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Hiraishi H, Kitahara Y, Kobayashi M, Hasegawa Y, Tsukui Y, Miida M, Nakao K, Ikeda S, Hirakawa T, Iwase A. Factors related to clearance of the small pelvic cavity during gynecologic laparoscopic surgery. J Obstet Gynaecol Res 2024; 50:1392-1397. [PMID: 38804513 DOI: 10.1111/jog.15978] [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: 11/14/2023] [Accepted: 05/09/2024] [Indexed: 05/29/2024]
Abstract
AIM To identify factors influencing the Trendelenburg angle required during laparoscopic gynecological surgery. METHODS Patients who underwent laparoscopic surgery at a single university hospital between May 1, 2019, and March 31, 2021 were enrolled. Data were extracted from the medical records, while magnetic resonance imaging scans and all laparoscopic surgery videos were retrospectively reviewed to assess the presence of the small intestine in the pelvic cavity as well as the adhesions at each site. Groups with and without the small intestine in the pelvic cavity, and those requiring a Trendelenburg angle above or below 13° were compared. RESULTS In total, 219 patients were examined. The Trendelenburg angle was significantly higher (p = 0.004), while a significant increase in ovarian adhesions was observed (p = 0.033; odds ratio [OR], 2.30; 95% confidence interval [CI], 1.05-5.01) in the group without the presence of the small intestine in the pelvic cavity. Furthermore, the group requiring a Trendelenburg angle of ≥13° had significantly thicker subcutaneous fat (p = 0.044) and more ileal adhesions (p = 0.040, OR, 1.82; 95% CI, 1.03-3.23) than the group with an angle of <13°. CONCLUSION Cases of ileal adhesions or thick subcutaneous fat are more likely to require a Trendelenburg angle of ≥13°. Therefore, Trendelenburg complications should be considered in this group. In addition, ovarian adhesions make it more difficult to exclude the small intestine from the small pelvic cavity, and may be associated with endometriosis.
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Affiliation(s)
- Hikaru Hiraishi
- Department of Obstetrics and Gynecology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Yoshikazu Kitahara
- Department of Obstetrics and Gynecology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Mio Kobayashi
- Department of Obstetrics and Gynecology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Yuko Hasegawa
- Department of Obstetrics and Gynecology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Yumiko Tsukui
- Department of Obstetrics and Gynecology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Miki Miida
- Department of Obstetrics and Gynecology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Kohshiro Nakao
- Department of Obstetrics and Gynecology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Sadatomo Ikeda
- Department of Obstetrics and Gynecology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Takashi Hirakawa
- Department of Obstetrics and Gynecology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Akira Iwase
- Department of Obstetrics and Gynecology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
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Kalinderis M, Kalinderi K, Athanasiadis A, Kalogiannidis I. Εlectrosurgery: understanding of basic principles, safe practices and applications in gynecologic surgery. Minerva Obstet Gynecol 2024; 76:376-385. [PMID: 37326355 DOI: 10.23736/s2724-606x.23.05308-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Electrosurgery is a continuously evolving field that has nowadays become a necessity in operating theatres. The expanding use of electrosurgery has been associated with a high number of thermal injuries, thus the fundamental understanding of how each of the energy devices work and their effect on biological tissues is very important and continuing education regarding electrosurgical technology is paramount for avoiding patient complications. This review describes the basic principles and modalities of electrosurgery, their biological effects on tissues and variables that can affect them, the evolution in the field of electrosurgery, its wide use in gynecological procedures, as well as the risk and complications that are commonly seen in electrosurgery.
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Affiliation(s)
- Michail Kalinderis
- Department of Gynecologic Oncology and Robotic Surgery, Royal Surrey County Hospital (RSCH), Guildford, UK -
- Department of Obstetrics and Gynecology, King's College Hospital NHS Foundation Trust, Princess Royal University Hospital, Orpington, UK -
| | - Kallirhoe Kalinderi
- Laboratory of Medical Biology-Genetics, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Apostolos Athanasiadis
- Third Department of Obstetrics and Gynaecology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Kalogiannidis
- Third Department of Obstetrics and Gynaecology, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Zhang RR, Zhang L, Zhao RH. Anti-infective therapy durations predict psychological stress and laparoscopic surgery quality in pelvic abscess patients. World J Psychiatry 2023; 13:903-911. [DOI: 10.5498/wjp.v13.i11.903] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 09/28/2023] [Accepted: 10/16/2023] [Indexed: 11/17/2023] Open
Abstract
BACKGROUND The degree of psychological stress and the difficulty and efficacy of laparoscopic surgery differ in patients with pelvic abscesses after different durations of anti-infection treatment.
AIM To compare and analyse the effects of different durations of anti-infective therapy on patients’ preoperative psychological stress level and the clinical efficacy of laparoscopic surgery in patients with pelvic abscesses to offer a reference for the selection of therapy plans.
METHODS A total of 100 patients with pelvic abscesses who were admitted to the Department of Gynecology of Suzhou Ninth Hospital affiliated to Soochow University (Suzhou Ninth People's Hospital) from January 2018 to December 2022 were retrospectively enrolled. According to the different durations of anti-infective therapy, they were divided into Group S (50 patients, received anti-infective therapy for 24-48 h) and Group L (50 patients, received anti-infective therapy for 48-96 h). Baseline data, state-trait anxiety score at admission and before surgery, self-rating anxiety scale (SAS) + self-rating depression scale (SDS) score, surgery time, adhesion grading score, intraoperative blood loss, presence or absence of intraoperative intestinal injury, ureteral injury or bladder injury, postoperative body temperature, length of hospital stay, and presence or absence of recurrence within 3 mo after surgery, chronic pelvic pain, incision infection, dysmenorrhea, menstrual disorder or intestinal obstruction were compared between the S group and the L group.
RESULTS There was no significant difference in the background data between the S group and the L group (P < 0.05). There was no significant difference in the state-trait anxiety score or SAS + SDS score between the S group and the L group on admission (P < 0.05). The state-trait anxiety score and SAS + SDS score of the S group were lower than those of Group L after receiving different durations of anti-infective therapy (P < 0.05). There was no significant difference in the incidence of intestinal, ureteral or bladder injury between the S group and the L group (P < 0.05). The surgery time of Group S was shorter than that of Group L, and the adhesion score and intraoperative blood loss volume were lower than those of Group L (P < 0.05). There was no significant difference in the incidence of incision infection, dysmenorrhea, menstrual disorder or intestinal obstruction between the S group and the L group (P < 0.05). The postoperative body temperature of Group S was lower than that of Group L (P < 0.05), and the hospital stay was shorter than that of Group L (P < 0.05). The incidences of recurrence and chronic pelvic pain within 3 mo after surgery were lower than that of Group L (P < 0.05).
CONCLUSION Twenty-four to forty-eight hours of anti-infective therapy is better than 48-96 h of anti-infective therapy for patients with pelvic abscesses because the degree of psychological stress is lower, which is more conducive to achieving better outcomes after laparoscopic surgery.
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Affiliation(s)
- Rui-Rui Zhang
- Department of Gynecology, Suzhou Ninth Hospital affiliated to Soochow University (Suzhou Ninth People's Hospital), Suzhou 215200, Jiangsu Province, China
| | - Lei Zhang
- Department of Gynecology, Suzhou Ninth Hospital affiliated to Soochow University (Suzhou Ninth People's Hospital), Suzhou 215200, Jiangsu Province, China
| | - Rui-Heng Zhao
- Department of Gynecology, Suzhou Ninth Hospital affiliated to Soochow University (Suzhou Ninth People's Hospital), Suzhou 215200, Jiangsu Province, China
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Abu Mahfouz IA, Asali FF, Abu Saleem HO, Mohammad MT, Al Mehaisen LM, Badran DH. Determining trainees' knowledge of surgical anatomy: A specialist's perspective. J Taibah Univ Med Sci 2021; 16:657-664. [PMID: 34690644 PMCID: PMC8498678 DOI: 10.1016/j.jtumed.2021.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 04/19/2021] [Accepted: 04/22/2021] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Intraoperative identification of anatomical structures can potentially reduce the risk of surgical complications. This study aims to report specialists' perspectives about the anatomical structures that third-year residents should be able to identify during surgical operations. In addition, the factors which may influence specialists' opinions are discussed. MATERIALS AND METHODS This qualitative cross-sectional study was conducted on obstetricians and gynaecologists between 1/2/2019 and 30/10/2019. The specialists practising in a hospital with a residency programme were included, and were asked to rate the importance of structures that a third-year resident should be able to identify during operations. We performed a comparison of responses based on specialists' age, gender, practice type, years of experience, and surgical workload. RESULTS One hundred and sixty-five specialists were recruited with a response rate of 69.3%. The mean age of respondents was 46.1 years, and they had a mean experience of 13.4 years. Furthermore, 86.6% of specialists rated all the anatomical structures as "more important". The importance of surgical structures, as rated by specialists, was not related to gender, years of experience, or surgical workload. The importance of 63% of the anatomical structures was rated higher by junior specialists than senior specialists. CONCLUSION Knowledge of anatomical structures is vital for gynaecologic residency training. Specialist's perceptions of the importance of various anatomical structures reflect their understanding of the training requirements. Our results highlighted the important anatomical structures that third-year residents are expected to identify during surgical operations. Future research may establish a reference for the core anatomy knowledge essential for each training year.
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Affiliation(s)
- Ismaiel A. Abu Mahfouz
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Al Balqa Applied University, Al Salt, Jordan
| | - Fida F. Asali
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Hashemite University, Al Zarqa, Jordan
| | - Heba O. Abu Saleem
- Department of Obstetrics and Gynaecology, Specialty Hospital, Amman, Jordan
| | - Maha T. Mohammad
- School of Rehabilitation Sciences, Department of Physiotherapy, University of Jordan, Amman, Jordan
| | - Lama M. Al Mehaisen
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Al Balqa Applied University, Al Salt, Jordan
| | - Darwish H. Badran
- Department of Anatomy and Histology, School of Medicine, The University of Jordan, Amman, Jordan
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Zhao J, Samaan JS, Toubat O, Samakar K. Laparoscopy as a Diagnostic and Therapeutic Modality for Chronic Abdominal Pain of Unknown Etiology: A Literature Review. J Surg Res 2020; 252:222-230. [PMID: 32289579 DOI: 10.1016/j.jss.2020.03.013] [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: 11/20/2019] [Revised: 02/14/2020] [Accepted: 03/08/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Investigate the diagnostic and therapeutic utility of laparoscopy in the management of patients with chronic abdominal pain of unknown origin. METHODS Ovid MEDLINE, PubMed, and SCOPUS databases were queried to identify relevant published studies. Data on the diagnostic and therapeutic utility of laparoscopy were abstracted and summarized. RESULTS Laparoscopy achieved a diagnosis in 65% to 94% of patients with chronic abdominal pain of unknown origin. Common intraoperative findings included adhesions, chronic appendicitis, hernias, and enlarged mesenteric lymph nodes. These findings corresponded with the therapeutic procedures that were performed, including laparoscopic adhesiolysis, appendectomy, and hernia repair. Therapeutic utility of laparoscopy based on pain relief, patient satisfaction, and quality of life ranged from 63% to 94%. CONCLUSIONS Based on current available evidence, diagnostic laparoscopy (DL) is a safe and effective method for identifying organic causes of chronic abdominal pain. Laparoscopic treatment also resulted in substantial pain relief for a majority of patients. However, the efficacy of laparoscopic adhesiolysis remains controversial. We would recommend the use of DL as an early diagnostic tool, but more robust studies are needed to establish the breadth of its therapeutic utility in clinical practice.
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Affiliation(s)
- Jasmine Zhao
- Division of Upper GI and General Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Jamil S Samaan
- Department of Medicine, Cedars Sinai Medical Center, Los Angeles, California
| | - Omar Toubat
- Division of Upper GI and General Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Kamran Samakar
- Division of Upper GI and General Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California.
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Binet A, Braïk K, Lengelle F, Laffon M, Lardy H, Amar S. Laparoscopic one port appendectomy: Evaluation in pediatric surgery. J Pediatr Surg 2018; 53:2322-2325. [PMID: 29370892 DOI: 10.1016/j.jpedsurg.2017.12.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 12/12/2017] [Accepted: 12/16/2017] [Indexed: 01/20/2023]
Abstract
BACKGROUND Appendectomy is a well-established surgical procedure in pediatric surgery used in the management of acute appendicitis. With the continuous advancement in the field of minimal invasive surgery, the recent focus is on single incision laparoscopic (SIL) surgery. SILA also goes further in order to decrease pain, improve recovery and enhance patient satisfaction. However, this approach is still not a well-established technique and not widely practiced, especially in pediatric surgery. METHODS We prospectively recorded the data in our pediatric universitary hospital center since January, 01 2017 to July, 01 2017. Patients included in this study were randomized in two groups: SILA group (managed by one-port laparoscopy, n=40) and LA group (conventional laparoscopy using three trocars, n=40). RESULTS The mean operative time for SILA was significantly lower. There were no postoperative complications in SILA group. If peritonitis was associated with appendicitis, the operative duration was not significantly different between each group. The duration in recovery room after surgery was significantly lower in SILA group. The morphine consumption was significantly lower for SILA group according to patient weight. SILA is less painful significantly than CLA for the first postoperative 6 h. After, even if SILA appears less painful, difference is not significant. The hospital length of stay was significantly higher in LA than SILA group CONCLUSIONS: SILA procedure for appendectomy appears to be safe and efficient for appendicitis management in children. This technique could be applied in routine as in emergency tome. TYPE OF STUDY Prospective comparative study LEVEL OF EVIDENCE: II.
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Affiliation(s)
- Aurelian Binet
- Pediatric Surgery Unit, Hospital, Universitary Center of Tours, Gatien de Clocheville Hospital, 37000 Tours, France.
| | - Karim Braïk
- Pediatric Surgery Unit, Hospital, Universitary Center of Tours, Gatien de Clocheville Hospital, 37000 Tours, France
| | - Francois Lengelle
- Pediatric anaesthetic Unit, Hospital Universitary Center of Tours, Gatien de Clocheville Hospital, 37000 Tours, France
| | - Marc Laffon
- Pediatric anaesthetic Unit, Hospital Universitary Center of Tours, Gatien de Clocheville Hospital, 37000 Tours, France
| | - Hubert Lardy
- Pediatric Surgery Unit, Hospital, Universitary Center of Tours, Gatien de Clocheville Hospital, 37000 Tours, France
| | - Sarah Amar
- Pediatric Surgery Unit, Hospital, Universitary Center of Tours, Gatien de Clocheville Hospital, 37000 Tours, France
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Abstract
Background Bowel injury remains a serious complication of gynecological laparoscopic surgery. We aimed to review the literature on this topic, combined with personal experiences, so as to give recommendations on how to avoid and manage this complication. Methods We performed a narrative review on bowel injury following gynecological laparoscopic surgery using PubMed covering prevention, diagnosis, and management. Search terms used were laparoscopy, gynaecology, injury, bowel, prevention, treatment. Results Important principles of prevention include proper pre-operative evaluation and increased laparoscopic surgical skills and knowledge. High clinical suspicion is crucial for early diagnosis. Diagnostic workup of suspected cases includes serial abdominal examination, measuring inflammatory markers, and performing imaging studies including abdominal ultrasound and CT scan. When bowel injury is recognized during the first laparoscopic procedure then laparoscopic primary suturing could be tried although laparotomy may be needed. When diagnosis is delayed, then laparotomy is the treatment of choice. The role of robotic surgery and three-dimensional laparoscopic gynecological surgery on bowel injury needs to be further assessed. Conclusion Early recognition of bowel injury is crucial for a favorable clinical outcome. A combined collaboration between gynecologists and general surgeons is important for timely and proper decisions to be made.
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Affiliation(s)
- Hassan M Elbiss
- Department of Obstetrics and Gynaecology, College of Medicine and Health Sciences, UAE University, 17666 Al-Ain, United Arab Emirates.
| | - Fikri M Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, UAE University,17666 Al-Ain, United Arab Emirates.
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Wong C, Merkur H. Inferior epigastric artery: Surface anatomy, prevention and management of injury. Aust N Z J Obstet Gynaecol 2015; 56:137-41. [PMID: 26627186 DOI: 10.1111/ajo.12426] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2015] [Accepted: 10/21/2015] [Indexed: 12/01/2022]
Affiliation(s)
- Clare Wong
- Sydney West Advanced Pelvic Surgery Unit; Blacktown Hospital; Blacktown NSW Australia
| | - Harry Merkur
- Sydney West Advanced Pelvic Surgery Unit; Blacktown Hospital; Blacktown NSW Australia
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Simsek G, Kartal A, Sevinc B, Tasci HI, Dogan S. Early hospital readmission after laparoscopic cholecystectomy. Surg Laparosc Endosc Percutan Tech 2015; 25:254-257. [PMID: 25856134 DOI: 10.1097/sle.0000000000000154] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Laparoscopic cholecystectomy (LC) now has become the golden standard in the treatment of symptomatic gallstone cholecystitis. AIM This retrospective analysis was conducted to clarify the reasons of early return to the hospital after discharge following a procedure like LC that has been frequently performed in daily surgical practice. MATERIALS AND METHODS This study covers 586 patients, who were called to follow-ups and thus evaluated, of 676 patients who had had LCs at Meram Medical School's General Surgery Clinic between January 2010 and May 2011. FINDINGS The rate of representation to the hospital during the early phase following LC was found to be 2.4% in our study. It was observed that 71% of returning patients had presented to the hospital with complaints of abdominal pain. DISCUSSION We believe that the rate of 2.4% early return to the hospital in our series is a bit high when all the complications are taken into consideration. This retrospective analysis, however, has shown that this rate can further be decreased by taking simple measures.
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Affiliation(s)
- Gurcan Simsek
- *Department of General Surgery, Konya Research and Training Hospital †Department of General Surgery, Meram Medical Faculty, Necmettin Erbakan University, Konya, Turkey
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Complications of minimally invasive procedures of the abdomen and pelvis: a comprehensive update on the clinical and imaging features. Emerg Radiol 2014; 22:283-94. [PMID: 25537821 DOI: 10.1007/s10140-014-1291-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2014] [Accepted: 12/12/2014] [Indexed: 12/18/2022]
Abstract
Minimally invasive gastrointestinal, genitourinary, and gynecological procedures are widely used in the clinical practice for diagnostic and therapeutic purposes. Complications both minor and major are not uncommon with these procedures. Imaging plays an important role in the detection and optimal management of these complications. Familiarity with the clinical and imaging features of these complications by radiologists can help in their timely detection.
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Yi C, Li L, Wang X, Liu X. Recurrence of uterine tissue residues after laparoscopic hysterectomy or myomectomy. Pak J Med Sci 2014; 30:1134-6. [PMID: 25225541 PMCID: PMC4163247 DOI: 10.12669/pjms.305.4509] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2013] [Revised: 11/04/2013] [Accepted: 06/25/2013] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To report a new complication after laparoscopic surgery i.e recurrence of endometrium and leiomyoma fragments from uterine tissue residues after laparoscopic hysterectomy or laparoscopic myomectomy. Methods : This study was carried out on three patients with the recurrence of endometrium or leiomyoma fragments from tissue residues after laparoscopic hysterectomy or laparoscopic myomectomy in the First Affiliated Hospital, Yangtze University, China. We also explored the possible reasons and corresponding preventative strategies. RESULTS Small residues of endometrium and leiomyoma fragments could implant into normal tissue anywhere in the peritoneal cavity after laparoscopic myomectomy or laparoscopic hysterectomy. CONCLUSION These cases emphasize the importance of removing every single fragment to prevent the recurrence of endometrium and leiomyoma from tissue residues.
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Affiliation(s)
- Cunjian Yi
- Cunjian Yi, MD, PhD , Department of Obstetrics and Gynecology, First Affiliated Hospital, Yangtze University, Jingzhou, Hubei Province 434000, P.R. China
| | - Li Li
- Li Li, MD, Department of Obstetrics and Gynecology, First Affiliated Hospital, Yangtze University, Jingzhou, Hubei Province 434000, P.R. China
| | - Xiaowen Wang
- Xiaowen Wang, MD , Department of Obstetrics and Gynecology, First Affiliated Hospital, Yangtze University, Jingzhou, Hubei Province 434000, P.R. China
| | - Xiangqiong Liu
- Xiangqiong Liu , MD, Department of Obstetrics and Gynecology, First Affiliated Hospital, Yangtze University, Jingzhou, Hubei Province 434000, P.R. China
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Nezhat CH, Katz A, Dun EC, Kho KA, Wieser FA. Novel port placement and 5-mm instrumentation for robotic-assisted hysterectomy. JSLS 2014; 18:167-73. [PMID: 24960478 PMCID: PMC4035625 DOI: 10.4293/108680813x13693422518399] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background and Objectives: The value of robotic surgery for gynecologic procedures has been critically evaluated over the past few years. Its drawbacks have been noted as larger port size, location of port placement, limited instrumentation, and cost. In this study, we describe a novel technique for robotic-assisted laparoscopic hysterectomy (RALH) with 3 important improvements: (1) more aesthetic triangular laparoscopic port configuration, (2) use of 5-mm robotic cannulas and instruments, and (3) improved access around the robotic arms for the bedside assistant with the use of pediatric-length laparoscopic instruments. Methods: We reviewed a series of 44 women who underwent a novel RALH technique and concomitant procedures for benign hysterectomy between January 2008 and September 2011. Results: The novel RALH technique and concomitant procedures were completed in all of the cases without conversion to larger ports, laparotomy, or video-assisted laparoscopy. Mean age was 49.9 years (SD 8.8, range 33–70), mean body mass index was 26.1 (SD 5.1, range 18.9–40.3), mean uterine weight was 168.2 g (SD 212.7, range 60–1405), mean estimated blood loss was 69.7 mL (SD 146.9, range 20–1000), and median length of stay was <1 day (SD 0.6, range 0–2.5). There were no major and 3 minor peri- and postoperative complications, including 2 urinary tract infections and 1 case of intravenous site thrombophlebitis. Mean follow-up time was 40.0 months (SD 13.6, range 15–59). Conclusion: Use of the triangular gynecology laparoscopic port placement and 5-mm robotic instruments for RALH is safe and feasible and does not impede the surgeon's ability to perform the procedures or affect patient outcomes.
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Affiliation(s)
- Ceana H Nezhat
- Emory University School of Medicine, Atlanta Center for Reproductive Medicine, Minimally Invasive and Robotic Surgery, 5555 Peachtree Dunwoody Road, Suite 276, Atlanta, GA 30342, USA.
| | - Adi Katz
- Department of Obstetrics and Gynecology, Northshore-Long Island Jewish Health Systems, Manhasset, New York, USA
| | - Erica C Dun
- Atlanta Center for Reproductive Medicine, Minimally Invasive and Robotic Surgery, Atlanta, Georgia, USA
| | - Kimberly A Kho
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Friedrich A Wieser
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia, USA
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Rao MP, Swamy V, Arole V, Mishra P. Study of the course of inferior epigastric artery with reference to laparoscopic portal. J Minim Access Surg 2013; 9:154-8. [PMID: 24250060 PMCID: PMC3830133 DOI: 10.4103/0972-9941.118826] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Accepted: 03/08/2013] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION: Laparoscopy has been in vogue for more than 2 decades. Making portals in the anterior abdominal wall for introducing laparoscopic instruments is done with trocar and cannula which is a blind procedure. Stab incision and trocar insertion, though safe, at times can lead to injury of blood vessels of anterior abdominal wall more so the inferior epigastric artery (IEA). Trauma to abdominal wall vessels is 0.2%-2% of laparoscopic procedures and said to be 3 per 1000 cases. Injury to IEA is one of the commonest complications seen. Purpose of the present study was to observe the course of IEA in 50 formalin preserved cadavers, by dissection. MATERIALS AND METHODS: In 50 formalin fixed cadavers, IEA was exposed by opening the rectus sheath. Rectus was divided and IEA was exposed. Five reference points A, B, C, D, and E were defined. A was at pubic symphysis, while E at umbilicus. B, C, and D were marked at the distance of 3.5, 7, and 10.5 cm, respectively from pubic symphysis. Distances of the IEA from these midline points were measured with the help of sliding vernier calipers. RESULTS: Significant observation was variations in the length of IEA. It was seen to end at a lower level than normal (three cases on right and four on left side) by piercing rectus. In 14, cadavers artery did not reach up to umbilicus on both sides. Nearest point of entry of IEA in to rectus sheath at the level of pubic symphysis was 1.2 cm on left and 3.2 cm on right side. Farthest point from point A was 6.8 cm on right and 6.9 cm on left side. Width of strip of abdominal wall which was likely to have IEA beneath was up to 4 cm till level C and beyond which it widened up to 5cm on left side and 6 cm on right at umbilicus. DISCUSSION: Present study did reveal notable variations in length and termination of IEA. No uniformity in entry of IEA in to the rectus sheath was observed. Findings did concur with earlier observations but the strip of skin of arterial zone was not equidistant from midline but had moved more medially on left side. Medial limit of this safety zone found to be lesser than 2 cm on left side. However, the lateral limit of the zone was within 7.5 cm. Additional variation was strip of abdominal wall likely to have IEA beneath was up to 4 cm till level C and had diverging limits beyond C. IEA was more notorious in its course. These variations prompt for a preoperative mapping of IEA and thus a useful step in preoperative protocol.
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Affiliation(s)
- Manvikar Purushottam Rao
- Department of Anatomy, Padmashree Dr. D. Y. Patil Medical College, Pimpri, Pune-411018, Maharashtra, India
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Lago J, Serralta D, García A, Martín J, Sanz M, Pérez MD, Turégano F. Randomized prospective trial on the occurrence of laparoscopic trocar site hernias. J Laparoendosc Adv Surg Tech A 2011; 21:775-9. [PMID: 22050610 DOI: 10.1089/lap.2011.0262] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Laparoscopy has become the gold standard in an increasing number of procedures. We analyze the incidence of trocar site hernias (TSH) and determine whether closure of the external fascia prevents onset of TSH and possible complications. METHODS We performed a simple-blind randomized trial with two groups, one in which all the orifices were closed by suturing the external fascia of the abdominal wall (group A), and another in which the orifices were left open, closing only the skin (group B). Monitoring for TSH lasted 2 years from the intervention. The trial has been registered at www.clinicaltrials.gov with the clinicaltrials.gov identifier number: NCT01240434. RESULTS A total of 195 patients were randomized. Thirty-three were removed from the study after conversion to open surgery, early open reoperation, or loss to follow-up. The remaining 162 patients comprised the study population, 80 in group A and 82 in group B. We found no differences between the groups regarding basic demographic data, kind of surgery, or topographic distribution of the trocars. Five TSH were diagnosed-four in group A and one in group B (P=.176)-and there was no relation between TSH and trocar size (11 or 12 mm) or location. We found 10 wound infections, 7 in group A and 3 in group B (P=.154). CONCLUSION Our study suggests that the onset of TSH does not depend on trocar size or location. There is no evidence that suture of the fascial defect prevents the onset of TSH. In addition, we found a trend toward a higher incidence of wound infection among patients in whom the fascia had been sutured.
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Affiliation(s)
- Jesús Lago
- Servicio de Cirugía General II, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
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Su WH, Cheng MH, Tsou TS, Cheung SM, Chang SP, Wang PH. Port wound closure assisted by Foley catheter: An easier way to provide fascia security. J Obstet Gynaecol Res 2009; 35:725-31. [DOI: 10.1111/j.1447-0756.2008.01008.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Lam A, Kaufman Y, Khong SY, Liew A, Ford S, Condous G. Dealing with complications in laparoscopy. Best Pract Res Clin Obstet Gynaecol 2009; 23:631-46. [PMID: 19539536 DOI: 10.1016/j.bpobgyn.2009.03.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2009] [Accepted: 03/16/2009] [Indexed: 11/26/2022]
Abstract
With increasing adoption of laparoscopic surgery in gynaecology, there has been a corresponding rise in the types and rates of complications reported. This article sets out to classify complications associated with laparoscopy according to the phases of the surgery; assess the incidence, the mechanisms, the presentations; and recommend methods for preventing and dealing with complications in laparoscopic surgery. Its aim is to promote a culture of risk management based on the development of strategies to improve patient safety and outcome.
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Affiliation(s)
- Alan Lam
- Centre for Advanced Reproductive Endosurgery, (CARE), Royal North Shore Hospital, University of Sydney, Sydney, Australia.
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Abstract
PURPOSE OF REVIEW The purpose of this review is to discuss the evolutionary changes that have taken place in the area of electrosurgery. The distinct differences between devices along with disadvantages and ways of minimizing hazards will be analyzed. RECENT FINDINGS Since the first surgical application of electricity in the 1880s, the use of radiofrequency current in surgery has grown. Although monopolar and bipolar energy form the backbone of electrosurgery, various modifications have been made to both the electrosurgical generators and the hand instruments. Much of the driving force behind these modifications has been the goal of minimizing possible complications while improving surgical efficiency. Recently, the ability to obtain vessel sealing has dramatically impacted clinical practice in open, laparoscopic, and vaginal surgery. SUMMARY Current evidence demonstrates the effectiveness and safety of electrosurgical devices in gynecologic surgery. Technology has evolved to allow vessel sealing capability through various instruments. Critical to the successful use of these advanced electrosurgical devices is a thorough understanding of their individual differences and nuances in order to obtain the desired tissue effects. Further studies are needed to determine the most appropriate applications and surgical procedures for these devices.
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Abstract
The ongoing desire to improve hemostasis and efficiency during surgery is manifested in the rapid development of electrosurgical technology. These changes have brought about a wide variety of devices available to the practicing surgeon during both open and endoscopic cases. Depending on the instrument chosen, various clinical effects ranging from simple coagulation to the sealing of large vascular bundles are obtained. However potential pitfalls or complications also exist. A thorough understanding of the pros and cons of these technological advancements can improve the operative experience for both surgeon and patient.
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Affiliation(s)
- K Wang
- Department of Obstetrics and Gynecology, University of Michigan Medical Center, Women's Hospital, Ann Arbor 48109, USA
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22
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Abstract
Laparoscopic urology has evolved considerably during last decade as well as number and spectrum of surgical related complications. Experiences reported by laparoscopic trained groups allow preventing, promptly recognizing, and safe and efficient management of the laparoscopic related complications. We present our complications in all patients undergoing urological laparoscopic procedures from November 1992 to June 2005. A literature search was conduced to evaluate complications of every laparoscopic procedure.
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Affiliation(s)
- O Castillo
- Unidad de Endourología y Laparoscopia Urológica, Clínica Santa María.
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Van Deusen S, Birkhahn RH, Gaeta TJ, Bove JJ. Delayed diagnosis of small bowel obstruction following laparoscopic lymph node dissection. J Emerg Med 2002; 23:243-6. [PMID: 12426014 DOI: 10.1016/s0736-4679(02)00525-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Laparoscopic surgical procedures are infrequently complicated by bowel herniation through unsutured trocar sites. Nevertheless, there is a risk of this complication in patients presenting with symptoms of small bowel obstruction after laparoscopy. We present a case of delayed small bowel obstruction due to a Richter's hernia, a rare type of hernia that involves incomplete protrusion of bowel wall through a surgical defect. Knowledge of this potential complication of laparoscopic procedures may prevent the significant morbidity that results from mechanical small bowel obstruction with necrosis.
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Affiliation(s)
- Shawn Van Deusen
- Department of Emergency Medicine, New York Methodist Hospital, Brooklyn, New York 11215, USA
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Abstract
Because of the lack of effective alternatives and the simplicity of the procedure, prophylactic oophorectomy is viewed as the best available tool for reducing the individual risk of ovarian cancer. The genetics of hereditary ovarian cancer are described in this chapter and a careful risk-versus-benefit assessment is provided with respect to two populations of patients that appear suitable candidates for this procedure. These include patients with increased risk of developing ovarian cancer due to hereditary genetic predisposition, in which the lifetime risk of ovarian cancer may be as high as 16-65%, depending on the penetrance of the germ-line mutation. Additionally, routine salpingo-oophorectomy in patients over 40 years undergoing scheduled gynaecological surgery or colorectal surgery might reduce the overall incidence of ovarian cancer by as much as 5% in the general population.
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Affiliation(s)
- George Coukos
- Division of Gynecologic Oncology, University of Pennsylvania Medical Center, 1000 Courtyard, 3400 Spruce Street, Philadelphia, PA 19104, USA
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Cravello L, Banet J, Agostini A, Bretelle F, Roger V, Blanc B. [Open laparoscopy: analysis of complications due to first trocar insertion]. GYNECOLOGIE, OBSTETRIQUE & FERTILITE 2002; 30:286-90. [PMID: 12043503 DOI: 10.1016/s1297-9589(02)00317-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To evaluate the complications of open laparoscopy during the set-up of laparoscopy in gynecologic surgery. DESIGN Retrospective study performed between February 1994 and January 2001 in a University Centre. PATIENTS AND METHODS 1,562 patients underwent open laparoscopies. Procedures were performed by 8 gynaecological surgeons. Peri- and postoperative complications were assessed and analysed. RESULTS Major injuries concerned gastrointestinal tract: 2 perforations with immediate diagnosis and one postoperative occlusion treated by delayed laparotomy (0.19%). No death occurred. No vascular injuries and no bladder complications were noted. CONCLUSION We recommend open laparoscopy because of its innocuity and easiness. Advantages concern decrease of major vascular injuries and early recognition of bowel injuries.
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Affiliation(s)
- L Cravello
- Service de gynécologie-obstétrique B, hôpital de la Conception, 147, bd Baille, 13385 Marseille, France.
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General Principles of Minimally Invasive Surgery. Surgery 2001. [DOI: 10.1007/978-3-642-57282-1_25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Larach SW, Gallagher JT. Complications of laparoscopic surgery for rectal cancer: avoidance and management. SEMINARS IN SURGICAL ONCOLOGY 2000; 18:265-8. [PMID: 10757893 DOI: 10.1002/(sici)1098-2388(200004/05)18:3<265::aid-ssu11>3.0.co;2-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Since laparoscopy was first introduced as a diagnostic tool for pelvic pathology 15 years ago, the technique has been successfully adapted by general and specialty surgeons as a therapeutic tool for a variety of diseases. Laparoscopic surgery has been used to treat colon and rectal pathology since 1991. The introduction and acceptance of this new access technique also brought the realization of specific complications associated with a laparoscopic approach. Advanced laparoscopic skills are required for laparoscopic pelvic and, to minimize laparoscopic-associated complications, specialized training is required. We will review the specific complications of the laparoscopic approach in pelvic surgery with a view to their recognition, prevention, and treatment.
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Affiliation(s)
- S W Larach
- Colon and Rectal Clinic of Orlando, Orlando, Florida, USA
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