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Abstract
If it is medically necessary to perform nonobstetrical abdominal surgery in pregnancy, a minimally invasive approach should be considered. The benefits of laparoscopy are well known and current studies promote the safety of laparoscopy in pregnancy, when certain guidelines are followed. This article will review the safety of surgery in pregnancy, maternal physiology, fetal considerations, maternal obesity, laparoscopic cerclage, large adnexal mass, and complications. Guidelines for surgery will be reviewed as well.
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Yanari S, Suto T, Fujiwara H, Ariyoshi Y, Umemura A, Sasaki A. Intraperitoneal onlay mesh repair (IPOM) plus technique using a hybrid procedure of open laparotomy and laparoscopic approach (hybrid IPOM plus) for incarceration of umbilical hernia in a severely obese patient: a case report. Surg Case Rep 2020; 6:83. [PMID: 32337655 PMCID: PMC7183571 DOI: 10.1186/s40792-020-00845-6] [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: 01/30/2020] [Accepted: 04/15/2020] [Indexed: 12/03/2022] Open
Abstract
Background A standard procedure for the treatment of incarcerated umbilical hernia among severely obese patients has yet to be established. We used the hybrid intraperitoneal onlay mesh repair (IPOM) plus method, which combines open and laparoscopic surgery to treat incarcerated umbilical hernia in a severely obese patient. Case presentation A 46-year-old man presented in our department with a chief complaint of a painful mass in the umbilical region. Incarcerated umbilical hernia was diagnosed on the basis of abdominal computed tomography, and the decision was made to perform emergency surgery. The patient was severely obese (body mass index, 53.8 kg/m2), and the incarcerated portion of the hernia was therefore first addressed by open surgery. As bowel resection was unnecessary, the risk of infection was considered low, and after direct closure of the hernia orifice, IPOM was performed laparoscopically using the hybrid IPOM plus method. Conclusion Among severely obese patients, first trocar insertion is difficult and the wound site tends to come under strain, meaning that simple closure of the hernia orifice results in a high recurrence rate. The hybrid IPOM plus method used in this case combines open surgery and laparoscopy and appears useful for treating uninfected incarcerated umbilical hernia in severely obese patients safely and with an anticipated low rate of postoperative recurrence.
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Affiliation(s)
- Shingo Yanari
- Department of Surgery, Morioka Municipal Hospital, 5-15-1 Motomiya, Morioka, Iwate, 020-0866, Japan
| | - Takayuki Suto
- Department of Surgery, Morioka Municipal Hospital, 5-15-1 Motomiya, Morioka, Iwate, 020-0866, Japan.
| | - Hisataka Fujiwara
- Department of Surgery, Morioka Municipal Hospital, 5-15-1 Motomiya, Morioka, Iwate, 020-0866, Japan
| | - Yu Ariyoshi
- Department of Surgery, Morioka Municipal Hospital, 5-15-1 Motomiya, Morioka, Iwate, 020-0866, Japan
| | - Akira Umemura
- Department of Surgery, Iwate Medical University School of Medicine, 1-1-1 Idaidori, Yahaba-cho, Shiwa-gun, Iwate, 028-3694, Japan
| | - Akira Sasaki
- Department of Surgery, Iwate Medical University School of Medicine, 1-1-1 Idaidori, Yahaba-cho, Shiwa-gun, Iwate, 028-3694, Japan
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Yong PJ, Thurston J, Singh SS, Allaire C. Guideline No. 386-Gynaecologic Surgery for Patients with Obesity. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 41:1356-1370.e7. [DOI: 10.1016/j.jogc.2018.12.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Yong PJ, Thurston J, Singh SS, Allaire C. Directive clinique No 386 - Chirurgie gynécologique chez les patientes obèses. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 41:1371-1388.e7. [PMID: 31443851 DOI: 10.1016/j.jogc.2019.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Hackethal A, Brennan D, Rao A, Land R, Obermair A, Nicklin J, Garrett A, Nascimento M, Crandon A, Perrin L, Chetty N. Consideration for safe and effective gynaecological laparoscopy in the obese patient. Arch Gynecol Obstet 2014; 292:135-41. [DOI: 10.1007/s00404-014-3600-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Accepted: 12/11/2014] [Indexed: 12/22/2022]
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Tinelli A, Malvasi A, Mynbaev OA, Tsin DA, Davila F, Dominguez G, Perrone E, Nezhat FR. Bladeless direct optical trocar insertion in laparoscopic procedures on the obese patient. JSLS 2014; 17:521-8. [PMID: 24398192 PMCID: PMC3866054 DOI: 10.4293/108680813x13693422519398] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Results of the study suggest that direct optical entry technique reduced entry time and blood loss with trends to slightly decrease the occurrence of minor vascular and bowel injuries in obese women. Background: Recently, we have shown advantages of a direct optical entry (DOE) using a bladeless trocar in comparison with the open Hasson technique (OHT) in older reproductive-age women with previous operations, as well as in comparison with Veress needle entry in reproductive-age and postmenopausal women. Objectives: A prospective multicenter randomized study to determine whether the DOE is feasible for establishing safe and rapid entry into the abdomen in comparison with those of the OHT in reproductive-age obese women. Methods: Two types of surgical techniques were blindly applied in 224 obese reproductive-age women with benign neoplastic diseases of ovary and uterus. Namely, laparoscopic entry into the abdomen in 108 patients was performed by DOE and in 116 women by OHT. Following parameters (entry time in seconds needed to establish the intra-abdominal vision after pneumoperitoneum, blood loss, occurrence of vascular and/or bowel injuries) were compared during surgery as main outcomes. Results: Main baseline characteristics of patients, including age (36.1 ± 4.5 vs 35.7 ± 5.8), body mass index (34.9 ± 5.1 vs 35.1 ± 4.9 kg/m2), and parity (2.1 ± 0.4 vs 1.9 ± 0.9), were not significantly different between the DOE and OHT groups (P > .05). While intraoperative parameters such as the entry time (71.9 ± 3.7 vs 215.1 ± 6.2 seconds) and blood loss value (9.7 ± 6.1 vs 12.2 ± 2.9 mL) were significantly reduced in the DOE group in comparison with those of OHT group (respectively, P < .0001 and < .01), there were also trends to slight decrease of the occurrence of the minor injuries, manifested as omental small vessels rupture (0 of 108 vs 4 of 116) and punctures and pinches of jejunal serosa (0 of 108 vs 3 of 116) in patients of the DOE group in comparison with those of OHT group (respectively, P = .0515 and = .0925). Conclusions: DOE reduced entry time and blood loss with trends to slightly decrease of the occurrence of the minor vascular and bowel injuries, thus enabling a possible alternative to OHT in obese women; however, further larger trials need to confirm the possible additional benefits of a DOE.
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Affiliation(s)
- Andrea Tinelli
- Department of Obstetrics and Gynecology, Division of Experimental Endoscopic Surgery, Imaging, Technology and Minimally Invasive Therapy, Vito Fazzi Hospital, Piazza Muratore, 73100 Lecce, Italy.
| | - Antonio Malvasi
- Department of Obstetrics and Gynaecology, Santa Maria Hospital, Bari, Italy
| | - Ospan A Mynbaev
- Experimental Researches and Modeling Division, Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - Daniel Alberto Tsin
- Department of Gynecology, Division of Minimal Invasive Endoscopy, The Mount Sinai Hospital of Queens, New York, NY, USA
| | - Fausto Davila
- Hospital Regional de Poza Rica, Sesver, Monterrey, Mexico
| | | | - Emanuele Perrone
- Department of Gynecology and Obstetrics, University of Perugia, Perugia, Italy
| | - Farr R Nezhat
- Columbia University College of Physicians and Surgeons, New York, NY, USA, Division of Gynecologic Oncology and the Department of Obstetrics and Gynecology, St. Luke's-Roosevelt Hospital Center, New York, NY, USA
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Ozdemir A, Gungorduk K, Ulker K, Yasar L, Ertas IE, Gokcu M, Solmaz U, Sanci M. Umbilical stalk elevation technique for safer Veress needle insertion in obese patients: a case-control study. Eur J Obstet Gynecol Reprod Biol 2014; 180:168-71. [PMID: 25027266 DOI: 10.1016/j.ejogrb.2014.06.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 06/09/2014] [Accepted: 06/13/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The purpose of this retrospective study was to compare our umbilical stalk elevation (USE) technique with the classic Veress needle (VN) technique in obese patients. STUDY DESIGN The USE technique was performed on 40 patients. One control per case was randomly selected from among those undergoing the classic VN technique using a random number table. In USE technique, a 12 mm skin incision was created at the superior crease of the umbilical fold, and the underlying subcutaneous adipose tissue was bluntly dissected using the tip of a fine clamp until the umbilical stalk was isolated at the inferior and central part of the incision. Next, the umbilical stalk was covered and held by a towel clip, and the abdominal wall was elevated by upward traction. The VN was then inserted nearly perpendicular to the incision and turned toward the pelvis immediately after resistance to the needle had been lost. A post-hoc power analysis was performed. RESULTS The number of attempts was significantly lower in the USE laparoscopy group than in the classic laparoscopy group (1.2 ± 0.4 vs. 2.1 ± 0.7, respectively; P<0.001). The USE technique group had a slightly shorter abdominal entry time than did the classic technique group (328.52 ± 63.71 vs. 434.95 ± 124.10s; P<0.001). Six (7.5%) failed insufflations occurred in our study (5 patients in the classic group vs. 1 patient in the USE group (P=0.10). CONCLUSION Our novel USE technique can be an effective means of establishing pneumoperitoneum in obese patients undergoing gynecologic laparoscopic procedures.
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Affiliation(s)
- Aykut Ozdemir
- Department of Gynecologic Oncology, Tepecik Education and Research Hospital, Izmir, Turkey.
| | - Kemal Gungorduk
- Department of Gynecologic Oncology, Tepecik Education and Research Hospital, Izmir, Turkey
| | - Kahraman Ulker
- Department of Obstetrics and Gynecology, Kafkas University School of Medicine, Kars, Turkey
| | - Levent Yasar
- Department of Obstetrics and Gynecology, Bakırkoy Dr. Sadi Konuk Education and Research Hospital, Istanbul, Turkey
| | - Ibrahim Egemen Ertas
- Department of Gynecologic Oncology, Tepecik Education and Research Hospital, Izmir, Turkey
| | - Mehmet Gokcu
- Department of Gynecologic Oncology, Tepecik Education and Research Hospital, Izmir, Turkey
| | - Ulas Solmaz
- Department of Gynecologic Oncology, Tepecik Education and Research Hospital, Izmir, Turkey
| | - Muzaffer Sanci
- Department of Gynecologic Oncology, Tepecik Education and Research Hospital, Izmir, Turkey
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Laparoscopy in the Morbidly Obese: Physiologic Considerations and Surgical Techniques to Optimize Success. J Minim Invasive Gynecol 2014; 21:182-95. [DOI: 10.1016/j.jmig.2013.09.009] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2013] [Revised: 09/26/2013] [Accepted: 09/26/2013] [Indexed: 01/13/2023]
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Laparoscopy in the morbidly obese pregnant patient using a modified foley lap-lift technique: case report. J Minim Invasive Gynecol 2011; 18:538-40. [PMID: 21777848 DOI: 10.1016/j.jmig.2011.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2011] [Revised: 04/01/2011] [Accepted: 04/19/2011] [Indexed: 11/24/2022]
Abstract
Obesity in women of reproductive age is increasing. Gynecologic laparoscopy in the morbidly obese pregnant patient presents challenges, and is not often attempted. Herein is reported a successful case using a modified Foley lap-lift technique, which improved visualization and facilitated mechanical ventilation.
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Abstract
The first laparoscopic surgery in pregnancy was a cholecystectomy in 1991. Since that time, a number of articles and case series have been published addressing laparoscopy in pregnancy. Current recommendations are on the basis of these findings, such as operating during any trimester in pregnancy can be safely performed, fetal heart monitoring should be made preoperatively and postoperatively, prophylactic tocolytics should not be used, and multiple entry techniques (Veress needle, Hasson trocar, or optical trocar) can be safely performed. This article will review anesthesia, fetal effects, obesity, complications, adnexal masses, and gastrointestinal issues.
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Affiliation(s)
- Lubna Chohan
- Department of Obstetrics, Gynecology, and Reproductive Sciences, The University of Texas Medical School, Houston, Texas, USA.
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Bashirov E, Cetiner S, Emre M, Seydaliyeva T, Alic V, Daglioglu K, Ozalevli M, San M, Topcuoglu MS. A randomized controlled study evaluating the effects of the temperature of insufflated CO2 on core body temperature and blood gases (an experimental study). Surg Endosc 2007; 21:1820-5. [PMID: 17516120 DOI: 10.1007/s00464-007-9295-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2006] [Accepted: 12/24/2006] [Indexed: 11/24/2022]
Abstract
BACKGROUND Heated carbon dioxide (CO2) was used for pneumoperitoneum (Pp) to prevent hypothermia. This study aimed to investigate the relationship between the temperature of the insufflated CO2 and blood gases together with the core body temperature (CBT). METHODS A prospective controlled study was performed with 24 pigs weighing approximately 20 kg randomized into four groups of 6 pigs each. A pneumoperitoneum at 12 mmHg of pressure was applied for 60 min with the pig under general anesthesia. The CO2)temperature was 22 degrees C in group 1, 37 degrees C in group 2, and 7 degrees C in group 3. In the "sham" group, pneumoperitoneum was not applied. Arterial blood pH and partial pressure of CO2 (PaCO2) were analyzed before insufflation, every 15 min during the pneumoperitoneum, and 15 min after the desufflation. The CBT was recorded before the insufflation, every 20 min during pneumoperitoneum, and 20 min after the desufflation. Blood gas analyses and CBT records for the "sham" group were performed at the same intervals. RESULTS Arterial blood pH gradually decreased during pneumoperitoneum. At the 60th minute of pneumoperitoneum, a minimum decrease in arterial blood pH (0.04; p = 0.027) and a minimum increase in PaCO2 (3.67; p = 0.027) were recorded in group 3, whereas a maximum decrease in arterial blood pH (0.18; p = 0.027) and a maximum increase in PaCO2 (17.17; p = 0.027) were recorded in group 2. There was a significant negative correlation between PaCO2 and arterial blood pH in all the groups (r = -0.993; p < 0.01). The mean values of CBT decreases were statistically significant in all the groups: group 1 (p = 0.023), group 2 (p = 0.026), group 3 (p = 0.026), and "sham" group (p = 0.024). CONCLUSIONS The changes in PaCO2 were directly proportional and the changes in pH contrarily proportional to the temperature of the insufflated CO2. Significant differences in CBT decreases were found between the groups receiving heated gas and room temperature gas and the groups receiving heated gas and gas below room temperature.
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Affiliation(s)
- E Bashirov
- Department of General Surgery, Mustafa Kemal University School of Medicine, Bagriyanik mah., 31100, Antakya, Hatay, Turkey.
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