Operative Gynecologic Laparoscopy Research Articles

An audit of complications of complex operative gynaecological laparoscopy at a tertiary healthcare facility in South Africa

Background. Operative laparoscopic surgery has many advantages over traditional/open laparotomy. However, it is also associated with complications particularly when performed for complex gynaecological procedures. There are very few reports on operative laparoscopic surgery from developing countries. Objective. To evaluate the intra- and postoperative complications associated with laparoscopic surgery performed for complex gynaecological conditions by a single surgeon at a tertiary institution. Method. This was a retrospective chart review of patients who underwent complex laparoscopic surgery between 2004 and 2016. Results. We retrieved 446 patient records. Surgery for extensive endometriosis (29.8%) and laparoscopic-assisted vaginal hysterectomy (29.8%) were the most common procedures. Less than a tenth of patients (4.3%; n=19) had complications, 9 had minor injuries (4 inferior epigastric vessel injury, 1 peritoneal vessel injury, 1 omental vessel injury, 1 surface tissue bleeding and 2 cases of postoperative ileus) and 10 had major injuries (6 intestinal, 2 ureteric and 3 bladder). More than a quarter of complications (26.3%; n=5) occurred at the time of abdominal entry, 63.2% (n=12) occured intraoperatively and 10.5% (n=2) occurred postoperatively. All entry injuries were vascular. Intestinal injury was the most common intraoperative complication. Conclusion. Despite the many advantages of laparoscopic surgery, complications occur particularly in patients with complex gynaecological pathology.

Operative Gynecologic Laparoscopy in Ile-Ife, Nigeria: Preliminary Experience

Background: Operative gynecologic laparoscopy (OGL) had remained in latency in Nigeria ostensibly because of widespread lack of equipment and skilled personnel. Following the tertiary health care intervention program of the Nigerian government, video-assisted laparoscopy equipment became available in the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife, Nigeria, in 2010. Methods: OGL was commenced in OAUTHC, Ile-Ife in 2011, and prospective data began to be collected using a specifically designed instrument. An analysis of the data collected over the 12-month period from November, 2011 to October, 2012 was performed. Results: There were 51 OGLs, making up 23.7% of the 215 gynecologic surgeries over the study period. The patients' ages ranged from 20 to 50 years (mean age=32.6±6.0 years). Ten (19.6%) of the OGLs were emergencies, whereas 41 (80.4%) were elective. Twenty-eight patients (54.9%) had tubal surgery for tubal-factor infertility, whereas 6 (11.8%) had endometriosis surgery. There were 6 salpingectomies for ectopic pregnancy (11.8%), including 1 heterotopic pregnancy. Two total laparoscopic hysterectomies (3.9%) and 2 ovarian cystectomies were also performed. The duration of surgery ranged from 33 minutes to 185 minutes (mean time=79.8±42.9 minutes). Various improvisations and local adaptations were necessary in the course of 14 procedures (27.5%). There were 5 conversions to laparotomy (9.8%), all following emergency laparoscopy. The duration of hospital stay postoperatively ranged from 4 hours to 5 days (median time=6 hours). There was no postoperative morbidity or mortality. Conclusions: With basic equipment and indigenous skilled personnel, routine OGL is possible even in resource-constrained settings such as Nigeria. Health care providers, therefore, need to consider and endorse this possibility for every patient requiring gynecologic surgery. (J GYNECOL SURG 29:186)

Total laparoscopic hysterectomy: A case report from ILE-IFE, Nigeria

Total laparoscopic hysterectomy (TLH) is an advanced gynecological laparoscopic procedure that is widely performed in the developed world. However, its feasibility in resource-poor settings is hampered by obvious lack of equipments and/or skilled personnel. Indeed, TLH has never been reported from any Nigerian hospital. We present a 50-year-old multipara scheduled for hysterectomy on account of pre-malignant disease of the cervix, who had TLH with bilateral salpingo-oophorectomy in the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, southwestern Nigeria and was discharged home on the first post-operative day. She was seen in the gynecology clinic a week later in stable condition and she was highly pleased with the outcome of her surgery. This case is presented to highlight the attainability of operative gynecological laparoscopy, including advanced procedures like TLH in a resource-constrained setting, through the employment of adequate local adaptation and clever improvisation.

A Multicentre Review of Operative Gynaecological Laparoscopy and Associated Complications in Northern Ireland; 347 Cases

A Multicentre Review of Operative Gynaecological Laparoscopy and Associated Complications in Northern Ireland; 347 Cases

Nezhat's Operative Gynecologic Laparoscopy and Hysteroscopy 3rd edition

Nezhat's Operative Gynecologic Laparoscopy and Hysteroscopy 3rd edition

To compare the efficacy of two doses of intraperitoneal bupivacaine for pain relief after operative laparoscopy in gynecology

To evaluate the effect of two doses of intraperitoneal bupivacaine administration for pain relief after operative gynecological laparoscopy. Prospective randomized study. The study group comprised 52 women undergoing gynecological laparoscopic surgery. A dose of either 0.125% bupivacaine 10 ml (50 mg) or 0.25% bupivacaine (100 mg) was instilled intraperitoneally at the end of the procedure. Pain scores were recorded in the postoperative period on a scale of 0-10 at 2, 4, 6 and 8 h intervals after the surgery. Any other side effect and the time and dose of analgesia required were noted. The results were compared in the two groups. One hundred milligrams of bupivacine provided pain relief for a longer duration (8 h), as compared to 50 mg of the drug (4-6 h). This difference was statistically significant. Analgesic requirement was also less in the 100 mg group. One hundred milligrams of intraperitoneal bupivacaine is much better than 50 mg in relieving pain after laparoscopic surgery.

Major complications of operative gynecologic laparoscopy in Southern Taiwan: A follow-up study

Study objectives This follow-up study examined the major complications among 4307 operative gynecologic laparoscopies. The overall complication rate and each individual category were compared with those of our previous study period. The clinical outcome and salvage procedures were correlated with the time of recognition and the severity of initial procedures in the individual injury type. Design Retrospective, comparative study based on medical record reviewing (Canadian Task Force classification II-3). Setting Tertiary teaching hospital, Chi Mei Foundation Hospital in southern Taiwan. Patients Records of women (n = 4307) aged 40.5 ± 11.7 years (mean ± SD [95% CI 40.1–40.5]) who underwent operative gynecologic laparoscopies from January 2000 through February 2006 were reviewed in this study. The complications were compared with those of our previous study based on 1507 laparoscopies performed between December 1992 and November 1999 for follow-up comparison. Interventions Gynecologic laparoscopic surgeries. Measurements and main results Thirty-four complications occurred in 31 patients requiring repair procedures, 3 of whom had multiple complications, with an overall complication rate of 0.72% (31/4307). There were 13 bladder injuries (0.30%), 7 bowel injuries (0.16%), 3 cases of internal bleeding (0.07%), 4 vaginal stump hematomas or abscesses (0.09%), 3 ureteral injuries (0.07%), 3 major vessel injuries (0.07%), and 1 trocar site hematoma (0.02%). In addition, there were 125 (2.88%) postoperative blood transfusions without additional operative intervention. The major complication rate decreased compared with that of the previous study (0.72% [95% CI 0.51%–1.02%] vs 1.59% [95% CI 1.07%–2.36%]; p = .005). The overall complication rates were not significantly different between laparoscopic hysterectomy (LH) group and non-LH group. However, bladder injury happened more frequently in the LH group, whereas bowel injury was more common in the non-LH group. In addition, the severity of the original injury, timing of recognition, and accompanying salvage procedures correlated with the clinical outcomes. Conclusion The significantly decreased major complication rate, as compared with that of our previous study period, confirms the importance of experience accumulation and use of preventive maneuvers in reducing the complication rate. There were no significant differences among the individual injury category during these 2 study periods. The manifestations of bowel injury were highly variable and individualized. The accumulation of surgical experience with the aid of preventive maneuvers is helpful to reduce the complication rate significantly.

Operative laparoscopy in The Netherlands: Diffusion and acceptance

Objective To evaluate and update the current status of the implementation of operative laparoscopy in gynaecology in The Netherlands by assessing diffusion and acceptance of each specific procedure per hospital. Study design In 2003 a questionnaire was sent to all hospitals ( n = 102), which addressed the total number and type of laparoscopic procedures performed in 2002 stratified by level of difficulty (level 1: diagnostic laparoscopy, sterilization, tubal patency tests; level 2: adhesiolysis, ectopic pregnancy (EP), laparoscopic treatment of endometriosis, cystectomy, oophorectomy, LAVH, tubal surgery for infertility; level 3: myomectomy, total laparoscopic hysterectomy (TLH) and sacropexy). Data were compared to previously published data of 1994. Results Response rate was 79% (81/102). Diffusion and acceptance of level 2 procedures increased significantly, except endometriosis and tubal surgery for infertility. Diffusion of LAVH was only 58%. Four percent of hysterectomies were LAVH. TLH and sacropexy were not performed. The diffusion of myomectomy increased significantly ( p = 0.01), whereas its acceptance remained low. Conclusions Although the diffusion of operative procedures has increased over the last decade, acceptance is still limited, especially for laparoscopic hysterectomy. The implementation of operative gynaecological laparoscopy in The Netherlands seems to develop at a slow pace.

Preemptive analgesia installation during gynecologic laparoscopy: A randomized trial

Study objective To evaluate the efficacy of intraoperative infusion of bupivacaine solution for the relief of pain after operative gynecologic laparoscopy. Design Prospective, double-blind, randomized, controlled trial (Canadian Task Force classification I4). Setting Tertiary teaching hospital. Patients Ninety-one women aged 16 to 69 years who underwent gynecologic laparoscopic surgery from November 2002 through November 2003. Interventions Group A (n = 30): intraperitoneal infusion of a mixture of 10 mL of 0.5% bupivacaine (50 mg) with epinephrine (1:500) in 40 mL of Ringer’s lactate solution postoperatively. Group B (n = 30): the same mixture solution infusion preoperatively and postoperatively (total 100 mg bupivacaine). Group C (n = 31): placebo. Measurements and main results Shoulder tip pain (STP), abdominal parietal pain (APP), and abdominal visceral pain (AVP) were recorded on a visual analog scale at 2, 4, 8, 16, and 24 hours postoperatively. A total of 79 patients fulfilled the study criteria. The overall incidence of STP was 60.8%. Abdominal visceral pain in group B was significantly less than in group C at 2 and 4 hours postoperatively (p = .011 and p = .010, respectively). No statistically significant difference was found in length of hospital stay, postoperative meperidine consumption, or side effects. Conclusion Intraperitoneal bupivacaine administration both immediately after placement of trocars and at the end of surgery was found to be effective in reducing the intensity of AVP but not in reducing STP, APP, or postoperative analgesia consumption after nonadvanced gynecologic laparoscopic procedures. The duration of the analgesic effect of bupivacaine instilled into the peritoneal cavity did not exceed 8 hours and probably was not dose related.

Effect of bupivacaine after operative laparoscopic gynecologic procedures

Study objective To evaluate the effect of intraperitoneal installation and periportal infiltration of bupivacaine on postoperative pain and return of bowel function. Design A prospective, double-blind, randomized trial (Canadian Task Force classification I). Setting GATA School of Medicine, Department of Obstetrics and Gynecology, Reproductive Endocrinology Unit. Patients Eighty patients undergoing operative gynecologic laparoscopy. Intervention Periportal infiltration of local anesthesia with 10 mL 0.5% bupivacaine before incision and another 20 mL 0.5% bupivacaine diluted with 20 mL of saline or equal amount of physiologic saline injected into the peritoneal cavity at the end of the procedure. Measurements and main results Each patient recorded the severity of her pain on a visual analog scale (VAS) at 1, 6, 18, and 24 hours and the time of first bowel movement and first flatus after surgery. Seventy-seven patients completed the study (38 in the bupivacaine group; 39 in the control group). The severity of postoperative pain, as recorded on the VAS, was significantly less at 1, 6, 18, and 24 hours after surgery in the group receiving bupivacaine compared with those in the control group. The first bowel movement in the bupivacaine group occurred earlier than in the control group (284.80 ± 31.62 min vs 453.23 ± 33.08 min, p <.001); similarly, the first flatus occurred earlier in the bupivacaine group than in the control group (466.2 ± 29.59 min vs 658.80 ± 40.92 min p <.001). Conclusion Intraperitoneal installation and periportal infiltration of bupivacaine decrease postoperative pain and hasten the return of bowel function. Both decreased postoperative pain and shortened duration for the return of bowel function are crucial for comfort and discharge of the patient.

Intraperitoneal Ropivacaine and a Gas Drain: Effects on Postoperative Pain in Laparoscopic Surgery

Study Objective To assess the benefits of the combination of a gas drain and the instillation of local anesthetic on the incidence of pain after operative gynecologic laparoscopy. Design Randomized control trial (Canadian Task Force classification I). Setting Tertiary referral center. Patients One hundred twenty-eight patients undergoing operative gynecologic laparoscopy procedures lasting less than 105 minutes. Interventions Postoperatively, one group received a blocked drain and saline placed intraperitoneally; a second group was given a blocked drain and ropivacaine; a third group received a patent drain and saline; and a fourth was given a patent drain and ropivacaine. Measurements and Main Results Visual analogue pain scores (VAS) were measured at 1, 2, 4, and 12 hours and day 1 to day 7. Also measured was opioid consumption at 4 hours, nausea, and activity scores. We found a statistically significant improvement in pain scores at 2 and 4 hours in the group allocated to receive a patent drain and ropivacaine. Conclusion We recommend the use of a gas drain and ropivacaine to reduce postoperative pain.

Operative Gynecological Laparoscopy – Principles and Techniques

This book is a reference book in laparoscopy for advanced surgeons and beginners alike. It contains four sections, 21 chapters and a colour atlas, covering almost all the aspects of laparoscopic surgery. Like any other good surgical textbook, it has excellent illustrations. Besides, the standard chapters of ectopic pregnancy, endometriosis, ovarian cysts, myomectomy, hysterectomy etc, the book includes some of the topics, which are not available in many standard textbooks. For example, a chapter on laparoscopy in pregnant patients, risk factors have been identified and solutions are given to make the procedures safe in pregnancy. Similarly, a chapter on complilcations – the authors have stressed on need of prevention of complications. Considerable space has been devoted to newer procedures and the instruments like minilaparoscopy. This shows the trend for the future. A chapter on gynaecological malignancy is primarily for those surgeons who have already acquired mastery in standard laparoscopic surgeries and would like to do more. This book is indeed a bible for gynecological endoscopic surgery, therefore it is recommended for all hospital libraries.

Operative gynecologic laparoscopy in the elderly

Operative gynecologic laparoscopy in the elderly

Intérêt du cathétérisme urétéral en cœliochirurgie

Objective – Describe indications and procedures of ureteral retrograde catheter placement in operative laparoscopy. Assess the security that allows this technique to avoid or detect ureteral injury. Study design – A cohort study over a five year period was peformed on 1722 patients who underwent an operative gynecologic laparoscopy. Surgical technique – When presumptive evidence of ureter adhesiolysis (dense adhesions from previous surgery, endometriosis), or suspicion of iatrogenic ureter transection, laparoscopic procedure was interrupted. A cystoscopy was performed and an internalized stent was inserted. Results – In nine cases (preventive indications), patients required this procedure in adnexal surgery (dense adhesions from previous operations endometriosis), in oophorectomy for residual ovary syndrome and ovarian remnant syndrome and in hysterectomy with an intraligamentary leiomyomata. In one case (diagnostic indication), ureteral catheter placement was performed after use of an endoscopic linear stapler during a laparoscopically assisted vaginal hysterectomy. Conclusion – This intra-operative procedure can allow better ureter recognition and its safe dissection when complex operative laparoscopy is foreseen.

Major Complications of Operative Gynecologic Laparoscopy in Southern Taiwan

Study Objective To describe our experience with major complications in gynecologic laparoscopy compared with literature reports. Design Retrospective study (Canadian Task Force classification II-3). Setting Two regional teaching hospitals in southern Taiwan. Patients One thousand five hundred seven women. Intervention Gynecologic laparoscopy. Measurements and Main Results The overall number of major complications in 1507 laparoscopies was 24 (1.6%): 6 bladder injuries, 5 bowel injuries, 4 ureteral injuries, 3 cases of delayed vaginal stump bleeding, 2 cases of postoperative ileus, 2 abscesses, 1 vessel injury, and 1 umbilical hernia. Complication rates were analyzed by type of surgery—laparoscopic-assisted vaginal hysterectomy (LAVH) versus non-LAVH. We correlated clinical outcome with time of recognition and treatment of complications. Our complication rates were similar to those reported in the literature and were not significantly different between LAVH and non-LAVH. Conclusion Early recognition of injuries, preferably intraoperatively, with immediate appropriate treatment is crucial. It is also important to be alert to early manifestations of complications in the postoperative observation period.

Surgical Complications of Diagnostic and Operative Gynaecological Laparoscopy: A Series of 29,966 Cases

No AccessJournal of UrologyUrological Survey: Abstracts: Urolithiasis, Endourology and Laparoscopic Surgery1 May 1999Surgical Complications of Diagnostic and Operative Gynaecological Laparoscopy: A Series of 29,966 Cases C. Chapron, D. Querleu, M.A. Bruhat, P. Madelenat, H. Fernandez, F. Pierre, and J.B. Dubuisson C. ChapronC. Chapron More articles by this author , D. QuerleuD. Querleu More articles by this author , M.A. BruhatM.A. Bruhat More articles by this author , P. MadelenatP. Madelenat More articles by this author , H. FernandezH. Fernandez More articles by this author , F. PierreF. Pierre More articles by this author , and J.B. DubuissonJ.B. Dubuisson More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(05)69047-7AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Surgical Complications of Diagnostic and Operative Gynaecological Laparoscopy: A Series of 29,966 Cases." The Journal of Urology, 161(5), p. 1734 Service de Chirurgie Gynecologique, Clinique Universitaire Baudelocque, CHU Cochin Port-Royal, Paris, France© 1999 by American Urological Association, Inc.FiguresReferencesRelatedDetails Volume 161Issue 5May 1999Page: 1734 Advertisement Copyright & Permissions© 1999 by American Urological Association, Inc.MetricsAuthor Information C. Chapron More articles by this author D. Querleu More articles by this author M.A. Bruhat More articles by this author P. Madelenat More articles by this author H. Fernandez More articles by this author F. Pierre More articles by this author J.B. Dubuisson More articles by this author Expand All Advertisement PDF downloadLoading ...

Surgical Complications of Diagnostic and Operative Gynaecological Laparoscopy

Surgical Complications of Diagnostic and Operative Gynaecological Laparoscopy

Ureteral Complications With Operative Gynecologic Laparoscopy

Ureteral Complications With Operative Gynecologic Laparoscopy

Ureteral Complications With Operative Gynecologic Laparoscopy

Abstract OBJECTIVE: The study assessed the incidence, diagnosis, management, and causes of ureteral injuries during major laparoscopic operations at our department in a 6-year period. STUDY DESIGN: The study was a chart review of 790 consecutive major laparoscopic procedures in 711 patients (mean age 37.4 ± 11.6 years, mean weight 64.3 ± 29.1 kg). RESULTS: There were four ureteral complications in three patients during or after laparoscopic operations: three of 711 patients (0.42%) and four of 790 procedures (0.38%). All three ureteral complications (one transection and a total of three ureterovaginal fistulas in two patients) occurred during laparoscopically assisted vaginal hysterectomies, for an incidence of 4.3%. There were no ureteral injuries in 291 salpingo-oophorectomies, 414 ovarian cystectomies, and 15 colposuspensions. Both delayed ureteral complications occurred in the lower segment of the ureter after laparoscopic bipolar coagulation and division of the cardinal ligament. CONCLUSION: We conclude that in laparoscopic surgery the ureter is most at risk when the cardinal ligament is dissected and divided below the uterine vessels. (Am J Obstet Gynecol 1998;178:967-70.)

Hemodynamic and hormonal changes during pneumoperitoneum and trendelenburg positioning for operative gynecologic laparoscopy surgery

Objective: The number and types of surgical procedures being preformed using laparoscopic technique is increasing due to technological advances. Recent studies suggest the carbon dioxide pneumoperitoneum and patient positioning causes hemodynamic alterations, respiratory acidosis, and a release of stress hormones. However, to date, no studies have investigated the physiological effect of laparoscopic procedures lasting more than 60 minutes on the stress response and the effect of Trendelenburg positioning. The purpose of this study was to identify the physiological effect of pneumoperitoneum and positioning during prolonged laparoscopy on hemodynamic (cardiac index, mean arterial pressure, heart rate, systemic vascular resistance, and stroke volume), metabolic (arterial blood gases), and hormone (arginine vasopressin, aldosterone, and plasma renin activity) parameters. We hypothesized that pneumoperitoneum and patient positioning will alter the hemodynamic, hormone, and metabolic parameters. Methods: The study was longitudinal in design and sampled a total of 31 healthy subjects having a gynecologic oncologic laparoscopic procedure at Hurley Medical Center, Flint, Michigan. The subjects were randomly assigned one of three groups receiving an initial insufflation pressure of either 10, 15, or 18 mmHg. After obtaining informed consent hemodynamic, metabolic, and hormone measurements were obtained at the following times: 1) pre-induction, 2) post-induction, 3) post-insufflation, 4) post-Trendelenburg 5 minutes and at 30, 60, 90, and 120 minutes post-insufflation. The results were analyzed using multivariate analysis of variance for repeated measures with a P < .05. A power of 0.9 was obtained to identify changes over time. Results: During the time course of the study the hemodynamic, metabolic, and hormonal parameters showed significant alterations. The most dramatic hemodynamic changes occurred post-insufflation characterized by a decrease in cardiac index and stroke volume with a concurrent increase in systemic vascular resistance. The metabolic parameters showed a significant decrease in pH and corresponding increase in Pa co 2. However, the pH and Pa co 2 remained within normal limits through the study. As part of the study’s protocol the investigators increased minute volume to control for a rise in Pa co 2 during the procedure. A significant increase was noted in aldosterone and arginine vasopressin at post-insufflation and Trendelenburg positioning. Plasma renin activity showed a dramatic increase following post-insufflation. None of the subjects developed any post anesthetic complications. Conclusion: Our study demonstrated that pneumoperitoneum and Trendelenburg positioning cause statistically significant elevations in the stress hormones and concurrently cause a decrease in hemodynamic parameters. A healthy patient may tolerate these changes but a patient with cardiovascular disease or pulmonary problems may not be able to compensate as efficiently.