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Mehrzad M, Kang AS, Armstrong AW, Eisen DB. Comparing Cosmetic Outcomes of Straight-Line Versus W-Plasty Techniques for Linear Postauricular Wound Closure: A Randomized Evaluator Blind Split-Scar Trial. Dermatol Surg 2024; 50:423-427. [PMID: 38416811 DOI: 10.1097/dss.0000000000004113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2024]
Abstract
BACKGROUND Surgeons' opinions vary on the cosmetic outcome of straight-line (SL) versus broken-line (W-plasty) closure methods. To date, no studies have compared the 2 techniques in the split-scar design model that resolves the confounding individual patient factors that affects the scar outcome. OBJECTIVE Compare outcomes and wound cosmesis with SL versus W-plasty closure techniques. METHODS This clinical trial was conducted with 50 linear surgical wounds randomized to SL closure on half and W-plasty on the other half. At 3 months, patients and 2 masked observers evaluated each scar using the Patient and Observer Scar Assessment Scale (Patient Observer Scar Assessment Scale [POSAS]). RESULTS The mean (SD) sum of the POSAS observer component scores were 16.6 (6.18) for the SL side and 15.5 (6.37) for the W-plasty side ( p = .49). The mean (SD) sum of the POSAS patient scores were 14.4 (6.8) in SL and 15.1 (8.2) in W-plasty ( p = .59). The mean (SD) complications were 0.08 (0.06) for SL and 0.02 (0.14) for W-plasty ( p = .18). CONCLUSION No statistically significant difference in wound cosmesis or complications was noted between SL versus W-plasty closure techniques. Surgeons may want to consider whether the extra time involved in placing zigzag W-plasty lines is worthwhile.
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Affiliation(s)
- Mehrnaz Mehrzad
- School of Medicine, University of California, Davis, Sacramento, California
| | - Alison S Kang
- Department of Dermatology, Health Sciences Campus, University of Southern California, Los Angeles, California
| | - April W Armstrong
- Departments of Dermatology, University of California, Davis, Sacramento, California
| | - Daniel B Eisen
- Departments of Dermatology, University of California, Davis, Sacramento, California
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2
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Li Y, Liu R, Li X. Comparison of efficacy of single-port versus conventional laparoscopic treatment for uterine leiomyoma: a latest meta-analysis. Front Oncol 2023; 13:1192582. [PMID: 37601692 PMCID: PMC10433900 DOI: 10.3389/fonc.2023.1192582] [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: 03/23/2023] [Accepted: 07/11/2023] [Indexed: 08/22/2023] Open
Abstract
Objective Single-port laparoscopy has been proposed as an ideal surgical method for the treatment of uterine leiomyoma. It can effectively remove the lesion, reduce the loss of hemoglobin, and has superior cosmetic effects. Therefore, we searched relevant studies and conducted a meta-analysis to evaluate the effect of single-port laparoscopy on myoma resection, hemoglobin loss, and scar beauty compared to conventional laparoscopy. Methods We systematically searched PubMed, EMBASE, scope, Cochrane, CNKI, and other databases to find randomized controlled studies on the efficacy of single-port laparoscopy and traditional laparoscopy for meta-analysis. The main outcomes of our study were the duration of surgery, the reduction of hemoglobin, and the cosmetic effect of the postoperative scar. The effect model was selected according to heterogeneity (random effect model or fixed effect model), and the relevant sensitivity analysis and publication bias test were performed. Results We searched a total of 501 related literature articles and finally included 19 studies involving 21 researchers. Comparison of single-port laparoscopic myomectomy with traditional surgery: Operation time had no significant difference (Standardized Mean Difference [SMD]: 0.13, 95% Confidence interval (CI), -0.04 to 0.30; I²=74%; P = 0.14); The reduction of hemoglobin is lower ([SMD]: -0.04; 95% CI, -0.23 to 0.14; I²=71%; P = 0.65), and the cosmetic effect of postoperative scar is more satisfactory ([SMD]: 0.42, 95% CI: 0.02 to 0.83; I²=72%, P= 0.04). There was no significant difference in conversion rate, postoperative pain, blood loss, postoperative gastrointestinal recovery time, or length of hospital stay. Conclusion Compared with traditional laparoscopy, the operation time of the treatment of uterine leiomyoma by single-port laparoscopy is not extended, the reduction of hemoglobin is less, and the cosmetic effect of the scar is better. Therefore, single-port laparoscopy is superior to traditional surgery in the treatment of uterine leiomyoma. Systematic review registration https://inplasy.com/inplasy-2023-3-0071/, identifier INPLASY202330071.
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Affiliation(s)
- Yanhui Li
- Department of Obstetrics and Gynaecology, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Rui Liu
- Department of Obstetrics and Gynecology, Dezhou United Hospital, Dezhou, Shandong, China
| | - Xue Li
- Department of Laboratory Medicine, People’s Hospital of Linyi County, Dezhou, Shandong, China
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3
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Chen S, Zhang G, Hua K, Ding J. Single-port laparoscopy versus conventional laparoscopy of benign adnexal masses during pregnancy: a retrospective case-control study. J Int Med Res 2022; 50:3000605221128153. [PMID: 36314266 PMCID: PMC9623375 DOI: 10.1177/03000605221128153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE To compare operative outcomes between single-port laparoscopy (SPL) and conventional laparoscopy (CL) to remove adnexal masses during pregnancy. METHODS This retrospective case-control study included all patients who had undergone laparoscopic removal of benign adnexal masses during pregnancy between October 2010 and January 2020. Multiple clinical characteristics and operative outcomes were retrospectively analysed and compared between patients who had undergone SPL versus CL, including cosmetic satisfaction with the scar, measured on a 10-point scale (10 indicating very satisfied). RESULTS A total of 64 patients were included (SPL, n = 22; and CL, n = 42). Overall scar satisfaction scores significantly favoured SPL versus CL (9.1 ± 1.7 versus 8.1 ± 1.3, respectively), however, surgery duration was significantly longer for SPL than CL (69.2 ± 21.0 min versus 54.7 ± 20.7 min). No incisional hernia was detected in the study. Operative blood loss, decrease in estimated haemoglobin level, length of hospital stay, and hospitalization expenses were comparable between the two groups. Pregnancy and fetal outcomes were not remarkably different. CONCLUSION For removal of benign adnexal masses during pregnancy, SPL may offer superior cosmetic satisfaction versus CL, and was not associated with additional perioperative danger, economic burden, or adverse pregnancy and neonatal outcomes.
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Affiliation(s)
- Sishi Chen
- Department of Gynaecology, the Obstetrics and Gynaecology Hospital of Fudan
University, Shanghai, China,Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases,
Shanghai, China
| | - Ganrong Zhang
- Department of Gynaecology, the Obstetrics and Gynaecology Hospital of Fudan
University, Shanghai, China,Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases,
Shanghai, China
| | - Keqin Hua
- Department of Gynaecology, the Obstetrics and Gynaecology Hospital of Fudan
University, Shanghai, China,Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases,
Shanghai, China,Ke-Qin Hua, Department of Gynaecology, the Obstetrics
and Gynaecology Hospital of Fudan University, 128 Shenyang Road, Shanghai 200090, China.
| | - Jingxin Ding
- Department of Gynaecology, the Obstetrics and Gynaecology Hospital of Fudan
University, Shanghai, China,Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases,
Shanghai, China,Jing-Xin Ding, Department of Gynaecology, the
Obstetrics and Gynaecology Hospital of Fudan University, 128 Shenyang Road, Shanghai 200090,
China.
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4
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Lee JH, Yoo HK, Park SY, Moon HS. Robotic single-port myomectomy using the da Vinci SP surgical system: A pilot study. J Obstet Gynaecol Res 2021; 48:200-206. [PMID: 34689396 DOI: 10.1111/jog.15076] [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: 05/10/2021] [Revised: 09/07/2021] [Accepted: 10/11/2021] [Indexed: 02/02/2023]
Abstract
AIM To report our initial experience with robotic single-port myomectomy (RSPM) using the da Vinci SP surgical system and to evaluate the feasibility of the procedure. MATERIAL AND METHODS This prospective observational study was performed at a university teaching hospital from January 2019 to December 2019. Sixty-one women with symptomatic fibroids received RSPM. RESULTS Based on seven resected fibroids and a maximal diameter of resected fibroids <10 cm, the women were arbitrarily divided into two groups. The mean number and maximal diameter of the removed fibroids were 3.7 ± 3.8 (2.3 ± 1.8 in Group 1 vs. 7.2 ± 5.3 in Group 2) and 7.6 ± 2.9 cm (6.8 ± 1.6 in Group 1 vs. 9.5 ± 4.3 in Group 2), respectively. The mean operation time, hemoglobin change, and hospital stay were 149.9 ± 72.9 min (123.8 ± 43.8 in Group 1 vs. 217.6 ± 89.4 in Group 2), 2.3 ± 1.0 g/dL (2.1 ± 0.9 in Group 1 vs. 2.7 ± 1.2 in Group 2), and 4.5 ± 0.8 days (4.4 ± 0.8 in Group 1 vs. 4.7 ± 0.9 in Group 2). There was no conversion to multi-port laparoscopy or laparotomy nor were there any major complications. CONCLUSIONS RSPM using the da Vinci SP surgical system is feasible surgical modality for women with symptomatic fibroid and is expected to increase indications of single-port myomectomy by solving many of the ergonomics problems inevitably accompanying single-port laparoscopic myomectomy.
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Affiliation(s)
- Jung Hun Lee
- Department of Obstetrics and Gynecology, Ewha Womans University Seoul Hospital, College of Medicine, Ewha Womans University, Seoul, South Korea
| | - Hae Kyung Yoo
- Department of Obstetrics and Gynecology, Ewha Womans University Seoul Hospital, College of Medicine, Ewha Womans University, Seoul, South Korea
| | - So Yun Park
- Department of Obstetrics and Gynecology, Ewha Womans University Seoul Hospital, College of Medicine, Ewha Womans University, Seoul, South Korea
| | - Hye-Sung Moon
- Department of Obstetrics and Gynecology, Ewha Womans University Seoul Hospital, College of Medicine, Ewha Womans University, Seoul, South Korea
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Fan X, Duan K, Zhang C, Guan X. Feasibility of two robotic single-site surgery techniques for adolescent endometriosis: Focal versus butterfly. Int J Med Robot 2021; 18:e2339. [PMID: 34661960 DOI: 10.1002/rcs.2339] [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: 08/15/2021] [Revised: 09/24/2021] [Accepted: 10/08/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE This study examined the feasibility of robotic laparoendoscopic single-site surgery (LESS) for the treatment of adolescent endometriosis (n = 36). Additionally, we assessed a novel technique known as butterfly resection for severe cases. METHODS This was a retrospective study of women from 12 to 21 years old who received therapeutic robotic LESS for symptomatic endometriosis by a single experienced surgeon. RESULTS There were 32 cases of peritoneal and four cases of deep infiltrating endometriosis (DIE). Focal resection was performed in 9/32 peritoneal and all DIE cases; butterfly resection was performed in the remaining 23/32 peritoneal. At 3 months, 16/23 had complete resolution of pelvic pain in the butterfly group versus 10/13 in the focal group (P = 0.64). CONCLUSION Robotic LESS produces safe outcomes with low complication rates. Butterfly resection may be considered for extensive lesions, with similar levels of pain relief compared to traditional focal resection techniques. CAPSULE Single-site robotic surgery produces safe outcomes with low complication rates in adolescents with endometriosis, with techniques customized based on disease severity.
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Affiliation(s)
- Xiaodong Fan
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA.,Tianjin Central Hospital of Gynecology Obstetrics Affiliated Hospital of Nankai University, Tianjin, China
| | - Kristina Duan
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA
| | - Chunhua Zhang
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA.,Department of Obstetrics and Gynecology, Huai'an Maternity and Child Healthcare Hospital Affiliated to Yangzhou Medical University, Jiangshu, China
| | - Xiaoming Guan
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA
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6
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Joo J, Pourang A, Tchanque-Fossuo CN, Armstrong AW, Tartar DM, King TH, Sivamani RK, Eisen DB. Undermining during cutaneous wound closure for wounds less than 3 cm in diameter: a randomized split wound comparative effectiveness trial. Arch Dermatol Res 2021; 314:697-703. [PMID: 34546436 PMCID: PMC9307554 DOI: 10.1007/s00403-021-02280-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 08/28/2021] [Accepted: 09/03/2021] [Indexed: 11/30/2022]
Abstract
Undermining is thought to improve wound outcomes; however, randomized controlled data regarding its efficacy are lacking in humans. The objective of this randomized clinical trial was to determine whether undermining low to moderate tension wounds improves scar cosmesis compared to wound closure without undermining. Fifty-four patients, 18 years or older, undergoing primary linear closure of a cutaneous defect with predicted postoperative closure length of ≥ 3 cm on any anatomic site were screened. Four patients were excluded, 50 patients were enrolled, and 48 patients were seen in follow-up. Wounds were divided in half and one side was randomized to receive either no undermining or 2 cm of undermining. The other side received the unselected intervention. Three months, patients and 2 masked observers evaluated each scar using the Patient and Observer Scar Assessment Scale (POSAS). A total of 50 patients [mean (SD) age, 67.6 (11.5) years; 31 (64.6%) male; 48 (100%) white] were enrolled in the study. The mean (SD) sum of the POSAS observer component scores was 12.0 (6.05) for the undermined side and 11.1 (4.68) for the non-undermined side (P = .60). No statistically significant difference was found in the mean (SD) sum of the patient component for the POSAS score between the undermined side [15.9 (9.07)] and the non-undermined side [13.33 (6.20)] at 3 months. For wounds under low to moderate perceived tension, no statistically significant differences in scar outcome or total complications were noted between undermined wound halves and non-undermined halves. Trail Registry: Clinical trials.gov Identifier NCT02289859. https://clinicaltrials.gov/ct2/show/NCT02289859.
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Affiliation(s)
- Jayne Joo
- Department of Dermatology, University of California, Davis, School of Medicine, 3301 C St, Ste 1400, Sacramento, CA, 95816, USA
| | - Aunna Pourang
- Department of Dermatology, University of California, Davis, School of Medicine, 3301 C St, Ste 1400, Sacramento, CA, 95816, USA
| | | | - April W Armstrong
- Department of Dermatology, Keck School of Medicine at University of Southern California, Los Angeles, CA, USA
| | - Danielle M Tartar
- Department of Dermatology, University of California, Davis, School of Medicine, 3301 C St, Ste 1400, Sacramento, CA, 95816, USA
| | - Thomas H King
- Department of Dermatology, University of California, Davis, School of Medicine, Sacramento, CA, USA
| | - Raja K Sivamani
- Department of Dermatology, University of California, Davis, School of Medicine, 3301 C St, Ste 1400, Sacramento, CA, 95816, USA.,Department of Biological Sciences, California State University, Sacramento, CA, USA.,College of Medicine, California Northstate University, Elk Grove, CA, USA.,Pacific Skin Institute, Sacramento, CA, USA
| | - Daniel B Eisen
- Department of Dermatology, University of California, Davis, School of Medicine, 3301 C St, Ste 1400, Sacramento, CA, 95816, USA.
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7
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Application of robotic single-site surgery with optional additional port for endometriosis: a single institution's experience. J Robot Surg 2021; 16:127-135. [PMID: 33651315 DOI: 10.1007/s11701-021-01217-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 02/20/2021] [Indexed: 10/22/2022]
Abstract
To evaluate the safety and feasibility of treating stage I-IV endometriosis patients with robotic single-site surgery (RSSS). A retrospective chart review was conducted on 334 patients with endometriosis treated by a single surgeon at a university hospital from January 2015 to November 2019. Surgeries were performed in a single institution between 2015 and 2019. All patients presented with pelvic pain and underwent surgical resection of the lesion. American Society of Reproductive Medicine (ASRM) standards were used to classify endometriosis. The primary goal of this study is to investigate the feasibility and safety of RSSS for surgical resection of stage I-IV endometriosis patients. We will compare patient characteristics and surgical parameters, such as blood loss, operating time, and postoperative complications, across different endometriosis stages to evaluate the effectiveness of this novel technique. RSSS was used for all cases, with no conversions to laparotomy or traditional laparoscopy. One to two additional ports were placed in 41 patients with deeply infiltrating endometriosis (DIE) involving the colorectal and urinary tract and/or extensive pelvic adhesions. Across patient groups, there were no significant differences in age, BMI, fertility history, abdominal surgery history, and hysterectomy ratio (P > 0.05). The median operation time was 140.25 min (range: 85.50-260.00 min, P < 0.05) and median blood loss was 31.25 mL (range: 15-100 mL, P < 0.05). Histopathology supported the diagnosis in 259/334 patients. The undiagnosed patients were associated with lower ASRM scores. For 83.3% of patients (295/334), the length of hospital stay was < 24 h. The postoperative complication rate was 6.0% (20/334), although only two cases were severe. Our results indicate that RSSS is an alternative, safe, and acceptable platform for the surgical treatment of all stages of endometriosis.
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8
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Luo W, Duan K, Zhang N, Delgado S, Guan Z, Guan X. A comparison of three approaches for laparoscopic single-site (LESS) myomectomy: conventional, robotic, and hand assisted. J Robot Surg 2020; 15:643-649. [PMID: 33026640 DOI: 10.1007/s11701-020-01151-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 09/25/2020] [Indexed: 01/09/2023]
Abstract
The objective of this study is to determine the feasibility and explore criteria for patient selection for three methods of LESS myomectomy: conventional (C-LESS), robotic-assisted (RA-LESS), and hand-assisted (HA-LESS). This was a retrospective case review of 72 patients with uterine myomas, conducted in a large academic tertiary care hospital between March 1, 2015, and November 7, 2018. LESS myomectomy via conventional, robotic, and hand-assisted routes. 43 patients underwent C-LESS, 15 underwent RA-LESS, and 14 underwent HA-LESS, with no conversions to open abdominal myomectomy. The operative outcomes were compared across the three approaches. The HA-LESS group had the largest mean number (HA: 6.9; C: 3.7; RA: 2.9, P=0.001), diameter (HA: 11.3 cm; C: 9.3 cm; RA: 7.1 cm, P=0.035), and weight (HA: 850.1 g; C: 320.7 g; RA: 181.1 g, P=0.003) of myomas removed per patient. The use of this method was also found to have a direct correlation with estimated preoperative uterine size (HA: 20.1 weeks; C: 16.2 weeks; RA: 12.0 weeks, P=0.001. Operative time and postoperative stay were found to be not statistically different across groups. We conclude that all three types of LESS myomectomy are feasible with comparable surgical outcomes. Most importantly, our findings indicate that hand assistance can be combined with C-LESS myomectomy for large or multi-fibroid uterus without compromising operating time or patient recovery. Notably, we found that uterine size could be a useful tool for the determination of the surgical approach.
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Affiliation(s)
- Weihua Luo
- Department of Obstetrics and Gynecology, Baylor College of Medicine, 6651 Main Street, 10th floor, Houston, TX, 77030, USA.,Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Kristina Duan
- Department of Obstetrics and Gynecology, Baylor College of Medicine, 6651 Main Street, 10th floor, Houston, TX, 77030, USA
| | - Ning Zhang
- Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Stephanie Delgado
- Department of Obstetrics and Gynecology, Baylor College of Medicine, 6651 Main Street, 10th floor, Houston, TX, 77030, USA
| | | | - Xiaoming Guan
- Department of Obstetrics and Gynecology, Baylor College of Medicine, 6651 Main Street, 10th floor, Houston, TX, 77030, USA.
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9
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Sklar LR, Pourang A, Armstrong AW, Dhaliwal SK, Sivamani RK, Eisen DB. Comparison of Running Cutaneous Suture Spacing During Linear Wound Closures and the Effect on Wound Cosmesis of the Face and Neck: A Randomized Clinical Trial. JAMA Dermatol 2020; 155:321-326. [PMID: 30649154 DOI: 10.1001/jamadermatol.2018.5057] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Surgeons have varying opinions on the ideal cutaneous suture spacing for optimal cosmetic outcomes. To date, no studies concerning the effect of suture spacing on cosmetic outcomes exist in the literature. Objective To compare outcomes and wound cosmesis achieved with running cutaneous sutures spaced 2 vs 5 mm apart. Design, Setting, and Participants This randomized clinical trial was conducted at the University of California, Davis dermatology clinic from November 28, 2017, to June 15, 2018. Fifty-six patients 18 years or older with surgical fusiform wounds (from Mohs procedure or surgical excision) on the head or neck with assumed closure lengths of at least 3 cm were screened. Six patients were excluded, 50 patients were enrolled, and 48 patients were followed up. Interventions Fifty surgical fusiform wounds were randomized to running cuticular closure with 2-mm spacing on half and 5-mm spacing on half. Main Outcomes and Measures At 3 months, patients and 2 masked observers evaluated each scar using the Patient and Observer Scar Assessment Scale (POSAS). Results A total of 50 patients (mean [SD] age, 71.1 [11.4] years; 43 [86%] male; 50 [100%] white) were enrolled in the study. The mean (SD) sum of the POSAS observer component scores was 10.7 (4.3) for the 2-mm interval side and 10.8 (3.5) for the 5-mm side at 3 months (P = .77). No statistically significant difference was found in the mean (SD) sum of the patient component for the POSAS score between the 2-mm interval side (10.2 [4.7]) and the 5-mm interval side (11.5 [6.4]) at 3 months (P = .24). No statistically significant difference was observed in mean (SD) scar width between the 2-mm side (0.9 [0.6] mm) and the 5-mm side (0.8 [0.4] mm; P = .15). Conclusions and Relevance No statistically significant difference in wound cosmesis or total complications were noted between running cuticular sutures spaced 2 vs 5 mm apart. Both suturing techniques resulted in similar cosmetic outcomes and complication rates. Surgeons may want to consider whether the extra time involved in placing very closely spaced cuticular sutures is worthwhile. Trial Registration ClinicalTrials.gov identifier: NCT03330041.
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Affiliation(s)
- Lindsay R Sklar
- Department of Dermatology, University of California, Davis, School of Medicine, Sacramento
| | - Aunna Pourang
- Department of Dermatology, University of California, Davis, School of Medicine, Sacramento
| | - April W Armstrong
- Department of Dermatology, Keck School of Medicine at University of Southern California, Los Angeles
| | - Simran K Dhaliwal
- Department of Dermatology, University of California, Davis, School of Medicine, Sacramento
| | - Raja K Sivamani
- Department of Dermatology, University of California, Davis, School of Medicine, Sacramento
| | - Daniel B Eisen
- Department of Dermatology, University of California, Davis, School of Medicine, Sacramento
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10
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Yuk JS, Kim YA, Lee JH. Hybrid Robotic Single-Site Myomectomy Using the GelPoint Platform. J Laparoendosc Adv Surg Tech A 2019; 29:1475-1480. [PMID: 31424320 DOI: 10.1089/lap.2019.0313] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background: To overcome the limitations of single-port laparoscopic myomectomy (SP-LM) and robotic single-site myomectomy (RSSM), we designed a new surgical technique, the so-called hybrid RSSM (H-RSSM), by integrating the advantages of both procedures. This study describes the surgical technique of H-RSSM and reports our initial experiences. Materials and Methods: Between February 2018 and September 2018, H-RSSM was performed in 25 women with symptomatic fibroids. During the H-RSSM, the enucleation of the fibroid was carried out using single-port laparoscopy and the uterine defect was repaired using robotic single-site surgery. To assess the feasibility and efficacy of H-RSSM, the results of this study were compared with those of our previous study on SP-LM and its modified surgical technique, so-called single-port laparoscopically assisted transumbilical ultraminilaparotomic myomectomy (SPLA-TUM). Results: The mean operation time, hemoglobin change, return of bowel activity, and length of hospital stay were 69.4 ± 18.2 minutes, 1.2 ± 0.9 g/dL, 37.1 ± 15.5 hours, and 4.0 ± 0.8 days, respectively. There was no conversion to laparotomy or multiport laparoscopy. There were no surgical or wound complications. Comparing with SP-LM and SPLA-TUM, H-RSSM had significantly shorter operation time and return of bowel activity. Conclusion: H-RSSM can reduce operating time and the conversion rate to multiport laparoscopy and can be considered a feasible alternative for selected patients with symptomatic fibroids. However, further studies are needed to clearly demonstrate these benefits.
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Affiliation(s)
- Jin-Sung Yuk
- The Department of Obstetrics and Gynecology, Sanggye Paik Hospital, School of Medicine, Inje University, Seoul, Republic of Korea
| | - Yeon A Kim
- The Department of Anesthesiology and Pain Medicine, Gyeongsang National University Changwon Hospital, School of Medicine, Gyeongsang National University, Changwon, Gyeongnam, Republic of Korea
| | - Jung Hun Lee
- The Department of Obstetrics and Gynecology, Ewha Womans University Seoul Hospital, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
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11
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Pourang A, Crispin MK, Clark AK, Armstrong AW, Sivamani RK, Eisen DB. Use of 5-0 Fast Absorbing Gut versus 6-0 Fast Absorbing Gut during cutaneous wound closure on the head and neck: A randomized evaluator-blinded split-wound comparative effectiveness trial. J Am Acad Dermatol 2019; 81:213-218. [DOI: 10.1016/j.jaad.2019.02.037] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 01/23/2019] [Accepted: 02/13/2019] [Indexed: 10/27/2022]
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12
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Koo YJ. Recent advances in minimally invasive surgery for gynecologic indications. Yeungnam Univ J Med 2018; 35:150-155. [PMID: 31620587 PMCID: PMC6784696 DOI: 10.12701/yujm.2018.35.2.150] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 09/28/2018] [Accepted: 10/01/2018] [Indexed: 12/13/2022] Open
Abstract
Recently, an increasing interest in less invasive surgery has led to the advent of laparoendoscopic single-site surgery (LESS) and natural orifice transluminal endoscopic surgery (NOTES). LESS and NOTES could be technically challenging, but available literature has demonstrated the feasibility and safety of LESS for benign gynecologic diseases. However, the evidence is not strong enough to recommend the use of LESS over that of conventional multiport laparoscopic surgery (MLS). As per the results of the most recently published meta-analysis, the majority of surgical outcomes are equivalent between LESS and MLS, except for the longer operative time in LESS for both adnexal surgery and hysterectomy. Although an increasing number of studies have reported on robotic LESS, NOTES, and LESS for gynecologic malignancy, definite conclusions have not been drawn owing to the lack of sufficient information.
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Affiliation(s)
- Yu-Jin Koo
- Department of Obstetrics and Gynecology, Yeungnam University College of Medicine, Daegu, Korea
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Chang JW, Oh J, Jung US. Umbilical Quilting Suture Technique during Single-Port Laparoscopic Surgery. JSLS 2018; 22:JSLS.2017.00088. [PMID: 29618919 PMCID: PMC5863694 DOI: 10.4293/jsls.2017.00088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background and Objectives Single-port laparoscopic surgery (SPLS) is popular in the gynecological field, because it is less invasive and leaves a smaller scar. However, the postoperative shape of the umbilicus is often distorted due to the intensive procedures performed through the small opening. In this report, we describe a technique for forming a satisfactory umbilicus in SPLS. Methods From March 2016 through April 2017, 32 patients were treated with SPLS by a single gynecologic surgeon. Group A (14 cases) underwent conventional umbilicus closure, and group B (18 cases) underwent a quilting suture technique. The umbilical shapes of each group were assessed by a plastic surgeon as was the patients' satisfaction. Evaluations were performed immediately after surgery and every month for 6 months thereafter. Results The postoperative umbilical shape in group A showed features, such as loss of depression, disappearance of the central vertical line, and irregularly bulging tissue, whereas group B had a shape similar to that of the natural umbilicus and maintained its depression and vertical line. The average scores of the plastic surgeons' evaluations immediately after the operation were 10.4 for group A and 15.1 for group B. The final scores obtained 6 months after surgery were 15.2 and 17.8, respectively. The patients' satisfaction scores immediately after the operation were 4.9 for group A and 7.3 for group B. The scores increased gradually, to 8.1 and 9.2, respectively, at 6 months after surgery. Conclusion Performing quilting sutures during wound closure in SPLS is effective for making an ideal umbilicus and ensuring patients' satisfaction.
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Affiliation(s)
| | - Jeongseok Oh
- Department of Plastic and Reconstructive Surgery
| | - Un Suk Jung
- Department of Obstetrics and Gynecology, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
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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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de Vries CE, Dekker AC, van Veen R, van der Zeeuw FT, Coblijn UK, Brölmann FE, van Wagensveld BA. Trocar port scar quality in morbidly obese patients after bariatric surgery. Surg Obes Relat Dis 2018; 14:616-622. [DOI: 10.1016/j.soard.2018.01.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 01/08/2018] [Accepted: 01/25/2018] [Indexed: 12/29/2022]
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Authors' Reply. J Minim Invasive Gynecol 2017; 25:190. [PMID: 29079465 DOI: 10.1016/j.jmig.2017.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Accepted: 10/18/2017] [Indexed: 11/22/2022]
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Lee D, Kim SK, Kim K, Lee JR, Suh CS, Kim SH. Advantages of Single-Port Laparoscopic Myomectomy Compared with Conventional Laparoscopic Myomectomy: A Randomized Controlled Study. J Minim Invasive Gynecol 2017; 25:124-132. [PMID: 28826957 DOI: 10.1016/j.jmig.2017.08.651] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 08/12/2017] [Accepted: 08/14/2017] [Indexed: 12/19/2022]
Abstract
STUDY OBJECTIVE To compare operative outcomes of single-port laparoscopic myomectomy (SP-LM) vs conventional laparoscopic myomectomy (CLM), including subjective and objective cosmetic aspects. DESIGN Prospective randomized controlled trial (Canadian Task Force classification I). SETTING University hospital. PATIENTS Women with uterine myoma scheduled for laparoscopic myomectomy. INTERVENTIONS Sixty-six women were assigned at random to either the SP-LM or CLM group. Surgical outcomes, including patient and observer scar assessments, were evaluated between the groups according to the intention-to-treat principle. MEASUREMENTS AND MAIN RESULTS There were no significant differences in demographic characteristics and properties of myomectomy between the groups. There also were no differences in surgical outcomes, such as operation time, estimated blood loss, and complications, between the 2 groups. The mean total score of the Observer Scar Assessment Scale was lower in the SP-LM group at 1 week (13.0 ± 3.2 vs 18.3 ± 4.8; p < .001) and 8 weeks (9.9 ± 3.2 vs 14.3 ± 3.8; p < .001) after discharge. Similar results were obtained for the Patient Scar Assessment Scale at 1 week (11.6 ± 7.2 vs 18.5 ± 12.8; p = .024) and 8 weeks (9.5 ± 6.0 vs 18.8 ± 9.1; p < .001) after discharge. Postoperative pain and analgesic consumption did not differ between the groups, except in patient-controlled analgesia consumption at 6 hours after operation, which was lower in the SP-LM group (12.7 ± 6.3 mL vs 16.4 ± 6.2 mL; p = .039). Operative outcomes were similar in the 2 groups. CONCLUSION SP-LM is associated with more favorable cosmetic outcomes and better patient satisfaction compared with CLM. There were no differences in operative outcomes and complications between the 2 modalities.
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Affiliation(s)
- Dayong Lee
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea; Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seul Ki Kim
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea; Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kidong Kim
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jung Ryeol Lee
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea; Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea.
| | - Chang Suk Suh
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Seok Hyun Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, Republic of Korea
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Yuk JS, Kim KH, Park JK, Lee JH. Single-port laparoscopic neosalpingostomy for hydrosalpinx. Gynecol Minim Invasive Ther 2017; 6:116-119. [PMID: 30254893 PMCID: PMC6135171 DOI: 10.1016/j.gmit.2017.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Revised: 02/22/2017] [Accepted: 03/07/2017] [Indexed: 11/17/2022] Open
Abstract
Background: To describe the surgical technique and our initial experience of single-port laparoscopic neosalpingostomy (SP-LN) for treatment of hydrosalpinx. Materials and methods: This prospective observational study was carried out at University teaching hospitals. Ten women underwent SP-LN for hydrosalpinx between November 2012 and December 2015. Results: The mean (range) age and body mass index were 29.3 (21–36) years and 22.2 (17.7–27.1) kg/m2, respectively. Six women had a history of previous abdominal surgery; laparoscopic unilateral salpingectomy for tubal pregnancy in two, laparoscopic appendectomy in three, and laparotomy appendectomy in one. Six women underwent unilateral SP-LN and nine women underwent bilateral SP-LN. The mean (range) operating time, hemoglobin change, return of bowel activity, and length of hospital stay were 91.5 (70–120) minutes, 0.7 (0.1–1.6) g/dL, 19.9 (7.1–25.4) hours, and 3.7 (3–4) days, respectively. There was no conversion to multiport laparoscopy or laparotomy. There were no surgical or wound complications in any patient. Conclusion: SP-LN might be a feasible and safe alternative in women with hydrosalpinx. However, further study is needed to confirm this preliminary result and to explore the obstetric outcomes following SP-LN.
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Affiliation(s)
- Jin-Sung Yuk
- Department of Obstetrics and Gynecology, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Changwon, Republic of Korea
| | - Kye Hyun Kim
- The Department of Obstetrics and Gynecology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ji Kwon Park
- Department of Obstetrics and Gynecology, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Changwon, Republic of Korea
| | - Jung Hun Lee
- Department of Obstetrics and Gynecology, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Changwon, Republic of Korea
- Corresponding author. Division of Gynecologic Oncology and Gynecologic Minimally Invasive Surgery Center, Department of Obstetrics and Gynecology, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, 11, Samjeongja-ro, Seongsan-gu, Changwon-si, Gyeongsangnam-do, 51472, Republic of Korea. E-mail address: (J.H. Lee)
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Laparoendoscopic single-site surgery versus conventional laparoscopy for hysterectomy: a systematic review and meta-analysis. Arch Gynecol Obstet 2017; 295:1089-1103. [PMID: 28357561 PMCID: PMC5388711 DOI: 10.1007/s00404-017-4323-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 02/06/2017] [Indexed: 02/07/2023]
Abstract
Purpose To assess the safety and effectiveness of LESS compared to conventional hysterectomy. Methods The systematic review and meta-analysis was performed according to the MOOSE guideline, and quality of evidence was assessed using GRADE. Different databases were searched up to 4th of August 2016. Randomized controlled trials and cohort studies comparing LESS to the conventional laparoscopic hysterectomy were considered for inclusion. Results Of the 668 unique articles, 23 were found relevant. We investigated safety by analyzing the complication rate and found no significant differences between both groups [OR 0.94 (0.61, 1.44), I2 = 19%]. We assessed effectiveness by analyzing conversion risk, postoperative pain, and patient satisfaction. For conversion rates to laparotomy, no differences were identified [OR 1.60 (0.40, 6.38), I2 = 45%]. In 3.5% of the cases in the LESS group, an additional port was needed during LESS. For postoperative pain scores and patient satisfaction, some of the included studies reported favorable results for LESS, but the clinical relevance was non-significant. Concerning secondary outcomes, only a difference in operative time was found in favor of the conventional group [MD 11.3 min (5.45–17.17), I2 = 89%]. The quality of evidence for our primary outcomes was low or very low due to the study designs and lack of power for the specified outcomes. Therefore, caution is urged when interpreting the results. Conclusion The single-port technique for benign hysterectomy is feasible, safe, and equally effective compared to the conventional technique. No clinically relevant advantages were identified, and as no data on cost effectiveness are available, there are currently not enough valid arguments to broadly implement LESS for hysterectomy. Electronic supplementary material The online version of this article (doi:10.1007/s00404-017-4323-y) contains supplementary material, which is available to authorized users.
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Tidwell WJ, Owen CE, Kulp-Shorten C, Maity A, McCall M, Brown TS. Fractionated Er:YAG laser versus fully ablative Er:YAG laser for scar revision: Results of a split scar, double blinded, prospective trial. Lasers Surg Med 2016; 48:837-843. [DOI: 10.1002/lsm.22562] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2016] [Indexed: 11/10/2022]
Affiliation(s)
- W. James Tidwell
- Division of Dermatology; University of Louisville; 3810 Springhurst Blvd. Louisville Kentucky 40241
| | - Cindy E. Owen
- Division of Dermatology; University of Louisville; 3810 Springhurst Blvd. Louisville Kentucky 40241
| | - Carol Kulp-Shorten
- Division of Dermatology; University of Louisville; 3810 Springhurst Blvd. Louisville Kentucky 40241
| | - Abhishek Maity
- The Fletcher School of Law and Diplomacy; Tufts University; 160 Packard Avenue Medford Massachusetts 02155
| | - Michael McCall
- Division of Dermatology; University of Louisville; 3810 Springhurst Blvd. Louisville Kentucky 40241
| | - Timothy S. Brown
- Division of Dermatology; University of Louisville; 3810 Springhurst Blvd. Louisville Kentucky 40241
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Guan X, Nguyen MTA, Walsh TM, Kelly B. Robotic Single-Site Endometriosis Resection Using Firefly Technology. J Minim Invasive Gynecol 2016; 23:10-1. [DOI: 10.1016/j.jmig.2015.08.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Accepted: 08/01/2015] [Indexed: 10/23/2022]
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22
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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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Laparoscopic Single-Site Myomectomy of 11-cm Intramural Myoma. J Minim Invasive Gynecol 2015; 22:936-7. [DOI: 10.1016/j.jmig.2015.05.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 05/27/2015] [Indexed: 01/15/2023]
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Park SY, Kim KH, Yuk JS, Ji HY, Lee JH. Skin closure methods after single port laparoscopic surgery: a randomized clinical trial. Eur J Obstet Gynecol Reprod Biol 2015; 189:8-12. [DOI: 10.1016/j.ejogrb.2015.03.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 02/24/2015] [Accepted: 03/05/2015] [Indexed: 10/23/2022]
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Yuk JS, Ji HY, Kim KH, Lee JH. Single-port laparoscopically assisted-transumbilical ultraminilaparotomic myomectomy (SPLA-TUM) versus single port laparoscopic myomectomy: a randomized controlled trial. Eur J Obstet Gynecol Reprod Biol 2015; 188:83-7. [DOI: 10.1016/j.ejogrb.2015.03.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 02/15/2015] [Accepted: 03/02/2015] [Indexed: 10/23/2022]
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Wang AS, Kleinerman R, Armstrong AW, Fitzmaurice S, Pascucci A, Awasthi S, Ratnarathorn M, Sivamani R, King TH, Eisen DB. Set-back versus buried vertical mattress suturing: Results of a randomized blinded trial. J Am Acad Dermatol 2015; 72:674-80. [DOI: 10.1016/j.jaad.2014.07.018] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Revised: 07/03/2014] [Accepted: 07/14/2014] [Indexed: 01/01/2023]
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Lee HJ, Kim JY, Kim SK, Lee JR, Suh CS, Kim SH. Learning Curve Analysis and Surgical Outcomes of Single-port Laparoscopic Myomectomy. J Minim Invasive Gynecol 2015; 22:607-11. [PMID: 25614346 DOI: 10.1016/j.jmig.2015.01.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 12/25/2014] [Accepted: 01/10/2015] [Indexed: 11/18/2022]
Abstract
STUDY OBJECTIVE To identify learning curves for single-port laparoscopic myomectomy (SPLM) and evaluate surgical outcomes according to the sequence of operation. DESIGN A retrospective study. SETTING A university-based hospital (Canadian Task Force classification II-2). PATIENTS The medical records from 205 patients who had undergone SPLM from October 2009 to May 2013 were reviewed. Because the myomectomy time was significantly affected by the size and number of myomas removed by SPLM, cases in which 2 or more of the myomas removed were >7 cm in diameter were excluded. Furthermore, cases involving additional operations performed simultaneously (e.g., ovarian or hysteroscopic surgery) were also excluded. A total of 161 cases of SPLM were included. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS We assessed the SPLM learning curve via a graph based on operation time versus sequence of cases. Patients were chronologically arranged according to their surgery dates and were then placed into 1 of 4 groups according to their operation sequence. SPLM was completed successfully in 160 of 161 cases (99.4%). One case was converted to multiport surgery. Basal characteristics of the patients between the 4 groups did not differ. The median operation times for the 4 groups were 112.0, 92.8, 83.7, and 90.0 minutes, respectively. Operation time decreased significantly in the second, third, and fourth groups compared with that in the first group (p < .001). Proficiency, which is the point at which the slope of the learning curve became less steep, was evident after about 45 operations. CONCLUSION Results from the current study suggested that proficiency for SPLM was achieved after about 45 operations. Additionally, operation time decreased with experience without an increase in complication rate.
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Affiliation(s)
- Hee Jun Lee
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ju Yeong Kim
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Seul Ki Kim
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jung Ryeol Lee
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea; Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea.
| | - Chang Suk Suh
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea; Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Seok Hyun Kim
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea; Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
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Eom JM, Kim KH, Yuk JS, Roh SI, Lee JH. Quality of life after single-port laparoscopic surgery versus conventional laparoscopic surgery for benign gynecologic disease. Surg Endosc 2014; 29:1850-5. [PMID: 25277482 DOI: 10.1007/s00464-014-3875-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Accepted: 09/02/2014] [Indexed: 01/22/2023]
Abstract
BACKGROUND The aim of current study was to determine whether single-port laparoscopic surgery (SP-LS) improves the health-related quality of life (QoL) compared with conventional laparoscopic surgery (conventional LS) in women with benign gynecologic disease. METHODS We performed a prospective case-control study from October 2010 to December 2012. A total of 273 women with benign gynecologic disease participated in this study, and 135 of them were in the SP-LS group and 138 in the conventional LS. We evaluated QoL after SP-LS or conventional LS. All patients were asked to complete short-form 36 (SF-36) QoL health surveys preoperatively and at 1, 3, and 6 months postoperatively. RESULTS Clinical characteristics and operative outcomes showed no significant differences between both groups. SP-LS had no benefits in QoL compared with conventional LS in the main categories, even though SP-LS showed statistically significant higher scores than conventional LS for the role of physical domain at 1 month postoperatively and for social function at 3 months postoperatively. In contrast to this, conventional LS had statistically significant higher scores than SP-LS for role function, bodily pain, general health, vitality, and emotional well-being at 6 months postoperatively. CONCLUSIONS With a 6-month follow-up, SP-LS does not offer a QoL benefit over conventional LS in women with benign gynecologic disease. However, a larger prospective randomized study would be required to confirm this.
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Affiliation(s)
- Jeong Min Eom
- Department of Obstetrics and Gynecology, National Medical Center, Seoul, Republic of Korea
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Lee JR, Lee JH, Kim JY, Chang HJ, Suh CS, Kim SH. Single port laparoscopic myomectomy with intracorporeal suture-tying and transumbilical morcellation. Eur J Obstet Gynecol Reprod Biol 2014; 181:200-4. [DOI: 10.1016/j.ejogrb.2014.07.051] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2013] [Revised: 03/23/2014] [Accepted: 07/30/2014] [Indexed: 11/28/2022]
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Kang JH, Lee DH, Lee JH. Single-Port Laparoscopically Assisted Transumbilical Ultraminilaparotomic Myomectomy. J Minim Invasive Gynecol 2014; 21:945-50. [DOI: 10.1016/j.jmig.2014.03.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Revised: 03/08/2014] [Accepted: 03/15/2014] [Indexed: 10/25/2022]
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Single-Port Access Laparoscopic Surgery in Gynecologic Oncology: Outcomes and Feasibility. Int J Gynecol Cancer 2014; 24:1126-32. [DOI: 10.1097/igc.0000000000000150] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ObjectivesSingle-port access laparoscopic surgery (SPALS) is supposed to simplify and improve the outcomes of current multiport laparoscopic procedures. This retrospective study was performed to assess the actual outcomes of SPALS in 2 simple gynecological oncology procedures, namely, diagnostic laparoscopy and bilateral adnexectomy.MethodsWe conducted a retrospective monocentric study. Case files of only those women who underwent bilateral adnexectomies and diagnostic and/or staging laparoscopy were studied with respect to the operative room time, intraoperative and postoperative complications, postoperative pain, and lengths of hospital stays. The main objective was to assess the feasibility and utility of SPALS surgery in gynecology. The secondary objective was to compare this group with a cohort of patients with multiport conventional laparoscopic surgery (MPCLS) performed during the same period.ResultsFrom December 2009 to March 2013, there were 134 patients who underwent these 2 procedures. Eighty adnexectomies were performed, 41 by SPALS and 39 by MPCLS. Fifty-four diagnostic laparoscopies were performed, with 27 patients in each group. In the group of adnexectomies, operative time was significantly lower in SPALS compared with MPCLS (36 vs 59 minutes, P < 10−4) and also compared with the postoperative stay (1 vs 2.2 nights, P < 10−4). By contrast, no significant difference was observed between the 2 methods of access in all the parameters studied in the group of diagnostic laparoscopies.ConclusionsOur experience demonstrates that SPALS is feasible and safe for simple gynecological procedures. This approach may result in a smooth postoperative course and shorter hospital stay and can thus be promoted to a day care procedure.
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Heinemann M, Hamouda S, Petrovic M, Jauffret C, Canone F, Chéreau-Ewald E, Buttarelli M, Houvenaeghel G, Lambaudie E. [Single-port surgery and adnexal procedures: which indications in oncological surgery?]. ACTA ACUST UNITED AC 2013; 41:421-6. [PMID: 23876419 DOI: 10.1016/j.gyobfe.2013.06.001] [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] [Received: 12/05/2012] [Accepted: 05/10/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To show the interest of single trocar in order to perform uni- or bilateral salpingo-oophorectomies. PATIENTS AND METHODS A descriptive study monocentric. RESULTS A total of 79 unilateral or bilateral salpingo-oophorectomies were performed by single-port laparoscopy between January 2010 and September 2012 at the Institut Paoli-Calmettes (Marseille). There are three surgical indications: diagnostic, therapeutic and prophylactic. The median age was 50 years (22-78 years). The median BMI was 22.4 kg/m(2) (17.5 to 37.7 kg/m(2)). The median blood loss was 0cc (0cc-50cc). The median hospital stay of patient was one day (0-6 days). The conversion rate in this study was 8.8%. DISCUSSION AND CONCLUSION The single-port laparoscopic approach to perform uni- or bilateral salpingo-oophorectomies is a natural evolution of the conventional laparoscopy. If the cosmetic role seems obvious, its therapeutic value compared to traditional technique must be demonstrated by prospective studies with larger numbers.
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Affiliation(s)
- M Heinemann
- Institut Paoli-Calmettes, Marseille, France.
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