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Hurni Y, Huber D. Omentectomy for oncological surgical staging by transvaginal natural orifice transluminal endoscopic surgery (vNOTES): a preliminary study. Front Surg 2023; 10:1224770. [PMID: 37576921 PMCID: PMC10413260 DOI: 10.3389/fsurg.2023.1224770] [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: 05/18/2023] [Accepted: 07/17/2023] [Indexed: 08/15/2023] Open
Abstract
Objective This study aimed to determine the feasibility of performing omentectomy by transvaginal natural orifice transluminal endoscopic surgery (vNOTES) for surgical staging of ovarian and high-risk endometrial malignancies. Methods This descriptive study was realized in a non-university hospital in Switzerland. Eighteen patients with suspicious adnexal masses or high-risk endometrial cancer underwent surgical staging comprising infracolic omentectomy by vNOTES between May 2020 and April 2023. Results Patients underwent oncological surgical staging for suspicious adnexal masses in 14 cases (77.8%) and high-risk endometrial cancer in 4 cases (22.2%). vNOTES omentectomies were performed in all patients without complications. Associated procedures included salpingo-oophorectomy (94.4%), hysterectomy (55.6%), peritoneal biopsies (33.3%), pelvic sentinel lymph node biopsies (22.2%), and appendectomy (5.6%). The median time to perform omentectomies was 9 (4-13) min. All oncological staging were completed by vNOTES. No significant intraoperative complications occurred. We observed 1 case (5.6%) of postoperative fever probably associated with vaginal cuff infection (Clavien-Dindo grade II). Conclusions This study demonstrated the feasibility of performing vNOTES oncological staging requiring complex extrapelvic procedures such as infracolic omentectomy, supporting its potential role for managing gynecological malignancies such as ovarian and high-risk endometrial cancers. However, before expanding this approach outside study settings, strong evidence of its feasibility, practical benefits, and long-term oncological outcomes are needed.
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Affiliation(s)
- Yannick Hurni
- Department of Gynecology and Obstetrics, Valais Hospital, Sion, Switzerland
| | - Daniela Huber
- Department of Gynecology and Obstetrics, Valais Hospital, Sion, Switzerland
- Department of Pediatrics, Gynecology and Obstetrics, Geneva University Hospitals, Geneva, Switzerland
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Noh JJ, Jeon JE, Jung JH, Kim TJ. Feasibility and Surgical Outcomes of Hybrid Robotic Single-Site Hysterectomy Compared with Single-Port Access Total Laparoscopic Hysterectomy. J Pers Med 2023; 13:1178. [PMID: 37511791 PMCID: PMC10382033 DOI: 10.3390/jpm13071178] [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: 07/02/2023] [Revised: 07/19/2023] [Accepted: 07/20/2023] [Indexed: 07/30/2023] Open
Abstract
We compared surgical outcomes between single-port access total laparoscopic hysterectomy (SPA-TLH) and hybrid robotic single-site hysterectomy (RSSH), a new technique of combining the benefits of SPA-TLH with RSSH in this study. A total of 64 patients were retrospectively analyzed. They underwent either hybrid RSSH or SPA-TLH for benign gynecologic disease between December 2018 and August 2021. To assess the feasibility of hybrid RSSH, the clinical characteristics and surgical outcomes were compared between the hybrid RSSH group (n = 29) and the SPA-TLH group (n = 35). All of the surgeries were completed without requiring additional ports or conversion to laparotomy. The surgical outcomes including total operative time, uterine weight, estimated blood loss, hemoglobin changes, length of hospital stay, and postoperative pain scores were not significantly different between the two groups. The colpotomy time, including the detachment of the uterosacral and cardinal ligaments, was shorter in the hybrid RSSH group than in the SPA-TLH group (8.0 min vs. 14.0 min; p = 0.029). However, the vaginal cuff closure time was longer in the hybrid RSSH group than in the SPA-TLH group (15.0 min vs.10.0 min; p = 0.001). No difference was observed with regards to intraoperative and postoperative complications. Hybrid RSSH appears to be a feasible procedure for hysterectomy in patients with benign gynecologic diseases.
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Affiliation(s)
- Joseph J Noh
- Gynecologic Cancer Center, Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Jung-Eun Jeon
- Gynecologic Cancer Center, Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Ji-Hee Jung
- Gynecologic Cancer Center, Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Tae-Joong Kim
- Gynecologic Cancer Center, Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
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Hurni Y, Romito F, Huber D. Transvaginal Natural Orifice Transluminal Endoscopic Surgery for Surgical Staging of Early-Stage Ovarian Cancers: A Report of Two Cases. Front Surg 2022; 9:833126. [PMID: 35372471 PMCID: PMC8967413 DOI: 10.3389/fsurg.2022.833126] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 02/21/2022] [Indexed: 12/15/2022] Open
Abstract
Surgical staging is essential in the management of ovarian cancers. This staging has traditionally been performed by laparotomy, but minimally invasive techniques are increasingly employed. Transvaginal natural orifice transluminal endoscopic surgery (vNOTES) is a promising technique in the field of gynecological oncology. We report 2 cases of vNOTES surgical staging for suspicious ovarian tumors. We operated on 2 patients aged of 81 and 62 years for low-grade serous ovarian carcinoma and ovarian cystadenofibroma, respectively. We performed surgical staging with a pure vNOTES technique for the first patient and used a hybrid approach for the second. No intraoperative or postoperative complications were observed. We suggest that vNOTES is a feasible and effective approach to surgically manage early-stage ovarian cancers.
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Affiliation(s)
- Yannick Hurni
- Department of Pediatrics, Gynecology and Obstetrics, Geneva University Hospitals, Geneva, Switzerland
- *Correspondence: Yannick Hurni
| | - Fabien Romito
- Department of Gynecology and Obstetrics, Valais Hospital, Sion, Switzerland
| | - Daniela Huber
- Department of Pediatrics, Gynecology and Obstetrics, Geneva University Hospitals, Geneva, Switzerland
- Department of Gynecology and Obstetrics, Valais Hospital, Sion, Switzerland
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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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Lowenstein L, Matanes E, Lauterbach R, Boulus S, Amit A, Baekelandt J. Transvaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) for omentectomy - A case series. Surg Oncol 2020; 34:186-189. [PMID: 32891327 DOI: 10.1016/j.suronc.2020.04.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 02/07/2020] [Accepted: 04/17/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND OBJECTIVE Transvaginal natural orifice transluminal endoscopic surgery (vNOTES) has been applied massively in the gynecological field in recent years. The aim of the current study is to present the surgical technique of vNOTES omentectomy and to evaluate the feasibility of this procedure. METHODS A case series study of the first 5 vNOTES omentectomy procedures performed for surgical staging of suspicious early stage ovarian cancer, at Rambam Health Care Campus (Israel) and Imelda Hospital (Belgium) between November 2018 and August 2019. Sociodemographic and clinical data were retrieved from patients' electronic charts. Primary points of interest included intra-operative bleeding, length of surgery, length of hospitalization, and surgical complications. RESULTS The median age was 61 years (range 50-72), and the median BMI was 27 kg/m2 (range 23-33). All the operations were carried out to completion through the vaginal GelPOINT, without insertion of an assistant abdominal trocar or conversion to another surgical approach. The median omentectomy time was 45 min (range: 39-52). The median estimated intraoperative blood loss was 150 ml (range: 20-200). The median hospital stay was 2 days (range: 1-3). CONCLUSIONS vNOTES is a feasible technique for omentectomy in early stage ovarian cancer, with low rates of complications and improved cosmetic results.
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Affiliation(s)
- Lior Lowenstein
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel; Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel.
| | - Emad Matanes
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel; Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Roy Lauterbach
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel; Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Sari Boulus
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel; Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Amnon Amit
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel; Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Jan Baekelandt
- Gynecological Oncology and Endoscopy, Imelda Hospital, Bonheiden, Antwerpen, Belgium
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Liang F, Xu X, Liang B. Comparison of Intraoperative Indicators and Postoperative Efficacy in Treatment of Benign Ovarian Tumor: Laparoscopy Versus Open Surgery. Am J Ther 2016; 24:e681-e688. [PMID: 26963724 DOI: 10.1097/mjt.0000000000000367] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This study aimed to compare intraoperative indicators and postoperative efficacy between laparoscopy and open surgery managing benign ovarian tumors. A total of 180 patients with benign ovarian tumor were enrolled; 105 underwent laparoscopy (LA group) and 75 underwent open surgery (OS group). Postoperative parameters were recorded. Preoperative and postoperative serum follicle-stimulating hormone, luteinizing hormone, and estradiol (E2) levels were determined using a BHP9507 chemiluminescence analyzer. The preoperative and postoperative serum C-reactive protein (CRP) level was examined using a QuikRead go CRP analyzer. Serum white blood cell and neutrophil (Ne) percentage were determined using an XT-2000i hematology analyzer. Compared with the OS group, intraoperative blood loss was less and the postoperative anal exhaust time, active time spent out of bed, length of hospitalization, time of indwelling catheter, and time of body temperature returning to normal were shorter in the LA group (all P < 0.001); the number of cases of intraoperative and postoperative complications and analgesia was less in the LA group (all P < 0.05). Six months after operation, serum follicle-stimulating hormone, luteinizing hormone, and E2 levels in the LA group were higher than those in the OS group (all P < 0.05). On day 1 and day 3 after operation, serum white blood cell and CRP levels and Ne percentage in the LA group were lower than those in the OS group (all P < 0.05). Laparoscopy is efficient and safe for managing benign ovarian tumors with comparable results to open surgery, and it is able to alleviate postoperative inflammation and minimize damage to the ovaries.
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Affiliation(s)
- Feng Liang
- 1Department of Maternity, Maternal and Child Health Care of Zaozhuang, Zaozhuang, China; and 2Department of Maternity, Peking Union Medical College Hospital, Beijing, China
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Kim JH, Lee YH, Chong GO, Lee YS, Cho YL, Hong DG. Total vaginal and single-port total laparoscopic hysterectomy for uterine benign diseases. MINIM INVASIV THER 2016; 25:148-53. [PMID: 26902788 DOI: 10.3109/13645706.2016.1141102] [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: 11/13/2022]
Abstract
OBJECTIVE This study aimed to review the surgical outcomes and health-related quality of life (HRQOL) of total vaginal (TVH) and single-port total laparoscopic hysterectomy (SP-TLH) for uterine benign diseases. STUDY DESIGN This study included 121 patients who had undergone TVH or SP-TLH for uterine benign diseases between April 2011 and July 2012. Surgical outcomes, complications, and HRQOL were reviewed in the two groups. Preoperative and postoperative HRQOL data from the 36-item Short Form questionnaire (SF-36) were recorded for all patients. RESULTS TVH was performed more often for the patients who had fewer previous operations (p = 0.32). In the TVH, there were fewer combined surgical procedures (p < 0.01), shorter operation times (p < 0.01), shorter vaginal stump suture times (p = 0.03) and lower complication rates (p < 0.01) than in SP-TLH. Overall, all SF-36 scales improved after surgery, except for the Social Functioning scale. There was no significant difference in any of the scales between the two groups. CONCLUSIONS TVH has equivalent effects on HRQOL as SP-TLH. SP-TLH is preferred for the cases with complicated and combined procedures.
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Affiliation(s)
- Ji Hyun Kim
- a Department of Obstetrics and Gynecology , Kyungpook National University Medical Center, Graduate School of Medicine , Daegu , South Korea
| | - Yoon Hee Lee
- a Department of Obstetrics and Gynecology , Kyungpook National University Medical Center, Graduate School of Medicine , Daegu , South Korea
| | - Gun Oh Chong
- a Department of Obstetrics and Gynecology , Kyungpook National University Medical Center, Graduate School of Medicine , Daegu , South Korea
| | - Yoon Soon Lee
- a Department of Obstetrics and Gynecology , Kyungpook National University Medical Center, Graduate School of Medicine , Daegu , South Korea
| | - Young Lae Cho
- a Department of Obstetrics and Gynecology , Kyungpook National University Medical Center, Graduate School of Medicine , Daegu , South Korea
| | - Dae Gy Hong
- a Department of Obstetrics and Gynecology , Kyungpook National University Medical Center, Graduate School of Medicine , Daegu , South Korea
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Single-port access versus conventional multi-port access total laparoscopic hysterectomy for very large uterus. Obstet Gynecol Sci 2015; 58:239-45. [PMID: 26023674 PMCID: PMC4444521 DOI: 10.5468/ogs.2015.58.3.239] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2014] [Revised: 10/08/2014] [Accepted: 10/10/2014] [Indexed: 12/27/2022] Open
Abstract
Objective The aim of this study was to compare the surgical outcomes of single-port access (SPA) and conventional multi-port access total laparoscopic hysterectomies (TLH) among patients with very large uteri (500 g or more). Methods Fifty consecutive patients who received TLH for large uterine myomas and/or adenomyoses weighing 500 g or more between February 2009 and December 2012 were retrospectively reviewed. SPA and conventional TLH were each performed in 25 patients. Surgical outcomes, including operation time, estimated blood loss, postoperative hemoglobin change, postoperative hospital stay, postoperative pain, and perioperative complications, were compared between the two groups. Results There were no significant demographic differences between the two groups. All operations were completed laparoscopically with no conversion to laparotomy. Total operation time, uterus weight, estimated blood loss, and postoperative hemoglobin change did not significantly differ between the two groups. Postoperative hospital stay was significantly shorter for the SPA-TLH group compared to that of the conventional TLH group (median [range], 3 [2.0-6.0] vs. 4 [3-7] days; P=0.004]. There were no inter-group differences in postoperative pain at 6, 24, and 72 hours after surgery. There was only one complicated case in each group. Conclusion SPA-TLH in patients with large uteri weighing 500 g or more is as feasible as conventional TLH. SPA-TLH is associated with shorter hospital stays compared to that of conventional TLH.
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Izadpanah M, Khalili H, Dashti-Khavidaki S, Mohammadi M. Heparin and related drugs for venous thromboembolism prophylaxis: subcutaneous or intravenous continuous infusion? J Comp Eff Res 2015; 4:167-84. [DOI: 10.2217/cer.14.78] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
In this article, the most evidenced approaches of unfractionated heparin administration for prevention of venous thromboembolism in medical and surgical hospitalized patients will be reviewed. Present data were collected by searching Scopus, PubMed, MEDLINE, Science direct, Clinical trials and Cochrane database systematic reviews. Subcutaneous low doses of unfractionated heparin (10000–15000 IU) in two or three divided doses per day are commonly administrated for venous thromboembolism prevention in different medical and surgical populations. In some populations such as obese surgical and critically ill patients, due to altered pharmacokinetics behavior of unfractionated heparin, continuous intravenous infusion of the low doses of unfractionated heparin has been proposed.
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Affiliation(s)
- Mandana Izadpanah
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, PO Box 14155/6451, Enghelab Avenue, Tehran 1417614411, Iran
| | - Hossein Khalili
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, PO Box 14155/6451, Enghelab Avenue, Tehran 1417614411, Iran
| | - Simin Dashti-Khavidaki
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, PO Box 14155/6451, Enghelab Avenue, Tehran 1417614411, Iran
| | - Mostafa Mohammadi
- Department of Anesthesiology & Critical Care Medicine, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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Operative outcomes of single-port-access laparoscopy-assisted vaginal hysterectomy compared with single-port-access total laparoscopic hysterectomy. Taiwan J Obstet Gynecol 2014; 53:486-9. [DOI: 10.1016/j.tjog.2013.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2013] [Indexed: 11/16/2022] Open
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Song T, Kim MK, Kim ML, Yoon BS, Seong SJ. Laparoendoscopic Single-Site Surgery for Extremely Large Ovarian Cysts: A Feasibility, Safety, and Patient Satisfaction Study. Gynecol Obstet Invest 2014; 78:81-7. [DOI: 10.1159/000363237] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Accepted: 04/24/2014] [Indexed: 11/19/2022]
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Koo YJ, Kim JE, Kim YH, Hahn HS, Lee IH, Kim TJ, Lee KH, Shim JU, Lim KT. Comparison of laparoscopy and laparotomy for the management of early-stage ovarian cancer: surgical and oncological outcomes. J Gynecol Oncol 2014; 25:111-7. [PMID: 24761214 PMCID: PMC3996260 DOI: 10.3802/jgo.2014.25.2.111] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Revised: 12/16/2013] [Accepted: 12/25/2013] [Indexed: 02/03/2023] Open
Abstract
Objective To investigate the surgical and oncological outcomes of laparoscopic surgery compared with laparotomy for the treatment of early-stage ovarian cancer. Methods Data from patients who underwent surgical management for early-stage ovarian cancer between 2006 and 2012 were retrospectively reviewed. All patients presented with stage I or II disease, and underwent comprehensive staging surgery consisting of a total hysterectomy, bilateral salpingo-oophorectomy, pelvic and para-aortic lymphadenectomy, omentectomy, and peritoneal cytology. Results Seventy-seven patients who underwent laparoscopic surgery (24 patients) or laparotomy (53 patients) were identified. Surgery for none of the patients was converted from laparoscopy to laparotomy. The mean operation time was shorter and the estimated blood loss was lower in the laparoscopy group than in the laparotomy group, though the differences were not statistically significant (193 min vs. 224 min, p=0.127; 698 mL vs. 973 mL, p=0.127). There were no differences in the intraoperative or postoperative complications. During a mean follow-up period of 31 months, tumor recurrence occurred in 4 patients: 2 (8.3%) in the laparoscopy group and 2 (3.8%) in the laparotomy group. The mean disease-free survival was 59 months after laparoscopy and 66 months after laparotomy (p=0.367). Conclusion Laparoscopic surgery seems to be adequate and feasible for the treatment of early-stage ovarian cancer with comparable results to laparotomy in terms of the surgical outcomes and oncological safety.
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Affiliation(s)
- Yu-Jin Koo
- Department of Obstetrics and Gynecology, Cheil General Hospital and Women's Healthcare Center, Kwandong University College of Medicine, Seoul, Korea
| | - Jung-Eun Kim
- Department of Obstetrics and Gynecology, Cheil General Hospital and Women's Healthcare Center, Kwandong University College of Medicine, Seoul, Korea
| | - Young-Hwa Kim
- Department of Radiology, Cheil General Hospital and Women's Healthcare Center, Kwandong University College of Medicine, Seoul, Korea
| | - Ho-Suap Hahn
- Department of Obstetrics and Gynecology, Cheil General Hospital and Women's Healthcare Center, Kwandong University College of Medicine, Seoul, Korea
| | - In-Ho Lee
- Department of Obstetrics and Gynecology, Cheil General Hospital and Women's Healthcare Center, Kwandong University College of Medicine, Seoul, Korea
| | - Tae-Jin Kim
- Department of Obstetrics and Gynecology, Cheil General Hospital and Women's Healthcare Center, Kwandong University College of Medicine, Seoul, Korea
| | - Ki-Heon Lee
- Department of Obstetrics and Gynecology, Cheil General Hospital and Women's Healthcare Center, Kwandong University College of Medicine, Seoul, Korea
| | - Jae-Uk Shim
- Department of Obstetrics and Gynecology, Cheil General Hospital and Women's Healthcare Center, Kwandong University College of Medicine, Seoul, Korea
| | - Kyung-Taek Lim
- Department of Obstetrics and Gynecology, Cheil General Hospital and Women's Healthcare Center, Kwandong University College of Medicine, Seoul, Korea
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Song T, Kim MK, Kim ML, Yoon BS, Seong SJ. Would Fewer Port Numbers in Laparoscopy Produce Better Cosmesis? Prospective Study. J Minim Invasive Gynecol 2014; 21:68-73. [DOI: 10.1016/j.jmig.2013.07.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2013] [Revised: 06/30/2013] [Accepted: 07/02/2013] [Indexed: 10/26/2022]
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Laparoendoscopic single-site versus conventional laparoscopic gynecologic surgery: a metaanalysis of randomized controlled trials. Am J Obstet Gynecol 2013; 209:317.e1-9. [PMID: 23860211 DOI: 10.1016/j.ajog.2013.07.004] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Revised: 06/03/2013] [Accepted: 07/01/2013] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To assess the current evidence regarding the efficiency, safety, and potential advantages of laparoendoscopic single-site surgery (LESS) for treating gynecologic diseases. STUDY DESIGN We comprehensively searched PubMed, Embase, and the Cochrane Library from their inception to December 2012. Two authors screened out duplicates and independently reviewed eligibility of each study. We included randomized controlled trials comparing LESS with conventional laparoscopy (CL) for treating gynecologic diseases. The primary outcomes were perioperative complication rate, conversion rate, postoperative pain, and cosmetic satisfaction. RESULTS We included 6 randomized controlled trials with 439 participants in the final analysis. There were no significant differences between LESS and CL in terms of perioperative complication rate (15.5% and 14.3%; risk ratio, 1.11; 95% confidence interval [CI], 0.74-1.67; P = .61), conversion rate (3.8% and 1.1%; risk ratio, 2.75; 95% CI, 0.73-10.33; P = .13), postoperative pain (weighted mean difference [WMD], -0.22; 95% CI, -1.29 to 0.85; P = .68), analgesic requirement (WMD, 0.41; 95% CI, -1.69 to 2.51; P = .70), and cosmetic satisfaction (WMD, 0.19; 95% CI, -0.30 to 0.68; P = .46). There were also no differences in terms of operative time (P = .65), hemoglobin change (P = .23), time to first flatus (P = .17), and length of hospital stay (P = .99) between both techniques. CONCLUSION This metaanalysis provides evidence that LESS is comparable in the efficacy and safety, but does not offer potential advantage such as better cosmesis and lesser pain compared with CL for treating gynecologic diseases.
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Mencaglia L, Mereu L, Carri G, Arena I, Khalifa H, Tateo S, Angioni S. Single port entry – Are there any advantages? Best Pract Res Clin Obstet Gynaecol 2013; 27:441-55. [DOI: 10.1016/j.bpobgyn.2012.12.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Accepted: 12/06/2012] [Indexed: 12/11/2022]
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Song T, Kim TJ, Cho J, Kim IR, Kang PN, Lee JW, Bae DS, Kim BG. Cosmesis and body image after single-port access surgery for gynaecologic disease. Aust N Z J Obstet Gynaecol 2013; 52:465-9. [PMID: 23045987 DOI: 10.1111/j.1479-828x.2012.01466.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Little is known about patient satisfaction with single-port access (SPA) surgery for gynaecologic disease related to body image and cosmesis. AIMS This study aimed to determine cosmetic satisfaction with SPA surgery. METHODS Postal questionnaires, including the Body Image Questionnaire, were sent to 159 women who had undergone SPA surgery between May 2008 and April 2010. RESULTS Hundred and forty-six women participated in this study. Most of the women reported a relatively high body image and cosmetic score. The mean scores were 19.6 ± 1.1 and 21.9 ± 2.5, respectively. More than 67% of the women (N = 98) reported that the scar was invisible, and 97.3% of the women said that they would recommend SPA surgery to others. CONCLUSION Single-port access surgery is a good option for the management of gynaecologic disease with respect to patient satisfaction.
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Affiliation(s)
- Taejong Song
- Department of Obstetrics and Gynaecology, CHA Gangnam Medical Centre, CHA University, Seoul, Korea
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Song T, Cho J, Kim TJ, Kim IR, Hahm TS, Kim BG, Bae DS. Cosmetic outcomes of laparoendoscopic single-site hysterectomy compared with multi-port surgery: randomized controlled trial. J Minim Invasive Gynecol 2013; 20:460-7. [PMID: 23541248 DOI: 10.1016/j.jmig.2013.01.010] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Revised: 01/12/2013] [Accepted: 01/14/2013] [Indexed: 11/15/2022]
Abstract
STUDY OBJECTIVE To compare cosmetic satisfaction with laparoendoscopic single-site surgery (LESS) compared with multi-port surgery. DESIGN Randomized controlled trial (Canadian Task Force classification I). SETTING University hospital. PATIENTS Twenty women who underwent laparoscopically-assisted vaginal hysterectomy (LAVH) via LESS or multi-port surgery. INTERVENTIONS Laparoendoscopic single-site surgery or multi-port surgery. MEASUREMENT AND MAIN RESULTS Cosmetic satisfaction was assessed using the Body Image Questionnaire at baseline and at 1, 4, and 24 weeks after surgery. Of the 20 LESS procedures, 1 was converted to multi-port surgery because of severe adhesions, and 1 woman assigned to undergo multi-port surgery was lost to follow-up. The 2 surgery groups did not differ in clinical demographic data and surgical results or postoperative pain scores at 12, 24, and 36 hours. Compared with the multi-port group, the LESS group reported significantly higher cosmetic satisfaction at 1, 4, and 24 weeks after surgery (p < .01). CONCLUSION Compared with multi-port surgery, LESS is not only a feasible approach with comparable operative outcomes but also has an advantage insofar as cosmetic outcome.
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Affiliation(s)
- Taejong Song
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University, Seoul, Korea
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Song T, Choi CH, Lee YY, Kim TJ, Lee JW, Sung CO, Song SY, Bae DS, Kim BG. Endocervical-Like versus Intestinal-Type Mucinous Borderline Ovarian Tumors: A Large Retrospective Series Focusing on the Clinicopathologic Characteristics. Gynecol Obstet Invest 2013; 76:241-7. [DOI: 10.1159/000356072] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2012] [Accepted: 09/30/2013] [Indexed: 11/19/2022]
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Song T, Lee Y, Kim ML, Yoon BS, Joo WD, Seong SJ, Kim IH. Single-port access total laparoscopic hysterectomy for large uterus. Gynecol Obstet Invest 2012. [PMID: 23207276 DOI: 10.1159/000341141] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND/AIMS To evaluate the feasibility and safety of single-port access total laparoscopic hysterectomy (SPA-TLH) for large uterus (>500 g). METHODS A prospective data collection was performed in 21 consecutive patients in March 2010 and August 2011. Surgical outcome including operative time (OT) and estimated blood loss (EBL) were analyzed. RESULTS SPA-TLH procedures were successfully performed in 16 cases (76.2%). Of the 5 failed cases, 4 were converted to multiport TLH because of distorted uterine contours and pelvic adhesions and 1 was converted to laparotomy for bleeding control. The median OT, uterine weight, and EBL were 110 (65-165) min, 600 (502-980) g, and 200 (100-800) ml, respectively. Spearman's correlation analysis demonstrated that OT and blood loss increased with increasing uterine weight (p = 0.003 and p = 0.033, respectively). No operative complications were observed during the hospital stay and 3-month follow-up following discharge. CONCLUSION SPA-TLH for large uterus is a feasible and safe technique.
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Affiliation(s)
- Taejong Song
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University, Seoul, Korea
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20
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Prognosis in patients with serous and mucinous stage I borderline ovarian tumors. Int J Gynecol Cancer 2012; 22:770-7. [PMID: 22426410 DOI: 10.1097/igc.0b013e31824b4076] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION The purpose to this study was to compare the clinicopathologic characteristics and prognosis of patients with serous stage I borderline ovarian tumors (BOTs) to patients with mucinous stage I BOTs. METHODS This was a retrospective cohort series of patients with stage I BOTs diagnosed and treated between 1995 and 2009 at a single institution. The records were analyzed for patients' clinicopathologic information. The recurrence rates were compared using the Kaplan-Meier method. RESULTS During the study period, 198 patients (73.6%) with mucinous BOTs and 71 patients (26.4%) with serous BOTs were identified. Patients with serous tumors tended to be asymptomatic (53.5%) and frequently had elevated CA-125 levels and positive results from peritoneal cytology. Conversely, mucinous tumors were more related to the presence of symptoms (70.7%), elevated CA-19-9 levels, and pseudomyxoma and were larger tumors with a mean size of 15.6 cm. After a median follow-up of 56.5 months, 15 patients had developed 16 recurrences. Among these, 14 borderline recurrences developed in 6 patients with mucinous tumors and in 7 patients with serous tumors, and 2 invasive recurrences developed in only patients with mucinous tumors. No difference in recurrence rate between mucinous and serous tumors was observed. In addition, no disease-related death occurred. CONCLUSIONS Our study found that, although distinct differences in clinical and pathologic characteristics between stage I mucinous and serous BOTs are seen, result from tumor histology was not associated with disease prognosis.
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Song T, Kim TJ, Kang HJ, Choi CH, Lee JW, Bae DS, Kim BG. Single-port access laparoscopic surgery using a novel laparoscopic port (Octo-Port). Taiwan J Obstet Gynecol 2012; 50:436-40. [PMID: 22212314 DOI: 10.1016/j.tjog.2011.10.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2011] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE We present our initial experience with single-port access (SPA) surgery using a novel laparoscopic port (Octo-Port). MATERIALS, METHODS, AND RESULTS In a prospective study, SPA surgery was carried out on 11 patients with the Octo-Port from July 2009 to December 2009 by a single surgeon (T.-J. K.). The procedures carried out were hysterectomy (seven patients), ovarian cystectomy (two patients) and salpingo-oophorectomy (two patients). In 10 cases the procedure was successfully performed without the use of additional ports. In one case the SPA procedure failed and ancillary ports were required; this patient had anatomical variations that made use of the SPA technique difficult. All procedures were performed without complications. There were no perioperative port-related or surgical problems. The Octo-Port had certain advantages such as reducing the need for long laparoscopic instruments, reducing extracorporeal instrumental crowding, and providing better deflection of smoke compared to other SPA devices that used a wound retractor and a glove. CONCLUSION Our study demonstrated that the Octo-Port allows laparoscopic surgery to be performed safely and easily with a reduced number of ports.
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Affiliation(s)
- Taejong Song
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University, Seoul, Korea
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22
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Zhang H, Zuo Z, Wang Y, Wang L, Zhu Z. A cohort study evaluating paraaortic lymphadenectomy in endometrial cancer. Oncol Lett 2012. [PMID: 23205136 DOI: 10.3892/ol.2012.919] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
The current study sought to assess the role of paraaortic lymphadenectomy (LNE) in females with endometrial cancer. A retrospective analysis of patients diagnosed with endometrial cancer of stage IA to II preoperatively, between 2009 and 2011 was conducted. Patients were included who had suffered from endometrial cancer without preoperative adjuvant therapy and who underwent hysterectomy plus systematic pelvic LNE and paraaortic LNE by laparoscopy or laparotomy. A total of 54 patients who underwent surgery for preoperative endometrial cancer were selected. All patients underwent LNE. The incidences of pelvic and paraaortic lymph node metastases were 11.1% (6/54) and 7.4% (4/54), with a total positive lymph node rate of 14.8% (8/54). In addition, among the 8 positive cases, 5 patients underwent laparotomy and 3 underwent laparoscopy; 3 cases were classified as stage I and 5 as stage II preoperatively. Of these, 7 patients were identified with pathology-related risk factors, including low differentiation or clear cell adenocarcinoma postoperatively. Discordance of pathological differentiation between the pre- and postoperative stages reached 57.1% (4/7). The results revealed the high occurrence of positive lymph nodes in endometrial cancer which demonstrate the importance of systematic LNE. Additonally, no severe complications were caused by LNE besides lymph cysts. In summary, it is neccesary to perform LNE, particularly the removal of the paraaortic lymph node, in patients with endometrial cancers in order to improve postoperative therapy. Laparoscopy has similar surgical effects as laparotomy, but has a number of advantages.
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Affiliation(s)
- Haiyan Zhang
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai 200011, P.R. China
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Song T, Kim TJ, Lee YY, Choi CH, Lee JW, Kim BG, Bae DS. Learning Curves for Single-Site Laparoscopic Ovarian Surgery. J Minim Invasive Gynecol 2012; 19:344-9. [DOI: 10.1016/j.jmig.2012.01.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2011] [Revised: 12/28/2011] [Accepted: 01/05/2012] [Indexed: 10/14/2022]
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Song T, Kim TJ, Lee YY, Choi CH, Lee JW, Kim BG, Bae DS. What is the learning curve for single-port access laparoscopic-assisted vaginal hysterectomy? Eur J Obstet Gynecol Reprod Biol 2011; 158:93-6. [DOI: 10.1016/j.ejogrb.2011.04.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2010] [Revised: 03/04/2011] [Accepted: 04/26/2011] [Indexed: 10/17/2022]
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Escobar PF. Robotic single-site surgery: from research to clinical practice? J Gynecol Oncol 2011; 22:65-6. [PMID: 21860730 PMCID: PMC3152757 DOI: 10.3802/jgo.2011.22.2.65] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2011] [Accepted: 05/02/2011] [Indexed: 11/30/2022] Open
Affiliation(s)
- Pedro F Escobar
- Department of Obstetrics & Gynecology and Women's Health Institute, Cleveland Clinic, OH, USA
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