Two-Port Access Laparoscopic Surgery in Gynecologic Oncology

Trocar Site Hernias in Bariatric Surgery-an Underestimated Issue: a Qualitative Systematic Review and Meta-Analysis

The reported incidence of trocar site hernias in bariatric surgery ranges between 0.5 and 3%. The best available evidence derives from retrospective studies analysing prospective databases, thus including only patients who presented with symptoms or received surgical treatment due to trocar site hernias after a laparoscopic bariatric procedure. A systematic literature research was conducted up until September 2017. Search strategies included proper combinations of the MeSH terms 'laparoscopy' and 'bariatric surgery', 'trocar/port' and 'hernia'. Searches were not limited by publication type or language. The review was registered in PROSPERO (ID 85102) and performed according to the PRISMA guidelines. Sixty-eight publications were included. Pooled hernia incidence was 3.22 (range 0-39.3%). Thirteen trials reported systematic closure of the fascia; 12 trials reported no closure. Data availability did not allow for pooling to calculate relative risk. Higher BMI and specific hernia examination using imaging modalities were associated with a significantly higher incidence of trocar site hernias. Studies dedicated to detection of TsH reported a pooled incidence of 24.5%. Trocar site hernias are an underestimated complication of minimally invasive multiportal bariatric surgery. While high-quality trials are not available allowing for a precise calculation of the incidence, existing data are indicative of very high incidence rates. Risk factors for developing a trocar site hernia in bariatric surgery have not yet been systematically analysed. Prospective studies in this field are necessary.

Tissue injuries after single-port and multiport laparoscopic gynecologic surgeries: A prospective multicenter study

The present study focused on the degree of tissue injury following single-port laparoscopic surgery (SPLS) and multiport laparoscopic surgery (MPLS) for the treatment of various benign gynecologic diseases. A total of 228 patients were prospectively enrolled at seven academic centers in South Korea between April 2011 and September 2012. Of these, 122 patients underwent SPLS and 106 patients underwent MPLS. The serum levels of C-reactive protein, creatine phosphokinase, lactic dehydrogenase and cancer antigen 125 were measured preoperatively and on postoperative day 4 by immunonephelometry. Cosmetic satisfaction and postoperative pain scores (visual analogue scale) were analyzed. Postoperative changes in the levels of the serum markers were found to be similar between the SPLS and MPLS groups. However, the postoperative pain scores at 48 h were significantly lower in the SPLS group when compared with those in the MPLS (P=0.001). In addition, patient-controlled analgesia was used more frequently by patients in the MPLS group (P=0.003). The present study is the first prospective investigation of tissue injury resulting from SPLS and MPLS in gynecology. In conclusion, the current study demonstrated that serum marker levels during SPLS were similar to those during MPLS in the treatment of benign gynecologic diseases. However, SPLS is a reasonable alternative to MPLS and is associated with comparable tissue injury, improved cosmesis and reduced postoperative pain.