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Wang PH, Yang ST, Chang WH, Liu CH, Lee FK, Lee WL. Endometriosis: Part I. Basic concept. Taiwan J Obstet Gynecol 2022; 61:927-934. [DOI: 10.1016/j.tjog.2022.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2022] [Indexed: 11/23/2022] Open
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Hu H, Choi JDW, Edye MB, Aitken T, Kapurubandara S. Gastric Injury at Laparoscopy for Gynecologic Indications: A Systematic Review. J Minim Invasive Gynecol 2022; 29:1224-1230. [PMID: 36184063 DOI: 10.1016/j.jmig.2022.09.058] [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: 07/23/2022] [Revised: 09/19/2022] [Accepted: 09/23/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE This systematic review aims to identify causes of increased risk for and location and mechanism of gastric injury at laparoscopy for gynecologic indications and determine optimal management. DATA SOURCES A prospectively registered systematic review (PROSPERO: CRD42021237999) was undertaken and performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Databases searched included Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Medline, Embase, Web of Science, SCOPUS, and Google Scholar from 1960 to 2021. METHODS OF STUDY SELECTION All study types were included involving female patients of any age with gastric injury at laparoscopy for gynecologic indication. TABULATION, INTEGRATION, AND RESULTS A total of 6294 articles were screened, from which 67 studies were selected for a full-text review. Twenty-eight articles were included, which contained 42 cases drawn from 7 observational studies, 4 case series, and 17 case reports. Of these, 93% (39/42) were at the time of laparoscopic entry, with Veress entry technique used in 79% of these cases (31/39). Eighteen cases reported an entry point, with 77% (14/18) occurring at the periumbilical entry point and 11% (2/18) occurring at Palmer's point. Of the cases with reported etiology for gastric distention or displacement, 64% (9/14) were owing to anesthetic cause. The most common sites of gastric injury were on the anterior stomach wall (n = 8) and the greater curvature (n = 5). Among patients with reported management (32/42), a similar proportion were managed conservatively (11) when compared with repair through laparotomy (13) or laparoscopy (8). All injuries were detected intraoperatively with no reported short-term sequelae. CONCLUSION This systematic review of the literature reveals that gastric injury at laparoscopy for gynecologic indications is a rare complication predominantly occurring during laparoscopic entry, most commonly at the periumbilical entry point. When detected intraoperatively, conservative management, laparoscopic, or open repair in the appropriate patient has been performed with no short-term sequelae. The limitations of this review include paucity of cases, detail, and timeline of publications.
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Affiliation(s)
- Hillary Hu
- Department of Obstetrics and Gynaecology, Westmead Hospital (Drs. Hu and Kapurubandara), Sydney, New South Wales, Australia.
| | - Joseph Do Woong Choi
- Department of Surgery, Blacktown and Mount Druitt Hospitals (Drs. Choi and Edye), Sydney, New South Wales, Australia
| | - Michael B Edye
- Department of Surgery, Blacktown and Mount Druitt Hospitals (Drs. Choi and Edye), Sydney, New South Wales, Australia; Western Sydney Universit (Dr. Edye), Sydney, New South Wales, Australiay
| | - Tess Aitken
- University of Sydney Library (X Aitken), Sydney, New South Wales, Australia
| | - Supuni Kapurubandara
- Department of Obstetrics and Gynaecology, Westmead Hospital (Drs. Hu and Kapurubandara), Sydney, New South Wales, Australia; University of Sydney (Dr. Kapurubandara), Sydney, New South Wales, Australia; Sydney West Advanced Pelvic Surgery Unit (Dr. Kapurubandara), Sydney, New South Wales, Australia
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Tchartchian G, Bojahr B, Krentel H, De Wilde RL. Evaluation of complications, conversion rate, malignancy rate, and, surgeon's experience in laparoscopic assisted supracervical hysterectomy (LASH) of 1274 large uteri: A retrospective study. Acta Obstet Gynecol Scand 2022; 101:1450-1457. [PMID: 36203317 PMCID: PMC9812207 DOI: 10.1111/aogs.14468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 09/15/2022] [Accepted: 09/16/2022] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Hysterectomy now belongs to standard gynecological procedures. Moreover, a shift towards laparoscopic techniques is ever more apparent as they provide many advantages such as less traumatization and shorter convalescence. Large uteri are still mentioned as contraindications for laparoscopic hysterectomy even though those patients might benefit from the lower morbidity associated with minimal invasive techniques. In this study, the largest reported so far, we analyzed intraoperative and postoperative complications as well as the surgeon's experience of laparoscopic assisted supracervical hysterectomy (LASH) in patients with a uterus weight over 500 g. MATERIAL AND METHODS The present retrospective study, between June 27, 1998 and August 31, 2019, evaluates 1274 patients with a uterus weight over 500 g who were treated with LASH for benign uterine diseases at the Clinic for Minimal Invasive Surgery (Berlin, Germany). All surgeries were performed by one of four in-house surgeons with experience in LASH: they had performed at least 500 LASH procedures before the study. Patients receiving surgical treatment for malignant tumors were not included in the study. Major and minor intraoperative and postoperative complications were recorded and evaluated. Additionally, medical files were evaluated for demographic data, American Society of Anesthesiologists score (I-IV), name of the surgeon, duration and indication for surgery, history of previous gynecological procedures and concomitant surgical interventions, weight of removed uterine tissue, duration of postoperative hospitalization in patients with complications, intraoperative conversion from laparoscopy to laparotomy, and malignancy rate. RESULTS The mean age was 47.0 ± 7.3 years and mean body mass index was 25.6 ± 7.1 kg/m2 . Average parity was 1.04 ± 1.57. Average uterus weight was 761.8 ± 317.9 g (500-4065 g). The mean duration of surgery was 96.9 ± 49.5 min; 54% of all patients were treated without concomitant intervention, conversion rate was 2.12%. The malignancy rate was 0.4% and the complication rate was 6.81% with 1.36% intraoperative complications and 5.45% postoperative complications. CONCLUSIONS The overall low complication and malignancy rates observed in this study allow us to present LASH as a safe and efficient alternative laparoscopic approach to remove uteri of any size in the hands of experienced surgeons.
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Affiliation(s)
| | - Bernd Bojahr
- Clinic for Gynecology and Breast CenterUniversitätsklinikum GreifswaldGreifswaldGermany
| | - Harald Krentel
- Clinic of Gynecology, Obstetrics, Gynecological Oncology and Senology, Academic Teaching HospitalBethesda HospitalDuisburgGermany
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Deep versus Moderate Neuromuscular Blockade in Gynecologic Laparoscopic Operations: Randomized Controlled Trial. J Pers Med 2022; 12:jpm12040561. [PMID: 35455677 PMCID: PMC9032163 DOI: 10.3390/jpm12040561] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 03/18/2022] [Accepted: 03/28/2022] [Indexed: 02/05/2023] Open
Abstract
Background: To investigate whether deep neuromuscular blockade (NMB) improves surgical conditions and postoperative pain compared to moderate block, in patients undergoing gynecologic laparoscopic surgery. Methods: A single blind, randomized, controlled trial was undertaken with laparoscopic gynecologic surgical patients, who were randomly assigned to one of the following two groups: patients in the first group received deep NMB (PTC 0-1) and in the other, moderate NMB (TOF 0-1). Primary outcomes included assessing the surgical conditions using a four-grade scale, ranging from 0 (extremely poor) to 3 (optimal), and patients’ postoperative pain was evaluated with a five-grade Likert scale and the analgesic consumption. Results: 144 patients were analyzed as follows: 73 patients received deep NMB and 71 moderate NMB. Mean surgical field scores were comparable between the two groups (2.44 for moderate vs. 2.68 for deep NMB). Regarding postoperative pain scores, the patients in the deep NMB experienced significantly less pain than in the group of moderate NMB (0.79 vs. 1.58, p < 0.001). Moreover, when the consumption of analgesic drugs was compared, the moderate NMB group needed more extra opioid analgesia than the deep NMB group (18.3% vs. 4.1%, p = 0.007). From the secondary endpoints, an interesting finding of the study was that patients on deep NMB had significantly fewer incidents of subcutaneous emphysema. Conclusions: Our data show that, during the performance of gynecologic laparoscopic surgery, deep NMB offers no advantage of operating filed conditions compared with moderate NMB. Patients may benefit from the deep block as it may reduce postoperative pain.
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King NR, Lin E, Yeh C, Wong JMK, Friedman J, Traylor J, Tsai S, Chaudhari A, Milad MP. Laparoscopic Major Vascular Injuries in Gynecologic Surgery for Benign Indications: A Systematic Review. Obstet Gynecol 2021; 137:434-442. [PMID: 33543898 DOI: 10.1097/aog.0000000000004280] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 11/19/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To identify the incidence, location, etiology, and mortality of major vascular injuries in gynecologic laparoscopy for benign indications. DATA SOURCES A systematic review of PubMed, EMBASE, Cochrane Library, ClinicalTrials.gov, and MEDLINE was conducted. METHODS OF STUDY SELECTION One thousand ninety-seven studies were screened for inclusion with 147 full-text articles reviewed. Sixty-six studies published between 1978 and 2016 met inclusion criteria, representing 197,062 surgeries. Articles that were included reported the incidence of major vascular injuries during gynecologic laparoscopy for benign indications. Exclusion criteria included surgery for gynecologic malignancy, duplicated data, case series and reports, manuscripts not in English, and studies published only as abstracts. TABULATION, INTEGRATION, AND RESULTS Injuries to the aorta, inferior vena cava, iliac (common, external, or internal), and inferior epigastric vessels were recorded, as were injuries denoted as major but not otherwise specified. A total of 179 major vascular injuries were reported with an incidence of 0.09% (95% CI 0.08-0.10). The inferior epigastric vessels were the most commonly injured vessel (0.04%, 95% CI 0.03-0.05), comprising 48% (95% CI 40-55) of all injuries. The majority of injuries occurred during abdominal entry (82%, 95% CI 76-89), and the remainder occurred during surgical dissection (18%, 95% CI 11-24). Most injuries were recognized intraoperatively (93%, 95% CI 87-100), and approximately half (55%, 95% CI 46-63) required laparotomy for repair. Only two of the 179 major vascular injuries resulted in death, for an overall mortality rate from vascular injuries of 0.001% (95% CI 0.000-0.004). CONCLUSION The incidence of major vascular injury during gynecologic laparoscopy found in this review is very low, and the vast majority of injuries did not result in death. Laparoscopy remains a safe surgical technique in relation to vascular injuries when performed for benign gynecologic disease.
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Affiliation(s)
- Nathan R King
- Department of Obstetrics and Gynecology and the Division of Biostatistics, Department of Preventive Medicine, Northwestern Feinberg School of Medicine, Chicago, Illinois; and the Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Su MH, Cho SW, Kung YS, Lin JH, Lee WL, Wang PH. Update on the differential diagnosis of gynecologic organ-related diseases in women presenting with ascites. Taiwan J Obstet Gynecol 2019; 58:587-591. [DOI: 10.1016/j.tjog.2019.07.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2019] [Indexed: 02/07/2023] Open
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Argentino GLS, Bueloni-Dias FN, Leite NJ, Peres GF, Elias LV, Bortolani VC, Padovani CR, Spadoto-Dias D, Dias R. The role of laparoscopy in the propaedeutics of gynecological diagnosis1. Acta Cir Bras 2019; 34:e20190010000010. [PMID: 30785511 PMCID: PMC6585922 DOI: 10.1590/s0102-865020190010000010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Accepted: 12/04/2018] [Indexed: 11/22/2022] Open
Abstract
Purpose To evaluate agreement between pre- and post-laparoscopy gynecological
diagnosis in order to demonstrate the rationality of this minimally invasive
technique use in gynecological propaedeutics. Methods Retrospective chart review study conducted between March 2010 and October
2016 based on a convenience sample. 315 patients undergoing surgical
laparoscopy at the Center of Gynecologic Endoscopy and Family Planning of
Botucatu Medical School/UNESP. Pre- and postoperative diagnoses were
compared by the diagnosis agreement test considering the proportions of
events. Results Laparoscopy contributed to diagnosis in 59.6% of infertility cases
(P>0.05), in 93.7% of chronic pelvic pain of undetermined origin
(P<0.01) and conclusively elucidated the diagnosis of acute abdomen and
the ruling out of tubo-ovarian abcess (P<0.05). Laparoscopy also
increased the diagnosis of pelvic-abdominal adhesions in 76.7% (P>0.05).
Conclusion The use of laparoscopy considerably contributed to diagnostic elucidation,
especially in cases of undetermined chronic pelvic pain.
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Affiliation(s)
- Gislaine Laperuta Serafim Argentino
- Assistant Physician, Gynecological Endoscopy and Family Planning Sector, Department of Gynecology and Obstetrics, Botucatu Medical School, Universidade Estadual Paulista (UNESP), Botucatu-SP, Brazil. Conception and design of the study; acquisition, analysis and interpretation of data; technical procedures; manuscript preparation
| | - Flávia Neves Bueloni-Dias
- Clinical Assistant Professor, Department of Gynecology and Obstetrics, Botucatu Medical School, UNESP, Botucatu-SP, Brazil. Acquisition, analysis and interpretation of data; technical procedures; manuscript preparation
| | - Nilton José Leite
- Assistant Physician, Gynecological Endoscopy and Family Planning Sector, Department of Gynecology and Obstetrics, Botucatu Medical School, Universidade Estadual Paulista (UNESP), Botucatu-SP, Brazil. Conception and design of the study; acquisition, analysis and interpretation of data; technical procedures; manuscript preparation
| | - Gustavo Filipov Peres
- Assistant Physician, Gynecological Endoscopy and Family Planning Sector, Department of Gynecology and Obstetrics, Botucatu Medical School, Universidade Estadual Paulista (UNESP), Botucatu-SP, Brazil. Conception and design of the study; acquisition, analysis and interpretation of data; technical procedures; manuscript preparation
| | - Leonardo Vieira Elias
- Assistant Physician, Gynecological Endoscopy and Family Planning Sector, Department of Gynecology and Obstetrics, Botucatu Medical School, Universidade Estadual Paulista (UNESP), Botucatu-SP, Brazil. Conception and design of the study; acquisition, analysis and interpretation of data; technical procedures; manuscript preparation
| | - Vitória Cristina Bortolani
- Resident, Department of Gynecology and Obstetrics, Botucatu Medical School, UNESP, Botucatu-SP, Brazil. Acquisition of data
| | - Carlos Roberto Padovani
- Full Professor, Department of Biostatistics, Botucatu Biosciences Institute, UNESP, Botucatu-SP, Brazil. Statistics analysis
| | - Daniel Spadoto-Dias
- Clinical Assistant Professor, Department of Gynecology and Obstetrics, Botucatu Medical School, UNESP, Botucatu-SP, Brazil. Acquisition, analysis and interpretation of data; technical procedures; manuscript preparation
| | - Rogério Dias
- Associate Professor III, Department of Gynecology and Obstetrics, Botucatu Medical School, UNESP, Botucatu-SP, Brazil. Conception and design of the study, manuscript preparation
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LASH in Severely Enlarged Uterine Leiomyoma: Removal of a Uterus of 4065 g. Case Rep Med 2018; 2018:2078923. [PMID: 30046311 PMCID: PMC6036857 DOI: 10.1155/2018/2078923] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Accepted: 06/06/2018] [Indexed: 11/28/2022] Open
Abstract
Today, even though minimally invasive approaches have become standard worldwide, large uteri are still mainly removed by means of open abdominal approaches. The present case describes the successful removal of the largest uterus ever reported (4065 g) by means of laparoscopy-assisted supracervical hysterectomy (LASH). We combined LASH with the changeover technique which allows a better access and view. We further explain how this approach allows for the safe minimally invasive removal of uteri of any size.
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Are Routine Blood Group and Save Samples Needed for Laparoscopic Day Case Surgery? World J Surg 2016; 40:1295-8. [DOI: 10.1007/s00268-016-3463-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Hirata T, Nakazawa A, Fukuda S, Hirota Y, Izumi G, Takamura M, Harada M, Koga K, Wada-Hiraike O, Fujii T, Osuga Y. Four Cases of Postoperative Pneumothorax Among 2814 Consecutive Laparoscopic Gynecologic Surgeries: A Possible Correlation Between Postoperative Pneumothorax and Endometriosis. J Minim Invasive Gynecol 2015; 22:980-4. [PMID: 25936271 DOI: 10.1016/j.jmig.2015.04.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 04/14/2015] [Accepted: 04/15/2015] [Indexed: 10/23/2022]
Abstract
STUDY OBJECTIVES To evaluate the frequency of pneumothorax after laparoscopic surgery and to identify possible correlations to endometriosis. DESIGN Retrospective review. SETTING Tokyo University Hospital between 2006 and 2013. PATIENTS Four patients among a total of 2814 patients with a postoperative pneumothorax. INTERVENTION Laparoscopic surgery for gynecologic benign disease. The main outcome was the clinical frequency and characteristics of the patients with postoperative pneumothorax. MEASUREMENTS AND MAIN RESULTS We observed 4 (0.14%) cases of postoperative pneumothorax after laparoscopic surgery, all of whom were diagnosed with endometriomas and developed a right-sided pneumothorax. The incidence of postoperative pneumothorax in 1097 patients with endometriomas was 0.36%, which was significantly higher than those without endometriomas. CONCLUSION The presence of endometrioma should be considered a risk factor for postoperative pneumothorax in gynecologic laparoscopic surgery.
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Affiliation(s)
- Tetsuya Hirata
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan.
| | - Akari Nakazawa
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Shinya Fukuda
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Yasushi Hirota
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Gentaro Izumi
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Masashi Takamura
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Miyuki Harada
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Kaori Koga
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Osamu Wada-Hiraike
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Tomoyuki Fujii
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Yutaka Osuga
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
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Cuss A, Bhatt M, Abbott J. Coming to terms with the fact that the evidence for laparoscopic entry is as good as it gets. J Minim Invasive Gynecol 2014; 22:332-41. [PMID: 25460522 DOI: 10.1016/j.jmig.2014.10.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2014] [Revised: 10/27/2014] [Accepted: 10/30/2014] [Indexed: 02/07/2023]
Abstract
Entry to the peritoneal cavity for laparoscopic surgery is associated with defined morbidity, with all entry techniques associated with substantial complications. Debate over the safest entry technique has raged over the last 2 decades, and yet, we are no closer to arriving at a scientifically valid conclusion regarding technique superiority. With hundreds of thousands of patients required to perform adequately powered studies, it is unlikely that appropriately powered comparative studies could be undertaken. This review examines the risk of complications related to laparoscopic entry, current statements from examining bodies around the world, and the medicolegal ramifications of laparoscopic entry complications. Because of the numbers required for any complications study, with regard to arriving at an evidence-based decision for laparoscopic entry, we ask: is the current literature perhaps as good as it gets?
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Affiliation(s)
- Amanda Cuss
- Royal Hospital for Women, Sydney, Australia and University of New South Wales, Sydney, Australia
| | | | - Jason Abbott
- Royal Hospital for Women, Sydney, Australia and University of New South Wales, Sydney, Australia.
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Affiliation(s)
- Michael Baggish
- The Women's Center, Saint Helena Hospital, Saint Helena, CA
- Department of Obstetrics and Gynecology, Good Samaritan Hospital, Cincinnati, OH (emeritus)
- Department of Obstetrics and Gynecology, University of California, San Francisco, San Francisco, CA
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Thiel JA, Lukwinski A, Kamencic H, Lim H. Oral Analgesia vs Intravenous Conscious Sedation during Essure Micro-Insert Sterilization Procedure: Randomized, Double-Blind, Controlled Trial. J Minim Invasive Gynecol 2011; 18:108-11. [DOI: 10.1016/j.jmig.2010.10.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2010] [Revised: 10/12/2010] [Accepted: 10/14/2010] [Indexed: 11/24/2022]
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Baggish MS. Urinary Tract Injuries Secondary to Gynecologic Laparoscopic Surgery: Analysis of 75 Cases. J Gynecol Surg 2010. [DOI: 10.1089/gyn.2010.0019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Michael S. Baggish
- Department of Obstetrics and Gynecology, Good Samaritan Hospital, and University of Cincinnati, College of Medicine, Cincinnati, OH
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Is It Possible to Use a Single Ancillary Trocar to Finish Laparoscopic Cystectomy? Taiwan J Obstet Gynecol 2009; 48:333-4. [DOI: 10.1016/s1028-4559(09)60320-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Su WH, Cheng MH, Tsou TS, Cheung SM, Chang SP, Wang PH. Port wound closure assisted by Foley catheter: An easier way to provide fascia security. J Obstet Gynaecol Res 2009; 35:725-31. [DOI: 10.1111/j.1447-0756.2008.01008.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Wang PH, Fuh JL, Chao HT, Liu WM, Cheng MH, Chao KC. Is the surgical approach beneficial to subfertile women with symptomatic extensive adenomyosis? J Obstet Gynaecol Res 2009; 35:495-502. [DOI: 10.1111/j.1447-0756.2008.00951.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Cost-Effectiveness Analysis Comparing the Essure Tubal Sterilization Procedure and Laparoscopic Tubal Sterilization. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2008; 30:581-585. [DOI: 10.1016/s1701-2163(16)32891-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Pitt T, Brethauer S, Sherman V, Udomsawaengsup S, Metz M, Chikunguwo S, Chand B, Schauer P. Diagnostic laparoscopy for chronic abdominal pain after gastric bypass. Surg Obes Relat Dis 2008; 4:394-8; discussion 398. [DOI: 10.1016/j.soard.2007.12.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2007] [Revised: 11/21/2007] [Accepted: 12/11/2007] [Indexed: 11/16/2022]
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Varma R, Gupta JK. Laparoscopic entry techniques: clinical guideline, national survey, and medicolegal ramifications. Surg Endosc 2008; 22:2686-97. [DOI: 10.1007/s00464-008-9871-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2007] [Revised: 01/12/2008] [Accepted: 01/27/2008] [Indexed: 12/20/2022]
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Baggish MS. One-Hundred and Thirty Small- and Large-Bowel Injuries Associated with Gynecologic Laparoscopic Operations. J Gynecol Surg 2007. [DOI: 10.1089/gyn.2007.b-02287] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Michael S. Baggish
- Department of Obstetrics and Gynecology, Good Samaritan Hospital, Cincinnati, OH
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Soong YK, Yu HT, Wang CJ, Lee CL, Huang HY. Urinary tract injury in laparoscopic-assisted vaginal hysterectomy. J Minim Invasive Gynecol 2007; 14:600-5. [PMID: 17848321 DOI: 10.1016/j.jmig.2007.05.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2007] [Revised: 05/10/2007] [Accepted: 05/12/2007] [Indexed: 11/19/2022]
Abstract
STUDY OBJECTIVE To evaluate the incidence and characteristics of urinary tract injury after laparoscopic-assisted vaginal hysterectomy (LAVH). DESIGN A retrospective study that evaluated all cases of urinary tract injury at the time of LAVH in an 11-year period. Parameters including surgical indication, site of injury, time of diagnosis, method of treatment, and long-term follow-up were analyzed. (Canadian Task Force classification II-2). SETTING Tertiary care university hospital. PATIENTS A total of 38 urinary tract injuries were found in 7725 LAVH. INTERVENTION LAVH and repair of urinary tract injuries with transvaginal or transabdominal approach. MEASUREMENTS AND MAIN RESULTS The incidence of urinary tract injury after LAVH was 4.9/1000 procedures: 3.9/1000 for urinary bladder injury and 1.0/1000 for ureteral injury. Prior cesarean section was the most common risk factor for bladder injuries. Ninety-six percent (29/30) of urinary bladder injuries were detected and treated during surgery. Half (4/8, 50%) of the ureteral injuries were identified during surgery. Of the 38 complications, 28 (75.7%) occurred in surgery. CONCLUSION Most urinary tract injuries in LAVH were identified during surgery and are associated with the surgeon's experience. Bladder injury can be repaired either transvaginally or abdominally; ureteral injury can be repaired abdominally.
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Affiliation(s)
- Yung-Kuei Soong
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Medical Center and Chang Gung University College of Medicine, Kwei-Shan, Tao-Yuan, Taiwan.
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Johnston K, Rosen D, Cario G, Chou D, Carlton M, Cooper M, Reid G. Major complications arising from 1265 operative laparoscopic cases: a prospective review from a single center. J Minim Invasive Gynecol 2007; 14:339-44. [PMID: 17478366 DOI: 10.1016/j.jmig.2006.12.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2006] [Revised: 12/04/2006] [Accepted: 12/04/2006] [Indexed: 12/25/2022]
Abstract
STUDY OBJECTIVE To identify the volume and type of laparoscopic surgery being performed. To review the incidence, nature of associated complications, and reasons for conversion to laparotomy. DESIGN A multicenter, prospective case load analysis and chart review, identifying operations performed by 6 advanced laparoscopic surgeons over a 12-month period (1/1/05 to 12/31/05). SETTING Surgical cases were performed in 5 hospitals in Sydney, New South Wales. PATIENTS One thousand two hundred sixty-five women underwent a variety of major and advanced operative procedures. MEASUREMENTS AND MAIN RESULTS A total of 1265 major and advanced laparoscopic procedures were performed. Laparoscopic hysterectomy accounted for 364 cases (28.8%), pelvic floor repair and Burch colposuspension 280 cases (22.2%), excisional endometriosis surgery 354 cases (28%), adnexal surgery 177 cases (13.9%), adhesiolysis 75 cases (5.9%), and miscellaneous cases 15 (1.2%). Overall major complications in terms of bowel, urologic, or major vessel injuries accounted for 8 cases (0.6%). There were 4 injuries of the bowel, 2 injuries to the bladder, and 2 injuries to ureters. There were no major vessel injuries. There were no injuries associated with primary trocar or Veres needle insertion. The most common perioperative morbidity reported was the requirement for blood transfusion (11 cases [0.9%]), and the second most common was venous thromboembolism (4 patients [0.3%]). Six (0.5%) cases were converted to laparotomy, 2 as a result of a complication and 4 for technical reasons. Six of the 8 complications were managed laparoscopically, and a multidisciplinary input was sought only in 4 of the 8 complications. CONCLUSIONS Despite the advanced nature of laparoscopic procedures performed by our group, the complication rate and conversion to laparotomy remain low. There is an increasing feasibility to perform traditional open operations laparoscopically. An increasing number of these complications are now being managed laparoscopically by the gynecologist.
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Affiliation(s)
- Keith Johnston
- Sydney Women's Endosurgery Centre, St George Private Hospital, Kogarah, New South Wales, Sydney, Australia.
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Chang WC, Hsu WC, Sheu BC, Huang SC, Torng PL, Chang DY. Minimizing bladder injury in laparoscopically assisted vaginal hysterectomy among women with previous cesarean sections. Surg Endosc 2007; 22:171-6. [PMID: 17522923 DOI: 10.1007/s00464-007-9404-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2007] [Revised: 02/19/2007] [Accepted: 03/14/2007] [Indexed: 02/07/2023]
Abstract
BACKGROUND This study demonstrated a method to prevent bladder injury during laparoscopically assisted vaginal hysterectomy (LAVH) to patients with vesicocervical adhesion after previous cesarean deliveries. METHODS Between July 2004 and July 2005, 50 women with vesicocervical adhesion who had given birth by cesarean delivery underwent LAVH. To minimize the chance of bladder injury, transvaginal lateral intervention was used to enter the anterior cul-de-sac during laparoscopic intrafascial hysterectomy. The lateral windows of the vesicocervical space were opened first. Usually, the potential spaces lateral to the adhesions could be developed easily by blunt finger dissection. Once adequate lateral spaces were created, an index finger was swept medially to define the margin of the midline adhesions secondary to the cesarean delivery scar. Under direct vision and finger guidance, the dense adhesions were dissected with more confidence and safety. Subsequently, the bladder was pushed gently aside to avert unexpected tearing or injury along the intrafascial hysterectomy. Because the vesico-uterine fold had been cut open previously under laparoscopy, the anterior cul-de-sac could be entered without much resistance. RESULTS The average age of the patients was 45 +/- 7 years, and the extirpated uterine weight was 323 +/- 170.8 g (range, 85-730 g). Intraoperatively, the mean operation time was 124.6 +/- 28.5 min (range, 80-235 min), and the average blood loss was 79.1 +/- 47.8 ml (range, 20-250 ml). The mean intramuscular meperidine requirements were 1.2 +/- 0.8 ampules (range, 0-2 ampules) (1 ampule = 50 mg), and the average hospital stay was 3.2 +/- 0.9 days (range, 2-5 days). Of these 50 patients, 24 (48%) had one, 22 (44%) had two, and 4 (8%) had three previous cesarean deliveries. No bladder injury occurred among the patients, and there was no other complication. CONCLUSION Transvaginal lateral intervention may help to minimize bladder injuries during LAVH for patients with previous cesarean deliveries.
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Affiliation(s)
- W-C Chang
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei, Taiwan
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Liu WM, Wang PH, Chou CS, Tang WL, Wang IT, Tzeng CR. Efficacy of combined laparoscopic uterine artery occlusion and myomectomy via minilaparotomy in the treatment of recurrent uterine myomas. Fertil Steril 2007; 87:356-61. [DOI: 10.1016/j.fertnstert.2006.07.1497] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2006] [Revised: 07/04/2006] [Accepted: 07/04/2006] [Indexed: 11/16/2022]
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Bojahr B, Raatz D, Schonleber G, Abri C, Ohlinger R. Perioperative complication rate in 1706 patients after a standardized laparoscopic supracervical hysterectomy technique. J Minim Invasive Gynecol 2006; 13:183-9. [PMID: 16698522 DOI: 10.1016/j.jmig.2006.01.010] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2005] [Revised: 01/12/2006] [Accepted: 01/16/2006] [Indexed: 11/15/2022]
Abstract
STUDY OBJECTIVE The aim of the study was to determine perioperative morbidity and complication rate after a standardized technique of laparoscopic supracervical hysterectomy (LASH). DESIGN Retrospective analysis of consecutive patients (Canadian Task Force classification II-3). SETTING Private hospital. PATIENTS Seventeen hundred and six consecutive patients with symptomatic uterine myomata, dysfunctional uterine bleeding, dysmenorrhea, or chronic pelvic pain. INTERVENTION Laparoscopic supracervical hysterectomy using a unipolar hook for dissection of the body of the uterus followed by electric morcellation. MEASUREMENTS AND MAIN RESULTS The main indications for LASH were uterine myomata with dysfunctional uterine bleeding (31.1%) or without (45.4%) and therapy-resistant dysfunctional uterine bleeding (21%). The mean uterine weight was 226.4 +/- 193.9 g (95% CI 217.1-235.6), the mean duration of surgery was 91.4 +/- 33.3 minutes (95% CI 89.9-93.0), and the mean duration of hospital stay was 2.15 +/- 0.63 days (95% CI 2.12-2.18). Nine hundred two (52.9%) of the patients had a history of at least one laparotomy. In 14 patients (0.82%), a conversion to laparotomy was necessary. Of these, 11 were due to the size and immobility of the uterus, one was due to severe adhesions, and two because of intraoperative complications. In total, five (0.3%) intraoperative and 20 (1.2%) postoperative complications occurred. The mean weight of the uterus in the five patients with intraoperative complications (three bladder injuries, one ureter injury, and one severe intraoperative bleed) was 818.4 +/- 911.9 g (95% CI -313.9-1950.7). In two patients who suffered trauma to the bladder, there was a history of cesarean sections (two and three, respectively). The most common postoperative complications were bleeding from the cervix and pain caused by adhesions or postoperative infection. CONCLUSION Laparoscopic supracervical hysterectomy is a minimally invasive surgical method that should be regarded as an alternative to all other methods of total hysterectomy in benign conditions of the uterus (uterine myomata, dysfunctional uterine bleeding, uterine adenomyosis) as it is associated with a low perioperative morbidity and a rapid period of convalescence. Of special significance is that LASH can be performed on nulliparous patients, patients who have not previously had vaginal delivery, and patients who have had previous abdominal surgery.
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Affiliation(s)
- Bernd Bojahr
- Clinic for Minimally Invasive Surgery, Minimally Invasive Center, Berlin, Germany.
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Cogan S, Bedaiwy MA, Paraiso MFR, Biscotti C. Healing patterns of bladder injuries incurred at laparoscopic hysterectomy: a histologic assessment. Int Urogynecol J 2006; 18:49-52. [PMID: 16547685 DOI: 10.1007/s00192-006-0093-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2005] [Accepted: 02/02/2006] [Indexed: 10/24/2022]
Abstract
The objective of this study was to describe histologic healing patterns of bladder injuries during laparoscopic hysterectomy. This was a prospective experimental analysis (Canadian Task Force classification II-1) performed at the Cleveland Clinic Foundation, Minimally Invasive Surgery Center animal laboratory using virgin female mongrels. Sixteen animals divided into groups of four underwent laparoscopic hysterectomy and bladder injury. In group 1, the bladder injury consisted of a 1-cm bladder base injury with bipolar electrosurgical current. In group 2, suture placement through full thickness bladder was performed during closure of the vaginal cuff. A 1-cm bladder base laceration with monopolar cautery was induced and repaired laparoscopically in group 3; group 4 underwent a similar injury to that of group 3 but the repair incorporated full thickness anterior vaginal cuff. Animals were euthanized at least 28 days after the surgery; the bladders and vaginas were harvested en bloc for histologic tissue preparation. Histologic qualifications of inflammation, fibrosis, granuloma formation, necrosis, cautery artifact, granulation tissue, the presence of arteritis, recanalization thrombus, foreign body giant cells, and fistula formation were evaluated at the sites of bladder injury. When analyzed separately, the difference in these post-injury histologic manifestations was not statistically significant. The same was true when comparison was made between groups 1 and 2 (no bladder laceration) vs groups 3 and 4 (monopolar-induced bladder base lacerations). After a healing period of at least 28 days, the histologic manifestations of the various bladder injuries in all groups are similar.
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Affiliation(s)
- Stephanie Cogan
- Department of Obstetrics and Gynecology, The Cleveland Clinic Foundation, 9500 Euclid Avenue, A81, Cleveland, OH, USA
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Gruber IV, Frank V, Wischnewsky M, De Wilde R, Kolmorgen K, Neis KJ, Hucke J, Mettler L, Wallwiener D, Schmidt EH. Komplikationen der gynäkologischen Endoskopie. GYNAKOLOGE 2005. [DOI: 10.1007/s00129-005-1766-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Chang WC, Huang SC, Sheu BC, Chen CL, Torng PL, Hsu WC, Chang DY. Transvaginal Hysterectomy or Laparoscopically Assisted Vaginal Hysterectomy for Nonprolapsed Uteri. Obstet Gynecol 2005; 106:321-6. [PMID: 16055582 DOI: 10.1097/01.aog.0000171106.39216.17] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND To define a rational guideline for the use of either laparoscopically assisted vaginal hysterectomy (LAVH) or transvaginal hysterectomy in dealing with a nonprolapsed uterus. METHODS A total of 452 patients receiving LAVH or transvaginal hysterectomy were retrospectively studied between October 2002 and October 2004. The operative time, estimated blood loss, uterine weight, and complications were all recorded for analysis. RESULTS Significant linear correlations of uterine weight with operative time and estimated blood loss could be seen only in the transvaginal hysterectomy group. Transvaginal hysterectomy required significantly shorter operative time, but longer duration when the uterine weight exceeded 350 g. These 452 patients were stratified into 4 subgroups according to the uterine weight and hysterectomy procedure. Data are expressed as the mean +/- standard deviation. For uterine weight less than 350 g, transvaginal hysterectomy had significantly shorter operative time than LAVH (80 +/- 27 minutes compared with 118 +/- 21 minutes, P < .05) but similar blood loss (70 mL compared with 74 mL). For uterine weight 350 g or less, transvaginal hysterectomy had not only significantly longer operative time (139 +/- 30 minutes compared with 118 +/- 17 minutes, P < .05) but also more blood loss (242 +/- 162 mL compared with 66 +/- 51 mL, P < .05) than LAVH. CONCLUSION In view of the shorter operative time and less blood loss, LAVH is preferable for uterine weight 350 g or more, whereas transvaginal hysterectomy is better in dealing with uteri weighing less than 350 g.
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Affiliation(s)
- Wen-Chun Chang
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan
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Lin ACM, Wu CC, Wang TL, Chang H. An unusual cause of volvulus: The misplaced suprapubic catheter. J Emerg Med 2005; 28:219-20. [PMID: 15707821 DOI: 10.1016/j.jemermed.2004.10.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2003] [Revised: 08/18/2004] [Accepted: 10/01/2004] [Indexed: 11/28/2022]
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Papaioannou S, Bourdrez P, Varma R, Afnan M, Mol BWJ, Coomarasamy A. Tubal evaluation in the investigation of subfertility: A structured comparison of tests. BJOG 2004; 111:1313-21. [PMID: 15663113 DOI: 10.1111/j.1471-0528.2004.00403.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Wang PH. Tuberculous Peritonitis Should Always be Considered as a Differential Diagnosis in Abdominal Carcinomatosis. Taiwan J Obstet Gynecol 2004. [DOI: 10.1016/s1028-4559(09)60083-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Gomez RG, Ceballos L, Coburn M, Corriere JN, Dixon CM, Lobel B, McAninch J. Consensus statement on bladder injuries. BJU Int 2004; 94:27-32. [PMID: 15217426 DOI: 10.1111/j.1464-410x.2004.04896.x] [Citation(s) in RCA: 141] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Ostrzenski A, Radolinski B, Ostrzenska KM. A review of laparoscopic ureteral injury in pelvic surgery. Obstet Gynecol Surv 2004; 58:794-9. [PMID: 14668660 DOI: 10.1097/01.ogx.0000097781.79401.0b] [Citation(s) in RCA: 121] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The objective of this study was to review the body of literature in reference to ureteral injury during laparoscopic surgeries and to determine: 1) the reported rates of ureteral injury; 2) the initial laparoscopic surgeries during which ureteral injury occurred; 3) the time of injury recognition (intra- versus postoperative); 4) the type, 5) the location, and 6) the mode of injury repair; and 7) the surgical laparoscopic instruments involved in ureteral injury. The appropriate medical subject heading (MSH) terms were selected and used in a search of the Medline computerized database and the online American College of Obstetricians and Gynecologists database. World literature published in the English language on ureteral injury during laparoscopic surgery between 1966 and 2003 was reviewed.A total of 70 reported instances of ureteral injury during laparoscopic surgery were identified among 2491 reported cases in which ureteral laparoscopic complications were discussed. Incidences of injury ranged from <1% to 2%. These 2491 cases of laparoscopy were presented as a mixed group, which included case reports, small series of studies, as well as longer, consecutive studies. In 18 of the 70 (25.7%) cases, the initial laparoscopic procedures during which ureteral injury occurred were not described or specified. In cases in which the type of laparoscopic surgery was specified, 14 of the 70 (20.0%) total cases of ureteral injury occurred during laparoscopically assisted vaginal hysterectomy (LAVH). Ureteral injury was identified intraoperatively in 6 of 70 (8.6%) cases, postoperatively in 49 of 70 (70.0%) cases, and, in 15 of 70 (21.4%) cases, the time of diagnosis was not specified. In 36 of the 70 (51.4%) reported injuries, the type of injury was not specified or described. In instances in which the types of injury were described, transection occurred most commonly, accounting for 14 of 70 (20.0%) injuries. The location of ureteral injury was not specified in 46 of the 70 (65.7%) cases. When location was specified, injuries most often occurred at or above the pelvic brim, accounting for 10 of the total 70 (14.3%). Electrocautery was involved in 17 of the 70 (24.3%) cases of ureteral injury, but in 34 of the 70 (48.6%) cases, the surgical laparoscopic instrument involved was not reported. A laparotomy was used to repair the ureteral injury in 43 of 70 (61.4%) cases.Ureteral injuries reported in peer-reviewed journals often lack detailed presentation of the initial laparoscopic surgeries during which ureteral injury occurred, or of the type, the location, and the instrumentation involved in ureteral injury. A high incidence of ureteral injury was found among the laparoscopic procedures analyzed in this review. Laparoscopically-assisted vaginal hysterectomy was the leading procedure in which injury occurred, and instruments involved in electrocoagulation were associated with the most injuries incurred during laparoscopic surgery.
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Abstract
OBJECTIVES To evaluate technique, complication rates, postoperative pain scores, and clinical outcomes in dogs after laparoscopic ovariohysterectomy (LOVH) or traditional ovariohysterectomy (OVH). STUDY DESIGN Prospective clinical trial. ANIMALS OR SAMPLE POPULATION Thirty-four intact female dogs, weighing 2.4-31 kg. METHODS LOVH (16 dogs) was performed by ligation of the uterus and ovaries with surgical wire, and then removal by an assisted laparoscopic technique. OVH was performed in 18 dogs. Subjective and objective pain scores were assigned at 0, 2, 8, and 24 hours. Surgical time, complications, and pain and incision scores were evaluated. Dogs were followed for up to 6 months. RESULTS The mean surgical time for LOVH (120 minutes; range, 47-175 minutes) was significantly longer than for OVH (69 minutes; range, 25-140 minutes). Significantly lower pain scores (subjective, in 2 of 10 categories; objective, in 8 of 10 categories) were identified with LOVH at 1 or more time periods. Surgical complications with LOVH were postoperative fever and anorexia (1 dog), minor splenic (3) or pedicle hemorrhage (4), intermittent vaginal hemorrhagic discharge (1), and suture reaction (3). Surgical complications with OVH were hemorrhage from an ovarian pedicle requiring reoperation (1 dog), dehiscence of the abdominal wall (1), and seroma (1). Anesthetic complications included hypotension in 8 OVH dogs and 1 LOVH dog, and hypothermia in 4 OVH and 9 LOVH dogs. The mean incision scores were lower for LOVH at all time periods. CONCLUSION LOVH was performed successfully in young nonparous dogs >10 kg. Surgical time and complication rates were greater; however, LOVH postoperative pain scores were < or =OVH scores. CLINICAL RELEVANCE LOVH is a potentially safe surgical alternative to traditional OVH in dogs. Equipment cost and necessity for more than 1 surgeon may limit its usefulness in small animal practice.
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Affiliation(s)
- Ellen B Davidson
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Oklahoma State University, Stillwater, OK 74078, USA.
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40
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Jones KD, Fan A, Sutton C. Safe entry during laparoscopy: a prospective audit in a district general hospital. ACTA ACUST UNITED AC 2003. [DOI: 10.1046/j.1365-2508.2002.00498.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Kruger PS, Whiteside RS. Pseudo-renal failure following the delayed diagnosis of bladder perforation after diagnostic laparoscopy. Anaesth Intensive Care 2003; 31:211-3. [PMID: 12712789 DOI: 10.1177/0310057x0303100214] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We present a case of bladder injury as a complication of gynaecological laparoscopic surgery. A young female presented with peritonitis, an acute systemic inflammatory response and biochemical features of acute renal failure secondary to urinary peritonitis. Laparotomy with drainage of urine from the peritoneal cavity and repair of the bladder perforation resulted in rapid resolution of the biochemical abnormalities.
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Affiliation(s)
- P S Kruger
- Department of Anaesthesia and Intensive Care, Ipswich Hospital, Ipswich, Queensland
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Brosens I, Gordon A, Campo R, Gordts S. Bowel injury in gynecologic laparoscopy. THE JOURNAL OF THE AMERICAN ASSOCIATION OF GYNECOLOGIC LAPAROSCOPISTS 2003; 10:9-13. [PMID: 12554987 DOI: 10.1016/s1074-3804(05)60227-7] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
STUDY OBJECTIVE To review surveys of the last decade on bowel injuries to evaluate the prevalence, causes, management, and outcomes of these events occurring during or as a result of laparoscopy. DESIGN Retrospective evaluation (Canadian Task Force classification II-2). SETTING Surveys and databases. PATIENTS None. INTERVENTION Data analysis. MEASUREMENTS AND MAIN RESULTS Combined data show that diagnostic and minor operative laparoscopy are associated with a 0.08% risk of bowel injury, and in major operative laparoscopy the risk increases to 0.33%. Injuries occurring during access and operative procedure decrease significantly with experience, but even in experienced hands injury during access cannot be avoided. Delayed diagnosis remains a major problem. Up to 15% of these injuries are not diagnosed during laparoscopy, and one of five cases of delayed diagnosis results in death. Perioperative diagnosis and immediate repair by laparoscopy or laparotomy reduce the likelihood of severe complications and consequently medicolegal actions. CONCLUSIONS Several surveys on complications of gynecologic laparoscopy tend to underestimate the risk of bowel injury. Prevention starts by awareness that such injury is an inherent risk of the technique, even in hands of experienced surgeons.
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Affiliation(s)
- Ivo Brosens
- Leuven Institute for Fertility and Embryology, Tiensevest 168, B-3000 Leuven, Belgium
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Chou YC, Wang PH, Yuan CC, Yen YK, Liu WM. Laparoscopic bipolar coagulation of uterine vessels to manage delayed postpartum hemorrhage. THE JOURNAL OF THE AMERICAN ASSOCIATION OF GYNECOLOGIC LAPAROSCOPISTS 2002; 9:541-4. [PMID: 12386370 DOI: 10.1016/s1074-3804(05)60533-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Postpartum hemorrhage (PPH) is a big challenge for obstetricians. Fertility-preserving procedures are encouraged, especially in young women. Bilateral hypogastric (internal iliac) artery ligation, bilateral uterine artery ligation after vaginal delivery or after cesarean delivery, and uterine artery embolization are well documented vascular occlusive methods for treating PPH. To our knowledge, the laparoscopic approach to uterine artery ligation has not been reported. A 29-year-old woman experienced delayed PPH. Although curettage of the uterine cavity to remove retained placenta was performed, bleeding did not stop. We successfully performed a relatively new method--laparoscopic bipolar coagulation of uterine vessels--to stop bleeding and preserve the uterus.
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Affiliation(s)
- Yu-Ching Chou
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, 201, Section 2, Shih-Pai Road, Taipei 112, Taiwan
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Yang CC, Chen P, Tseng JY, Wang PH. Advantages of open laparoscopic surgery over exploratory laparotomy in patients with tubo-ovarian abscess. THE JOURNAL OF THE AMERICAN ASSOCIATION OF GYNECOLOGIC LAPAROSCOPISTS 2002; 9:327-32. [PMID: 12101330 DOI: 10.1016/s1074-3804(05)60412-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
STUDY OBJECTIVE To compare laparoscopic surgery and conventional laparotomy in managing patients with tubo-ovarian abscess (TOA). DESIGN Retrospective study (Canadian Task Force classification II-2). SETTING Regional hospital. PATIENTS Sixty-nine women with clinically suspicious TOA. INTERVENTION Operative laparoscopy or laparotomy. MEASUREMENTS AND MAIN RESULTS Laparoscopic surgery in 19 women had significant advantages over laparotomy in 37 women. It decreased hospital stay (5.37 +/-1.38 days vs 8.92 +/- 2.59 days, p = 0.0001), had a lower percentage of wound infections, and had a shorter time for fever to subside (25.79 +/- 11.45 vs 39.46 +/- 17.47 hrs, p = 0.003). CONCLUSION Although management of TOA consists of conservative medical treatment with antibiotics, it is now widely accepted that surgical intervention should be pursued early after the diagnosis. Open laparoscopy seems to be a good alternative to traditional laparotomy in managing these patients.
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Affiliation(s)
- Chih-Chun Yang
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, 201, Section 2, Shih-Pai Road, Taipei 112, Taiwan
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