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Xiao J, Fu K, Duan K, Wang J, Sunkara S, Guan X. Pregnancy-preserving Laparoendoscopic Single-site Surgery for Gynecologic Disease: A Case Series. J Minim Invasive Gynecol 2020; 27:1588-1597. [PMID: 32126300 DOI: 10.1016/j.jmig.2020.02.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 02/13/2020] [Accepted: 02/22/2020] [Indexed: 01/05/2023]
Abstract
STUDY OBJECTIVE The study objective was to assess the feasibility of laparoendoscopic single-site surgery (LESS) for the management of nonobstetric, gynecologic disease processes in pregnant patients. DESIGN A retrospective case series of 13 pregnant women aged 21 to 42 years who underwent LESS for various gynecologic pathology. If able to be contacted, the patients were followed up until the delivery of the fetus. SETTING The surgeries were performed in a single institution between January 2015 and June 2019. PATIENTS The patients were selected if a laparoscopic intervention was indicated. INTERVENTIONS The cases included 6 ovarian cystectomies and 2 salpingo-oophorectomies for adnexal masses; 1 myomectomy for a degenerated myoma; 1 salpingectomy for a heterotopic pregnancy; 2 cerclage placements for recurrent pregnancy loss and cervical insufficiency; and 1 paratubal cystectomy. The patients underwent LESS through a 2.5-cm umbilical incision. The masses were exteriorized using a laparoscopic specimen retrieval bag, with the exception of 2 large adnexal masses, which were aspirated at the incision site, exteriorized after content drainage, and cystectomies performed extracorporeally. The fascial incision was repaired with a permanent suture. MEASUREMENTS AND MAIN RESULTS Various data were collected from patients, including age, surgical and obstetric history, gestational age at surgery, and ultrasonic imaging results. The outcomes measured were operative duration, intraoperative bleeding, postoperative symptoms, fetal monitoring before and after surgery, pathologic findings, conversions, intraoperative complications, and pregnancy outcomes. Eight cases were performed in the first trimester, 4 in the second trimester, and 1 in the third trimester, with the surgeries lasting between 45 minutes and 298 minutes. The blood loss ranged from 5 mL to 300 mL, and postoperative symptoms of mild pelvic or abdominal pain were reported. There were 2 conversions to traditional multiport laparoscopic surgery for the 2 cerclage cases, and there were no open surgery conversions or intraoperative complications. The fetal heart rate ranged between 130 beats per minute and 167 beats per minute postoperatively. Of the 9 patients who were able to be contacted for follow-up, all had successful deliveries. One patient was healthy at 31 weeks and 5 days without complication at the time of her last follow-up. CONCLUSION LESS may be performed by experienced surgeons on gravid patients in any trimester for adnexal masses, myomas, heterotopic pregnancy, and cervical incompetence. Future multiple-center studies may provide further evidence that LESS is a feasible and safe option for gynecologic surgery during pregnancy.
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Affiliation(s)
- Jing Xiao
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas (Drs. Xiao, Fu, Duan, Sunkara, and Guan); Department of Gynecology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong, China (Drs. Xiao and Wang)
| | - Kristi Fu
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas (Drs. Xiao, Fu, Duan, Sunkara, and Guan); Department of Gynecology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong, China (Drs. Xiao and Wang)
| | - Kristina Duan
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas (Drs. Xiao, Fu, Duan, Sunkara, and Guan); Department of Gynecology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong, China (Drs. Xiao and Wang)
| | - Junling Wang
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas (Drs. Xiao, Fu, Duan, Sunkara, and Guan); Department of Gynecology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong, China (Drs. Xiao and Wang)
| | - Sowmya Sunkara
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas (Drs. Xiao, Fu, Duan, Sunkara, and Guan); Department of Gynecology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong, China (Drs. Xiao and Wang)
| | - Xiaoming Guan
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas (Drs. Xiao, Fu, Duan, Sunkara, and Guan); Department of Gynecology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong, China (Drs. Xiao and Wang)..
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Rezai S, Giovane RA, Minton H, Bardawil E, Zhang Y, Patil NM, Henderson CE, Guan X. Laparoendoscopic Single-Site Surgery for Management of Heterotopic Pregnancy: A Case Report and Review of Literature. Case Rep Obstet Gynecol 2018; 2018:7232637. [PMID: 30069420 PMCID: PMC6057289 DOI: 10.1155/2018/7232637] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Revised: 04/15/2018] [Accepted: 04/26/2018] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Heterotopic pregnancy occurs when two pregnancies occur simultaneously in the uterus and an ectopic location. Treatment includes removal of the ectopic pregnancy with preservation of the intrauterine pregnancy. Treatment is done laparoscopically with either a Laparoendoscopic Single-Site Surgery (LESS) or a multiport laparoscopic surgery. CASE We present a case of a first trimester heterotopic pregnancy in a 42-year-old gravida 5, para 0-1-3-1 female with previous history of left salpingectomy, who underwent laparoscopic right salpingectomy and lysis of adhesions (LOA) via Single-Incision Laparoscopic Surgery (SILS). CONCLUSION Although LESS for benign OB/GYN cases is feasible, safe, and equally effective compared to the conventional laparoscopic techniques, studies have suggested no clinically relevant advantages in the frequency of perioperative complications between LESS and conventional methods. No data on the cost effectiveness of LESS versus conventional methods are available. LESS utilizes only one surgical incision which may lead to decreased pain and better cosmetic outcome when compared to multiport procedure. One significant undesirable aspect of LESS is the crowding of the surgical area as only one incision is made. Therefore, all instruments go through one port, which can lead to obstruction of the surgeon's vision and in some cases higher rate of procedure failure resulting in conversion to multiport procedure.
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Affiliation(s)
- Shadi Rezai
- Department of Obstetrics and Gynecology, Southern California Kaiser Permanente, Kern County, 1200 Discovery Drive, Bakersfield, CA 93309, USA
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Baylor College of Medicine, 6651 Main Street, 10 Floor, Houston, TX 77030, USA
| | - Richard A. Giovane
- University of Alabama, Department of Family Medicine, 801 Campus Drive, Tuscaloosa, AL 35487, USA
| | - Heather Minton
- University of Birmingham, School of Medicine, 1720 2 Avenue, Birmingham, AL 35294, USA
| | - Elise Bardawil
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Baylor College of Medicine, 6651 Main Street, 10 Floor, Houston, TX 77030, USA
| | - Yiming Zhang
- Division of Reproductive Medicine, Jinan Central Hospital Group, 105 Jiefang Road, Jinan City, Shandong Province 250013, China
| | - Ninad M. Patil
- Department of Pathology & Immunology, Baylor College of Medicine, 6651 Main Street, 4 Floor, Houston, TX 77030, USA
| | - Cassandra E. Henderson
- Maternal and Fetal Medicine, Department of Obstetrics and Gynecology, Lincoln Medical and Mental Health Center, 234 East 149 Street, Bronx, NY 10451, USA
| | - Xiaoming Guan
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Baylor College of Medicine, 6651 Main Street, 10 Floor, Houston, TX 77030, USA
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