Gynecologic Laparoscopy Research Articles

Performing and Evaluation of Deep Learning Models for Uterus Detection on Soft-Tissue Cadavers in Laparoscopic Gynecology

Performing and Evaluation of Deep Learning Models for Uterus Detection on Soft-Tissue Cadavers in Laparoscopic Gynecology

Conversion to laparotomy in bening gynecologic laparoscopic surgery; Can surgical experience be protective

Laparoscopy is a surgical technique that is frequently used in the treatment of benign cases, but the conversion to open surgery (CTOS) complication is higher than laparotomy. In some cases, a conversion from laparoscopic surgery to open surgery is necessary to prevent or treat difficulties. In this study, the effect of surgical expertise on CTOS was evaluated on patients who had undergone laparoscopic surgery for benign indications. A total of 305 patients were included during the study period. These patients were divided into two groups: CTOS group (7 patients) and successful laparoscopy group (298 patients). Benign gynecological laparoscopy operation was converted to open surgery in 7 of 305 patients (2.29%) included in this study. Open surgery significantly prolonged hospital stays in patients compared to laparoscopic surgery. While wound infection was observed in 3 patients who underwent open surgery, no infection was observed in laparoscopic surgery group. Obtained results demonstrated that age, body mass index, sufficient surgical expertise, history of previous abdominal surgery and endometriosis, obstetrical status, abdomino-pelvic adhesions, and frozen pelvis did not create risk factor for CTOS in the treatment of benign cases with laparoscopic surgery. It was concluded that the conversion to open surgery is connected with technical problems instead of complication management or surgical complexity.

Effect of Dexmedetomidine on Recovery from Anesthesia in Gynecologic Laparoscopic Surgery

To evaluate the effect of dexmedetomidine on patient recovery from anesthesia in gynecologic laparoscopic surgery. A total of 74 patients who underwent gynecological laparoscopic surgery in our hospital between January 2020 and March 2022 were recruited and assigned via random method to receive either 0.6 μg/ kg of saline (observation group) or 0.6 μg/kg of dexmedetomidine (experimental group) before anesthesia induction during gynecologic laparoscopic surgery, with 37 cases in each group. Outcome measures included postoperative indices (recovery time, awakening time, orientation recovery time and extubation time), Ramsay scores, hemodynamic indices (heart rate, mean arterial pressure, pulse oximetry) at different time points and postoperative adverse events. Dexmedetomidine resulted in significantly shorter respiratory recovery time, awakening time, orientation recovery time and extubation time vs. control treatment (p<0.05). The Ramsay scores in the experimental group were significantly higher than those in the observation group (p<0.05) after treatment. Patients receiving dexmedetomidine showed lower heart rate and mean arterial pressure levels and higher pulse oximetry levels at extubation and 15 min after extubation than the controls (p<0.05). The incidence of postoperative adverse reactions in the experimental group was significantly lower than that in the observation group (p<0.05). Dexmedetomidine effectively shortens the recovery time of respiration, awakening time, recovery time of orientation and extubation time in patients undergoing gynecological laparoscopy and maintains the hemodynamic stability of the body without increasing the risk of postoperative adverse events in patients.

A study of menstrual cycle effects on pain perception, haemodynamic response to laryngoscopy, and postoperative outcome in gynaecological laparoscopy

ABSTRACT Background The physiological alterations that occur during the females’ reproductive age due to hormonal fluctuations throughout the menstrual cycle may affect the perioperative period and impact the postoperative outcome. This study evaluated the impact of menstrual cycle phases on pain perception, haemodynamic response to laryngoscopy, postoperative agitation, nausea, and vomiting in women undergoing laparoscopic gynaecological procedures. Methods This prospective observational study included 60 women who were randomly assigned to have diagnostic gynaecological laparoscopy during their menstrual cycle’s luteal or follicular phases. Patients were divided into two groups: follicular and luteal group. Preoperatively a blood sample was withdrawn for measurement of norepinephrine, estradiol, and progesterone levels. Anaesthetic techniques were standardized in both groups. In the postoperative period, another blood sample was withdrawn from all patients and sent for norepinephrine measurement. Before induction of anaesthesia, baseline HR, SBP, DBP, and MAP were measured. Then, following endotracheal intubation at 1, 3 and 5 minutes. Pain perception was assessed using Numerical Rating Scale (NRS); in response to IV cannulation, then postoperative abdominal pain and shoulder referred pain were assessed every 15 minutes till the end of 1st hour, then every 6 hours till discharge. The incidence of postoperative nausea and vomiting was recorded at the same time points of pain assessment. Postoperative agitation was assessed using Richmond Agitation-Sedation Scale (RASS). Results Women in the follicular phase showed higher postoperative pain, higher incidence of postoperative nausea, and more increase in HR and delayed return to baseline value post tracheal intubation as compared to luteal phase.

Application of enhanced recovery after surgery for patients undergoing gynecologic laparoscopy

Application of enhanced recovery after surgery for patients undergoing gynecologic laparoscopy

Driving pressure-guided ventilation improves homogeneity in lung gas distribution for gynecological laparoscopy: a randomized controlled trial

To investigate whether driving pressure–guided ventilation could contribute to a more homogeneous distribution in the lung for gynecological laparoscopy. Chinese patients were randomized, after pneumoperitoneum, to receive either positive end expiratory pressure (PEEP) of 5 cm H2O (control group), or individualized PEEP producing the lowest driving pressure (titration group). Ventilation homogeneity is quantified as the global inhomogeneity (GI) index based on electrical impedance tomography, with a lower index implying more homogeneous ventilation. The perioperative arterial oxygenation index and respiratory system mechanics were also recorded. Blood samples were collected for lung injury biomarkers including interleukin-10, neutrophil elastase, and Clara Cell protein-16. A total of 48 patients were included for analysis. We observed a significant increase in the GI index immediately after tracheal extubation compared to preinduction in the control group (p = 0.040) but not in the titration group (p = 0.279). Furthermore, the GI index was obviously lower in the titration group than in the control group [0.390 (0.066) vs 0.460 (0.074), p = 0.0012]. The oxygenation index and respiratory compliance were significantly higher in the titration group than in the control group. No significant differences in biomarkers or hemodynamics were detected between the two groups. Driving pressure–guided PEEP led to more homogeneous ventilation, as well as improved gas exchange and respiratory compliance for patients undergoing gynecological laparoscopy.Trial Registration: ClinicalTrials.gov NCT04374162; first registration on 05/05/2020.

Dexamethasone as analgesic in different types of gynecologic surgery – A literature review

Background: Dexamethasone is a glucocorticoid and is widely used for postoperative nausea and vomiting (PONV). Recent studies and subsequent guidelines also suggest a role as an analgesic. Dexamethasone as an analgesic has been studied with varying degrees of success in different types of surgery with intravenous doses ranging from 4 mg to 80 mg. The procedure specific postoperative pain management (PROSPECT) guidelines for elective cesarean sections, laparoscopic hysterectomy and oncologic breast surgery all recommend the use of dexamethasone as an analgesic in a multimodal pain regimen, however a particular dose is not mentioned. Objective: To provide a literature review of the use of dexamethasone as an analgesic and at what dosage it has been studied in elective cesarean sections, gynecological laparoscopy and oncologic breast surgery. Methods: The Embase, PubMed, and Cochrane databases were searched for randomized controlled trials published between 2000 and 2021. Results: A total of thirty-four articles were found. Fourteen about elective cesarean section, Thirteen concerning gynecologic laparoscopy and seven regarding oncologic breast surgery. Literature review demonstrated that during elective cesarean section the intravenous (IV) doses ranged from 4 mg to 16 mg. The most investigated IV dose was 8 mg, but overall studies showed conflicting results concerning pain scores and analgesic use. In gynecologic laparoscopy the IV dose ranged from 4 mg to 15mg and again 8 mg was the most frequently studied dose. The IV dose of dexamethasone in oncologic breast surgery ranged from 8 mg to 24 mg. Also in these studies the results were conflicting. In addition, dexamethasone was used as an adjunct to locoregional blocks (perineural use): the transversus abdominis block (TAP) in cesarean section, the serratus anterior plane block (SAP) and the paravertebral block (PVB) in oncologic breast surgery. Conclusion: This literature review provides an overview of the use of dexamethasone in elective cesarean section, gynecologic laparoscopic surgery and oncological breast surgery. Three routes of administration were examined: intravenous, perineural and intraperitoneal. IV 8 mg dexamethasone was the most studied dosage but there were mixed results. Based on this literature review we cannot draw any conclusions regarding the analgesic dose. Further research, with more qualitative RCT’s and systematic reviews with meta-analysis are needed.

8605 Gynecologic Laparoscopy in the Bariatric Patient: A Retrospective Review of Abdominal Access and Associated Complications

<h3>Study Objective</h3> To provide clinical direction on laparoscopic abdominal entry techniques in women with known history of laparoscopic Roux-en-Y Gastric Bypass (RYGB) undergoing gynecologic surgery and to identify any associated complications. <h3>Design</h3> Retrospective Chart Review and Case Series. <h3>Setting</h3> Community-based tertiary care medical center. <h3>Patients or Participants</h3> All patients who underwent RYGB between 2013 and 2020 and had a subsequent gynecologic procedure. <h3>Interventions</h3> Abdominal access. <h3>Measurements and Main Results</h3> Thirty-one patients were identified, of which 18 had an adnexal surgery and 13 a hysterectomy. At time of surgery, the mean age was 44 years and body mass index was 32 kg/m². The average interval time from RYGB to gynecologic surgery was 29 months. The majority of women (71%) had additional abdominal surgeries, among them 82% had prior laparotomies. Three entry sites were identified at the initial attempt to access the abdominal cavity; umbilical (71%), left upper quadrant (LUQ, 26%) and left lower quadrant (LLQ, 3%). Closed entry technique using the Veress needle was the most commonly used entry technique (68% versus 29% for optical trocar entry and 3% for open entry). There were no injuries resulting from abdominal access irrespective of the entry site or technique chosen. However, access was unsuccessful in 25% (2 out of 8) of the cases when attempted in the LUQ, resulting in conversion to alternative entry sites. <h3>Conclusion</h3> Successful and safe abdominal access in the bariatric patient can sometimes be challenging and preoperative surgical planning is essential. While no injuries during entry were reported regardless of site chosen, closed entry at the umbilicus using the Veress needle was the technique the most practiced and was associated with fewer attempts and conversions to alternative sites as compared to LUQ entry.

Comparison of Intraperitoneal Dexamethasone, Dexmedetomidine, and Dexamethasone–Dexmedetomidine Combination on Postoperative Nausea, Vomiting, and Analgesics Requirement after Gynecological Laparoscopy

Background: Female patients who undergo gynecological laparoscopic surgery are more likely to suffer from postoperative nausea and vomiting (PONV). The study aimed to probe and investigate the effectiveness of intraperitoneal administration of dexamethasone, dexmedetomidine, and combination in reducing the incidence of PONV and postoperative analgesic requirements in laparoscopic hysterectomies. Materials and Methods: One hundred ninety-two female patients undergoing laparoscopic hysterectomies were randomly assigned to four groups. Anesthesia was identical in each group. Patients in the group D1 received dexamethasone 8 mg, group D2 received dexmedetomidine 1 μg/kg, group D3 received dexamethasone 8 mg + dexmedetomidine 1 μg/kg combination, and group D4 received 20 mL normal saline intraperitoneally at the end of the surgery, before trocar removal. The primary outcome was the incidence of PONV experienced by the patients within 24-h postoperative period. Results: In the first 24 h postoperatively, the incidence of PONV was significantly reduced in D1, D2, and D3 groups compared with D4 (P = 0.001); however, there were no significant differences among the three groups. The requirement for rescue antiemetic and rescue analgesic was similar among the groups but significantly decreased compared with the control group (group D4) (P = 0.002 and P = 0.0003, respectively). Conclusion: Intraperitoneal administration of dexamethasone, dexmedetomidine, and a combination of dexamethasone–dexmedetomidine in laparoscopic hysterectomies significantly reduces both PONV and postoperative analgesics requirements compared with the control group.

The Effect of Opioid-Free Anesthesia on the Quality of Recovery After Gynecological Laparoscopy: A Prospective Randomized Controlled Trial.

PurposeOpioid-free anesthesia (OFA) is an emerging technique that eliminates intraoperative use of opioids and is associated with lower postoperative opioid consumption and reduced adverse postoperative events. The present study investigated the effect of OFA on the quality of recovery in patients undergoing gynecological laparoscopy.Patients and MethodsSeventy-five adult patients undergoing elective gynecological laparoscopy were randomly assigned to the OFA group with dexmedetomidine and lidocaine or the remifentanil-based anesthesia (RA) group with remifentanil. Patients, surgeons, and medical staff members providing postoperative care and assessing outcomes were blinded to group allocation. The anesthesiologist performing general anesthesia could not be blinded due to the different drug administration protocols by groups. The primary outcome was the quality of recovery measured using the Quality of Recovery-40 (QoR-40) questionnaire. Secondary outcomes were postoperative pain score, intraoperative and postoperative adverse events, and stress hormones levels.ResultsThe patients in both groups had comparable baseline characteristics. The QoR-40 score on postoperative day 1 was significantly higher in the OFA group than in the RA group (155.9 ± 21.2 in the RA group vs 166.9 ± 17.8 in the OFA group; mean difference: −11.0, 95% confidence interval: −20.0, −2.0; p = 0.018). The visual analog scale score at 30 min after surgery was significantly lower in the OFA group than in the RA group (6.3 ± 2.3 in the RA group vs 4.1 ± 2.1 in the OFA group; p < 0.001). The incidences of nausea and shivering in the post-anesthetic care unit were also significantly lower in the OFA group (p = 0.014 and 0.025; respectively). Epinephrine levels were significantly lower in the OFA group (p = 0.002).ConclusionOFA significantly improved the quality of recovery in patients undergoing gynecological laparoscopy.

Virtual reality and its use in post-operative pain following laparoscopy: a feasibility study

Pain following laparoscopic surgery remains a neglected healthcare issue. Virtual reality-mediated therapy’s (VRT) analgesic potential could address this. However, its effect in this setting remains unexplored. We aimed to establish the feasibility and safety of VRT as an adjunct analgesic following gynaecological laparoscopy and explore differences between active distraction and passive meditation content. 35 women were enrolled into an open crossover pilot and randomised to either intervention group 1 (active then passive content) or intervention group 2 (passive then active content) following surgery. VRT was administered in two 10-min segments with a 10-min washout period in between. Pain scores, opioid requirements and side effects were recorded before and after each segment whilst questionnaires evaluated acceptability. We observed a significant reduction in pain over time for the entire study population (F = 8.63, p < 0.0005) but no differences between intervention groups, in contrast to many studies demonstrating an increase in pain during this time. During segment one, intervention group 1 (n = 18) were administered significantly less opioid than intervention group 2 (n = 17) [0.0 (0.0–7.5) vs. 3.0(0.0–10.0), p = 0.04]. Intervention group 1 rated the VRT experience significantly higher than intervention group 2 (7.97 vs. 6.62. p = 0.017). 97.1% (n = 34) would recommend VRT to a friend and use it as the standard-of-care in future procedures. These results demonstrate that post-operative VRT is feasible and safe. However, adequately powered studies are needed to appropriately determine its efficacy.

Relationship between Preoperative Lower Back Pain and Severe Postoperative Pain after Gynecologic Laparoscopy: A Prospective Observational Study.

We hypothesized that preoperative lower back pain (LBP) may be associated with the severity of postoperative pain after gynecologic laparoscopy. This prospective observational study aimed to investigate the association between preoperative LBP and postoperative pain. We assessed the intensity of LBP before surgery and the postoperative pain after surgery. The abilities of preoperative LBP intensity, age, body mass index, and anesthetic duration time to predict moderate-to-severe postoperative pain were measured using receiver operating characteristic analysis. The data of 148 patients were analyzed. Only preoperative LBP intensity showed a significant association with moderate-to-severe postoperative pain (area under the curve, 0.71; 95% confidence interval, 0.63–0.79; p < 0.001). Preoperative LBP rated three on a numeric rating scale (NRS) had the highest combined sensitivity (75.3%) and specificity (58.3%). Patients with LBP above NRS 3 had more severe postoperative pain than those who did not (pain score 5.3 ± 2.2 vs. 3.9 ± 1.9, p < 0.001), leading to more opioid requirement in the recovery room (48.5% vs. 27.5%, p = 0.014). Preoperative LBP intensity is a useful factor for identifying patients at risk for pain after gynecologic laparoscopy.

Effect of Preoperative Oral Carbohydrate on Patients Undergoing Gynecological Laparoscopic Surgery With Different Fasting Times: A Randomized Control Study

This study aimed to investigate the effect of preoperative oral carbohydrates (POC) on patients undergoing gynecological laparoscopic surgery with different fasting times. A randomized control study. Two hundred patients were randomly divided into F group (first operation without carbohydrates intake), S group (second operation without carbohydrates intake), Fpo group (first operation with POC intake), and Spo group (second operation with POC intake). The visual analog scale (VAS) of thirst and hunger, perioperative bufferexcess (BE), electrolyte and glucose levels, as well as insulin resistance (IR) were compared. Time to first flatus, hospital stay, and eating time were also recorded. POC reduces the aggravation of thirst and hunger discomfort during the perioperative period. Abnormal perioperative BE and lactate levels were found in patients of F and S groups, while those in the Fpo and Spo groups almost returned to normal. Patients in all groups had preoperative hypokalemia, and those in the Fpo and Spo groups recovered quickly to normal intraoperatively. IR in patients in the Fpo and Spo groups retured to preoperative levels after surgery while, those in the F and S groups persisted until 48 hour postoperatively. No significant differences in postoperative nausea and vomiting, time to first flatus, time of first eating, and postoperative hospital stay were found among the four groups. POC accelerates postoperative recovery in patients undergoing gynecological laparoscopy with different fasting times.

Severe Hyponatremia and Cerebral Edema after Laparoscopic Salpingectomy, Hysteroscopy Myomectomy, and Adenomyosis Resection

Abstract The usage of hypotonic irrigation solution during hysteroscopy and laparoscopy can cause systemic fluid absorption and complications such as hyponatremia, fluid overload, and cerebral edema. Moreover, Trendelenburg position on gynecologic laparoscopy with a long duration can increase intracranial pressure and decrease cerebral perfusion pressure. A woman, 39 years old, suffered from severe hyponatremia and cerebral edema after hysteroscopy myomectomy, laparoscopic salpingectomy, adenomyosis resection, and adhesiolysis procedure. Water for injection was used as an irrigation solution during the procedure, totaling 20 L. The position of the procedure was supine, Trendelenburg, with a procedure duration of 4 h 50 min. A spontaneous respiratory trigger was not found for about 1 h during extubation. We found anisochoric pupil 5/4 mm without direct and indirect light reflex on physical examination. From the laboratory result, the sodium level was 118. Brain CT scan with contrast showed cerebral edema. Sodium correction was given using NaCl 3%, 500 mL/24 h IV drip. Sodium was corrected slowly and cautiously to prevent cerebral pontine myelinolysis. In the ICU, the sodium level was increased to a normal level. But, the light reflex was still absent, and the pupil was anisochoric. Brain MRI showed diffuse cerebral edema.

Experience and Limitations of Gynecological Laparoscopy for a Beginner in Private Practice

Introductions: Minimally invasive surgery is now the standard surgical procedure for benign gynecological diseases and plays an increasing role in their treatment. This study presents a personal series of an evaluation of the laparoscopic surgical approach. Its outcomes in the surgical treatment of patients with benign gynecological diseases. Aim: The study aimed to evaluate the outcome of gynecological laparoscopy in a low-resource setting. Method: This cross-sectional study was conducted in a private hospital in Rajshahi, Bangladesh. It is a retrospective surgical series of patients performed by the author, which analyzes (n=24) female patient treated from 2019 to December 2020. Results: A number of 24 female patients were included in this study; their mean age was 32.6 years. Among them diagnostic laparoscopy was done in 13 patients. This is mostly due to primary sub-fertility and therapeutic laparoscopy in 11 patients (2 salpingectomy for ectopic pregnancy, 3 laparoscopically assisted vaginal hysterectomy, 1 myomectomy, 1 TLH, 1 laparoscopic adhesiolysis, 2 Ovarian cystectomy, and 1 left sided salpingoophorectomy was done for ovarian cyst). 1 laparoscopic procedure for LAVH was converted to laparotomy due to excessive bleeding. 20 patients were released without incident, but post-Surgical site infection occurred in 1 patient. There was no significant difference in operative complications, blood loss, or length of hospital stay compared to conventional laparoscopic surgery reported in the literature. The perioperative complications are minimal in this personal series. In this study, laparoscopic myomectomy and laparoscopic adhesiolysis for pelvic endometriosis. It took longer to perform using this approach compared with other procedures. Conclusion: Despite having many benefits over conventional procedures, gynecological laparoscopy has several limitations, especially in a low resource-poor setting (Lack of knowledge, Popularity among patients, Higher cost, Long learning curve, Instrumental backup). This paper reported a feasible and safe surgical approach to laparoscopic surgery for gynecological diseases.

Bowel Injuries after Laparoscopic Ovarian Drilling: Observation of Three Cases with Review of Literatures

Background : Bowel injury remains a potential serious complication of gynecological laparoscopy. Electro thermal energy, especially in the form of monopolar diathermy, is used widely during Laparoscopic Ovarian Drilling (LOD) by diathermy for clomiphene-resistant polycystic ovary disease (PCOD). Occasionally there can be unrecognized transfer of energy in the operating area, resulting in electro thermal bowel injury. If iatrogenic bowel injury is not recognized at the time it occurs, it can have devastating consequences. Objectives : Through personal observations of 3 patients who underwent (LOD) for clomiphene-resistant (PCOD) followed by bowel perforation ,we highlighted their ways of presentation , recognition , avoidance and management of such complication. Setting : Surgical wards of Al-Jamhoori Teaching Hospital in Mosul City Patients and Methods : Through personal observation, we report a series of 3 infertile women who underwent laparoscopic ovarian drilling for clomiphene resistant infertility but were readmitted 2-3 days later with pinhole leaks from perforated bowel . Results : After (LOD ) ,two patients out of three were urgently explored via laparotomy and multiple bowel perforations were found and repaired. Consequently they improved .The third patient presented lately after rupture of bowel and peritonitis. Although she underwent explorative laparotomy but her condition was potentially fatal and died from sepsis. Conclusion : Gynecologists should be aware for the proper, safe and judicious use of diathermy during (LOD) to avoid complications with consultation and involvement of surgeons early following the procedure. High clinical suspicion is crucial for early diagnosis of bowel injuries. When diagnosis is delayed, then morbidity and mortality rises.

Laparoscopic gynecological surgery under minimally invasive anesthesia: a prospective cohort study

The purpose of this study is to assess the feasibility and the perioperative outcomes of laparoscopic gynecological surgery in regional anesthesia (RA) from the point of view of the surgeon, anesthesiologist and patient. This is a prospective cohort study comprising sixty-six women planned to undergo gynecologic laparoscopy surgery for benign pathology at tertiary care gynecolgical center of the University Federico II of Naples. Women were assigned, according to their preference, to either RA (Group A) or general anesthesia (GA) (Group B). Surgical, anesthesiologic and postoperative recovery data were recorded. Postoperative pain was considered as the primary outcome. Secondary outcomes included mobilization, length of hospital stay, global surgeons and patient satisfaction, intraoperative pain assessment in Group A. Immediate postoperative pain was significantly lower in Group A 0 vs 2 (p < 0.001), with no significant differences at 24 h. The secondary outcome demonstrated early patient’s mobilization (p < 0.001) as well as early discharge (p < 0.001) and greater patient’s satisfaction for the Group A. In these patients, a maximum pain score of 3 points out of 5 was recorded through the entire surgery. RA showed to decrease the impact of surgical stress and to guarantee a quicker recovery without compromising surgical results. Although several surgical approaches can be employed to treat different conditions, RA technique could be a viable option for well-selected patients affected by gynecological diseases.

Feasibility of immediate removal of urinary catheter after laparoscopic gynecological surgery for benign diseases: Ameta-analysis of randomized controlled trials.

The proper time for removing the urinary catheter after gynecologic laparoscopy is unclear. To assess the feasibility of immediate catheter removal after benign gynecologic laparoscopy. PubMed, Embase, Web of Science, Cochrane Central Register of Controlled Trials, and Wanfang Data were searched from inception to November 30, 2021. Only randomized controlled trials published in English or Chinese comparing immediate versus delayed catheter removal after gynecologic laparoscopy for benign diseases were included. The primary outcome was the incidence of postoperative urinary retention (PUR). A random effects model was used to calculate pooled relative risk (RR) and 95% confidence interval (CI). Six studies were included in this meta-analysis. There was no significant difference in PUR between immediate and delayed catheter removal (RR 1.51, 95% CI 0.37-6.18), but the evidence was of very low quality. Subgroup analysis according to the type of surgery showed a higher rate of PUR with immediate removal after hysterectomy than after other surgeries. Immediate removal was associated a lower incidence of urinary tract infection and a shorter time to mobilization compared with delayed removal. Immediate removal of the urinary catheter is feasible and beneficial after benign gynecologic laparoscopy.

The Gynecologic Laparoscopic Surgery: Experience of Center of Fertility and Reproductive Medicine at St. Paul’s Hospital Millennium Medical College

Background: Recent data suggests that up to 80% of gynecologic surgeries can be accomplished laparoscopically. However, laparoscopy does not come without risks – specifically risks of injury to the bowel, urinary tract, and vasculature. This study assesses the indications for, as well as the complications and outcomes of laparoscopic surgery at the Center of Fertility and Reproductive Medicine at St Paul’s Hospital Millennium Medical College. Methods and Materials: This is a cross sectional retrospective study using data abstracted from medical records between April 2019 to September 2020. We included all gynecologic laparoscopies done during this date range. The data was collected with Open Data Kit (ODK) software and then transferred to Microsoft Excel for analysis. We set statistical significance at P &lt;0.05. Results: There were 135 gynecologic surgeries performed, with a mean patient age of 32.4 years. About two-thirds of them presented with primary infertility, and 30% had a previous laparotomy or laparoscopy. Twenty percent had previously been diagnosed with tuberculosis. The main indication for laparoscopy was hydrosalpinx which accounted for 51.1% of surgeries. For patients who underwent surgery for a diagnosis of hydrosalpinx, the majority (54%) underwent bilateral salpingectomy. Our complication rate was 3.7% and rate of conversion to laparotomy was 5.2%. Conclusion: Our complication rate was higher than previously published laparoscopic complication rates from Asia and Europe. The majority of our complications were bladder and bowel injuries. Complications were managed predominately by conversion to laparotomy. Keywords: gynecology, laparoscopy, complications, Saint Paul’s Hospital Millennium Medical College.

Ascertaining the Effects of Tissue Sealers on Minor Laparoscopic Procedures between Obstetrics and Gynecology Residents: A Prospective Cohort Study.

Background and Objectives: The type of instrumentation used during laparoscopic surgery might impact on the learning curve of resident surgeons. The aim of this study was to investigate differences in operator satisfaction and surgical outcomes between tissue sealers and classic bipolar instruments during gynecological laparoscopies performed by residents. Materials and Methods: A prospective cohort study conducted at two tertiary university hospitals between March 2019 and March 2021, on consecutive procedures: salpingo-oophorectomies (Group 1) and salpingectomies (Group 2), subdivided according to the utilized device: radiofrequency tissue sealers (Groups A1 and A2) or bipolar forceps (Groups B1 and B2). Results: 80 procedures were included. Concerning salpingo-oophorectomies, better visibility (8.4 ± 0.8 vs. 7.3 ± 0.9; p = 0.03), reduced difficulty (5.4 ± 1.2 vs. 7.0 ± 1.4; p = 0.02), improved overall satisfaction (9.2 ± 0.4 vs. 7.6 ± 1.0; p = 0.02) and reduced procedure time (7.8 ± 3.4 vs. 12.6 ± 3.1; p = 0.01) were reported by residents using tissue sealers. Intraoperative blood loss (12.2 ± 4.7 mL vs. 33.2 ± 9.7 mL; p = 0.01) and 24 h postoperative pain (4.5 ± 1.1 vs. 5.7 ± 1.8; p = 0.03) were lower in group A1 than B1. For salpingectomies, a significant reduction in duration was found in A2 compared to B2 (7.2 ± 3.4 min vs. 13.8 ± 2.2 min; p = 0.02). Tissue sealers enhanced visibility (8.1 ± 1.1 vs. 6.7 ± 1.4; p = 0.01), difficulty (6.5 ± 1.1 vs. 7.5 ± 0.9; p = 0.04) and improved satisfaction (9.3 ± 0.5 vs. 7.5 ± 0.6; p = 0.01). Moreover, hemoglobin loss and postoperative pain were reduced in A2 relative to B2 [(8.1 ± 4.2 % vs. 4.5 ± 1.1%; p = 0.02) and (5.1 ± 0.9 vs. 4.1 ± 0.8; p = 0.03), respectively] Conclusions: The use of sealing devices by residents was related to reduced difficulty as well improved visibility and overall satisfaction, with improved surgical outcomes.