Laparoscopic Gynecologic Procedures Research Articles

Delayed-onset ureteral lesions due to thermal energy: an emerging condition.

To describe the risks of ureteral damage occurring during urological and gynecological procedures utilizing energybased surgical devices (ESD) during both laparoscopic and open procedures. During the last 20 months we observed five cases of iatrogenic ureteral lesions caused by ESD which required open surgery. There were 3 lesions of the lower ureter occurring during gynecological laparoscopic or robotic procedures, and 2 lesions of the upper ureter occurring during open enucleation of low-stage renal cell carcinomas. In the laparoscopic gynecological lesions the cause was attributable to monopolar cutting and bipolar coagulation: they presented with urine extravasation after 20, 15 and 15 days respectively and required ureteral reimplantation in 2 out of 3 cases. In the upper ureteral lesions the causes were bipolar coagulation and LigaSure Impact TM used for perirenal fat dissection: they presented after 2 and 4 months respectively and required uretero-ureterostomy and inferior nephropexy in one case and nephrectomy in the other. In 3 out of 5 cases there was an unsuccessful attempt at placing an ureteral double J stent, and in the 2 cases where it was placed it did not prevent the formation of subsequent stricture in one. The widespread diffusion of ESD has the potential drawback of inadvertent thermal energy transmission to the ureter. Delayed presentation of ureteral lesions and difficulties in ureteral stent placement were the common features of the cases observed. Inadvertent ureteral damage by different thermal energy sources is an emerging condition, requiring awareness, prompt recognition and adequate treatment with the reconstructive urology principles.

Umbilical stalk elevation technique for safer Veress needle insertion in obese patients: a case–control study

ObjectiveThe purpose of this retrospective study was to compare our umbilical stalk elevation (USE) technique with the classic Veress needle (VN) technique in obese patients. Study designThe USE technique was performed on 40 patients. One control per case was randomly selected from among those undergoing the classic VN technique using a random number table. In USE technique, a 12mm skin incision was created at the superior crease of the umbilical fold, and the underlying subcutaneous adipose tissue was bluntly dissected using the tip of a fine clamp until the umbilical stalk was isolated at the inferior and central part of the incision. Next, the umbilical stalk was covered and held by a towel clip, and the abdominal wall was elevated by upward traction. The VN was then inserted nearly perpendicular to the incision and turned toward the pelvis immediately after resistance to the needle had been lost. A post-hoc power analysis was performed. ResultsThe number of attempts was significantly lower in the USE laparoscopy group than in the classic laparoscopy group (1.2±0.4 vs. 2.1±0.7, respectively; P<0.001). The USE technique group had a slightly shorter abdominal entry time than did the classic technique group (328.52±63.71 vs. 434.95±124.10s; P<0.001). Six (7.5%) failed insufflations occurred in our study (5 patients in the classic group vs. 1 patient in the USE group (P=0.10). ConclusionOur novel USE technique can be an effective means of establishing pneumoperitoneum in obese patients undergoing gynecologic laparoscopic procedures.

Interventions for the reduction of shoulder pain following gynaecological laparoscopic procedures

Interventions for the reduction of shoulder pain following gynaecological laparoscopic procedures

Is venous thromboprophylaxis necessary in patients undergoing minimally invasive surgery for a gynecologic malignancy?

ObjectivesCurrent recommendations for the use of venous thromboprophylaxis in patients undergoing minimally invasive surgery (MIS) for a gynecologic malignancy are derived from patients undergoing open surgery. Our objective was to determine the 30-day prevalence of symptomatic venous thromboembolism (VTE) after laparoscopic gynecologic oncology procedures in patients who received no thromboprophylaxis. MethodsBetween January 2006 and September 2013, women who underwent MIS for endometrial, cervical or ovarian cancer at a single institution were included. Data on patient demographics, diagnosis, comorbidities, perioperative characteristics, use of thromboprophylaxis, and diagnosis of VTE were collected retrospectively. ResultsOf the 419 patients who underwent MIS for a gynecologic cancer, 352 (84%) received no VTE prophylaxis. At least a total laparoscopic hysterectomy (simple or radical) or pelvic lymph node dissection was performed in 95% of these patients. The median length of surgery was 137min and 95% of patients were discharged home within 1day of surgery. The rate of VTE in the 352 untreated patients was 0.57% (1 pulmonary embolism and 1 deep vein thrombosis). There were no VTE diagnosed within 30days of surgery in the 67 patients who received anticoagulant thromboprophylaxis. ConclusionThe rate of VTE is low in patients undergoing minimally invasive surgery for a gynecologic malignancy despite no VTE prophylaxis. The benefits of routine use of VTE prophylaxis in this population are questionable.

Surgical skills of specialty trainees in emergency gynaecological laparoscopic procedures: A national UK survey

A web-based survey was e-mailed to all specialty trainees ST Years 3–7 (n = 773) to assess their competence in emergency laparoscopic procedures. The trainees were asked about their competence level in a diagnostic laparoscopy; a salpingectomy; a salpingotomy; and an oophorectomy/cystectomy for adnexal torsion. Subsequently, they were asked how they would manage a tubal ectopic pregnancy with contralateral tubal disease. We received 202 responses (26%) and of these: 79% of trainees can perform a diagnostic laparoscopy independently; 32% can perform a salpingectomy and 12% can perform a salpingotomy independently; 14% can manage an adnexal torsion without supervision.

Abordaje laparoscópico del dolor abdominal agudo en mujeres en edad fértil

ObjectivesTo assess the effectiveness of the laparoscopic approach in acute abdominal pain in women of reproductive age presenting to the Emergency Department. Material and methodsWe performed an observational, prospective study of acute abdominal pain treated by gynecological laparoscopic procedures. The main variables evaluated were the cause of pain, type of surgery, complications, and conversions to open surgery. ResultsBetween January 2009 and December 2011, we performed 110 urgent laparoscopic interventions. The reasons for surgery were rupture of an ovarian cyst in 40 interventions (36.7%), an ectopic pregnancy in 24 (21.8%), a pelvic inflammatory disease in 23 (20.9%), adnexal torsion in 12 (10.9%), and other reasons in 11 (10%). In these 110 interventions, there was one case of postoperative bleeding requiring reintervention and one case of conversion. ConclusionsThe laparoscopic approach is safe and effective in urgent gynecological surgery.

Preemptive analgesia of oral clonidine during subarachnoid block for laparoscopic gynecological procedures: A prospective study.

Background:Preemptive analgesia is known modality to control the peri-operative pain. The present study was aimed to evaluate the effects of oral clonidine on subarachnoid block characteristics, hemodynamic changes, sedation and respiratory efficiency in patients undergoing laparoscopic gynecological procedures.Patients and Methods:A total of 64 adult consenting females of American Society of Anesthesiologist physical status I and II were randomized double blindly into two groups of 32 patients each. Patients in the clonidine group received oral clonidine (100 μg) and patients of the control group received placebo capsule, 90 min before subarachnoid block with 0.5% hyperbaric bupivacaine (3.5 ml). The onset of sensory and motor block, maximum cephalic sensory level and regression times of sensory and motor blockade were assessed. Intra-operative hemodynamic changes, respiratory efficiency, shoulder pain and sedation score were recorded. The other side-effects, if any were noted and managed.Results:The onset of sensory blockade was earlier in patients of clonidine group with prolonged duration of analgesia (216.4 ± 23.3 min vs. 165.8 ± 37.2 min, P < 0.05), but no significant difference was observed on motor blockade between groups. The hemodynamic parameters and respiratory efficiency were maintained within physiological limits in patients of clonidine group and no patient experienced shoulder pain. The Ramsey sedation score was 2.96 ± 0.75. In the control group, 17 patients experienced shoulder pain, which was effectively managed with small doses of ketamine and 15 patients required midazolam for anxiety.Conclusion:Premedication with oral clonidine (100 μg) has enhanced the onset and prolonged the duration of spinal analgesia, provided sedation with no respiratory depression. The hemodynamic parameters remained stabilized during the pneumoperitoneum.

Efficacy of orally disintegrating film of ondansetron versus intravenous ondansetron in prophylaxis of postoperative nausea and vomiting in patients undergoing elective gynaecological laparoscopic procedures: A prospective randomised, double-blind placebo-controlled study.

Background and Aims:Ondansetron is one of the most widely used drugs for postoperative nausea and vomiting (PONV) prophylaxis. Orally disintegrating film (ODF) formulations are relatively recent innovations. We evaluated the efficacy of ODF of ondansetron for the prophylaxis of PONV.Methods:One hundred and eighty American Society of Anaesthesiologists-I or II women, in the age group 18-65 years, scheduled for elective gynaecological laparoscopic procedures were studied in a prospective randomised, double-blind, placebo-controlled trial. The patients were randomised into four groups: Placebo, intravenous (IV) ondansetron 4 mg, ODF of ondansetron 4 mg (ODF4) and 8 mg (ODF8) groups. PONV was assessed in two epochs of 0-6 and 7-24 h. Primary outcome measure was the incidence of PONV and secondary outcome measures were severity of nausea, need for rescue anti-emetic, analgesic consumption, time to oral intake, overall patient satisfaction and side effects such as headache and dizziness. PONV was compared using analysis of variance or Mann–Whitney U-test as applicable.Results:Data of 173 patients were analysed. The incidence of postoperative nausea was significantly lower (P = 0.04) only during the 0-6 h in the ODF8 group when compared with the placebo group. During the 0-6 h interval postoperatively, the ODF8 group had a significantly lower incidence of vomiting when compared with the placebo (P = 0.002) and the IV group (P = 0.044). During the 0-24 h interval postoperatively, ODF4 (P = 0.01) and ODF8 (P = 0.002) groups had a significantly lower incidence of vomiting compared to the placebo group.Conclusions:Orally disintegrating film of ondansetron is an efficacious, novel, convenient and may be a cost-effective option for the prophylaxis of PONV.

Use of gynaecological laparoscopy in a hospital ward in the West Bank, occupied Palestinian territory: a retrospective audit

Background Gynaecological laparoscopy is an important diagnostic and interventional method. It is widely applied, and increasingly accepted by the community because it is minimally invasive and is cheaper than the other methods. The introduction of gynaecological laparoscopy at Hebron Governmental Hospital, West Bank, occupied Palestinian territory (oPt), was an important step forward in service delivery. Despite several logistical barriers to adequate service provision in the biggest city in the oPt, the hospital serves more than 600 000 citizens with a small gynaecological ward (22 beds at the time of the study) and few funding sources compared with other hospitals in the oPt. Additionally our ward is the busiest compared with the gynaecological wards in other hospitals in the oPt. Our aim was to show that use of minimally invasive surgery such as laparoscopy can reduce hospital admission time and costs with a complication rate in the oPt that does not differ much from the international rate. Methods All gynaecological laparoscopic procedures (diagnostic and interventional) that were done between Jan 1, 2011, and Jan 1, 2013, in Hebron Hospital were included in this retrospective study. After obtaining written or verbal informed consent from all patients included in the study, data were gathered for inpatient stay and rates of complications. Our data were compared with those reported internationally in PubMed in recent years. We used SPSS (version 17.0) for the statistical analysis. The hospital's medical counsel provided ethics approval to undertake the study. Findings 200 women (mean age 28 years [range 25–35]) were admitted for gynaecological laparoscopic intervention: 65 for diagnostic laparoscopy and 135 for interventional laparoscopy. The inpatient stay in our ward was 1 day, similar to that reported internationally. The overall complication rate in the ward was 6% (six intraoperative and six postoperative complications). The complication rate reported in the Department of Obstetrics and Gynecology, St John Hospital and Medical Center, Detroit, MI, USA, was 9·8% between January, 1996, and June, 1996, and the overall complication rate in the Centre Hospitalier Universitaire Cochin Saint-Vincent-de-Paul, Paris, France, was 4·64 per 1000 gynaecological laparoscopies. Interpretation The use of laparoscopic gynaecology for diagnosis and treatment of emerging indications is an important advantage, especially for patients who have several logistical barriers to accessing health care in the oPt—eg, long distance from the hospital—because it can reduce the inpatient stay and the need for postoperative care. However, care must be taken with interventional laparoscopy to reduce the risk of complications. Funding Italian Association for Solidarity Among People.

Urinary Tract Injury at the Time of Laparoscopic and Robotic Surgery

To report a series of urinary tract injuries resultant of laparoscopic or robotic procedures performed for a gynecologic indication. We identified 16 patients with urinary tract fistulas after laparoscopic or robotic gynecologic procedures between 2009 and 2012. We extracted demographic data and prior surgical data as well as reviewed our management of each case. Thirteen subjects had undergone robotic procedures, 2 traditional laparoscopies, and a single-port laparoscopy with time to presentation from 2 days to 9 months postoperatively. Seven patients presented with vesicovaginal fistulas (43%), of which one healed spontaneously. Eight patients had ureterovaginal fistulas. Two patients (25%) were managed with ureteroneocystotomy, 2 patients (25%) were managed with Boari flap, and 4 patients (50%) were managed with double-J stent placement. One patient had a vesicocervical fistula managed via trachelectomy and partial cystectomy. The authors have seen an increase in referrals for urinary tract fistulas in minimally invasive surgery. It is imperative to investigate the effect of a steep learning curve, unfamiliarity with new energy sources, or poor patient selection as contributing factors.

Efficacy of ondansetron for postoperative nausea and vomiting in patients undergoing gynecological laparoscopic surgery: a meta-analysis of randomized controlled trials

Objective To evaluate the effcacy and safety of 5-HT3 receptor inhibitor ondansetron injected in the postoperative nausea and vomiting (PONV) in patients undergoing gynecological laparoscopic surgery under general anesthesia.Methods We searched the CNKI,CBM,Chongqing VIP,Wanfang Data Base,Pubmed,Springer,Embase,and Web of knowledge to identify randomized controlled trials (RCTs) about ondansetron in preventing PONV in patients undergoing gynecological laparoscopic surgery under general anesthesia from 1995 to 2012.We also consulted references of the included studies for omission.The methodological quality of the included RCTs was assessed and data were extracted according to the standard of the Cochrane Handbook 5.0.1.The meta-analyses were performed by Stata1 1.0 software.A total of 18 RCTs involving 1 597 patients were included.Results The results of meta-analyses showed that:① Effcacy:a single intravenous injection of ondansetron could decrease the incidence of PONV in patients undergoing gynecological laparoscopic surgery under general anesthesia (RR=0.210,95％CI=0.164-0.268),and a single 8 mg Ⅳ dose of ondansetron is no more effective than a single 4 mg Ⅳ dose of Ondansetron for prevention (RR=0.948,95％ CI =0.433-2.075),furthermore,ondanstron administered at the beginning of the gynecological laparoscopic procedures is more effective in preventing PONV than at the end of the surgery (RR=0.450,95％CI=0.290-0.698).Moreover,equivalent effcacy was seen between the ondansetron and droperidol in reducing PONV in patients undergoing gynecological laparoscopic survey,but the combination of ondansetron and droperidol further attenuated this incidence when compared to 4 mg ondansetron alone.② Safety:ondansetron injected could not significantly lessen the incidence of postoperative headache and fever.Conclusions A single 4 mg Ⅳ dose of ondansetron injected at the beginning of the gynecological laparoscopic survey can significantly decrease the incidence of PONV after general anesthesia,and it will not increase the adverse effect and the incidence of postoperative complications.And the combination of ondansetron and low dose of droperidol is more efficacious as a prophylactic antiemetic than ondansetron alone in women undergoing general anesthesia for gynecological laparoscopy. Key words: Randomized controlled trials; Meta-analysis; Ondansetron; Postoperative nausea and vomiting; gynecological; laparoscopic surgery

Preoperative pregabalin does not reduce propofol ED50: a randomized controlled trial

In many studies, gabapentinoids, such as pregabalin, have been shown to reduce preoperative anxiety. This anxiolysis is often accompanied by sedation, one of the most frequent side effects of pregabalin. We hypothesized that pregabalin taken preoperatively could reduce propofol requirements for induction of general anesthesia. A randomized double-blind placebo-controlled trial was conducted after approval by the local ethics committee. Fifty women aged 18-40 yr, American Anesthesiologists Society physical status I and II, and scheduled to undergo elective laparoscopic gynecologic procedures were enrolled after written consent. Treatment group patients were given pregabalin 150 mg po one hour before surgery while patients in the control group received a placebo. The primary outcome was the propofol dose required to achieve a targeted anesthetic depth in 50% of the population, i.e., effective dose (ED)50. The ED50 was estimated using Dixon's up-and-down methodology. The targeted anesthetic depth was defined based on predetermined entropy monitoring values (State Entropy [SE] < 50 and Response Entropy [RE]-SE < 10). As a secondary outcome, we tested if pregabalin reduced pre-induction anxiety levels which were measured on a 0-100 scale. The propofol ED50 was not statistically different between the pregabalin group (mean 1.33 mg·kg(-1); 95% confidence interval [CI] 1.23 to 1.43) vs the placebo group (mean 1.37 mg·kg(-1); 95% CI 1.28 to 1.46); P = 0.19. Also, pre-induction anxiety level was not different between groups (median 31; interquartile range [IQR] [10-52] vs median 42; IQR [4-71], respectively; P = 0.41). Preoperative pregabalin does not reduce propofol requirements in a population of healthy young women undergoing laparoscopic gynecologic procedures. This study failed to show a pre-induction anxiolytic effect of pregabalin in such a population. This trial was registered at www.clinicaltrials.gov (NCT01158859).

A comparative study of four combinations of anesthetic drugs for assessing the intraocular pressure changes during gynaecological laparoscopic procedures.

Aims and Objectives:Laparoscopic surgery is the choice for gynaecological surgery these days, but pneumoperitoneum (PNO) and trendelenburg position increase the intraocular pressure (IOP) leading to decrease in perfusion of retina and at times the significant risk of ischemic retinopathy. Our present aim is to find out the suitable combination of induction and maintenance agent for combating the increase in IOP by PNO, lithotomy and trendelenburg position, and to study the changes in IOP at different time points and positions in gynaecological laparoscopic procedures.Patients and methods:After taking permission from the Ethical Committee 120 female patients of ASA grade 1 and II were divided arbitrarily in four groups each comprising 30 patients. In group A and B induction was done with propofol 2.5 mg/kg given IV and in group C and D induction was done with thiopentone 5 mg/kg given IV. Atracurium 0.5 mg/kg IV was used as neuromuscular blocking agent (NMBA).Laryngeal mask airway (LMA) was inserted in all the cases and patients were ventilated with Bain's circuit. Maintenance of anesthesia was done with total intra venous anesthesia (TIVA) with propofol and100% oxygen in group A and C. In group B and D maintenance was done with 1% isoflurane with oxygen (O2) and nitrous oxide (N2O) in the ratio of 40:60. Changes in IOP, heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean blood pressure (MBP) were measured. Baseline readings were taken initially and then 2 min after premedication, 1 min after LMA insertion, 1 min after PNO with lithotomy position, 5 min after 20° head down tilt and PNO in situ and 2 min after exsufflation of PNO with supine horizontal position.Results and Conclusion:To mitigate increase in IOP during gynaecological laparoscopic surgeries, propofol, and propofol TIVA (Group A) proved to be the best option. Propofol and isoflurane (Group B) thiopentone and propofol TIVA (Group C) were not as effective as group A. However, induction with thiopentone and maintenance with isoflurane (Group D) were not effective at all.

Randomized double blind trial of intraperitoneal instillation of bupivacaine and morphine for pain relief after laparoscopic gynecological surgeries

Background:Intraperitoneal injection of anesthetic has been proposed to minimize postoperative pain after laparoscopic surgery. So a randomized, placebo-controlled study was conducted to compare the effectiveness of intraperitoneal bupivacaine with or without morphine for postoperative analgesia after laparoscopic gynecological surgeries.Methods:A total of 90 ASA I and II female patients scheduled for laparoscopic gynecological procedures were enrolled in the randomized double blind prospective study. The drug was injected intraperitoneally before the removal of trocar at the end of surgery. In group BM (n=30): 0.25% bupivacaine 30 ml + 2 mg morphine, in group BO (n=30) 30 ml 0.25% bupivacaine and in group C (n=30) 30 ml of saline was injected intraperitoneally. Postoperative quality of analgesia was assessed by VAS (0-100), for 24 hours and when VAS >40, rescue analgesic was administered. Total dose of rescue analgesia and side effects were noted.Results:Intraperitoneal instillation of bupivacaine and morphine significantly reduces immediate postoperative pain (VAS: 23.33±6.04 vs. 45.5±8.57). It also reduces pain at 4 hours after surgery in the BM group (VAS 24±12.13 vs. 41.17±7.27 in the BO group). The time of administration of first rescue analgesic was significantly higher in the BM group (6.15 hours) compared to the BO group (4.51 hours). The total dosage of rescue analgesic was more in the BO and C groups compared to the BM group.Conclusion:Addition of morphine to local anesthetic significantly prolonged the time to first rescue analgesic requirement and the total consumption of rescue analgesic in 24 hours without any significant increase in adverse events.

A Comparative Study of Two Disposable Supraglottic Devices in Diagnostic Laparoscopy in Gynecology

ABSTRACT Introduction This prospective study compares the efficacy of two disposable supraglottic airway devices with separate gastric access and integral bite block, the inflatable cuff of the LMA SupremeTM against the noninflatable i-gelTM cuff in providing an adequate seal for laparoscopic surgery. Materials and methods Ninety women of ASA grade I and II undergoing diagnostic laparoscopy with Trendelenburg position were randomly allocated to receive either size 3 LMA Supreme or i-gel. Induction and maintenance protocols were similar and patients were not paralyzed. We compared the airway leak pressure, ease and time to insert the device and a 10 FG nasogastric tube through it, and to note complications if any. Results There was no difference in airway leak pressure between the two devices (24.4 ± 4.0 vs 23.6 ± 3.8 cm H2O, p &gt; 0.05). Forty-one (91%) LMA Supremes and forty (88.8%) i-gels were successfully inserted on the first attempt, with similar ease, and comparable times (13.8 ± 4.9 sec for LMA Supreme vs 14.5 ± 6.7 sec for i-gel; p &gt; 0.05). Gastric tube insertion was easier and achieved more quickly with LMA Supreme compared to i-gel (9.0 ± 3.1 sec vs 14.3 ± 7.5 sec, respectively; p &lt; 0.01), but clinical significance of this finding is questionable. There was blood on removal of four LMA Supremes and three i-gel. Four patients in the LMA Supreme group and one patient in the i-gel group experience mild postoperative sore throat. Conclusion Both LMA Supreme and i-gel are equally effective ventilator devices for diagnostic gynecological laparoscopic procedures. How to cite this article Chattopadhyay S, Goswami S. A Comparative Study of Two Disposable Supraglottic Devices in Diagnostic Laparoscopy in Gynecology. J South Asian Feder Obst Gynae 2013;5(3):124-128.

Preventing slide in Trendelenburg position: randomized trial comparing foam and gel pads.

To compare patient slide in Trendelenburg position using egg-crate foam or gel pad. This randomized trial compared slide on friction pads during Trendelenburg position for robotic and laparoscopic gynecologic procedures in 61 patients at the Mayo Clinic Florida between March 11, 2010 and May 31, 2011. Data was analyzed using Student's t test with significance defined as p≤0.05. There was no significant difference in mean slide according to pad type (foam 3.0±SD 2.1cm; gel 4.5±SD 4.0cm, p=0.08). Minor complaints occurred in 10% of patients, and did not differ by group (p=0.4). Most complaints (98%) were transient shoulder or neck pain. A single patient had both transient right hand numbness and right lateral thigh paresthesia. We assessed outcomes by chart review from the inpatient care and postoperative evaluation notes (mean 44±SD 17days), and by review of any intervening notes that occurred before the study's end (mean 345±SD 116days). Trendelenburg-related slide is equivalent on either egg-crate foam or gel pad.

Resultados de 1.000 cirugías ginecológicas laparoscópicas sucesivas

ObjectivesTo review the indications and outcomes of 1,000 consecutive laparoscopic surgeries. Material and methodsWe carried out an observational, retrospective study of the first 1,000 gynecological laparoscopic procedures performed in our hospital. Data on complications and conversions were recorded. ResultsBetween January 2005 and November 2011, we performed 1000 laparoscopic surgeries: 452 (45.2%) ovarian procedures, 200 (20%) hysterectomies for benign causes, 105 (10.5%) gynecological neoplasms, 88 (8.8%) tubal ligations, 75 (7.5%) diagnostic laparoscopies, 56 (5.6%) myomectomies, 19 (1.9%) sacropexies and 5 (0.5%) appendectomies. There were 22 major complications (2.2%) and 32 conversions to open surgery (3.2%). ConclusionThe laparoscopic approach to gynecological surgery is safe and effective.

Incidence of Upper Extremity Neurologic Injury in Laparoscopic Gynecologic Procedures Using the Bean Bag and Shoulder Support To Prevent Patient Displacement

To determine the incidence of brachial plexus neuropathy in gynecologic laparoscopic cases using “bean bag”(OlympicVac-Pac®, NatusMedical) and shoulder supports (Allen®) with convoluted foam armboard pads (MedlineIndustries). The secondary goals were to determine patient displacement and what variables correlated with that movement.

Feasibility of Intra-Abdominal Tissue Isolation and Extraction, within an Artificially Created Pneumoperitoneum, at Laparoscopy for Gynecologic Procedures

Study ObjectiveThis study evaluates the feasibility of tissue isolation and extraction within an artificially created, intra-abdominal, pneumoperitoneum device.DesignInstitutional IRB exempt retrospective chart review.SettingTwo University of Minnesota affiliated community hospitals.Patients12 consecutive patients underwent gynecologic laparoscopic procedures where tissue was excised. Procedures were performed from November, 2011 to March, 2012 by a single surgeon. The study comprised 10 LESS LSH, 1 LESS Oophorectomy and 1 LESS TLH.InterventionLaparoscopic camera and morcellator were then inserted within the device and the tissue was morcellated and removed.The device was removed and inspected for defects. Pathologic assessment of the resected tissue was performed. Operative times were recorded.Measurements and Main ResultsAll tissues were able to be morcellated and removed with direct visualization, within the artificially created pneumoperitoneum device. There was no intra-abdominal spillage. Average operative time was 83min (range 49-121 min). Mean uterine pathology weight was 142gm (range 53-317 gm). Preoperative pathology was anticipated to be benign in all cases. Post operative pathology revealed one case of unanticipated ovarian malignancy.ConclusionCurrent laparoscopic tissue isolation and extraction devices require tissue capture and retrieval in a bag. The laparoscopic incision is often enlarged to accomplish extraction of the bag containing the specimen. Morcellation that is carried out without tissue containment requires tedious inspection and copious irrigation. Seeded tissue fragments have led to parasitic masses and unanticipated cancers have been morcellated leading to upstaging. The unanticipated ovarian malignancy in this study was not upstaged. Tissue isolation and extraction within an artificially created pneumoperitoneum is reproducible, safe and efficient. Study ObjectiveThis study evaluates the feasibility of tissue isolation and extraction within an artificially created, intra-abdominal, pneumoperitoneum device. This study evaluates the feasibility of tissue isolation and extraction within an artificially created, intra-abdominal, pneumoperitoneum device. DesignInstitutional IRB exempt retrospective chart review. Institutional IRB exempt retrospective chart review. SettingTwo University of Minnesota affiliated community hospitals. Two University of Minnesota affiliated community hospitals. Patients12 consecutive patients underwent gynecologic laparoscopic procedures where tissue was excised. Procedures were performed from November, 2011 to March, 2012 by a single surgeon. The study comprised 10 LESS LSH, 1 LESS Oophorectomy and 1 LESS TLH. 12 consecutive patients underwent gynecologic laparoscopic procedures where tissue was excised. Procedures were performed from November, 2011 to March, 2012 by a single surgeon. The study comprised 10 LESS LSH, 1 LESS Oophorectomy and 1 LESS TLH. InterventionLaparoscopic camera and morcellator were then inserted within the device and the tissue was morcellated and removed.The device was removed and inspected for defects. Pathologic assessment of the resected tissue was performed. Operative times were recorded. Laparoscopic camera and morcellator were then inserted within the device and the tissue was morcellated and removed.The device was removed and inspected for defects. Pathologic assessment of the resected tissue was performed. Operative times were recorded. Measurements and Main ResultsAll tissues were able to be morcellated and removed with direct visualization, within the artificially created pneumoperitoneum device. There was no intra-abdominal spillage. Average operative time was 83min (range 49-121 min). Mean uterine pathology weight was 142gm (range 53-317 gm). Preoperative pathology was anticipated to be benign in all cases. Post operative pathology revealed one case of unanticipated ovarian malignancy. All tissues were able to be morcellated and removed with direct visualization, within the artificially created pneumoperitoneum device. There was no intra-abdominal spillage. Average operative time was 83min (range 49-121 min). Mean uterine pathology weight was 142gm (range 53-317 gm). Preoperative pathology was anticipated to be benign in all cases. Post operative pathology revealed one case of unanticipated ovarian malignancy. ConclusionCurrent laparoscopic tissue isolation and extraction devices require tissue capture and retrieval in a bag. The laparoscopic incision is often enlarged to accomplish extraction of the bag containing the specimen. Morcellation that is carried out without tissue containment requires tedious inspection and copious irrigation. Seeded tissue fragments have led to parasitic masses and unanticipated cancers have been morcellated leading to upstaging. The unanticipated ovarian malignancy in this study was not upstaged. Tissue isolation and extraction within an artificially created pneumoperitoneum is reproducible, safe and efficient. Current laparoscopic tissue isolation and extraction devices require tissue capture and retrieval in a bag. The laparoscopic incision is often enlarged to accomplish extraction of the bag containing the specimen. Morcellation that is carried out without tissue containment requires tedious inspection and copious irrigation. Seeded tissue fragments have led to parasitic masses and unanticipated cancers have been morcellated leading to upstaging. The unanticipated ovarian malignancy in this study was not upstaged. Tissue isolation and extraction within an artificially created pneumoperitoneum is reproducible, safe and efficient.

Pain reduction by continuous intraperitoneal nebulization of ropivacaine during gynecological laparoscopic surgery

The objective of this study was to examine the analgesic effect of intraperitoneal nebulization of ropivacaine during gynecological laparoscopic procedures for patients anesthetized with an ultrashort-acting opiate. The study was a double-blinded placebo-controlled randomized trial (Canadian Task Force classification I) and involved 40 patients (20 patients in each arm) undergoing elective gynecological same-day outpatient laparoscopic surgery including unilateral/bilateral salpingo-oophorectomy or unilateral/bilateral ovarian cystectomy at the University Hospital Ambulatory Gynecological Endoscopic Unit. The study group received 10 ml of 1 % ropivacaine, and the control group received 10 ml of sterile water by intraperitoneal nebulization. Vital signs were recorded and summarized. Postoperatively, patients were followed up for 24 h including visual analogue scale (VAS) scores and analgesic usage. Results showed no significant differences between the two groups in terms of patient characteristics and surgical data. There were no significant differences between the groups in postoperative VAS scores at rest at the different time intervals. VAS scores during strain showed significantly decreased pain at the postoperative 2-h interval (p < 0.05). Postoperative opiate and nonopiate analgesia consumption was similar for both groups. Patients in the study groups required more antiemetic agents compared to the control group patients (p < 0.05). There were no reported side effects related to ropivacaine. Intraperitoneal nebulization of 100 mg of ropivacaine during gynecological laparoscopy under general anesthesia with an ultrashort-acting opiate does not reduce postoperative pain and it does not reduce postoperative opiate and nonopiate analgesia consumption.