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Siebert T, Moersdorf G, Colberg T. Laparoscopic application of sodium hyaluronate-carboxymethylcellulose barrier in abdominopelvic surgery: A Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Systematic Review Protocols-compliant systematic review and meta-analysis. Surgery 2024; 175:1358-1367. [PMID: 38429164 DOI: 10.1016/j.surg.2024.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 01/03/2024] [Accepted: 01/12/2024] [Indexed: 03/03/2024]
Abstract
BACKGROUND We aimed to evaluate the incidence of postoperative adhesion formation and adhesion-related consequences (eg, bowel obstruction) after placement of a sodium hyaluronate-carboxymethylcellulose adhesion barrier after laparoscopic abdominopelvic surgery. METHODS In this systematic review and meta-analysis, we searched the Medical Literature Analysis and Retrieval System Online and Embase via Ovid, Cochrane Central Register of Controlled Trials, ScienceDirect, BIOSIS Previews, Cumulative Index to Nursing and Allied Health Literature, and Clinical Trial Registries. A manual search (eg, Google Scholar and professional association websites) was also conducted to supplement the electronic database results. Two reviewers independently identified relevant studies based on inclusion and exclusion criteria and extracted data. RESULTS A total of 28 studies were included in the systematic qualitative review. Three of the 28 studies included had comparable outcome measures, interventions, and control groups, allowing the pooling of study data. A total of 938 patients (490 patients in the sodium hyaluronate-carboxymethylcellulose barrier group and 448 in the no adhesion barrier group) from these 3 studies were included in the meta-analyses, which found the incidence of bowel obstruction was significantly lower (65% risk reduction) in the sodium hyaluronate-carboxymethylcellulose barrier group compared with the control group (relative risk = 0.35; 95% confidence interval, 0.19-0.63; P = .005) with extremely low heterogeneity between studies (I2 = 0; P = .41). The placement of sodium hyaluronate-carboxymethylcellulose barrier laparoscopically did not create new safety signals nor did it increase the incidence of adverse events. CONCLUSION Our meta-analysis found that laparoscopic application of a sodium hyaluronate-carboxymethylcellulose barrier in abdominopelvic surgery reduces the risk of bowel obstruction where applied during the early postoperative phase.
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Affiliation(s)
- Terri Siebert
- Medical Affairs, Baxter Healthcare Corporation, Deerfield, IL.
| | | | - Torben Colberg
- Medical Affairs, Baxter Healthcare Corporation, Deerfield, IL
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Chikazawa K, Imai K, Misawa M, Kuwata T. A novel technique for applying interceed ® in laparoscopic surgery: The triangle I-CEED method. Gynecol Minim Invasive Ther 2022; 11:188-189. [PMID: 36158289 PMCID: PMC9491060 DOI: 10.4103/gmit.gmit_86_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 10/05/2021] [Accepted: 12/23/2021] [Indexed: 11/04/2022] Open
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Sano R, Ota Y, Tanaka T, Suzuki S, Shimoya K, Shiota M. A New Technique for Seprafilm ® That Can Be Practiced with a 5-mm Trocar. Gynecol Minim Invasive Ther 2021; 10:168-170. [PMID: 34485062 PMCID: PMC8384026 DOI: 10.4103/gmit.gmit_36_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 10/16/2020] [Accepted: 10/22/2020] [Indexed: 12/21/2022] Open
Abstract
Seprafilm® is an adhesion barrier sheet. However, it is difficult to handle it through a 5-mm trocar. We have devised a method of applying Seprafilm® safely and reliably through a 5-mm trocar by using a holder that comes with the film. We practiced this method in three cases of total laparoscopic hysterectomy for uterine leiomyoma. The quarter-pack is cut into three pieces. The film placed on the holder sheet was rolled up with forceps (or wrapped around forceps) and inserted into a 5 mm trocar. After application, the center of the short axis of the holder was pinched with a grasping forceps, and the holder was drawn out of the body through the trocar. Of the 36 pieces placed, Seprafilm® broke only in once. Insertion was successful in 100%, and the holder was successfully retrieved through the trocar in 92% (33/36) of the cases. The holder may be easily retrieved after application. This technique represents an extremely simple versatile application method in operations in which only 5-mm trocars can be used.
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Affiliation(s)
- Rikiya Sano
- Department of Gynecologic Oncology, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - Yoshiaki Ota
- Department of Gynecologic Oncology, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - Tamaki Tanaka
- Department of Obstetrics and Gynecology, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - Soichiro Suzuki
- Department of Gynecologic Oncology, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - Koichiro Shimoya
- Department of Obstetrics and Gynecology, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - Mitsuru Shiota
- Department of Gynecologic Oncology, Kawasaki Medical School, Kurashiki, Okayama, Japan
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Hsu CS, Ding DC. Feasibility of Wet and Non-Wet Placement of Seprafilm in Laparoscopic Surgeries: A Randomized Controlled Trial. J Clin Med 2021; 10:jcm10163526. [PMID: 34441822 PMCID: PMC8396985 DOI: 10.3390/jcm10163526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 07/30/2021] [Accepted: 08/09/2021] [Indexed: 11/20/2022] Open
Abstract
Seprafilm becomes brittle and sticky after contact with water, rendering it difficult to use in laparoscopic surgery. Hence, Seprafilm is not used frequently in laparoscopic surgery. This prospective randomized controlled trial aimed to compare the feasibility of two methods of application of Seprafilm: wet and non-wet. Two groups comprised 30 patients, each with 180 pieces of Seprafilm. Symptomatic patients who underwent laparoscopic surgeries, including hysterectomy and adnexal surgeries, were recruited. Successful application of Seprafilm was defined as a smooth attachment to the site of application. Sticky and fractured Seprafilm sheets were defined as failed applications. Between March 2016 and December 2017, 60 patients underwent laparoscopic Seprafilm placement. The preparation time was 32.67 ± 16.63 and 79.50 ± 22.01 s in the non-wet and wet groups, respectively (p < 0.00). The success rate of application was 95.4% in the non-wet group and 98.3% in the wet group (p = 0.09). Placement time was 599.50 ± 90.18 s and 592.53 ± 105.82 s in the non-wet and wet groups, respectively (p = 0.25). In conclusion, the wet and non-wet application methods of Seprafilm were feasible in laparoscopic surgeries. The preparation time was different between the two groups. However, the rate of successful application and placement time was not different between the two groups.
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Affiliation(s)
- Chun-Shuo Hsu
- Department of Obstetrics and Gynecology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Tzu Chi University, Chiayi 622, Taiwan;
| | - Dah-Ching Ding
- Department of Obstetrics and Gynecology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Tzu Chi University, Hualien 970, Taiwan
- Institute of Medical Sciences, School of Medicine, Tzu Chi University, Hualien 970, Taiwan
- Correspondence: ; Tel.: +886-3-8577161
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Nakashima M, Takeuchi M, Kawakami K. Effectiveness of barrier agents for preventing postoperative bowel obstruction after laparoscopic surgery: a retrospective cohort study. Surg Today 2021; 51:1335-1342. [PMID: 33646411 DOI: 10.1007/s00595-021-02258-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 12/18/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE The effectiveness of using anti-adhesion agents in laparoscopic surgery is controversial. We compared the outcomes of patients exposed to anti-adhesion agents (barrier group) with those of patients not exposed (no barrier group) in laparoscopic surgery. METHODS Using a nationwide claim-based database in Japan, we analyzed data from patients who underwent laparoscopic surgery between 2005 and 2019 and compared the patient characteristics and the proportion of those with bowel obstruction between the barrier and no barrier groups. We also performed several sensitivity and subgroup analyses. RESULTS Of the 57,499 patients who met the inclusion criteria, 14,360 and 43,139 were assigned to the barrier and no barrier groups, respectively. The proportion of patients with a bowel obstruction in the two groups did not differ among all patients hospitalized for obstruction (1.1 vs. 1.1%, p = 0.63) and those requiring surgery (0.2 vs. 0.2%, p = 0.39). In the sensitivity analysis with propensity score matching, the incidences of bowel obstruction between the barrier and non-barrier groups were equivocal (1.3 vs. 1.6%), but statistically marginal (chi-square test, p = 0.035; log-rank test, p = 0.09). CONCLUSION The use of barrier agents for adhesive prevention did not show clear effectiveness for the prevention of bowel obstruction after laparoscopic surgery for unselected cases. Further studies focusing on more specific procedures are needed.
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Affiliation(s)
- Masayuki Nakashima
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshida Konoecho, Sakyoku, Kyoto, 606-8501, Japan
| | - Masato Takeuchi
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshida Konoecho, Sakyoku, Kyoto, 606-8501, Japan
| | - Koji Kawakami
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshida Konoecho, Sakyoku, Kyoto, 606-8501, Japan.
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Shimizu A, Kai M, Tasaki M, Chino N, Hasegawa K, Kokudo N. Evaluation of adhesion barrier types in a rat hepatectomy-induced adhesion model. BMC Surg 2020; 20:252. [PMID: 33109146 PMCID: PMC7590730 DOI: 10.1186/s12893-020-00877-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 09/23/2020] [Indexed: 12/21/2022] Open
Abstract
Background Adhesion formation after hepatectomy creates problems for repeat hepatectomy. This study aimed to compare the effectiveness of a spray (AdSpray) and sheet adhesion barrier (Seprafilm) in a rat hepatectomy-induced adhesion model. Methods Thirty male Sprague-Dawley rats underwent partial resection of the left lateral liver lobe. They were randomly assigned to control (n = 10), AdSpray (n = 10), and Seprafilm groups. Seven days after surgery, the animals were sacrificed, and adhesions at the hepatic resection surface were blindly evaluated. Results In the control group, adhesions were formed in all 10 animals (100%), with a 69% adhesion extent (mean). In the AdSpray group, the incidence of adhesions (40%) and the adhesion extent (mean, 10%) were significantly lower than in the control group (incidence; p = 0.0147, adhesion extent; p = 0.0007). In the Seprafilm group, the incidence of adhesions was 70%. The adhesion extent of Seprafilm (mean, 30%) was significantly lower than in the control group (p = 0.0492). No significant differences were observed between the AdSpray and Seprafilm groups. As for histopathological examination, animals in the AdSpray group showed a similar healing profile to that of the control group without delayed healing and regeneration of mesothelial cells. In contrast, the Seprafilm group showed ongoing foreign body reaction to Seprafilm, and regeneration of mesothelial cells was immature at 7 days. Conclusions Both the spray-type gel and sheet adhesion barriers significantly reduced adhesion formation after hepatectomy. The spray-type adhesion barrier caused no adverse events and induced favorable healing. These adhesion barriers may be effective in hepatectomy. Further animal studies and clinical trials are required to determine their benefits in clinical use.
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Affiliation(s)
- Atsushi Shimizu
- Hepatobiliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Miho Kai
- Terumo Corporation, R&D Center, 1500 Inokuchi, Nakai-machi, Ashigarakami-gun, Kanagawa, 259-0151, Japan.
| | - Masako Tasaki
- Terumo Corporation, R&D Center, 1500 Inokuchi, Nakai-machi, Ashigarakami-gun, Kanagawa, 259-0151, Japan
| | - Naotaka Chino
- Terumo Corporation, R&D Center, 1500 Inokuchi, Nakai-machi, Ashigarakami-gun, Kanagawa, 259-0151, Japan
| | - Kiyoshi Hasegawa
- Hepatobiliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Norihiro Kokudo
- National Center for Global Health and Medicine, Tokyo, Japan
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Learning curve analysis of applying Seprafilm hyaluronic acid/carboxymethylcellulose membrane during laparoscopic hysterectomy. Sci Rep 2020; 10:16592. [PMID: 33024214 PMCID: PMC7538582 DOI: 10.1038/s41598-020-73692-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 09/20/2020] [Indexed: 01/22/2023] Open
Abstract
This study was designed to evaluate the learning curve of applying Seprafilm (modified hyaluronic acid and carboxymethylcellulose; Genzyme, Cambridge, MA, USA) during laparoscopic hysterectomy or subtotal hysterectomy with or without adnexectomy. In this retrospective cohort study, 35 patients who underwent laparoscopic hysterectomy or subtotal hysterectomy with or without adnexectomy were enrolled. The Seprafilm was cut into 4 pieces, rolled up with a trimmed plastic sleeve and delivered through an incision wound made for the 5-mm ancillary trocar. The membrane was unrolled and placed on the rough surface after hysterectomy or subtotal hysterectomy with or without adnexectomy. The time from the insertion of the first piece of membrane into the abdominal cavity to the complete removal of the trimmed plastic sleeve was recorded. The median time for Seprafilm placement was 3 min. The learning curve was analyzed using the power-law method and suggested that 10 cases were required to achieve proficiency in the procedure. The presence of adnexectomy was significantly associated with the time required for Seprafilm placement (P < 0.001). Although Seprafilm placement is more complicated compared to the liquid and gel forms of anti-adhesion barriers, surgical proficiency seemed to be attained after 10 cases for an experienced surgeon.
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Weng CH, Chao AS, Huang HY, Huang YT, Wu KY, Su YY, Yang LY, Chao A, Wang CJ. A Simple Technique for the Placement of Seprafilm, a Sodium Hyaluronate or Carboxymethylcellulose Absorbable Barrier, during Laparoscopic Myomectomy. J Minim Invasive Gynecol 2019; 27:1203-1208. [PMID: 31877383 DOI: 10.1016/j.jmig.2019.12.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 12/02/2019] [Accepted: 12/04/2019] [Indexed: 12/23/2022]
Abstract
This report describes a simple technique using conventional instrumentation for the placement of Seprafilm, a sodium hyaluronate or carboxymethylcellulose absorbable barrier for adhesion prevention. A total of 378 women with uterine myomas undergoing laparoscopic myomectomies had 737 Seprafilm pieces placed. Seprafilm sheet was softened through exposure to room air for 5 minutes, cut into 4 pieces (length, 5-10 mm), rolled up alongside a plastic sheet cut from a camera drape cover, and gently placed at the right paracolic gutter. The Seprafilm pieces unfolded semiautomatically on release and were then placed on the uterus. The median time to apply per Seprafilm piece was 1 (range: 0.8-3.5) minute. We failed to place 16 pieces (16 of 737, 2.2%) in 11 patients. Virginal status, myoma weight, and the number of removed myomas were the risk factors of failed placement. Our technique for Seprafilm placement during laparoscopic myomectomy is simple and safe.
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Affiliation(s)
- Cindy Hsuan Weng
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou, Taoyuan (Drs. Weng, A-S. Chao, Y-T. Huang, Wu, Su, A. Chao, and Wang); College of Medicine, Chang Gung University, Taoyuan (Drs. A-S. Chao, Wu, A. Chao, and Wang); Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Taipei (Dr. H-Y. Huang); Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Linkou, Taoyuan (Dr. A. Chao); Clinical Trial Center and Linkou Medical Center, Chang Gung Memorial Hospital, Linkou (Dr. Yang), Taiwan
| | - An-Shine Chao
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou, Taoyuan (Drs. Weng, A-S. Chao, Y-T. Huang, Wu, Su, A. Chao, and Wang); College of Medicine, Chang Gung University, Taoyuan (Drs. A-S. Chao, Wu, A. Chao, and Wang); Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Taipei (Dr. H-Y. Huang); Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Linkou, Taoyuan (Dr. A. Chao); Clinical Trial Center and Linkou Medical Center, Chang Gung Memorial Hospital, Linkou (Dr. Yang), Taiwan
| | - Hui-Yu Huang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou, Taoyuan (Drs. Weng, A-S. Chao, Y-T. Huang, Wu, Su, A. Chao, and Wang); College of Medicine, Chang Gung University, Taoyuan (Drs. A-S. Chao, Wu, A. Chao, and Wang); Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Taipei (Dr. H-Y. Huang); Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Linkou, Taoyuan (Dr. A. Chao); Clinical Trial Center and Linkou Medical Center, Chang Gung Memorial Hospital, Linkou (Dr. Yang), Taiwan
| | - Yi-Ting Huang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou, Taoyuan (Drs. Weng, A-S. Chao, Y-T. Huang, Wu, Su, A. Chao, and Wang); College of Medicine, Chang Gung University, Taoyuan (Drs. A-S. Chao, Wu, A. Chao, and Wang); Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Taipei (Dr. H-Y. Huang); Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Linkou, Taoyuan (Dr. A. Chao); Clinical Trial Center and Linkou Medical Center, Chang Gung Memorial Hospital, Linkou (Dr. Yang), Taiwan
| | - Kai-Yun Wu
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou, Taoyuan (Drs. Weng, A-S. Chao, Y-T. Huang, Wu, Su, A. Chao, and Wang); College of Medicine, Chang Gung University, Taoyuan (Drs. A-S. Chao, Wu, A. Chao, and Wang); Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Taipei (Dr. H-Y. Huang); Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Linkou, Taoyuan (Dr. A. Chao); Clinical Trial Center and Linkou Medical Center, Chang Gung Memorial Hospital, Linkou (Dr. Yang), Taiwan
| | - Yu-Ying Su
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou, Taoyuan (Drs. Weng, A-S. Chao, Y-T. Huang, Wu, Su, A. Chao, and Wang); College of Medicine, Chang Gung University, Taoyuan (Drs. A-S. Chao, Wu, A. Chao, and Wang); Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Taipei (Dr. H-Y. Huang); Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Linkou, Taoyuan (Dr. A. Chao); Clinical Trial Center and Linkou Medical Center, Chang Gung Memorial Hospital, Linkou (Dr. Yang), Taiwan
| | - Lan-Yan Yang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou, Taoyuan (Drs. Weng, A-S. Chao, Y-T. Huang, Wu, Su, A. Chao, and Wang); College of Medicine, Chang Gung University, Taoyuan (Drs. A-S. Chao, Wu, A. Chao, and Wang); Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Taipei (Dr. H-Y. Huang); Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Linkou, Taoyuan (Dr. A. Chao); Clinical Trial Center and Linkou Medical Center, Chang Gung Memorial Hospital, Linkou (Dr. Yang), Taiwan
| | - Angel Chao
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou, Taoyuan (Drs. Weng, A-S. Chao, Y-T. Huang, Wu, Su, A. Chao, and Wang); College of Medicine, Chang Gung University, Taoyuan (Drs. A-S. Chao, Wu, A. Chao, and Wang); Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Taipei (Dr. H-Y. Huang); Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Linkou, Taoyuan (Dr. A. Chao); Clinical Trial Center and Linkou Medical Center, Chang Gung Memorial Hospital, Linkou (Dr. Yang), Taiwan
| | - Chin-Jung Wang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou, Taoyuan (Drs. Weng, A-S. Chao, Y-T. Huang, Wu, Su, A. Chao, and Wang); College of Medicine, Chang Gung University, Taoyuan (Drs. A-S. Chao, Wu, A. Chao, and Wang); Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Taipei (Dr. H-Y. Huang); Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Linkou, Taoyuan (Dr. A. Chao); Clinical Trial Center and Linkou Medical Center, Chang Gung Memorial Hospital, Linkou (Dr. Yang), Taiwan.
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Ota K, Sato K, Ogasawara J, Takahashi T, Mizunuma H, Tanaka M. Safe and easy technique for the laparoscopic application of Seprafilm® in gynecologic surgery. Asian J Endosc Surg 2019; 12:242-245. [PMID: 30549222 DOI: 10.1111/ases.12621] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Revised: 04/19/2018] [Accepted: 05/20/2018] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Laparoscopic surgery is a minimally invasive surgery, and the rate of postoperative adhesions is low. Although Seprafilm® helps to reduce adhesions, its application in the abdominal cavity during laparoscopic surgery is difficult because of its material. Therefore, we propose an easy method for applying this adhesion barrier. MATERIALS AND SURGICAL TECHNIQUE The Seprafilm is cut into four equal pieces. The four pieces are stacked, firmly folded twice, and grasped with the forceps. The reducer sleeve is slid over the bundle of Seprafilm. The forceps with the reducer sleeve is inserted through a 12-mm trocar near the target area. The reducer sleeve is then slid down the forceps to uncover the Seprafilm. Finally, each piece of Seprafilm is applied over the suture area. In all cases, the Seprafilm was successfully applied to the intended target. There were no cases in which Seprafilm was incompletely applied or in which it could not be used because of moistening. The average application times of surgeon 1 and surgeon 2 were 4.8 min and 5.0 min, respectively; this difference was not significant. There were no postoperative complications in any case. DISCUSSION It is safe and easy to use our simple technique to apply Seprafilm adhesion barrier laparoscopically. Further studies are warranted to prove Seprafilm's efficacy after such application.
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Affiliation(s)
- Kuniaki Ota
- Fukushima Medical Center for Children and Women, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Kenji Sato
- Department of Obstetrics and Gynecology, School of Medicine, Keio University, Tokyo, Japan
| | - Jun Ogasawara
- Department of Obstetrics and Gynecology, School of Medicine, Keio University, Tokyo, Japan
| | - Toshifumi Takahashi
- Fukushima Medical Center for Children and Women, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Hideki Mizunuma
- Fukushima Medical Center for Children and Women, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Mamoru Tanaka
- Department of Obstetrics and Gynecology, School of Medicine, Keio University, Tokyo, Japan
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Farag S, Padilla PF, Smith KA, Sprague ML, Zimberg SE. Management, Prevention, and Sequelae of Adhesions in Women Undergoing Laparoscopic Gynecologic Surgery: A Systematic Review. J Minim Invasive Gynecol 2018; 25:1194-1216. [DOI: 10.1016/j.jmig.2017.12.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 12/11/2017] [Accepted: 12/17/2017] [Indexed: 01/09/2023]
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Kai M, Maeda K, Tasaki M, Kira S, Nakamura S, Chino N, Hagiwara H, Nishida H, Kawanishi T. Evaluation of a Spray-type, Novel Dextrin Hydrogel Adhesion Barrier Under Laparoscopic Conditions in a Porcine Uterine Horn Adhesion Model. J Minim Invasive Gynecol 2018; 25:447-454. [DOI: 10.1016/j.jmig.2017.09.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 09/23/2017] [Accepted: 09/26/2017] [Indexed: 01/02/2023]
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Abstract
Background and Objectives: Postoperative adhesions occur less often in laparoscopies than in laparotomies, but the incidence can be reduced further. Seprafilm, a sodium hyaluronate/carboxymethylcellulose absorbable barrier, was developed to prevent adhesions after abdominal surgery, and is approved for postoperative adhesion prevention. However, Seprafilm is seldom used in laparoscopic surgery because of its tendency to break apart when it is inserted into the abdominal cavity through a trocar, resulting in a high placement failure rate. We propose a better method for applying the adhesion barrier Seprafilm in single- or multiport gynecologic surgery. Methods: This is a retrospective analysis of patients who underwent multi- or single-port gynecologic laparoscopies from December 2014 through January 2016 in Buddhist Tzu Chi General Hospital, Hualien, 46 patients received Seprafilm (Genzyme Corp., Cambridge, MA, USA) via the proposed method. A piece of Seprafilm was cut into quarters. To moisten and soften the Seprafilm, each piece was placed on a wet wrung gauze until it became naturally curled. Two pieces of the film were rolled up with the backing paper that came from the package of Seprafilm. Holding the rolled Seprafilm with a grasper, the surgeon delivered it into the abdomen through a 11-mm trocar. Results: The success rates of Seprafilm insertion and correct placement were 100% (46/46) and 95.7%, respectively. In 2 single-port (2/26) laparoscopic surgeries, the placement of the film failed; all placements in the multiport laparoscopic surgeries were successful (20/20). The average time required for placement of pieces of Seprafilm per surgery was 4.0 ± 1.47 minutes among all surgeries; significantly more time was needed in the single-port surgeries (mean, 4.4 ± 1.59 minutes) than in the multiport surgery (mean, 3.4 ± 1.13 minutes) (P < .05). Conclusions: This method of Seprafilm placement is a simple technique that does not need special equipment and ensures a high success rate. The placement of the film takes longer in single-port surgeries than in multiport surgeries.
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Affiliation(s)
- Mun-Kun Hong
- Department of Obstetrics and Gynecology, Buddhist Tzu Chi General Hospital, Tzu Chi University, and Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan
| | - Dah-Ching Ding
- Department of Obstetrics and Gynecology, Buddhist Tzu Chi General Hospital, Tzu Chi University, and Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan
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Ding DC, Hong MK, Chu TY, Chang YH, Liu HW. Robotic single-site supracervical hysterectomy with manual morcellation: Preliminary experience. World J Clin Cases 2017; 5:172-177. [PMID: 28560234 PMCID: PMC5434316 DOI: 10.12998/wjcc.v5.i5.172] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 12/08/2016] [Accepted: 03/02/2017] [Indexed: 02/05/2023] Open
Abstract
AIM To evaluate the feasibility, safety and peri- and postoperative outcomes of robotic single-site supracervical hysterectomy (RSSSH) for benign gynecologic disease.
METHODS We report 3 patients who received RSSSH for adenomyosis of the uterus from November 2015 to April 2016. We evaluated the feasibility, safety and outcomes among these patients.
RESULTS The mean surgical time was 244 min and the estimated blood loss was 216 mL, with no blood transfusion necessitated. The docking time was shortened gradually from 30 to 10 min. We spent 148 min on console operation. Manual morcellation time was also short, ranging from 5 to 10 min. The mean hospital stay was 5 d. Lower VAS pain score was also noted. There is no complication during or after surgery.
CONCLUSION RSSSH is feasible and safe, incurs less postoperative pain and gives good cosmetic appearance. The technique of in-bag, manual morcellation can avoid tumor dissemination.
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Nakagawa H, Yoshimura K, Nishimura K, Hachisuga T. Novel technique for adhesion barrier insertion by using cut-off surgical glove fingers in laparoscopic surgery. J Obstet Gynaecol Res 2017; 43:909-912. [PMID: 28422364 DOI: 10.1111/jog.13303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 11/10/2016] [Accepted: 01/09/2017] [Indexed: 11/28/2022]
Abstract
AIM Laparoscopic surgery causes fewer postoperative adhesions than laparotomy and adhesion barriers are used to lessen the chance of adhesion. Sodium hyaluronate and carboxymethylcellulose (SH-CMC), a bioresorbable membrane, is effective in preventing adhesions. However, its properties make it difficult to insert the film into the abdominal cavity and to place it into the target area during laparoscopic surgeries. Here we report a novel technique for applying SH-CMC during laparoscopic surgeries by using cut-off surgical glove fingers. METHODS In our dry-box experiment, we found that SH-CMC became more flexible after moisturizing for 30 s. Therefore, for this procedure, we moisturizing both sides of the SH-CMC sheet (7.35 × 6.35 cm) on wet gauze (for 30 s). The film was rolled into cut-off surgical glove fingers and inserted into the abdominal cavity through a 12-mm trocar. The film was then removed from the glove finger and unrolled onto the target area (glove-finger method). RESULTS The dry-box experiment revealed that moisturizing both sides of SH-CMC for 30 s/side, 15 min after package removal, made the film more flexible. Ninety of 96 attempts with SH-CMC were successful among the 24 patients who underwent total laparoscopic hysterectomy with our glove-finger method. CONCLUSION Our glove-finger method can realize the smooth application of SH-CMC to the target area during laparoscopic surgeries.
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Affiliation(s)
- Hitomi Nakagawa
- Department of Obstetrics and Gynecology, Wakamatsu Hospital, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Kazuaki Yoshimura
- Department of Obstetrics and Gynecology, Wakamatsu Hospital, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Kazuaki Nishimura
- Department of Obstetrics and Gynecology, Wakamatsu Hospital, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Toru Hachisuga
- Department of Obstetrics and Gynecology, Wakamatsu Hospital, University of Occupational and Environmental Health, Kitakyushu, Japan
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