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Hou Q, Li X, Li Y, Zhang Q, Liu T, Huang L, Gong Z, Feng D, Gu D, Lin Y, He L. Analysis and suggestions on the complications in 2000 cases of transvaginal natural orifice transluminal endoscopic surgery: Can it be a conventional surgery? Int J Gynaecol Obstet 2024; 164:541-549. [PMID: 37621209 DOI: 10.1002/ijgo.15035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 07/12/2023] [Accepted: 07/25/2023] [Indexed: 08/26/2023]
Abstract
OBJECTIVE To reflect on the complications of transvaginal natural orifice transluminal endoscopic surgery (vNOTES), identify the corresponding risk factors, and provide caution to surgeons when performing this novel surgery. METHODS A retrospective study was carried out among 2000 patients in our hospital who underwent vNOTES between May 2019 and May 2022. Perioperative complications were stratified in chronological order and divided into those developed while establishing the vNOTES approach, during surgery, postoperatively, and 1 month after discharge. The complications were classified based on the Modified Clavien-Dindo classifications. The causes of each type III/IV complication were analyzed. RESULTS Of the 2000 patients, 88 (4.4%) experienced complications, which is not higher than that reported in laparoendoscopic surgery in previous studies. Grade I, II, III, IV, and V complications developed in 19 (0.95%), 57 (2.85%), 11 (0.55%), 1 (0.05%), and 0 (0%) patients, respectively. Complications were developed while establishing the approach platform, during the surgery, postoperatively, and within 1 month after discharge in 5 (0.25%), 30 (1.50%), 50 (2.50%), and 3 (0.15%) patients, respectively. Eight patients (0.4%) underwent conversion, including five cases of rectal injury repair. CONCLUSION The summarized suggestions were divided into three levels. Considering the security and effectiveness of vNOTES, it can be routinely used in various gynecologic operations. However, surgeons should focus on preoperative evaluation, strictly conduct preoperative disinfection, conform to prompt conversion during surgery, call for the presence of experienced doctors, and have routine use of antibiotics to prevent postoperative infections. TRIAL REGISTRATION ChiCTR2100053483.
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Affiliation(s)
- Qiannan Hou
- Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Xin Li
- Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Yan Li
- Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Qiang Zhang
- Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Tianjiao Liu
- Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Lu Huang
- Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Zhaolin Gong
- Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Dan Feng
- Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Dingqian Gu
- Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Yonghong Lin
- Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Li He
- Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
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Jensen A, Heinemeier IIK, Schroll JB, Rudnicki M. Iatrogenic bladder injury following gynecologic and obstetric surgery: A systematic review and meta-analysis. Acta Obstet Gynecol Scand 2023; 102:1608-1617. [PMID: 37552010 PMCID: PMC10619603 DOI: 10.1111/aogs.14641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 07/01/2023] [Accepted: 07/04/2023] [Indexed: 08/09/2023]
Abstract
INTRODUCTION Iatrogenic bladder injury is a rare complication following obstetric and gynecologic surgery and only sparse information is available regarding length of transurethral catheterization following injuries, suturing techniques including choice of suture, and complications. The primary aim of this systematic review was to evaluate length of transurethral catheterization in relation to complications following iatrogenic bladder injury. Second, we aimed to evaluate the number of complications following repair of iatrogenic bladder injuries and to describe suture technique and best choice of suture. MATERIAL AND METHODS A systematic review and meta-analysis was conducted, and the results were presented in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Embase, and Medline electronic databases were searched, and followed by screening from two independent reviewers. Studies published between January 2000 and March 2023 describing methods of bladder injury repair following obstetric or gynecologic benign surgery were included. Data extraction was done using Covidence. We performed a meta-analysis on complications after repair and explored this with a meta-regression analysis (Metafor package R) on length of catheterization to determine if length of catheterization influenced the risk of complication. A risk of bias tool from Cochrane was used to assess risk of bias and the study was registered in PROSPERO (CRD42021290586). RESULTS Out of 2175 articles, we included 21 retrospective studies, four prospective studies, and one case-control study. In total, 595 bladder injuries were included. Cesarean section was the most prominent surgery type, followed by laparoscopically assisted vaginal hysterectomy. We found no statistically significant association between length of transurethral catheterization and numbers of complications following repair of iatrogenic bladder injuries. More than 90% of injuries were recognized intraoperatively. Approximately 1% had complications following iatrogenic bladder injury repair (0.010, 95% confidence interval 0.0015-0.0189, 26 studies, 595 participants, I2 = 4%). CONCLUSIONS Our review did not identify conclusive evidence on the length of postoperative catheterization following bladder injury warranting further research. However, the rate of complications was low following iatrogenic bladder injury with a wide range of repair approaches.
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Affiliation(s)
- Ann‐Sophie Jensen
- Department of Obstetrics and GynecologyOdense University HospitalOdenseDenmark
- Department of Clinical Research, Faculty of Health ScienceUniversity of Southern DenmarkOdenseDenmark
| | - Ina Isabell Kathleen Heinemeier
- Department of Obstetrics and GynecologyOdense University HospitalOdenseDenmark
- Department of Clinical Research, Faculty of Health ScienceUniversity of Southern DenmarkOdenseDenmark
| | - Jeppe Bennekou Schroll
- Department of Obstetrics and GynecologyOdense University HospitalOdenseDenmark
- Department of Clinical Research, Faculty of Health ScienceUniversity of Southern DenmarkOdenseDenmark
- Center for Evidence‐Based Medicine Odense (CEBMO) and Cochrane DenmarkUniversity of Southern DenmarkOdenseDenmark
- Department of Clinical ResearchUniversity of Southern DenmarkOdenseDenmark
- Open Patient Data Exploratory Network, OPENOdense University HospitalOdenseDenmark
| | - Martin Rudnicki
- Department of Obstetrics and GynecologyOdense University HospitalOdenseDenmark
- Department of Clinical Research, Faculty of Health ScienceUniversity of Southern DenmarkOdenseDenmark
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Wei G, Harley F, O’Callaghan M, Adshead J, Hennessey D, Kinnear N. Systematic review of urological injury during caesarean section and hysterectomy. Int Urogynecol J 2023; 34:371-389. [PMID: 36251061 PMCID: PMC9870963 DOI: 10.1007/s00192-022-05339-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 08/05/2022] [Indexed: 01/28/2023]
Abstract
INTRODUCTION AND HYPOTHESIS We aim to review iatrogenic bladder and ureteric injuries sustained during caesarean section and hysterectomy. METHODS A search of Cochrane, Embase, Medline and grey literature was performed using methods pre-published on PROSPERO. Eligible studies described iatrogenic bladder or ureter injury rates during caesarean section or hysterectomy. The 15 largest studies were included for each procedure sub-type and meta-analyses performed. The primary outcome was injury incidence. Secondary outcomes were risk factors and preventative measures. RESULTS Ninety-six eligible studies were identified, representing 1,741,894 women. Amongst women undergoing caesarean section, weighted pooled rates of bladder or ureteric injury per 100,000 procedures were 267 or 9 events respectively. Injury rates during hysterectomy varied by approach and pathological condition. Weighted pooled mean rates for bladder injury were 212-997 events per 100,000 procedures for all approaches (open, vaginal, laparoscopic, laparoscopically assisted vaginal and robot assisted) and all pathological conditions (benign, malignant, any), except for open peripartum hysterectomy (6,279 events) and laparoscopic hysterectomy for malignancy (1,553 events). Similarly, weighted pooled mean rates for ureteric injury were 9-577 events per 100,000 procedures for all hysterectomy approaches and pathologies, except for open peripartum hysterectomy (666 events) and laparoscopic hysterectomy for malignancy (814 events). Surgeon inexperience was the prime risk factor for injury, and improved anatomical knowledge the leading preventative strategy. CONCLUSIONS Caesarean section and most types of hysterectomy carry low rates of urological injury. Obstetricians and gynaecologists should counsel the patient for her individual risk of injury, prospectively establish risk factors and implement preventative strategies.
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Affiliation(s)
- Gavin Wei
- grid.410678.c0000 0000 9374 3516Department of Urology, Austin Health, Melbourne, Australia
| | - Frances Harley
- grid.417072.70000 0004 0645 2884Department of Urology, Western Health, Melbourne, Australia
| | - Michael O’Callaghan
- grid.1010.00000 0004 1936 7304Adelaide Medical School, University of Adelaide, Adelaide, Australia ,grid.414925.f0000 0000 9685 0624Urology Unit, Flinders Medical Centre, Bedford Park, Adelaide, Australia ,grid.1014.40000 0004 0367 2697Flinders University, Adelaide, Australia
| | - James Adshead
- grid.415953.f0000 0004 0400 1537Lister Hospital, Stevenage, UK
| | - Derek Hennessey
- grid.411785.e0000 0004 0575 9497Department of Urology, Mercy University Hospital, Cork, Ireland
| | - Ned Kinnear
- grid.410678.c0000 0000 9374 3516Department of Urology, Austin Health, Melbourne, Australia ,grid.1010.00000 0004 1936 7304Adelaide Medical School, University of Adelaide, Adelaide, Australia
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King NR, Lin E, Yeh C, Wong JMK, Friedman J, Traylor J, Tsai S, Chaudhari A, Milad MP. Laparoscopic Major Vascular Injuries in Gynecologic Surgery for Benign Indications: A Systematic Review. Obstet Gynecol 2021; 137:434-442. [PMID: 33543898 DOI: 10.1097/aog.0000000000004280] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 11/19/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To identify the incidence, location, etiology, and mortality of major vascular injuries in gynecologic laparoscopy for benign indications. DATA SOURCES A systematic review of PubMed, EMBASE, Cochrane Library, ClinicalTrials.gov, and MEDLINE was conducted. METHODS OF STUDY SELECTION One thousand ninety-seven studies were screened for inclusion with 147 full-text articles reviewed. Sixty-six studies published between 1978 and 2016 met inclusion criteria, representing 197,062 surgeries. Articles that were included reported the incidence of major vascular injuries during gynecologic laparoscopy for benign indications. Exclusion criteria included surgery for gynecologic malignancy, duplicated data, case series and reports, manuscripts not in English, and studies published only as abstracts. TABULATION, INTEGRATION, AND RESULTS Injuries to the aorta, inferior vena cava, iliac (common, external, or internal), and inferior epigastric vessels were recorded, as were injuries denoted as major but not otherwise specified. A total of 179 major vascular injuries were reported with an incidence of 0.09% (95% CI 0.08-0.10). The inferior epigastric vessels were the most commonly injured vessel (0.04%, 95% CI 0.03-0.05), comprising 48% (95% CI 40-55) of all injuries. The majority of injuries occurred during abdominal entry (82%, 95% CI 76-89), and the remainder occurred during surgical dissection (18%, 95% CI 11-24). Most injuries were recognized intraoperatively (93%, 95% CI 87-100), and approximately half (55%, 95% CI 46-63) required laparotomy for repair. Only two of the 179 major vascular injuries resulted in death, for an overall mortality rate from vascular injuries of 0.001% (95% CI 0.000-0.004). CONCLUSION The incidence of major vascular injury during gynecologic laparoscopy found in this review is very low, and the vast majority of injuries did not result in death. Laparoscopy remains a safe surgical technique in relation to vascular injuries when performed for benign gynecologic disease.
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Affiliation(s)
- Nathan R King
- Department of Obstetrics and Gynecology and the Division of Biostatistics, Department of Preventive Medicine, Northwestern Feinberg School of Medicine, Chicago, Illinois; and the Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Prolapsed epiploica of bowel after robotic hysterectomy: A case report. Ann Med Surg (Lond) 2020; 60:146-148. [PMID: 33145023 PMCID: PMC7595933 DOI: 10.1016/j.amsu.2020.10.055] [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: 06/22/2020] [Revised: 10/20/2020] [Accepted: 10/21/2020] [Indexed: 11/22/2022] Open
Abstract
Purpose Vaginal cuff dehiscence with evisceration was defined as expulsion of intraperitoneal organs through the separated incision. Prolapsed epiploica of the colon is a rare complication after hysterectomy. The most common organ to prolapsed out from the dehiscence vaginal cuff is terminal ileum. We reported the first known case of prolapsed epiploica of the colon after robotic hysterectomy. Case This is a case who had prolapse of a vaginal tumor after sexual intercourse 5 months after robotic hysterectomy. Vaginal tumor resection and primary closure were performed successfully without complications. The final pathology revealed fat prolapse with foreign body reaction and confirmed prolapse of epiploica of the colon. Being aware of the risk factors and patients who are more likely to develop this complication is essential in making the correct diagnosis in time. Major conclusion Patients with a higher risk of vaginal cuff dehiscence are advised to avoid sexual activity for a longer period of time. Surgical intervention is the primary treatment. Prolapsed epiploica of the colon should be kept in mind for those who have undergone hysterectomy in order to provide appropriate treatment in time.
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Macciò A, Chiappe G, Kotsonis P, Lavra F, Nieddu R, Onnis P, Sanna E, Mais V, Madeddu C. The utility of fibrinogen level as a predictor of complications after laparoscopic gynecologic surgery: a prospective observational study. GYNECOLOGICAL SURGERY 2019; 16:11. [DOI: 10.1186/s10397-019-1064-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Accepted: 10/10/2019] [Indexed: 09/27/2023]
Abstract
AbstractBackgroundComplications after laparoscopic gynecological surgery may increase patients’ morbidity and mortality; therefore, their timely diagnosis and early treatment would help clinicians to avoid life-threatening situations. We aimed to evaluate the predictive role of fibrinogen for diagnosing complications after laparoscopic gynecologic surgery for benign and malignant conditions.Patients and methodsAll patients who underwent elective laparoscopic gynecologic surgery between June 2013 and December 2017 at the Department of Gynecologic Oncology, Azienda Ospedaliera Brotzu, Cagliari, were prospectively included. Post-operative complications were assessed and graded according to the Clavien-Dindo classification. Fibrinogen and white blood cell level were determined preoperatively, on the first post-operative day and at the appearance of symptoms indicative of an irregular post-operative course or at the time of re-hospitalization for persistent symptoms. The postoperative changes (calculated from the first postoperative day) were correlated with the occurrence and severity of complications and their predictive role was assessed.ResultsWe enrolled 1016 patients: 36% underwent surgery for benign pathologies (mainly voluminous fibromatous uteri and severe deep endometriosis) and 64% for gynecologic malignancies. The overall complication rate was of 3.45%, the rate of major postoperative complications was 2.85%. A postoperative fibrinogen increase ≥ 20% had a high diagnostic accuracy to identify postoperative complications early (AUC 0.931, sensitivity 89%, and specificity 99%). The magnitude of postoperative fibrinogen change was associated with complication severity.ConclusionsOur findings demonstrated that fibrinogen increase can enable the early detection of postoperative complications after laparoscopic gynecological surgery. Further prospective and multi-center studies are warranted to confirm these results.
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Ortiz-Martínez RA, Betancourt-Cañas AJ, Bolaños-Náñez DM, Cardona-Narváez T, Portilla ED, Flórez-Victoria O. Prevalence of surgical complications in gynecological surgery at the Hospital Universitario San José in Popayán, Colombia. 2015. REVISTA DE LA FACULTAD DE MEDICINA 2018. [DOI: 10.15446/revfacmed.v66n4.63743] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Introduction: Every surgery has risk of complications; prognosis depends on prompt diagnosis and timely management.Objective: To determine the prevalence of surgical complications in gynecological surgery in a tertiary care hospital and to explore associated factors.Materials and methods: Prevalence study with secondary analysis of medical records of patients who underwent scheduled gynecological surgery. The outcome variable was complications reported during a period of less than 30 days. The universe was established, and clinical, biological and sociodemographic variables were collected. To determine prevalence, the total number of complications was taken as the numerator and the total number of records was used as the denominator. To explore associated factors, odds ratio (OR) was used as a measure of association with a 95% CI.Results: 591 records were reviewed, finding a surgical management of ectopic pregnancy prevalence of 3.8% (OR=3.73, CI95%: 2.41-92.52). Obesity (OR 12.47, CI95%: 4.48-33.19) and gynecological surgery for malignancy (OR 3.73, CI95%: 1.14- 10.48) were associated with complications.Conclusion: The prevalence found in our institution was similar to what most studies have reported.
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Intra-Abdominal Hemorrhage Complicating Electrothermal Arterial Injury During Pelvic Surgery: A Case Report. Am J Forensic Med Pathol 2017; 38:362-366. [PMID: 29068812 DOI: 10.1097/paf.0000000000000354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Iatrogenic vascular injury is a potentially serious complication of surgical procedures. Here we report a case of delayed fatal intra-abdominal hemorrhage because of electrocautery injury of a right external iliac artery. The decedent, a 31-year-old woman, died suddenly on postoperative day 1 after a laparoscopic staging operation for an ovarian tumor. Her past medical history included a recent diagnosis of a microinvasive carcinoma in the background of a mucinous cystic neoplasm of the right ovary. Postmortem examination revealed a young woman with evidence of emergency intervention, recent laparoscopic pelvic surgery, and pale hypostasis limited to the back surfaces of the body. The internal examination confirmed the postmortem computed tomography findings of a large amount of blood in the pelvic and abdominal cavities and evidence of recent surgical intervention. The soft tissues around the aorta and major pelvic vessels showed electrocautery change and marked perivascular hemorrhage preferentially surrounding the right external iliac artery. Histological examination of the vascular bundle showed an electrocautery injury of the arterial wall: transmural necrosis, acute inflammation, and hemorrhage. In this report, we offer an approach to a postmortem examination in postoperative deaths with emphasis on deaths due to iatrogenic vascular injuries and discuss the rationale for determining the manner of death.
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Putz A, Bohlin T, Rakovan M, Putz AM, De Wilde RL. European operative registry to avoid complications in operative gynecology. Best Pract Res Clin Obstet Gynaecol 2016; 35:113-23. [DOI: 10.1016/j.bpobgyn.2015.11.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 11/27/2015] [Indexed: 11/29/2022]
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Hirata T, Nakazawa A, Fukuda S, Hirota Y, Izumi G, Takamura M, Harada M, Koga K, Wada-Hiraike O, Fujii T, Osuga Y. Four Cases of Postoperative Pneumothorax Among 2814 Consecutive Laparoscopic Gynecologic Surgeries: A Possible Correlation Between Postoperative Pneumothorax and Endometriosis. J Minim Invasive Gynecol 2015; 22:980-4. [PMID: 25936271 DOI: 10.1016/j.jmig.2015.04.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 04/14/2015] [Accepted: 04/15/2015] [Indexed: 10/23/2022]
Abstract
STUDY OBJECTIVES To evaluate the frequency of pneumothorax after laparoscopic surgery and to identify possible correlations to endometriosis. DESIGN Retrospective review. SETTING Tokyo University Hospital between 2006 and 2013. PATIENTS Four patients among a total of 2814 patients with a postoperative pneumothorax. INTERVENTION Laparoscopic surgery for gynecologic benign disease. The main outcome was the clinical frequency and characteristics of the patients with postoperative pneumothorax. MEASUREMENTS AND MAIN RESULTS We observed 4 (0.14%) cases of postoperative pneumothorax after laparoscopic surgery, all of whom were diagnosed with endometriomas and developed a right-sided pneumothorax. The incidence of postoperative pneumothorax in 1097 patients with endometriomas was 0.36%, which was significantly higher than those without endometriomas. CONCLUSION The presence of endometrioma should be considered a risk factor for postoperative pneumothorax in gynecologic laparoscopic surgery.
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Affiliation(s)
- Tetsuya Hirata
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan.
| | - Akari Nakazawa
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Shinya Fukuda
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Yasushi Hirota
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Gentaro Izumi
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Masashi Takamura
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Miyuki Harada
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Kaori Koga
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Osamu Wada-Hiraike
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Tomoyuki Fujii
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Yutaka Osuga
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
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Lönnerfors C, Reynisson P, Persson J. A randomized trial comparing vaginal and laparoscopic hysterectomy vs robot-assisted hysterectomy. J Minim Invasive Gynecol 2014; 22:78-86. [PMID: 25045857 DOI: 10.1016/j.jmig.2014.07.010] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 07/09/2014] [Accepted: 07/12/2014] [Indexed: 02/06/2023]
Abstract
STUDY OBJECTIVE To investigate the hospital cost and short-term clinical outcome of traditional minimally invasive hysterectomy vs robot-assisted hysterectomy in women primarily not considered candidates for vaginal surgery. DESIGN Randomized controlled trial (Canadian Task Force classification I). SETTING University Hospital in Sweden. PATIENTS One hundred twenty-two women with uterine size ≤ 16 gestational weeks scheduled to undergo minimally invasive hysterectomy because of benign disease. INTERVENTIONS Robot-assisted hysterectomy or traditional vaginal or laparoscopic minimally invasive hysterectomy. MEASUREMENTS AND MAIN RESULTS All women underwent surgery as randomized. There were no demographic differences between the 2 groups. Vaginal hysterectomy was possible in 41% in the traditional minimally invasive group, at a mean hospital cost of $4579 compared with $7059 for traditional laparoscopic hysterectomy. This was reflected in a mean hospital cost of $993 more per robotic-assisted hysterectomy than for traditional minimally invasive hysterectomy when the robot was a preexisting investment. This hospital cost increased by $1607 when including investments and cost of maintenance. A per-protocol subanalysis comparing laparoscopy and robotics demonstrated similar hospital cost when the robot was a preexisting investment ($7059 vs $7016). Robotic-assisted hysterectomy was associated with less blood loss and fewer postoperative complications. CONCLUSION A similar hospital cost can be attained for laparoscopy and robotics when the robot is a preexisting investment. From the perspective of hospital costs, robotic-assisted hysterectomy is not advantageous for treating benign conditions when a vaginal approach is feasible in a high proportion of patients.
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Affiliation(s)
- Celine Lönnerfors
- Department of Obstetrics and Gynecology, Skåne University Hospital and Lund University, Lund, Sweden
| | - Petur Reynisson
- Department of Obstetrics and Gynecology, Skåne University Hospital and Lund University, Lund, Sweden
| | - Jan Persson
- Department of Obstetrics and Gynecology, Skåne University Hospital and Lund University, Lund, Sweden.
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Rettenmaier CR, Rettenmaier NB, Abaid LN, Brown JV, Micha JP, Mendivil AA, Wojciechowski T, Goldstein BH, Markman M. The Incidence of Genitourinary and Gastrointestinal Complications in Open and Endoscopic Gynecologic Cancer Surgery. Oncology 2014; 86:303-7. [DOI: 10.1159/000360294] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 02/02/2014] [Indexed: 11/19/2022]
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Surgical trends for benign ovarian tumors among hospitals of different accreditation levels: An 11-year nationwide population-based descriptive study in Taiwan. Taiwan J Obstet Gynecol 2013; 52:498-504. [DOI: 10.1016/j.tjog.2013.10.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Accepted: 11/22/2012] [Indexed: 11/20/2022] Open
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Jo EJ, Lee YY, Kim TJ, Choi CH, Lee JW, Bae DS, Kim BG. Management and Outcome of Rectal Injury During Gynecologic Laparoscopic Surgery. J Minim Invasive Gynecol 2013; 20:166-71. [PMID: 23295198 DOI: 10.1016/j.jmig.2012.10.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Revised: 10/01/2012] [Accepted: 10/18/2012] [Indexed: 10/27/2022]
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Ding DC, Chu TY, Chang YH. Trend changes in the proportion of minimal invasive hysterectomies over a five-year period: A single-center experience. Tzu Chi Med J 2012. [DOI: 10.1016/j.tcmj.2012.08.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Cipullo L, Lucio C, Zullo F, Fulvio Z, Visconti F, Federica V, Palatucci V, Valeria P, Pascale R, Renato P, Marra ML, Luisa MM, Guida M, Maurizio G. Gastric injuries during gynaecologic laparoscopy. Arch Gynecol Obstet 2012; 286:1081-6. [PMID: 22639137 DOI: 10.1007/s00404-012-2389-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2011] [Accepted: 05/10/2012] [Indexed: 10/28/2022]
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Trends in Various Types of Surgery for Hysterectomy and Distribution by Patient Age, Surgeon Age, and Hospital Accreditation: 10-Year Population-Based Study in Taiwan. J Minim Invasive Gynecol 2010; 17:612-9. [DOI: 10.1016/j.jmig.2010.04.010] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2010] [Revised: 04/12/2010] [Accepted: 04/23/2010] [Indexed: 11/18/2022]
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Is It Possible to Use a Single Ancillary Trocar to Finish Laparoscopic Cystectomy? Taiwan J Obstet Gynecol 2009; 48:333-4. [DOI: 10.1016/s1028-4559(09)60320-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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A prospective comparison of vaginal stump suturing techniques during total laparoscopic hysterectomy. Arch Gynecol Obstet 2009; 282:631-8. [DOI: 10.1007/s00404-009-1300-0] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2009] [Accepted: 11/12/2009] [Indexed: 10/20/2022]
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Tchente Nguefack C, Mboudou E, Tejiokem MC, Doh A. [Complications of laparoscopic surgery in gynecology unit A of Yaoundé General Hospital, Cameroon]. JOURNAL DE GYNECOLOGIE, OBSTETRIQUE ET BIOLOGIE DE LA REPRODUCTION 2009; 38:545-51. [PMID: 19833453 DOI: 10.1016/j.jgyn.2009.06.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2009] [Revised: 06/16/2009] [Accepted: 06/24/2009] [Indexed: 11/30/2022]
Abstract
The aim of the study was to describe the morbidity and mortality of gynaecological laparoscopy in a pilot center of Cameroon. It was a monocentric retrospective study over a period of seven years. All files of patients who had laparoscopic surgery in the service were reviewed. Files with incomplete information were excluded. Complications were defined as an event that had modified the usual cause of the procedure or of the postoperative period. They were classified as surgical complications (during insertion of Veress needle and trocarts, intraoperative and postoperative complications) also reorganised as major and minor complications and anaesthetic complications. The rate of laparoconconversion was noted. The data of 609 patients was gathered and examined. Their mean age was 31.57 (19-63years). The mean parity and gestity was 0.77 and 1.82, respectively. The common findings in their past history were sexually transmitted infection (39.9%), criminal abortions (35.03%) and previous surgery (39.1%). Infertility was the main indication of the surgery (76.3%) followed by postmyomectomy adhesiolysis (15%). The main operative findings were adhesions (78.16%). The mortality rate is 0.16%. The surgical morbidity rate is 2.46% with 0.99% of complications during insertion of Veress needle and trocarts and 1.48% during surgery. Among these complications, 1.8% were minor complications and 0.66%, major ones. Five patients had complications due to anaesthesia (0.82%). Postoperative complications (8.3%) were of low gravity and were mainly digestive, infectious and moderate vaginal bleeding. The rate of laparoconversion was 2.46%, mainly due to difficulties during surgery. This study shows that operative gynaecologic laparoscopy is associated with acceptable mortality and morbidity rate in our milieu.
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Affiliation(s)
- C Tchente Nguefack
- Service de gynécologie et obstétrique, faculté de médecine et des sciences pharmaceutiques, hôpital général de Douala, université de Douala, BP 4312, Douala, Cameroun.
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Laparoscopic Radical Nephrectomy for Unilateral Renal Cancer in Children. Surg Laparosc Endosc Percutan Tech 2009; 19:148-52. [DOI: 10.1097/sle.0b013e31819f204d] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kyung MS, Choi JS, Lee JH, Jung US, Lee KW. Laparoscopic Management of Complications in Gynecologic Laparoscopic Surgery: A 5-year Experience in a Single Center. J Minim Invasive Gynecol 2008; 15:689-94. [DOI: 10.1016/j.jmig.2008.07.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2008] [Revised: 06/11/2008] [Accepted: 07/03/2008] [Indexed: 10/21/2022]
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Cho FN. A technique to deal with severe adhesions between the uterus and bladder or rectum in laparoscopic-assisted vaginal hysterectomy. J Minim Invasive Gynecol 2007; 14:750-1. [DOI: 10.1016/j.jmig.2007.07.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2007] [Revised: 07/04/2007] [Accepted: 07/11/2007] [Indexed: 11/29/2022]
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