Laparoscopic Gynecologic Operations Research Articles

Can serum tumor necrosis factor-alpha predict peritoneal adhesions prior to secondary laparoscopic procedures?

This study aimed to investigate the incidence and degree of postoperative intra-abdominal adhesions(POAs) in secondary laparoscopic procedures and assess the power of the preoperative levels of tumor necrosis factor-alpha(TNF-α) and interleukin-1 beta(IL-1β) and selected peripheral inflammatory biomarkers(PIBs) in the prediction of the development and extent of POA. This prospective study enrolled 103 patients who had previously undergone at least one or more laparoscopic abdominal or gynecological operations. We examined TNF-α, IL-1β, and PIBs, namely C-reactive protein, white blood cell count, neutrophil-to-lymphocyte ratio(NLR), platelet-to-lymphocyte ratio, and systemic immune-inflammation index(SII) according to the presence, location, and score of adhesions determined during secondary laparoscopic procedures. Only age, postoperative adhesion index(PAI) score, NLR, SII, TNF-α, and IL-1β resulted in a significant difference in the existence of adhesion(P<0.05). The correlation analysis of TNF-α with variables showed that the PAI score and IL 1β levels had a significantly positive correlation. The presence and extent of POA could be predicted by examining the preoperative TNF-α level in patients who had laparoscopic abdominal surgery previously. We could overcome adverse events during secondary laparoscopic procedures by assessing high-risk patients and integrating a personalized surgical approach to managing selected patients.

Prevalence of negative sliding sign representing pouch of Douglas obliteration during pelvic transvaginal ultrasound for any indication

Pouch of Douglas (POD) obliteration can be predicted with a high degree of certainty and reproducibility using the dynamic transvaginal ultrasound (TVS) sliding-sign technique. So far, studies on POD obliteration prediction have focused on tertiary-care populations with high prevalence of endometriosis; however, POD obliteration may exist in individuals with asymptomatic endometriosis or other conditions. Our primary aim was to determine the prevalence of a negative sliding sign, representing POD obliteration, in a cohort of patients undergoing TVS for any gynecological indication. This was a prospective observational study of consecutive women with an indication for gynecological TVS, conducted at a high-volume ultrasound practice between July and August 2018. Clinical and surgical history, indication for TVS and TVS findings were documented. The prevalence of TVS-confirmed POD obliteration, determined by interpretation of the sliding sign, was calculated for the entire cohort and for the subgroups of women with and without risk factors for endometriosis. High risk for endometriosis was defined as having (1) a TVS referral for endometriosis-like pelvic pain or endometriosis specifically and/or (2) clinical symptoms or signs suggestive of endometriosis. Low risk was defined as the absence of these characteristics. During the study period, 1043 consecutive women underwent TVS. After excluding those who underwent transabdominal ultrasound, had a history of hysterectomy or with missing data, 909 women were analyzed. The prevalence of a negative sliding sign in the entire cohort was 47/909 (5.2%). A negative sliding sign was observed in 22/639 (3.4%) women with a low risk for endometriosis and 25/243 (10.3%) of those with a high risk for endometriosis (difference in proportions, 6.9% (95% CI 2.8-10.9%); P < 0.001). We have demonstrated an overall prevalence of a negative sliding sign, suggesting POD obliteration, of 5.2% (or 1/20) in women seeking TVS for a gynecological indication. The prevalence of negative sliding sign in low-risk women is not negligible (3.4% or 1/29 women). These women are most likely to have asymptomatic endometriosis or another important etiology of POD obliteration. The prevalence of a negative sliding sign is approximately three-times higher in women with signs and/or symptoms of endometriosis (10.3% vs 3.4%). Copyright © 2020 ISUOG. Published by John Wiley & Sons Ltd.

Enhanced recovery after surgery outcomes in minimally invasive nonhysterectomy gynecologic procedures

Improved patient outcomes and satisfaction associated with enhanced recovery after surgery protocols have increasingly replaced traditional perioperative anesthesia care. Fast-track surgery pathways have been extensively validated in patients undergoing hysterectomies, yet the impact on fertility-sparing laparoscopic gynecologic operations, particularly those addressing chronic pain conditions, has not been examined. The objective of the study was to determine the effects of enhanced recovery after surgery pathway implementation compared with conventional perioperative care in women undergoing laparoscopic minimally invasive nonhysterectomy gynecologic procedures. We conducted a retrospective cohort study of women undergoing uterine-sparing laparoscopic gynecologic procedures for benign conditions (tubal/adnexal pathology, endometriosis, or leiomyomas) during a 24 month period before and after enhanced recovery after surgery implementation at a tertiary care center. We compared immediate perioperative outcomes and 30 day complications. The primary outcome was same-day discharge rates. Factors influencing unplanned admissions, postoperative pain, sedation, nausea, and vomiting represented secondary analyses. A total of 410 women (enhanced recovery after surgery, n= 196; conventional perioperative care, n= 214) met inclusion criteria. Following enhanced recovery after surgery implementation, same-day discharge rates increased by 9.4% (P= .001). Reductions in postoperative pain and nausea/vomiting represented the primary driving factor behind lower unplanned admissions. Higher preoperative antiemetic medication administration in the enhanced recovery after surgery group resulted in a 57% reduction in postanesthesia care unit antiemetics (P < .001). Total perioperative narcotic medication use was also significantly reduced by 64% (P < .001), and the enhanced recovery after surgery cohort still demonstrated significantly lower postanesthesia unit care pain scores at hours 2 and 3 (P < .001). A 19 minute shorter postanesthesia care unit stay was noted in the enhanced recovery after surgery cohort (P= .036). Increased same-day discharge did not lead to higher postoperative complications or changes in 30 day emergency department visits or readmissions in patients with enhanced recovery after surgery. Enhanced recovery after surgery implementation resulted in increased same-day discharge rates and improved perioperative outcomes without affecting 30 day morbidity in women undergoing laparoscopic minimally invasive nonhysterectomy gynecologic procedures.

Comparative Study of Ondansetron, Haloperidol or Midazolam in Prevention of Post-Operative Nausea and Vomiting in Laparoscopic Gynecological Operations

AbstractBackground: Post-Operative Nausea and Vomiting (PONV) is a common, undesirable effect after surgery per-formed under general anesthesia.Aim of Study: The aim of this study is to compare the effect of ondansetron, haloperidol or midazolam in the pre-vention of PONV in non-smoker females undergoing laparo-scopic gynecological operations under general anesthesia.Patient and Methods: This prospective randomized con-trolled study carried out in Tanta University Hospital for six months (from November 2016 to April 2017). This study included 90 nonsmoker female patients, aged between 18 and 60 years, ASA I & II, scheduled for laparoscopic gynecological operations under general anesthesia. The anesthetic technique, drugs, monitoring, and care were standardized in all the patients during the perioperative period. Patients were ran-domly allocated to one of three groups (n=30 for each group): Group I ondansetron (O) 4mg I.V ondansetron was given at the end of surgery. Group II haloperidol (H) 1mg I.V haloperi-dol was given at the end of surgery. Group III midazolam (M) 2mg I.V midazolam was given 30 minutes before the end of surgery. Dexamethasone 4mg was added to each study group after induction of anesthesia. For the first 24 hours after anesthesia, the presence or absences of nausea, vomiting or retching were recorded. Rescue antiemetic was given if the patient complains of PONV.Results: Mean response during 0-24 hours was 86.7%, 80%, 83.3% in ondansetron, haloperidol and midazolam groups, respectively. No significant difference through the three groups was found. (p-value=0.787). Regarding rescue antiemetics, there was no statistically significant difference between the three groups. Upon arrival to PACU and after 60 minutes, there was no statistically significant difference in sedation score.Conclusion: In the studied surgical population, the efficacy and toxicity of post-operative nausea and vomiting prophylaxis with haloperidol 1mg or midazolam 2mg were not significantly different from ondansetron 4mg.

Діагностика та ендоскопічне лікування аномалій розвитку матки

The objective: rising of efficiency of expeditious treatment of women with anomalies of development of uterus on the basis of scientific justification and introduction of advanced algorithm of diagnostic and treatment-and-prophylactic actions. Materials and research methods. We surveyed 50 women of genesial age with anomalies of development of uterus (the main group) and 30 women of genesial age without anomalies of development of a uterus (control group). The complex of the conducted researches included clinical, ehografical, endoscopic, laboratory and statistical methods. Results. Results of the conducted researches testify that use of the algorithm improved by us allows to normalize condition of all links of systemic hemostasis that frequency depression is promoted by the trombogemorragical of complications and to improvement of recovery treatment after laparoscopic gynecologic operations of women with anomalies of development of uterus. Conclusion. Use of the differentiated approach to expeditious treatment of anomalies of development of uterus in combination with advanced algorithm of treatment-and-prophylactic actions allows to reduce duration of operation by 7.5% and an operational hemorrhage for 10.0%, and also to prevent development the trombogemorragical of complications. Key words: anomalies of development of uterus, diagnostics, endoscopic treatment.

Can the effect of adhesion barriers and/or intravesical balloon inflation improve bladder autoaugmentation outcomes in a rabbit model?

Bladder augmentation is used for the treatment of bladder dysfunction in order to minimize intravesical pressure and increase bladder capacity. However, less-invasive procedures, such as autoaugmentation, have been proposed due to several complications that have occurred using bowel and gastric segments. The technique of autoaugmentation involves wide excision of the detrusor by leaving the bladder mucosa intact and has shown increased bladder capacity and compliance. An additional step to keep the achieved surface area of this non-contractible bladder segment and, thus, bladder capacity, was reported by using an intravesical balloon to prevent shrinkage of the surgically achieved diverticulum during autoaugmentation. On the other hand, adhesion barriers (AB) with absorbable hydrogel, which can spare tissue and organ plans, are used to prevent postsurgical adhesions. The efficacy of sprayable AB has been demonstrated in animal models and it is now mostly used in laparoscopic surgeries. The present study aimed to compare the efficacy of AB and/or intravesical balloon insertion, which might potentially improve the urodynamic and histopathological outcomes of autoaugmentation in a rabbit model. A total of 25 New Zealand rabbits were included in the study. Following the surgical reduction to form a low-capacity bladder model (35-40% of the initial volume), standard detrusorotomy was performed in all groups except the sham group. Group 2 had only autoaugmentation as the control group. The bladders in Group 3 were supported with an intravesical balloon. An Adhesion Barrier System (CUI Tissue Expander) was used for all bladders in Group 4, without balloon inflation. In Group 5, both intravesical balloon inflation and adhesion barrier application were performed following autoaugmentation. Urodynamic evaluations were performed at day 0 before reduction, day 0 after reduction, and the 90th postoperative day. Capacity and compliance measurements were noted. Bladders were histopathologically evaluated. Expression of CD31 (microvessel density) and fibrosis were noted. Autoaugmentation does not result in a reliable increase in bladder capacity and compliance when compared to a sham group. Urodynamic measurements were similar in balloon-inflated groups (Group 3 and Group 5), showing a statistically significant improvement. Sprayable AB system alone revealed a slight, but not statistically significant, increase (Table). No significant differences between all five groups were detected regarding microvessel density (CD31 expression) and fibrosis. In the present study, the intravesical balloon application (IVBA) efficiency was investigated alone and in combination with AB. The main basis of this study were the previous findings, which demonstrated prevention or decrease in the contraction of diverticula by IVBA. The role of AB alone or within a combination was also evaluated. Adhesion barriers are mostly used in laparoscopic gynecologic and colorectal operations. They decrease the postoperative adhesions by forming a physical barrier. In the present study, it was thought that AB might reduce postoperative adhesions and enhance the outcome of autoaugmentation. One of the most important outcomes was the inconsistency of fibrosis density with final bladder capacity and compliance values; this finding did not support the role of fibrosis prevention with IVBA. The present study had some limitations: the partial cystectomy method, which was used to form a low-compliance bladder, is a different clinical condition to neurogenic bladder, and a rectal catheter was not used during urodynamic evaluation. General anesthesia and muscle relaxant were performed during urodynamy and abdominal contractions were not seen. Bladder autoaugmentation in a rabbit model, followed by intravesical balloon inflation offers improvement in bladder capacity and compliance. The use of sprayable adhesion barrier hydrogel technology may facilitate tissue healing and result in it being easier to maintain the success achieved by surgery when only supported with an intravesical balloon.

Are skin scar characteristics associated with the degree of pelvic adhesions at laparoscopy?

To investigate whether individual or a combination of abdominal surgical scar characteristics can predict the severity and extent of intra-abdominal adhesions. A prospective cohort study. A tertiary referral center in the United Kingdom. One hundred women who had previously undergone abdominopelvic surgery and were undergoing an elective laparoscopic gynecologic operations. Abdominal scars were evaluated preoperatively using the modified Manchester Scar Questionnaire Adhesions were assessed intraoperatively and compared with the cutaneous findings. Presence and severity of intra-abdominal adhesions. Of 100 women recruited into this study, 71 (71%) women were found to have intra-abdominal Aadhesions, and 29 (29%) had no adhesions. Women who had more than one abdominal scar, a palpable scar, and/or a longer scar were most likely to have pelvic adhesions during the current surgery. Women with the highest mean scar scores also had a greater total adhesion score. Adhesions are a common postoperative consequence of open or laparoscopic surgery. Skin scar characteristics are associated with the presence and degree of pelvic adhesions. Future studies should examine whether these characteristics can be used as a preoperative predictive tool to facilitate surgical decision-making and elective operating room organization.

Lower Extremity Venous Doppler Evaluation in Patients Undergoing Laparoscopic Gynecological Operations

Laparoscopy is established as a standard of care in a variety of gynecological pathologies. Pneumoperitoneum and reverse Trendelenburg positioning during laparoscopy have been claimed to increase thrombosis risk, albeit these proposals are still controversial. The aim of this study was to assess lower extremity venous blood flow by Doppler sonography in patients undergoing laparoscopic gynecological surgeries. A prospective, nonrandomized, controlled study was designed to compare lower extremity venous Doppler measurements in patients undergoing diagnostic and operative gynecological laparoscopies. In the period from May 2010 to April 2011, in total, 96 patients operated on for various gynecological complaints excluding malignancy were enrolled in the study. Thirty-two of these patients underwent diagnostic laparoscopy, 34 underwent operative laparoscopy, and 30 underwent open surgery. Lower extremity venous blood flow was investigated by Doppler sonography in patients the day before surgery and 24 hours afterward. Preoperative and postoperative Doppler measurements were obtained from bilateral common and superficial femoral, bilateral great saphenous, and bilateral popliteal veins. Lower extremity venous Doppler measurements were similar in diagnostic and operative laparoscopy groups. Femoral venous blood flow measurements were observed to be similar, but great saphenous and popliteal blood flows were found to be significantly decreased in the open surgery group compared with laparoscopic operations. The laparoscopic approach in gynecological surgery is not associated with an adverse effect on lower extremity blood flow and seems not to bring an additional risk of thrombosis.

Effect of local anesthetics on postoperative pain and opioid consumption in laparoscopic colorectal surgery

Several studies have evaluated use of local anesthetic, specifically, administration of intraperitoneal anesthetic, during laparoscopic general surgery and gynecologic operations, with varying results. There have been no studies to determine the role of local anesthetic in laparoscopic colorectal surgery. This study evaluates the efficacy of subcutaneous and intraperitoneal anesthetic in reducing postoperative pain following common laparoscopic colorectal procedures, in patients managed with enhanced recovery care pathways. A single-institution retrospective cohort analysis of 172 patients who underwent common elective laparoscopic colorectal procedures was carried out. Over three consecutive time periods, patients were divided into three study arms, based on administration of local anesthetic. The first group received no local anesthetic (n = 66), the next received only subcutaneous bupivacaine (n = 67), and the final group received both subcutaneous bupivacaine and intraperitoneal lidocaine (n = 44). Pain scores, time in the postoperative care unit, and the amount of opioid pain medication consumed in the immediate postoperative period were quantified. There was no difference in pain scores reported between the three study arms, including upon arrival and upon leaving the recovery unit (P ≤ 0.086, P ≤ 0.166), and at 3, 6, 9, and 12 h postoperatively (P ≤ 0.332, P ≤ 0.142, P ≤ 0.155, P ≤ 0.872). There was no significant difference in the amount of postoperative opioid analgesia consumed between the three study arms on postoperative day 0 and on postoperative day 1 (P ≤ 0.365, P ≤ 0.458). There were no significant differences in the amount of time spent in the postoperative care unit, hospital stay, 30 day morbidity, or 30 day mortality between the three study arms. Use of local anesthetic does not influence postoperative opioid requirements or patients' subjective report of pain following laparoscopic colorectal procedures managed within enhanced recovery care pathways.

Bladder perforation during laparoscopy detected by gaseous distention of the urinary bag -A report of two cases-

Bladder perforation during laparoscopy is a recognized, uncommon complication. We present two cases of bladder perforation during laparoscopic gynecologic operations that were detected by gaseous distention of the urinary bag. Bladder perforation occurred through laparoscopic division of adhesion. One bladder perforation was repaired laparoscopically, and the other case was repaired by laparotomy during the same general anesthesia. In this report, we present evidence that monitoring a gas-distended urinary bag during a laparoscopic procedure can help detect intraoperative bladder perforation.

Ureteric Injuries during Laparoscopic Gynecological Operations

Objective: To review the literature regarding ureteral injuries that occured during laparoscopic gynecological operations and determinepreventive methods.Material and methods: We have evaluated all the articles related with ureteral injuries of laparoscopic operations between the years 2000and 2010, and selected 14 of them.Results: The rate of injury is 0.093 to 1.1%. Most of the injuries occured at distal third of ureter due to close proximity to uterine artery.Unfortunately, most of the injuries were diagnosed postoperatively. The most common injury type was thermal injury, and the treatmentof choice was often by laparotomy, particularly ureteroneocystostomy.The best way to prevent injury is a through knowledge of pelvicanatomy and principles of electrosurgery together with enough expertise.Conclusion: Ureteric injury prevention and if occured, timely diagnosis is prudent to prevent serious morbidities.

Anesthetic Maintenance of Video-Assisted Endolaparoscopic Surgery for Female Infertility

Objective: to provide a rationale for the use of ketorolac tromethamine (ketorol) as an analgesic component of general anesthesia during endoscopic gynecological surgery for infertility. The case records of 200 women aged 19 to 35 years, operated on for infertility, were retrospectively studied. All the patients were divided into 4 groups (50 patients in each). Group 1 used ketamine-seduxen anesthesia; Group 2 received dormicum-based ataralgesia; Group 3 had neuroleptanalgesia; Group 4 had diprivan anesthesia with pre-emptive ketorol analgesia. The anesthesia risk was referred as to ASA grade 1. All modes of anesthesia provided its adequacy. Among Groups 1-to-3 patients, 28—40% needed additional postoperative analgesia and 8—12% required postoperative artificial ventilation (AI); postoperative nausea and vomiting (PONV) occurred in 6—8% in these groups. Group 4 patients were in no need of additional analgesia and augmented AI; PONV did not occur. None of the anesthesia modes affected the hemostatic system. Preemptive analgesia with ketorol in combination with diprivan ensured adequate anesthesia during laparoscopic gynecological operations for infertility, caused no PONV, required no augmented postoperative AI or additional postoperative analgesia, and induced no hemorrhagic events. Key words: preemptive analgesia, ketorol, laparoscopic gynecological operations.

The influence of dexamethasone and ketolgan on postoperative nausea and vomiting and estimation of risk factors in women undergoing gynecologic laparoscopic surgeries

The aim of this study was to determine the effect of dexamethasone and ketolgan on postoperative nausea and vomiting and to evaluate risk factors for postoperative nausea and vomiting. A prospective, double-blind, randomized clinical study was carried out. One hundred fifty-three ASA I-II women undergoing laparoscopic gynecologic operations were randomized into three groups: dexamethasone group (n=51), ketolgan group (n=51), and control group (n=51). Patients in the dexamethasone group were given 4 mg of dexamethasone intravenously before the induction of general anesthesia, the ketolgan group received 30-mg ketolgan intravenously, and control group did not receive any medication. The incidence and severity of postoperative nausea and vomiting were registered 24 hours after the surgery. The incidence of postoperative nausea and vomiting in the dexamethasone group was 13.8%; in the ketolgan group, 37.3%, and in the control group, 58.9% (P=0.026). Patients with a history of migraine suffered from postoperative nausea and vomiting in 70.3% of cases and migraine-free patients in 25.8% of cases (P=0.015). Opioids for postoperative analgesia increased the incidence of postoperative nausea and vomiting as compared with nonsteroidal anti-inflammatory drugs (P=0.00002). Preoperative medication with dexamethasone significantly reduces the incidence of postoperative nausea and vomiting. Avoidance of opioids for postoperative analgesia reduces the incidence of postoperative nausea and vomiting. Migraine and motion sickness are independent risk factors for postoperative nausea and vomiting.

Comparison of Direct and Delayed Ureteroureterostomy after Laparoscopic Gynecologic Operation

Comparison of Direct and Delayed Ureteroureterostomy after Laparoscopic Gynecologic Operation

Comparison of Direct and Delayed Ureteroureterostomy after Laparoscopic Gynecologic Operation

Comparison of Direct and Delayed Ureteroureterostomy after Laparoscopic Gynecologic Operation

Effect of remifentanil on intraocular pressure during laparoscopic gynecologic operations

Objective To observe the effect of remifentanil on intraocular pressure during laparoscopic gynecologic operations. Methods Forty patients undergoing laparoscopic gynecologic operation under complete intravenous anesthesia were divided into two groups randomly : group Ⅰ (control) and group Ⅱ (remffentanil) . Group Ⅰ: Anesthesia was induced with midazolam, propofol, vecuronium and fentanyl and maintained with continuous infusion of propel. Group Ⅱ : maintained with continuous infusion of remifentanil to replace the fentanyl, the others were same as group Ⅰ. The intraocular pressure was detected by Tono-Pen XL Tonometer at the time points of 5 min after anesthesia induction(T0) , 5 min after artificial pneumoperitoneum(Tt), 15 min after artificial pneumoperitoneum(T2), 5 min before the end of artificial pneumoperitoneum (T3) , 5 min after the end of artificial pneumoperitoneum (T4) and 15 min after the end of artificial pneumoporitoneum(T4), MAP ,HR,PETCO2 and PAW be recorded at the same time. Results Compared to the group Ⅰ, MAP and IOP of the group Ⅱ at T1 ,T2 and T3 were decreased significantly(P <0.05). There were no significant differences in HR, PETCO2 ,PAW between two groups at all time points. Conclusion Remifentanil can obtund the increase in IOP during laparoseopic gynecologic operations. Key words: Remifentanil ; Intraocular pressure; Laparoscopic ; Gynecology

Hemodynamic Changes during Epidural Anesthesia with Various Local Anesthetics

Central hemodynamic stability during gynecological laparoscopic operations remains an important problem of anes-thesiological monitoring. Subjects and methods. Fifty-eight patients who had undergone various gynecological laparoscopic operations were examined. According to the mode of anesthesia, the patients were divided into 2 groups: 1) 29 patients who received epidural anesthesia with ropivacaine; 2) 29 who had epidural anesthesia using lidocaine. The indices of cardiac performance (stroke volume, stroke index, and cardiac output), blood (diastolic, systolic, and mean) pressure, vascular parameters (linear blood flow velocity, total peripheral vascular resistance) were determined by volumetric compression oscillometry. Results. The study indicated that all the modes of anesthesia demonstrated the satisfactory condition of the cardiovascular system, but the highest stability of hemodynamic parameters was recorded in the epidural ropivacaine group. In this group, there were steady-state reductions in diastolic, systolic, mean blood pressures, and total vascular peripheral resistance and increases in stroke index, stroke volume, and linear blood flow velocity. Conclusion. Epidural anesthesia using ropivacaine during gynecological surgical endoscopic interventions is the method of analgesia causing minimal hemodynamic disorders. Key words: hemodynamics, epidural anesthesia, laparoscopic gynecological operations.

The effects of intraperitoneal tramadol, tenoxicam and bupivacaine on pain relief after laparoscopic gynecological procedures

Purpose: Patients undergoing laparoscopic procedures may experience postoperative pain. We conducted a randomized, double-blinded, placebo-controlled trial to evaluate the effectivenesses of peritoneal tramadol as an opioid analgesic, tenoxicam as an anti-imflammatory drug and bupivacaine as a local anesthetic. Methods: Patients were randomly assigned to one of four groups of 20 patients each. Group A received 50 mg tramadol (in 20 ml volume with 0.9% saline), group B received 20 mg tenoxicam (in 20 ml volume with 0.9% saline), group C received 20 ml 0.9% saline and group D received 50 mg bupivacaine HCl in 20 ml volume (10 ml 0.5% bupivacaine with 10 ml 0.9% saline) after surgery. Pain was assessed using a visual analog scale and a verbal rating scale at 30 and 60 min, and 2 and 4 h after surgery. Results: Pain intensity and analgesic requirements were significantly less in the group receiving intraperitoneal tramadol, tenoxicam and bupivacaine compared to placebo group. The pain scores of tenoxicam group at 30 and 60 min, and 2 h after surgery were significantly lower than those of the group B, C and D. There was no statistically significant difference in any group at 4 h after surgery. Conclusion: The results indicate that intraperitoneal application of tramadol, tenoxicam and bupivacaine is simple, cheap and effective for reducing pain after laparoscopic gynecological operations.

The advantage of integrated operating systems for highly advanced laparoscopic gynecological operations

The advantage of integrated operating systems for highly advanced laparoscopic gynecological operations

Antimicrobial Prophylaxis in Laparoscopic Gynecologic Surgery: A Prospective Randomized Study Comparing Amoxicillin-Clavulanic Acid with Cefazolin

Numerous studies have been published in recent years about antimicrobial prophylaxis in gynecologic surgery, but the optimal drug and schedule for the different surgical procedures is still a matter of debate. The aim of the present study was to compare two ultra-short term antimicrobial prophylaxis regimens (amoxicillin-clavulanic acid and cefazolin) in preventing infections following laparoscopic gynecologic operations. Three hundred sixty women hospitalized for a laparoscopic gynecologic surgery procedure were included in the study between January 1999, and December 2001. Patients were randomly allocated to receive amoxicillin-clavulanic acid (2.2 g) [Group A] or cefazolin (2 g) [Group B] as a single dose 30 minutes before surgery. Each patient was assessed daily until discharge to evidence febrile status and the presence of infections at the operative site, urinary tract and respiratory tract. In the amoxicillin-clavulanic acid (Group A) and cefazolin (Group B) groups, overall 164 and 172 patients, respectively, were evaluable for prophylactic efficacy at hospital discharge. Infectious complications were infrequent in both groups with febrile morbidity occurring in only one patient (0.6%) in the amoxicillin- clavulanic group. No sign of infections at the surgical site, urinary tract and respiratory tract was observed in either group. No death due to sepsis was recorded. It is concluded that ultra-short term prophylaxis with both amoxicillin-clavulanic acid and cefazolin is safe and effective in elective laparoscopic gynecologic surgery.