Laparoscopic Wound Research Articles

916 The Use of Absorbable Suture Versus Staples Versus Tissue Glue in Laparoscopic Port Skin Closure. a Prospective, Randomised Control Trial. the STILS Trial

Abstract Aim The closure of surgical wounds following laparoscopic surgery is not currently standardised. The aim of this study was to compare the three main methods of closure – Stitches, Staples, and Tissue Glue to evaluate which of these produce optimum cosmetic outcomes, results in least wound complications and which is most cost-effective. This would enable the adoption of a standard protocol for closure of laparoscopic wound sites. Method This was a prospective, randomised controlled trial. Patients undergoing elective, laparoscopic surgeries were consented and randomised into one of the three treatment arms (Stitches–Subcuticular 4–0Monocryl;Skin Staples or Tissue Glue). Pre-defined, specific guidelines for each of the closure methods were followed. Data recorded at the time of surgery included: Number/Size of Port Sites, time taken and Quantity of closure material used. At an interval follow-up appointment, the wounds were evaluated using the ‘Patient and Observer Scar Assessment Scale’ (POSAS), wound complications recorded, and photographs taken to facilitate further evaluation by a third-party clinician. Results A total of 147 patients were recruited with 138 completing full follow-up. In the ‘Sutures’ arm the average Observer Scar Score(OSS) was 10.3;Patient Scar Score(PSS) was 12.6;Rate of wound closure(RWC) 4.3mm/min;Wound complication rate(WCR) 0.08%;Cost €4.22/patient. The ‘Staples’ arm demonstrated an average OSS-13.1;PSS-16.4;RWC-15.7mm/min;WCR-0.06%;Cost €21.97/patient(excluding labour for ROS). In the ‘Tissue Glue’ arm there was an average OSS-15.7;PSS-18.4;RWC-5.1mm/min;WCR-.19%; Cost €21.10/patient. Conclusions Laparoscopic port site closure with 4–0 Monocryl was most superior with regards to cosmetic outcome and cost-effectiveness. Staples was the fastest method of closure and lowest complication rate.

A randomised clinical trial to compare octyl cyanoacrylate with absorbable monofilament sutures for the closure of laparoscopic cholecystectomy port incisions.

Tissue adhesives have gained increasing use as a possible method of wound closure. We compared the use of 2-octyl cyanoacrylate (OCA) or subcuticular suture in incisions sutures for the closure of laparoscopic cholecystectomy port incisions. A prospective randomised controlled trial was performed. Patients were randomised to have closure of laparoscopic port sites using either OCA or sutures. Patients were reviewed at 24 hours and returned for follow-up 1 week and 1 month after postoperatively. At these times, different wound characteristics were documented: Two tools were used to measure the cosmetic result using Hollander wound evaluation scale (HWES) and the patient and observer scar assessment scale (POSAS). A total of 70 patients, 35 in each group were enrolled. The wounds were closed significantly faster in the OCA group (mean 229.16 [±43.7] seconds versus 258.82 [±51.7] seconds, P = .01). Statistically significant difference in favour of using OCA was found for dehiscence (17.1% versus none in the suture group, P = .025) after 1 week. However, no difference was found for wound dehiscence after 1 month. OCA and suture groups did not differ significantly on patient satisfaction. There were no differences in the percentage of wounds achieving optimal scores on the HWES (suture 85.7% versus OCA 74.2%, P = .169). Nerveless, wound evolution was judged to be significantly better in the OCA group using POSAS. Patients' median POSAS was 9.45 (6-11) and 11.43 (10-13) in the OCA and suture groups, respectively (P = .005), and surgeon's median POSAS was 9.42 (6-11) and 11.48 (10-13) in the OCA and suture groups, respectively (P = .006). N-butyl-cyanoacrylate tissue adhesive is an acceptable technique for the closure of laparoscopic wounds with less operative time, and cosmetic results are comparable to suturing.

PS02.019: THORACOSCOPIC INTRATHORACIC ESOPHAGO-GASTRIC ANASTOMOSIS WITH PATIENT IN PRONE POSITION

Abstract Description After laparoscopic gastric conduit creation the patient is placed in prone position, with single-lumen endotracheal intubation. A right pneumothorax at 8 mmHg is created with a port at the apex of the scapula; two operative trocars are inserted in the right 5th and 9th intercostal spaces. The esophageal dissection in performed with an en bloc linfadenectomy. The distal part of the esophagus is tied up with a loop; the esophagus in then divided with an electrocautery scissor. A manual purse-string is made in the proximal esophageal stump with a Prolene 2/0. The envil of a circular stapler is put inside the chest through a port or during the laparoscopic procedure opening the right pleura; so it is introduced in the esophageal stump and the purse-string is closed. The incision of the lower port is enlarged and a laparoscopic wound retractor device is inserted. The specimen and the gastric conduit are retrieved; the stapler is introduced trough the laparoscopic wound retractor tip and through a small gastrostomy in the gastric tube; the puncturing shaft is pulled out through the greater gastric curve. We ensure the gastric conduit to the stapler with a second envil; it is introduced in the chest. After opening the stapler and loosing the second envil we perfomed the esophago-gastric anastomosis. A linear stapler is used to remove the excess of the stomach with the gastrostomy. Some interrupted stitches fixed the anastomosis to the mediastinal pleura. Two right chest tubes are inserted. Disclosure All authors have declared no conflicts of interest.

Development and Feasibility of a Robotic Laparoscopic Clipping Tool for Wound Closure and Anastomosis.

This paper reports the design, development, and initial evaluation of a robotic laparoscopic clipping tool for single manipulator wound closure and anastomosis (tubular reconnection). The tool deploys biodegradable clips and clasps with the goal of (i) integrating grasping and suturing into a single device for single hand or manipulator use, (ii) applying the equivalent of interrupted sutures without the need of managing suture thread, and (iii) allowing for full six degrees-of-freedom (DOFs) laparoscopic control when mounted on a robot arm. The specifications, workflow, and detailed design of the robotic laparoscopic tool and injection molded bio-absorbable T shaped clip and locking clasp are reported. The clipping tool integrates forceps to grab and stabilize tissue and a clip and clasp applier to approximate and fixate the tissue. A curved needle is advanced on a circular needle path and picks up and drags clips through tissue. The clip is then tightened through the tissue and a clasp is clamped around the clip, before the clip is released from the needle. Results of several bench test runs of the tool show: (a) repeatable circular needle drive, (b) successful pick-up and deployment of clips, (c) successful shear of the clip to release the clip from the needle, and (d) closure of clasp on clip with an average of 2.0 N holding force. These data indicate that the robotic laparoscopic clipping tool could be used for laparoscopic wound closure and anastomosis.

Laparoscopic partial nephrectomy with superselective balloon embolization of renal artery

To use superselective balloon embolization of segmental branches of the renal artery for intraoperative hemostasis during partial nephrectomy for renal malignancy. From October 2015 to September 2016, 11 patients, including 3 males and 8 females aged 29-72 (mean 56.8) years underwent laparoscopic partial nephrectomy with superselective balloon embolization. In 5 and 6 cases the tumors were located in the right and left kidney, respectively, and in 7, 1 and 3 cases they were found in lower, upper and middle segments, respectively. The of tumor size ranged from 0.9 to 3.8 cm (mean 1.9 cm). All patients underwent standard preoperative evaluation including urinary tract ultrasound, multislice computed tomography (MSCT) with contrast enhancement, renal scintigraphy and separate assessment of each kidney function. The complexity of the planned partial nephrectomy was evaluated using a R.E.N.A.L. nephrometry scoring system based on MSCT data. The mean score averaged 5.1 points, which corresponds to a low complexity for resection. The mean blood loss was 50 mL. The duration of laparoscopic stage was reduced from 150 to 60 minutes averaging 104.3 minutes. Mean total operating time from the beginning of selective renal angiography to laparoscopic wound suturing was 168.5 minutes. The mean renal ischemia time was 112.5 (90 to 150) minutes, which was due to performing different stages of the operation in different operating rooms. Given superselectivity of embolization, ischemic changes occurred only in a limited part of the parenchyma surrounding the tumor. Using balloon occlusion, unlike permanent embolization by microgranules, coils or other embolic agents, minimized ischemic injury of intact parenchyma around resected tumors. At the same time, it provided completely dry resection margins for full control. Renal ultrasound on the 3d-4th day postoperatively showed no pathological formations in the perirenal space and no changes in the pelvicalyceal system and kidney size. The proposed method of superselective balloon embolization of renal artery branches helped maintain blood circulation in intact parenchyma, which was an important factor in preventing acute renal injury during organ-sparing operations.

Laparoscopic Vaginoplasty Using a Sigmoid Graft Through the Umbilical Single-Incision Hybrid Transperineal Approach: Our Initial Experience

For better cosmetic appearance, attempts to reduce the number of laparoscopic wounds have been sought. Investigators have thus begun to carry out procedures through a single incision or natural orifice endoscopic surgery instead of using conventional laparoscopic surgery. The authors here describe transumbilical single-incision hybrid transperineal laparoscopic surgery as a novel approach for vaginoplasty using a sigmoid graft. From August 2010 to October 2012, 15 young females with Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome underwent laparoscopic sigmoid vaginosplasty using a combined transumbilical single-incision and transperineal approach. A multichannel single port was placed through the umbilical incision for the main laparoscopic procedures. A 12-mm trocar as an assisting working port was inserted into the pelvic cavity through the transvaginal dimple between the rectum and urethra. A functioning vagina 12-15 cm in length and approximately 4 cm in width was created in all the patients. The average operative time and hospital stay were 151.5±34.2 minutes and 7.4±3.2 days, respectively. The only perioperative complications were 1 case of stress ulcer and 1 case with umbilical infection. All patients were satisfied with the surgery, and 12 of them had subsequent sexual activity. Transumbilical single-incision hybrid transperineal laparoscopic sigmoid vaginoplasty offers a feasible scarless approach for females with MRKH syndrome. The favorable cosmetic results would favor use of this type of vaginoplasty as an alternative to the conventional laparoscopic approach.

A Prospective, Randomized, Controlled, Double-Masked, Multi-Center Clinical Trial of Medical Adhesives for the Closure of Laparoscopic Incisions

Study ObjectiveTo compare LiquiBand Surgical S (LB) (Advanced Medical Solutions Ltd, Plymouth, UK) with High Viscosity Dermabond (DB) (Ethicon Inc., Kirkland, Scotland) for the closure of laparoscopic wounds. DesignProspective, multicenter, randomized, controlled trial (Canadian Task Force classification I). SettingMultiple district hospitals. ParticipantsA total of 433 subjects were enrolled between 2006 and 2009 at 4 investigational sites. InterventionsIn this study, LB, an octyl/butyl cyanoacrylate blend, and DB, an octyl-based cyanoacrylate, were compared for topical skin closure of laparoscopic port sites (www.clinicaltrials.gov; study identifier NCT00762905). Main ResultsHigh dermal apposition and cosmesis scores resulted from the use of both adhesives along with low rates of wound dehiscence and suspected infections. Masked evaluators and patients favored DB in the healing of the incisions (98.3% DB vs 93.9% LB, p < .05) and (97.2% DB vs 89.4% LB, p < .05). However, there was no difference in the overall satisfaction of the appearance of the wounds. LB was found to be significantly (p < .05) faster (LB = 32.1 seconds; DB, 50.3 seconds) and easier to use than DB, and surgical users were significantly more satisfied with using LB for wound closure. ConclusionThe results of this trial show the efficacy of LB for the closure of topical skin incisions; LB was significantly faster, easier to use, and resulted in greater user satisfaction compared with DB.

LiquiBand® Surgical S topical adhesive versus sutures for the closure of laparoscopic wounds. A randomized controlled trial

Cyanoacrylate adhesives offer the surgeon and patient an alternative to subcuticular suturing. LiquiBand® Surgical S (LBSS) is a new formulation with a blend of monomeric n-butyl and 2-octyl cyanoacrylates. In this study, the effectiveness, safety, and clinical utility of LBSS was compared to Vicryl™ sutures for the closure of laparoscopic incisions. This was a prospective randomized study of LBSS skin adhesive versus Vicryl™ sutures for the topical closure of laparoscopic surgical incisions. Subjects were asked to return at 2 weeks postsurgery to report complications and adverse events. Wounds were evaluated for apposition and cosmesis using a modified Hollander Wound Evaluation Scale (HWES). The Shapiro–Wilk test of normality was done. Independent-samples T test, Mann Whitney U test, and chi-square test were used to compare variables between the two wound closure methods. A total of 114 subjects participated in this trial completing all aspects of the study. Fifty-five subjects received sutures for topical wound closure, with 59 subjects receiving LBSS. Surgeons were found to be satisfied with 100 % of all applications using the LBSS device. One hundred percent of wounds closed with sutures and 98.9 % wounds closed with LBSS achieving an optimal HWES of 0. There was no statistical difference in cosmesis or complications for either method. Closure with LBSS was significantly faster by a mean of 2 min. LiquiBand® Surgical S is as good as sutures for the closure of laparoscopic wounds in terms of cosmesis and complications with the added benefit of being significantly faster.

The incidence of trocar-site hernia in minimally invasive bariatric surgery: A comparison of multi versus single-port laparoscopy

Single-port laparoscopy (SPL) employs a 1.5- to 2.5-cm incision at the umbilicus for the placement of a single working port. We hypothesized that the longer incision created by SPL compared with multiport laparoscopy may increase the incidence of trocar-site hernias. We examined our experience with SPL in bariatric operations. There were 734 laparoscopic sleeve gastrectomy and laparoscopic adjustable gastric banding procedures performed at our institution between 2001 and 2011. Fifty-eight patients were lost to follow-up or had a short duration of follow-up (<1 month). Of the remaining 676 cases, 163 were performed via SPL. All laparoscopic wounds created by trocar size greater than 12 mm were closed with absorbable suture. Patient demographics of the SPL group and the multiport group were similar in terms of age, gender, and comorbidities. The average body mass index (BMI) of the SPL group was lower than the multiport group (43.5 ± 5.3 vs. 45.8 ± 7.7, p < 0.01). The mean follow-up for the SPL group was 11 months versus 24 months for the multiport group. There were three trocar-site hernias out of 513 cases in the multiport compared to one hernia out of 163 cases in the SPL group (0.6 vs. 0.6 %, p = 0.967). All trocar-site hernias occurred at the 15-mm port site. The median time to hernia occurrence for the multiport group was 13 months (range, 1-18). In the SPL group, the hernia occurred at 8 months. On multivariate analysis, age, BMI, SPL, procedure type, and the postoperative weight loss were not associated with the development of trocar-site hernias. SPL did not increase the rate of trocar-site hernia in this series. A low rate of trocar-site hernia can be achieved with the use of SPL in bariatric surgery.

An improved technique for Soave trans-anal pull-through

To describe a new technique for the Soave trans-anal pull-through. After the mucosectomy during a Soave's procedure, a laparoscopic wound retractor was used to line the distal rectal segment to facilitate delivery of the proximal bowel through a narrow scarred pelvis. The technique greatly assisted delivery of the proximal bowel and helped prevent mesenteric injury. Soave trans-anal pull-through is a difficult operation that is largely confined to specialist centres. We describe an improvement to the technique that greatly facilitates the procedure.

Incisional hernia rates following laparoscopic colorectal resection

Introduction In published series with satisfactory follow-up incisional hernia rates following laparotomy vary between 4 and 18%, with up to 75% developing within two years of operation. This therefore represents the commonest complication following open abdominal surgery and a substantial added workload for the colorectal/general surgeon. Aim To prospectively review incisional hernia rates in patients undergoing laparoscopic colorectal resection in a single centre. Methods All laparoscopic wounds were closed in identical fashion to open closure technique, utilising 0-monofilament, polyglyconate and a mass closure technique, followed by a subcuticular, polyglactin-910 suture for skin closure. All patients were subsequently examined in an outpatient setting by a senior surgeon independent to the original procedure. Results 167 consecutive patients undergoing laparoscopic colorectal resections (94M:73F; median age 68 years) were included. Median incision length for specimen extraction was 6 cm (range 3–11 cm) and patients were followed-up for a median of 36 months (range 24–77 months). Twelve (7%) patients developed an incisional hernia (ten in specimen extraction wounds and two in port-site wounds), ten of whom underwent successful laparoscopic repairs. Of the remaining patients, one remains symptomatic and awaits repair, and one is asymptomatic and unfit for surgery. Conclusions The well-documented advantages of laparoscopic surgery include reduced hospital stay, early return to activity, decreased analgesic requirements and improved cosmesis. However, the results of this study suggest that incisional hernia rates are not decreased by laparoscopic surgery, although the hernias may be smaller and more amenable to repair by laparoscopic approaches.

Laparoscopic treatment of colorectal neoplasia

A recent major advance in the surgical treatment of colorectal cancer has been the introduction of laparoscopic surgery. Laparoscopic colectomy is associated with decreased postoperative pain, faster ileus resolution, shorter hospital stay, improved cosmesis, and decreased morbidity when compared with open colectomy. However, early reports of high rates of laparoscopic wound metastases gave rise to questions regarding the adequacy of the laparoscopic technique for curative resection of malignancies. These concerns over oncologic outcomes are addressed by several single and multi-institutional randomized trials in the United States and throughout the world that have compared laparoscopic-assisted colectomy with conventional open colectomy. These studies have established both the short- and long-term safety and oncologic efficacy of laparoscopic colectomy for cancer. To ensure successful outcomes, surgeons performing laparoscopic colectomy should be adequately experienced. Limitations include the technical requirements of advanced laparoscopic skills and training, increased operative time, and equipment costs. Despite these limitations, patient recovery benefits may offset the increased operative costs and result in improved outcome overall.

Closure of laparoscopic trocar site wounds with cyanoacrylate tissue glue: a simple technical solution.

Cyanoacrylate-based tissue glue has been widely used for many years around the world, and was recently approved for use in the United States, mainly for skin cuts and lacerations. Other applications were described, in different surgical situations. Although ideal for small, clean incisions, its use in laparoscopic surgery is currently limited. Over a year period, 100 patients with more 250 trocar site wounds had their wounds glued using histoacryl. Infection rate was extremely low (one case), and partial dehiscence of the wound happened in two patients, where wound edge approximation was not optimal. Cosmetic results were excellent and patient satisfaction was high, as no sutures had to be removed. Glue application is easy and quick, with no risk of needle sticks, and it is a viable option for laparoscopic wound closure.

Revision Laparoscopy for Incarcerated Hernia At a 5-mm Trocar Site Following Pediatric Laparoscopic Surgery

We report the case of a 6-month-old female infant who developed post-operative bowel obstruction due to an incarcerated hernia through a 5-mm laparoscopic wound. The patient underwent laparoscopic Nissen fundoplication for gastroesophageal reflux. On day 6, she showed symptoms of ileus, and the diagnosis of a trocar wound hernia was made on day 13. The herniated intestine was reduced and the defective peritoneum and fascia were closed under relaparoscopic guidance, thus avoiding full-scale laparotomy. A trocar wound hernia causing early postoperative bowel obstruction is a rare complication, especially at 5-mm trocar puncture sites. Intraoperative dislodgment and reinsertion of working trocars may create fascial defects larger than the actual size of the trocar. All laparoscopic puncture wounds, even those <10 mm in size, should be closed at the fascial level in infants. Revision laparoscopy is considered preferable to manage trocar site complications in children.

Antifibrinolytic Additives to Fibrin Glue for Laparoscopic Wound Closure in Urinary Tract

Fibrinolytic activity of urine may rapidly degrade fibrin glue used in the urinary tract, thereby limiting tissue adhesion. The goals of this study were to verify the ability of antifibrinolytic agents to delay the degradation of fibrin glue in the urinary tract and to assess the results of this delay on subsequent wound healing. In 25 domestic pigs, a 3.5-cm incision in the urinary bladder was left open (N = 6) or closed laparoscopically with fibrin glue alone (N = 6), fibrin glue containing aprotinin 5000 KIU/mL (N = 6), or fibrin glue containing aprotinin 2500 KIU/mL with (N = 4) or without (N = 3) aminocaproic acid 12.5 mg/mL. At harvest 7 days later, the bladder was tested for leakage. Histologic features were scored by a pathologist blinded to the closure method. There were no significant differences among the groups in the amount of leakage at harvest. Significant fibrin glue material in the wound was noted more often in the pigs treated with fibrin glue plus aprotinin (7 of 13) than in the fibrin glue-only group (0 of 6; P = 0.04). The presence of significant fibrin material in the wound correlated well with absence of granulation tissue (P < 0.001), such that granulation tissue bridging the wound edges was found more often in the fibrin glue-only group (6 of 6) than in the groups treated with fibrin glue plus aprotinin (4 of 13; P = 0.01). Although aprotinin +/- aminocaproic acid did delay the degradation of fibrin glue used to close a bladder wound, it was associated with inhibition of granulation tissue in the glued wound. These findings suggest that aprotinin alone and aprotinin plus aminocaproic acid are not useful additives to fibrin glue used for wound closure in the urinary tract.

General oncologic effects of the laparoscopic surgical approach. 1997 Frankfurt international meeting of animal laparoscopic researchers.

The results from the majority of the reviewed studies support the hypothesis that abdominal surgery, performed via either a large incision or CO2 pneumoperitoneum, systemically encourages tumor growth in the postoperative period. A full laparotomy incision appears to have a significantly greater effect than CO2 pneumoperitoneum on postoperative tumor growth. Whether the large tumor observed in the surgical groups are the result of increased tumor cell proliferation or diminished tumor cell death remains unclear. There is some evidence pointing to both mechanisms. The loss of the postoperative tumor growth differences between the open and pneumo animals in the athymic mouse experiment suggests that cell-mediated immune function plays a role in tumor containment. The proliferation study results, however, suggest that other stimulatory influence(s) are also at work. Clearly, much research needs to be done regarding the etiology of these tumor growth differences. Other tumor cell lines need to be studied, and investigations regarding tumor growth in an intra-abdominal location need be performed as well. This body of research suggests that the manner in which the surgeon gains access to the abdominal cavity may have an impact on the propensity of tumor cells to implant, survive, and grow in the period immediately after surgery. If true, this may be the most compelling justification for the use of minimally invasive techniques for the curative resection of malignancies. However, it remains to be proven that human tumors will demonstrate differences in tumor growth similar to those noted in some of these animals models. Furthermore, it is not all clear that slight differences in tumor growth postoperatively will translate into significant differences in long-term survival or recurrence rates. At first glance, the existence of port-site tumors would appear to contradict totally the conclusions of many studies discussed in this synopsis. If laparoscopic methods are associated with decreased rates of tumor growth and establishment, then why do port-site tumors form? This is a complex issue calling for discussion that goes far beyond the scope of this article. However, several brief comment on this topic follow. The etiology of port tumors is unknown, although traumatization of the tumor during mobilization, resection, or removal is likely to play a significant role in the liberation of tumor cells from the primary. A relatively small protective benefit, in terms of slower tumor growth rates in laparoscopic patients, will likely not be sufficient to prevent a large inoculum of viable tumor cells in an abdominal wound from establishing a metastasis. Furthermore, as suggested earlier, the systemic effects on tumor growth may be different from the local (i.e., intra-abdominal or abdominal wound) effects. Finally, the true incidence of port tumors remains unknown. It has not been definitively established that the laparoscopic wound tumor incidence is significantly higher than the open rate, although this is the assumption of most surgeons. Several relatively large recently published laparoscopic series have reported port tumor incidences of 0 to 1.2%, which is in the same "ballpark" as the 0.6 1.0% abdominal wound tumor incidences mentioned in several open colectomy series. Clearly, much more research in this area is needed to understand port tumors better and to reconcile the port tumor results with the systemic tumor growth benefits that may be associated with minimally invasive methods.

Tumour cell wound distribution after colectomy in a porcine model.

Concerns over tumour implants have impeded the adoption of laparoscopic surgery for cancer. Explanations assume an increased number of malignant cells present in trocar wound sites. The following are tested in the present paper: (i) that the magnitude of wound contamination following surgery is related to the location of the tumour cells; and (ii) the surgical approach. We have used a porcine sigmoid colectomy model to compare the number of tumour cells on laparoscopic wounds after resections in the presence of intraluminal, intramural and intraperitoneal 51Cr-labelled, fixed HeLa tracer cells. Open colectomies were also performed in the presence of intraperitoneal tracer cells and their numbers on laparotomy wound surfaces were determined by gamma counting. With intraperitoneal cells, laparotomies had 1087 (+/- 106) tracer cells per mm (n = 4) while trocar wounds had 103 (+/- 54) cells per mm (n = 10) (P > 0.05). Resection of intramural tumours resulted in lower trocar wound contamination (0.9 +/- 0.6 cells/mm, n = 3). Resection of colon including intraluminal tracer cells resulted in 2.9 +/- 2.1 cells/mm on trocar wounds (n = 3). More tumour cells were deposited on open than laparoscopic trocar wound surfaces. Also, the risk of wound implantation is less with intraluminal or intramural tumours than with intraperitoneal cells (P > 0.05).

Patient satisfaction following transcervical resection of the endometrium.

Menorrhagia affects 20-30% of healthy women, many of whom undergo hysterectomy. In recent years, transcervical resection of the endometrium (TCRE) has become an alternative surgical option. This observational study assesses patient satisfaction following TCRE. The case notes of 55 patients who had a TCRE in the Coombe Womens' Hospital, Dublin, in 1992 were reviewed. Patients were sent a postal questionnaire at an interval ranging from 3 to 15 months post TCRE. 49 patients responded, of whom 76% were satisfied with TCRE. Thirty one per cent experienced amenorrhoea, 55% hypomenorrhoea, and 14% had no change in menstrual blood loss. Twenty two per cent required subsequent treatment. The complication rate was 11% (2 uterine perforations, 3 endometritis, 1 laparoscopic wound infection). We conclude that TCRE is an effective and safe treatment for menorrhagia, and is associated with a high rate of patient satisfaction.