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Okabe H, Masuda T, Tomita M, Ono A, Kuroda D, Kuroki H, Nitta H, Hibi T, Baba H, Sugita H. Diagnostic accuracy of preoperative adhesion mapping by ultrasonography for laparoscopic surgery in patients with past abdominal surgery with special reference to loose adhesion. Asian J Endosc Surg 2024; 17:e13332. [PMID: 38922724 DOI: 10.1111/ases.13332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 04/27/2024] [Accepted: 05/21/2024] [Indexed: 06/28/2024]
Abstract
PURPOSE Endoscopic surgery is widely accepted for both elective and emergent abdominal surgery. This study was performed to assess the accuracy of preoperative adhesion mapping by abdominal ultrasonography (US). METHODS Intra-abdominal intestinal adhesions on the abdominal wall in 50 patients with a history of abdominal surgery were prospectively assessed by the visceral slide test with US before laparoscopic surgery from 2019 to 2022. Adhesion was assessed in six separate abdominal zones during US. Actual adhesion on the abdominal wall was confirmed during laparoscopic surgery. RESULTS The sliding distances in upper right, upper central, upper left, lower right, lower central, and lower left zones in patients with versus without intestinal adhesion were 4.4 versus 1.4 cm (P = .004), 3.4 versus 2.5 cm, 4.3 versus 1.3 cm (P = .011), 3.1 versus 1.5 cm (P = .0014), 3.3 versus 1.1 cm (P = .013), and 3.4 versus 0.8 cm (P = .0061), respectively. Receiver operating characteristic analysis revealed the optimal value of sliding distance as 2.5 cm and the area under the curve as 0.86. The specificity of US assessment of adhesion was lower in the central zone than in lateral zones. Loose adhesion mostly seen around the scar was attributed to either filmy tissue or omental adhesion, leading to visceral sliding during US. CONCLUSION This study revealed the reason for insufficient accuracy of preoperative US assessment of intestinal adhesion around the scar area because of loose adhesion. The upper lateral area might be optimal for first port insertion.
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Affiliation(s)
- Hirohisa Okabe
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Toshiro Masuda
- Department of Surgery, Kumamoto Regional Medical Center, Kumamoto, Japan
| | - Masahiro Tomita
- Department of Surgery, Kumamoto Regional Medical Center, Kumamoto, Japan
| | - Asuka Ono
- Department of Surgery, Kumamoto Regional Medical Center, Kumamoto, Japan
| | - Daisuke Kuroda
- Department of Surgery, Kumamoto Regional Medical Center, Kumamoto, Japan
| | - Hideyuki Kuroki
- Department of Surgery, Kumamoto Regional Medical Center, Kumamoto, Japan
| | - Hidetoshi Nitta
- Department of Surgery, Kumamoto Regional Medical Center, Kumamoto, Japan
| | - Taizo Hibi
- Department of Pediatric Surgery and Transplantation, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Hideo Baba
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Hiroki Sugita
- Department of Surgery, Kumamoto Regional Medical Center, Kumamoto, Japan
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Miti C, Busuulwa P, Scott R, Bloomfield-Gadelha H. Primary entry trocar design and entry-related complications at laparoscopy in obese patients: meta-analysis. BJS Open 2023; 7:zrad047. [PMID: 37352873 PMCID: PMC10289830 DOI: 10.1093/bjsopen/zrad047] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 03/07/2023] [Accepted: 03/19/2023] [Indexed: 06/25/2023] Open
Abstract
BACKGROUND Safe primary entry at laparoscopy could present challenges in obese patients. Various techniques have been proposed in previous studies, however, the characteristics of the actual device utilized may be more influential than the technique in achieving successful abdominal entry in patients with increased BMI. METHODS This systematic review and meta-analysis included both randomized and non-randomized studies gathered with no date filters from MEDLINE, Embase, Scopus, Web of Science and Clinicaltrials.gov. PRISMA guidelines underpinned the conduct and reporting of the review. The meta-analysis of proportions was conducted using a generalized linear mixed model and analyses included random-effects models. The primary outcome was the proportion of first access vascular and visceral injuries incurred in the process of laparoscopic abdominal surgery in patients with a BMI >30 kg/m2. Subgroup analysis was performed for optical versus non-optically enabled devices. RESULTS In total, 5403 patients were analysed across 13 observational studies with a mean BMI of 45.93 kg/m2. In 216 patients from two randomized studies, the mean BMI was 39.92 kg/m2. The overall incidence using a random-effects model was 8.1 per 1000 events of visceral and vascular injuries (95 per cent c.i. 0.003 to 0.024). Heterogeneity was statistically significant at I2 = 80.5 per cent (69.6 per cent; 87.5 per cent, P< 0.0001). In a subgroup analysis, a tendency towards reduced injuries when optical devices were employed was observed with one per 100 injuries in these trocars (95 per cent c.i. 0.001 to 0.018) versus four per 100 (95 per cent c.i. -0.019 to -0.102) in non-optically enabled devices. CONCLUSION Injuries during primary laparoscopic entry undertaken in obese patient groups are uncommon. Due to considerable heterogeneity in the small number of examined studies, evidence was insufficient and largely of low quality to ascribe differences in the incidence of injuries to the characteristics of the primary entry trocar utilized.
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Affiliation(s)
- Chimwemwe Miti
- Department of Electrical and Electronic Engineering, EPSRC Centre for Doctoral Training in Digital Health and Care, University of Bristol, Bristol, UK
| | - Paula Busuulwa
- Department of Academic Obstetrics & Gynaecology, Liverpool Women’s Hospital, Liverpool, UK
| | - Richard Scott
- Department of Engineering Mathematics and Bristol Robotics Laboratory, University of Bristol, Bristol, UK
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Eisenstein D, Shukr G, Gonte M, Webber V, Zwain O. E-Z point: A new safe and reproducible laparoscopic entry in the left upper quadrant using a veress needle. J Hum Reprod Sci 2022; 15:300-306. [DOI: 10.4103/jhrs.jhrs_70_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 08/01/2022] [Accepted: 08/02/2022] [Indexed: 11/04/2022] Open
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Jain point: an alternate laparoscopic non-umbilical first blind entry port to avoid vessel, viscera, adhesions and bowel (VVAB). Updates Surg 2021; 73:2321-2329. [PMID: 34121164 PMCID: PMC8606393 DOI: 10.1007/s13304-021-01099-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 05/20/2021] [Indexed: 11/23/2022]
Abstract
The Jain point entry is based on the concept of non-umbilical entry to avoid sudden catastrophic injury to major retroperitoneal vessels, viscera, adhesions and bowel which could happen before the start of procedure by blind umbilical entry. To study the safety and efficacy of a novel first non-umbilical blind entry port. Tertiary referral centre for advanced laparoscopic surgeries with active training and fellowship programs. A large retrospective study of 7802 cases done at Vardhman Infertility & Laparoscopy Centre from January 2011 to December 2020. In all cases, first blind entry was by veress needle and 5 mm trocar and telescope through a non-umbilical port, The Jain point, irrespective of BMI, large masses, lax abdomen, previous surgery and complex situations. Patients’ demographic profile, types of surgeries performed and entry-related complications were recorded and analysed. Mean age of patients was 33 years with BMI ranging from 12.66 to 54.41 kg/m2. Thus, Jain point can be applicable for all ranges of BMI, all types of surgeries from simple to complex and large masses. Entry related minor complications were in 3.4% cases while major complication involving bowel occurred in one case. No case of injury to major retro-peritoneal vessel was seen. Jain point entry is a novel, first blind 5 mm non-umbilical, entry technique in a variety of surgeries and previous scars and patients with wide range of BMI. It has a short learning curve and continues as main ergonomic working port.
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Vilos GA, Ternamian A, Laberge PY, Vilos AG, Abu-Rafea B, Scattolon S, Leyland N. Directive clinique n° 412: Entrée laparoscopique en chirurgie gynécologique. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2020; 43:390-405.e1. [PMID: 33373696 DOI: 10.1016/j.jogc.2020.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Vilos GA, Ternamian A, Laberge PY, Vilos AG, Abu-Rafea B, Scattolon S, Leyland N. Guideline No. 412: Laparoscopic Entry for Gynaecological Surgery. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2020; 43:376-389.e1. [PMID: 33373697 DOI: 10.1016/j.jogc.2020.12.012] [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] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate the benefits and risks of laparoscopic surgery and provide clinical direction on entry techniques, technologies, and their associated complications in gynaecological surgery. TARGET POPULATION All patients, including pregnant women and women with obesity, undergoing laparoscopic surgery for various gynaecological indications. OPTIONS The laparoscopic entry techniques and technologies reviewed in formulating this guideline included the closed (Veress needle-pneumoperitoneum-trocar) technique, direct trocar insertion, open (Hasson) technique, visual entry systems, and disposable shielded and radially expanding trocars. OUTCOMES Implementation of this guideline should optimize decision-making in the selection of entry technique for laparoscopic surgery. EVIDENCE We searched English-language articles from September 2005 to December 2019 in PubMed/MEDLINE, Embase, Science Direct, Scopus, and Cochrane Library using the following MeSH search terms alone or in combination: laparoscopic entry, laparoscopy access, pneumoperitoneum, Veress needle, open (Hasson), direct trocar, visual entry, shielded trocars, radially expanded trocars, and laparoscopic complications. VALIDATION METHODS The authors rated the quality of evidence and strength of recommendations using the Canadian Task Force on Preventive Health Care approach (Appendix A). INTENDED AUDIENCE Surgeons performing laparoscopic gynaecological surgery. SUMMARY STATEMENTS RECOMMENDATIONS.
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Jain N, Jain V, Agarwal C, Bansal P, Gupta S, Bansal B. Left Lateral Port: Safe Laparoscopic Port Entry in Previous Large Upper Abdomen Laparotomy Scar. J Minim Invasive Gynecol 2019; 26:973-976. [PMID: 31256782 DOI: 10.1016/j.jmig.2018.10.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 10/18/2018] [Accepted: 10/19/2018] [Indexed: 11/24/2022]
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Glatz T, Horvath P, Lang SA, Archid R, Nadiradze G. Staging laparoscopy and Pressurized IntraPeritoneal Aerosol Chemotherapy (PIPAC) for peritoneal metastasis: safe access to the abdomen. Pleura Peritoneum 2019; 4:20190004. [PMID: 31198854 PMCID: PMC6545875 DOI: 10.1515/pp-2019-0004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 03/05/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Pressurized IntraPeritoneal Aerosol Chemotherapy (PIPAC) is an innovative drug delivery technique. Most common indication is palliative therapy of peritoneal metastasis of gastrointestinal and gynecological origin in the salvage situation. Access to the abdomen is the critical step of the procedure, since most patients had previous surgery. Potential pitfalls include non-access because of adhesions, bowel access lesions and postoperative subcutaneous toxic emphysema. METHODS We propose a technique, the "finger-access technique" that might prevent largely these pitfalls. A minilaparotomy of 3 cm is performed in the midline, a finger introduced into the abdomen and a 5-mm double-balloon trocar (no Hasson trocar) is placed under finger protection at some distance of the first incision. The fascia of the minilaparotomy, not the skin, is then closed. The abdomen is insufflated with CO2 and tightness is controlled with saline solution in the minilaparotomy. A second 10-12 mm trocar is then introduced under videoscopic control. The first trocar is then visualized through the second one to exclude a bowel lesion during first access. RESULTS AND CONCLUSIONS In our hands, this access technique has shown to be safe and effective.
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Affiliation(s)
- Torben Glatz
- Department of General and Visceral Surgery, University of Freiburg, Freiburg, Germany
| | - Philipp Horvath
- Department of General and Transplant Surgery and National Center for Pleura and Peritoneum, University of Tübingen, Tübingen, Germany
| | - Sven A. Lang
- Department of General and Visceral Surgery, University of Freiburg, Freiburg, Germany
| | - Rami Archid
- Department of General and Transplant Surgery and National Center for Pleura and Peritoneum, University of Tübingen, Tübingen, Germany
| | - Giorgi Nadiradze
- Department of General and Transplant Surgery and National Center for Pleura and Peritoneum, University of Tübingen, Tübingen, Germany
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Mohammadi M, Shakiba B, Shirani M. Comparison of two methods of laparoscopic trocar insertion (Hasson and Visiport) in terms of speed and complication in urologic surgery. Biomedicine (Taipei) 2018; 8:22. [PMID: 30474603 PMCID: PMC6254099 DOI: 10.1051/bmdcn/2018080422] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 07/23/2018] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Nowadays, diverse approaches have been existed for laparoscopic procedures. The most common laparoscopic entry methods included close and direct entry laparoscopy and open (Hasson) laparoscopy. There is no evidence regarding the superiority in safety and initial speed for the use of open and optical laparoscopic entry. Therefore, the sight of current study was to evaluate comparative survey of two methods of laparoscopic trocar insertion (Hasson and VisiportTM) in terms of speed and complications in urologic surgery. METHODS This expertized base clinical trial study was conducted on 100 patients who underwent urological laparoscopy in Alzahra Hospital, Isfahan, Iran. These patients were randomly divided to two groups (n = 50). One group underwent open laparoscopy and another group Visiport optical trocar. Speed and Complications of urologic surgery was extracted from medical records. Independent T test was used for doing of analysis. RESULTS The mean age of patients in Hasson and Visiport laparoscopic group was 41.4 ± 11.2 and 41.6 ± 15 years old, respectively (p = 0.91). The mean time for initial trocar placement in patients who underwent Visiport trocar system and Hasson laparoscopic technique was 37.7 ± 15.59 and 95.4 ± 31.75 seconds. There was gratifying difference between two techniques of laparoscopic trocar insertion (Hasson and Visiport) in terms of speed (p = 0.000). In addition, complications were observed in 8% of patients who underwent Visiport trocar system. However, no complications were observed in Hasson laparoscopy group. CONCLUSION Visiport optical trocar technique is faster for initial trocar placement than open laparoscopy. However it is associated with complications compared to open laparoscopy. Therefore, there is evidence of benefit in terms of speed for initial trocar placement and harm based on complications in Visiport trocar system.
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Affiliation(s)
- Mehrdad Mohammadi
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Department of Urology, Isfahan University of Medical Sciences Isfahan Iran
| | - Behnam Shakiba
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Department of Urology, Isfahan University of Medical Sciences Isfahan Iran
| | - Matin Shirani
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Department of Urology, Isfahan University of Medical Sciences Isfahan Iran
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Djokovic D, Gupta J, Thomas V, Maher P, Ternamian A, Vilos G, Loddo A, Reich H, Downes E, Rachman IA, Clevin L, Abrao MS, Keckstein G, Stark M, van Herendael B. Principles of safe laparoscopic entry. Eur J Obstet Gynecol Reprod Biol 2016; 201:179-88. [DOI: 10.1016/j.ejogrb.2016.03.040] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Jain N, Sareen S, Kanawa S, Jain V, Gupta S, Mann S. Jain point: A new safe portal for laparoscopic entry in previous surgery cases. J Hum Reprod Sci 2016; 9:9-17. [PMID: 27110072 PMCID: PMC4817291 DOI: 10.4103/0974-1208.178637] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION The present study was performed to assess the safety and feasibility of a new laparoscopic entry site in cases suspected of adhesions due to previous surgery. MATERIALS AND METHODS It is a retrospective study undertaken at a tertiary care referral center for advanced gynecological laparoscopic surgery from January 2011 to December 2014. RESULTS In 624 patients with a history of previous abdominal surgeries, the laparoscopic entry site was through a newly devised point. It is a point in the left paraumbilical region at the level of umbilicus, in a straight line drawn vertically upward from a point 2.5 cm medial to anterior superior iliac spine. Intra-abdominal adhesions were found in 487 (78.0%) patients, and umbilical adhesions in 404 (64.7%) patients with past abdominal surgeries. CONCLUSION There were no significant entry-related, intra-operative, or postoperative complications with the use of this entry point. It is also suitable as a main working port during the course of surgery.
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Affiliation(s)
- Nutan Jain
- Vardhman Infertility and Endoscopy Centre, Muzaffarnagar, Uttar Pradesh, India
| | - Sweta Sareen
- Vardhman Infertility and Endoscopy Centre, Muzaffarnagar, Uttar Pradesh, India
| | - Swati Kanawa
- Vardhman Infertility and Endoscopy Centre, Muzaffarnagar, Uttar Pradesh, India
| | - Vandana Jain
- Vardhman Infertility and Endoscopy Centre, Muzaffarnagar, Uttar Pradesh, India
| | - Sunil Gupta
- Vardhman Infertility and Endoscopy Centre, Muzaffarnagar, Uttar Pradesh, India
| | - Sonika Mann
- Vardhman Infertility and Endoscopy Centre, Muzaffarnagar, Uttar Pradesh, India
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Sabry M, Ait Allah AS, Roshdy E, Al-Hendy A. Laparoscopic management of a large torted ovarian cyst in an adolescent virgin: a case report. Int J Womens Health 2012; 4:223-5. [PMID: 22675267 PMCID: PMC3367404 DOI: 10.2147/ijwh.s27969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
We report a case of a torted mature cystic teratoma in a 23-year-old, sexually inactive, virgin female which necessitated immediate laparoscopy. The patient and her family stressed that the integrity of the hymen must be maintained at any cost, for cultural reasons. We opted out of our routine intravaginal preparation for laparoscopic surgery to honor the patient’s request to maintain the integrity of the hymen. Left salpingo-oophorectomy was accomplished, and the specimen was removed using a large nephrectomy endobag. Here, we describe techniques that are useful for this procedure, including the use of gauze attached to ovum forceps to manipulate the uterus through the rectum, and a review of the literature.
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Affiliation(s)
- Mohamed Sabry
- Department of Obstetrics and Gynecology, Sohag Faculty of Medicine, Sohag University, Sohag, Egypt
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Jiang X, Anderson C, Schnatz PF. The safety of direct trocar versus Veress needle for laparoscopic entry: a meta-analysis of randomized clinical trials. J Laparoendosc Adv Surg Tech A 2012; 22:362-70. [PMID: 22423957 DOI: 10.1089/lap.2011.0432] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE This study assessed the safety of direct trocar insertion (DTI) versus Veress needle followed by primary trocar insertion (VN). METHODS Ovid MEDLINE(®), Cochrane Library, Google Scholar, Scopus, and the reference lists of published articles were searched up to September 2011 to identify randomized clinical trials comparing DTI with VN. This meta-analysis was restricted to randomized studies comparing the safety of these two laparoscopic entry techniques. RESULTS Seven randomized studies consisting of 2940 women (VN, n=1525; DTI, n=1415) were identified. The data on the safety of two entry techniques were abstracted, integrated, and analyzed with the meta-analysis method and are presented as pooled relative risk (RR) with 95% confidence intervals (CI). There were 4 cases of a major complication in the VN group in contrast to none in the DTI group. Pooled results failed to show a statistically significant difference in the risk of major complications between the two groups. A significantly higher risk of minor complications was detected in the VN group (RR [95% CI]=10.78 [6.27-18.51]). Among minor complications, preperitoneal injuries (46.73 [11.55-189.10]) and omental injuries (4.51 [2.12-9.62]) were the two most common complications in the VN group. There were significantly increased risks of multiple insertions (more than two attempts) (2.99 [2.11-4.23]) and failed entry (2.21[1.07-4.56]) in the VN group. CONCLUSION This meta-analysis suggests that the commonly used VN entry technique carries a significantly increased risk of minor complications. In addition, the likelihood of multiple insertions and failed entry are significantly higher in the VN group.
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Affiliation(s)
- Xuezhi Jiang
- Department of Obstetrics and Gynecology, The Reading Hospital and Medical Center, Reading, Pennsylvania 19612-6052, USA.
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Tinelli A, Malvasi A, Istre O, Keckstein J, Stark M, Mettler L. Abdominal access in gynaecological laparoscopy: a comparison between direct optical and blind closed access by Verres needle. Eur J Obstet Gynecol Reprod Biol 2010; 148:191-4. [DOI: 10.1016/j.ejogrb.2009.10.025] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2008] [Revised: 05/13/2009] [Accepted: 10/20/2009] [Indexed: 11/29/2022]
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Tinelli A, Malvasi A, Hudelist G, Istre O, Keckstein J. Abdominal Access in Gynaecologic Laparoscopy: A Comparison Between Direct Optical and Open Access. J Laparoendosc Adv Surg Tech A 2009; 19:529-33. [DOI: 10.1089/lap.2008.0322] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Andrea Tinelli
- Department of Obstetrics and Gynecology, Vito Fazzi Hospital, Lecce, Italy
| | - Antonio Malvasi
- Department of Obstetrics and Gynecology, Santa Maria Hospital, Bari, Italy
| | - Gernot Hudelist
- Department of Obstetrics and Gynecology, LKH Villach, Centre for Endometriosis, Villach, Austria
| | - Olav Istre
- Department of Gynecology and Obstetrics, Ullevaal University Hospital, Kirkeveien, Oslo, Norway
| | - Joerg Keckstein
- Department of Obstetrics and Gynecology, LKH Villach, Centre for Endometriosis, Villach, Austria
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Passerotti CC, Begg N, Penna FJ, Passerotti AMA, Leite KR, Antunes AA, Srougi M, Retik AB, Nguyen HT. Safety Profile of Trocar and Insufflation Needle Access Systems in Laparoscopic Surgery. J Am Coll Surg 2009; 209:222-32. [DOI: 10.1016/j.jamcollsurg.2009.03.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2009] [Revised: 03/18/2009] [Accepted: 03/24/2009] [Indexed: 11/28/2022]
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Muppala H, Rafi J, Najia SK. Laparoscopic insufflation through a defined surgical point in the left upper quadrant: a 3-year experience. ACTA ACUST UNITED AC 2008. [DOI: 10.1007/s10397-008-0397-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Varma R, Gupta JK. Laparoscopic entry techniques: clinical guideline, national survey, and medicolegal ramifications. Surg Endosc 2008; 22:2686-97. [DOI: 10.1007/s00464-008-9871-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2007] [Revised: 01/12/2008] [Accepted: 01/27/2008] [Indexed: 12/20/2022]
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Behera M, Vilos GA, Hollett-Caines J, Abu-Rafea B, Ahmad R. Laparoscopic findings, histopathologic evaluation, and clinical outcomes in women with chronic pelvic pain after hysterectomy and bilateral salpingo-oophorectomy. J Minim Invasive Gynecol 2007; 13:431-5. [PMID: 16962527 DOI: 10.1016/j.jmig.2006.05.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2006] [Revised: 05/10/2006] [Accepted: 05/12/2006] [Indexed: 11/15/2022]
Abstract
STUDY OBJECTIVE To laparoscopically evaluate the pelvis of patients with chronic pelvic pain after hysterectomy and bilateral salpingo-oophorectomy, to determine any associated factors to the pain. DESIGN Retrospective cohort of patients with chronic pelvic pain after hysterectomy and bilateral salpingo-oophorectomy (Canadian Task Force Classification II-2). SETTING University-affiliated teaching hospital. PATIENTS From January 1990 through May 2002, 124 women with chronic pelvic pain after hysterectomy and bilateral salpingo-oophorectomy underwent laparoscopic and histopathologic evaluation of the pelvis. INTERVENTION Diagnostic laparoscopy was performed to inspect the pelvis for any signs of pathology. If any abnormalities were visualized, they were treated with CO2 laser resection and sent for histopathologic evaluation. MAIN OUTCOME MEASURES Laparoscopic and histopathologic findings of the pelvis, as well as subjective pain improvement after laparoscopy. CONCLUSION The most common histopathologic findings at laparoscopy in women with chronic pelvic pain after hysterectomy and bilateral salpingo-oophorectomy included adhesions, adnexal remnants, and endometriosis. Laparoscopic treatment of any pelvic pathologic condition improved pain symptoms in these women.
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Affiliation(s)
- Millie Behera
- Department of Obstetrics and Gynecology, St. Joseph's Health Care, University of Western Ontario, London, Ontario, Canada
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