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Park SH, Kim YN, Hwang J, Kim KY, Cho M, Kim YM, Hyung WJ, Kim HI. Safety and feasibility of reduced-port robotic distal gastrectomy for gastric cancer: a phase I/II clinical trial using the da Vinci Single Port(SP) robotic system. Sci Rep 2023; 13:18578. [PMID: 37903856 PMCID: PMC10616185 DOI: 10.1038/s41598-023-45655-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 10/22/2023] [Indexed: 11/01/2023] Open
Abstract
Minimally invasive surgery reduces surgical trauma and the size and number of incisions. The da Vinci SP robotic surgical system was designed to overcome the technical demands of single-incision laparoscopic surgery. This study aimed to demonstrate the safety and feasibility of single-port (SP) robotic distal gastrectomy (SPRDG) for patients with gastric cancer using the da Vinci SP system (Intuitive Surgical Inc., Sunnyvale, CA, USA). This study was designed as a single-arm prospective phase I/II clinical trial of SPRDG (first posted date: 21/09/2021, NCT05051670; clinicaltrials.gov). SPRDG using the da Vinci SP system was performed on 19 patients with gastric cancer between December 2021 and October 2022. The primary outcome was the safety of SPRDG as measured by major postoperative complications. The secondary outcomes were operation time, bleeding amount, bowel motility recovery, and length of hospital stay. SPRDG was performed in all 19 patients without unexpected events, such as use of additional trocars or conversion to laparoscopic or open surgery. No major complications occurred postoperatively (0/19, 0.0%). The mean operation time was 218 min (range 164-286 min). The mean hospital stay duration was 3.2 days (range 2-4 days). This phase I/II clinical trial, performed by a single expert surgeon, demonstrated the safety and feasibility of SPRDG with the da Vinci SP system in selected patients with gastric cancer. SPRDG could be a reasonable alternative to conventional or reduced-port minimally invasive gastrectomy, as it has cosmetic advantages, early recovery, and safe discharge.
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Affiliation(s)
- Sung Hyun Park
- Department of Surgery, Yonsei University College of Medicine, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul, 03722, Korea
- Gastric Cancer Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
| | - Youn Nam Kim
- Department of Biostatistics, Graduate School of Public Health, Yonsei University, Seoul, Korea
| | - Jawon Hwang
- Department of Surgery, Yonsei University College of Medicine, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul, 03722, Korea
- Gastric Cancer Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
| | - Ki-Yoon Kim
- Department of Surgery, Yonsei University College of Medicine, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul, 03722, Korea
- Gastric Cancer Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
| | - Minah Cho
- Department of Surgery, Yonsei University College of Medicine, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul, 03722, Korea
- Gastric Cancer Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
| | - Yoo Min Kim
- Department of Surgery, Yonsei University College of Medicine, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul, 03722, Korea
- Gastric Cancer Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
| | - Woo Jin Hyung
- Department of Surgery, Yonsei University College of Medicine, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul, 03722, Korea
- Gastric Cancer Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
| | - Hyoung-Il Kim
- Department of Surgery, Yonsei University College of Medicine, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul, 03722, Korea.
- Gastric Cancer Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea.
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He H, Li T, Cui M, Jiang Q, Jiang F, Li M, Liu Y. Effect of two different laparoscopic techniques on post-operative wound complications in patients with benign gynaecological diseases: A meta-analysis. Int Wound J 2023; 21:e14382. [PMID: 37830298 PMCID: PMC10828522 DOI: 10.1111/iwj.14382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 08/23/2023] [Accepted: 08/24/2023] [Indexed: 10/14/2023] Open
Abstract
Single-port laparoscopy (SPL) has existed for several years. This meta-analysis was conducted to evaluate the efficacy of SPL compared with conventional laparoscopy (CL) in the treatment of benign gynecologic adnexal lesions. The purpose of this meta-analysis is to evaluate the superiority of SPL versus CL in the treatment of post-operative wound pain. The study looked for English-language publications from PubMed, Embase, Cochrane Library and the Web of Science until June 2023. The main result was the visual analogue scale (VAS) after 2, 4, 6, 8, 12, 24 and 48 h after operation. The paper contains 10 related papers by means of e-search. Of these, 4 were randomized controlled trials (RCTs), while 6 were non-RCTs. The results indicated that SPL and CL were significantly different after 2, 24 and 48 h after operation. SPL had lower post-operative pain after 2 h compared with CL (MD, -0.6; 95% CI, -0.98, -0.21; p = 0.002). After the operation, SPL also had a lower incidence of post-operative pain after 24 h compared with CL (MD, -0.59; 95% CI, -1.12, -0.06; p = 0.03). And the difference in pain was at 48 h after the most significant (MD, -0.49; 95% CI, -0.75, -0.23; p = 0.0002). But after 6, 8 and 12 h after operation, there was no significant difference in the degree of pain. Thus, SPL operations may result in a lower degree of pain than CL in both the post-operative and far post-operative phase.
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Affiliation(s)
- Haining He
- Department of Gynaecology and Obstetrics, Sichuan Provincial People's Hospital, School of MedicineUniversity of Electronic Science and Technology of ChinaChengduChina
| | - Tinglan Li
- People's Hospital of Aba Tibetan and Qiang Autonomous PrefectureAbaChina
| | - Manman Cui
- Department of Gynaecology and Obstetrics, Sichuan Provincial People's Hospital, School of MedicineUniversity of Electronic Science and Technology of ChinaChengduChina
| | - Qin Jiang
- Department of Gynaecology and Obstetrics, Sichuan Provincial People's Hospital, School of MedicineUniversity of Electronic Science and Technology of ChinaChengduChina
| | - Fuchuan Jiang
- Department of Gynaecology and Obstetrics, Sichuan Provincial People's Hospital, School of MedicineUniversity of Electronic Science and Technology of ChinaChengduChina
| | - Min Li
- Department of Gynaecology and Obstetrics, Sichuan Provincial People's Hospital, School of MedicineUniversity of Electronic Science and Technology of ChinaChengduChina
| | - Yi Liu
- Department of Gynaecology and Obstetrics, Sichuan Provincial People's Hospital, School of MedicineUniversity of Electronic Science and Technology of ChinaChengduChina
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Noh JJ, Jeon JE, Jung JH, Kim TJ. Feasibility and Surgical Outcomes of Hybrid Robotic Single-Site Hysterectomy Compared with Single-Port Access Total Laparoscopic Hysterectomy. J Pers Med 2023; 13:1178. [PMID: 37511791 PMCID: PMC10382033 DOI: 10.3390/jpm13071178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 07/19/2023] [Accepted: 07/20/2023] [Indexed: 07/30/2023] Open
Abstract
We compared surgical outcomes between single-port access total laparoscopic hysterectomy (SPA-TLH) and hybrid robotic single-site hysterectomy (RSSH), a new technique of combining the benefits of SPA-TLH with RSSH in this study. A total of 64 patients were retrospectively analyzed. They underwent either hybrid RSSH or SPA-TLH for benign gynecologic disease between December 2018 and August 2021. To assess the feasibility of hybrid RSSH, the clinical characteristics and surgical outcomes were compared between the hybrid RSSH group (n = 29) and the SPA-TLH group (n = 35). All of the surgeries were completed without requiring additional ports or conversion to laparotomy. The surgical outcomes including total operative time, uterine weight, estimated blood loss, hemoglobin changes, length of hospital stay, and postoperative pain scores were not significantly different between the two groups. The colpotomy time, including the detachment of the uterosacral and cardinal ligaments, was shorter in the hybrid RSSH group than in the SPA-TLH group (8.0 min vs. 14.0 min; p = 0.029). However, the vaginal cuff closure time was longer in the hybrid RSSH group than in the SPA-TLH group (15.0 min vs.10.0 min; p = 0.001). No difference was observed with regards to intraoperative and postoperative complications. Hybrid RSSH appears to be a feasible procedure for hysterectomy in patients with benign gynecologic diseases.
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Affiliation(s)
- Joseph J Noh
- Gynecologic Cancer Center, Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Jung-Eun Jeon
- Gynecologic Cancer Center, Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Ji-Hee Jung
- Gynecologic Cancer Center, Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Tae-Joong Kim
- Gynecologic Cancer Center, Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
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Kang JH, Lee KA, Heo YR, Kim WY, Paik ES. Efficacy of a continuous wound infiltration system for postoperative pain management in gynecologic patients who underwent single-port access laparoscopy for adnexal disease. Front Med (Lausanne) 2023; 10:1199428. [PMID: 37476613 PMCID: PMC10354268 DOI: 10.3389/fmed.2023.1199428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 06/19/2023] [Indexed: 07/22/2023] Open
Abstract
Introduction Single-port access (SPA) laparoscopy requires only one incision, unlike conventional laparoscopy. However, its umbilical incision is larger than that of conventional laparoscopy and can be vulnerable to postoperative pain. This study aimed to evaluate whether simultaneous use of a continuous wound infiltration (CWI) system and intravenous patient-controlled analgesia (IV PCA) effectively decreases surgical site pain in patients who underwent SPA laparoscopy due to gynecologic adnexal disease. Methods A total of 371 patients who underwent SPA laparoscopy and who received IV PCA or CWI was retrospectively reviewed (combined group [CWI + IV PCA, n = 159] vs. PCA group [IV PCA only, n = 212]). To evaluate postoperative pain management, the numeric rating scale (NRS) pain score after surgery, total amount of fentanyl administered via IV PCA, and additional pain killer consumption were collected. Results The NRS scores at 12 h (1.90 ± 1.11 vs. 2.70 ± 1.08, p < 0.001) and 24 h (1.82 ± 0.82 vs. 2.11 ± 1.44, p = 0.026) after surgery were significantly lower in the combined group than in the PCA group. The total amount of PCA fentanyl was significantly smaller in the combined group than in the PCA group (p < 0.001). The total quantity of rescue analgesics was smaller in the combined group than in the PCA group (p < 0.05). Conclusion Combined use of the CWI system and IV PCA is an effective postoperative pain management strategy in patient who underwent SPA laparoscopy for adnexal disease.
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Affiliation(s)
- Jun-Hyeok Kang
- Department of Obstetrics and Gynecology, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Uijeongbu, Republic of Korea
| | - Kyung A Lee
- Department of Obstetrics and Gynecology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yae Rin Heo
- Department of Obstetrics and Gynecology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Woo Young Kim
- Department of Obstetrics and Gynecology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - E Sun Paik
- Department of Obstetrics and Gynecology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Tan W, Deng Y, Deng L, Tang S, Yao Y, Wei H, Zhong K, Wang Y. A preoperative scoring system to predict the probability of laparoendoscopic single-site extracorporeal cystectomy in patients with benign ovarian cysts. Front Surg 2022; 9:991450. [DOI: 10.3389/fsurg.2022.991450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 10/03/2022] [Indexed: 11/05/2022] Open
Abstract
ObjectiveTo develop a preoperative scoring system (PSS) to predict whether laparoendoscopic single-site extracorporeal (LESS-E) cystectomy can be performed in patients with benign ovarian cysts.MethodWe reviewed data on patients who underwent LESS cystectomy between August 2016 and October 2019 at the first Affiliated Hospital, Army Medical University. The independent predictors of LESS-E cystectomy in patients with benign ovarian cysts were identified using multivariate logistic regression analyses. A nomogram for predicting LESS-E cystectomy in patients with benign ovarian cysts was developed, and to simplify the score, we establish a preoperative scoring system to guide the choice of surgical approach in patients with highly probable benign ovarian cysts.ResultsOur analysis showed that age, BMI, height and the diameter of ovarian cysts were independent predictors of LESS-E cystectomy. A nomogram was developed based on these four factors, which had a concordance index of 0.838 and R2 = 0.415. To simplify the score, the predicted indicators in the regression model were scored by dividing the beta coefficient by the absolute value of the minimum beta coefficient, and the sum of each predictor score established a PSS. In the total set, the selected cutoff value according to the maximum point of the Youden index was 8, and a preoperative score ≥ 8 identified patients undergoing LESS-E cystectomy with a positive predictive value of 67.4% and a negative predictive value of 88.6%.ConclusionA PSS to predict the chances of LESS-E cystectomy was established. This system could be helpful for selecting the appropriate surgical strategy for patients with benign ovarian cysts.
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Single Incision Pediatric Endoscopic Surgery: From Myth to Reality a Case Series. ACTA ACUST UNITED AC 2019; 55:medicina55090574. [PMID: 31500274 PMCID: PMC6780980 DOI: 10.3390/medicina55090574] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 09/03/2019] [Accepted: 09/05/2019] [Indexed: 12/27/2022]
Abstract
Laparoscopic surgery has continued to evolve to minimize access sites and scars in both the adult and pediatric populations. In children, single-incision pediatric endoscopic surgery (SIPES) has been shown to be effective, feasible, and safe with comparative results to multiport equivalents. Thus, the use of SIPES continues over increasingly complex cases, however, conceptions of its efficacy continue to vary greatly. In the present case series and discussion, we review the history of SIPES techniques and its current application today. We present this in the setting of five common myths about SIPES techniques: limitations against complex cases, restrictions to specialized training, increased morbidity outcomes, increased operative lengths, and increased operative costs. Regarding the myth of SIPES being limited in application to simple cases, examples were highlighted throughout the literature in addition to the authors’ own experience with three complex cases including resection of a lymphatic malformation, splenectomy with cholecystectomy, and distal pancreatectomy with splenectomy. A review of SIPES learning curves shows equivalent operative outcomes to multiport learning curves and advancements towards practical workshops to increase trainee familiarity can help assuage these aptitudes. In assessing comorbidities, adult literature reveals a slight increase in incisional hernia rates, but this does not correlate with single-incision pediatric data. In experienced hands, operative SIPES times average approximate multiport laparoscopic equivalents. Finally, regarding expenses, SIPES represents an equivalent alternative to laparoscopic techniques.
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Chang Y, Kay N, Huang MR, Huang SJ, Tsai EM. Laparoendoscopic Single-Site Supracervical Hysterectomy with Manual Morcellation: A Retrospective Study. J Minim Invasive Gynecol 2018; 25:1094-1100. [DOI: 10.1016/j.jmig.2018.02.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Revised: 01/27/2018] [Accepted: 02/02/2018] [Indexed: 10/17/2022]
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Cela V, Marrucci E, Angioni S, Freschi L. Robot-assisted laparoscopic single-site hysterectomy: our experience and multicentric comparison with single-port laparoscopy. ACTA ACUST UNITED AC 2018; 70:621-628. [PMID: 29856186 DOI: 10.23736/s0026-4784.18.04197-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Analysis of perioperative outcomes of robotic single-site technique and to compare surgical outcomes with a new laparo-endoscopic single-port surgery (LESS) technique for total hysterectomy. METHODS Perioperative data from 12 women undergone robotic single-site hysterectomy (RSSH) for benign or oncologic disease were compared with data from 15 patients who underwent total laparo-endoscopic single-site hysterectomy (LESSH) for benign disease using the new X-Cone (Karl Storz, Tuttlingen, Germany). The CUSUM technique for quantitative assessment of the learning curve was then performed. RESULTS The mean operative time (OT) was 85±33 minutes for RSSH group and 100±20 minutes for LESSH group. Mean blood loss was 80±18 mL and 92±21 mL for RSSH and LESSH, respectively. For each group, the CUSUM learning curves identified two phases with a highly significant decrease of mean OT between phase 1 and phase 2 in both groups. The OT of both groups during phase 2 was significantly lower than during phase 1. CONCLUSIONS This study confirms the safety and reproducibility of the RSS. The comparison between RSS and LESS techniques has shown that RSS has important advantages over the LESS, like deeper learning curve, lower OT not correlated with age and uterus size.
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Affiliation(s)
- Vito Cela
- Division of Gynecology and Obstetrics, University of Pisa, Pisa, Italy
| | - Elena Marrucci
- Division of Gynecology and Obstetrics, University of Pisa, Pisa, Italy
| | - Stefano Angioni
- Division of Obstetrics and Gynecology, University Medical School of Cagliari, Cagliari, Italy
| | - Letizia Freschi
- Division of Gynecology and Obstetrics, University of Pisa, Pisa, Italy -
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Single port laparoscopy (SPL): Retrospective study evaluating postoperative pain in comparison with conventional laparoscopy (CL). J Gynecol Obstet Hum Reprod 2018; 47:365-369. [PMID: 29654938 DOI: 10.1016/j.jogoh.2018.04.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Revised: 04/03/2018] [Accepted: 04/10/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To compare postoperative pain after single port laparoscopy (SPL) approach with conventional laparoscopy (CL) in case of adnexectomy. MATERIAL AND METHODS This is a retrospective monocentric study involving patients who underwent adnexal surgery by SPL or CL for a suspected benign disease or as a preventive measure. The main outcome measure was the level of postoperative pain. RESULTS A total of 87 patients were enrolled. Within 2h, the numerical scale (NS) was 1.9 in SPL group and 2.0 in the CL group (P=0.85). The next day, the NS was 1.8 in SPL group and 1.5 in CL group (P=0.55). The operating time was significantly shorter in SPL group (33 versus 56min, 95% CI [-31; -15], P<0.001) and no rupture of ovarian cysts occurred in this group. There was no significant difference concerning complications, length of hospital stay, general satisfaction and POSAS (Patient and Observer Scar Assessment Scale) score. CONCLUSION This study confirms the feasibility of single-port laparoscopic adnexectomy. We have not shown significant difference in postoperative pain but the operating time was significantly reduced under the guise of an experienced surgeon.
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Single-Port Laparoscopy vs Conventional Laparoscopy in Benign Adnexal Diseases: A Systematic Review and Meta-Analysis. J Minim Invasive Gynecol 2017; 24:1083-1095. [DOI: 10.1016/j.jmig.2017.07.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 06/26/2017] [Accepted: 07/03/2017] [Indexed: 12/20/2022]
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Karasu Y, Akselim B, Kavak Cömert D, Ergün Y, Ülker K. Comparison of single-incision and conventional laparoscopic surgery for benign adnexal masses. MINIM INVASIV THER 2017; 26:278-283. [PMID: 28290726 DOI: 10.1080/13645706.2017.1299763] [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: 10/20/2022]
Abstract
BACKGROUND Our aim was to compare single incision and conventional laparoscopic surgeries performed for benign adnexal masses with regard to their intraoperative characteristics and postoperative pain levels. MATERIAL AND METHODS The main outcome measures were laparoscopic entry time, total operation time, amount of bleeding, intraoperative complications, post-operative pain scores, additional analgesic requirements, and length of hospital stay. RESULTS A total of 71 women, 39 in the conventional laparoscopy group and 32 in the SILS group, participated in the study. Demographic findings did not differ between the two groups. Similarly, rates of intraoperative complications, rates of conversion to laparotomy, pre- and postoperative hematocrit levels were not significantly different between the groups. Laparoscopic entry time was shorter in the SILS group (10.4 ± 5.9 min. vs. 5.28 ± 1.7 min.). However, total operation time was similar in the two groups. The groups did not show significant differences regarding additional analgesic requirements, or postoperative pain scores after 24 h. However, pain scores in the recovery room and after six and 12 h were lower in the SILS group. CONCLUSION SILS seems to be effective and safe for the treatment of benign adnexal masses. SILS appears to be advantageous regarding postoperative pain especially in the early period.
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Affiliation(s)
- Yetkin Karasu
- a Obstetrics and Gynecology , Ankara Training and Research Hospital , Ankara , Turkey
| | - Burak Akselim
- a Obstetrics and Gynecology , Ankara Training and Research Hospital , Ankara , Turkey
| | - Duygu Kavak Cömert
- a Obstetrics and Gynecology , Ankara Training and Research Hospital , Ankara , Turkey
| | - Yusuf Ergün
- a Obstetrics and Gynecology , Ankara Training and Research Hospital , Ankara , Turkey
| | - Kahraman Ülker
- b Obstetrics and Gynecology , Memorial Şişli Hospital , İstanbul , Turkey
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Gargiulo AR, Choussein S, Srouji SS, Cedo LE, Escobar PF. Coaxial robot-assisted laparoendoscopic single-site myomectomy. J Robot Surg 2016; 11:27-35. [DOI: 10.1007/s11701-016-0603-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 04/26/2016] [Indexed: 12/30/2022]
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Boruta DM. Laparoendoscopic single-site surgery in gynecologic oncology: An update. Gynecol Oncol 2016; 141:616-623. [PMID: 26980644 DOI: 10.1016/j.ygyno.2016.03.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 03/09/2016] [Accepted: 03/10/2016] [Indexed: 12/14/2022]
Abstract
The preferred surgical approach for many gynecologic oncology procedures is now laparoscopy. Reduced morbidity, shorter hospitalization and a more rapid recovery have been associated with minimally invasive surgical approaches when compared to laparotomy. Incisional morbidity, including vascular and viscous injury, postoperative hernia, infection, and pain remain significant concerns. Use of fewer and smaller incisions during laparoscopy may be expected to further minimize these risks. Laparoendoscopic single-site surgery (LESS), or single incision laparoscopy, describes the use of one small skin incision to complete laparoscopic surgical procedures. Recent advances in instrumentation have allowed increasingly complex procedures in gynecologic cancer patients to be completed. This review will serve as an update in regards to implementation of LESS in gynecologic oncology. Technical challenges encountered during performance of LESS as well as strategies to overcome these challenges will be discussed.
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Affiliation(s)
- David M Boruta
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Yawkey Suite 9E, 55 Fruit Street, Boston, MA 02114, USA.
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Yang J, Na YJ, Song YJ, Choi OH, Lee SK, Kim HG. The effectiveness of laparoendoscopic single-site surgery (LESS) compared with conventional laparoscopic surgery for ectopic pregnancy with hemoperitoneum. Taiwan J Obstet Gynecol 2016; 55:35-9. [PMID: 26927245 DOI: 10.1016/j.tjog.2015.02.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2015] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE The purpose of this study was to compare clinical outcomes of conventional laparoscopic surgery and laparoendoscopic single-site surgery (LESS) in the surgical treatment of tubal ectopic pregnancy. MATERIAL AND METHODS A total of 156 patients were diagnosed with ectopic pregnancies by ultrasonography and serum β-human chorionic gonadotrophin (β-hCG) levels at Pusan National University Yangsan Hospital from January 2009 through December 2013. We excluded 28 patients who only received medical treatment, 15 patients who underwent surgery by laparotomy for severe hypovolemic shock, and 30 patients who presented with less than 1 L of hemoperitoneum. Of the 83 patients with massive hemoperitoneum, 38 patients had LESS performed while the remaining 45 patients underwent conventional laparoscopic surgery. RESULTS In this study, there were no statistically significant differences in clinical outcomes in either surgical method except for operative time. Operative time of LESS was significantly shorter than conventional surgery for patients with more than 500 mL of hemoperitoneum. CONCLUSION LESS is a safe and feasible surgical approach in the treatment of tubal ectopic pregnancy. At the same time, LESS has been shown to be more effective than conventional laparoscopic surgery in handling massive hemoperitoneum of more than 1 L, which is a common complication of ectopic pregnancy.
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Affiliation(s)
- Juseok Yang
- Department of Obstetrics and Gynecology, Pusan National University Yangsan Hospital, Yangsan, South Korea; Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, South Korea
| | - Yong Jin Na
- Department of Obstetrics and Gynecology, Pusan National University Yangsan Hospital, Yangsan, South Korea; Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, South Korea
| | - Yong Jung Song
- Department of Obstetrics and Gynecology, Pusan National University Yangsan Hospital, Yangsan, South Korea; Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, South Korea
| | - Ook Hwan Choi
- Department of Obstetrics and Gynecology, Pusan National University Yangsan Hospital, Yangsan, South Korea; Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, South Korea
| | - Sun Kyung Lee
- Department of Obstetrics and Gynecology, Pusan National University Yangsan Hospital, Yangsan, South Korea; Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, South Korea
| | - Hwi Gon Kim
- Department of Obstetrics and Gynecology, Pusan National University Yangsan Hospital, Yangsan, South Korea; Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, South Korea.
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Kikuchi I, Kumakiri J, Aoki Y, Ujihira U, Tejima K, Tsuzuki Y, Sakamoto A, Saito J, Nojima M, Yoshida K, Takeda S. Reduced-port surgery in gynecologic fields. Gynecol Minim Invasive Ther 2015. [DOI: 10.1016/j.gmit.2015.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Angioni S, Pontis A, Sedda F, Zampetoglou T, Cela V, Mereu L, Litta P. Single-port versus conventional multiport access prophylactic laparoscopic bilateral salpingo-oophorectomy in high-risk patients for ovarian cancer: a comparison of surgical outcomes. Onco Targets Ther 2015; 8:1575-80. [PMID: 26170692 PMCID: PMC4485856 DOI: 10.2147/ott.s82570] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Bilateral salpingo-oophorectomy (BSO) in carriers of BRCA1 and BRCA2 mutations is widely recommended as part of a risk-reduction strategy for ovarian or breast cancer due to an underlying genetic predisposition. BSO is also performed as a therapeutic intervention for patients with hormone-positive premenopausal breast cancer. BSO may be performed via a minimally invasive approach with the use of three to four 5 mm and/or 12 mm ports inserted through a skin incision. To further reduce the morbidity associated with the placement of multiple port sites and to improve cosmetic outcomes, single-port laparoscopy has been developed with a single access point from the umbilicus. The purpose of this study was to evaluate the surgical outcomes associated with reducing the risks of salpingo-oophorectomy performed in a single port, while comparing multiport laparoscopy in women with a high risk for ovarian cancer. Single-port laparoscopy-BSO is feasible and safe, with favorable surgical and cosmetic outcomes when compared to conventional laparoscopy.
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Affiliation(s)
- Stefano Angioni
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Alessandro Pontis
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Federica Sedda
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | | | - Vito Cela
- Department of Obstetrics and Gynecology, University of Pisa, Pisa, Italy
| | | | - Pietro Litta
- Department of Obstetrics and Gynecology, University of Padua, Padua, Italy
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Robotic single-site myomectomy: initial report and technique. Fertil Steril 2015; 103:1370-7.e1. [DOI: 10.1016/j.fertnstert.2015.02.021] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 02/18/2015] [Accepted: 02/18/2015] [Indexed: 02/08/2023]
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18
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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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Huang BS, Wang PH, Tsai HW, Hsu TF, Yen MS, Chen YJ. Single-port compared with conventional laparoscopic cystectomy for ovarian dermoid cysts. Taiwan J Obstet Gynecol 2014; 53:523-9. [DOI: 10.1016/j.tjog.2014.05.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2014] [Indexed: 11/16/2022] Open
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20
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L’annexectomie par cœlio-chirurgie mono-trocart pour tous. ACTA ACUST UNITED AC 2014; 42:561-6. [DOI: 10.1016/j.gyobfe.2014.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Accepted: 06/16/2014] [Indexed: 12/22/2022]
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21
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Rabischong B, Compan C, Savary D, Bourdel N, Canis M, Mage G, Botchorishvili R. La laparoscopie par incision unique en gynécologie : état des lieux en 2013. ACTA ACUST UNITED AC 2013; 42:445-57. [DOI: 10.1016/j.jgyn.2013.03.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Revised: 03/26/2013] [Accepted: 03/27/2013] [Indexed: 11/16/2022]
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22
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Tuschy B, Berlit S, Brade J, Sütterlin M, Hornemann A. Gynaecological laparoscopic surgery for benign conditions: do women care about incisions? Eur J Obstet Gynecol Reprod Biol 2013; 169:84-7. [DOI: 10.1016/j.ejogrb.2013.02.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Revised: 11/04/2012] [Accepted: 02/05/2013] [Indexed: 10/27/2022]
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23
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Mencaglia L, Mereu L, Carri G, Arena I, Khalifa H, Tateo S, Angioni S. Single port entry – Are there any advantages? Best Pract Res Clin Obstet Gynaecol 2013; 27:441-55. [DOI: 10.1016/j.bpobgyn.2012.12.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Accepted: 12/06/2012] [Indexed: 12/11/2022]
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24
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Bedaiwy MA, Franjoine SE, Ali MK. Laparoendoscopic single-site (LESS) surgery in gynecology: Current status and future directions. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2013. [DOI: 10.1016/j.mefs.2012.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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25
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de Poncheville L, Smirnoff A, Ménard J, Corbineau G, Vié-Buret V, Nohra O, Leyre S, Drapier E. [Feasibility of laparoendoscopic single-site surgery in gynecology with conventional laparoscopic instruments]. ACTA ACUST UNITED AC 2012; 40:729-33. [PMID: 23165226 DOI: 10.1016/j.gyobfe.2012.09.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2012] [Accepted: 08/09/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVES To describe the safety and efficacy of single-port access for laparoscopic surgery in gynecology with conventional laparoscopic instruments. PATIENTS AND METHODS In this prospective study, we report our experience with 90 patients who underwent Single Port Access (SPA) laparoscopic surgery for gynecologic pathology with the use of the SILS(®) Port Multiple Instrument Access Port (Covidien(®), Mansfield, MA). RESULTS We realised 15 ovarian cystectomies, 30 salpingo-oophrectomies with 14 one side, 9 lysis of adhesions, 7 distal tubal repairs, 6 salpingectomy, 8 other procedures. The mean surgical time is 47 min (25-120). One conversion to conventional laparoscopy and one in laparotomy were performed. The mean duration stay is 2 days [1-3]. DISCUSSION AND CONCLUSION SPA in gynecology is feasible with conventional laparoscopic instruments. SPA surgery represents the newest frontier in minimally invasive surgery.
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Affiliation(s)
- L de Poncheville
- Clinique du Mail Capio, 96, allée du Mail, 17000 La Rochelle, France.
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Fagotti A, Bottoni C, Fanfani F, Scambia G. Some criticism about postoperative pain after adnexal surgery performed by single-port versus standard laparoscopy. Fertil Steril 2012; 99:e3. [PMID: 23103019 DOI: 10.1016/j.fertnstert.2012.10.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Accepted: 10/08/2012] [Indexed: 10/27/2022]
Affiliation(s)
- Anna Fagotti
- Catholic University of the Sacred Heart, Rome, Italy
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