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Angioni S, Saponara S, D'Ancona G, Sicilia G, D'Alterio MN, Vitale SG. Safety, Efficacy, and Cost-effectiveness of Organ Suspension in Laparoscopic Gynecologic Surgery: A Retrospective Cohort Study to Validate an Innovative Technique: Laparoscopic Organ Suspension sec. Angioni. Gynecol Obstet Invest 2024:1-8. [PMID: 38697034 DOI: 10.1159/000538787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 04/05/2024] [Indexed: 05/04/2024]
Abstract
OBJECTIVES This study aims to evaluate the safety, efficacy, and cost-effectiveness of the Laparoscopic Organ Suspension (OS) sec. Angioni, an innovative approach to transient OS in laparoscopic gynecological procedures. Recognizing the need to enhance surgical site access and overcome limitations of existing organ retraction methods, the study investigates a novel, in-theater constructed OS device. DESIGN This retrospective observational study was conducted from March 2019 to May 2021 and included 330 patients who underwent multiport or single-site-port laparoscopic surgery employing Angioni's technique for transient pelvic OS. PARTICIPANTS/MATERIALS, SETTING, METHODS Participants included individuals undergoing surgery for conditions such as endometriosis, ovarian cancer, endometrial cancer, pelvic prolapse, and benign ovarian cysts. The Laparoscopic OS sec. Angioni utilizes a segment of a Foley catheter connected to a Polyglactin suture to provide adjustable tension, minimizing the need for reconfiguration during surgery. RESULTS The application of this OS technique resulted in an average suspension time of 1.9 min, with no significant difference between senior and junior surgeons. The method proved more time-efficient for posterior peritoneum suspension than other published methods and showed no additional risks of organ damage, bleeding, conversion to laparotomy, or OS-related complications. The secondary outcomes revealed reduced hospital stays and minimal blood loss, highlighting the procedure's overall efficiency. LIMITATIONS Given its retrospective and single-center nature, the study's results may not be widely generalizable. Prospective multicentric comparative studies are recommended to further validate Angioni's technique. CONCLUSIONS Laparoscopic OS sec. Angioni is introduced as a straightforward, safe, and cost-effective method that significantly streamlines the surgical process. Its adaptability and ease of use suggest that it could be a valuable addition to current gynecological surgical practices, with potential implications for increasing efficiency and reducing procedural costs. Future studies are required to confirm these results across diverse clinical environments.
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Affiliation(s)
- Stefano Angioni
- Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Stefania Saponara
- Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy,
| | - Gianmarco D'Ancona
- Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Gilda Sicilia
- Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Maurizio Nicola D'Alterio
- Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Salvatore Giovanni Vitale
- Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
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Ovariopexy-Before and after Endometriosis Surgery. Biomedicines 2020; 8:biomedicines8120533. [PMID: 33255531 PMCID: PMC7759852 DOI: 10.3390/biomedicines8120533] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 11/12/2020] [Accepted: 11/19/2020] [Indexed: 11/17/2022] Open
Abstract
Endometriosis surgery is often very challenging. Key to complete resection of endometriosis is access to the retroperitoneum. Endometriosis can involve the ureter and uterine vessels, and ovary on the lateral pelvic wall makes retroperitoneal access difficult. Primary and post-surgical adhesions prevalence in endometriosis is very high. Ovariopexy, transposition of ovaries temporarily, is done for better surgical access and to reduce postoperative adhesions. We concluded that although limited evidence, ovariopexy is an excellent tool to aid endometriosis surgery and prevent postoperative adhesions. It is cost effective, simple and complication rate almost nil. More robust trials are required to substantiate evidence for its impact on preventing postoperative adhesions and its effect on fertility. In this review, we describe our technique of ovariopexy supplemented with a video, with the aim to put light on this useful and important technique, which is beneficial both for surgeons and patients.
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Budden A, Ravendran K, Abbott JA. Identifying the Problems of Randomized Controlled Trials for the Surgical Management of Endometriosis-associated Pelvic Pain. J Minim Invasive Gynecol 2020; 27:419-432. [DOI: 10.1016/j.jmig.2019.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 10/24/2019] [Accepted: 11/01/2019] [Indexed: 12/20/2022]
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Giampaolino P, Della Corte L, Saccone G, Vitagliano A, Bifulco G, Calagna G, Carugno J, Di Spiezio Sardo A. Role of Ovarian Suspension in Preventing Postsurgical Ovarian Adhesions in Patients with Stage III-IV Pelvic Endometriosis: A Systematic Review. J Minim Invasive Gynecol 2018; 26:53-62. [PMID: 30092363 DOI: 10.1016/j.jmig.2018.07.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 07/28/2018] [Accepted: 07/30/2018] [Indexed: 10/28/2022]
Abstract
Endometriosis is a benign complex gynecologic condition with high morbidity that affects women of reproductive age. Pelvic adhesion formation represents a serious clinical challenge in the management of patients with endometriosis. Several interventions aimed at reducing postoperative ovarian adhesion formation have been proposed in recent years. Here we summarize the published evidence on the efficacy of ovarian suspension in preventing postoperative ovarian adhesion formation in women undergoing laparoscopic surgery for stage III-IV endometriosis. The research was conducted using electronic databases. A review of the abstracts of all references retrieved from the search was conducted. Selection criteria for the systematic review included all randomized controlled trials (RCTs) and nonrandomized studies (NRSs) of premenopausal women diagnosed with stage III-IV pelvic endometriosis who underwent ovarian suspension or no ovarian suspension (control group). The RCTs were eligible for meta-analysis. Eight studies, 2 RCTs and 6 NRSs, were included in the systematic review. In all 8 studies, ovarian suspension was performed during surgery for stage III-IV endometriosis. The site of the suspension was the anterior abdominal wall in 76.8% of the cases. Five studies reported the use of polypropylene as suture for the suspension. Removal of the suspension suture in the postoperative period was reported in 6 studies. Pooled data from a meta-analysis of the RCTs show that women who underwent ovarian suspension had a significantly lower incidence of postoperative adhesion formation, particularly of moderate to severe adhesions. Ovarian suspension may reduce the rate and severity of postoperative adhesions formation in women undergoing laparoscopy for the treatment of stage III-IV endometriosis; however, RCTs with larger sample sizes are needed.
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Affiliation(s)
- Pierluigi Giampaolino
- From the Departments of Public Health (Drs Giampaolino and Di Spiezio Sardo) and Neuroscience and Reproductive and Odontostomatological Sciences (Drs Della Corte, Saccone, and Bifulco), School of Medicine, University of Naples Federico II, Naples, Italy
| | - Luigi Della Corte
- From the Departments of Public Health (Drs Giampaolino and Di Spiezio Sardo) and Neuroscience and Reproductive and Odontostomatological Sciences (Drs Della Corte, Saccone, and Bifulco), School of Medicine, University of Naples Federico II, Naples, Italy
| | - Gabriele Saccone
- From the Departments of Public Health (Drs Giampaolino and Di Spiezio Sardo) and Neuroscience and Reproductive and Odontostomatological Sciences (Drs Della Corte, Saccone, and Bifulco), School of Medicine, University of Naples Federico II, Naples, Italy
| | - Amerigo Vitagliano
- Department of Woman's and Child's Health, University of Padua, Padua, Italy (Dr Vitagliano)
| | - Giuseppe Bifulco
- From the Departments of Public Health (Drs Giampaolino and Di Spiezio Sardo) and Neuroscience and Reproductive and Odontostomatological Sciences (Drs Della Corte, Saccone, and Bifulco), School of Medicine, University of Naples Federico II, Naples, Italy
| | - Gloria Calagna
- Department of Obstetrics and Gynecology, "Villa Sofia Cervello" University of Palermo, Palermo, Italy (Dr Calagna)
| | - Jose Carugno
- UHealth Obstetrics & Gynecology, Miller School of Medicine, University of Miami, Miami, Florida (Dr Carugno)
| | - Attilio Di Spiezio Sardo
- From the Departments of Public Health (Drs Giampaolino and Di Spiezio Sardo) and Neuroscience and Reproductive and Odontostomatological Sciences (Drs Della Corte, Saccone, and Bifulco), School of Medicine, University of Naples Federico II, Naples, Italy.
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Koninckx PR, Gomel V, Ussia A, Adamyan L. Role of the peritoneal cavity in the prevention of postoperative adhesions, pain, and fatigue. Fertil Steril 2016; 106:998-1010. [PMID: 27523299 DOI: 10.1016/j.fertnstert.2016.08.012] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 07/30/2016] [Accepted: 08/02/2016] [Indexed: 02/08/2023]
Abstract
A surgical trauma results within minutes in exudation, platelets, and fibrin deposition. Within hours, the denuded area is covered by tissue repair cells/macrophages, starting a cascade of events. Epithelial repair starts on day 1 and is terminated by day 3. If repair is delayed by decreased fibrinolysis, local inflammation, or factors in peritoneal fluid, fibroblast growth starting on day 3 and angiogenesis starting on day 5 results in adhesion formation. For adhesion formation, quantitatively more important are factors released into the peritoneal fluid after retraction of the fragile mesothelial cells and acute inflammation of the entire peritoneal cavity. This is caused by mechanical trauma, hypoxia (e.g., CO2 pneumoperitoneum), reactive oxygen species (ROS; e.g., open surgery), desiccation, or presence of blood, and this is more severe at higher temperatures. The inflammation at trauma sites is delayed by necrotic tissue, resorbable sutures, vascularization damage, and oxidative stress. Prevention of adhesion formation therefore consists of the prevention of acute inflammation in the peritoneal cavity by means of gentle tissue handling, the addition of more than 5% N2O to the CO2 pneumoperitoneum, cooling the abdomen to 30°C, prevention of desiccation, a short duration of surgery, and, at the end of surgery, meticulous hemostasis, thorough lavage, application of a barrier to injury sites, and administration of dexamethasone. With this combined therapy, nearly adhesion-free surgery can be performed today. Conditioning alone results in some 85% adhesion prevention, barriers alone in 40%-50%.
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Affiliation(s)
- Philippe R Koninckx
- Department of Obstetrics and Gynecology, Catholic University Leuven, University Hospital, Gasthuisberg, Leuven, Belgium; Gruppo Italo Belga, Villa del Rosario and Gemelli Hospitals Università Cattolica, Rome, Italy.
| | - Victor Gomel
- Department of Obstetrics and Gynecology, University of British Columbia, Women's Hospital, Vancouver, British Columbia, Canada
| | - Anastasia Ussia
- Gruppo Italo Belga, Villa del Rosario and Gemelli Hospitals Università Cattolica, Rome, Italy
| | - Leila Adamyan
- Department of Operative Gynecology, Federal State Budget Institution V. I. Kulakov Research Center for Obstetrics, Gynecology, and Perinatology, Ministry of Health of the Russian Federation, Moscow, Russia; Department of Reproductive Medicine and Surgery, Moscow State University of Medicine and Dentistry, Moscow, Russia, Russian Federation
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Pergialiotis V, Frountzas M, Siotos C, Karampetsou N, Perrea DN, Efthymios Vlachos D. Cesarean wound scar characteristics for the prediction of pelvic adhesions: a meta-analysis of observational studies. J Matern Fetal Neonatal Med 2016; 30:486-491. [PMID: 27072887 DOI: 10.1080/14767058.2016.1176135] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE The pathophysiologic processes that result in wound healing are the same regardless of the tissue involved. The purpose of the present meta-analysis is to evaluate whether cesarean scar characteristics may predict the presence of pelvic adhesions. MATERIALS AND METHODS We conducted a systematic review searching the Medline (1966-2016), Scopus (2004-2016), ClinicalTrials.gov (2008-2016), Cochrane Central Register of Controlled Trials CENTRAL (1999-2016) and Google Scholar (2004-2016) databases together with reference lists from included studies. All prospective and retrospective observational cohort studies were included. Statistical meta-analysis was performed using the RevMan 5.1 software. RESULTS Current evidence suggests that depressed scars are positively associated with intra-abdominal adhesions (ΟR 2.79, 95%CI 1.74-4.46). Elevated scars might also correlate with the presence of adhesions, however, this association did not reach statistical significance (OR 1.61, 95%CI 0.91-2.85, p = 0.10). The same was reported in the case of scar pigmentation (REM, OR 1.68, 95%CI 0.86-3.26, p = 0.13). Flat scars were predictive of the absence of adhesions (899 patients, REM, OR 0.33, 95%CI 0.23-0.54, p < 0.00001). CONCLUSION According to our meta-analysis, abdominal wound characteristics following cesarean section can predict the presence of adhesions. However, given the small number of published studies, further research is needed to corroborate our findings.
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Affiliation(s)
- Vasilios Pergialiotis
- a Laboratory of Experimental Surgery and Surgical Research N.S. Christeas , National and Kapodistrian University of Athens , Athens , Greece and
| | - Maximos Frountzas
- a Laboratory of Experimental Surgery and Surgical Research N.S. Christeas , National and Kapodistrian University of Athens , Athens , Greece and
| | - Charalampos Siotos
- a Laboratory of Experimental Surgery and Surgical Research N.S. Christeas , National and Kapodistrian University of Athens , Athens , Greece and
| | - Nikoleta Karampetsou
- a Laboratory of Experimental Surgery and Surgical Research N.S. Christeas , National and Kapodistrian University of Athens , Athens , Greece and
| | - Despina N Perrea
- a Laboratory of Experimental Surgery and Surgical Research N.S. Christeas , National and Kapodistrian University of Athens , Athens , Greece and
| | - Dimitrios Efthymios Vlachos
- b 1st Department of Obstetrics and Gynecology, Alexandra University Hospital, National and Kapodistrian University of Athens , Athens , Greece
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