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Niu G, Zhao H, Wang H, Zhao L, Zhai Y. Single-Incision Plus One Port Laparoscopic Surgery for Myomectomy: A Retrospective Study. J INVEST SURG 2023; 36:2221738. [PMID: 37336518 DOI: 10.1080/08941939.2023.2221738] [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: 12/02/2022] [Revised: 05/22/2023] [Accepted: 05/31/2023] [Indexed: 06/21/2023]
Abstract
BACKGROUND The purpose of this study was to evaluate the effect of single-incision plus one port laparoscopic surgery (SILS + 1) for myomectomy. METHODS We retrospectively analyzed data from patients who underwent laparoendoscopic single-site myomectomy (LESS-M group, n = 40) and SILS + 1 (SILS + 1-M group, n = 40) for myomectomy at our hospital from October 2018 through December 2020. The patients' baseline demographic information and clinical data were compared between the two groups. RESULTS The results showed that no significant difference in basic characteristics or between the number, size, and location of uterine myomas between the two groups (p < 0.05). However, the surgery was more difficult and the total operating time was significantly longer in the LESS-M group compared to the SILS + 1-M group (83.5 ± 14.2 vs. 108.2 ± 18.1 min, p = 0.001). Moreover, the estimated intraoperative blood loss (113.4 ± 46.5 vs. 211.4 ± 60.3 ml, p = 0.001) and changes in hemoglobin level (13.1 ± 7.6 vs. 18.2 ± 6.0, p = 0.001) were significantly lower in the SILS + 1-M group compared to the LESS-M group. In addition, no serious intraoperative or postoperative complications occurred after surgery in either group. The clinical outcomes in the SILS + 1-M group were associated with a significant reduction in total surgical time compared to the LESS-M group (p < 0.05). CONCLUSION SILS + 1 for myomectomy is popular in clinics, with a satisfactory clinical effect.
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Affiliation(s)
- Gaoli Niu
- Department of Gynecologic Oncology, The First Affiliated Hospital of Henan Polytechnic University (The Second People's Hospital of Jiaozuo), Jiaozuo, China
| | - Hua Zhao
- Department of Gynecology and Obstetrics, Henan Provincial People's Hospital, Zhengzhou, China
| | - Hong Wang
- Department of Gynecologic Oncology, The First Affiliated Hospital of Henan Polytechnic University (The Second People's Hospital of Jiaozuo), Jiaozuo, China
| | - Lingli Zhao
- Department of Gynecologic Oncology, The First Affiliated Hospital of Henan Polytechnic University (The Second People's Hospital of Jiaozuo), Jiaozuo, China
| | - Yanhong Zhai
- Department of Gynecology and Obstetrics, Henan Provincial People's Hospital, Zhengzhou, China
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Li Y, Wang C, Chen W, Chen C, Tang X, Wang H, Chen J, Liu Q, Li W, Li Y, Chen P, Luo Y, Su C. Selection of surgical modality for massive splenomegaly in children. Surg Endosc 2023; 37:9070-9079. [PMID: 37798532 PMCID: PMC10709218 DOI: 10.1007/s00464-023-10462-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 09/06/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND Laparoscopic splenectomy (LS), a treatment for both benign and malignant splenic diseases, can prove technically challenging in patients with massive splenomegaly. In particular, the optimal surgical modality for treating massive splenomegaly in children remains controversial. METHODS The clinicopathologic data of 289 pediatric patients undergoing splenectomy for massive splenomegaly were studied in a retrospective analysis. Accordingly, the patients were classified into the LS surgery group and open splenectomy (OS) surgery group. In the laparoscopy cohort, they were separated into two subgroups according to the method of surgery: the multi-incision laparoscopic splenectomy (MILS) and the single-incision laparoscopic splenectomy (SILS) surgery groups, respectively. Patient demographics, clinical data, surgery, complications, and postoperative recovery underwent analysis. Concurrently, we compared the risk of adverse laparoscopic splenectomy outcomes utilizing univariable and multivariable logistic regression. RESULTS The total operation time proved remarkably shorter in the OS group in contrast to the LS group (149.87 ± 61.44 versus 188.20 ± 52.51 min, P < 0.001). Relative to the OS group, the LS group exhibited lowered postoperative pain scores, bowel recovery time, and postoperative hospitalization time (P < 0.001). No remarkable difference existed in post-operation complications or mortality (P > 0.05). Nevertheless, the operation duration was remarkably longer in the SILS surgery group than in the MILS surgery group (200 ± 46.11 versus 171.39 ± 40.30 min, P = 0.02). Meanwhile, the operative duration of MILS and SILS displayed a remarkable positive association with splenic length. Moreover, the operative duration of SILS displayed a remarkable positive association with the age, weight, and height of the sick children. Splenic length proved an independent risk factor of adverse outcomes (P < 0.001, OR 1.378). CONCLUSIONS For pediatric patients with massive splenomegaly who can tolerate prolonged anesthesia and operative procedures, LS surgery proves the optimal treatment regimen. SILS remains a novel surgery therapy which may be deemed a substitutional surgery approach for treating massive splenomegaly.
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Affiliation(s)
- Yong Li
- Department of Pediatric Surgery, The First Affiliated Hospital of Guangxi Medical University, Shuangyong Road No.6, Region Qingxiu, Nanning, 530021, Guangxi Province, China
| | - Congjun Wang
- Department of Pediatric Surgery, The First Affiliated Hospital of Guangxi Medical University, Shuangyong Road No.6, Region Qingxiu, Nanning, 530021, Guangxi Province, China
| | - Weilong Chen
- Department of Pediatric Surgery, Zhuhai Women and Children's Hospital, Ningxi Road No.543, Region Xiangzhou, Zhuhai, 519000, Guangdong Province, China
| | - Chao Chen
- Department of Pediatric Surgery, The First Affiliated Hospital of Guangxi Medical University, Shuangyong Road No.6, Region Qingxiu, Nanning, 530021, Guangxi Province, China
| | - Xianming Tang
- Department of Pediatric Surgery, The First Affiliated Hospital of Guangxi Medical University, Shuangyong Road No.6, Region Qingxiu, Nanning, 530021, Guangxi Province, China
| | - Hong Wang
- Department of Pediatric Surgery, The First Affiliated Hospital of Guangxi Medical University, Shuangyong Road No.6, Region Qingxiu, Nanning, 530021, Guangxi Province, China
| | - Jiabo Chen
- Department of Pediatric Surgery, The First Affiliated Hospital of Guangxi Medical University, Shuangyong Road No.6, Region Qingxiu, Nanning, 530021, Guangxi Province, China
| | - Qiang Liu
- Department of Pediatric Surgery, The First Affiliated Hospital of Guangxi Medical University, Shuangyong Road No.6, Region Qingxiu, Nanning, 530021, Guangxi Province, China
| | - Wei Li
- Department of Pediatric Surgery, The First Affiliated Hospital of Guangxi Medical University, Shuangyong Road No.6, Region Qingxiu, Nanning, 530021, Guangxi Province, China
| | - Yanqiang Li
- Department of Pediatric Surgery, The First Affiliated Hospital of Guangxi Medical University, Shuangyong Road No.6, Region Qingxiu, Nanning, 530021, Guangxi Province, China
| | - Peng Chen
- Department of Pediatric Surgery, The First Affiliated Hospital of Guangxi Medical University, Shuangyong Road No.6, Region Qingxiu, Nanning, 530021, Guangxi Province, China
| | - Yige Luo
- Department of Pediatric Surgery, The First Affiliated Hospital of Guangxi Medical University, Shuangyong Road No.6, Region Qingxiu, Nanning, 530021, Guangxi Province, China.
| | - Cheng Su
- Department of Pediatric Surgery, The First Affiliated Hospital of Guangxi Medical University, Shuangyong Road No.6, Region Qingxiu, Nanning, 530021, Guangxi Province, China.
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Single incision laparoscopic surgery using conventional laparoscopic instruments versus two-port laparoscopic surgery for adnexal lesions. Sci Rep 2021; 11:4118. [PMID: 33602951 PMCID: PMC7892849 DOI: 10.1038/s41598-021-82204-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 01/13/2021] [Indexed: 11/08/2022] Open
Abstract
Single incision laparoscopic surgery (SILS) has emerged as least invasive interventions for gynecologic disease. However, SILS is slow to gain in popularity due to difficulties in triangulation and instrument crowding. Besides, the costly instruments may influence patients' will to have this procedure, and limit other medical expense as well. To optimize outcome and reduce cost, the objective of this study is to evaluate the feasibility and safety for patients undergoing adnexal surgeries using conventional laparoscopic instruments with SILS (SILS-C), and to compare with those of patients subject to TP using conventional laparoscopic instruments (TP-C). This is a retrospective case-control study. The data dated from April 2011 to April 2018. Patients who received concomitant multiple surgeries, were diagnosed with suspected advanced stage ovarian malignancy, or required frozen sections for intraoperative pathologic diagnosis were excluded. Demographic data, including the age, body weight, height, previous abdominal surgery were obtained. The surgical outcomes were compared using conventional statistical methods. 259 patients received SILS-C. The operating time was 63.83 ± 25.31 min. Blood loss was 2.38 ± 6.09 c.c. 58 patients (24.38%) needed addition of port to complete surgery. 384 patients received TP-C. Compared with SILS-C, the operating time was shorter (57.32 ± 26.38 min, OR = 0.984, CI = 0.975-0.992). The patients were further divided into unilateral or bilateral adnexectomy, and unilateral or bilateral cystectomy. Other than the operating time in unilateral cystectomy (66.12 ± 19.5 vs. 58.27 ± 23.92 min, p = .002), no statistical differences were observed in the subgroup analysis. Single incision laparoscopic surgery using conventional laparoscopic instruments is feasible and safe as initial approach to adnexal lesions. In complex setting as unilateral cystectomy or pelvic adhesions, two-port access may be considered.
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Ma J, Yang J, Cheng S, Jin Y, Zhang N, Wang C, Wang Y. The Learning Curve of Laparoendoscopic Single-Site Surgery in Benign Gynecological Diseases. J INVEST SURG 2021; 35:363-370. [PMID: 33395538 DOI: 10.1080/08941939.2020.1867673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To analyze and draw the learning curve of laparoendoscopic single-site surgery (LESS) in various benign gynecological diseases, so as to provide a reference for applying this cutting-edge technique. METHODS A retrospective analysis of LESS was conducted. Factors influencing the LESS learning process were assessed using Cox's proportional hazards regression. The cumulative sum (CUSUM) value and the learning curve were calculated and visualized based on operation time (OT), blood loss (BL), conventional laparoscopic surgery (CLS), conversion rate (CV), and complications (CP). The CUSUM value was defined as the sum of CUSUMOT, CUSUMBL, CUSUMCV, and CUSUMCP. RESULTS A total of 445 cases, including adnexectomies (n = 147), ovarian cystectomies (n = 175), and myomectomies (n = 123) were analyzed. Multivariate regression analysis indicated that adhesion grade (HR, 1.462; 95% CI, 1.016-1.994; p = .045), surgical type (HR, 1.283; 95% CI, 1.042-1.429; p = .024), and surgeon CLS experience (HR, 1.372; 95% CI, 1.097-2.246; p = .012) were independent factors predicting surgeons' mastery of the LESS technique. Among gynecologists with CLS experience, the cutoff points were 17, 20, and 27 cases for adnexectomy, ovarian cystectomy, and myomectomy, respectively. For those without CLS experience, the corresponding cutoff values were 19, 27, and 35 cases. CONCLUSION The learning curve of LESS for benign gynecological diseases indicates a stepwise process, during which the surgeon's CLS experience is the key, especially in ovarian cystectomy and myomectomy. For the training of young gynecologists, CLS should be emphasized in the early stage, and LESS should be introduced gradually.
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Affiliation(s)
- Jun Ma
- Department of Obstetrics and Gynecology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Jiani Yang
- Department of Obstetrics and Gynecology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Shanshan Cheng
- Department of Obstetrics and Gynecology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Yue Jin
- Department of Obstetrics and Gynecology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Nan Zhang
- Department of Obstetrics and Gynecology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Chao Wang
- Department of Obstetrics and Gynecology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Yu Wang
- Department of Obstetrics and Gynecology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
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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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The Clinical Application of a Self-developed Gasless Laparoendoscopic Operation Field Formation Device on Patients Undergoing Cholecystectomy. Surg Laparosc Endosc Percutan Tech 2020; 30:441-446. [PMID: 32555068 DOI: 10.1097/sle.0000000000000809] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND We have designed a new gasless laparoscopic operation field formation (LOFF) device for cholecystectomy which was successfully tested on animal model. The goal of this study is to investigate the feasibility, safety and effectiveness of this LOFF device on patients undergoing cholecystectomy. METHODS Patients with cholecystolithiasis or gallbladder polyps who underwent single port cholecystectomy from June 2015 to May 2016 were retrospectively reviewed. Either the LOFF-assisted laparoendoscopic single-port surgery (LESS) (LOFF-LESS) or the traditional LESS was performed. Operation time, intraoperative bleeding, postoperative hospital stay, surgical complications, incision pain score, shoulder and back pain and cosmetic satisfaction were compared. RESULTS A total of 186 patients were included in this study, with 79 in the LOFF-LESS group and 107 in the LESS group. There was no significant difference between LOFF-LESS group and LESS group in operation field establishment time, cholecystectomy time, intraoperative bleeding, postoperative hospital stay, incision pain and cosmetic satisfaction. A lower intraoperative arterial carbon dioxide pressure was documented in the LOFF-LESS group (P<0.01). The incidence of postoperative shoulder and back pain was significantly lower in LOFF-LESS group (P<0.01). CONCLUSION LOFF-LESS has comparable benefits of traditional LESS; it deceases incidence of pneumoperitoneum related complications as well.
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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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Su X, Jin X, Wen C, Xu Q, Cai C, Zhong Z, Tang X. Outcome of Gynecologic Laparoendoscopic Single-Site Surgery with a Homemade Device and Conventional Laparoscopic Instruments in a Chinese Teaching Hospital. BIOMED RESEARCH INTERNATIONAL 2020; 2020:5373927. [PMID: 32076607 PMCID: PMC6996709 DOI: 10.1155/2020/5373927] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 12/20/2019] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To demonstrate various benign gynecologic diseases that can be performed by laparoendoscopic single-site surgery (LESS) with conventional laparoscopic instruments. METHOD Patients with benign gynecologic diseases that need ovarian cystectomy, fallopian tube resection, or myomectomy were divided into experimental group and control group, and perioperative outcomes of these patients were analyzed. RESULTS From November 2017 to May 2018, 65 LESS gynecological surgeries were performed, among which there were 25 ovarian cystectomies, 28 unilateral fallopian tube resections, and 12 myomectomies. All the surgeries were completed smoothly, and only one surgery needed one more additional port. No patients have severe complications. Operative time, intraoperative blood loss, and perioperative complications have no difference between the two groups. The LESS laparoscopy group had less postoperative pain scores and longer bowel recovering time, compared with the conventional laparoscopy group (<0.05). CONCLUSION Compared with traditional laparoscopy, LESS surgery with conventional laparoscopic instruments is feasible and safe, but postoperative exhaust time is longer than the control group.
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Affiliation(s)
- Xianghui Su
- Department of Minimal Invasive Gynecology, Guangzhou Women and Children's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Xiaolong Jin
- Department of Minimal Invasive Gynecology, Guangzhou Women and Children's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Canliang Wen
- Department of Minimal Invasive Gynecology, Guangzhou Women and Children's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Qiong Xu
- Department of Minimal Invasive Gynecology, Guangzhou Women and Children's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Chunfang Cai
- Department of Minimal Invasive Gynecology, Guangzhou Women and Children's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Zhuohui Zhong
- Department of Minimal Invasive Gynecology, Guangzhou Women and Children's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Xiang Tang
- Department of Minimal Invasive Gynecology, Guangzhou Women and Children's Hospital, Guangzhou Medical University, Guangzhou, China
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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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