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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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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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Single port access laparoscopic surgery for large adnexal tumors: Initial 51 cases of a single institute. Obstet Gynecol Sci 2017; 60:32-38. [PMID: 28217669 PMCID: PMC5313361 DOI: 10.5468/ogs.2017.60.1.32] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 08/08/2016] [Accepted: 08/09/2016] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE Investigation of initial 51 cases of single port access (SPA) laparoscopic surgery for large adnexal tumors and evaluation of safety and feasibility of the surgical technique. METHODS We retrospectively reviewed the medical records of the first 51 patients who received SPA laparoscopic surgery for large adnexal tumors greater than 10 cm, from July 2010 to February 2015. RESULTS SPA adnexal surgeries were successfully completed in 51 patients (100%). The mean age, body mass index of the patients were 43.1 years and 22.83 kg/m2, respectively. The median operative time, median blood loss were 73.5 (range, 20 to 185) minutes, 54 (range, 5 to 500) mL, and the median tumor diameter was 13.6 (range, 10 to 30) cm. The procedures included bilateral salpingo-oophorectomy (n=18, 36.0%), unilateral salpingo-oophorectomy (n=14, 27.45%), and paratubal cystectomy (n=1, 1.96%). There were no cases of malignancy and none were insertion of additional ports or conversion to laparotomy. The cases with intraoperative spillage were 3 (5.88%) and benign cystic tumors. No other intraoperative and postoperative complications were observed during hospital days and 6-weeks follow-up period after discharge. CONCLUSION Our results suggest that SPA laparoscopic surgery for large adnexal tumors may be a safe and feasible alternative to conventional laparoscopic surgery.
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Single-Incision Single-Instrument Adnexal Surgery in Pediatric Patients. Minim Invasive Surg 2015; 2015:246950. [PMID: 26557994 PMCID: PMC4617692 DOI: 10.1155/2015/246950] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 09/01/2015] [Accepted: 09/02/2015] [Indexed: 01/30/2023] Open
Abstract
Introduction. Pediatric surgeons often practice pediatric gynecology. The single-incision single-instrument (SISI) technique used for appendectomy is applicable in gynecologic surgery. Methods. We retrospectively analyzed the records of patients undergoing pelvic surgery from 2008 to 2013. SISI utilized a 12 mm transumbilical trocar and an operating endoscope. The adnexa can be detorsed intracorporeally or extracorporealized via the umbilicus for lesion removal. Results. We performed 271 ovarian or paraovarian surgeries in 258 patients. In 147 (54%), the initial approach was SISI; 75 cases (51%) were completed in patients aged from 1 day to 19.9 years and weighing 4.7 to 117 kg. Conversion to standard laparoscopy was due to contralateral oophoropexy, solid mass, inability to mobilize the adnexa, large mass, bleeding, adhesions, or better visualization. When SISI surgery was converted to Pfannenstiel, the principal reason was a solid mass. SISI surgery was significantly shorter than standard laparoscopy. There were no major complications and the overall cohort had an 11% minor complication rate. Conclusion. SISI adnexal surgery is safe, quick, inexpensive, and effective in pediatric patients. SISI was successful in over half the patients in whom it was attempted and offers a scarless result. If unsuccessful, the majority of cases can be completed with standard multiport laparoscopy.
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Yun JA, Kim HC, Park JS, Cho YB, Yun SH, Lee WY. Perioperative and Oncologic Outcomes of Single-incision Laparoscopy Compared with Conventional Laparoscopy for Colon Cancer: An Observational Propensity Score-matched Study. Am Surg 2015. [DOI: 10.1177/000313481508100337] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Single-incision laparoscopic (SIL) surgery is a recent advance in minimally invasive surgical techniques. From May 2011 to August 2012, 77 patients underwent primary SIL surgery for colon cancer by one colorectal surgeon. Among them, 61 patients were one-to-one-matched to control patients who had undergone conventional laparoscopic (CL) surgery with a propensity-matched score, and the outcomes were compared. Two hundred forty-seven patients with colon cancer underwent radical colectomy. Of these, 77 patients underwent SIL colectomy. After matching, there were no significant differences in the general characteristics between the patients undergoing the two types of surgery. Operation time was significantly longer in SIL surgery (139 vs 121 minutes, P = 0.001), but procedure time (107 vs 99 minutes, P = 0.069) was not significantly longer than CL surgery after eliminating closure time (31 vs 22 minutes, P < 0.001) from the operation time. There was no significant difference in postoperative complications between the two groups (3.3 vs 1.6%, P = 1.000). The mean number of harvested lymph nodes was 23 and 22 for SIL and CL surgery, respectively ( P = 0.332). The mean follow-up period was 15.7 for the SIL group and 21.4 months for the CL group ( P < 0.001) with two recurrences in the SIL group (3.3%) and three recurrences in the CL group (4.9%, P = 1.000). Disease-free survival at 20 months did not differ significantly between the two groups (93.3 vs 94.7%, P = 0.939). SIL for colonic malignancy can be safely applied for various types of operations and can provide equivalent oncologic resection and perioperative outcomes compared with CL surgery.
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Affiliation(s)
- Jung-A Yun
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hee Cheol Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jong Seob Park
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yong Beom Cho
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Seong Hyeon Yun
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Woo Yong Lee
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Single-Port (Octoport) Assisted Extracorporeal Ovarian Cystectomy for the Treatment of Large Ovarian Cysts: Compare to Conventional Laparoscopy and Laparotomy. J Minim Invasive Gynecol 2015; 22:45-9. [DOI: 10.1016/j.jmig.2014.06.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 06/01/2014] [Accepted: 06/04/2014] [Indexed: 11/20/2022]
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Huang BS, Wang PH, Tsai HW, Hsu TF, Yen MS, Chen YJ. Single-port compared with conventional laparoscopic cystectomy for ovarian dermoid cysts. Taiwan J Obstet Gynecol 2014; 53:523-9. [DOI: 10.1016/j.tjog.2014.05.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2014] [Indexed: 11/16/2022] Open
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Gasless laparoendoscopic single-site surgery for management of adnexal masses during pregnancy. Eur J Obstet Gynecol Reprod Biol 2014; 180:28-34. [DOI: 10.1016/j.ejogrb.2014.06.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Revised: 06/14/2014] [Accepted: 06/19/2014] [Indexed: 11/17/2022]
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Borghese B, Marzouk P, Santulli P, de Ziegler D, Chapron C. Traitements chirurgicaux des tumeurs ovariennes présumées bénignes. ACTA ACUST UNITED AC 2013; 42:786-93. [DOI: 10.1016/j.jgyn.2013.09.033] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Torng PL, Lin KH, Hwang JS, Liu HS, Chen IH, Chen CL, Huang SC. Learning curve for laparoendoscopic single-site surgery for an experienced laparoscopic surgeon. Gynecol Minim Invasive Ther 2013. [DOI: 10.1016/j.gmit.2013.07.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Fujimoto A, Osuga Y, Sakurabashi A, Hisatomi S, Kaneko J, Hasegawa K, Yano T, Kokudo N, Kozuma S. Laparoendoscopic single-site concomitant surgery for gallstones and a giant ovarian teratoma. Asian J Endosc Surg 2013; 6:223-5. [PMID: 23879416 DOI: 10.1111/ases.12019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2012] [Revised: 11/28/2012] [Accepted: 12/09/2012] [Indexed: 12/01/2022]
Abstract
Laparoendoscopic single-site (LESS) technique has gained popularity in several fields of surgery. Our patient had multiple gallstones and a left ovarian mature cystic teratoma 12 cm in diameter. She underwent concomitant laparoscopic cholecystectomy and adnectomy using LESS technique. Using a transient gasless technique resulted in the extraction of a giant ovarian tumor through the umbilical incision with no leakage into the abdominal cavity. Concomitant LESS surgery is feasible and has many benefits both for patients and doctors - cosmetics, possibly less pain, avoidance of multiple surgeries and cost-effectiveness. LESS technique is also useful for extracting a giant tumor with the transient gasless technique. This novel method might be applied to the removal of a tumor suspicious for malignancy.
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Affiliation(s)
- Akihisa Fujimoto
- Department of Obstetrics and Gynecology, The University of Tokyo, Tokyo, Japan.
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Pontarelli EM, Emami C, Nguyen NX, Torres M, Anselmo DM. Single-incision laparoscopic resection of ovarian masses in children: a preliminary report. Pediatr Surg Int 2013; 29:715-8. [PMID: 23728507 DOI: 10.1007/s00383-013-3325-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/14/2013] [Indexed: 12/17/2022]
Abstract
PURPOSE Ovarian masses in the pediatric population are commonly resected with a three or four port laparoscopic approach. Single-incision laparoscopic (SIL) resection is an alternative approach. However, there is limited experience with this modality in ovarian mass resection. METHODS We reviewed SIL ovarian mass resections performed by our group from 2010 to 2012. We evaluated patient demographics, surgery statistics, and hospital course. RESULTS Six patients were identified with mean age of 14 years. Imaging studies showed cystic masses ranging 4-6 cm in five patients, and 20 cm in one patient. One patient presented with recurrent teratoma. Pathology revealed four benign teratomas, one benign cyst, and one serous cystadenoma. Average operating time was 75 min. All patients had an ovarian-preserving resection. Three patients had cyst spillage, including the one who presented with recurrence (this was the only patient with a subsequent recurrence). Hospital stay averaged 37 h. Narcotic use averaged 9.9 mg of morphine daily. All patients had excellent cosmetic results, and no postoperative complications. CONCLUSIONS Ovarian cystic mass excision using the SIL approach carries a higher risk of tumor spillage. Although the incidence of malignancy is low, they cannot be conclusively excluded with our current preoperative evaluations. At this time, we recommend SIL resection only for simple cysts with low malignant potential; however, further experience with this procedure will likely improve the risk of tumor spillage in the future.
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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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Feasibility of laparoscopically assisted extracorporeal cystectomy via single suprapubic incision using an adjustable-view laparoscope to treat large benign ovarian cysts: comparison with conventional procedure. Eur J Obstet Gynecol Reprod Biol 2013; 168:64-7. [DOI: 10.1016/j.ejogrb.2012.12.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Revised: 10/23/2012] [Accepted: 12/31/2012] [Indexed: 11/19/2022]
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Lacher M, Kuebler JF, Yannam GR, Aprahamian CJ, Perger L, Beierle EA, Anderson SA, Chen MK, Harmon CM, Muensterer OJ. Single-incision pediatric endosurgery for ovarian pathology. J Laparoendosc Adv Surg Tech A 2013; 23:291-6. [PMID: 23402287 DOI: 10.1089/lap.2012.0380] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Despite being pioneered by gynecologists, single-incision endosurgery has not been widely reported for the treatment of ovarian and adnexal pathology in neonates, children, and adolescents. We describe our initial experience using single-incision pediatric endosurgery (SIPES) for these indications and discuss advantages and drawbacks. SUBJECTS AND METHODS All children who underwent SIPES with a preoperative diagnosis of ovarian or adnexal pathology were included in the study. Data on age, operative time, complications, length of hospital stay, and outcomes were collected. RESULTS From January 2010 until January 2012, 19 girls (mean age, 11.4 years; range, 6 days-17 years; weight range, 4.0-90 kg) underwent SIPES procedures for ovarian or adnexal diagnoses, including hemorrhagic/follicular/paratubal cysts (n=8), torsion (n=7), tumor (n=3), and parauterine cyst (n=1). The operations included cyst unroofing (n=4), detorsion and oophoropexy (n=7), (salpingo)oophorectomy (n=5), marsupialization of cyst (n=2), and cyst aspiration (n=1). Median operative time was 42 ± 29 minutes; there were no conversions to conventional laparoscopy or open surgery. Fifteen patients (79%) were discharged within 24 hours after the procedure. There were no peri- or postoperative complications. Histopathology showed hemorrhagic/follicular/paratubal cyst (n=7), necrotic/calcified ovarian tissue after torsion (n=6), cystadenofibroma (n=1), granulosa cell tumor (n=1), and mature teratoma (Grade 0) (n=1). CONCLUSIONS SIPES is an excellent alternative to conventional laparoscopy for the treatment of adnexal pathology. Using a single umbilical incision that can be enlarged instead of three smaller trocar sites facilitates the resection and extraction of ovarian masses without compromising cosmesis.
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Affiliation(s)
- Martin Lacher
- Division of Pediatric Surgery, Department of Surgery, Children's of Alabama, University of Alabama at Birmingham, Birmingham, Alabama.
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