Use of the LAP DISK (abdominal wall sealing device) in laparoscopically assisted myomectomy

Gasless laparoscopically assisted myomectomy using a wound retraction system

INTRODUCTION

The purpose of this study was to elucidate the feasibility of gasless laparoscopically assisted myomectomy (LAM) using a wound retraction system. This method treats symptomatic uterine myomas by combining laparoscopy with a mini-laparotomy to enucleate myoma nodules and to close the uterine myometrium.

METHODS

This study includes 275 patients who underwent gasless LAM. For patients with fewer than three myoma nodules, the location of the largest nodule was classified as anterior, fundal, or posterior. The operative outcomes, intraoperative and postoperative courses, and complications were examined.

RESULTS

All operations were performed satisfactorily, and no conversions to laparotomy were required. None of the patients developed serious complications. The mean blood loss and operating time were 190.3 mL and 152.2 minutes, respectively. The mean myoma size was 8.9 cm, and the mean number of myomas per patient was 2.8. The average postoperative hospital stay was 5.7 days. There were no significant differences in resected myoma size, blood loss, and surgical duration with respect to the location of the largest nodule.

CONCLUSION

Gasless LAM with a wound retractor is feasible and allows surgeons to perform myomectomy safely and cost-effectively, without requiring advanced laparoscopic surgical skills and while maintaining minimum invasiveness.

Comparing uterine fibroids treated by myomectomy through traditional laparotomy and 2 modified approaches: ultraminilaparotomy and laparoscopically assisted ultraminilaparotomy

OBJECTIVE

We sought to compare myomectomy performed by laparotomy (LT), and 2 other modified approaches: ultraminilaparotomy (UMLT) and laparoscopically assisted UMLT for uterine fibroids with a size <8 cm and the number <5.

STUDY DESIGN

A cohort study, including 79 (35.3%) women in the LT group, 71 (31.7%) in the UMLT group, and 74 (33.0%) in the laparoscopically assisted UMLT group, was conducted. The outcome was measured by comparing surgical parameters, immediate postoperative recovery, and therapeutic outcomes.

RESULTS

The median follow-up was 52 months with similar recurrence rates in the 3 groups. The modified approaches had advantages not only in the surgical parameters, but also in postoperative recovery, compared to LT (all P < .05).

CONCLUSION

UMLT and laparoscopically assisted UMLT can be used successfully in place of LT in the management of uterine fibroids.

HAND-ASSISTED LAPAROSCOPY ON A SHOESTRING

BACKGROUND

Hand-assisted laparoscopic surgery is useful in difficult laparoscopic operations. Expensive and cumbersome devices are necessary to ensure airtightness between the surgeon's hand and the abdominal wall so that pneumoperitoneum can be maintained.

METHOD

A simple method of maintaining pneumo-peritoneum in hand-assisted laparoscopic surgery was carried out by tying a strong nylon suture in a criss-cross fashion on one end of the incision. Airtightness was maintained by tightening the suture around the wrist and wedging the dorsum of the hand against the abdominal wall.

RESULT

The method was used successfully to remove a pyonephrotic left kidney in a 28-year-old man from Papua New Guinea.

CONCLUSION

Hand-assisted laparoscopic operations can be carried out expediently and inexpensively without specialized equipment by simply tying a shoestring suture at one end of the wound.

Wound retraction system for gasless laparoscopic-assisted myomectomy with a subcutaneous abdominal wall-lift method

Over the course of 4 years we evaluated 209 women using gasless laparoscopic-assisted myomectomy and a wound retractor. Three were no significant differences in blood loss or surgical duration despite myoma size or location. Gasless laparoscopic-assisted myomectomy utilizing a wound retractor is an effective procedure for women desiring uterine preservation without significantly longer surgery duration.