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Pickett CM, Seeratan DD, Mol BWJ, Nieboer TE, Johnson N, Bonestroo T, Aarts JW. Surgical approach to hysterectomy for benign gynaecological disease. Cochrane Database Syst Rev 2023; 8:CD003677. [PMID: 37642285 PMCID: PMC10464658 DOI: 10.1002/14651858.cd003677.pub6] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
BACKGROUND Currently, there are five major approaches to hysterectomy for benign gynaecological disease: abdominal hysterectomy (AH), vaginal hysterectomy (VH), laparoscopic hysterectomy (LH), robotic-assisted hysterectomy (RH) and vaginal natural orifice hysterectomy (V-NOTES). Within the LH category we further differentiate the laparoscopic-assisted vaginal hysterectomy (LAVH) from the total laparoscopic hysterectomy (TLH) and single-port laparoscopic hysterectomy (SP-LH). OBJECTIVES To assess the effectiveness and safety of different surgical approaches to hysterectomy for women with benign gynaecological conditions. SEARCH METHODS We searched the following databases (from their inception to December 2022): the Cochrane Gynaecology and Fertility Specialised Register of Controlled Trials, CENTRAL, MEDLINE, Embase, CINAHL and PsycINFO. We also searched the trial registries and relevant reference lists, and communicated with experts in the field for any additional trials. SELECTION CRITERIA We included randomised controlled trials (RCTs) in which clinical outcomes were compared between one surgical approach to hysterectomy and another. DATA COLLECTION AND ANALYSIS At least two review authors independently selected trials, assessed risk of bias and performed data extraction. Our primary outcomes were return to normal activities, satisfaction and quality of life, intraoperative visceral injury and major long-term complications (i.e. fistula, pelvic-abdominal pain, urinary dysfunction, bowel dysfunction, pelvic floor condition and sexual dysfunction). MAIN RESULTS We included 63 studies with 6811 women. The evidence for most comparisons was of low or moderate certainty. The main limitations were poor reporting and imprecision. Vaginal hysterectomy (VH) versus abdominal hysterectomy (AH) (12 RCTs, 1046 women) Return to normal activities was probably faster in the VH group (mean difference (MD) -10.91 days, 95% confidence interval (CI) -17.95 to -3.87; 4 RCTs, 274 women; I2 = 67%; moderate-certainty evidence). This suggests that if the return to normal activities after AH is assumed to be 42 days, then after VH it would be between 24 and 38 days. We are uncertain whether there is a difference between the groups for the other primary outcomes. Laparoscopic hysterectomy (LH) versus AH (28 RCTs, 3431 women) Return to normal activities may be sooner in the LH group (MD -13.01 days, 95% CI -16.47 to -9.56; 7 RCTs, 618 women; I2 = 68%, low-certainty evidence), but there may be more urinary tract injuries in the LH group (odds ratio (OR) 2.16, 95% CI 1.19 to 3.93; 18 RCTs, 2594 women; I2 = 0%; moderate-certainty evidence). This suggests that if the return to normal activities after abdominal hysterectomy is assumed to be 37 days, then after laparoscopic hysterectomy it would be between 22 and 25 days. It also suggests that if the rate of ureter injury during abdominal hysterectomy is assumed to be 0.2%, then during laparoscopic hysterectomy it would be between 0.2% and 2%. We are uncertain whether there is a difference between the groups for the other primary outcomes. LH versus VH (22 RCTs, 2135 women) We are uncertain whether there is a difference between the groups for any of our primary outcomes. Both short- and long-term complications were rare in both groups. Robotic-assisted hysterectomy (RH) versus LH (three RCTs, 296 women) None of the studies reported satisfaction rates or quality of life. We are uncertain whether there is a difference between the groups for our other primary outcomes. Single-port laparoscopic hysterectomy (SP-LH) versus LH (seven RCTs, 621 women) None of the studies reported satisfaction rates, quality of life or major long-term complications. We are uncertain whether there is a difference between the groups for rates of intraoperative visceral injury. Total laparoscopic hysterectomy (TLH) versus laparoscopic-assisted vaginal hysterectomy (LAVH) (three RCTs, 233 women) None of the studies reported satisfaction rates or quality of life. We are uncertain whether there is a difference between the groups for rates of intraoperative visceral injury or major long-term complications. Transvaginal natural orifice transluminal endoscopic surgery (V-NOTES) versus LH (two RCTs, 96 women) We are uncertain whether there is a difference between the groups for rates of bladder injury. Our other primary outcomes were not reported. Overall, adverse events were rare in the included studies. AUTHORS' CONCLUSIONS Among women undergoing hysterectomy for benign disease, VH appears to be superior to AH. When technically feasible, VH should be performed in preference to AH because it is associated with faster return to normal activities, fewer wound/abdominal wall infections and shorter hospital stay. Where VH is not possible, LH has advantages over AH including faster return to normal activities, shorter hospital stay, and decreased risk of wound/abdominal wall infection, febrile episodes or unspecified infection, and transfusion. These advantages must be balanced against the increased risk of ureteric injury and longer operative time. When compared to LH, VH was associated with no difference in time to return to normal activities but shorter operative time and shorter hospital stay. RH and V-NOTES require further evaluation since there is a lack of evidence of any patient benefit over conventional LH. Overall, the evidence in this review has to be interpreted with caution as adverse event rates were low, resulting in low power for these comparisons. The surgical approach to hysterectomy should be discussed with the patient and decided in the light of the relative benefits and hazards. Surgical expertise is difficult to quantify and poorly reported in the available studies and this may influence outcomes in ways that cannot be accounted for in this review. In conclusion, when VH is not feasible, LH has multiple advantages over AH, but at the cost of more ureteric injuries. Evidence is limited for RH and V-NOTES.
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Affiliation(s)
- Charlotte M Pickett
- Department of Obstetrics and Gynecology, University of California San Diego, La Jolla, California, USA
| | - Dachel D Seeratan
- Department of Obstetrics and Gynaecology, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Ben Willem J Mol
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia
| | | | - Neil Johnson
- Obstetrics & Gynaecology, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Tijmen Bonestroo
- Department of Obstetrics and Gynecology, Rijnstate Hospital, Arnhem, Netherlands
| | - Johanna Wm Aarts
- Obstetrics and Gynaecology, Amsterdam University Medical Centers, Amsterdam, Netherlands
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Tica VI, Tica AA, De Wilde RL. The Future in Standards of Care for Gynecologic Laparoscopic Surgery to Improve Training and Education. J Clin Med 2022; 11:jcm11082192. [PMID: 35456285 PMCID: PMC9028106 DOI: 10.3390/jcm11082192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/05/2022] [Accepted: 04/07/2022] [Indexed: 11/16/2022] Open
Abstract
Standards of care offer doctors and patients the confidence that an established quality, evidence-based, care is provided, and represent a tool for optimal responding to the population’s needs. It is expected that they will increasingly express a multimodal relationship with gynecologic laparoscopy. Laparoscopy is, now, a standard procedure in operative gynecology, standards are embedded in many laparoscopic procedures, standardization of the skills/competency assessment has been progressively developed, and the proof of competency in laparoscopy may become a standard of care. A continuous development of surgical education includes standard equipment (that may bring value for future advance), standardized training, testing (and performance) assessment, educational process and outcome monitoring/evaluation, patients’ care, and protection, etc. Standards of care and training have a reciprocally sustaining relationship, as training is an essential component of standards of care while care is provided at higher standards after a structured training and as credentialing/certification reunites the two. It is envisaged that through development and implementation, the European wide standards of care in laparoscopic surgery (in close harmonization with personalized medicine) would lead to effective delivery of better clinical services and provide excellent training and education.
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Affiliation(s)
- Vlad I. Tica
- Department of Obstetrics and Gynecology, Doctoral School, University “Ovidius”—Constanta, University Emergency County Hospital of Constanta—Bul. Tomis, 140, Academy of Romanian Scientists, 900591 Constanta, Romania;
| | - Andrei A. Tica
- Department of Pharmacology, University of Medicine and Pharmacy of Craiova, Emergency County Hospital of Craiova, Str. Tabaci, nb. 1, 200534 Craiova, Romania
- Correspondence:
| | - Rudy L. De Wilde
- Pius Hospital, Carl von Ossietzky University, 26121 Oldenburg, Germany;
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Ultra-minimally invasive surgery in gynecological patients: a review of the literature. Updates Surg 2022; 74:843-855. [PMID: 35366181 PMCID: PMC9213331 DOI: 10.1007/s13304-022-01248-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 01/21/2022] [Indexed: 01/18/2023]
Abstract
In the last decade, Ultra-minimally invasive surgery (UMIS) including both minilaparoscopic (MH) and percutaneous (PH) endoscopic surgery achieved widespread use around the world. Despite UMIS has been reported as safe and feasible surgical procedure, most of the available data are drawn from retrospective studies, with a limited number of cases and heterogeneous surgical procedures included in the analysis. This literature review aimed to analyze the most methodologically valid studies concerning major gynecological surgeries performed in UMIS. A literature review was performed double blind from January to April 2021. The keywords ‘minilaparoscopy’; ‘ultra minimally invasive surgery’; ‘3 mm’; ‘percutaneous’; and ‘Hysterectomy’ were selected in Pubmed, Medscape, Scopus, and Google scholar search engines. PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines were followed for the drafting of the systematic review. The systematic literature research provided 298 studies, of which 9 fell within the inclusion criteria. Two hundred ninety-six total patients were included, 148 for both PH and MH groups. Median age (48 years), BMI (24 kg/m2), OT (90 min), EBL (50 ml), time to discharge (1 day), self scar evaluation (10/10), and VAS (3/10) were reported. The most frequent intraoperative complication in both the PH and MH groups was surgical bleeding. The UMIS approaches were feasible and safe even for complex gynecological procedures. Operative times and complications were superimposable to the “classical” minimally invasive approaches reported in the literature. The reported results apply only to experienced surgeons.
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Sassani JC, Clark SG, McGough CE, Shepherd JP, Bonidie M. Sacrocolpopexy experience with a novel robotic surgical platform. Int Urogynecol J 2022; 33:3255-3260. [PMID: 35312804 DOI: 10.1007/s00192-022-05155-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 02/20/2022] [Indexed: 12/01/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The objective was to describe early experience performing sacrocolpopexy using a novel robotic surgical platform. METHODS This is a case series of all women who underwent robotic-assisted sacrocolpopexy using a new robotics platform (TransEnterix Senhance) between January 2019 and July 2021. All sacrocolpopexies were performed by a single Female Pelvic Medicine and Reconstructive surgeon at a large academic institution. Perioperative information including complications was abstracted from the medical record. Anatomical recurrence was defined as any anatomical point at or past the hymen (≥0). Data are descriptive, with Mann-Whitney U test used for comparison of operative time between the first and second half of the patients. RESULTS A total of 25 sacrocolpopexies were performed using the new robotics platform. Mean age was 62.3 years (±9.2) and mean BMI was 26.5 (±3.8). Ten (40.0%) patients had a prior hysterectomy. Most (n = 21, 84.0%) had stage III or IV prolapse preoperatively. Mean operative time was 210.2 min (±48.6) and median estimated blood loss was 35 ml (IQR 25-50). Mean operative time decreased between the first and second half of the patients (231.7 min vs 190.3 min, p = 0.047). There were no major intraoperative complications. Median follow-up time was 16 weeks (IQR 4-34) and there were no subjective recurrences or retreatments during this period. Two patients (8.0%) had anatomical recurrence without subjective bother. There were two postoperative readmissions (8.0%) within 30 days for small bowel obstruction, one treated surgically and the other with nonsurgical management. CONCLUSIONS Our case series demonstrates feasibility and successful early adoption of a new robotics platform for robotic sacrocolpopexy.
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Affiliation(s)
- Jessica C Sassani
- Division of Urogynecology, Department of Obstetrics, Gynecology & Reproductive Sciences, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
| | - Stephanie Glass Clark
- Division of Urogynecology, Department of Obstetrics, Gynecology & Reproductive Sciences, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Christine E McGough
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Jonathan P Shepherd
- Department of Obstetrics & Gynecology, University of Connecticut Health Center, Farmington, CT, USA
| | - Michael Bonidie
- Division of Urogynecology, Department of Obstetrics, Gynecology & Reproductive Sciences, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Abstract
Objective: To explore the time characteristics of shoulder pain after laparoscopic gynecological operation. Methods: We conducted prospective clinical observations and literature review. We studied 442 cases of laparoscopic gynecological surgery. We used a visual analogue scale to evaluate the pain of patients at different time points after operation. We searched the English literature of shoulder pain after gynecological laparoscopic surgery. The observation time points of these studies included 12–24 hours or the first day after surgery, and at least one time point before this time point. Results: The total incidence of shoulder pain was 68%. More than 90% of patients begin to feel shoulder pain on the first day after surgery, not on the day of surgery. 26 articles observed the severity of postlaparoscopic shoulder pain (PLSP) at different time points, of which 17 articles found that the intensity of the shoulder pain peaked at 12–24 hours or the first day after operation. Discussion: The occurrence of PLSP presents obvious time characteristics. The incidence and severity of PLSP peaked on the first day or 12–24 hours after operation. To prevent and treat PLSP better, clinicians should make a more in-depth study according to the time characteristics of PLSP.
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Affiliation(s)
- Xinyou Li
- Department of Anesthesiology, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, Shandong
| | - Kezhong Li
- Department of Anesthesiology, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, Shandong
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6
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Abstract
Background and Objectives Laparoscopic hysterectomy provides patients and surgeons with benefits of less pain, quicker recovery, and better scar cosmesis. Previously, robotic surgical hysterectomy was reserved for patients with complicated disease issues. The objective of this case series was evaluating a new robotic surgical platform, Senhance Surgical System, as a surgical tool in common gynecological procedures. Methods The clinic routinely collects surgical and outcome data for all patients and procedures. Data on robotic surgery in hysterectomy, salpingectomy, endometriosis excision, and lysis of adhesions was evaluated. Results Fifteen consecutive patients that underwent gynecological surgery using the Senhance System were assessed. Average age was 47.27 years (31 - 63 years). Ten procedures were robotic total laparoscopic hysterectomy and 14 of 15 procedures had at least one salpingectomy. Average blood loss was 52.7 mL (10 - 100 mL). Pain scores at discharge averaged 1.42 and 2.73 at two weeks post-surgery. Minimal pain medication was used. Patient satisfaction with the surgery was 98% and satisfaction with scarring was 100%. Return to normal activities and to work averaged 7.93 and 11.1 days respectively. The haptic feedback and the platform visualization of the procedure was useful. The system provided more surgeon control over both camera and tools compared to previously used robotic systems and traditional laparoscopic surgery. Conclusion This initial experience with Senhance Surgical System provided a stable, precise surgical technique with enhanced visualization within the confined space of the abdomen during gynecological surgery. The initial results suggest high patient satisfaction with gynecological surgery and resulting scars. Further study is needed to validate the findings.
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Affiliation(s)
- Steven D McCarus
- Division of Gynecological Surgery, Advent Health Winter Park Hospital, Winter Park, FL
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The risk of shoulder pain after laparoscopic surgery for infertility is higher in thin patients. Sci Rep 2021; 11:13421. [PMID: 34183708 PMCID: PMC8238963 DOI: 10.1038/s41598-021-92762-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 06/08/2021] [Indexed: 02/06/2023] Open
Abstract
Postlaparoscopic shoulder pain (PLSP) is a common clinical problem that needs to be addressed by medical professionals who are currently perform laparoscopic surgeries. The purpose of this study was to determine the perioperative clinical factors and demographic characteristics associated with PLSP. A prospective observational study was performed with 442 inpatients undergoing laparoscopic surgery for infertility. The pain visual analogue scale was used as the measuring instrument. To identify the predictors of PLSP, we performed multivariate conditional logistic regression. PLSP was correlated with body mass index (BMI, odds ratio = 0.815). The incidence of shoulder pain and more severe shoulder pain in patients with a lower BMI was significantly higher than it was in patients with a higher BMI, and BMI was significantly negatively correlated with PLSP. Most of the patients (95%) began to experience shoulder pain on the first postoperative day, and it rarely occurred on the day of surgery. Patients with lower BMI presented a higher risk of reporting shoulder pain on the first postoperative day. We should identify high-risk patients in advance and make specific treatment plans according to the characteristics of their symptoms.
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Casarin J, Cimmino C, Artuso V, Cromi A, Ghezzi F. Minilaparoscopy in gynecology: applications, benefits and limitations. Minerva Obstet Gynecol 2021; 73:179-184. [PMID: 33435662 DOI: 10.23736/s2724-606x.20.04753-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The word "minilaparoscopy" refers to laparoscopic surgical procedures performed using <5-mm trocars, with the exception of the umbilical access. The aim of this review is to explore the feasibility of minilaparoscopy in gynecologic surgery, focusing on instruments, surgical techniques, application and limits of this approach. In this review the authors discussed the positive features and limitation of 3-mm laparoscopy for gynecologic surgery. Using smaller trocars decreases incisional and postoperative pain, and shortens hospitalization, and provides a better cosmetic outcome. Transvaginal specimen extraction can be used to maximize the aesthetic outcomes. A minilaparoscopic surgical procedure is accomplished with lower carbon dioxide pressures, reducing pneumoperitoneum related complications. Accurate patient selection is critical in order to offer the best laparoscopic approach, considering that obesity and endometriosis may represent a challenge for 3-mm surgical tools, which are more flexible and have lower grasping ability. Minilaparoscopy has been shown as a valid alternative to conventional laparoscopy both for diagnostic purpose, major surgical procedures and oncological surgery. Minilaparoscopy in gynecologic surgery represents an option for selected patients, for both benign and malignant indications. The aesthetic outcome represents the main benefit of this approach. Surgeons must be aware of few limitations of this technique such as severe obesity and endometriosis.
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Affiliation(s)
- Jvan Casarin
- Department of Gynecology and Obstetrics, F. Del Ponte Hospital, University of Insubria, Varese, Italy -
| | - Chiara Cimmino
- Department of Gynecology and Obstetrics, F. Del Ponte Hospital, University of Insubria, Varese, Italy
| | - Valeria Artuso
- Department of Gynecology and Obstetrics, F. Del Ponte Hospital, University of Insubria, Varese, Italy
| | - Antonella Cromi
- Department of Gynecology and Obstetrics, F. Del Ponte Hospital, University of Insubria, Varese, Italy
| | - Fabio Ghezzi
- Department of Gynecology and Obstetrics, F. Del Ponte Hospital, University of Insubria, Varese, Italy
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Percutaneous-assisted vs mini-laparoscopic hysterectomy: comparison of ultra-minimally invasive approaches. Updates Surg 2020; 73:2347-2354. [PMID: 32996053 DOI: 10.1007/s13304-020-00893-5] [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: 05/11/2020] [Accepted: 09/21/2020] [Indexed: 01/28/2023]
Abstract
To assess the feasibility and the safety of the ultra-minimally invasive (U-MIS) approaches in gynecology, we compared our experience in percutaneous assisted hysterectomy (PSS-H) with a series of 3 mm mini-laparoscopy hysterectomy (m-LPS-H). 126 patients affected by benign and malignant gynecological conditions were considered eligible for minimally invasive hysterectomy: 80 patients received PSS approach and 46 m-LPS approach. For both groups, we evaluated intra and perioperative outcomes, post-operative pain and cosmetic outcomes. The baseline characteristics were comparable between the two study groups. As well, no differences were reported in the clinical indications for hysterectomy, principally fibroids/adenomyosis, endometrial hyperplasia and early stage endometrial cancer. The median operative time was 88.5 (40-190) minutes for PSS-H group and 95.0 (42-231) minutes in m-LPS-H group (p = 0.131). No differences were detected in median estimated blood loss (p = 0.104) as well, in the uterine manipulator usage (p = 0.127) between the two different surgical approaches. Only 1 (2.2%) conversion to standard laparoscopy occurred in m-LPS-H group (p = 0.691). One intra-operative complication was recorded 1 (1.3%) in the PSS-H group (p = 0.367). The post-operative early complication was recorded in five cases of PSS-H group (p = 0.158), none for m-LPS-H procedures. The results in post-operative pain detection was statistically significant after 4 h in favor of m-LPS-H group (p = 0.001). After 30 days no differences in cosmetic satisfaction were detected between the two groups (p = 0.206). PSS-H and m-LPS-H are two valid U-MIS alternatives for benign gynecological conditions and low/intermediate risk endometrial cancer.
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Perrone E, Rossitto C, Fanfani F, Cianci S, Fagotti A, Uccella S, Vizzielli G, Vascone C, Restaino S, Fedele C, Saleh FL, Scambia G, Gueli Alletti S. Percutaneous-Assisted versus Laparoscopic Hysterectomy: A Prospective Comparison. Gynecol Obstet Invest 2020; 85:318-326. [PMID: 32920558 DOI: 10.1159/000509877] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 06/22/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To evaluate the feasibility of percutaneous approach, we prospectively compared our experience in percutaneous-assisted hysterectomy (PSS-H) with that in a series of laparoscopic hysterectomies (LPS-Hs). METHODS In this multicentric cohort study, from May 2015 to October 2017, 160 patients affected by benign and malignant gynecological conditions were considered eligible for minimally invasive surgery (MIS): 80 patients received PSS-H and 80 LPS-H. In each group, 30 cases of low-/intermediate-risk endometrial cancer were enrolled. For both groups, we documented preoperative outcomes, postoperative pain, and cosmetic outcomes. RESULTS No statistically significant differences were noted in baseline characteristics or operative time. We observed significant differences in estimated blood loss: median of 50 cc (PSS-H) and 100 cc (LPS-H) (p = 0.0001). In LPS-H, we reported 4 (5.0%) intraoperative complications and 1 (1.3%) in PSS-H. Thirty-day complications were 4 (5%) in PSS-H and 11 (13.8%) in LPS-H (p = 0.058). No significative differences were found in visual analog scale score, despite a relevant disparity in cosmetic outcome (p = 0.0001). For oncological cases, the 2 techniques had comparable intra- and postoperative outcomes and oncological accuracy. CONCLUSIONS In this study, we reported that PSS-H is comparable to LPS-H for intra- and perioperative outcomes and postoperative pain, while PSS-H seems to be superior in cosmetic outcomes and patient satisfaction. PSS-H may represent a valid alternative in ultra-MIS for benign gynecological conditions and low-/intermediate-risk endometrial cancer.
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Affiliation(s)
- Emanuele Perrone
- Department of Obstetrics and Gynecology, Fondazione Policlinico Universitario A. Gemelli, IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy,
| | - Cristiano Rossitto
- Department of Obstetrics and Gynecology, Fondazione Policlinico Universitario A. Gemelli, IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Fanfani
- Department of Obstetrics and Gynecology, Fondazione Policlinico Universitario A. Gemelli, IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy
| | - Stefano Cianci
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Anna Fagotti
- Department of Obstetrics and Gynecology, Fondazione Policlinico Universitario A. Gemelli, IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy
| | - Stefano Uccella
- Division of Obstetrics and Gynecology, Ospedale degli Infermi, Biella, Italy
| | - Giuseppe Vizzielli
- Department of Obstetrics and Gynecology, Fondazione Policlinico Universitario A. Gemelli, IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy
| | - Carmine Vascone
- Department of Obstetrics and Gynecology, Pineta Grande Hospital, Castel Volturno, Italy
| | - Stefano Restaino
- Department of Obstetrics and Gynecology, Fondazione Policlinico Universitario A. Gemelli, IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy
| | - Camilla Fedele
- Department of Obstetrics and Gynecology, Fondazione Policlinico Universitario A. Gemelli, IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy
| | - Farrah Layla Saleh
- Department of Obstetrics, Gynecology & Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Giovanni Scambia
- Department of Obstetrics and Gynecology, Fondazione Policlinico Universitario A. Gemelli, IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy
| | - Salvatore Gueli Alletti
- Department of Obstetrics and Gynecology, Fondazione Policlinico Universitario A. Gemelli, IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy
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Laganà AS, Garzon S, Gisone B, Casarin J, Ghezzi F. Intraperitoneal ultrasound scan by culdotomy before laparoscopic ovarian resection: a novel approach. MINIM INVASIV THER 2020; 31:479-482. [PMID: 32903130 DOI: 10.1080/13645706.2020.1815063] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
We describe a novel technique of intraperitoneal ultrasound scan by culdotomy before laparoscopic ovarian resection. To preserve the ovarian parenchyma in a recurrence of serous borderline ovarian tumor, a usual transvaginal ultrasound probe was introduced into the abdominal cavity, covered by a sterile bag, through posterior colpotomy. The pelvis was filled with saline solution and the ultrasound imaging was performed allowing the identification of tumor margins. After precise cystectomy, the tumor was delivered within the endo bag, through the posterior colpotomy. This new approach may be a feasible, effective and cheap technique to guide laparoscopic surgery for complex and/or small ovarian tumors.
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Affiliation(s)
- Antonio Simone Laganà
- Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
| | - Simone Garzon
- Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
| | - Baldo Gisone
- Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
| | - Jvan Casarin
- Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
| | - Fabio Ghezzi
- Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
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Misirlioglu S, Giray B, Vatansever D, Arslan T, Urman B, Taskiran C. Mini-plus percutaneous setting in total laparoscopic hysterectomy. MINIM INVASIV THER 2020; 31:284-290. [PMID: 32723200 DOI: 10.1080/13645706.2020.1794899] [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] [Indexed: 10/23/2022]
Abstract
INTRODUCTION We aimed to analyze the preliminary experience of a mini-plus percutaneous instrument (MpPc) setting in total laparoscopic hysterectomy (TLH). MATERIAL AND METHODS Forty-three women who underwent a mini-plus percutaneous total laparoscopic hysterectomy at a tertiary-care university-based teaching hospital and academic affiliated private hospital between May 2017 and 2018 were included. MpPc-TLH was performed through one optical trans-umbilical 5-mm trocar, one 5-mm ancillary port on the right side, either one 2.4-mm percutaneous endoscopic instrument or 3-mm mini-laparoscopic port on the right upper quadrant and if required one 3-mm ancillary port on the left lower quadrant. RESULTS A total of 43 patients were included, with a median age of 48 years (range, 38-71 years). Indication for surgery included uterine myomas (n = 20), benign adnexal mass (n = 7), endometrial intraepithelial neoplasia (n = 6), endometrial cancer (n = 5), adenomyosis with abnormal bleeding (n = 3), and high-grade cervical dysplasia (n = 2). The median operating time was 100 min (range, 60-180 min), and the median estimated blood loss was 30 ml (range, 20-60ml). The median postoperative abdominal pain Visual Analog Scale score was 3 (range, 0-6). CONCLUSIONS The preliminary data suggest that MpPc approach is a feasible and safe surgical modality for total laparoscopic hysterectomy.
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Affiliation(s)
- Selim Misirlioglu
- Department of Obstetrics and Gynecology, VKF Koc University Hospital, Istanbul, Turkey
| | - Burak Giray
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Zeynep Kamil Women and Children's Health Training and Research Hospital, Istanbul, Turkey
| | - Dogan Vatansever
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, VKF Koc University School of Medicine, Istanbul, Turkey
| | - Tonguc Arslan
- Women's Health Center, VKF American Hospital, Istanbul, Turkey
| | - Bulent Urman
- Women's Health Center, VKF American Hospital, Istanbul, Turkey.,Department of Obstetrics and Gynecology, VKF Koc University School of Medicine, Istanbul, Turkey
| | - Cagatay Taskiran
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, VKF Koc University School of Medicine, Istanbul, Turkey.,Women's Health Center, VKF American Hospital, Istanbul, Turkey
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Recknagel JD, Goodman LR. Clinical Perspective Concerning Abdominal Entry Techniques. J Minim Invasive Gynecol 2020; 28:467-474. [PMID: 32712324 DOI: 10.1016/j.jmig.2020.07.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 07/15/2020] [Accepted: 07/18/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Entry into the abdomen during operative laparoscopy is a source of some controversy regarding the safest and most useful method. The objective of this review is to describe, compare, and contrast the most popular entry techniques. DATA SOURCES Data were collected from the historical starting point until present day from English language journal articles and book chapters. METHODS OF STUDY SELECTION Descriptive accounts dating back to the start of laparoscopy in the 1970s and spanning to present day well-designed randomized controlled trials and Cochrane reviews were compiled to evaluate the evidence for the effectiveness and safety of abdominal entry techniques. TABULATION, INTEGRATION, AND RESULTS The most common sites of entry are the umbilicus and the left upper quadrant. Between the Veress needle, direct trocar insertion, and open entry there is no high-quality evidence to suggest that any of these offers a universal safety advantage. The Veress needle is still the most used among gynecologists and facilitates primary trocar placement. Direct trocar entry under laparoscopic visualization may be underused, is faster, and may result in fewer failed entries. Open (Hasson) entry can be more technically challenging, but may be best for patients with suspected intra-abdominal adhesions. CONCLUSION Surgeon comfort is critical in choosing the entry site, method, and equipment. Surgeon familiarity with entry-failure troubleshooting, possible complications, and management is essential because major entry complications are rare in modern laparoscopy but critical because the essential steps of recognition and management can be lifesaving.
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Affiliation(s)
- Johnathon D Recknagel
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of North Carolina Hospitals, Chapel Hill, North Carolina (all authors)
| | - Linnea R Goodman
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of North Carolina Hospitals, Chapel Hill, North Carolina (all authors).
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14
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Delgado-Sánchez E, Peay-Pinacho JA, Hernández Gutiérrez A, Álvarez Bernardi J, Zapardiel I. Role of single-site and mini-laparoscopy in gynecologic surgery. Minerva Obstet Gynecol 2020; 73:166-178. [PMID: 32677777 DOI: 10.23736/s2724-606x.20.04607-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Laparoscopy is a surgical procedure that has been used widely in medicine over the last thirty years. In gynecology, laparoscopy is the "gold standard" for the majority of gynecological procedures, as its superiority over laparotomy has been widely demonstrated. In recent years, the current trend of gynecologists is to make laparoscopy surgery even less invasive by reducing the number of incisions in the skin, as it happens with laparoendoscopic single-site surgery, or by reducing the size of them as in mini-laparoscopy. The aim of this work was to perform an extensive review and update of the evolution of single-port surgery and mini-laparoscopic surgery in gynecology as well as to evaluate its current role in this field. EVIDENCE ACQUISITION A systematic review was performed during April and May 2020. PRISMA guidelines were followed for the literature search. EVIDENCE SYNTHESIS The main objective of performing less invasive procedures is to reduce both intraoperative complications (decreased risk of bleeding or damage to internal organs), and postoperative ones (hernias through the trocar) and improve cosmetic results. Results of studies about LESS and mini-LPS showed encouraging results, being both of them safe with a similar perioperative and postoperative outcome. They have the approval of the international surgical community as well as patients' satisfaction with cosmetic results. CONCLUSIONS Minimally invasive surgery is the present and future in gynecological surgery. More prospective randomized trials are needed in order to obtain valid results and affirm that both LESS and Mini-LPS are superior to conventional laparoscopy.
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Affiliation(s)
- Elsa Delgado-Sánchez
- Department of Gynecology, Infanta Sofía University Hospital, San Sebastián de los Reyes, Spain
| | - John A Peay-Pinacho
- Department of Gynecology, Infanta Sofía University Hospital, San Sebastián de los Reyes, Spain
| | | | - Julio Álvarez Bernardi
- Department of Gynecology, Infanta Sofía University Hospital, San Sebastián de los Reyes, Spain
| | - Ignacio Zapardiel
- Unit of Gynecologic Oncology, La Paz University Hospital (IdiPAZ), Madrid, Spain -
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15
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Boza A, Urman B, Vatansever D, Ceyhan M, Mısırlıoglu S, Koca S, Çapraz K, Tunga Dogan A, Taskıran C. Mini-Laparoscopic Gynecological Surgery Using Smaller Ports Minimizes Incisional Pain and Postoperative Scar Size: A Paired Sample Analysis. Surg Innov 2020; 27:455-460. [PMID: 32501743 DOI: 10.1177/1553350620923526] [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] [Indexed: 01/02/2023]
Abstract
Objective. The aim of this study was to assess postoperative incisional pain and cosmetic scores in mini-laparoscopic gynecological surgeries undertaken with different port sizes. Material and Method. In this prospective study, all women who underwent mini-laparoscopic gynecological surgery with 2.4-, 3-, and 5-mm lateral ports for benign gynecological conditions between March 2017 and April 2019 were included. The primary outcome was postoperative incisional pain at rest, walking, and after a provoked Valsalva maneuver assessed by numeric rating scale scores at 6 hours, 12 hours, 24 hours, and 3 days and 7 days after surgery. Secondary outcome measures included cosmetic scores of each port site (evaluated by using patient-observer scar assessment scale [POSAS]), operation time, and intra- and postoperative complications. Results. A total of 330 lateral port sites in 110 patients who underwent benign gynecological surgery via mini-laparoscopy were assessed for pain and cosmetic appearance. Pain scores at each time point were significantly lower for 2.4- and 3-mm ports than those for 5-mm ports; however, no significant difference was detected between 2.4-mm and 3-mm port sites (P = .6). The difference was more evident at 24 hours when routine analgesic drugs were stopped (P = .004). For POSAS scores, both 2.4-mm and 3-mm ports were superior to 5-mm port sites (P = .002); however, there was no significant difference between 2.4-mm and 3-mm port sites (P = .2). There were 2 port-related complications: one subcutaneous emphysema and one bleeding from a 5-mm trocar site 1 hour after surgery. Conclusion. Mini-laparoscopic gynecologic surgery using smaller ports resulted in decreased postoperative incisional pain and superior cosmetic appearance.
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Affiliation(s)
- Aysen Boza
- Womens' Health Center, 64090American Hospital, Turkey
| | - Bulent Urman
- Womens' Health Center, 64090American Hospital, Turkey
| | - Dogan Vatansever
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, 145809Koc University, Turkey
| | - Mehmet Ceyhan
- Womens' Health Center, 64090American Hospital, Turkey
| | - Selim Mısırlıoglu
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, 145809Koc University, Turkey
| | - Sema Koca
- Womens' Health Center, Division of Gynecologic Oncology, 64090American Hospital, Turkey
| | - Kevser Çapraz
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, 145809Koc University, Turkey
| | - Alper Tunga Dogan
- Department of Anesthesiology and Reanimation, 64090American Hospital, Turkey
| | - Cagatay Taskıran
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, 145809Koc University, Turkey.,Womens' Health Center, Division of Gynecologic Oncology, 64090American Hospital, Turkey
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16
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Béguinot M, Botchorishvili R, Comptour A, Curinier S, Campagne-Loiseau S, Chauvet P, Pereira B, Pouly JL, Rabischong B, Canis M, Bourdel N. Minilaparoscopic Total Hysterectomy in Current Practice Feasibility and Benefits: A Unicentric, Randomized Controlled Trial. J Minim Invasive Gynecol 2019; 27:673-680. [PMID: 31173939 DOI: 10.1016/j.jmig.2019.05.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Revised: 05/06/2019] [Accepted: 05/22/2019] [Indexed: 10/26/2022]
Abstract
STUDY OBJECTIVE To investigate whether mini-instrumentation may be used for hysterectomy (HT) by all surgeons (assistants and seniors) without increasing the operative time or altering surgeon working conditions. DESIGN A unicenter, randomized controlled, single blind, parallel, noninferiority trial comparing 2 surgical techniques. SETTING A tertiary referral center. PATIENTS Thirty-two patients undergoing HT for a benign gynecologic disease were enrolled in this study in our center between April 2, 2015, and June 1, 2018. Sixteen patients were randomized in group A and 16 patients in group B. INTERVENTIONS HT with bilateral annexectomy or ovarian conservation using 3-mm instruments (group A) or conventional 5-mm instruments (group B). MEASUREMENTS AND MAIN RESULTS Concerning the primary outcome, the operative time for the HT 3-mm group was 128 minutes (range, 122-150 minutes) versus 111 minutes (range, 92-143 minutes) for the HT 5-mm group (i.e., δ = 17 [90% confidence interval, -6 to 39]), with rejection of the noninferiority threshold at 35 minutes. Thirty-one percent of HTs initially performed using 3-mm instruments were completed with conventional instruments. HTs performed with mini-instruments required more concentration (p = .02) with surgeons reporting higher levels of frustration (p = .009) and sense of failure (p = .006). Patients tend to experience greater satisfaction regarding scars with a significant difference noted during the postoperative visit both for scar pain (1 vs 4 patients with moderate pain [30-50 mm on the Patient Scar Assessment Scale) in the HT 3-mm group and the HT 5-mm group, respectively) and scar firmness (p = .021; 3 vs 7 patients with moderate firmness [30-50 mm on the Patient Scar Assessment Scale] in the HT 3-mm group and the HT 5-mm group, respectively). CONCLUSION Total minilaparoscopic HT appears inferior to standard laparoscopy in terms of operative time and surgeon working conditions; only the short-term cosmetic appearance was in favor of the 3-mm approach.
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Affiliation(s)
- Marie Béguinot
- Department of Gynecologic Surgery (Drs. Béguinot, Botchorishvili, Comptour, Curinier, Campagne-Loiseau, Chauvet, Pouly, Rabischong, Canis, and Bourdel); Centre Hospitalier Universitaire Clermont-Ferrand, Clermont-Ferrand, France, and Department of Surgery, Jean Perrin Comprehensive Center, Clermont-Ferrand, France (Dr. Béguinot)
| | - Revaz Botchorishvili
- Department of Gynecologic Surgery (Drs. Béguinot, Botchorishvili, Comptour, Curinier, Campagne-Loiseau, Chauvet, Pouly, Rabischong, Canis, and Bourdel)
| | - Aurélie Comptour
- Department of Gynecologic Surgery (Drs. Béguinot, Botchorishvili, Comptour, Curinier, Campagne-Loiseau, Chauvet, Pouly, Rabischong, Canis, and Bourdel)
| | - Sandra Curinier
- Department of Gynecologic Surgery (Drs. Béguinot, Botchorishvili, Comptour, Curinier, Campagne-Loiseau, Chauvet, Pouly, Rabischong, Canis, and Bourdel)
| | - Sandrine Campagne-Loiseau
- Department of Gynecologic Surgery (Drs. Béguinot, Botchorishvili, Comptour, Curinier, Campagne-Loiseau, Chauvet, Pouly, Rabischong, Canis, and Bourdel)
| | - Pauline Chauvet
- Department of Gynecologic Surgery (Drs. Béguinot, Botchorishvili, Comptour, Curinier, Campagne-Loiseau, Chauvet, Pouly, Rabischong, Canis, and Bourdel)
| | - Bruno Pereira
- Biostatistics Division (Direction de la Recherche Clinique et de l'Innovation) (Dr. Pereira)
| | - Jean-Luc Pouly
- Department of Gynecologic Surgery (Drs. Béguinot, Botchorishvili, Comptour, Curinier, Campagne-Loiseau, Chauvet, Pouly, Rabischong, Canis, and Bourdel)
| | - Benoit Rabischong
- Department of Gynecologic Surgery (Drs. Béguinot, Botchorishvili, Comptour, Curinier, Campagne-Loiseau, Chauvet, Pouly, Rabischong, Canis, and Bourdel)
| | - Michel Canis
- Department of Gynecologic Surgery (Drs. Béguinot, Botchorishvili, Comptour, Curinier, Campagne-Loiseau, Chauvet, Pouly, Rabischong, Canis, and Bourdel)
| | - Nicolas Bourdel
- Department of Gynecologic Surgery (Drs. Béguinot, Botchorishvili, Comptour, Curinier, Campagne-Loiseau, Chauvet, Pouly, Rabischong, Canis, and Bourdel).
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17
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Tantchev L, Kotzev A, Yordanov AA. Disturbed Interstitial Pregnancy: A First Case of Successful Treatment Using a Mini-Laparoscopic Approach. ACTA ACUST UNITED AC 2019; 55:medicina55050215. [PMID: 31137907 PMCID: PMC6571741 DOI: 10.3390/medicina55050215] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 04/08/2019] [Accepted: 05/21/2019] [Indexed: 12/17/2022]
Abstract
Interstitial ectopic pregnancy (EP) is a life-threatening condition due to the risk of massive hemorrhage in the event of its disturbance. We present the case of a 27-year-old patient who was admitted with massive hemoperitoneum, caused by the rupture of an interstitial pregnancy in the area of the fallopian tube stump, which had been removed after a previous ectopic pregnancy. The condition was overcome using a mini-laparoscopic approach (2.6 mm, 30° optics), with one 3 mm port for micro-laparoscopic instruments and one 10 mm port. Such an approach has not yet been reported in the available literature, among the casuistically reported cases of pregnancy in the tubal stump. We consider that the technique is safe, completely in the interest of the patient, applicable by an experienced team, and in agreement with modern trends regarding the minimization of operative access.
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Affiliation(s)
- Latchesar Tantchev
- Obstetrics and Gynecology Clinic, Acibadem City Clinic Hospital "Tokuda", PC 1000 Sofia City, Bulgaria.
| | - Andrey Kotzev
- Clinic of Gastroenterology, University Hospital for Active Treatment "Alexandrovska", PC 1000 Sofia City, Bulgaria.
| | - And Angel Yordanov
- Clinic of Oncological Gynecology, University General Hospital for Active Treatment "Dr. G. Stranski", PC 5800 Pleven City, Bulgaria.
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18
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Lirk P, Thiry J, Bonnet MP, Joshi GP, Bonnet F. Pain management after laparoscopic hysterectomy: systematic review of literature and PROSPECT recommendations. Reg Anesth Pain Med 2019; 44:425-436. [DOI: 10.1136/rapm-2018-100024] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 12/23/2018] [Accepted: 12/31/2018] [Indexed: 11/03/2022]
Abstract
Background and objectivesLaparoscopic hysterectomy is increasingly performed because it is associated with less postoperative pain and earlier recovery as compared with open abdominal hysterectomy. The aim of this systematic review was to evaluate the available literature regarding the management of pain after laparoscopic hysterectomy.Strategy and selection criteriaRandomized controlled trials evaluating postoperative pain after laparoscopic hysterectomy published between January 1996 and May 2018 were retrieved, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, from the EMBASE and MEDLINE databases and the Cochrane Register of Controlled Trials. Efficacy and adverse effects of analgesic techniques were assessed.ResultsOf the 281 studies initially identified, 56 were included. Of these, 31 assessed analgesic or anesthetic interventions and 25 assessed surgical interventions. Acetaminophen, non-steroidal anti-inflammatory drugs, and dexamethasone reduced opioid consumption. Limited evidence hindered recommendations on alpha-2-agonists. Inconsistent evidence was found in the studies investigating pregabalin and transversus abdominis plane block, and no evidence was found for intraperitoneal local anesthetics, port site infiltration, or single-port laparoscopy. Measures to lower peritoneal insufflation pressure or humidify or heat insufflated gas seem to reduce the incidence of shoulder pain, but not abdominal pain.ConclusionsThe baseline analgesic regimen for laparoscopic hysterectomy should include acetaminophen, a non-steroidal anti-inflammatory drug, dexamethasone, and opioids as rescue analgesics.
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19
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Baekelandt JF, De Mulder PA, Le Roy I, Mathieu C, Laenen A, Enzlin P, Weyers S, Mol BWJ, Bosteels JJA. Hysterectomy by transvaginal natural orifice transluminal endoscopic surgery versus laparoscopy as a day‐care procedure: a randomised controlled trial. BJOG 2018; 126:105-113. [DOI: 10.1111/1471-0528.15504] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2018] [Indexed: 12/31/2022]
Affiliation(s)
- JF Baekelandt
- Department of Obstetrics and Gynaecology Imelda Hospital Bonheiden Belgium
| | - PA De Mulder
- Department of Anaesthesiology Imelda Hospital Bonheiden Belgium
| | - I Le Roy
- Department of Anaesthesiology Imelda Hospital Bonheiden Belgium
| | - C Mathieu
- Clinical and Experimental Endocrinology KU Leuven – University of Leuven Leuven Belgium
| | - A Laenen
- Leuven Biostatistics and Statistical Bioinformatics Centre (L‐BioStat) KU Leuven – University of Leuven Leuven Belgium
| | - P Enzlin
- Interfaculty Institute for Family and Sexuality Studies KU Leuven – University of Leuven Leuven Belgium
| | - S Weyers
- Universitaire Vrouwenkliniek University of Ghent Ghent Belgium
| | - BWJ Mol
- Department of Obstetrics and Gynaecology Monash University Clayton Vic. Australia
| | - JJA Bosteels
- Department of Obstetrics and Gynaecology Imelda Hospital Bonheiden Belgium
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20
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Abdel-Karim AM, El Tayeb MM, Yahia E, Elmissiry M, Hassouna M, Elsalmy S. Evaluation of the Role of Laparoendoscopic Single-Site Surgery vs Minilaparoscopy for Treatment of Upper Urinary Tract Pathologies: Prospective Randomized Comparative Study. J Endourol 2018; 31:1237-1242. [PMID: 29020831 DOI: 10.1089/end.2017.0363] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVES To present the first prospective randomized comparison between laparoendoscopic single-site surgery (LESS) and minilaparoscopy (ML) for treatment of upper urinary tract pathologies. PATIENTS AND METHODS Between January 2013 and June 2015, patients with different upper urinary pathologies were blindly randomized to both LESS and ML. All procedures were done by single experienced surgeon. Both cohorts were compared regarding demographic data, peri and postoperative characteristics, and visual analog pain scale (VAS). Cosmetic outcome was assessed after 12 months using patient scar assessment scale (PSAS) and observer scar assessment scale (OSAS). RESULTS Sixty patients were randomized into two equal groups with comparable demographic and preoperative characteristics. Indications included nephrectomy, pyeloplasty, cyst marsupialization, adrenalectomy, and repair of retrocaval ureter. Operative time was 167 ± 24 and 145 ± 39 minutes in LESS and ML groups, respectively (p = 0.09). Estimated blood loss was 59 ± 34 and 43 ± 42 mL in both groups, respectively (p = 0.2). VAS was 1.7 ± 0.6 and 2.8 ± 0.5 in both groups, respectively (p = 0.02). PSAS and OSAS were 5.9 ± 0.85 and 10.6 ± 1.98 vs 8.9 ± 0.9 and 13.5 ± 6.3 in both groups, respectively (p > 0.05). There were no intraoperative complications, conversions to open surgery, or conventional laparoscopy in both groups. Mean postoperative Diclofenac Na was 151.7 ± 35.6 and 169.7 ± 47.3 mg in both groups, respectively (p = 0.04). Postoperative complications rate and hospital stay were comparable between both groups. CONCLUSION Both LESS and ML have comparable operative time, blood loss, complication rate, and hospital stay in treatment of upper urinary tract pathologies. However, LESS is associated with less analgesic requirement and better cosmetic outcome.
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Affiliation(s)
- Aly M Abdel-Karim
- Urology Department, Faculty of Medicine, Alexandria University , Alexandria, Egypt
| | - Marawan M El Tayeb
- Urology Department, Faculty of Medicine, Alexandria University , Alexandria, Egypt
| | - Elsaid Yahia
- Urology Department, Faculty of Medicine, Alexandria University , Alexandria, Egypt
| | - Mostafa Elmissiry
- Urology Department, Faculty of Medicine, Alexandria University , Alexandria, Egypt
| | - Mohamed Hassouna
- Urology Department, Faculty of Medicine, Alexandria University , Alexandria, Egypt
| | - Salah Elsalmy
- Urology Department, Faculty of Medicine, Alexandria University , Alexandria, Egypt
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21
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Uccella S, Buda A, Morosi C, Di Martino G, Delle Marchette M, Reato C, Casarin J, Ghezzi F. Minilaparoscopy vs Standard Laparoscopy for Sentinel Node Dissection: A Pilot Study. J Minim Invasive Gynecol 2018; 25:461-466.e1. [DOI: 10.1016/j.jmig.2017.10.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 10/01/2017] [Accepted: 10/03/2017] [Indexed: 12/17/2022]
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22
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Wong M, Morris S, Wang K, Simpson K. Managing Postoperative Pain After Minimally Invasive Gynecologic Surgery in the Era of the Opioid Epidemic. J Minim Invasive Gynecol 2017; 25:1165-1178. [PMID: 28964926 DOI: 10.1016/j.jmig.2017.09.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 09/16/2017] [Accepted: 09/19/2017] [Indexed: 12/14/2022]
Abstract
In this review, we examine the evidence behind nonopioid medication alternatives, peripheral nerve blocks, surgical techniques, and postoperative recovery protocols that can help minimize and effectively treat postoperative pain after minimally invasive gynecologic surgery (MIGS). Because of the depth and heterogeneity of the data, a narrative review was performed of reported interventions. A comprehensive review was performed of PubMed, Embase, and the Cochrane Database with a focus on randomized controlled trials. In the absence of literature specific to benign gynecology, similar specialty or procedural data were reviewed. A variety of nonopioid medications, surgical techniques, and postoperative recovery protocols have shown significant improvements in postoperative pain after gynecologic surgery. Nonopioid medication options that are beneficial include acetaminophen, nonsteroidal anti-inflammatories, and antiepileptics. Incision infiltration with local anesthesia also significantly reduces pain. Surgically, minimally invasive approaches, reducing the laparoscopic trocar size to <10 mm, and evacuating the pneumoperitoneum at the end of the case all have significant benefits. Lastly, enhanced recovery pathways show promise in reducing pain after MIGS. By using a multimodal approach, minimally invasive gynecologic surgeons can help to minimize and manage postoperative pain with less reliance on opioid pain medications.
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Affiliation(s)
- Marron Wong
- Center for Minimally Invasive Gynecologic Surgery, Newton-Wellesley Hospital, Newton, Massachusetts.
| | - Stephanie Morris
- Center for Minimally Invasive Gynecologic Surgery, Newton-Wellesley Hospital, Newton, Massachusetts
| | - Karen Wang
- Department of Minimally Invasive Gynecologic Surgery, Johns Hopkins Medical Center, Baltimore, Maryland
| | - Khara Simpson
- Department of Minimally Invasive Gynecologic Surgery, Johns Hopkins Medical Center, Baltimore, Maryland
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23
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Gencdal S, Aydogmus H, Aydogmus S, Kolsuz Z, Kelekci S. Mini-Laparoscopic Versus Conventional Laparoscopic Surgery for Benign Adnexal Masses. J Clin Med Res 2017; 9:613-617. [PMID: 28611862 PMCID: PMC5458659 DOI: 10.14740/jocmr3060w] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2017] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Minimally invasive endoscopic surgery has become an acceptable method for gynecologic indications for more than 20 years. We aimed to compare clinical and surgical outcomes between mini-laparoscopic surgery (MLS) and conventional laparoscopic surgery (CLS) for benign adnexal masses. As far as we know, no comparative study exists between these two minimal invasive procedures. METHODS During the period between January 2014 and December 2016, a total number of 132 laparoscopic surgeries were performed for bening adnexal masses in our clinic. Seventy women underwent CLS and 62 women underwent MLS. Pathological results and operating time of procedures, estimated blood loss, preoperative and postoperative complications, patient scale and observer scale (POSAS) and length of hospital stay were recorded. RESULTS There was no difference between the two groups regarding preoperative diagnosis, intraoperative surgical procedure performed, and length of hospital stay. The groups were compared in terms of postoperative pathological diagnosis using the Chi-square test, and there was a statistically significant difference between the two groups. Comparing the operation time and hematocrit change, there were statistically significant differences between the two groups. Both patient and observer PSOAS scar scores were better in MLS group (P < 0.05). CONCLUSIONS Mini-laparoscopy can be safely and effectively used to perform benign adnexal mass surgery.
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Affiliation(s)
- Servet Gencdal
- Obstetrics and Gynecology Clinic, Izmir Ataturk Education and Research Hospital, Ministry of Health, Izmir, Turkey
| | - Huseyin Aydogmus
- Obstetrics and Gynecology Clinic, Izmir Ataturk Education and Research Hospital, Ministry of Health, Izmir, Turkey
| | - Serpil Aydogmus
- Department of Obstetrics and Gynecology, School of Medicine, Izmir Katip Celebi University, Izmir, Turkey
| | - Zafer Kolsuz
- Obstetrics and Gynecology Clinic, Izmir Ataturk Education and Research Hospital, Ministry of Health, Izmir, Turkey
| | - Sefa Kelekci
- Department of Obstetrics and Gynecology, School of Medicine, Izmir Katip Celebi University, Izmir, Turkey
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Kundu S, Weiss C, Hertel H, Hillemanns P, Klapdor R, Soergel P. Association between intraabdominal pressure during gynaecologic laparoscopy and postoperative pain. Arch Gynecol Obstet 2017; 295:1191-1199. [PMID: 28285427 DOI: 10.1007/s00404-017-4325-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 02/07/2017] [Indexed: 01/08/2023]
Abstract
PURPOSE Laparoscopy is nowadays a well-established surgical method and plays a main role in an ever-increasing range of indications in gynaecology. High-quality studies of surgical techniques are necessary to improve the quality of patient care. The present study aims at evaluating postoperative pain after gynaecological laparoscopy depending on the intraoperative CO2 pressure. METHODS In a prospective, monocentric, randomized single-blind study at the Department of Gynaecology and Obstetrics at the Hannover Medical School, we include patients scheduled for different laparoscopic procedures. Randomization of the intraoperative CO2 pressure was carried out in six groups. Pain was assessed the day after surgery by the blinded nurse using a visual analogue scale. RESULTS 550 patients were included in the period from May 2013 to January 2016. The analysis of the per protocol population PPP (n = 360) showed no statistically significant difference between the six intervention groups with regard to mean postoperative pain perception. In direct comparison between two groups, an intraoperative CO2 pressure of 15 mmHg was associated with a significant higher pain score than a pressure of 12 mmHg. The difference was 7.46 mm on a 10 cm VAS. CONCLUSIONS The results of our study indicate that a CO2 pressure of 12 versus 15 mmHg can be advantageous. However, the clinical relevance remains unclear due to the low difference in pain. The additional benefit of an even lower pressure of 10 or 8 mmHg cannot be reliably assessed; we found signs of poor visibility conditions in these low pressure groups.
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Affiliation(s)
- Sudip Kundu
- Department of Obstetrics and Gynaecology, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany.
| | - Clara Weiss
- Department of Obstetrics and Gynaecology, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany
| | - Hermann Hertel
- Department of Obstetrics and Gynaecology, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany
| | - Peter Hillemanns
- Department of Obstetrics and Gynaecology, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany
| | - Rüdiger Klapdor
- Department of Obstetrics and Gynaecology, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany
| | - Philipp Soergel
- Department of Obstetrics and Gynaecology, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany
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Fanfani F, Restaino S, Rossitto C, Gueli Alletti S, Costantini B, Monterossi G, Cappuccio S, Perrone E, Scambia G. Total Laparoscopic (S-LPS) versus TELELAP ALF-X Robotic-Assisted Hysterectomy: A Case-Control Study. J Minim Invasive Gynecol 2016; 23:933-8. [PMID: 27247263 DOI: 10.1016/j.jmig.2016.05.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 05/20/2016] [Accepted: 05/20/2016] [Indexed: 01/20/2023]
Abstract
STUDY OBJECTIVE To compare the feasibility and safety of the TELELAP ALF-X system and standard laparoscopy for total hysterectomy to treat patients with benign and early malignant gynecologic disease. DESIGN Single-institution retrospective case-control study (Canadian Task Force classification II-2). SETTING Catholic University of the Sacred Heart, Rome, Italy. PATIENTS Between October 2013 and May 2015, 203 women underwent TELELAP-ALF X (group 1) or standard laparoscopic (group 2) total hysterectomy and were enrolled. INTERVENTIONS Total standard laparoscopy vs TELELAP ALF-X robot-assisted hysterectomy for benign and early malignant gynecologic disease. MEASUREMENTS AND MAIN RESULTS In group 1, the median age was 55 years (range, 40-79 years), median body mass index (BMI) was 25 kg/m(2) (range, 17-38 kg/m(2)), and 51 patients (58%) had undergone previous abdominal surgery. In the control group, the median age was 55 years (range, 34-90 years), median BMI was 25 kg/m(2) (range, 17-41 kg/m(2)), and 31 patients (27%) had previous abdominal surgery. The median operative time was 147 minutes (range, 58-320 minutes) in group 1 and 80 minutes (range, 22-300 minutes) in group 2 (p = .055). The median estimated blood loss was 57 mL (range, 0-600 mL) in group 1 and 99 mL (range, 0-400 mL) in group 2, with no significant differences between the 2 groups (p = .963). Procedures were successfully performed without conversion in 94.3% of cases in the group 1 and in all cases in group 2. Early postoperative pain was significantly lower in group 2. CONCLUSION TELELAP ALF-X hysterectomy in patients with benign and early malignant gynecologic disease is feasible and safe, and can be considered a valid option for these patients.
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Affiliation(s)
- Francesco Fanfani
- Department of Medicine and Aging Sciences, G. D'Annunzio University of Chieti-Pescara, Chieti, Italy.
| | - Stefano Restaino
- Department of Obstetrics and Gynecology, University of Trieste, Trieste, Italy
| | - Cristiano Rossitto
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy
| | - Salvatore Gueli Alletti
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy
| | - Barbara Costantini
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy
| | - Giorgia Monterossi
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy
| | - Serena Cappuccio
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy
| | - Emanuele Perrone
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy
| | - Giovanni Scambia
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy
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Ferreira H, Ferreira C, Nogueira-Silva C, Tomé A, Guimarães S, Correia-Pinto J. Minilaparoscopic Versus Conventional Laparoscopic Sacrocolpopexy: A Comparative Study. J Laparoendosc Adv Surg Tech A 2016; 26:386-92. [DOI: 10.1089/lap.2015.0381] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Hélder Ferreira
- Department of Obstetrics and Gynecology, Centro Hospitalar do Porto, Porto, Portugal
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal
- ICVS/3B's - PT Government Associate Laboratory, Braga, Guimarães, Portugal
| | - Carlos Ferreira
- Department of Urology, Hospital Pedro Hispano, Matosinhos, Portugal
| | - Cristina Nogueira-Silva
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal
- ICVS/3B's - PT Government Associate Laboratory, Braga, Guimarães, Portugal
- Department of Obstetrics and Gynecology, Hospital de Braga, Braga, Portugal
| | - Antonio Tomé
- Department of Obstetrics and Gynecology, Centro Hospitalar do Porto, Porto, Portugal
| | - Serafim Guimarães
- Department of Obstetrics and Gynecology, Centro Hospitalar do Porto, Porto, Portugal
| | - Jorge Correia-Pinto
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal
- ICVS/3B's - PT Government Associate Laboratory, Braga, Guimarães, Portugal
- Department of Pediatric Surgery, Hospital de Braga, Braga, Portugal
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Telelap ALF-X vs Standard Laparoscopy for the Treatment of Early-Stage Endometrial Cancer: A Single-Institution Retrospective Cohort Study. J Minim Invasive Gynecol 2016; 23:378-83. [DOI: 10.1016/j.jmig.2015.11.006] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 11/06/2015] [Accepted: 11/10/2015] [Indexed: 12/21/2022]
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Firme WA, Carvalho GL, Lima DL, Lopes VGDP, Montandon ID, Santos Filho F, Shadduck PP. Low-Friction Minilaparoscopy Outperforms Regular 5-mm and 3-mm Instruments for Precise Tasks. JSLS 2016; 19. [PMID: 26390530 PMCID: PMC4558417 DOI: 10.4293/jsls.2015.00067] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background and Objectives: Therapeutic laparoscopy was incorporated into surgical practice more than 25 y ago. Several modifications have since been developed to further minimize surgical trauma and improve results. Minilaparoscopy, performed with 2- to 3-mm instruments was introduced in the mid 1990s but failed to attain mainstream use, mostly because of the limitations of the early devices. Buoyed by a renewed interest, new generations of mini instruments are being developed with improved functionality and durability. This study is an objective evaluation of a new set of mini instruments with a novel low-friction design. Method: Twenty-two medical students and 22 surgical residents served as study participants. Three designs of laparoscopic instruments were evaluated: conventional 5 mm, traditional 3 mm, and low-friction 3 mm. The instruments were evaluated with a standard surgical simulator, emulating 4 exercises of various complexities, testing grasping, precise 2-handed movements, and suturing. The metric measured was time to task completion, with 5 replicates for every combination of instrument–exercise–participant. Results: For all 4 tasks, the instrument design that performed the best was the same in both the medical student and surgical resident groups. For the gross-grasping task, the 5-mm conventional instruments performed best, followed by the low-friction mini instruments. For the 3 more complex and precise tasks, the low-friction mini instruments outperformed both of the other instrument designs. Conclusion: In standard surgical simulator exercises, low-friction minilaparoscopic instruments outperformed both conventional 3- and 5-mm laparoscopic instruments for precise tasks.
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Acton JN, Salfinger SG, Tan J, Cohen PA. Outcomes of Total Laparoscopic Hysterectomy Using a 5-mm Versus 10-mm Laparoscope: A Randomized Control Trial. J Minim Invasive Gynecol 2016; 23:101-6. [DOI: 10.1016/j.jmig.2015.09.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 08/02/2015] [Accepted: 09/01/2015] [Indexed: 11/25/2022]
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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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Fanfani F, Restaino S, Gueli Alletti S, Fagotti A, Monterossi G, Rossitto C, Costantini B, Scambia G. TELELAP ALF-X Robotic-assisted Laparoscopic Hysterectomy: Feasibility and Perioperative Outcomes. J Minim Invasive Gynecol 2015; 22:1011-7. [DOI: 10.1016/j.jmig.2015.05.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 04/26/2015] [Accepted: 05/06/2015] [Indexed: 10/23/2022]
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Aarts JWM, Nieboer TE, Johnson N, Tavender E, Garry R, Mol BWJ, Kluivers KB. Surgical approach to hysterectomy for benign gynaecological disease. Cochrane Database Syst Rev 2015; 2015:CD003677. [PMID: 26264829 PMCID: PMC6984437 DOI: 10.1002/14651858.cd003677.pub5] [Citation(s) in RCA: 261] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The four approaches to hysterectomy for benign disease are abdominal hysterectomy (AH), vaginal hysterectomy (VH), laparoscopic hysterectomy (LH) and robotic-assisted hysterectomy (RH). OBJECTIVES To assess the effectiveness and safety of different surgical approaches to hysterectomy for women with benign gynaecological conditions. SEARCH METHODS We searched the following databases (from inception to 14 August 2014) using the Ovid platform: Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE; EMBASE; Cumulative Index to Nursing and Allied Health Literature (CINAHL) and PsycINFO. We also searched relevant citation lists. We used both indexed and free-text terms. SELECTION CRITERIA We included randomised controlled trials (RCTs) in which clinical outcomes were compared between one surgical approach to hysterectomy and another. DATA COLLECTION AND ANALYSIS At least two review authors independently selected trials, assessed risk of bias and performed data extraction. Our primary outcomes were return to normal activities, satisfaction, quality of life, intraoperative visceral injury and major long-term complications (i.e. fistula, pelvi-abdominal pain, urinary dysfunction, bowel dysfunction, pelvic floor condition and sexual dysfunction). MAIN RESULTS We included 47 studies with 5102 women. The evidence for most comparisons was of low or moderate quality. The main limitations were poor reporting and imprecision. Vaginal hysterectomy (VH) versus abdominal hysterectomy (AH) (nine RCTs, 762 women)Return to normal activities was shorter in the VH group (mean difference (MD) -9.5 days, 95% confidence interval (CI) -12.6 to -6.4, three RCTs, 176 women, I(2) = 75%, moderate quality evidence). There was no evidence of a difference between the groups for the other primary outcomes. Laparoscopic hysterectomy (LH) versus AH (25 RCTs, 2983 women)Return to normal activities was shorter in the LH group (MD -13.6 days, 95% CI -15.4 to -11.8; six RCTs, 520 women, I(2) = 71%, low quality evidence), but there were more urinary tract injuries in the LH group (odds ratio (OR) 2.4, 95% CI 1.2 to 4.8, 13 RCTs, 2140 women, I(2) = 0%, low quality evidence). There was no evidence of a difference between the groups for the other primary outcomes. LH versus VH (16 RCTs, 1440 women)There was no evidence of a difference between the groups for any primary outcomes. Robotic-assisted hysterectomy (RH) versus LH (two RCTs, 152 women)There was no evidence of a difference between the groups for any primary outcomes. Neither of the studies reported satisfaction rates or quality of life.Overall, the number of adverse events was low in the included studies. AUTHORS' CONCLUSIONS Among women undergoing hysterectomy for benign disease, VH appears to be superior to LH and AH, as it is associated with faster return to normal activities. When technically feasible, VH should be performed in preference to AH because of more rapid recovery and fewer febrile episodes postoperatively. Where VH is not possible, LH has some advantages over AH (including more rapid recovery and fewer febrile episodes and wound or abdominal wall infections), but these are offset by a longer operating time. No advantages of LH over VH could be found; LH had a longer operation time, and total laparoscopic hysterectomy (TLH) had more urinary tract injuries. Of the three subcategories of LH, there are more RCT data for laparoscopic-assisted vaginal hysterectomy and LH than for TLH. Single-port laparoscopic hysterectomy and RH should either be abandoned or further evaluated since there is a lack of evidence of any benefit over conventional LH. Overall, the evidence in this review has to be interpreted with caution as adverse event rates were low, resulting in low power for these comparisons. The surgical approach to hysterectomy should be discussed and decided in the light of the relative benefits and hazards. These benefits and hazards seem to be dependent on surgical expertise and this may influence the decision. In conclusion, when VH is not feasible, LH may avoid the need for AH, but LH is associated with more urinary tract injuries. There is no evidence that RH is of benefit in this population. Preferably, the surgical approach to hysterectomy should be decided by the woman in discussion with her surgeon.
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Affiliation(s)
- Johanna WM Aarts
- Radboud University Nijmegen Medical CenterDepartment of Obstetrics and GynaecologyGeert Grooteplein 10NijmegenNetherlands6500HB
| | - Theodoor E Nieboer
- Radboud University Nijmegen Medical CenterDepartment of Obstetrics and GynaecologyGeert Grooteplein 10NijmegenNetherlands6500HB
| | - Neil Johnson
- University of AdelaideRobinson Research InstituteNorwich Centre Ground Floor, 55 King William RoadNorth AdelaideAdelaideSouth AustraliaAustralia5006
| | - Emma Tavender
- Monash UniversityAustralian Satellite of the Cochrane EPOC Group, Department of SurgeryLevel 6, 99 Commercial RoadMelbourneVictoriaAustraliaVIC 3004
| | - Ray Garry
- University of Teeside and South Cleveland Hospital, MiddlesbroughGynaecological Surgery94 WestgateGuisboroughYorkshireUKTS14 6AP
| | - Ben Willem J Mol
- The University of AdelaideThe Robinson Institute, School of Paediatrics and Reproductive HealthLevel 3, Medical School South BuildingFrome RoadAdelaideSouth AustraliaAustraliaSA 5005
| | - Kirsten B Kluivers
- Radboud University Nijmegen Medical CenterDepartment of Obstetrics and GynaecologyGeert Grooteplein 10NijmegenNetherlands6500HB
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Uccella S, Cromi A, Casarin J, Bogani G, Serati M, Gisone B, Pinelli C, Fasola M, Ghezzi F. Minilaparoscopic Versus Standard Laparoscopic Hysterectomy for Uteri ≥16 Weeks of Gestation: Surgical Outcomes, Postoperative Quality of Life, and Cosmesis. J Laparoendosc Adv Surg Tech A 2015; 25:386-91. [PMID: 25839384 DOI: 10.1089/lap.2014.0478] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- Stefano Uccella
- Department of Obstetrics and Gynecology, University of Insubria, Del Ponte Hospital, Varese, Italy
| | - Antonella Cromi
- Department of Obstetrics and Gynecology, University of Insubria, Del Ponte Hospital, Varese, Italy
| | - Jvan Casarin
- Department of Obstetrics and Gynecology, University of Insubria, Del Ponte Hospital, Varese, Italy
| | - Giorgio Bogani
- Department of Obstetrics and Gynecology, University of Insubria, Del Ponte Hospital, Varese, Italy
| | - Maurizio Serati
- Department of Obstetrics and Gynecology, University of Insubria, Del Ponte Hospital, Varese, Italy
| | - Baldo Gisone
- Department of Obstetrics and Gynecology, University of Insubria, Del Ponte Hospital, Varese, Italy
| | - Ciro Pinelli
- Department of Obstetrics and Gynecology, University of Insubria, Del Ponte Hospital, Varese, Italy
| | - Maddalena Fasola
- Department of Obstetrics and Gynecology, University of Insubria, Del Ponte Hospital, Varese, Italy
| | - Fabio Ghezzi
- Department of Obstetrics and Gynecology, University of Insubria, Del Ponte Hospital, Varese, Italy
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Fanfani F, Monterossi G, Fagotti A, Rossitto C, Gueli Alletti S, Costantini B, Gallotta V, Selvaggi L, Restaino S, Scambia G. The new robotic TELELAP ALF-X in gynecological surgery: single-center experience. Surg Endosc 2015; 30:215-21. [PMID: 25840895 DOI: 10.1007/s00464-015-4187-9] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 03/24/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND To evaluate the safety and feasibility of the new robotic TELELAP ALF-X platform in a heterogeneous series of gynecological procedures. METHODS Between September 2013 and May 2014, 146 patients were enrolled in this Phase II study trial. Patients with presumed benign or borderline adnexal disease, and benign and early stage malignant uterine disease were prospectively included. RESULTS Median age was 52 years (range 19-79 years), and median BMI was 23.7 (range 17.3-34.0 kg/m(2)). Sixty-two patients (32.5%) underwent mono/bilateral salpingo-oophorectomy or cyst removal (Group A), four patients (2.7%) myomectomy (Group B), 46 patients (31.5%) total hysterectomy (Group C), and 34 (23.3%) endometrial cancer staging (Group D). Median docking time was 7 min (range 3-36). Median OT was 35 min (range 17-145) in the Group A, 40 min (range 10-50) in the Group B, 133 min (range 58-320) in the Group C, and 160 min (range 69-290) in the Group D. Reduction in OT over the study period for hysterectomy (p < 0.001) and adnexal surgery (p < 0.002) was observed. We registered two laparoscopic conversion (3.2%) in the Group A and two (4.3 %) in the Group C. In the Group D, we showed one (2.9%) laparoscopic and two (5.8%) laparotomic conversions. One patient (2.17%) in the Group C was readmitted in the early postoperative period for severe vaginal bleeding. CONCLUSIONS We report the first series of a novel robotic approach for the treatment of various gynecological conditions. When performed by experienced minimally invasive surgeons, TELELAP ALF-X is feasible and safe. Further studies are mandatory to define the benefits, advantages, and costs of this new robotic approach with respect to others minimally invasive approaches.
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Affiliation(s)
- Francesco Fanfani
- Division of Gynecologic Oncology, Department of Women and Child Health, Catholic University of the Sacred Heart, Rome, Italy.
| | - Giorgia Monterossi
- Division of Gynecologic Oncology, Department of Women and Child Health, Catholic University of the Sacred Heart, Rome, Italy
| | - Anna Fagotti
- Minimally Invasive Gynecology, St. Maria Hospital, University of Perugia, Terni, Italy
| | - Cristiano Rossitto
- Division of Gynecologic Oncology, Department of Women and Child Health, Catholic University of the Sacred Heart, Rome, Italy
| | - Salvatore Gueli Alletti
- Division of Gynecologic Oncology, Department of Women and Child Health, Catholic University of the Sacred Heart, Rome, Italy
| | - Barbara Costantini
- Division of Gynecologic Oncology, Department of Women and Child Health, Catholic University of the Sacred Heart, Rome, Italy
| | - Valerio Gallotta
- Division of Gynecologic Oncology, Department of Women and Child Health, Catholic University of the Sacred Heart, Rome, Italy
| | - Luigi Selvaggi
- Division of Gynecologic Oncology, Department of Women and Child Health, Catholic University of the Sacred Heart, Rome, Italy
| | - Stefano Restaino
- Division of Gynecologic Oncology, Department of Women and Child Health, Catholic University of the Sacred Heart, Rome, Italy
| | - Giovanni Scambia
- Division of Gynecologic Oncology, Department of Women and Child Health, Catholic University of the Sacred Heart, Rome, Italy
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Fanfani F, Boruta DM, Fader AN, Vizza E, Growdon WB, Kushnir CL, Corrado G, Scambia G, Turco LC, Fagotti A. Feasibility and Surgical Outcome in Obese Versus Nonobese Patients Undergoing Laparoendoscopic Single-site Hysterectomy: A Multicenter Case-control Study. J Minim Invasive Gynecol 2015; 22:456-61. [DOI: 10.1016/j.jmig.2014.12.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2014] [Revised: 12/04/2014] [Accepted: 12/07/2014] [Indexed: 11/28/2022]
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Acton J, Salfinger S. Effect of Umbilical Port and Endoscope Size on Discharge Times and Postoperative Recovery After Total Laparoscopic Hysterectomy: A Retrospective Review. J Gynecol Surg 2014. [DOI: 10.1089/gyn.2013.0098] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jade Acton
- Department of Obstetrics and Gynaecology, King Edward Memorial Hospital, Subiaco, Perth, Western Australia, Australia
- Department of Gynaecologic Oncology, St. John of God Hospital, Subiaco, Perth, Western Australia, Australia
| | - Stuart Salfinger
- Department of Obstetrics and Gynaecology, King Edward Memorial Hospital, Subiaco, Perth, Western Australia, Australia
- Department of Gynaecologic Oncology, St. John of God Hospital, Subiaco, Perth, Western Australia, Australia
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David G, Boni L, Rausei S, Cassinotti E, Dionigi G, Rovera F, Spampatti S, Colombo EM, Dionigi R. Use of 3 mm percutaneous instruments with 5 mm end effectors during different laparoscopic procedures. Int J Surg 2014; 11 Suppl 1:S61-3. [PMID: 24380556 DOI: 10.1016/s1743-9191(13)60019-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND PURPOSE With a recent focus on minimizing the visibility of scars, new techniques have been developed. Minilaparoscopy reemerged as an attractive option for surgery as it limits tissue trauma, reduces post-operative pain and improves cosmesis. This study was designed to describe our experience with percutaneous trocarless 3 mm instruments used in combination with standard 5 mm and 10 mm laparoscopic instruments in different general surgery procedures. METHODS We used the PSS (Percutaneous Surgical Set, Ethicon Endo surgery, Cincinnati, OH, USA) in different surgical procedures as accessory instruments in combination with standard 5 mm and 10 mm standard laparoscopic instruments. MAIN FINDINGS The use of percutaneous instruments was safe and feasible in all performed procedures. The surgical technique was not modified. The percutaneous instruments can assure a good grip and can be used for traction and counter-traction. No complications have been described. No pain at the site of insertion has been reported. The skin, muscle and peritoneal defects were smaller than with the 3 mm laparoscopic traditional instruments. CONCLUSIONS Percutaneous approach seems to be a good option in general surgery in terms of efficiency, offering better cosmetic results and good pain control.
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Affiliation(s)
- Giulia David
- Department of Surgical and Morphological Sciences Insubria, University of Insubria Varese, 1st Division of Surgery Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Luigi Boni
- Department of Surgical and Morphological Sciences Insubria, University of Insubria Varese, 1st Division of Surgery Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Stefano Rausei
- Department of Surgical and Morphological Sciences Insubria, University of Insubria Varese, 1st Division of Surgery Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Elisa Cassinotti
- Department of Surgical and Morphological Sciences Insubria, University of Insubria Varese, 1st Division of Surgery Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Gianlorenzo Dionigi
- Department of Surgical and Morphological Sciences Insubria, University of Insubria Varese, 1st Division of Surgery Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Francesca Rovera
- Department of Surgical and Morphological Sciences Insubria, University of Insubria Varese, 1st Division of Surgery Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Sebastiano Spampatti
- Department of Surgical and Morphological Sciences Insubria, University of Insubria Varese, 1st Division of Surgery Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Elisabetta Marta Colombo
- Department of Surgical and Morphological Sciences Insubria, University of Insubria Varese, 1st Division of Surgery Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Renzo Dionigi
- Department of Surgical and Morphological Sciences Insubria, University of Insubria Varese, 1st Division of Surgery Ospedale di Circolo e Fondazione Macchi, Varese, Italy
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Porpiglia F, Autorino R, Cicione A, Pagliarulo V, Falsaperla M, Volpe A, Gozen AS, Celia A, De Sio M, Saita A, Damiano R, Zacchero M, Fiori C, Terrone C, Bertolo R, Greco F, Breda A, Lima E, Rassweiler J. Contemporary urologic minilaparoscopy: indications, techniques, and surgical outcomes in a multi-institutional European cohort. J Endourol 2014; 28:951-7. [PMID: 24708491 DOI: 10.1089/end.2014.0134] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To provide an analytical overview of contemporary indications, techniques, and outcomes of urologic minilaparoscopy (ML) in multiple European centers. METHODS Data of patients who had undergone a minilaparoscopic urologic procedure at nine European institutions between 2009 and 2012 were retrospectively gathered. Surgical procedures were classified as upper or lower urinary tract and as ablative or extirpative and reconstructive. The main surgical outcome parameters were analyzed and relevant operative data related to the surgical technique were recorded. RESULTS Overall, 192 patients (mean age 45.25±17.8 years) were included in the analysis. Most of them were nonobese (mean body mass index [BMI] 24.7±3.6 kg/m(2)) at low estimated surgical risk (mean American Society of Anesthesiologists [ASA] 1.69±0.68). Indications for surgery were mostly nononcologic (132 cases, 68.8%). Most of the procedures were done in the upper urinary tract (133 cases, 69.2%) and were mostly with a reconstructive intent (109 cases, 56.7%). Overall operative time was 132.7±52.3 minutes with an estimated blood loss of 60.9±47.6 mL while the mean hospital stay was 5±2.1 days. Most of the postoperative complications were low Clavien grade (1 and 2), with only one (0.5%) grade 3 and one (0.5%) grade 4 complications recorded. CONCLUSIONS A broad range of common procedures can be safely and effectively performed with ML techniques. By duplicating the principles of standard laparoscopy, but potentially offering less surgical scar and trauma, ML can be regarded as a viable option when looking for a virtually "scarless" surgery.
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Ng YW, Lim LM, Fong YF. Minilaparoscopic hysterectomy made easy: First report on alternative instrumentation and new integrated energy platform. J Obstet Gynaecol Res 2014; 40:1436-40. [DOI: 10.1111/jog.12354] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Accepted: 11/11/2013] [Indexed: 11/26/2022]
Affiliation(s)
- Ying Woo Ng
- Department of Obstetrics and Gynaecology; National University Hospital; Singapore
| | - Li Min Lim
- Department of Obstetrics and Gynaecology; National University Hospital; Singapore
| | - Yoke Fai Fong
- Department of Obstetrics and Gynaecology; National University Hospital; Singapore
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Bogani G, Cromi A, Casarin J, Ghezzi F. Low pneumoperitoneum pressure reduces pain after mini-laparoscopic hysterectomy: results from two independent randomized controlled trails. J Minim Invasive Gynecol 2014; 21:967-8. [PMID: 24582627 DOI: 10.1016/j.jmig.2014.02.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 02/21/2014] [Indexed: 10/25/2022]
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Bogani G, Uccella S, Cromi A, Serati M, Casarin J, Pinelli C, Ghezzi F. Low vs standard pneumoperitoneum pressure during laparoscopic hysterectomy: prospective randomized trial. J Minim Invasive Gynecol 2013; 21:466-71. [PMID: 24374246 DOI: 10.1016/j.jmig.2013.12.091] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Revised: 12/11/2013] [Accepted: 12/13/2013] [Indexed: 11/26/2022]
Abstract
STUDY OBJECTIVE To compare the use of low pneumoperitoneum pressure (LPP; 8 mm Hg) vs standard pneumoperitoneum pressure (SPP; 12 mm Hg) during mini-laparoscopic hysterectomy (MLH). DESIGN Randomized controlled trial (Canadian Task Force classification I). SETTING Tertiary care center. PATIENTS Forty-two consecutive women scheduled to undergo MLH to treat benign uterine disease. INTERVENTIONS Women were randomly selected to undergo MLH using LPP (n = 20) or SPP (n = 22). MLH was performed via 3-mm ancillary ports. MEASUREMENTS AND MAIN RESULTS The primary outcome was to evaluate changes in abdominal and shoulder-tip pain via a 100-mm visual analog scale at 1, 3, and 24 hours postoperatively. All procedures were completed via mini-laparoscopy without the need to increase intra-abdominal pressure or convert to conventional laparoscopy or open surgery. Intraoperatively, 1 episode of severe bradycardia occurred in the LPP group, whereas no intraoperative complications were recorded in the SPP group (p = .47). No postoperative complications were recorded (p > .99). Abdominal pain was similar between groups at each time point. Incidence and intensity of shoulder-tip pain at 1 and 3 hours postoperatively was lower in the LPP group than in the SPP group (p < .05), whereas no between-group differences were observed at 24 hours (p > .05). Rescue analgesic requirement did not differ statistically between the LPP and SPP groups (20% vs 41%, respectively; p = .19; odds ratio, 2.7; 95% confidence interval, 0.69-11.08). CONCLUSION In experienced hands, use of LPP is safe and feasible. During performance of MLH, compared with SPP, LPP is a simple method that offers advantages of less shoulder-tip pain.
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Affiliation(s)
- Giorgio Bogani
- Department of Obstetrics and Gynaecology, University of Insubria, Del Ponte Hospital, Varese, Italy.
| | - Stefano Uccella
- Department of Obstetrics and Gynaecology, University of Insubria, Del Ponte Hospital, Varese, Italy
| | - Antonella Cromi
- Department of Obstetrics and Gynaecology, University of Insubria, Del Ponte Hospital, Varese, Italy
| | - Maurizio Serati
- Department of Obstetrics and Gynaecology, University of Insubria, Del Ponte Hospital, Varese, Italy
| | - Jvan Casarin
- Department of Obstetrics and Gynaecology, University of Insubria, Del Ponte Hospital, Varese, Italy
| | - Ciro Pinelli
- Department of Obstetrics and Gynaecology, University of Insubria, Del Ponte Hospital, Varese, Italy
| | - Fabio Ghezzi
- Department of Obstetrics and Gynaecology, University of Insubria, Del Ponte Hospital, Varese, Italy
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Ghezzi F, Cromi A, Uccella S, Bogani G, Sturla D, Serati M, Bolis P. Nerve-sparing minilaparoscopic versus conventional laparoscopic radical hysterectomy plus systematic pelvic lymphadenectomy in cervical cancer patients. Surg Innov 2013; 20:493-501. [PMID: 23339145 DOI: 10.1177/1553350612472986] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
AIM To present our preliminary experience with nerve-sparing minilaparoscopic radical hysterectomy plus pelvic lymphadenectomy for the surgical treatment of cervical cancer and to compare outcomes with those of the conventional laparoscopic approach. METHODS Data of 87 consecutive women who underwent minimally invasive surgery for early and locally advanced stage cervical cancer were prospectively collected. Ten women who underwent laparoscopic surgery using a nerve-sparing technique performed through 3-mm ancillary ports were compared with the 77 patients who had standard laparoscopic surgery previously with 3 sovrapubic 5-mm trocars. RESULTS Minilaparoscopic radical hysterectomy was successfully accomplished in every case with no conversion to standard laparoscopy or open surgery. Two (2.6%) conversions to open surgery occurred in the conventional laparoscopy group. Surgical characteristics (operative time, estimated blood loss, and length of stay) and complication rate were similar between the 2 groups. No differences in the amount of parametrial and vaginal tissue removed were observed. The number of lymph nodes retrieved through minilaparoscopy was higher than conventional laparoscopy (30 [range = 26-38] vs 22 [range = 8-49]; P = .002). However, no difference was observed when the analysis was restricted to the last 10 conventional procedures (30 [range = 26-38] vs 29 [range = 24-49]; P = .81). CONCLUSIONS Our data show that minilaparoscopic radical hysterectomy with pelvic lymphadenectomy is a feasible procedure if performed by skilled surgeons.
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Affiliation(s)
- Fabio Ghezzi
- 1University of Insubria, Del Ponte Hospital, Varese, Italy
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Minilaparoscopic radical hysterectomy for cervical cancer: Multi-institutional experience in comparison with conventional laparoscopy. Eur J Surg Oncol 2013; 39:1094-100. [DOI: 10.1016/j.ejso.2013.07.096] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Revised: 07/11/2013] [Accepted: 07/25/2013] [Indexed: 12/16/2022] Open
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Nomura H, Okuda K, Saito N, Fujiyama F, Nakamura Y, Yamashita Y, Terai Y, Ohmichi M. Mini-laparoscopic surgery versus conventional laparoscopic surgery for patients with endometriosis. Gynecol Minim Invasive Ther 2013. [DOI: 10.1016/j.gmit.2013.05.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Ichikawa M, Ono S, Mine K, Akira S. Changing our view of minimally invasive gynecologic surgery: a review of laparoendoscopic single-site surgery and a report on new approaches. Asian J Endosc Surg 2013; 6:151-7. [PMID: 23741981 DOI: 10.1111/ases.12041] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2012] [Revised: 03/07/2013] [Accepted: 04/07/2013] [Indexed: 01/18/2023]
Abstract
The recent emergence of laparoendoscopic single-site surgery (LESS) has had a great impact on gynecology. As LESS grows in popularity, attention has been paid to the procedure's cosmetic benefits. Although in theory LESS is an ideal approach that leaves no visible scars and improves patients' quality of life, the outcomes are not always ideal according to recently published data. Therefore, alternative approaches, such as mini-laparoscopy, are also becoming more popular. Herein, we review randomized trials studying the benefits of LESS in gynecology and discuss alternative approaches. Finally, we propose the mimic approach as the next generation for non-visible scar surgery.
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Affiliation(s)
- Masao Ichikawa
- Department of Obstetrics and Gynecology, Nippon Medical School, Tokyo, Japan.
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Fanfani F, Gallotta V, Fagotti A, Rossitto C, Piovano E, Scambia G. Total microlaparoscopic radical hysterectomy in early cervical cancer. JSLS 2013; 17:111-5. [PMID: 23743381 PMCID: PMC3662727 DOI: 10.4293/108680812x13517013318319] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
This report suggests that microlaparoscopy has a role in the management of early cervical cancer with results comparable with standard laparoscopy. Background and Objective: In less than 2 decades, laparoscopy has contributed to modification in the management of early cervical cancer patients, and all comparisons between open and laparoscopic-based radical operations showed an identical oncological outcome. The aim of this study is to describe surgical instrumentations and technique to perform total microlaparoscopy radical hysterectomy in early cervical cancer patients and report our preliminary results in terms of operative time and perioperative outcomes. Methods: Between January 1, 2012, and March 25, 2012, 4 consecutive early cervical cancer patients were enrolled in this study. Results: We performed 3 type B2 and 1 type C1-B2 total microlaparoscopy radical hysterectomy, and in all cases concomitant bilateral salpingo-oophorectomy and pelvic lymphadenectomy were carried out. Median operative time was 165 minutes (range: 155 to 215) (mean: 186), and median estimated blood loss was 30 mL (range: 20 to 50). Median number of pelvic lymph nodes removed was 12 (range: 11 to 15). All procedures were completed without 5-mm port insertion and without conversion. No intraoperative or early postoperative complications were reported. Conclusions: This report suggests a role of microlaparoscopy in the surgical management of early cervical cancer with adequate oncological results, superimposable operative time, and perioperative outcomes with respect to standard laparoscopy.
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Affiliation(s)
- Francesco Fanfani
- Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy.
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Taş B, Donatsky AM, Gögenur I. Techniques to reduce shoulder pain after laparoscopic surgery for benign gynaecological disease: a systematic review. ACTA ACUST UNITED AC 2013. [DOI: 10.1007/s10397-013-0791-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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49
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Fanfani F, Fagotti A, Gagliardi ML, Monterossi G, Rossitto C, Costantini B, Gueli Alletti S, Vizzielli G, Ercoli A, Scambia G. Minilaparoscopic Versus Single-Port Total Hysterectomy: A Randomized Trial. J Minim Invasive Gynecol 2013; 20:192-7. [DOI: 10.1016/j.jmig.2012.11.007] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Revised: 11/19/2012] [Accepted: 11/21/2012] [Indexed: 11/15/2022]
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Fanfani F, Fagotti A, Rossitto C, Gagliardi ML, Ercoli A, Gallotta V, Gueli Alletti S, Monterossi G, Turco LC, Scambia G. Laparoscopic, minilaparoscopic and single-port hysterectomy: perioperative outcomes. Surg Endosc 2012; 26:3592-6. [PMID: 22678177 DOI: 10.1007/s00464-012-2377-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2012] [Accepted: 05/03/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE This study was designed to compare perioperative outcomes and postoperative pain of standard laparoscopic (S-LPS), minilaparoscopic (M-LPS), and laparoendoscopic single-site (LESS) hysterectomy. METHODS A single-institutional, matched, retrospective, cohort study was performed. Between May 2010 and March 2011, 85 consecutive women were submitted to a total laparoscopic hysterectomy by S-LPS, M-LPS, and single-port LESS. Perioperative outcomes of these three techniques were analyzed and compared. RESULTS Demographics and baseline characteristics of each group were absolutely comparable. The median operative time was longer [105 (range, 75-125) min] in the LESS group compared with the M-LPS group [90 (range, 60-120) min; p < 0.011] and S-LPS [80 (range, 50-110) min; p < 0.001]. No statistically significant differences have been reported for estimated blood loss or intra- and early postoperative complications. Postoperative pain control was better for LESS and M-LPS than S-LPS. CONCLUSIONS M-LPS and LESS hysterectomy can be performed safely, and both seem to be associated with a halving of early postoperative pain with a lower request of analgesics.
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Affiliation(s)
- Francesco Fanfani
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, L.go A. Gemelli 8, 00168, Rome, Italy.
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