Abstract
This study was designed to evaluate the learning curve of applying Seprafilm (modified hyaluronic acid and carboxymethylcellulose; Genzyme, Cambridge, MA, USA) during laparoscopic hysterectomy or subtotal hysterectomy with or without adnexectomy. In this retrospective cohort study, 35 patients who underwent laparoscopic hysterectomy or subtotal hysterectomy with or without adnexectomy were enrolled. The Seprafilm was cut into 4 pieces, rolled up with a trimmed plastic sleeve and delivered through an incision wound made for the 5-mm ancillary trocar. The membrane was unrolled and placed on the rough surface after hysterectomy or subtotal hysterectomy with or without adnexectomy. The time from the insertion of the first piece of membrane into the abdominal cavity to the complete removal of the trimmed plastic sleeve was recorded. The median time for Seprafilm placement was 3 min. The learning curve was analyzed using the power-law method and suggested that 10 cases were required to achieve proficiency in the procedure. The presence of adnexectomy was significantly associated with the time required for Seprafilm placement (P < 0.001). Although Seprafilm placement is more complicated compared to the liquid and gel forms of anti-adhesion barriers, surgical proficiency seemed to be attained after 10 cases for an experienced surgeon.
Highlights
Minimizing scarring and cosmetic damage during surgery is crucial for both external and internal body parts
Seprafilm is composed of two anionic polysaccharides, modified hyaluronic acid and carboxymethylcellulose, which makes it brittle and causes it to adhere to moist surfaces such as surrounding tissues and surgical instruments leading to a high placement failure rate
This study aimed to evaluate the learning curve of applying Seprafilm during laparoscopic hysterectomy or subtotal hysterectomy with or without adnexectomy by a single surgeon using the power-law method
Summary
Minimizing scarring and cosmetic damage during surgery is crucial for both external and internal body parts. Interceed (Gynecare, Ethicon, a Johnson & Johnson Company, Somerville, NJ, USA), Seprafilm (Genzyme, Cambridge, MA, USA), Hyalobarrier Gel (Fidia Advanced Biopolymers, Abano Terme, Italy), Adept (Icodextrin 4% solution; Baxter Healthcare, Deerfield, IL, USA), and BarriGel (HANBIO, New Taipei City, Taiwan) are the currently available adhesion barriers in our hospital, used after gynecologic and obstetric surgery. Several different techniques have been published on the insertion of S eprafilm[4,5,6,7,8,9]; none has investigated the associated learning curve of applying this barrier after laparoscopic surgery. This study aimed to evaluate the learning curve of applying Seprafilm during laparoscopic hysterectomy or subtotal hysterectomy with or without adnexectomy by a single surgeon using the power-law method
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