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Abstract
Minimally invasive surgery continues to transform the field of gynecological surgery and is now the standard of care for the surgical treatment of many diseases in gynecology. Owing to minimally invasive surgery's clear advantages, new advances in technology are being employed rapidly and enabling even the most complicated procedures to be performed less invasively. We examine recent literature on minimally invasive surgical innovations, advances, and common practices in benign gynecology that, from our point of view, made an impact on the way laparoscopic surgery is performed and managed in the last decade.
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Affiliation(s)
- Lior Levy
- Gynaecological Endoscopy and Endometriosis Surgery, Department of Obstetrics and Gynaecology Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Jim Tsaltas
- Gynaecological Endoscopy and Endometriosis Surgery, Department of Obstetrics and Gynaecology Monash Health, Monash University, Melbourne, Victoria, Australia
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2
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The role of port site local anesthetic injection in laparoendoscopic single site surgery: a prospective randomized study. Obstet Gynecol Sci 2020; 63:387-394. [PMID: 32489985 PMCID: PMC7231930 DOI: 10.5468/ogs.2020.63.3.387] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 11/19/2019] [Accepted: 12/18/2019] [Indexed: 11/30/2022] Open
Abstract
Objective To investigate the role of port-site bupivacaine hydrochloride injection in laparoendoscopic single-site surgery (LESS) as a means of postoperative umbilical pain alleviation. Methods A total of 200 consecutive patients who underwent LESS from October 2018 to February 2019 were included in this randomized prospective case control study. The patients were alternatively assigned to either the study group (0.25% 10-mL bupivacaine hydrochloride injection at the 1.5-cm umbilical incision site after surgery) or the control group (no injection). All patients underwent surgery at the National Health Insurance Service Ilsan Hospital under the same operational setting by 3 board-certified gynecologists. Postoperative umbilical pain scores assessed using the visual analog scale were compared between the 2 groups as the primary outcome. Student's t-test, χ2 test, and a linear mixed model were used for the statistical analysis. A P-value of <0.05 was considered to be statistically significant. Results The patients' age, body mass index, and menopausal status; type of surgery performed; and need for additional trocar insertion exhibited a significant difference between the bupivacaine injection and non-injection groups. After adjusting for various confounding variables, the postoperative umbilical pain scores measured at postoperative 2–3 hours, 6–10 hours, 1 day, and 3 days did not exhibit a significant difference between the 2 groups. Conclusion Port-site bupivacaine injection in LESS did not show any additive effect in alleviation of postoperative umbilical pain.
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Mustea A, Holthaus B, Elmeligy H, Krüger-Rehberg S, Trojnarska D, Alwafai Z, Sternberg J, Stope MB, Kohlmann T, Meinhold-Heerlein I, Koensgen D. Comparison of laparoscopy-assisted vaginal hysterectomy as endoscopic single-station surgery and conventional laparoscopic hysterectomy—surgical effects on safety and quality of life. ACTA ACUST UNITED AC 2019. [DOI: 10.1186/s10397-019-1062-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Abstract
Background
To extend the benefits of minimally invasive surgery, an increasing enthusiasm has emerged for the laparo-endoscopic single-site surgery (LESS). The idea of LESS is to allow inserting multiple laparoscopic instruments through only one umbilical incision instead of multiple abdominal incisions.
Methods
Sixty patients from three different centers in Germany were randomized (1:1) to conventional laparoscopic hysterectomy (n = 31) or LESS hysterectomy (n = 29). The study focused in particular on the safety and efficacy of both techniques.
Results
The mean operative time was comparable in both groups (68.2 vs 73.6 min., p = 0.409; 95% CI − 18.69–7.12). No differences were seen regarding estimated blood loss (p = 0.915; 95% CI − 21.02–18.88), intra- and postoperative complications (p = 0.944), and wound infection rates (p = 0.944). Patients within the LESS group experienced significantly less pain in the first 24 h postoperatively (p = 0.006); the pain scores at 3, 5, 7 days and 2 months postoperatively were comparable.
Conclusion
LESS hysterectomy is a reliable and safe option in gynecologic surgery. Compared to conventional laparoscopic hysterectomy, LESS surgery demonstrated comparable surgical properties in regard to blood loss, duration of surgery, and intra-/postoperative complications. Notably, patients undergoing LESS hysterectomy experienced some less pain postoperatively.
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Diaz R, Davalos G, Welsh LK, Portenier D, Guerron AD. Use of magnets in gastrointestinal surgery. Surg Endosc 2019; 33:1721-1730. [PMID: 30805789 DOI: 10.1007/s00464-019-06718-w] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 02/19/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Laparoscopic and endoscopic surgery has undergone vast progress during the last 2 decades, translating into improved patient outcomes. A prime example of this development is the use of magnetic devices in gastrointestinal surgery. Magnetic devices have been developed and implemented for both laparoscopic and endoscopic surgery, providing alternatives for retraction, anchoring, and compression among other critical surgical steps. The purpose of this review is to explore the use of magnetic devices in gastrointestinal surgery, and describe different magnetic technologies, current applications, and future directions. METHODS IRB approval and written consent were not required. In this review of the existing literature, we offer a critical examination at the use of magnets for gastrointestinal surgery currently described. We show the experiences done to date, the benefits in laparoscopic and endoscopic surgery, and additional future implications. RESULTS Magnetic devices have been tested in the field of gastrointestinal surgery, both in the contexts of animal and human experimentation. Magnets have been mainly used for retraction, anchoring, mobilization, and anastomosis. CONCLUSION Research into the use of magnets in gastrointestinal surgery offers promising results. The integration of these technologies in minimally invasive surgery provides benefits in various procedures. However, more research is needed to continually evaluate their impact and implementation into surgical practice.
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Affiliation(s)
- Ramon Diaz
- Division of Minimally Invasive, Metabolic and Weight Loss Surgery, Department of Surgery, Duke Health System, Duke University, 407 Crutchfield Street, Durham, NC, 27704, USA
| | - Gerardo Davalos
- Division of Minimally Invasive, Metabolic and Weight Loss Surgery, Department of Surgery, Duke Health System, Duke University, 407 Crutchfield Street, Durham, NC, 27704, USA
| | - Leonard K Welsh
- Division of Minimally Invasive, Metabolic and Weight Loss Surgery, Department of Surgery, Duke Health System, Duke University, 407 Crutchfield Street, Durham, NC, 27704, USA
| | - Dana Portenier
- Division of Minimally Invasive, Metabolic and Weight Loss Surgery, Department of Surgery, Duke Health System, Duke University, 407 Crutchfield Street, Durham, NC, 27704, USA
| | - Alfredo D Guerron
- Division of Minimally Invasive, Metabolic and Weight Loss Surgery, Department of Surgery, Duke Health System, Duke University, 407 Crutchfield Street, Durham, NC, 27704, USA.
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Terzi H, Biler A, Turkay U, Kale A. A comparison of novel laparoscopic suturing techniques in single-port surgery. MINIM INVASIV THER 2019; 28:338-343. [DOI: 10.1080/13645706.2019.1567554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Hasan Terzi
- Department of Obstetrics and Gynecology, University of Medical Sciences, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey
| | - Alper Biler
- Department of Obstetrics and Gynecology, University of Medical Sciences, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Unal Turkay
- Department of Obstetrics and Gynecology, University of Medical Sciences, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey
| | - Ahmet Kale
- Department of Obstetrics and Gynecology, University of Medical Sciences, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey
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Koo YJ. Recent advances in minimally invasive surgery for gynecologic indications. Yeungnam Univ J Med 2018; 35:150-155. [PMID: 31620587 PMCID: PMC6784696 DOI: 10.12701/yujm.2018.35.2.150] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 09/28/2018] [Accepted: 10/01/2018] [Indexed: 12/13/2022] Open
Abstract
Recently, an increasing interest in less invasive surgery has led to the advent of laparoendoscopic single-site surgery (LESS) and natural orifice transluminal endoscopic surgery (NOTES). LESS and NOTES could be technically challenging, but available literature has demonstrated the feasibility and safety of LESS for benign gynecologic diseases. However, the evidence is not strong enough to recommend the use of LESS over that of conventional multiport laparoscopic surgery (MLS). As per the results of the most recently published meta-analysis, the majority of surgical outcomes are equivalent between LESS and MLS, except for the longer operative time in LESS for both adnexal surgery and hysterectomy. Although an increasing number of studies have reported on robotic LESS, NOTES, and LESS for gynecologic malignancy, definite conclusions have not been drawn owing to the lack of sufficient information.
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Affiliation(s)
- Yu-Jin Koo
- Department of Obstetrics and Gynecology, Yeungnam University College of Medicine, Daegu, Korea
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Single port laparoscopy (SPL): Retrospective study evaluating postoperative pain in comparison with conventional laparoscopy (CL). J Gynecol Obstet Hum Reprod 2018; 47:365-369. [PMID: 29654938 DOI: 10.1016/j.jogoh.2018.04.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Revised: 04/03/2018] [Accepted: 04/10/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To compare postoperative pain after single port laparoscopy (SPL) approach with conventional laparoscopy (CL) in case of adnexectomy. MATERIAL AND METHODS This is a retrospective monocentric study involving patients who underwent adnexal surgery by SPL or CL for a suspected benign disease or as a preventive measure. The main outcome measure was the level of postoperative pain. RESULTS A total of 87 patients were enrolled. Within 2h, the numerical scale (NS) was 1.9 in SPL group and 2.0 in the CL group (P=0.85). The next day, the NS was 1.8 in SPL group and 1.5 in CL group (P=0.55). The operating time was significantly shorter in SPL group (33 versus 56min, 95% CI [-31; -15], P<0.001) and no rupture of ovarian cysts occurred in this group. There was no significant difference concerning complications, length of hospital stay, general satisfaction and POSAS (Patient and Observer Scar Assessment Scale) score. CONCLUSION This study confirms the feasibility of single-port laparoscopic adnexectomy. We have not shown significant difference in postoperative pain but the operating time was significantly reduced under the guise of an experienced surgeon.
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Abstract
Endometriosis is a common disease affecting reproductive age women. Pain is one of the most common symptoms associated with endometriosis. When medical therapy has failed or in known deeply infiltrating endometriosis, surgical management is warranted. Laparoscopy is the gold standard for diagnosis and treatment of endometriosis. Recent developments in surgery have shown the feasibility of robotic surgery for endometriosis, although these methods have not been shown to be superior to conventional laparoscopy. Enhanced imaging techniques including fluorescence imaging and narrow band imaging have also been studied. However, long-term clinical benefits have yet to be demonstrated.
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Biler A, Kale A, Terzi H, Solmaz U. Newly Developed Laparoscopic Needle Holder That Facilitates Knot Tying Makes Vaginal Cuff Suturing Easy in Single-Port Laparoscopic Hysterectomy. Surg Innov 2017; 24:605-610. [PMID: 28933250 DOI: 10.1177/1553350617731985] [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: 12/30/2022]
Abstract
BACKGROUND To evaluate vaginal cuff closure times of a single-port laparoscopic hysterectomy using a newly developed Turkish-made laparoscopic needle holder (TMLNH) with a single-port laparoscopic hysterectomy using a laparoscopic needle holder with pistol handle (LNHPH). METHODS We retrospectively reviewed 68 patients who underwent single-port laparoscopic hysterectomy using a TMLNH (n = 38) or a LNHPH (n = 30). Patients' age, parity, body mass index, mean operating time, mean vaginal cuff suturing time, uterine weight, estimated blood loss, drop of hemoglobin level, return of bowel activity, hospital stay, conversion to multiport access, conversion to laparotomy, and postoperative and intraoperative outcomes were analyzed. RESULTS The TMLNH group had a shorter operative time ( P < .001) and a shorter vaginal cuff suturing time ( P < .001) compared with the LNHPH group during a single-port laparoscopic hysterectomy. There was no difference in intraoperative and postoperative complications. CONCLUSION The TMLNH facilitates vaginal cuff suturing and decreases operation time during a single-port laparoscopic hysterectomy. We proposed that the TMLNH is a promising technique for suturing and vaginal cuff closure in a single-port laparoscopic hysterectomy.
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Affiliation(s)
- Alper Biler
- 1 Tepecik Training and Research Hospital, Izmir, Turkey
| | - Ahmet Kale
- 2 Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey
| | - Hasan Terzi
- 2 Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey
| | - Ulas Solmaz
- 1 Tepecik Training and Research Hospital, Izmir, Turkey
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Laparoendoscopic single-site surgery versus conventional laparoscopy for hysterectomy: a systematic review and meta-analysis. Arch Gynecol Obstet 2017; 295:1089-1103. [PMID: 28357561 PMCID: PMC5388711 DOI: 10.1007/s00404-017-4323-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 02/06/2017] [Indexed: 02/07/2023]
Abstract
Purpose To assess the safety and effectiveness of LESS compared to conventional hysterectomy. Methods The systematic review and meta-analysis was performed according to the MOOSE guideline, and quality of evidence was assessed using GRADE. Different databases were searched up to 4th of August 2016. Randomized controlled trials and cohort studies comparing LESS to the conventional laparoscopic hysterectomy were considered for inclusion. Results Of the 668 unique articles, 23 were found relevant. We investigated safety by analyzing the complication rate and found no significant differences between both groups [OR 0.94 (0.61, 1.44), I2 = 19%]. We assessed effectiveness by analyzing conversion risk, postoperative pain, and patient satisfaction. For conversion rates to laparotomy, no differences were identified [OR 1.60 (0.40, 6.38), I2 = 45%]. In 3.5% of the cases in the LESS group, an additional port was needed during LESS. For postoperative pain scores and patient satisfaction, some of the included studies reported favorable results for LESS, but the clinical relevance was non-significant. Concerning secondary outcomes, only a difference in operative time was found in favor of the conventional group [MD 11.3 min (5.45–17.17), I2 = 89%]. The quality of evidence for our primary outcomes was low or very low due to the study designs and lack of power for the specified outcomes. Therefore, caution is urged when interpreting the results. Conclusion The single-port technique for benign hysterectomy is feasible, safe, and equally effective compared to the conventional technique. No clinically relevant advantages were identified, and as no data on cost effectiveness are available, there are currently not enough valid arguments to broadly implement LESS for hysterectomy. Electronic supplementary material The online version of this article (doi:10.1007/s00404-017-4323-y) contains supplementary material, which is available to authorized users.
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Abstract
Recently, a new platform of abdominal access, called single-port surgery, has emerged in human and veterinary laparoscopy. The single-port platform enables all laparoscopic instruments, including the telescope, to pass individually through the same abdominal incision. Recently, there have been several published reports documenting the efficacy and safety of single-port procedures in veterinary patients. This article discusses the common single-port devices and instrumentation, as well as procedures now routinely offered in veterinary minimally invasive surgery.
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Freschi L, Pluchino N, Angioni S, Simi G, Ruggiero M, Cela V. A Novel System for Single-Port Laparoscopic Surgery: Preliminary Experience. Gynecol Obstet Invest 2016; 81:454-60. [PMID: 27198919 DOI: 10.1159/000443394] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 12/14/2015] [Indexed: 11/19/2022]
Abstract
AIMS To present preliminary data of single-access laparoscopic surgery with a new device for the treatment of benign adnexal pathologies. METHODS Ten women with benign adnexal pathologies underwent salpingectomy (n = 4) and ovarian/para-ovarian cyst enucleation (n = 6) using a laparo-endoscopic single-port approach with an innovative advanced multiport reusable trocar inserted transumbilically through a small wound retractor. Trocar introduction time, operative time, estimated blood loss, conversion to standard laparoscopy, peri- and postoperative complications, hospital stay and Visual Analog Scale score (as assessment of pain and cosmesis) were analyzed. RESULTS Port placement was successful in all patients. Mean trocar introduction time was 4.4 min (range 3.4-5.3 min) and no intra or postoperative complication occurred. The mean operating time was 50.0 ± 9.2 min and mean blood loss was 28.5 ± 8.8 ml. The mean hospital stay following surgery was 1.6 ± 0.5 days and convalescence was complete in 1 week. Neither scores for postoperative incisional pain nor cosmesis side effects have been observed in any subjects. CONCLUSION We concluded that adnexal single-port surgery performed with this innovative advanced surgical instrumentation is a feasible, safe, and effective technique that drastically reduces postoperative pain and does not compromise cosmetic appearance. The isolation of the operative field by means of the drape prevents the contamination of the port site that occurs frequently, and mainly in adnexal pathologies of uncertain etiology. In addition, the ease of insertion and the conformation of the new port access also make the procedure feasible in obese patients.
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Affiliation(s)
- Letizia Freschi
- Division of Gynecology and Obstetrics, University of Pisa, Pisa, Italy
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Pontis A, Sedda F, Mereu L, Podda M, Melis GB, Pisanu A, Angioni S. Review and meta-analysis of prospective randomized controlled trials (RCTs) comparing laparo-endoscopic single site and multiport laparoscopy in gynecologic operative procedures. Arch Gynecol Obstet 2016; 294:567-77. [DOI: 10.1007/s00404-016-4108-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 04/22/2016] [Indexed: 12/31/2022]
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Bresson L, Allard-Duclercq C, Narducci F, Tresch E, Lesoin A, Ahmeidi A, Leblanc E. Single-port or Classic Laparoscopy Compared With Laparotomy to Assess the Peritoneal Cancer Index in Primary Advanced Epithelial Ovarian Cancer. J Minim Invasive Gynecol 2016; 23:825-32. [PMID: 27068278 DOI: 10.1016/j.jmig.2016.03.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 03/31/2016] [Accepted: 03/31/2016] [Indexed: 12/16/2022]
Abstract
A thorough laparoscopic assessment of the abdominopelvic cavity is a crucial step in the workup of primary advanced epithelial ovarian cancer to decide whether up-front cytoreductive surgery or neoadjuvant chemotherapy is the best option for adequate management. The purpose of our study was to compare single-port laparoscopy (SPL), classic laparoscopy (CL), and laparotomy using the peritoneal cancer index (PCI). Patients treated for Fédération Internationale de Gynécologie et d'Obstétrique stage 3 or 4 epithelial ovarian cancer were included in our study when they underwent a PCI evaluation by laparoscopy followed by laparotomy for cytoreduction. According to the technique used for the "noninvasive" procedure (SPL vs CL), 2 groups were compared retrospectively. The individual records of all patients were reviewed and analyzed. From 2011 to 2014, 21 patients were assessed for PCI by SPL plus laparotomy versus 21 by CL plus laparotomy. The clinicopathological features were similar in both groups (not significant [NS]), except for performance status >0, which was more frequent in the SPL group (39% vs 6%, p = .04). Quotation of PCI was possible for all patients. Nonbrowsing areas marked 3 procedures in the SPL group and 2 procedures in the CL group (NS). The mean PCI score and the score of each region assessed by SPL and CL were comparable with the evaluation by laparotomy (NS). Completeness of cytoreduction was achieved in 78% of cases in both groups (NS). SPL and widely mini-invasive procedures seem to be effective tools compared with laparotomy to adequately assess the resectability of a peritoneal carcinomatosis using the PCI.
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Affiliation(s)
- Lucie Bresson
- Department of Gynecologic Oncology, Oscar Lambret Center, Lille Cedex, France.
| | | | - Fabrice Narducci
- Department of Gynecologic Oncology, Oscar Lambret Center, Lille Cedex, France
| | | | - Anne Lesoin
- Department of Gynecologic Oncology, Oscar Lambret Center, Lille Cedex, France
| | - Abesse Ahmeidi
- Department of Anesthesia, Oscar Lambret Center, Lille Cedex, France
| | - Eric Leblanc
- Department of Gynecologic Oncology, Oscar Lambret Center, Lille Cedex, France
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Angioni S, Pontis A, Multinu A, Melis G. Safe endobag morcellation in a single-port laparoscopy subtotal hysterectomy. MINIM INVASIV THER 2015; 25:113-6. [PMID: 26902985 DOI: 10.3109/13645706.2015.1109521] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Recently, the American Food and Drug Administration (FDA) published an alert about the risks of uterine tissue morcellation during laparoscopic procedures. In particular, the possible risk of spreading an undiagnosed malignant tumor was emphasized. From then on, a fervent debate in the media has led major scientific societies to express their position on the matter. We present a safe endobag abdominal morcellation in a single port-access laparoscopy subtotal hysterectomy. The endobag abdominal morcellation is feasible and safe; consequently, the development of devices dedicated to intracavitary morcellation in a closed system has been encouraged.
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Affiliation(s)
- Stefano Angioni
- a Department of Surgical Sciences , University of Cagliari , Monserrato , Italy
| | - Alessandro Pontis
- b U.O.C Obstetric and Gynecology , Ospedale San Francesco , Nuoro Italy
| | - Angelo Multinu
- b U.O.C Obstetric and Gynecology , Ospedale San Francesco , Nuoro Italy
| | - Gianbenedetto Melis
- a Department of Surgical Sciences , University of Cagliari , Monserrato , Italy
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Jennings AJ, Spencer RJ, Hanks L, Barroilhet L, Kushner D, Rose S, Rice L, Al-Niaimi A. The Feasibility and Safety of Adopting Single-Incision Laparoscopic Surgery into Gynecologic Oncology Practice. J Minim Invasive Gynecol 2015; 23:358-63. [PMID: 26561374 DOI: 10.1016/j.jmig.2015.11.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 10/30/2015] [Accepted: 11/02/2015] [Indexed: 11/27/2022]
Abstract
STUDY OBJECTIVE To determine the complications associated with single-incision laparoscopy in gynecologic oncology surgery. DESIGN A retrospective cohort (Canadian Task Force classification II-3). SETTING A single academic institution. PATIENTS One hundred fifteen consecutive patients undergoing single-incision laparoscopy with suspected gynecologic oncology conditions. INTERVENTIONS Single-incision laparoscopy. MEASUREMENTS AND MAIN RESULTS One hundred fifteen patients underwent single-incision laparoscopy. The mean age was 55.3 ± 13.1 years. For procedures completed via single-incision laparoscopy (102/115 [88.7%]), the mean operative time was 130.7 ± 55.5 minutes. The average blood loss was 63 ± 111 mL. The conversion to open rate was 13 of 115 (12.17%). The conversion rate of the 55 patients with benign conditions was lower (2/55 [3.64%]) compared with the 60 patients with malignant conditions (11/60 [18.33%]). The hernia rate was 2 of 115 (1.80%), 1 of which was a recurrent hernia. The median time for follow-up was 30 days (range, 5-653 days). CONCLUSION Single-incision laparoscopy provides a feasible, safe, and promising minimally invasive modality for treating gynecologic oncology patients.
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Affiliation(s)
- Ashley J Jennings
- Division of Gynecology, Department of Obstetrics and Gynecology, University of Wisconsin, Madison, Wisconsin
| | - Ryan J Spencer
- Division of Gynecology, Department of Obstetrics and Gynecology, University of Wisconsin, Madison, Wisconsin
| | - Laura Hanks
- Division of Gynecology, Department of Obstetrics and Gynecology, University of Wisconsin, Madison, Wisconsin
| | - Lisa Barroilhet
- Division of Gynecology, Department of Obstetrics and Gynecology, University of Wisconsin, Madison, Wisconsin
| | - David Kushner
- Division of Gynecology, Department of Obstetrics and Gynecology, University of Wisconsin, Madison, Wisconsin
| | - Stephen Rose
- Division of Gynecology, Department of Obstetrics and Gynecology, University of Wisconsin, Madison, Wisconsin
| | - Laurel Rice
- Division of Gynecology, Department of Obstetrics and Gynecology, University of Wisconsin, Madison, Wisconsin
| | - Ahmed Al-Niaimi
- Division of Gynecology, Department of Obstetrics and Gynecology, University of Wisconsin, Madison, Wisconsin.
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Chung JH, Baek JM, Chung K, Park EK, Jeung IC, Chang HT, Choi JH, Kim CJ, Lee YS. A comparison of postoperative pain after transumbilical single-port access and conventional three-port total laparoscopic hysterectomy: a randomized controlled trial. Acta Obstet Gynecol Scand 2015; 94:1290-6. [DOI: 10.1111/aogs.12767] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 08/31/2015] [Indexed: 12/01/2022]
Affiliation(s)
- Ji-Hyun Chung
- Department of Anesthesiology and Pain Medicine; Catholic University of Korea; Seoul Korea
| | - Jong Min Baek
- Department of General Surgery; Catholic University of Korea; Seoul Korea
| | - Kyudon Chung
- Department of Anesthesiology and Pain Medicine; Catholic University of Korea; Seoul Korea
| | - Eun Kyung Park
- Department of Obstetrics and Gynecology; Catholic University of Korea; Seoul Korea
| | - In Cheul Jeung
- Department of Obstetrics and Gynecology; Catholic University of Korea; Seoul Korea
| | - Hyun Tae Chang
- Department of Anesthesiology and Pain Medicine; Catholic University of Korea; Seoul Korea
| | - Ji Hyang Choi
- Department of Obstetrics and Gynecology; Seoul Medical Center; Seoul Korea
| | - Chan Joo Kim
- Department of Obstetrics and Gynecology; Catholic University of Korea; Seoul Korea
| | - Yong Seok Lee
- Department of Obstetrics and Gynecology; Catholic University of Korea; Seoul Korea
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Kale A, Terzi H, Yavuz A, Kale E. Single-port access total laparoscopic hysterectomy with Korean-made OCTO Port: Turkish surgeons' initial experience. J OBSTET GYNAECOL 2015; 36:114-8. [PMID: 26408502 DOI: 10.3109/01443615.2015.1041885] [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
We present our initial experience with single-port access total laparoscopic hysterectomy (TLH) surgery using a Korean-made laparoscopic port (OCTO™ Port). In a retrospective study, single-port access TLH (SPA-TLH) with the OCTO Port was performed on 34 patients with benign gynaecological indications from July 2013 to May 2014 by two surgeons (Ahmet Kale and Hasan Terzi). All patients were divided into two groups. The first 15 patients who underwent SPA-TLH were classified as Group 1, and the second 19 patients who underwent SPA-TLH were classified as Group 2. Patient data were analyzed for age, body mass index (BMI, kg/m(2)), weight of uterus, vaginal cuff suturation time, estimated blood loss, operation time, hysterectomy indications and operative outcomes. The median time needed for the surgery was 75 min in both groups. The duration of suturing of the vaginal cuff was shorter in Group 2 compared with that in Group 1. The estimated blood loss was less in Group 2 compared with Group 1: Four patients in Group 1 required blood transfusion while none of the patients in Group 2 required blood transfusion. The OCTO Port has soft and flexible instrumental movements, which can reduce crowding of instruments during surgery, and the cap rotates 360 degrees. The OCTO Port might facilitate the learning curve of single-port laparoscopic hysterectomy surgery.
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Affiliation(s)
- A Kale
- a Kocaeli Derince Training and Research Hospital , Department of Obstetrics and Gynecology , Kocaeli , Turkey
| | - H Terzi
- a Kocaeli Derince Training and Research Hospital , Department of Obstetrics and Gynecology , Kocaeli , Turkey
| | - A Yavuz
- a Kocaeli Derince Training and Research Hospital , Department of Obstetrics and Gynecology , Kocaeli , Turkey
| | - E Kale
- b Kocaeli Derince Training and Research Hospital , Department of Biochemistry , Kocaeli , Turkey
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Angioni S, Pontis A, Sedda F, Zampetoglou T, Cela V, Mereu L, Litta P. Single-port versus conventional multiport access prophylactic laparoscopic bilateral salpingo-oophorectomy in high-risk patients for ovarian cancer: a comparison of surgical outcomes. Onco Targets Ther 2015; 8:1575-80. [PMID: 26170692 PMCID: PMC4485856 DOI: 10.2147/ott.s82570] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Bilateral salpingo-oophorectomy (BSO) in carriers of BRCA1 and BRCA2 mutations is widely recommended as part of a risk-reduction strategy for ovarian or breast cancer due to an underlying genetic predisposition. BSO is also performed as a therapeutic intervention for patients with hormone-positive premenopausal breast cancer. BSO may be performed via a minimally invasive approach with the use of three to four 5 mm and/or 12 mm ports inserted through a skin incision. To further reduce the morbidity associated with the placement of multiple port sites and to improve cosmetic outcomes, single-port laparoscopy has been developed with a single access point from the umbilicus. The purpose of this study was to evaluate the surgical outcomes associated with reducing the risks of salpingo-oophorectomy performed in a single port, while comparing multiport laparoscopy in women with a high risk for ovarian cancer. Single-port laparoscopy-BSO is feasible and safe, with favorable surgical and cosmetic outcomes when compared to conventional laparoscopy.
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Affiliation(s)
- Stefano Angioni
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Alessandro Pontis
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Federica Sedda
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | | | - Vito Cela
- Department of Obstetrics and Gynecology, University of Pisa, Pisa, Italy
| | | | - Pietro Litta
- Department of Obstetrics and Gynecology, University of Padua, Padua, Italy
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20
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Angioni S, Pontis A, Cela V, Sedda F, Genazzani AD, Nappi L. Surgical technique of endometrioma excision impacts on the ovarian reserve. Single-port access laparoscopy versus multiport access laparoscopy: a case control study. Gynecol Endocrinol 2015. [PMID: 26213861 DOI: 10.3109/09513590.2015.1017812] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Several recent studies report the detrimental effect of endometrioma excision on the ovarian reserve. Surgical technique and the excessive use of bipolar coagulation could be the key factors. Single-port access laparoscopy (SPAL) ovarian cystectomy has been reported as a comparable procedure to conventional laparoscopy in terms of operative outcomes. The aim of this study was to evaluate whether the single-port surgery affects the ovarian reserve whilst performing laparoscopic ovarian cystectomy for unilateral endometrioma. This was a prospective, case-control study of 99 women with unilateral endometrioma. Forty-nine women underwent single-port cystectomy and 50 women underwent multiport laparoscopic (MPL) conventional cystectomy. The primary outcome was the assessment of the ovarian reserve. We evaluated the serum anti-Mullerian hormone (AMH) levels before, 4-6 weeks and 3 months after surgery. At T2 we performed an ultrasound assessment of the antral follicular count (AFC). We have drawn attention to a statistically significant decrease of the mean AMH value and AFC in the SPAL group at the 4-6-week and 3-month follow-up compared to the conventional laparoscopy group. In conclusion, our results suggest that SPAL cystectomy should not be recommended to patients undergoing surgery for endometrioma excision who want to preserve their fertility.
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Affiliation(s)
- Stefano Angioni
- Department of Surgical Sciences, University of Cagliari , Monserrato , Italy
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21
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Fistarol M, Giostri PG, Bechara Noviello M, Silva Santos Filho A, Alencar de Lima Rezende C, Fulgêncio Brandão AH. Single-Port Laparoscopy as a Feasible Technique to Approach Benign Adnexal Mass Surgically. J Gynecol Surg 2015. [DOI: 10.1089/gyn.2014.0095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Marina Fistarol
- Hospital da Baleia, Fundação Benjamin Guimarães, Belo Horizonte, MG, Brazil
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22
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Single-port Access Subtotal Laparoscopic Hysterectomy: A Prospective Case-Control Study. J Minim Invasive Gynecol 2015; 22:807-12. [PMID: 25796219 DOI: 10.1016/j.jmig.2015.03.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 03/09/2015] [Accepted: 03/13/2015] [Indexed: 11/20/2022]
Abstract
STUDY OBJECTIVE The objective was to evaluate the perioperative outcomes, safety, and patient acceptance of single-port access laparoscopic subtotal hysterectomy (SPAL-SH) in comparison with conventional multiport access laparoscopic subtotal hysterectomy (MPAL-SH). DESIGN Case-control study. Canadian Task Force Classification II-2. SETTING The study was conducted at university hospitals in Cagliari, Italy, and Rouen, France. PATIENTS Sixty-one women with metrorrhagia, abnormal uterine bleeding with uterine myomas, or symptomatic adenomyosis were included in the study. INTERVENTIONS Thirty-one patients underwent SPAL-SH, and 30 patients underwent conventional MPAL-SH. MEASUREMENTS AND MAIN RESULTS We analyzed the data to compare the outcomes of SPAL-SH versus MPAL-SH. Patients in the SPAL-SH group had longer operative times than those in the MPAL-SH group (p < .001) but shorter hospital stays (p < .001). Postoperative pain immediately after surgery, after 6 hours, and after 24 hours were lower in the SPAL-SH group (p < .001). The SPAL-SH group reported significantly higher cosmetic satisfaction at 1, 4, and 24 weeks after surgery (p < .01). CONCLUSION We conclude that SPAL-SH is a feasible and safe alternative to standard MPAL-SH in selected patients. Ongoing refinement of the surgical technique and instrumentation is likely to expand its role in gynecologic surgery in the future. In addition, SPAL-SH has a definite benefit in relation to body image and cosmesis.
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Santos Filho AS, Noviello MB, Damasceno RCF, Patrício EDC, Félix LR, Giostri PG, Brandão AHF. Single-site laparoscopy in gynecology: preliminary study of a series of 50 cases. Rev Assoc Med Bras (1992) 2015; 60:548-54. [PMID: 25650855 DOI: 10.1590/1806-9282.60.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Accepted: 05/22/2014] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE to describe the initial experience of a gynecology team, at a tertiary care center, when performing single-port laparoscopic surgery. METHODS this is a retrospective study reviewing the medical records of 50 patients treated at the outpatient gynecology clinic of our institution between June 2012 and July 2013 who underwent single-port laparoscopic surgery. This study was approved by the institution's Ethics in Research Committee. RESULTS the mean age of patients is 37.8 years, ranging from 18 to 70 years, and the most frequent surgical indications were adnexal mass (72%) and chronic pelvic pain (24%). The mean operative time was 94.4 minutes with a mean hospital stay of 25.8 hours. There were no perioperative complications. We recorded two conversions to laparotomy due to technical difficulties during the procedure. All cases of conversion had pelvic adhesions. All operative complications were successfully treated and none were considered severe. CONCLUSION this is one of the largest case series in the literature regarding surgical treatment by single-port laparoscopy in gynecology and presents evidence on reduction of surgical morbidity and satisfactory cosmetic results. We conclude that single-port laparoscopy is a viable minimally invasive technique, and that it contributes to the construction of a new scenario in modern gynecological surgery.
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Angioni S, Pontis A, Cela V, Nappi L, Mereu L, Litta P. Single-Port Access Laparoscopic Hysterectomy: A Literature Review. J Gynecol Surg 2014. [DOI: 10.1089/gyn.2014.0045] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
- Stefano Angioni
- Department of Surgical Sciences, Division of Gynecology and Obstetrics, University of Cagliari, Monserrato, Cagliari, Italy
| | - Alessandro Pontis
- Department of Surgical Sciences, Division of Gynecology and Obstetrics, University of Cagliari, Monserrato, Cagliari, Italy
| | - Vito Cela
- Division of Gynecology and Obstetrics, Department of Reproductive Medicine and Child Development, University of Pisa, Pisa, Italy
| | - Luigi Nappi
- Division of Gynecology and Obstetrics, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Liliana Mereu
- Division of Gynecology and Obstetrics, Ospedale Santa Chiara, Trento, Italy
| | - Pietro Litta
- Division of Gynecology and Obstetrics, Department of Department of Women's and Children's Health, University of Padua, Padua, Italy
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Diaphragmatic Endometriosis: Review of the Literature and First Case of Robot-Assisted Laparoscopic Treatment. JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS 2014. [DOI: 10.5301/je.5000179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background Thoracic endometriosis is a rare disorder affecting women in reproductive age. The etiopathogenesis of this disease is not well understood. The symptoms appear, but not necessarily, during periods in person affected by the condition. Methods A 35-year-old woman came to our clinic, the Infertility and Assisted Reproduction Center of the University of Pisa, for infertility treatment. She described a clinical history of abdominal pain with irradiation up to the right shoulder, depending on her breathing or position, during menstruation. She also reported that she did not experience these symptoms while taking an oral contraceptive. Pelvic ultrasound examination and thorax X-ray were normal. The patient also underwent thoracic and abdominal pelvis magnetic resonance imaging (MRI). Thoracic MRI revealed a nodule on the right hemidiaphragm. It was decided to perform surgical removal of the nodule. Robotic-assisted surgery was used because of its multiple advantages in comparison with laparoscopic surgery, such as a 3-dimensional view, a decrease in surgeon fatigue and tremors, and an increase of wrist motion with improved dexterity and greater surgical precision. The surgery was performed in May 2012. The patient was put on the left lateral bedside. Pneumoperitoneum with CO2 was established with an intra-abdominal pressure of 12 mm Hg using a Veress needle. Robotic trocars of 8-mm diameter were introduced at the diaphragmatic level and connected to the robot arms. Her pelvic and abdominal organs appeared healthy. The right hemidiaphragm presented adherence with the liver due to endometriosis disease. We removed the adhesion, and we performed the excision of the diaphragmatic endometriotic nodule. The nodule was extracted through an endobag. Operative time lasted 2 hours. Conclusions The postoperative evolution was satisfactory, and the patient left the hospital on the third postoperative day. No complications occurred. We showed that this approach is feasible and safe, without conversion to laparotomy.
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Kim SK, Lee JH, Lee JR, Suh CS, Kim SH. Laparoendoscopic Single-site Myomectomy Versus Conventional Laparoscopic Myomectomy: A Comparison of Surgical Outcomes. J Minim Invasive Gynecol 2014; 21:775-81. [DOI: 10.1016/j.jmig.2014.03.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 03/04/2014] [Accepted: 03/04/2014] [Indexed: 10/25/2022]
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Angioni S, Pontis A, Dessole M, Surico D, De Cicco Nardone C, Melis I. Pain control and quality of life after laparoscopic en-block resection of deep infiltrating endometriosis (DIE) vs. incomplete surgical treatment with or without GnRHa administration after surgery. Arch Gynecol Obstet 2014; 291:363-70. [PMID: 25151027 DOI: 10.1007/s00404-014-3411-5] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Accepted: 08/07/2014] [Indexed: 12/11/2022]
Abstract
PURPOSE To evaluate the role of post-surgical medical treatment with GnRHa in patients with DIE (Deep Infiltrating Endometriosis) that received complete or incomplete surgery laparoscopic excision. METHODS Hundred fifty-nine patients with deep infiltrating endometriosis of the cul-de-sac and of the rectovaginal septum with pelvic pain undergoing laparoscopic surgery in academic tertiary-care medical center. Eighty patients underwent complete laparoscopic excision of DIE (Arm A) while 79 patients underwent incomplete surgery (Arm B). After surgery each surgical arm was randomized in two groups: no treatment groups 1A [40 pts] and 1B [40 pts] and GnRHa treatment for 6 months groups 2A [40 pts] and 2B [39 pts]. Pain recurrence and quality of life were evaluated in follow-up of 12 months and compared between groups. RESULTS No differences were observed between patient groups 1A and 2A. Groups 1A, 2A and 2B obtained significantly lower pain scores than those achieved by the group 1B undergoing incomplete surgical treatment and no post-surgical therapy. At 1-year follow-up patients treated with en-block resection (Groups 1A and 2A) showed the lowest pain scores and the highest quality of life in comparison with the other two groups (Group 1B and 2B). CONCLUSION GnRHa administration is followed by a temporary improvement of pain in patients with incomplete surgical treatment. It seems that it has no role on post-surgical pain when the surgeon is able to completely excise DIE implants.
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Affiliation(s)
- S Angioni
- Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy,
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28
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Angioni S, Mais V, Pontis A, Peiretti M, Nappi L. First case of prophylactic salpingectomy with single port access laparoscopy and a new diode laser in a woman with BRCA mutation. GYNECOLOGIC ONCOLOGY CASE REPORTS 2014; 9:21-3. [PMID: 25426409 PMCID: PMC4241483 DOI: 10.1016/j.gynor.2014.05.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Accepted: 05/13/2014] [Indexed: 01/11/2023]
Abstract
Single port access laparoscopy may be suggested for prophylactic salpingectomy in BRCA carriers. Diode laser salpingectomy could preserve ovarian function as it can cut and coagulate with extreme precision and minimal thermal damage.
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Affiliation(s)
- S Angioni
- Division of Gynecology and Obstetrics, Department of Surgical Sciences, Division of Obstetrics and Gynecology, University of Cagliari, Italy
| | - V Mais
- Division of Gynecology and Obstetrics, Department of Surgical Sciences, Division of Obstetrics and Gynecology, University of Cagliari, Italy
| | - A Pontis
- Division of Gynecology and Obstetrics, Department of Surgical Sciences, Division of Obstetrics and Gynecology, University of Cagliari, Italy
| | - M Peiretti
- Division of Gynecology and Obstetrics, Department of Surgical Sciences, Division of Obstetrics and Gynecology, University of Cagliari, Italy
| | - L Nappi
- Division of Gynecology and Obstetrics, Department of Medical and Surgical Sciences, Institute of Obstetrics and Gynecology, University of Foggia, Italy
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Yoon BS, Kim YS, Seong SJ, Song T, Kim ML, Kim MK, Paek JY. Impact on ovarian reserve after laparoscopic ovarian cystectomy with reduced port number: a randomized controlled trial. Eur J Obstet Gynecol Reprod Biol 2014; 176:34-8. [DOI: 10.1016/j.ejogrb.2014.02.025] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Revised: 01/22/2014] [Accepted: 02/09/2014] [Indexed: 12/17/2022]
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Vettoretto N, Cirocchi R, Randolph J, Parisi A, Farinella E, Romano G. Single incision laparoscopic right colectomy: a systematic review and meta-analysis. Colorectal Dis 2014; 16:O123-32. [PMID: 24354622 DOI: 10.1111/codi.12526] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Accepted: 09/20/2013] [Indexed: 12/13/2022]
Abstract
AIM A meta-analysis was performed to compare the outcome of single incision laparoscopic right hemicolectomy with standard multiport laparoscopic right hemicolectomy. METHOD A systematic search of databases was carried out to extract comparative studies (randomized and non-randomized, prospective and retrospective). Data were analysed according to Cochrane Collaboration guidelines. A meta-analysis was performed when the data permitted this form of analysis. RESULTS Nine comparative studies were retrieved comprising 241 patients with single incision and standard laparoscopy. None of these was randomized. There was no significant difference between the two methods for the primary end-points of mortality, morbidity and cancer-specific parameters and for the secondary end-points of operation time, blood loss, ileus, hospital stay and conversion. It was not possible to analyse pain and cosmetics data owing to insufficient information. CONCLUSION Single incision laparoscopic right hemicolectomy is comparable with standard multiport laparoscopic right hemicolectomy in primary and secondary outcomes. Given current information it is justified to use single incision laparoscopic right hemicolectomy, but there is a need for a prospective randomized study.
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Affiliation(s)
- N Vettoretto
- Laparoscopic Surgical Unit, M. Mellini Hospital, Chiari, Italy
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