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García-Cabra DA, Montoya-Alvarez S, Ordorica-Flores RM, Ochoa-Toledo L, Lorias-Espinoza D, Pérez-Escamirosa F. Novices' learning curve in single-port surgery using three surgical training programs. MINIM INVASIV THER 2024; 33:90-101. [PMID: 38109095 DOI: 10.1080/13645706.2023.2293917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 11/15/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND The objective of this study was to evaluate the novices' learning curves and proficiency level reached in laparoendoscopic single-site (LESS) surgery using three surgical training programs. MATERIAL AND METHODS Participants were randomly divided into three groups, who trained in a specific practice regimen for 12 days using a laparoscopic box simulator and three tasks. Group A trained in three stages using conventional laparoscopic surgery (CLS) with straight instruments, and LESS with straight and articulating instruments for four days each. Group B trained in two stages in LESS with straight and articulating instruments for six days each. Group C trained only in LESS with articulating instruments exclusively for all 12 days. Performance was registered daily during the 12 days to evaluate the participants' progress. RESULTS Pre- and post-training analysis of the three groups showed significant differences in performance, denoting the significant improvement in their LESS skills, with no difference between the groups. Group C reached a high level of technical competence with their specific training program in LESS, obtaining a lower asymptote and slow learning rate. CONCLUSION Specific training programs in LESS settings using articulated instruments showed a slower learning rate than the other programs but better proficiency in the technique with the best surgical performance.
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Affiliation(s)
- Damaris Areli García-Cabra
- Instituto de Ciencias Aplicadas y Tecnología (ICAT), Universidad Nacional Autónoma de México (UNAM), Ciudad de México, México
- Facultad de Medicina, Universidad Veracruzana, Managua, Veracruz, México
| | - Salvador Montoya-Alvarez
- Sección de Bioelectrónica, Departamento de Ingeniería Eléctrica, Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional (CINVESTAV-IPN), Ciudad de México, México
| | | | - Luis Ochoa-Toledo
- Instituto de Ciencias Aplicadas y Tecnología (ICAT), Universidad Nacional Autónoma de México (UNAM), Ciudad de México, México
| | - Daniel Lorias-Espinoza
- Sección de Bioelectrónica, Departamento de Ingeniería Eléctrica, Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional (CINVESTAV-IPN), Ciudad de México, México
| | - Fernando Pérez-Escamirosa
- Instituto de Ciencias Aplicadas y Tecnología (ICAT), Universidad Nacional Autónoma de México (UNAM), Ciudad de México, México
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2
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He H, Li T, Cui M, Jiang Q, Jiang F, Li M, Liu Y. Effect of two different laparoscopic techniques on post-operative wound complications in patients with benign gynaecological diseases: A meta-analysis. Int Wound J 2023; 21:e14382. [PMID: 37830298 PMCID: PMC10828522 DOI: 10.1111/iwj.14382] [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: 08/07/2023] [Revised: 08/23/2023] [Accepted: 08/24/2023] [Indexed: 10/14/2023] Open
Abstract
Single-port laparoscopy (SPL) has existed for several years. This meta-analysis was conducted to evaluate the efficacy of SPL compared with conventional laparoscopy (CL) in the treatment of benign gynecologic adnexal lesions. The purpose of this meta-analysis is to evaluate the superiority of SPL versus CL in the treatment of post-operative wound pain. The study looked for English-language publications from PubMed, Embase, Cochrane Library and the Web of Science until June 2023. The main result was the visual analogue scale (VAS) after 2, 4, 6, 8, 12, 24 and 48 h after operation. The paper contains 10 related papers by means of e-search. Of these, 4 were randomized controlled trials (RCTs), while 6 were non-RCTs. The results indicated that SPL and CL were significantly different after 2, 24 and 48 h after operation. SPL had lower post-operative pain after 2 h compared with CL (MD, -0.6; 95% CI, -0.98, -0.21; p = 0.002). After the operation, SPL also had a lower incidence of post-operative pain after 24 h compared with CL (MD, -0.59; 95% CI, -1.12, -0.06; p = 0.03). And the difference in pain was at 48 h after the most significant (MD, -0.49; 95% CI, -0.75, -0.23; p = 0.0002). But after 6, 8 and 12 h after operation, there was no significant difference in the degree of pain. Thus, SPL operations may result in a lower degree of pain than CL in both the post-operative and far post-operative phase.
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Affiliation(s)
- Haining He
- Department of Gynaecology and Obstetrics, Sichuan Provincial People's Hospital, School of MedicineUniversity of Electronic Science and Technology of ChinaChengduChina
| | - Tinglan Li
- People's Hospital of Aba Tibetan and Qiang Autonomous PrefectureAbaChina
| | - Manman Cui
- Department of Gynaecology and Obstetrics, Sichuan Provincial People's Hospital, School of MedicineUniversity of Electronic Science and Technology of ChinaChengduChina
| | - Qin Jiang
- Department of Gynaecology and Obstetrics, Sichuan Provincial People's Hospital, School of MedicineUniversity of Electronic Science and Technology of ChinaChengduChina
| | - Fuchuan Jiang
- Department of Gynaecology and Obstetrics, Sichuan Provincial People's Hospital, School of MedicineUniversity of Electronic Science and Technology of ChinaChengduChina
| | - Min Li
- Department of Gynaecology and Obstetrics, Sichuan Provincial People's Hospital, School of MedicineUniversity of Electronic Science and Technology of ChinaChengduChina
| | - Yi Liu
- Department of Gynaecology and Obstetrics, Sichuan Provincial People's Hospital, School of MedicineUniversity of Electronic Science and Technology of ChinaChengduChina
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Chen Y, Zheng Y, Wang P, Wang Q, Yang F, Zhou S. Single-port robotic surgery using the EDGE SP1000 surgical system in gynaecology: Initial experience of a single institution. Int J Med Robot 2023:e2578. [PMID: 37727013 DOI: 10.1002/rcs.2578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 08/22/2023] [Accepted: 09/05/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND The EDGE SP1000 is a newly developed single-port (SP) robotic surgical system whose clinical evaluation in gynaecology has not yet been addressed. METHODS This is a single-arm clinical trial evaluating the perioperative outcomes of patients receiving EDGE SP1000 assisted surgeries. Patients with either benign or malignant gynaecological diseases suitable for robotic surgery were included, and their data were prospectively collected. RESULTS Eighteen patients were included and 8 of them had malignant conditions. The total operative time was 190.1 ± 83.3 min for benign diseases and 254.4 ± 59.4 min for malignant diseases. The mean estimated blood loss was 25 mL (range, 5-100). No assistant ports or conversions were required. No perioperative complications occurred. Overall satisfaction with the umbilical wounds was expressed at the 1-month follow-up. CONCLUSION EDGE SP1000 SP robotic surgical system is technically feasible and safe in various gynaecological surgeries with good cosmetic effects.
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Affiliation(s)
- Yu Chen
- Department of Gynecologic Oncology, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Ying Zheng
- Department of Gynecologic Oncology, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Ping Wang
- Department of Gynecologic Oncology, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Qiao Wang
- Department of Gynecologic Oncology, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Fan Yang
- Department of Gynecologic Oncology, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Shengtao Zhou
- Department of Gynecologic Oncology, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
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4
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Muacevic A, Adler JR, Pajai S, Mohammad S. Laparoendoscopic Single-Site Surgery (LESS): A Shift in Gynecological Minimally Invasive Surgery. Cureus 2022; 14:e32205. [PMID: 36620796 PMCID: PMC9813544 DOI: 10.7759/cureus.32205] [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: 08/18/2022] [Accepted: 12/05/2022] [Indexed: 12/12/2022] Open
Abstract
Laparotomy was once the preferred modality of treatment for various gynecological conditions. However, over the years, with the advancements worldwide, a new technique for surgery, laparoscopy, came into play. Since then, laparoscopy is preferred over laparotomy for diagnostic and therapeutic purposes since it was less invasive than laparotomy. Further advancements include laparoendoscopic single-site surgery (LESS), which is a procedure that, as the name implies, only uses one port. It includes using a single incision near the umbilicus in contrast to laparoscopy, which traditionally includes one main port incision and various other side ports. Through the port, multiple devices can be inserted into the cavity. The use of a single port can reduce post-operative complications and help reduce the duration of hospital stays. A single incision near the umbilicus would not leave a very significant scar, and the wound healing time would be comparatively less, reducing the hospital stay time. This novel technique is, therefore, an amalgamation of traditional surgery and recently surfacing minimally invasive surgery. Other modalities which are being used widely include vaginal natural orifice transluminal endoscopic surgery (vNOTES). Since the ports formed are frequently inconspicuous, these procedures leave patients with "scarless" results.
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Jang TK, Chung H, Kwon SH, Shin SJ, Cho CH. Robotic single-site versus multiport radical hysterectomy in early stage cervical cancer: An analysis of 62 cases from a single institution. Int J Med Robot 2021; 17:e2255. [PMID: 33817949 PMCID: PMC8365681 DOI: 10.1002/rcs.2255] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 03/01/2021] [Accepted: 03/24/2021] [Indexed: 12/09/2022]
Abstract
Background This study aimed to compare the surgical outcomes and cost of robotic single‐site radical hysterectomy (RSSRH) versus robotic multiport radical hysterectomy (RMPRH) with pelvic lymph node dissection in early stage cervical cancer. Methods Sixty‐two patients with early stage cervical cancer were recruited between November 2011 and July 2017 and underwent RSSRH (20 patients) and RMPRH (42 patients) for early stage cervical cancer using the da Vinci Si Surgical System (Intuitive Surgical). Results There were no significant difference between the two groups in most of parameters. However, postoperative hospital discharge and total hospital costs for RSSRH were significantly shorter than RMPRH (both p < 0.001). However, lymph node retrieval of RMPRH was significantly higher than RSSRH in (18.0 vs. 9.5, respectively; p < 0.001). Conclusions RSSRH has comparable surgical outcomes to the RMPRH method. RSSRH could be considered a surgical option in a well‐selected patient group.
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Affiliation(s)
- Tae-Kyu Jang
- Department of Obstetrics and Gynecology, Keimyung University School of Medicine, Daegu, South Korea
| | - Hyewon Chung
- Department of Obstetrics and Gynecology, Keimyung University School of Medicine, Daegu, South Korea
| | - Sang-Hoon Kwon
- Department of Obstetrics and Gynecology, Keimyung University School of Medicine, Daegu, South Korea
| | - So-Jin Shin
- Department of Obstetrics and Gynecology, Keimyung University School of Medicine, Daegu, South Korea
| | - Chi-Heum Cho
- Department of Obstetrics and Gynecology, Keimyung University School of Medicine, Daegu, South Korea
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6
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Gözüküçük M, Karasu Y, Kaya S, Yangır E, Üstün Y. Conventional versus single-incision laparoscopy for the surgical treatment of ovarian torsion. J Minim Access Surg 2021; 18:207-211. [PMID: 35046166 PMCID: PMC8973497 DOI: 10.4103/jmas.jmas_114_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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7
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Pan C, Zhao R, Jiang Y. Is safe and effective LESS in benign adnexal diseases: A systematic review and meta-analysis. INTERNATIONAL JOURNAL OF SURGERY OPEN 2020. [DOI: 10.1016/j.ijso.2020.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
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8
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Robotic single-site staging operation for early-stage endometrial cancer: initial experience at a single institution. Obstet Gynecol Sci 2019; 62:149-156. [PMID: 31139590 PMCID: PMC6520544 DOI: 10.5468/ogs.2019.62.3.149] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 05/28/2018] [Accepted: 11/20/2018] [Indexed: 01/13/2023] Open
Abstract
Objective The aims of this study were to introduce surgical guidelines, and to evaluate the feasibility and safety of a robotic single-site staging (RSSS) operation for early-stage endometrial cancer. Methods Patients with a preoperative diagnosis of endometrial cancer (International Federation of Gynecology and Obstetrics stages IA to IB) from endometrial curettage and preoperative imaging studies were selected at Dongsan Medical Center from March 2014 to November 2015. All surgical procedures, including hysterectomy, salpingo-oophorectomy, bilateral pelvic node dissection, and cytology aspiration, were performed by robotic single-site instruments (da Vinci Si® surgical system; Intuitive Surgical, Sunnyvale, CA, USA). Results A total of 15 women with early-stage endometrial cancer underwent the RSSS operation. The median patient age and body mass index were 53 years (range, 37-70 years) and 25.4 kg/m2 (range, 18.3-46.4 kg/m2). The median docking time, console time, and total operative time were 8 minutes (range, 4-15 minutes), 75 minutes (range, 55-115 minutes), and 155 minutes (range, 125-190 minutes), respectively. The median retrieval of both pelvic lymph nodes was 9 (range, 6-15). There were no conversions to laparoscopy or laparotomy. Conclusion The RSSS operation is feasible and safe in patients with early-stage endometrial cancer. In this study, operative times were reasonable, and the surgical procedure was well-tolerated by the patients. Further evaluation of patients with early-stage endometrial cancer should be performed in large-scale comparative studies using the laparoendoscopic, single-site staging operation to confirm the safety and benefits of the RSSS operation for early-stage endometrial cancer.
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9
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Liu Z, Tian S, Yan Z, Yu X, Li X, Tao Y. Robotic single-site surgery for mature cyst teratoma cystectomy: an initial case series study in a single medical center in China. Ther Clin Risk Manag 2019; 15:179-185. [PMID: 30774353 PMCID: PMC6353228 DOI: 10.2147/tcrm.s176852] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objective To report the first case series of robotic single-site (RSS) surgery via the da Vinci Si Surgical System for mature cyst teratoma cystectomy in China. Materials and methods The study was devised as a retrospective study in a single medical center. Five patients with mature cyst teratomas requested a minimally invasive surgical treatment. These patients were treated with RSS surgery for mature cyst teratoma between January 2014 and January 2015. RSS mature cyst teratoma cystectomies were performed with the da Vinci single-site platform in the Hainan branch of PLA General Hospital. Data regarding patient characteristics, surgical approach, and perioperative clinical outcomes were collected and analyzed in a retrospective study. Results All RSS procedures were completed successfully in the five patients. No instrument failure was noted during the procedures. The median operating time was 65 minutes (range 45–100 minutes). The median docking time was 20 minutes (range 18–28 minutes). No instrument failure was noted during any surgical procedures. The median blood loss was 30 mL (range 10–70 mL). No patient had massive intraoperative bleeding nor required a transfusion. No extra trocar was placed during the surgery. None of the patients had bladder or rectal injury. The median length of stay in hospital was 2.8 days. All patients were followed up until 6 months postoperatively, and no surgical complication occurred. Conclusion RSS mature cyst teratoma cystectomy using the wristed semirigid instrumentation is feasible. Randomized controlled trials with a larger number of patients and longer postoperative follow-up should be conducted to further evaluate the effect of this therapeutic strategy.
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Affiliation(s)
- Zhongyu Liu
- Department of Obstetrics and Gynecology, PLA General Hospital, Beijing 100853, PR China,
| | - Shuang Tian
- Department of Obstetrics and Gynecology, PLA General Hospital, Beijing 100853, PR China,
| | - Zhifeng Yan
- Department of Obstetrics and Gynecology, PLA General Hospital, Beijing 100853, PR China,
| | - Xiurong Yu
- Department of Anesthesia Surgery Center, Hainan Branch of PLA General Hospital, Sanya 572013, PR China
| | - Xiuli Li
- Department of Obstetrics and Gynecology, PLA General Hospital, Beijing 100853, PR China, .,Department of Obstetrics and Gynecology, Hainan Branch of PLA General Hospital, Sanya 572013, PR China,
| | - Ye Tao
- Department of Ophthalmology, PLA General Hospital, Beijing 100853, PR China,
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10
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Akhoondinasab MR, Sadeghi S, Mirzaii-Dizgah I. Tendon Harvest for Treatment of Radial Nerve Palsy Using Endoscopic Technique. World J Plast Surg 2018; 7:332-336. [PMID: 30560073 PMCID: PMC6290315 DOI: 10.29252/wjps.7.3.332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Endoscopic method for many surgeries with minimal access is proposed to be effective for preventing the excessive scar formation, reducing pain, cosmesis, and the early return to work. Surgical outcomes of endoscopic and open methods for tendon harvest in treatment of radial nerve palsy were evaluated. METHODS In a randomized single-blind clinical trial study, 10 patients with radial nerve palsy who referred to the Plastic Surgery Department of the Fatimah Zahra Hospital, Iran University of Medical Sciences, Tehran, Iran were divided into two equal groups. Flexor carpi radialis (FCR), flexor carpi ulnaris (FCU) and the palmaris longus (PL) tendons were harvested by endoscopic or open techniques. The outcomes (tendon harvest time, rate of post-surgical pain, amount of pain medication, patient satisfaction, amount of scar, and length of scar) are measured. RESULTS There was no significant difference in time of surgery between two methods. Vancouver scar scale, cosmetic satisfaction, severity of postoperative pain and also drugs for pain relief after tendon harvest surgery were significantly lower in endoscopic method than open method. CONCLUSION Regarding the low invasiveness, high satisfaction rate of patients, low pain severity, low scar and the little need for opiate to reduce pain in the endoscopic method, endoscopic tendon harvest technique for radial nerve palsy seems to have priority over open method.
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Affiliation(s)
- Mohammad-Reza Akhoondinasab
- Department of Plastic and Reconstructive Surgery, Fatimah Zahra Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Sharyar Sadeghi
- Department of Plastic and Reconstructive Surgery, Fatimah Zahra Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Iraj Mirzaii-Dizgah
- Department of Physiology, School of Medicine, AJA University of Medical Sciences, Tehran, Iran
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Koo YJ. Recent advances in minimally invasive surgery for gynecologic indications. Yeungnam Univ J Med 2018; 35:150-155. [PMID: 31620587 PMCID: PMC6784696 DOI: 10.12701/yujm.2018.35.2.150] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 09/28/2018] [Accepted: 10/01/2018] [Indexed: 12/13/2022] Open
Abstract
Recently, an increasing interest in less invasive surgery has led to the advent of laparoendoscopic single-site surgery (LESS) and natural orifice transluminal endoscopic surgery (NOTES). LESS and NOTES could be technically challenging, but available literature has demonstrated the feasibility and safety of LESS for benign gynecologic diseases. However, the evidence is not strong enough to recommend the use of LESS over that of conventional multiport laparoscopic surgery (MLS). As per the results of the most recently published meta-analysis, the majority of surgical outcomes are equivalent between LESS and MLS, except for the longer operative time in LESS for both adnexal surgery and hysterectomy. Although an increasing number of studies have reported on robotic LESS, NOTES, and LESS for gynecologic malignancy, definite conclusions have not been drawn owing to the lack of sufficient information.
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Affiliation(s)
- Yu-Jin Koo
- Department of Obstetrics and Gynecology, Yeungnam University College of Medicine, Daegu, Korea
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12
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Robotic-assisted laparoscopic myomectomy: the feasibility in single-site system. Obstet Gynecol Sci 2018; 62:56-64. [PMID: 30671394 PMCID: PMC6333759 DOI: 10.5468/ogs.2019.62.1.56] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Revised: 10/25/2018] [Accepted: 10/26/2018] [Indexed: 12/22/2022] Open
Abstract
Objective To evaluate the feasibility of robotic single-site myomectomy (RSSM). Methods Medical records of 355 consecutive women who underwent robotic-assisted laparoscopic myomectomy were retrospectively reviewed. Clinical characteristics were compared between multi-site and single-site systems. After 1:1 propensity score matching for the total myoma number, largest myoma size, and total tumor weight (105 women in each group), surgical outcomes were also compared between the 2 systems. Results A total of 105 (29.6%) and 250 (70.4%) women underwent RSSM and robotic multi-site myomectomy (RMSM), respectively. RSSM was more commonly performed in women with lower body mass index (21.6 vs. 22.5 kg/m2, P=0.014), without peritoneal adhesions (7.6% vs. 24.8%, P<0.001), and less (2.6 vs. 4.6, P<0.001) and smaller (6.3 vs. 7.7 cm, P<0.001) myomas compared to RMSM. After propensity score matching, the largest myoma size (P=0.143), total myoma number (P=0.671), and tumor weight (P=0.510) were not significantly different between the 2 groups. Although the docking time was significantly longer in the RSSM group (5.1 vs. 3.8 minutes, P=0.005), total operation time was similar between RSSM and RMSM groups (145.9 vs. 147.3 minutes, P=0.856). Additionally, hemoglobin decrement was lower in the RSSM group than in the RMSM group (1.4 vs. 1.8 g/dL, P=0.009). No surgical complication was observed after RSSM, while 1 ileus and 2 febrile complications occurred in women that underwent RMSM (0% vs. 2.9%, P=0.246). Conclusion Although RMSM is preferred for women with multiple large myomas in real clinical practice, RSSM seems to be a feasible surgical method for less complicated cases, and is associated with minimal surgical morbidity.
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Karasu Y, Akselim B. Feasibility of single-incision laparoscopy for ruptured ectopic pregnancies with hemoperitoneum. MINIM INVASIV THER 2018; 28:46-50. [PMID: 29741420 DOI: 10.1080/13645706.2018.1470538] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
BACKGROUND The aim of this study was to compare single-incision laparoscopic surgery (SILS) and conventional laparoscopy in ectopic pregnancies accompanied by severe hemoperitoneum. MATERIAL AND METHODS The main outcome measures were duration of surgery, intraoperative bleeding quantity, complications, post-operative pain scores, additional analgesic requirements, and length of hospital stay. RESULTS A total of 53 women, 28 in the conventional laparoscopy group and 25 in the SILS group, participated in the study. There were no differences in demographic characteristics between the two groups. There were no differences in terms of variables including gestational week, beta human chorionic gonadotropin (βhCG) levels, and operation time. No intraoperative complications were observed in either group. The groups exhibited no significant differences regarding additional analgesic requirements or postoperative pain scores. However, pain at the sixth postoperative hour was lower in the SILS group. This effect was not observed at 12 and 24 hours. CONCLUSION SILS appears to be effective and safe for the treatment of ruptured ectopic pregnancies accompanied by hemoperitoneum.
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Affiliation(s)
- Yetkin Karasu
- a Obstetrics and Gynecology , Ankara Training and Research Hospital , Ankara , Turkey
| | - Burak Akselim
- a Obstetrics and Gynecology , Ankara Training and Research Hospital , Ankara , Turkey
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14
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Gasparri ML, Mueller MD, Taghavi K, Papadia A. Conventional versus Single Port Laparoscopy for the Surgical Treatment of Ectopic Pregnancy: A Meta-Analysis. Gynecol Obstet Invest 2018; 83:329-337. [PMID: 29669329 DOI: 10.1159/000487944] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 02/22/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND/AIMS A new minimally invasive laparoscopic approach for ectopic pregnancy, the laparo-endoscopic single site surgery (LESS), has recently been introduced. The aim of this study is to compare the surgical outcome of this approach with conventional laparoscopy for ectopic pregnancy. METHOD A review following the Preferred Reporting Items for Systematic reviews and Meta-Analyses statement was performed. Electronic databases PubMed, MEDLINE, and Scopus were searched in December 2017 by searching the terms "single port laparoscopy" or "laparoendoscopic single site-surgery" or "single site laparoscopy" or "single-incision laparoscopic surgery" and "ectopic pregnancy." Studies comparing the 2 techniques and reporting surgical outcome were selected. Endpoints included comparison of length of operative time (OT), hemoglobin drop, length of hospitalization, number of patients requiring packed red blood cells (PRBC) transfusion, intra- and post-operative complication rates between patients undergoing conventional laparoscopy and those undergoing LESS. RESULTS A total of 56 studies were retrieved of which 5 studies including 460 patients met selection criteria. No differences were found between conventional laparoscopy and LESS with regards to length of OT time (even after stratification for presence of hemoperitoneum and/or adhesions), length of hospitalization, mean hemoglobin drop, number of patients requiring transfusions of PRBC, and intra- and post-operative complications. CONCLUSION The management of ectopic pregnancies with LESS does not seem to be superior to conventional laparoscopy.
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Affiliation(s)
- Maria Luisa Gasparri
- Department of Obstetrics and Gynecology, University Hospital of Berne and University of Berne, Berne, Switzerland.,Department of Gynecology Obstetrics and Urology, Sapienza Univeristy of Rome, Rome, Italy.,Surgical and Medical Department of Translational Medicine, Sapienza University of Rome, Rome, Italy
| | - Michael D Mueller
- Department of Obstetrics and Gynecology, University Hospital of Berne and University of Berne, Berne, Switzerland
| | - Katayoun Taghavi
- Department of Obstetrics and Gynecology, University Hospital of Berne and University of Berne, Berne, Switzerland
| | - Andrea Papadia
- Department of Obstetrics and Gynecology, University Hospital of Berne and University of Berne, Berne, Switzerland
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Abstract
Minimally invasive surgery continues to transform the field of gynecologic oncology and has now become the standard of care for many early-stage malignancies. The proven benefits of minimally invasive surgery are driving the rapid introduction and dissemination of novel technologies and the increasing ability to perform even the most complex procedures less invasively. In this article, we will review the current literature on traditional multiport laparoscopy, robotic-assisted laparoscopy, laparoendoscopic single-site surgery as well as robotic-assisted laparoendoscopic single-site surgery, with a specific focus on their role in the treatment of gynecologic malignancies.
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Moawad GN, Tyan P, Khalil EDA. Two-port robotic hysterectomy: a novel approach. J Robot Surg 2018; 12:655-656. [PMID: 29574567 DOI: 10.1007/s11701-018-0797-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 03/08/2018] [Indexed: 11/25/2022]
Abstract
The objective of the study was to demonstrate a novel technique for two-port robotic hysterectomy with a particular focus on the challenging portions of the procedure. The study is designed as a technical video, showing step-by-step a two-port robotic hysterectomy approach (Canadian Task Force classification level III). IRB approval was not required for this study. The benefits of minimally invasive surgery for gynecological pathology have been clearly documented in multiple studies. Patients had fewer medical and surgical complications postoperatively, better cosmesis and quality of life. Most gynecological surgeons require 3-5 ports for the standard gynecological procedure. Even though the minimally invasive multiport system provides an excellent safety profile, multiple incisions are associated with a greater risk for morbidity including infection, pain, and hernia. In the past decade, various new methods have emerged to minimize the number of ports used in gynecological surgery. The interventions employed were a two-port robotic hysterectomy, using a camera port plus one robotic arm, with a focus on salpingectomy and cuff closure. We describe a transvaginal and a transabdominal approach for salpingectomy and a novel method for cuff closure. The transvaginal and transabdominal techniques for salpingectomy for two-port robotic-assisted hysterectomy provide excellent tension and exposure for a safe procedure without the need for an extra port. We also describe a transvaginal technique to place the vaginal cuff on tension during closure. With the necessary set of skills on a carefully chosen patient, two-port robotic-assisted total laparoscopic hysterectomy is a feasible procedure.
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Affiliation(s)
- Gaby N Moawad
- Department of Minimally Invasive Gynecologic Surgery, George Washington University, Washington, DC, USA
| | - Paul Tyan
- Department of Obstetrics and Gynecology, George Washington University, 900 23rd St NW, Washington, DC, 20037, USA.
| | - Elias D Abi Khalil
- Department of Minimally Invasive Gynecologic Surgery, George Washington University, Washington, DC, USA
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Robot-assisted myomectomy. Best Pract Res Clin Obstet Gynaecol 2018; 46:113-119. [PMID: 29103894 DOI: 10.1016/j.bpobgyn.2017.09.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 09/11/2017] [Indexed: 12/11/2022]
Abstract
Uterine fibroids are the most common tumors of the uterus and the female pelvis and are associated with substantial morbidity for several women. In women with a wish to preserve fertility, a myomectomy is the surgical procedure of choice when medical therapy is inadequate. Despite evidence that minimally invasive surgery is preferable to laparotomy, most myomectomies are still performed by laparotomy. Robotic surgery was introduced to overcome some of the difficulties associated with laparoscopic surgery. A myomectomy is a suture-intensive surgery where the properties of a surgical robot have been suggested to be of particular value. Robotic myomectomy is feasible and safe, with similar outcome to laparoscopic surgery, although a robotic procedure is associated with a higher cost. The introduction of robotic surgery has expanded the indications for minimally invasive myomectomy to more complex cases previously performed by laparotomy. Randomized trials comparing different approaches to myomectomy are yet to be published. More studies are needed to determine the patients in whom a robotic approach is most beneficial, both in terms of patient outcomes and cost efficiency.
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Single-Port Laparoscopy vs Conventional Laparoscopy in Benign Adnexal Diseases: A Systematic Review and Meta-Analysis. J Minim Invasive Gynecol 2017; 24:1083-1095. [DOI: 10.1016/j.jmig.2017.07.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 06/26/2017] [Accepted: 07/03/2017] [Indexed: 12/20/2022]
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Dressler J, Jorgensen LN. The use of expanding ports in laparo-endoscopic single-site surgery may cause more pain: a meta-analysis of randomized clinical trials. Surg Endosc 2017; 31:4400-4411. [PMID: 28364149 DOI: 10.1007/s00464-017-5487-z] [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: 07/21/2016] [Accepted: 02/20/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Previous meta-analyses on the clinical outcome after laparo-endoscopic single-site surgery (LESS) versus conventional laparoscopic surgery (CLS) have not revealed any major differences in postoperative pain between the two procedures. This meta-analysis aims to evaluate the difference in postoperative pain between the two procedures, focusing on whether LESS was conducted with a non-expanding port (LESSnonex) or a port expanding (LESSex) within the incision. METHOD EMBASE, Medline, PubMed, Science Citation Index Expanded, and Cochrane Central Register of Controlled Trials were searched for randomized clinical trials (RCTs) on LESS versus CLS for general abdominal procedures. Weighted mean difference (WMD) and Odds ratios (OR) were calculated with 95% confidence intervals (CI). RESULTS A total of 29 RCTs with 2999 procedures were included. Pain (VAS 0-10) 6 h after surgery was significantly lower in the group where LESS was conducted with LESSnonex compared to CLS, WMD=-0.72 (- 1.10 to - 0.33). Pain 18-24 h was significantly higher in the group where LESS was conducted with LESSex compared to CLS, WMD = 0.38 (0.01-0.75). Wound-related complications were significantly more frequent in LESSex procedures compared to CLS, OR = 1.94 (1.03-3.63). CONCLUSION The present meta-analysis indirectly indicates that the type of access device that is used for an abdominal LESS procedure may contribute to the development of early postoperative pain as the use of a non-expanding model was associated with a more advantageous outcome. Direct randomized comparison of LESSnonex and LESSex is warranted to confirm if the use of expanding access devices generates more pain and wound complications.
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Affiliation(s)
- Jannie Dressler
- Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen, 2400, Copenhagen, NV, Denmark.
| | - Lars N Jorgensen
- Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen, 2400, Copenhagen, NV, Denmark
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Karasu Y, Akselim B, Kavak Cömert D, Ergün Y, Ülker K. Comparison of single-incision and conventional laparoscopic surgery for benign adnexal masses. MINIM INVASIV THER 2017; 26:278-283. [PMID: 28290726 DOI: 10.1080/13645706.2017.1299763] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Our aim was to compare single incision and conventional laparoscopic surgeries performed for benign adnexal masses with regard to their intraoperative characteristics and postoperative pain levels. MATERIAL AND METHODS The main outcome measures were laparoscopic entry time, total operation time, amount of bleeding, intraoperative complications, post-operative pain scores, additional analgesic requirements, and length of hospital stay. RESULTS A total of 71 women, 39 in the conventional laparoscopy group and 32 in the SILS group, participated in the study. Demographic findings did not differ between the two groups. Similarly, rates of intraoperative complications, rates of conversion to laparotomy, pre- and postoperative hematocrit levels were not significantly different between the groups. Laparoscopic entry time was shorter in the SILS group (10.4 ± 5.9 min. vs. 5.28 ± 1.7 min.). However, total operation time was similar in the two groups. The groups did not show significant differences regarding additional analgesic requirements, or postoperative pain scores after 24 h. However, pain scores in the recovery room and after six and 12 h were lower in the SILS group. CONCLUSION SILS seems to be effective and safe for the treatment of benign adnexal masses. SILS appears to be advantageous regarding postoperative pain especially in the early period.
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Affiliation(s)
- Yetkin Karasu
- a Obstetrics and Gynecology , Ankara Training and Research Hospital , Ankara , Turkey
| | - Burak Akselim
- a Obstetrics and Gynecology , Ankara Training and Research Hospital , Ankara , Turkey
| | - Duygu Kavak Cömert
- a Obstetrics and Gynecology , Ankara Training and Research Hospital , Ankara , Turkey
| | - Yusuf Ergün
- a Obstetrics and Gynecology , Ankara Training and Research Hospital , Ankara , Turkey
| | - Kahraman Ülker
- b Obstetrics and Gynecology , Memorial Şişli Hospital , İstanbul , Turkey
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Minimally Invasive Gynecologic Surgery for Benign Conditions: Progress and Challenges. Obstet Gynecol Surv 2016; 70:656-66. [PMID: 26490165 DOI: 10.1097/ogx.0000000000000237] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of this review is to evaluate the progress made in laparoscopic and hysteroscopic gynecologic surgery and address challenges still faced by surgeons using minimally invasive techniques to improve the care of women with noncancerous gynecologic problems. METHODS Relevant literature was reviewed and evidence-based arguments put forward in the article for the progress that has been made and the deficiencies that still exist. RESULTS In the last 2 decades, enormous progress has been made in providing minimally invasive surgical options for women with gynecologic diseases. The progress has been especially striking in the performance of hysterectomy, the most common major surgery performed on nonpregnant women. The recent controversy over power morcellation has revealed a poor understanding of the literature concerning leiomyosarcoma leading to confusion and consequently denial of minimally invasive surgical options for many women. Hysteroscopic surgery has been evolving rapidly with the development of hysteroscopic morcellator, global endometrial ablation systems, and hysteroscopic tubal sterilization. CONCLUSIONS Although huge advances have been made in minimally invasive gynecologic surgery, high-quality evidence from well-designed clinical trials is lacking for many of the new technologies. Accurate estimates regarding the risk of occult leiomyosarcoma are also lacking. Additional research is urgently needed to address these deficiencies.
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Pontis A, Sedda F, Mereu L, Podda M, Melis GB, Pisanu A, Angioni S. Review and meta-analysis of prospective randomized controlled trials (RCTs) comparing laparo-endoscopic single site and multiport laparoscopy in gynecologic operative procedures. Arch Gynecol Obstet 2016; 294:567-77. [DOI: 10.1007/s00404-016-4108-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 04/22/2016] [Indexed: 12/31/2022]
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Gargiulo AR, Choussein S, Srouji SS, Cedo LE, Escobar PF. Coaxial robot-assisted laparoendoscopic single-site myomectomy. J Robot Surg 2016; 11:27-35. [DOI: 10.1007/s11701-016-0603-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 04/26/2016] [Indexed: 12/30/2022]
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Cai HH, Liu MB, He YL. Treatment of Early Stage Endometrial Cancer by Transumbilical Laparoendoscopic Single-Site Surgery Versus Traditional Laparoscopic Surgery: A Comparison Study. Medicine (Baltimore) 2016; 95:e3211. [PMID: 27057851 PMCID: PMC4998767 DOI: 10.1097/md.0000000000003211] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
To compare the outcomes of transumbilical laparoendoscopic single-site surgery (TU-LESS) versus traditional laparoscopic surgery (TLS) for early stage endometrial cancer (EC).We retrospectively reviewed the medical records of patients with early stage EC who were surgically treated by TU-LESS or TLS between 2011 and 2014 in a tertiary care teaching hospital. We identified 18 EC patients who underwent TU-LESS. Propensity score matching was used to match this group with 18 EC patients who underwent TLS.All patients underwent laparoscopic-assisted vaginal hysterectomy, bilateral salpingo-oophorectomy, and systematic pelvic lymphadenectomy by TU-LESS or TLS without conversion to laparoscopy or laparotomy. Number of pelvic lymph nodes retrieved, operative time and estimated blood loss were comparable between 2 groups. Satisfaction values of the cosmetic outcome evaluated by the patient at day 30 after surgery were significantly higher in TU-LESS group than that in TLS group (9.6 ± 0.8 vs 7.5 ± 0.7, P < 0.001), while there was no statistical difference in postoperative complications within 30 days after surgery, postoperative hospital stay, and hospital cost.For the surgical management of early stage EC, TU-LESS may be a feasible alternative approach to TLS, with comparable short-term surgical outcomes and superior cosmetic outcome. Future large-scale prospective studies are needed to identify these benefits.
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Affiliation(s)
- Hui-Hua Cai
- From the Department of Obstetrics and Gynecology (H-hC and Y-lH), Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China; and Department of Obstetrics and Gynecology (M-bL), Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
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Ikumoto T, Yamagishi H, Iwatate M, Sano Y, Kotaka M, Imai Y. Feasibility of single-incision laparoscopic cholecystectomy for acute cholecystitis. World J Gastrointest Endosc 2015; 7:1327-1333. [PMID: 26722614 PMCID: PMC4689795 DOI: 10.4253/wjge.v7.i19.1327] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 09/03/2015] [Accepted: 11/04/2015] [Indexed: 02/05/2023] Open
Abstract
AIM: To assess the safety of single-incision laparoscopic cholecystectomy (SILC) for acute cholecystitis.
METHODS: All patients who underwent SILC at Sano Hospital (Kobe, Japan) between January 2010 and December 2014 were included in this retrospective study. Clinical data related to patient characteristics and surgical outcomes were collected from medical records. The parameters for assessing the safety of the procedure included operative time, volume of blood loss, achievement of the critical view of safety, use of additional trocars, conversion to laparotomy, intraoperative and postoperative complications, and duration of postoperative hospital stay. Patient backgrounds were statistically compared between those with and without conversion to laparotomy.
RESULTS: A total of 100 patients underwent SILC for acute cholecystitis during the period. Preoperative endoscopic treatment was performed for suspected choledocholithiasis in 41 patients (41%). The mean time from onset of acute cholecystitis was 7.7 d. According to the Updated Tokyo Guidelines (TG13) for the severity of cholecystitis, 86 and 14 patients had grade I and grade II acute cholecystitis, respectively. The mean operative time was 87.4 min. The mean estimated blood loss was 80.6 mL. The critical view of safety was obtained in 89 patients (89%). Conversion laparotomy was performed in 12 patients (12%). Postoperative complications of Clavien-Dindo grade III or greater were observed in 4 patients (4%). The mean duration of postoperative hospital stay was 5.7 d. Patients converted from SILC to laparotomy tended to have higher days after onset.
CONCLUSION: SILC is feasible for acute cholecystitis; in addition, early surgical intervention may reduce the risk of laparotomy conversion.
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Abstract
Objective To compare the intraoperative and postoperative outcomes of laparoendoscopic single-site surgery (LESS) versus conventional laparoscopic surgery in women with ovarian mature cystic teratoma. Methods A retrospective review of 303 women who underwent LESS (n=139) or conventional laparoscopic surgery (n=164) due to ovarian mature cystic teratoma was performed. Intra- and postoperative outcomes were compared between the two groups. Results There was no intergroup difference in age, body weight, height, body mass index, comorbidities, tumor size, bilaterality of tumor, or the type of surgery. However, more patients in the LESS group had a history of previous abdominal surgery (19.4% vs. 6.7%, P=0.001). Surgical outcomes including operating time (89 vs. 87.8 minutes, P=0.734), estimated blood loss (69.4 vs. 68.4 mL, P=0.842), transfusion requirement (2.2% vs. 0.6%, P=0.336), perioperative hemoglobin level change (1.3 vs. 1.2 g/dL, P=0.593), postoperative hospital stay (2.0 vs. 2.1 days, P=0.119), and complication rate (1.4% vs. 1.8%, P=0.999) did not differ between LESS and conventional groups. Postoperative pain scores measured using a visual analogue scale were significantly lower in the LESS group at 8 hours (P=0.021), 16 hours (P=0.034), and 32 hours (P=0.004) after surgery, and 32 of 139 patients (23%) in the LESS group and 78 of 164 patients (47.6%) in the conventional group required at least one additional analgesic (P<0.001). Conclusion LESS was feasible and showed comparable surgical outcomes with conventional laparoscopic surgery for women with ovarian mature cystic teratoma. LESS was associated with less postoperative pain and required less analgesia.
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Park JY, Kim DY, Kim SH, Suh DS, Kim JH, Nam JH. Laparoendoscopic Single-site Compared With Conventional Laparoscopic Ovarian Cystectomy for Ovarian Endometrioma. J Minim Invasive Gynecol 2015; 22:813-9. [DOI: 10.1016/j.jmig.2015.03.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 03/14/2015] [Accepted: 03/17/2015] [Indexed: 10/23/2022]
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Abstract
BACKGROUND AND OBJECTIVES Keyless abdominal rope-lifting surgery is a novel, gasless, single-incision laparoscopic surgical technique. In this study we aimed to compare the postoperative pain from keyless abdominal rope-lifting surgery with carbon dioxide laparoscopy performed for benign ovarian cysts. METHODS During a 20-month period, 77 women underwent surgery for a benign ovarian cyst. Keyless abdominal rope-lifting surgery and conventional carbon dioxide laparoscopy techniques were used for the operations in 32 women and 45 women, respectively. The 2 operative techniques were compared with regard to demographic characteristics; preoperative, intraoperative, and postoperative data including early postoperative pain scores; and frequency of shoulder pain and analgesic requirements. RESULTS Data regarding demographic characteristics, preoperative findings, cyst diameters and rupture rates, intra-abdominal adhesions, intraoperative blood loss, and postoperative hospital stay did not differ between groups (P > .05). However, the mean operative and abdominal access times were significantly longer in the keyless abdominal rope-lifting surgery group (P < .05). Visual analog scale pain scores at initially and at the second, fourth, and 24th hours of the postoperative period were significantly lower in the keyless abdominal rope-lifting surgery group (P < .05). Similarly, keyless abdominal rope-lifting surgery caused significantly less shoulder pain and additional analgesic use (P < .05). CONCLUSION Keyless abdominal rope-lifting surgery seems to cause less pain in the management of benign ovarian cysts in comparison with conventional carbon dioxide laparoscopy.
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Affiliation(s)
- Kahraman Ülker
- Department of Obstetrics and Gynecology, Kafkas University School of Medicine, Kars, Turkey
| | - Ürfettin Hüseyinoğlu
- Department of Anesthesia and Reanimation, Kafkas University School of Medicine, Kars, Turkey
| | - Melek Çiçek
- Department of Obstetrics and Gynecology, Kafkas University School of Medicine, Kars, Turkey
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Fridman D, Saraf S, Homel P, Wagner J. Single-Incision Laparoscopy as the Primary Approach to Benign Hysterectomies: A Single-Surgeon, Single-Year-Experience with a Retrospective Control. J Gynecol Surg 2015. [DOI: 10.1089/gyn.2014.0082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Dmitry Fridman
- Department of Obstetrics and Gynecology, Montefiore Medical Center, Bronx, NY
| | - Sumit Saraf
- Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, NY
| | - Peter Homel
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY
| | - John Wagner
- Huntington Hospital, Department of Obstetrics and Gynecology, Huntington, NY
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Chen KH, Chen LR, Seow KM. Ovarian Suspension With Adjustable Sutures: An Easy and Helpful Technique for Facilitating Laparoendoscopic Single-Site Gynecologic Surgery. J Minim Invasive Gynecol 2015; 22:767-75. [PMID: 25757814 DOI: 10.1016/j.jmig.2015.02.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Revised: 02/25/2015] [Accepted: 02/26/2015] [Indexed: 11/30/2022]
Abstract
STUDY OBJECTIVE To describe a method of ovarian suspension with adjustable sutures (OSAS) for facilitating laparoendoscopic single-site gynecologic surgery (LESS) and to investigate the effect of OSAS on LESS. DESIGN Prospective cohort study (Canadian Task Force classification: II-2). SETTING University teaching hospital. PATIENTS One hundred seventy-eight patients with benign 5- to 15-cm cystic ovarian tumors who underwent LESS with OSAS (suspension group, n = 90) and without OSAS (control group, n = 88). INTERVENTIONS For patients who underwent OSAS (suspension group), 1 end of double-head straight needles with a polypropylene suture was inserted into the pelvic cavity through the abdominal skin to penetrate the cyst or ovarian parenchyma and puncture outside the abdominal skin. After cutting off the needles, both sides of the remaining suture were held together by a clamp, without knotting, so that the manipulator could "lift," "loosen," or "fix" the stitches to adjust the tension. MEASUREMENTS AND MAIN RESULTS The average time to create OSAS was 2.9 min. For the suspension and control groups, the average blood loss was 81.4 and 131.8 mL (p < .001), and the operative time was 42.0 and 61.3 min (p < .001), respectively. There were no significant differences in the incidence of complications (5.6% vs 9.1%; p = .365), but there were significant differences in conversions to standard non-single-site laparoscopy (5.6% vs 15.9%; p = .025) and laparotomy (1.1% vs 6.8%; p = .040). Logistic regression analysis revealed that the ratios of conversion to standard non-single-site laparoscopy (odds ratio [OR], 0.126; 95% confidence interval [CI], 0.311-0.508) and laparotomy (OR, 0.032; 95% CI, 0.002-0.479) were much lower in the suspension group; the risk of complications was comparable (OR, 0.346; 95% CI, 0.085-1.403). CONCLUSION OSAS is an easy, safe, and feasible method that offers advantages during LESS. Although routine use of OSAS is not necessary, OSAS can be considered during LESS to facilitate the surgery.
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Affiliation(s)
- Kuo-Hu Chen
- Department of Obstetrics and Gynecology, Taipei Tzu-Chi Hospital, The Buddhist Tzu-Chi Medical Foundation, Taipei, Taiwan, and School of Medicine, Tzu-Chi University, Hualien, Taiwan.
| | - Li-Ru Chen
- Mackay Memorial Hospital, Taipei, Taiwan, and Department of Mechanical Engineering, National Chiao-Tung University, Hsinchu, Taiwan
| | - Kok-Min Seow
- Department of Obstetrics and Gynecology, Shin Kong Wu Ho-Su Memorial Hospital, and Department of Obstetrics and Gynecology, National Yang-Ming University, Taipei, Taiwan
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Santos Filho AS, Noviello MB, Damasceno RCF, Patrício EDC, Félix LR, Giostri PG, Brandão AHF. Single-site laparoscopy in gynecology: preliminary study of a series of 50 cases. Rev Assoc Med Bras (1992) 2015; 60:548-54. [PMID: 25650855 DOI: 10.1590/1806-9282.60.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Accepted: 05/22/2014] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE to describe the initial experience of a gynecology team, at a tertiary care center, when performing single-port laparoscopic surgery. METHODS this is a retrospective study reviewing the medical records of 50 patients treated at the outpatient gynecology clinic of our institution between June 2012 and July 2013 who underwent single-port laparoscopic surgery. This study was approved by the institution's Ethics in Research Committee. RESULTS the mean age of patients is 37.8 years, ranging from 18 to 70 years, and the most frequent surgical indications were adnexal mass (72%) and chronic pelvic pain (24%). The mean operative time was 94.4 minutes with a mean hospital stay of 25.8 hours. There were no perioperative complications. We recorded two conversions to laparotomy due to technical difficulties during the procedure. All cases of conversion had pelvic adhesions. All operative complications were successfully treated and none were considered severe. CONCLUSION this is one of the largest case series in the literature regarding surgical treatment by single-port laparoscopy in gynecology and presents evidence on reduction of surgical morbidity and satisfactory cosmetic results. We conclude that single-port laparoscopy is a viable minimally invasive technique, and that it contributes to the construction of a new scenario in modern gynecological surgery.
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Bedaiwy MA, Sheyn D, Eghdami L, Abdelhafez FF, Volsky JG, Fader AN, Nickles-Fader A, Escobar PF. Laparoendoscopic single-site surgery for benign ovarian cystectomies. Gynecol Obstet Invest 2015; 79:179-83. [PMID: 25660750 DOI: 10.1159/000367659] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Accepted: 08/14/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Single-port laparoscopy (LESS) utilizes a single, multichannel port in an attempt to decrease postoperative pain, while enhancing cosmesis and minimizing the potential risks and morbidities associated with the multiple ports used in conventional laparoscopy. METHODS We performed a retrospective study examining three tertiary care referral centers. From September 2009 until March 2013, 31 patients with ovarian cystic lesions were treated using the LESS technique. A control group of 57 patients who underwent conventional laparoscopic ovarian cystectomy was included for comparison. RESULTS All patients underwent a technically successful cystectomy. There were no statistically significant differences in the mean operative time or estimated blood loss between the two groups. Narcotic use during the recovery period was reported in less patients in the LESS group than in the laparoscopic group (p = 0.05). CONCLUSIONS The LESS technique can be used to safely perform cystectomies on women with benign ovarian cysts. Additional investigation is needed to evaluate the safety, cost-effectiveness and long-term outcomes of this new approach.
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Affiliation(s)
- Mohamed A Bedaiwy
- Department of Gynecology, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
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Scheib SA, Fader AN. Gynecologic robotic laparoendoscopic single-site surgery: prospective analysis of feasibility, safety, and technique. Am J Obstet Gynecol 2015; 212:179.e1-8. [PMID: 25088863 DOI: 10.1016/j.ajog.2014.07.057] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Revised: 07/07/2014] [Accepted: 07/30/2014] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Multiple reports suggest that laparoendoscopic single-site surgery is technically feasible, safe, and effective in treating a variety of gynecological disease processes. The study purpose was to assess the feasibility and safety of a novel robotic single-site platform (R-LESS) for the surgical treatment of benign and malignant gynecological conditions. STUDY DESIGN A single-institution, prospective analysis of 40 women treated with R-LESS on the gynecology and gynecological oncology services from June 2013 through March 2014. Women undergoing hysterectomy or adnexal surgery for either a benign or malignant gynecological condition were offered robotic single-site surgery during the study period of June 1, 2013, through April 1, 2014. Patients underwent surgery through a single 2.5-3.0 cm umbilical incision with a multichannel port and utilizing the da Vinci robotic single-site platform. Two surgeons with extensive laparoendoscopic single-site experience participated. RESULTS Forty patients had R-LESS performed. Procedures included total laparoscopic hysterectomy, laparoscopic supracervical hysterectomy, salpingo-oophorectomy, ovarian cystectomy, excision of endometriosis, and a combined case of total laparoscopic hysterectomy and cholecystectomy. Median age and body mass index were 42 years and 28.2 kg/m(2), respectively. Median operating time, defined as the interval between incision start to closure, was 134 minutes (range, 84-311 minutes). Median vaginal cuff closure was 21 minutes (range, 9-77 minutes). Overall, there appeared to be a linear relationship between vaginal cuff closure time, console time, and operating time with number of cases performed. Procedures were successfully performed via R-LESS in 92.5% of cases; 2 cases required 1 additional port and there was 1 conversion to traditional multiport robotic surgery. There was 1 major postoperative complication (2.5%) and 1 readmission (2.5%). After a median follow-up period of 230 days (range, 61-256), there have been no postoperative hernias diagnosed. CONCLUSION We present one of the first series of robotic laparoendoscopic single-site surgery for the treatment of various gynecological conditions. When performed by experienced minimally invasive surgeons, R-LESS is feasible and safe in select patients. Further studies are needed to better define the ideal gynecological procedures to perform using robotic single-site surgery and to assess the benefits and costs of R-LESS compared with multiport robotic and conventional laparoscopic approaches.
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Gracia M, Sisó C, Martínez-Zamora MÀ, Sarmiento L, Lozano F, Arias MT, Beltrán J, Balasch J, Carmona F. Immune and Stress Mediators in Response to Bilateral Adnexectomy: Comparison of Single-Port Access and Conventional Laparoscopy in a Porcine Model. J Minim Invasive Gynecol 2014; 21:837-43. [DOI: 10.1016/j.jmig.2014.03.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2014] [Revised: 03/15/2014] [Accepted: 03/18/2014] [Indexed: 11/24/2022]
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Kim S, Kim YS, Min YD. SMA Syndrome Treated by Single Incision Laparoscopic Duodenojejunostomy. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2014; 7:87-9. [PMID: 25210483 PMCID: PMC4149391 DOI: 10.4137/ccrep.s17553] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 07/09/2014] [Accepted: 07/16/2014] [Indexed: 12/12/2022]
Abstract
Superior mesenteric artery (SMA) syndrome is a mechanical duodenal obstruction by the SMA. The traditional approach to SMA syndrome was open bypass surgery. Nowadays, a conventional approach has been replaced by laparoscopic surgery. But single incision laparoscopic approach for SMA syndrome is rare. Herein, we report the first case of SMA syndrome patient who was treated by single incision laparoscopic duodenojejunostomy.
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Affiliation(s)
- Sungsoo Kim
- Department of Surgery, Chosun University College of Medicine, Gwangju, Korea
| | - Yoo Seok Kim
- Department of Surgery, Chosun University College of Medicine, Gwangju, Korea
| | - Young-Don Min
- Department of Surgery, Chosun University College of Medicine, Gwangju, Korea
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Park JY, Nho J, Cho IJ, Park Y, Kim DY, Suh DS, Kim JH, Nam JH. Laparoendoscopic single-site versus conventional laparoscopic-assisted vaginal hysterectomy for benign or pre-invasive uterine disease. Surg Endosc 2014; 29:890-7. [DOI: 10.1007/s00464-014-3747-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Accepted: 07/11/2014] [Indexed: 12/01/2022]
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Hirata T, Fujimoto A, Koga K, Wada-Hiraike O, Fujii T, Osuga Y. Concomitant ovarian drilling and oocyte retrieval by laparoendoscopic single-site surgery led to live birth using in vitro
maturation of oocyte and transfer of frozen-thawed blastocyst in woman with polycystic ovary syndrome. J Obstet Gynaecol Res 2014; 40:1431-5. [DOI: 10.1111/jog.12365] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Accepted: 11/27/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Tetsuya Hirata
- Department of Obstetrics and Gynecology; Faculty of Medicine; University of Tokyo; Tokyo Japan
| | - Akihisa Fujimoto
- Department of Obstetrics and Gynecology; Sanraku Hospital; 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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Evaluation of Patient Satisfaction Using the EORTC IN-PATSAT32 Questionnaire and Surgical Outcome in Single-Port Surgery for Benign Adnexal Disease: Observational Comparison with Traditional Laparoscopy. DIAGNOSTIC AND THERAPEUTIC ENDOSCOPY 2013; 2013:578392. [PMID: 24371418 PMCID: PMC3859206 DOI: 10.1155/2013/578392] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Revised: 09/29/2013] [Accepted: 10/08/2013] [Indexed: 01/17/2023]
Abstract
Laparoscopic surgery has been demonstrated as a valid approach in almost all gynaecologic procedures including malignant diseases. Benefits of the minimally invasive approach over traditional open surgery have been well demonstrated in terms of minimal perioperative morbidity and reduced postoperative pain and hospital stay duration, with consequent quick postoperative recovery (Medeiros et al. (2009)). Single-port surgery resurfaced in gynaecology surgery in recent years and renewed interest among other surgeons and within the industry to develop this field (Podolsky et al. (2009)). Patient satisfaction is emerging as an increasingly important measure of quality which represents a complex entity that is dependent on patient demographics, comorbidities, disease, and, to a large extent, patient expectations (Tomlinson and Ko (2006)). It can be broadly thought to refer to all relevant experiences and processes associated with health care delivery (Jackson et al. (2001)). In this study we aim to compare single-port surgery (SPS) with conventional laparoscopy in terms of patient satisfaction using the EORTC IN-PATSAT32 questionnaire. We also evaluate the main surgical outcomes of both minimally invasive approaches.
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