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Güngördük K, Gülseren V, Özdemir İA. Laparoscopic surgery of large adnexal masses (>12 cm): Single port or conventional? Asian J Endosc Surg 2023. [PMID: 36793236 DOI: 10.1111/ases.13170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 12/28/2022] [Accepted: 02/02/2023] [Indexed: 02/17/2023]
Abstract
INTRODUCTION We aimed to compare single-port laparoscopic surgery (SPLS) and conventional multiport laparoscopic surgery (CMLS) for large adnexal mass (AM). METHODS Patients undergoing laparoscopy (LS) due to huge AMs (≥12 cm) between 2016 and 2021 were evaluated retrospectively. The SPLS procedure was applied in 25 cases, and CMLS was performed in 32 cases. The premier result was the grade of the postoperative improvement according to the Quality of Recovery (QoR)-40 questionnaire score (24 h after the surgical procedure; postoperative day 1). Observer Scar Assessment Scale (OSAS) and Patient Observer Scar Assessment Scale (PSAS) were also evaluated. RESULTS A total of 57 cases undergoing SPLS (n = 25) or CMLS (n = 32) due to a large AM (≥12 cm) were analyzed. No meaningful distinctions in age, menopausal status, body mass index, or mass size were observed between the two cohorts. The operation time was shorter in the SPLS than CPLS cohort (42.2 ± 3.3 vs. 47.6 ± 6.2; p < 0.001). Unilateral salpingo-oophorectomy was performed in 84.0% of cases in the SPLS cohort and 90.6% of patients in the CMLS cohort (p = 0.360). The QoR-40 points were significantly higher in the SPLS than the CMLS group (154.9 ± 12.0 vs. 146.2 ± 17.1; p = 0.035). The OSAS and PSAS scores were lower in the SPLS than the CMLS group. CONCLUSION LS can be used for large cysts that are not considered to be at risk of malignancy. The postoperative recovery time was shorter in patients undergoing SPLS compared to CMLS.
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Affiliation(s)
- Kemal Güngördük
- Faculty of Medicine, Department of Obstetrics and Gynecology, Division of gynecologic oncology, Sıtkı Koçman University, Muğla, Turkey
| | - Varol Gülseren
- Faculty of Medicine, Department of Obstetrics and Gynecology, Division of gynecologic oncology, Erciyes University, Kayseri, Turkey
| | - İsa Aykut Özdemir
- Department of Obstetrics and Gynecology, Division of gynecologic oncology, Medipol University, İstanbul, Turkey
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Tan W, Deng Y, Deng L, Tang S, Yao Y, Wei H, Zhong K, Wang Y. A preoperative scoring system to predict the probability of laparoendoscopic single-site extracorporeal cystectomy in patients with benign ovarian cysts. Front Surg 2022; 9:991450. [DOI: 10.3389/fsurg.2022.991450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 10/03/2022] [Indexed: 11/05/2022] Open
Abstract
ObjectiveTo develop a preoperative scoring system (PSS) to predict whether laparoendoscopic single-site extracorporeal (LESS-E) cystectomy can be performed in patients with benign ovarian cysts.MethodWe reviewed data on patients who underwent LESS cystectomy between August 2016 and October 2019 at the first Affiliated Hospital, Army Medical University. The independent predictors of LESS-E cystectomy in patients with benign ovarian cysts were identified using multivariate logistic regression analyses. A nomogram for predicting LESS-E cystectomy in patients with benign ovarian cysts was developed, and to simplify the score, we establish a preoperative scoring system to guide the choice of surgical approach in patients with highly probable benign ovarian cysts.ResultsOur analysis showed that age, BMI, height and the diameter of ovarian cysts were independent predictors of LESS-E cystectomy. A nomogram was developed based on these four factors, which had a concordance index of 0.838 and R2 = 0.415. To simplify the score, the predicted indicators in the regression model were scored by dividing the beta coefficient by the absolute value of the minimum beta coefficient, and the sum of each predictor score established a PSS. In the total set, the selected cutoff value according to the maximum point of the Youden index was 8, and a preoperative score ≥ 8 identified patients undergoing LESS-E cystectomy with a positive predictive value of 67.4% and a negative predictive value of 88.6%.ConclusionA PSS to predict the chances of LESS-E cystectomy was established. This system could be helpful for selecting the appropriate surgical strategy for patients with benign ovarian cysts.
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Lee SR. Fast Leak-Proof, Intraumbilical, Single-Incision Laparoscopic Ovarian Cystectomy for Huge Ovarian Masses: "Hybrid Cystectomy and Reimplantation" Method. ACTA ACUST UNITED AC 2021; 57:medicina57070680. [PMID: 34356961 PMCID: PMC8305641 DOI: 10.3390/medicina57070680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 06/29/2021] [Accepted: 06/30/2021] [Indexed: 11/25/2022]
Abstract
Background and Objectives: To introduce a new technique for fast leakage-proof, intraumbilical, single-incision laparoscopic ovarian cystectomy for huge ovarian masses (>10 cm) Materials and Methods: Seven consecutive, reproductive-aged women, including three adolescents, with huge ovarian masses (mature cystic teratoma, n = 4; endometrioma, n = 2; and mucinous cystadenoma, n = 1) who underwent transumbilical single-incision ovarian cystectomy with the new “hybrid cystectomy and reimplantation” method were included. The procedure was: (1) trans-umbilical single-incision laparoscopy; (2) inspection of the pelvic cavity and placing the mass in a laparoscopic endo-bag for cystic content leakage prevention; (3) in-bag resection using cold scissors and minimal cauterization of the cystectomy site; (4) in-bag tissue extraction; (5) rapid extracorporeal cystectomy with traction without electrocautery; (6) re-insertion of the retrieved ovarian cortex intracorporeally through the single port, and (7) intracorporeal suture of the retrieved tissue to the in situ ovary. Results: The mean patient age was 24.71 ± 6.56 (range 17–37) years and the mean maximal diameter of the masses was 17.71 ± 2.86 (range 13–22) cm. There was no case of unintended intracorporeal cyst rupture and no need for copious irrigation for washing and suctioning the leaked mass content. The mean total operating time was 76.42 ± 6.39 (range 65–85) min, the total volume of saline used for irrigation was 814.28 ± 331.35 (range 500–1500) mL, and the estimated blood loss was 107.14 ± 47.72 (range 50–200) mL. There were no perioperative complications. All patients except the two endometriosis patients had regular, normal menstruation. Conclusions: Our preliminary findings were encouraging in terms of the safety and efficiency of the new method. Future trials need to elucidate the benefits of this method in terms of fertility preservation.
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Affiliation(s)
- Sa Ra Lee
- Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea
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Kang JH, Noh JJ, Jeong SY, Shim JI, Lee YY, Choi CH, Lee JW, Kim BG, Bae DS, Kim HS, Kim TJ. Feasibility of Single-Port Access (SPA) Laparoscopy for Large Ovarian Tumor Suspected to Be Borderline Ovarian Tumor. Front Oncol 2020; 10:583515. [PMID: 33042851 PMCID: PMC7526335 DOI: 10.3389/fonc.2020.583515] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 08/24/2020] [Indexed: 11/19/2022] Open
Abstract
Objectives To compare the surgical, pathological and oncological outcomes of single-port access (SPA) laparoscopy against laparotomy for large ovarian tumor (>15 cm) suspected to be a borderline ovarian tumor (BOT) on preoperative imaging. Methods A retrospective review of the patients who underwent SPA laparoscopy (SPA Group) or laparotomy (Laparotomy Group) for suspected BOT was performed. Surgical outcomes, including the rates of iatrogenic spillage of tumor contents, and oncological outcomes, such as recurrence-free survival (RFS) and overall survival (OS), were compared between the two groups. Correlation between intraoperative frozen section analysis and permanent pathology results was also assessed. Results A total of 178 patients underwent surgical treatment for suspected large BOT. Among them, 105 patients with a mean tumor diameter of 20.9 ± 6.5 cm underwent SPA laparoscopy, and the other 73 patients, with a mean tumor diameter 20.2 ± 5.9 cm, underwent laparotomy. The mean operation time did not differ between the two groups (99.1 ± 41.9 min for SPA Group vs. 107.3 ± 35.7 min for Laparotomy Group, p = 0.085). There was no difference in the occurrence of iatrogenic spillage of tumor contents between the groups either (11.4% in the SPA Group vs. 6.8% in the Laparotomy Group, p = 0.381). However, the postoperative complication rates were significantly higher in the Laparotomy Group compared with SPA Group (16.4% vs. 5.7%, p = 0.025). The surgical approach was not associated with the misdiagnosis rates of frozen section analysis (19% in the SPA Group vs. 26% in the Laparotomy Group, p = 0.484). The most common histologic type of the tumors was mucinous in both groups. Conclusion SPA laparoscopy is feasible, safe, and not inferior to laparotomy for surgical treatment of large ovarian tumors that suspected to be BOT on preoperative imaging.
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Affiliation(s)
- Jun-Hyeok Kang
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Joseph J Noh
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Soo Young Jeong
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jung In Shim
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Yoo-Young Lee
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Chel Hun Choi
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jeong-Won Lee
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Byoung-Gie Kim
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Duk-Soo Bae
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hyun-Soo Kim
- Department of Pathology and Translation Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Tae-Joong Kim
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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Wolfman W, Thurston J, Yeung G, Glanc P. Guideline No. 404: Initial Investigation and Management of Benign Ovarian Masses. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2020; 42:1040-1050.e1. [PMID: 32736855 DOI: 10.1016/j.jogc.2020.01.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 01/16/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To provide recommendations for a systematic approach to the initial investigation and management of a benign ovarian mass and facilitate patient referral to a gynaecologic oncologist for management. INTENDED USERS Obstetricians, gynaecologists, family physicians, internists, nurse practitioners, radiologists, general surgeons, medical students, medical residents, fellows, and other health care providers. TARGET POPULATION Women ≥18 years of age presenting for evaluation of an ovarian mass (including simple and unilocular cystic masses, endometriomas, dermoids, fibromas, and hemorrhagic cysts) who are not acutely symptomatic and without known genetic predisposition to ovarian cancer. OUTCOMES This guideline aims to encourage conservative management and help reduce unnecessary surgery and long-term health complications, maintain fertility, and decrease operative costs and improve overall patient care and outcomes by providing criteria for referral of patients with ultrasound imaging findings suggestive of a malignant mass to a gynaecologic oncologist. EVIDENCE Databases searched: Medline, Cochrane, and PubMed. Medical terms used: benign asymptomatic and symptomatic ovarian cysts, adnexal masses, oophorectomy, ultrasound diagnosis of cysts, simple ultrasound rules, surgical and medical therapies for cysts, screening for ovarian cancer, ovarian torsion, and menopause. Initial search was completed by 2017 and updated in 2018. Exclusion criteria were malignant ovarian cystic masses, endometriosis therapies, and other adnexal pathologies unrelated to the ovary. VALIDATION METHODS The content and recommendations were drafted and agreed upon by the authors. The Society of Obstetricians and Gynaecologists of Canada's Board of Directors approved the final draft for publication. The quality of evidence was rated using the criteria described in the Grading of Recommendations Assessment, Development and Evaluation methodology framework. BENEFITS, HARMS, COSTS Implementation of the recommendations could reduce costs due to unnecessary surgeries and hospitalizations and reduce lost work days and the risk of loss of fertility, early menopause, and surgical complications. SUMMARY STATEMENTS (GRADE RATINGS IN PARENTHESES) RECOMMENDATIONS (GRADE RATINGS IN PARENTHESES).
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Wolfman W, Thurston J, Yeung G, Glanc P. Directive clinique no 404 : Évaluation initiale et prise en charge des masses ovariennes bénignes. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2020; 42:1051-1062.e1. [DOI: 10.1016/j.jogc.2020.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abstract
The aim of this study was to compare the spillage rate and surgical outcomes between the leak-proof technique and the conventional technique in laparoscopy for large ovarian cysts (more than 15 cm in diameter) presumed to be benign tumours and free from adhesion. Thirty-five consecutive patients who underwent laparoscopy with the leak-proof technique between 2017 and 2019 (the practice change cohort) were compared retrospectively with 35 case-matched consecutive patients who underwent the conventional purse-string method between 2014 and 2016 (the historical cohort). In the practice change cohort, through the wound retractor in the umbilicus, large ovarian cysts were first covered with a sterilised vinyl membrane applied with a skin adhesive, then punctured, and the contents directly aspirated. The primary outcome was tumour spillage. The two cohorts had similar baseline characteristics. The spillage rate in the practice change cohort was significantly lower than in the historical cohort (0% vs 28.6%; p = .001). Other surgical outcomes, including operative time, operative blood loss, hospital stay, and operative complications were similar between the cohorts. In conclusion, laparoscopy with the leak-proof technique is reliable, safe, and easily implemented in the management of selected patients with large ovarian tumours and low probability of malignancy.IMPACT STATEMENTWhat is already known on this subject: Large ovarian cysts preclude the laparoscopic surgery because the size of the cyst interferes with adequate visualisation of the pelvic anatomy and confines the mobilisation of laparoscopic devices.What do the results of this study add: Laparoscopy with the leak-proof technique is reliable, safe, and easily implemented in the management of selected patients with large ovarian tumours and low probability of malignancy.What are the implications of these findings for clinical practice and/or further research: This technique is easily implemented and useful for most gynaecologic surgeons in treating extremely large ovarian cysts.
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Affiliation(s)
- Taejong Song
- Department of Obstetrics and Gynecology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ji-Hee Sung
- Department of Obstetrics and Gynecology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Lin Y, Liu M, Ye H, He J, Chen J. Laparoendoscopic single-site surgery compared with conventional laparoscopic surgery for benign ovarian masses: a systematic review and meta-analysis. BMJ Open 2020; 10:e032331. [PMID: 32066600 PMCID: PMC7045036 DOI: 10.1136/bmjopen-2019-032331] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Revised: 12/16/2019] [Accepted: 12/20/2019] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE We aimed to evaluate the safety, efficiency and preferred indication for laparoendoscopic single-site surgery (LESS) compared with conventional laparoscopic (CL) surgery for benign ovarian masses. DESIGN A systemic review and cumulative meta-analysis were performed in line with the criteria of Grading of Recommendations Assessment, Development and Evaluation: levels of evidence and grades of recommendation. DATA SOURCES We comprehensively searched the electronic databases including PubMed, Medline, Embase and the Cochrane Library in November 2018. ELIGIBILITY CRITERIA FOR SELECTING STUDIES We included all randomised controlled trials (RCTs) and retrospective studies published in recent 10 years, which investigated the performance of LESS versus CL in patients at all ages with benign ovarian masses. RESULTS Four RCTs and nine retrospective studies published in recent decade including 1542 cases (744 cases for LESS and 798 cases for CL) were identified. Perioperative complication was consisted of intraoperative and postoperative complications, including ileus, wound infection or dehiscence and incisional hernia. Although LESS has less postoperative analgesic consumption (46.78% and 79.25%; OR: 0.49; 95% CI: 0.33 to 0.74, p<0.001) and shorter hospital stay (weighted mean difference (WMD): -0.24 days; 95% CI: -0.35 to -0.14; p<0.001), CL has less perioperative complications (6.59% and 2.85%; OR: 2.08; 95% CI: 1.05 to 4.11, p=0.04) and shorter operative time (WMD: 3.43 min; 95% CI: -0.03 to 6.88; p=0.05). Body mass index, history of previous abdominal surgery, size of adnexal mass, estimated blood loss and postoperative pain scores did not differ significantly between two techniques. CONCLUSIONS The indications of LESS for benign ovarian masses are similar to CL and it has better postoperative recovery. However, with less perioperative complications, CL surgery is safer than LESS.
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Affiliation(s)
- Yun Lin
- Department of Gynecology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
- Shantou University Medical College, Shantou, Guangdong, China
| | - Mubiao Liu
- Department of Gynecology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Haiyan Ye
- Department of Gynecology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Jianhui He
- Department of Gynecology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Jianguo Chen
- Department of Gynecology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
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Ki EY, Park EK, Jeong IC, Bak SE, Hwang HS, Chung YH, Song MJ. Laparoendoscopic Single Site Surgery for the Treatment of Huge Ovarian Cysts Using an Angiocatheter Needle. Yonsei Med J 2019; 60:864-869. [PMID: 31433584 PMCID: PMC6704019 DOI: 10.3349/ymj.2019.60.9.864] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 06/14/2019] [Accepted: 07/05/2019] [Indexed: 11/27/2022] Open
Abstract
PURPOSE The aim of this study was to evaluate the feasibility and safety of laparoendoscopic single site (LESS) surgery using an angiocatheter needle in patients with huge ovarian cysts (diameter ≥15 cm). MATERIALS AND METHODS Thirty-one patients with huge ovarian cysts underwent LESS surgery using an angiocatheter needle between March 2011 and August 2016. An intra-umbilical vertical incision (1.5-2.0 cm) was made in the midline. After the cyst wall was punctured using an angiocatheter needle, the fluid contents were aspirated with a connected vacuum aspirator. After placing a Glove port in the umbilical incision, LESS surgery was performed using a rigid 0-degree, 5-mm laparoscope and conventional, rigid, straight laparoscopic instruments. Knife-in-bag morcellation was instituted for specimen collection. RESULTS The median maximal diameter of ovarian cysts was 18 cm (range, 15-30 cm), the median operation time was 150 minutes (range, 80-520 minutes), and the median volume of blood loss was 100 mL (range, 20-800 mL). Three patients (9.7%) were diagnosed with malignant ovarian cancer using intraoperative frozen examination, and 1 patient was converted to laparotomy due to advanced disease. Thirty patients underwent LESS, and there was no need for an additional laparoscopic port. CONCLUSION LESS surgery using an angiocatheter needle, with leaving only a small postoperative scar, was deemed feasible for the management of huge ovarian cysts.
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Affiliation(s)
- Eun Young Ki
- Department of Obstetrics and Gynecology, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea
| | - Eun Kyung Park
- Department of Obstetrics and Gynecology, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea
| | - In Cheol Jeong
- Department of Obstetrics and Gynecology, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea
| | - Sung Eun Bak
- Department of Obstetrics and Gynecology, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea
| | - Hye Sung Hwang
- Department of Obstetrics and Gynecology, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea
| | - Yoo Hyun Chung
- Department of Obstetrics and Gynecology, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea
| | - Min Jong Song
- Department of Obstetrics and Gynecology, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea.
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Casarin J, Laganà AS, Uccella S, Cromi A, Pinelli C, Gisone B, Borghi C, Cominotti S, Garzon S, Morotti M, Tozzi R, Ghezzi F. Surgical treatment of large adnexal masses: a retrospective analysis of 330 consecutive cases. MINIM INVASIV THER 2019; 29:366-374. [PMID: 31375049 DOI: 10.1080/13645706.2019.1649700] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Introduction: In the present study, perioperative outcomes of laparoscopy (LPS) were compared to open surgery (OS) for the treatment of large adnexal masses (AM).Material and methods: Retrospective observational cohort study. Data of consecutive patients who underwent ovarian cystectomy or salpingo-oophorectomy for large AM (diameter ≥10 cm) at a referral minimally invasive gynecologic center were analyzed. Propensity score match (PSM) analysis was used to minimize covariate imbalances between the two groups.Results: Overall 330 patients, 285 (86.4%) LPSs and 45 (13.6%) OSs were included. PSM showed LPS (vs. OS) to be associated with less intraoperative blood loss (mL: 131.1 ± 52.6 vs. 545.5 ± 101.2; p = .007), shorter operative time (min: 84.8 ± 77.9 vs. 123.7 ± 70.1; p < .001), but higher rate of spillage (54.5% vs. 12.1%; p < .001). Among the LPS group, a positive correlation between AM size and both conversion to open surgery and need for mini-laparotomy was found (p < .05).Conclusions: An accurate patient selection, a dedicated workup, and an appropriate counselling are mandatory before LPS for large AM. The increased risks of intraoperative spillage associated with the minimally invasive approach should be acknowledged.
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Affiliation(s)
- Jvan Casarin
- Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy.,Gynecologic Oncology Unit, Oxford University Hospitals, NHS Trust, Oxford, UK
| | - Antonio Simone Laganà
- Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
| | - Stefano Uccella
- Department of Woman and Child Health, Fondazione Policlinico Agostino Gemelli, I.R.C.C.S. Rome, Italy
| | - Antonella Cromi
- Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
| | - Ciro Pinelli
- Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
| | - Baldo Gisone
- Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
| | - Camilla Borghi
- Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
| | - Selene Cominotti
- Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
| | - Simone Garzon
- Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
| | - Matteo Morotti
- Gynecologic Oncology Unit, Oxford University Hospitals, NHS Trust, Oxford, UK
| | - Roberto Tozzi
- Gynecologic Oncology Unit, Oxford University Hospitals, NHS Trust, Oxford, UK
| | - Fabio Ghezzi
- Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
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Song T, Kim MK, Jung YW, Yun BS, Seong SJ, Choi CH, Kim TJ, Lee JW, Bae DS, Kim BG. Minimally invasive compared with open surgery in patients with borderline ovarian tumors. Gynecol Oncol 2017; 145:508-512. [DOI: 10.1016/j.ygyno.2017.03.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 03/24/2017] [Accepted: 03/24/2017] [Indexed: 01/12/2023]
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Kim JS, Lee IO, Eoh KJ, Chung YS, Lee I, Lee JY, Nam EJ, Kim S, Kim YT, Kim SW. Surgical technique for single-port laparoscopy in huge ovarian tumors: SW Kim's technique and comparison to laparotomy. Obstet Gynecol Sci 2017; 60:178-186. [PMID: 28344959 PMCID: PMC5364100 DOI: 10.5468/ogs.2017.60.2.178] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 09/29/2016] [Accepted: 10/05/2016] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE This study aimed to introduce a method to remove huge ovarian tumors (≥15 cm) intact with single-port laparoscopic surgery (SPLS) using SW Kim's technique and to compare the surgical outcomes with those of laparotomy. METHODS Medical records were retrospectively reviewed for patients who underwent either SPLS (n=21) with SW Kim's technique using a specially designed 30×30-cm2-sized 3XL LapBag or laparotomy (n=22) for a huge ovarian tumor from December 2008 to May 2016. Perioperative surgical outcomes were compared. RESULTS In 19/21 (90.5%) patients, SPLS was successfully performed without any tumor spillage or conversion to multi-port laparoscopy or laparotomy. There was no significant difference in patient characteristics, including tumor diameter and total operation time, between both groups. The postoperative hospital stay was significantly shorter for the SPLS group than for the laparotomy group (median, 2 [1 to 5] vs. 4 [3 to 17] days; P<0.001). The number of postoperative general diet build-up days was also significantly shorter for the SPLS group (median, 1 [1 to 4] vs. 3 [2 to 16] days; P<0.001). Immediate post-operative pain score was lower in the SPLS group (median, 2.0 [0 to 8] vs. 4.0 [0 to 8]; P=0.045). Patient-controlled anesthesia was used less in the SPLS group (61.9% vs. 100%). CONCLUSION SPLS was successful in removing most large ovarian tumors without rupture and showed quicker recovery and less immediate post-operative pain in comparison to laparotomy. SPLS using SW Kim's technique could be a feasible solution to removing huge ovarian tumors.
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Affiliation(s)
- Jeong Sook Kim
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Women's Cancer Center, Yonsei Cancer Center, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - In Ok Lee
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Women's Cancer Center, Yonsei Cancer Center, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Kyung Jin Eoh
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Women's Cancer Center, Yonsei Cancer Center, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Young Shin Chung
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Women's Cancer Center, Yonsei Cancer Center, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Inha Lee
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Women's Cancer Center, Yonsei Cancer Center, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Jung-Yun Lee
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Women's Cancer Center, Yonsei Cancer Center, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Eun Ji Nam
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Women's Cancer Center, Yonsei Cancer Center, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Sunghoon Kim
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Women's Cancer Center, Yonsei Cancer Center, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Young Tae Kim
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Women's Cancer Center, Yonsei Cancer Center, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Wun Kim
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Women's Cancer Center, Yonsei Cancer Center, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea
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Liu LL, Bao N, Lu HW. Effects of CO 2 Pneumoperitoneum on the Cognitive Function of Patients Undergoing Gynecologic Laparoscopy. Gynecol Obstet Invest 2015; 81:90-5. [DOI: 10.1159/000376576] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Accepted: 01/26/2015] [Indexed: 11/19/2022]
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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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15
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Akdemir A, Yildirim N, Zeybek B, Karaman S, Sendag F. Single Incision Trans-Umbilical Total Hysterectomy: Robotic or Laparoscopic? Gynecol Obstet Invest 2015; 80:93-8. [DOI: 10.1159/000370000] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 11/18/2014] [Indexed: 11/19/2022]
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