasible and safe in selected patients with symptomatic myomas. Supplementary Information The online version contains supplementary material available at 10.1007/s00464-020-08044-y.
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Gasless Laparoscopic Myomectomy Using A J-shaped Retractor and Suture Technique. Surg Laparosc Endosc Percutan Tech 2020; 30:356-360. [PMID: 32788566 DOI: 10.1097/sle.0000000000000794] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aimed to compare gasless single-port access (SPA) laparoscopic myomectomy using a J-shaped retractor and conventional SPA laparoscopic myomectomy. STUDY DESIGN The medical records of 60 patients who underwent laparoscopic myomectomy between January 2016 and August 2019 were reviewed. Thirty patients underwent gasless SPA laparoscopic myomectomy using a J-shaped retractor, and 30 patients underwent conventional SPA laparoscopic myomectomy. The 2 groups were compared in terms of surgical outcomes. In gasless laparoscopic myomectomy, closure of the uterine defect after myomectomy was performed using an extracorporeal suture technique with a Kelly clamp and knot pusher. RESULTS On comparing gasless SPA and conventional SPA laparoscopic myomectomy, no significant differences were observed in age, body mass index, parity, previous abdominal surgery, and size of the dominant uterine myoma. The median retraction setup time from skin incision was 8 minutes (range, 5 to 15 min) with gasless SPA laparoscopic myomectomy. The median total operation times were 105 minutes (range, 62 to 210 min) with gasless SPA myomectomy and 110 minutes (range, 60 to 270 min) with conventional SPA myomectomy, and there was no significant difference (P=0.251). There was no difference between the groups in terms of estimated blood loss. None of the patients experienced laparotomy conversion in both groups. No major complications, such as urologic, bowel, and vessel injuries, were found in both groups. CONCLUSION Gasless SPA laparoscopic myomectomy using a J-shaped retractor is a safe and feasible approach, which allows for easy and convenient suturing of a uterine defect after myomectomy.
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Hwang JH, Kim SR, Kim JH, Kim BW. Gasless single-port access laparoscopy using a J-shaped retractor in patients undergoing adnexal surgery. Surg Endosc 2020; 35:2457-2464. [PMID: 32444972 DOI: 10.1007/s00464-020-07654-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Accepted: 05/14/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The aim of this study was to compare gasless single-port access (SPA) laparoscopy using a J-shaped retractor and conventional SPA laparoscopy in patients undergoing adnexal surgery. Study design The medical records of 80 patients who underwent laparoscopic adnexal surgery between May 2017 and April 2019 were reviewed. Of the 80 patients, 40 patients underwent gasless SPA laparoscopy using a J-shaped retractor and 40 underwent conventional SPA laparoscopy. All surgeries were performed by one laparoscopic surgeon. Surgical outcomes were compared between the two groups. RESULTS There are no significant differences in age, body mass index, parity, previous abdominal surgery, tumor marker, and tumor diameter between the gasless and conventional groups. The median retraction setup time from skin incision was 7 min (range 5-12 min) in gasless SPA laparoscopic adnexal surgery. The median total operation times were 55.5 min (range 30-155 min) in the gasless group and 55 min (range 30-165 min) in the conventional group without a significant difference. Additionally, there were no differences in operation type, conversion rate of laparotomy, use of an additional trocar, and pathological outcomes between the two groups. No major complications, such as urologic, bowel, and vessel injuries, were found in both groups. CONCLUSIONS Gasless SPA laparoscopy using a J-shaped retractor appears to offer a better alternative to conventional SPA laparoscopy that avoids the potential negative effects of carbon dioxide gas in selected cases.
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Affiliation(s)
- Jong Ha Hwang
- Department of Obstetrics and Gynecology, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Simgokro 100 gil 25 Seo-gu, Incheon, 22711, South Korea
| | - Soo Rim Kim
- Department of Obstetrics and Gynecology, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Simgokro 100 gil 25 Seo-gu, Incheon, 22711, South Korea
| | - Jang Heub Kim
- Department of Obstetrics and Gynecology, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Simgokro 100 gil 25 Seo-gu, Incheon, 22711, South Korea
| | - Bo Wook Kim
- Department of Obstetrics and Gynecology, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Simgokro 100 gil 25 Seo-gu, Incheon, 22711, South Korea.
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Dubuisson J, Heersche S, Petignat P, Undurraga M. Laparoscopic Management of Giant Ovarian Cysts Using the Alexis Laparoscopic System®: A Case Series. Front Surg 2020; 7:24. [PMID: 32435653 PMCID: PMC7218052 DOI: 10.3389/fsurg.2020.00024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 04/08/2020] [Indexed: 11/13/2022] Open
Abstract
Objective: The aim of this study was to review the characteristics of patients who underwent laparoscopic removal of giant ovarian cysts using the Alexis Laparoscopic System® and confirm the safety and feasibility of this technique. Method: We conducted a retrospective review of data of women undergoing the procedure from March 2014 to February 2019. Inclusion criteria were ovarian cysts of at least 15 cm. Exclusion criteria were the presence of solid components and suspicion of neoplasia on imaging. Results: Six patients were included in the series. Median size of the cysts at imaging was 22.8 cm (range 15–30 cm), while median volume was 5.9 L (range 1.9–15.6 L). Mean age of operated women was 59 years (range 21–88 years). All patients underwent exclusive laparoscopic management except one patient who underwent a conversion into midline laparotomy. The size of the skin incision initially performed to puncture the cyst ranged from 2.5 to 4 cm. On final pathological reports, two cysts were mucinous cystadenomas, and four were serous cystadenomas. There was no epithelial ovarian cancer or borderline tumor in any of the specimen operated. Conclusion: Laparoscopic management of giant ovarian cysts using the Alexis Laparoscopic System® is safe and feasible in well-selected cases. Midline laparotomy can thus be avoided, decreasing the risk of post-operative complications and increasing quality of life of patients.
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Affiliation(s)
- Jean Dubuisson
- Gynaecological Surgery Unit, Department of Women-Children-Teenagers, University Hospitals of Geneva, Geneva, Switzerland
| | - Sidney Heersche
- Gynaecological Surgery Unit, Department of Women-Children-Teenagers, University Hospitals of Geneva, Geneva, Switzerland
| | - Patrick Petignat
- Gynaecological Surgery Unit, Department of Women-Children-Teenagers, University Hospitals of Geneva, Geneva, Switzerland
| | - Manuela Undurraga
- Gynaecological Surgery Unit, Department of Women-Children-Teenagers, University Hospitals of Geneva, Geneva, Switzerland
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Ng MWV, Ng KC. Gasless single-incision laparoscopic inguinal hernia repair: initial experience. Hernia 2017; 21:803-808. [PMID: 28808824 DOI: 10.1007/s10029-017-1637-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Accepted: 08/06/2017] [Indexed: 11/24/2022]
Abstract
PURPOSE Laparoscopic hernioplasty has been gaining its popularity in the past decade for its rapid recovery. Single-incision surgery, as its possible advancement, has also received more attention. Traditional laparoscopic surgery with carbon dioxide insufflation precluded patients with underlying cardiovascular or pulmonary disease from minimal invasive surgery. We report our early experience with gasless single-incision laparoscopic inguinal hernia repair via totally extraperitoneal (TEP) approach. METHODS Between 2010 and 2012, 15 consecutive patients underwent gasless laparoscopic inguinal hernia repair by the same surgeon, using abdominal wall lifting technique with a self-tailored device. Patient demographics, hernia characteristics, operative findings and postoperative outcomes were analyzed prospectively. RESULTS Of the 15 patients, all had unilateral hernia. Two presented with acute incarceration, in which one required bowel resection. There was no conversion to open surgery or insertion of additional ports. The median operating time was 80 min (range 51-130) for elective repair and 178 min (range 135-220) for emergency repair. The median hospital stay was 1 day (range 1-6) with minimal requirement of analgesics. Median time taken to resume normal activity was 2 days (range 1-6). No major medical complications or mesh infection was encountered. One patient developed hematoma and was successfully managed by salvage laparoscopic reoperation. During a median follow-up of 54 months (range 38-60), none experienced recurrence. CONCLUSION Gasless single-incision TEP is feasible with favorable results, even in high-risk patients with compromised cardiorespiratory status. This technique can also be applied to emergency setting in patients with incarcerated inguinal hernia requiring bowel resection. Future large scale randomized study is needed to verify the effectiveness of this technique.
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Affiliation(s)
- M W V Ng
- Department of Surgery, Caritas Medical Centre, 111 Wing Hong Street, Sham Shui Po, Kowloon, Hong Kong, People's Republic of China
| | - K C Ng
- Department of Surgery, Caritas Medical Centre, 111 Wing Hong Street, Sham Shui Po, Kowloon, Hong Kong, People's Republic of China.
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Demirayak G. A different technique in gasless laparoendoscopic single-site hysterectomy. J OBSTET GYNAECOL 2017; 37:622-626. [DOI: 10.1080/01443615.2017.1282444] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Gökhan Demirayak
- Department of Obstetrics and Gynecology, Okmeydani Education and Research Hospital, Istanbul, Turkey
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Abstract
BACKGROUND AND OBJECTIVES Keyless abdominal rope-lifting surgery is a novel, gasless, single-incision laparoscopic surgical technique. In this study we aimed to compare the postoperative pain from keyless abdominal rope-lifting surgery with carbon dioxide laparoscopy performed for benign ovarian cysts. METHODS During a 20-month period, 77 women underwent surgery for a benign ovarian cyst. Keyless abdominal rope-lifting surgery and conventional carbon dioxide laparoscopy techniques were used for the operations in 32 women and 45 women, respectively. The 2 operative techniques were compared with regard to demographic characteristics; preoperative, intraoperative, and postoperative data including early postoperative pain scores; and frequency of shoulder pain and analgesic requirements. RESULTS Data regarding demographic characteristics, preoperative findings, cyst diameters and rupture rates, intra-abdominal adhesions, intraoperative blood loss, and postoperative hospital stay did not differ between groups (P > .05). However, the mean operative and abdominal access times were significantly longer in the keyless abdominal rope-lifting surgery group (P < .05). Visual analog scale pain scores at initially and at the second, fourth, and 24th hours of the postoperative period were significantly lower in the keyless abdominal rope-lifting surgery group (P < .05). Similarly, keyless abdominal rope-lifting surgery caused significantly less shoulder pain and additional analgesic use (P < .05). CONCLUSION Keyless abdominal rope-lifting surgery seems to cause less pain in the management of benign ovarian cysts in comparison with conventional carbon dioxide laparoscopy.
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Affiliation(s)
- Kahraman Ülker
- Department of Obstetrics and Gynecology, Kafkas University School of Medicine, Kars, Turkey
| | - Ürfettin Hüseyinoğlu
- Department of Anesthesia and Reanimation, Kafkas University School of Medicine, Kars, Turkey
| | - Melek Çiçek
- Department of Obstetrics and Gynecology, Kafkas University School of Medicine, Kars, Turkey
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Chen KH, Chen LR, Seow KM. Ovarian Suspension With Adjustable Sutures: An Easy and Helpful Technique for Facilitating Laparoendoscopic Single-Site Gynecologic Surgery. J Minim Invasive Gynecol 2015; 22:767-75. [PMID: 25757814 DOI: 10.1016/j.jmig.2015.02.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Revised: 02/25/2015] [Accepted: 02/26/2015] [Indexed: 11/30/2022]
Abstract
STUDY OBJECTIVE To describe a method of ovarian suspension with adjustable sutures (OSAS) for facilitating laparoendoscopic single-site gynecologic surgery (LESS) and to investigate the effect of OSAS on LESS. DESIGN Prospective cohort study (Canadian Task Force classification: II-2). SETTING University teaching hospital. PATIENTS One hundred seventy-eight patients with benign 5- to 15-cm cystic ovarian tumors who underwent LESS with OSAS (suspension group, n = 90) and without OSAS (control group, n = 88). INTERVENTIONS For patients who underwent OSAS (suspension group), 1 end of double-head straight needles with a polypropylene suture was inserted into the pelvic cavity through the abdominal skin to penetrate the cyst or ovarian parenchyma and puncture outside the abdominal skin. After cutting off the needles, both sides of the remaining suture were held together by a clamp, without knotting, so that the manipulator could "lift," "loosen," or "fix" the stitches to adjust the tension. MEASUREMENTS AND MAIN RESULTS The average time to create OSAS was 2.9 min. For the suspension and control groups, the average blood loss was 81.4 and 131.8 mL (p < .001), and the operative time was 42.0 and 61.3 min (p < .001), respectively. There were no significant differences in the incidence of complications (5.6% vs 9.1%; p = .365), but there were significant differences in conversions to standard non-single-site laparoscopy (5.6% vs 15.9%; p = .025) and laparotomy (1.1% vs 6.8%; p = .040). Logistic regression analysis revealed that the ratios of conversion to standard non-single-site laparoscopy (odds ratio [OR], 0.126; 95% confidence interval [CI], 0.311-0.508) and laparotomy (OR, 0.032; 95% CI, 0.002-0.479) were much lower in the suspension group; the risk of complications was comparable (OR, 0.346; 95% CI, 0.085-1.403). CONCLUSION OSAS is an easy, safe, and feasible method that offers advantages during LESS. Although routine use of OSAS is not necessary, OSAS can be considered during LESS to facilitate the surgery.
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Affiliation(s)
- Kuo-Hu Chen
- Department of Obstetrics and Gynecology, Taipei Tzu-Chi Hospital, The Buddhist Tzu-Chi Medical Foundation, Taipei, Taiwan, and School of Medicine, Tzu-Chi University, Hualien, Taiwan.
| | - Li-Ru Chen
- Mackay Memorial Hospital, Taipei, Taiwan, and Department of Mechanical Engineering, National Chiao-Tung University, Hsinchu, Taiwan
| | - Kok-Min Seow
- Department of Obstetrics and Gynecology, Shin Kong Wu Ho-Su Memorial Hospital, and Department of Obstetrics and Gynecology, National Yang-Ming University, Taipei, Taiwan
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Ülker K, Anuk T, Bozkurt M, Karasu Y. Large bowel injuries during gynecological laparoscopy. World J Clin Cases 2014; 2:846-851. [PMID: 25516859 PMCID: PMC4266832 DOI: 10.12998/wjcc.v2.i12.846] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 09/04/2014] [Accepted: 09/17/2014] [Indexed: 02/05/2023] Open
Abstract
Laparoscopy is one of the most frequently preferred surgical options in gynecological surgery and has advantages over laparotomy, including smaller surgical scars, faster recovery, less pain and earlier return of bowel functions. Generally, it is also accepted as safe and effective and patients tolerate it well. However, it is still an intra-abdominal procedure and has the similar potential risks of laparotomy, including injury of a vital structure, bleeding and infection. Besides the well-known risks of open surgery, laparoscopy also has its own unique risks related to abdominal access methods, pneumoperitoneum created to provide adequate operative space and the energy modalities used during the procedures. Bowel, bladder or major blood vessel injuries and passage of gas into the intravascular space may result from laparoscopic surgical technique. In addition, the risks of aspiration, respiratory dysfunction and cardiovascular dysfunction increase during laparoscopy. Large bowel injuries during laparoscopy are serious complications because 50% of bowel injuries and 60% of visceral injuries are undiagnosed at the time of primary surgery. A missed or delayed diagnosis increases the risk of bowel perforation and consequently sepsis and even death. In this paper, we aim to focus on large bowel injuries that happen during gynecological laparoscopy and review their diagnostic and management options.
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Liao CH, Kuo IM, Fu CY, Chen CC, Yang SJ, Ouyang CH, Wang SY, Chen SW, Hsu YP, Kang SC. Gasless laparoscopic assisted surgery for abdominal trauma. Injury 2014; 45:850-4. [PMID: 24268191 DOI: 10.1016/j.injury.2013.10.041] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Revised: 10/01/2013] [Accepted: 10/25/2013] [Indexed: 02/02/2023]
Abstract
BACKGROUND Numerous studies have described the effectiveness of laparoscopy for trauma patients. In gas-filling laparoscopic surgery, most of the disadvantages are related to a positive pressure pneumoperitoneum that compromises the cardiopulmonary function. The main advantage of gasless laparoscopic assisted surgery (GLA) is that it does not affect the haemodynamic status, which is particularly critical for trauma patients. The purpose of this study was to investigate the feasibility and safety of GLA for abdominal trauma. MATERIALS AND METHODS This was a retrospective, 1:2 matched case-control study of all trauma gasless assisted laparoscopies performed from January 2010 until January 2013 in a Level I trauma centre. In total, 965 patients with abdominal trauma were admitted. According to the abdominal trauma protocol, a total of 93 hemodynamically stable patients required the operation; we selected fifteen patients to undergo GLA and matched 30 other patients to undergo laparotomy. Demographic information, perioperative findings, injury severity score, and postoperative recovery were recorded and analyzed. RESULTS A total of fifteen patients (ten men, five women) with a mean age of 44.4, standard deviation (SD) 13.2 years underwent GLA for abdominal trauma. Eight patients had penetrating injuries, while seven had blunt injuries. Overall, 73% patients had multiple injuries. The mean time to the identified lesion was 23.1, SD 10.9min, and the mean operative time was 109.7, SD 33.5min. Most of the lesions were repaired concurrently by GLA. One conversion to laparotomy was done. The mean length of hospital stay (HLOS) was 9.1, SD 4.5 days. No mortality occurred in this series. The mean follow-up was 22.0, SD 7.9 months, and there were no significant events during this period. The mean operative times were comparable in the GLA and open surgery group (109.7, SD 33.5 vs. 131.2, SD 43.6min; p=0.076). Compared with the open surgery group, the HLOS was significantly shorter in the GLA group (9.1, SD 4.5 vs.16.3, SD 6.4 days; p=0.030). CONCLUSION GLA offers both therapeutic and diagnostic advantages for patients with abdominal trauma. GLA shares the advantages of laparoscopy and prevents the cardiopulmonary function from being compromised due to pneumoperitoneum, which is especially critical for trauma patients.
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Affiliation(s)
- Chien-Hung Liao
- Department of Traumatology and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - I-Ming Kuo
- Department of Traumatology and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Chih-Yuan Fu
- Department of Traumatology and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Chih-Chi Chen
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Shang-Ju Yang
- Department of Traumatology and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Chun-Hsiang Ouyang
- Department of Traumatology and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Shang-Yu Wang
- Department of Traumatology and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Shao-Wei Chen
- Department of Cardiac Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Pao Hsu
- Department of Traumatology and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Shih-Ching Kang
- Department of Traumatology and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.
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Comparison of tubal sterilization procedures performed by keyless abdominal rope-lifting surgery and conventional CO2 laparoscopy: a case controlled clinical study. ScientificWorldJournal 2013; 2013:963615. [PMID: 24453932 PMCID: PMC3886610 DOI: 10.1155/2013/963615] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Accepted: 10/08/2013] [Indexed: 12/12/2022] Open
Abstract
Objective. To evaluate the safety and efficacy of Keyless Abdominal Rope-Lifting Surgery (KARS), for tubal sterilization procedures in comparison with the conventional CO2 laparoscopy. Material and Methods. During a one-year period, 71 women underwent tubal ligation surgery. Conventional laparoscopy (N = 38) and KARS (N = 33) were used for tubal sterilization. In KARS, an abdominal access pathway through a single intra-abdominal incision was used to place transabdominal sutures that elevated the abdominal wall, and the operations were performed through the intraumbilical entry without the use of trocars. In CO2 laparoscopy, following the creation of the CO2 pneumoperitoneum a 10 mm trocar and two 5 mm trocars were introduced into the abdominal cavity. Tubal sterilizations were performed following the creation of the abdominal access pathways in both groups. The groups were compared with each other. Results. All operations could be performed by KARS without conversion to CO2 laparoscopy or laparotomy. The mean operative time of the two groups was not significantly different (P > 0.05). Intra- and postoperative findings including complications, bleeding, and hospital stay time did not differ between groups (P > 0.05). Conclusion. KARS for tubal sterilization seems safe and effective in terms of cosmesis, postoperative pain, and early hospital discharge.
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Hoellen F, Rody A, Ros A, Bruns A, Cirkel C, Bohlmann MK. Hybrid approach of retractor-based and conventional laparoscopy enabling minimally invasive hysterectomy in a morbidly obese patient: case report and review of the literature. MINIM INVASIV THER 2013; 23:184-7. [PMID: 24329014 DOI: 10.3109/13645706.2013.870577] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Minimally invasive hysterectomy in obese patients may be limited by laparoscopic sight on the one hand and by intraoperative complications related to reduced ventilation due to pneumoperitoneum on the other. Retractor-based laparoscopy offers an operative technique reducing anesthesia risks. We report the case of laparoscopic hysterectomy in an obese patient of short stature. Laparoscopic supracervical hysterectomy was performed by a hybrid approach of a retractor system exerting its effects on lifting the abdominal wall through gravity and conventional laparoscopy, thus bypassing the adverse effects of pneumoperitoneum on ventilation.
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Affiliation(s)
- Friederike Hoellen
- Department of Gynecology and Ostetrics, University Hospital Schleswig Holstein , Campus Luebeck, Luebeck , Germany
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