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Griva P, Talliou C, Rougeris L, Samara D, Panagouli K, Varvarousi G, Papa M, Kathopoulis N, Chantziara V, Rovina N. Restoration of Pulmonary Compliance after Laparoscopic Gynecologic Surgery Using a Recruitment Maneuver. J Pers Med 2024; 14:451. [PMID: 38793032 PMCID: PMC11122417 DOI: 10.3390/jpm14050451] [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: 03/13/2024] [Revised: 04/12/2024] [Accepted: 04/23/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND/OBJECTIVES This study aimed to investigate the hypothesis that an alveolar recruitment maneuver can restore lung compliance to initial values after laparoscopic gynecological surgery. METHODS A total of 31 patients who underwent laparoscopic gynecological surgery were enrolled. Protective mechanical ventilation was applied, and the radial artery was catheterized in all patients. An alveolar recruitment maneuver (incremental and decremental positive end-expiratory pressure) was applied ten minutes after the release of pneumoperitoneum. The respiratory mechanics and blood gas results were recorded at eight different time points: after induction of anesthesia (T1), in the lithotomy position (T2), in the Trendelenburg position (T3), 10 and 90 min after insufflation of carbon dioxide (T4 and T5), in the supine position (T6), after desufflation (T7), and 10 min after an alveolar recruitment maneuver at the end of surgery (T8). RESULTS Pneumoperitoneum and the Trendelenburg position caused a decline of 15 units in compliance (T7 vs. T1; p < 0.05) compared to baseline. After the alveolar recruitment maneuver, compliance increased by 17.5% compared with the mean value of compliance at time T1 (T8 vs. T1; p < 0.05). The recruitment maneuver had favorable results in patients with low initial compliance (41.5 mL/cmH2O, IQR: 9.75 mL/cmH2O), high Body Mass Index 30.32 kg/m2 (IQR: 1.05 kg/m2), and high initial plateau airway pressure (16.5 cmH2O, IQR: 0.75 cmH2O). CONCLUSIONS Lung compliance does not return to initial values after performing laparoscopic gynecological procedures. However, after the release of pneumoperitoneum, an alveolar recruitment maneuver is beneficial as it improves compliance and gas exchange.
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Affiliation(s)
- Panagiota Griva
- Department of Anesthesiology, University General Hospital Attikon,12462 Athens, Greece
| | - Christina Talliou
- Department of Anesthesiology, University General Hospital Attikon,12462 Athens, Greece
| | - Loizos Rougeris
- Department of Anaesthesiology, Rea Maternity Hospital, 17564 Athens, Greece
| | - Dimitra Samara
- Department of Anesthesiology, University General Hospital Attikon,12462 Athens, Greece
| | - Konstantina Panagouli
- Department of Anesthesiology, University General Hospital Attikon,12462 Athens, Greece
| | - Giolanda Varvarousi
- Department of Anaesthesiology, General Hospital of Athens Alexandra, 11528 Athens, Greece
| | - Maria Papa
- Department of Anaesthesiology, General Hospital of Athens Alexandra, 11528 Athens, Greece
| | - Nikolaos Kathopoulis
- Department of Obstetrics and Gynaecology, General Hospital of Athens Alexandra, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Vasiliki Chantziara
- 1st Department of Respiratory Medicine, Sotiria Thoracic Diseases Hospital of Athens, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Nikoletta Rovina
- 1st Department of Respiratory Medicine, Sotiria Thoracic Diseases Hospital of Athens, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
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Bahrami F, Maheux-Lacroix S, Bougie O, Boutin A. Day surgery for endometriosis in Canada: A retrospective cohort of trend and regional variation in types of surgeries and their complications. Aust N Z J Obstet Gynaecol 2023; 63:760-767. [PMID: 37264738 DOI: 10.1111/ajo.13705] [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: 12/20/2022] [Accepted: 05/08/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND A significant proportion of patients with endometriosis require surgery for management of the disease. AIMS We aimed to assess the trend and regional variation in day surgeries for endometriosis across Canada and to identify perioperative complications associated with types of surgeries and their temporal trend and regional variation. MATERIALS AND METHODS We conducted a retrospective cohort study of women undergoing day surgeries for endometriosis between 2015 and 2019 using Canadian administrative data from the National Ambulatory Care Reporting System, which includes data from four provinces (Ontario (ON), Alberta (AB), Nova Scotia (NS) and Prince Edward Island (PEI)). Multivariate logistic regression models were used to compare perioperative complication rates, while adjusting for site(s) of endometriosis lesion, age, type of surgical intervention, and comorbidities. RESULTS During the study period, the rate of day surgeries for endometriosis remained nearly constant at 80-90 cases per 100 000 women of reproductive age (P = 0.12). The rate of day surgeries was significantly different between provinces (AB = 94, NS = 93 vs ON = 85 per 100 000 women of reproductive age: P < 0.02). The odds of complications decreased with time (2019 vs 2015; adjusted odds ratio (aOR): 0.84; 95% CI: 0.73-0.98). There was a significant regional variation in the frequency of perioperative complications (PEI vs ON aOR: 4.13, 95% CI: 2.58-6.62; and NS vs ON aOR: 1.47, 95% CI: 1.11-1.95). CONCLUSION The rates of day surgery for endometriosis remained stable and the risks of perioperative complications decreased during the five-year study period. However, there were significant regional variations in the risk of perioperative complications.
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Affiliation(s)
- Foruzan Bahrami
- Reproduction, Mother and Youth Health Unit, CHU de Québec-Université Laval Research Center, Quebec City, Quebec, Canada
| | - Sarah Maheux-Lacroix
- Department of Obstetrics and Gynaecology, Université Laval, and Reproduction, Mother and Youth Health Unit, CHU de Québec-Université Laval Research Center, Quebec City, Quebec, Canada
| | - Olga Bougie
- Department of Obstetrics and Gynecology, Queen's University, Kingston, Ontario, Canada
| | - Amélie Boutin
- Department of Pediatrics, Université Laval, and Reproduction, Mother and Youth Health & Population Health and Optimal Health Practices Units, CHU de Québec-Université Laval Research Center, Quebec City, Quebec, Canada
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Patel N, Chaudhari K, Jyotsna G, Joshi JS. Surgical Frontiers: A Comparative Review of Robotics Versus Laparoscopy in Gynecological Interventions. Cureus 2023; 15:e49752. [PMID: 38161931 PMCID: PMC10757673 DOI: 10.7759/cureus.49752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 11/30/2023] [Indexed: 01/03/2024] Open
Abstract
This review comprehensively examines the current state and future directions of gynecological surgery, focusing on the comparative analysis of laparoscopy and robotic surgery. The overview highlights the evolution of these surgical techniques, emphasizing their impact on patient outcomes, procedural efficiency, and safety profiles. The analysis encompasses critical factors such as cost-effectiveness, learning curves, and implications for postoperative recovery. The future of gynecological surgery is envisioned through emerging technologies, including augmented reality, single-incision laparoscopy, and artificial intelligence. The coexistence of laparoscopy and robotics is explored, acknowledging their respective strengths and roles in shaping women's healthcare. In conclusion, the dynamic nature of the field is underscored, emphasizing the need for a patient-centered and adaptable approach. Collaboration between healthcare professionals, engineers, and researchers is pivotal in unlocking these innovations' full potential, ensuring continued advancements in gynecological surgery for improved outcomes and enhanced patient care.
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Affiliation(s)
- Nainita Patel
- Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Kamlesh Chaudhari
- Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Garapati Jyotsna
- Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Jalormy S Joshi
- Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Darwish A, Tawfik M, Gaflan A, Darwish D. Intraoperative and Postoperative Outcomes of Modified Bidirectional Intra-Umbilical Incision versus Infra-Umbilical Incision for Direct Trocar Insertion in Gynaecological Laparoscopy: A randomised controlled trial. Sultan Qaboos Univ Med J 2023; 23:455-462. [PMID: 38090239 PMCID: PMC10712379 DOI: 10.18295/squmj.5.2023.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 03/01/2023] [Accepted: 03/22/2023] [Indexed: 12/18/2023] Open
Abstract
Objectives This study aimed to describe a modified, curved, deep, bidirectional, intra-umbilical, vertical incision for primary trocar insertion and prospectively compare its intraoperative and postoperative outcomes with an infra-umbilical incision in gynaecologic laparoscopy. Methods Between August 2019 and March 2021, 110 patients subjected to the direct trocar insertion technique for laparoscopic intervention were classified into two groups. Group A comprised 55 cases of infra-umbilical incision, whereas group B comprised 55 cases of a modified, curved, longitudinal, deep, bidirectional, intra-umbilical incision. Afterwards, intraoperative and postoperative assessments were performed. Results The increase in the numbers of parity, gravidity and previous caesarean sections was found to be statistically significant; a smaller number of infertility complaints were observed in group B. Similarly, group B expressed a statistically significant less peri-trocar CO2 leakage (46 [83.6%] patients versus 28 [50.9%] patients) and more tightness of the primary portal entry (45 [81.8%] patients versus 30 [54.5%] patients) when compared to group A throughout the whole operation. After a one-month follow-up, a statistically significant (P = 0.029) decrease in the Observer Scar Assessment Scale and Patient Scar Assessment Scale scores in group B (10.4 ± 4.2 and 11.8 ± 4.3, respectively), demonstrating better cosmoses when compared to group A (13.3 ± 5.7 and 16.0 ± 6.8, respectively). Conclusion Performing a modified, curved, deep, bidirectional, intra-umbilical, vertical incision for the insertion of a primary laparoscopic trocar (i.e. Darwish laparoscopic entry) is a simple and fast step that results in the elimination of intraoperative gas leakage and trocar slippage without the need for any additional sutures. Aesthetically, it results in a better scar with satisfactory cosmoses when compared to an infra-umbilical incision.
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Affiliation(s)
- Atef Darwish
- Department of Obstetrics & Gynecology, Women’s Health University Hospital, Assiut University, Assiut, Egypt
| | - Mohammad Tawfik
- Department of Obstetrics & Gynecology, Women’s Health University Hospital, Assiut University, Assiut, Egypt
| | - Amal Gaflan
- Department of Obstetrics & Gynecology, Women’s Health University Hospital, Assiut University, Assiut, Egypt
| | - Dina Darwish
- Department of Obstetrics & Gynecology, Women’s Health University Hospital, Assiut University, Assiut, Egypt
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Kampan NC, Teik CK, Shafiee MN. Where are we going with sentinel nodes mapping in ovarian cancer? Front Oncol 2022; 12:999749. [PMID: 36408149 PMCID: PMC9669053 DOI: 10.3389/fonc.2022.999749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 10/12/2022] [Indexed: 11/06/2022] Open
Abstract
Lymph node involvement is a major predictive indicator in early-stage epithelial ovarian cancer (EOC). There is presently no effective way to determine lymph node involvement other than surgical staging. As a result, traditional ovarian cancer surgery still includes pelvic and paraaortic lymphadenectomy. However, it might be linked to higher blood loss, lengthier operations, and longer hospital stays. The creation of a technique for accurately predicting nodal status without significant lymphadenectomy is thus the subject of ongoing research. Sentinel lymph nodes (SLN) mapping is a routine procedure in oncological surgery and has been proven to be effective and safe in cervical, vulvar, and uterine cancer. On the other hand, SLN mapping is not yet widely accepted and recognized in EOC. A thorough search of the literature was conducted between January 1995 to March 2022, using PubMed and Embase. This review included studies on lymphatic outflow of the ovaries and the sentinel lymph node method. A total of 13 studies involving 212 patients who underwent sentinel lymph node mapping for ovaries were included. Both open and laparoscopic approach are used. The most popular injection site is the ovarian ligaments, and a variety of agents are utilized, although the main markers were, technetium-99m radiocolloid (Tc-99m) or indocyanine green, either alone or in combination. Overall detection rate for SLN in ovaries is 84.5% (interquartile range: 27-100%). We suggest a standardized method for sentinel lymph node mapping in ovarian cancer. The detection rates, characterization and true positive rates of the approach in investigations support further study. The use of ultra-staging is essential for lower-volume metastasis and reproducibility. To ascertain the clinical utility of sentinel node in early ovarian cancer, larger collaborative prospective clinical trials are necessary.
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Hu H, Choi JDW, Edye MB, Aitken T, Kapurubandara S. Gastric Injury at Laparoscopy for Gynecologic Indications: A Systematic Review. J Minim Invasive Gynecol 2022; 29:1224-1230. [PMID: 36184063 DOI: 10.1016/j.jmig.2022.09.058] [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: 07/23/2022] [Revised: 09/19/2022] [Accepted: 09/23/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE This systematic review aims to identify causes of increased risk for and location and mechanism of gastric injury at laparoscopy for gynecologic indications and determine optimal management. DATA SOURCES A prospectively registered systematic review (PROSPERO: CRD42021237999) was undertaken and performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Databases searched included Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Medline, Embase, Web of Science, SCOPUS, and Google Scholar from 1960 to 2021. METHODS OF STUDY SELECTION All study types were included involving female patients of any age with gastric injury at laparoscopy for gynecologic indication. TABULATION, INTEGRATION, AND RESULTS A total of 6294 articles were screened, from which 67 studies were selected for a full-text review. Twenty-eight articles were included, which contained 42 cases drawn from 7 observational studies, 4 case series, and 17 case reports. Of these, 93% (39/42) were at the time of laparoscopic entry, with Veress entry technique used in 79% of these cases (31/39). Eighteen cases reported an entry point, with 77% (14/18) occurring at the periumbilical entry point and 11% (2/18) occurring at Palmer's point. Of the cases with reported etiology for gastric distention or displacement, 64% (9/14) were owing to anesthetic cause. The most common sites of gastric injury were on the anterior stomach wall (n = 8) and the greater curvature (n = 5). Among patients with reported management (32/42), a similar proportion were managed conservatively (11) when compared with repair through laparotomy (13) or laparoscopy (8). All injuries were detected intraoperatively with no reported short-term sequelae. CONCLUSION This systematic review of the literature reveals that gastric injury at laparoscopy for gynecologic indications is a rare complication predominantly occurring during laparoscopic entry, most commonly at the periumbilical entry point. When detected intraoperatively, conservative management, laparoscopic, or open repair in the appropriate patient has been performed with no short-term sequelae. The limitations of this review include paucity of cases, detail, and timeline of publications.
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Affiliation(s)
- Hillary Hu
- Department of Obstetrics and Gynaecology, Westmead Hospital (Drs. Hu and Kapurubandara), Sydney, New South Wales, Australia.
| | - Joseph Do Woong Choi
- Department of Surgery, Blacktown and Mount Druitt Hospitals (Drs. Choi and Edye), Sydney, New South Wales, Australia
| | - Michael B Edye
- Department of Surgery, Blacktown and Mount Druitt Hospitals (Drs. Choi and Edye), Sydney, New South Wales, Australia; Western Sydney Universit (Dr. Edye), Sydney, New South Wales, Australiay
| | - Tess Aitken
- University of Sydney Library (X Aitken), Sydney, New South Wales, Australia
| | - Supuni Kapurubandara
- Department of Obstetrics and Gynaecology, Westmead Hospital (Drs. Hu and Kapurubandara), Sydney, New South Wales, Australia; University of Sydney (Dr. Kapurubandara), Sydney, New South Wales, Australia; Sydney West Advanced Pelvic Surgery Unit (Dr. Kapurubandara), Sydney, New South Wales, Australia
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Scientometric analysis of global research output in robotic gynecologic surgery. INTERNATIONAL JOURNAL OF SURGERY OPEN 2022. [DOI: 10.1016/j.ijso.2022.100544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Liu Y, Tan X, Cheng Y, Wang B, Zhang H, Zhang L, Liu D, Qi X. Pilot Study of Effects of Intermittent Pneumatic Compression in the Immediate Peri-Operative Period on Hemodynamic Parameters in Patients After Laparoscopic Gynecologic Surgery. Front Surg 2022; 9:896452. [PMID: 35747433 PMCID: PMC9209646 DOI: 10.3389/fsurg.2022.896452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 05/17/2022] [Indexed: 11/13/2022] Open
Abstract
The randomized controlled study investigated the impacts of immediate peri-operative Intermittent pneumatic compression (IPC) on hemodynamic indicators in patients undergoing laparoscopic gynecologic surgery. Patients scheduled for elective laparoscopic gynecologic surgery were randomized to control (IPC not used), pre-operative IPC, post-operative IPC, and peri-operative IPC (performed both before and after surgery) groups. Systolic blood pressure (SBP), mean blood pressure (MBP) cardiac output (CO), heart rate (HR) and systemic vascular resistance (SVR) were measured at different time points. The results showed that SBP changes not obviously over time in the control and peri-operative IPC group. Compared with values before surgery, the pre-operative IPC group had a lower SBP (P < 0.01) at the end of PACU stay, whereas the post-operative IPC group had a higher SBP (P < 0.01) after surgery. All groups exhibited little or no variation in HR, CO and SVR. Conclusion is peri-operative IPC has no major adverse effects on hemodynamic parameters.
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Affiliation(s)
- Yanchang Liu
- Operation Room, Shenzhen Maternity & Child Healthcare Hospital, The First School of Clinical Medicine, Southern Medical University, Shenzhen, China
| | - Xuhong Tan
- Operation Room, Shenzhen Maternity & Child Healthcare Hospital, The First School of Clinical Medicine, Southern Medical University, Shenzhen, China
| | - Yujin Cheng
- Operation Room, Shenzhen Maternity & Child Healthcare Hospital, The First School of Clinical Medicine, Southern Medical University, Shenzhen, China
| | - Baojun Wang
- Operation Room, Shenzhen Maternity & Child Healthcare Hospital, The First School of Clinical Medicine, Southern Medical University, Shenzhen, China
| | - Hanyu Zhang
- Operation Room, Shenzhen Maternity & Child Healthcare Hospital, The First School of Clinical Medicine, Southern Medical University, Shenzhen, China
| | - Lili Zhang
- Operation Room, Shenzhen Maternity & Child Healthcare Hospital, The First School of Clinical Medicine, Southern Medical University, Shenzhen, China
| | - Danyong Liu
- Department of Anesthesiology, Shenzhen Maternity & Child Healthcare Hospital, The First School of Clinical Medicine, Southern Medical University, Shenzhen, China
| | - Xiaofei Qi
- Department of Anesthesiology, Shenzhen Maternity & Child Healthcare Hospital, The First School of Clinical Medicine, Southern Medical University, Shenzhen, China
- Correspondence: Xiaofei Qi
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