Laparoscopic Open Surgery 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.

Systematic review of patient-specific pre-operative predictors of pain improvement to endometriosis surgery.

SummaryBackgroundUp to 28% of endometriosis patients do not get pain relief from therapeutic laparoscopy but this subgroup is not defined.ObjectivesTo identify any prognostic patient-specific factors (such as but not limited to patients’ type or location of endometriosis, sociodemographics and lifestyle) associated with a clinically meaningful reduction in post-surgical pain response to operative laparoscopic surgery for endometriosis.Search strategyPubMed, Cochrane and Embase databases were searched from inception to 19 May 2020 without language restrictions. Backward and forward citation tracking was used.Selection criteria, data collection and analysis:Cohort studies reporting prognostic factors, along with scores for domains of pain associated with endometriosis before and after surgery, were included. Studies that compared surgeries, or laboratory tests, or outcomes without stratification were excluded. Results were synthesised but variation in study designs and inconsistency of outcome reporting precluded us from doing a meta-analysis.Main resultsFive studies were included. Quality assessment using the Newcastle–Ottawa scale graded three studies as high, one as moderate and one as having a low risk of bias. Four of five included studies separately reported that a relationship exists between more severe endometriosis and stronger pain relief from laparoscopic surgery.ConclusionCurrently, there are few studies of appropriate quality to answer the research question. We recommend future studies report core outcome sets to enable meta-analysis.Lay summaryEndometriosis is a painful condition caused by displaced cells from the lining of the womb, causing inflammation and scarring inside the body. It affects 6–10% of women and there is no permanent cure. Medical and laparoscopic surgical treatments are available, but about 28% of patients do not get the hoped-for pain relief after surgery. Currently, there is no way of predicting who gets better and who does not. We systematically searched the world literature to establish who may get better, in order to improve counselling when women choose treatment options. We identified five studies of variable quality showing: More complex disease (in specialist hands) responds better to surgery than less, but more studies needed.

Effect of local infiltration with oxytocin on hemodynamic response to surgical incision and postoperative pain in patients having open laparoscopic surgery under general anesthesia.

Preemptive analgesia encompasses different perioperative interventions that have the final aim of decreasing postoperative pain and improving recovery. Recently, peripheral analgesic effects of oxytocinergic modulation have been suggested. In this regard, we tested the potential analgesic effects of subcutaneous oxytocin (OT) infiltration in patients submitted to laparoscopic cholecystectomy. Thirty patients with similar general characteristics and medical physical conditions were evaluated. The patients were assigned by simple random selection to one of three groups: (a) OT group (n=10), which received preincisional subcutaneous OT (4µg/4 ml saline) in the surgical sites for trocar placements; (b) Lidocaine group (n=10), which received subcutaneous lidocaine 1% (4ml) in the surgical sites; and (c) Control group (n=10), which did not receive any treatment. Then we measured the effect of those treatments on the hemodynamic variations produced as responses to the surgical incisions and trocar insertions (open port placements using the Hasson technique). Moreover, we assessed the intensity of postoperative pain with the visual analogue scale during recovery and 24hr after surgery. Hemodynamic parameters were stable in both intervention groups (subcutaneous OT and lidocaine) during the surgical incisions and trocar placements, whereas a most likely sympathetic activation due to trocar insertions (open port placements) was not blunted in the placebo group. Furthermore, postoperative pain was diminished in both OT and lidocaine groups when compared to the control group. Preincisional subcutaneous OT administration reduced the hemodynamic response produced by the latter. Furthermore, OT also diminished postoperative pain.

Comparison of clinical curative effects between laparoscopic and traditional open surgery for the treatment of rectal cancer

Objective To investigate and compare the clinical efficacy and safety of laparoscopic and traditional open surgery in the rectal cancer surgery. Methods From March 2007 to February 2013, 86 patients with radical resection of rectal carcinoma in General Surgery Department of Pinggu District Hospital of Beijing were selected as research objects, according to random number table method, they were divided into laparoscopic group(n=43) and laparotomy group(n=43). The laparoscopic group was given laparoscopic radical resection of rectal cancer, the laparotomy group was given traditional open surgery.The baseline data, operative incision length, intraoperative blood loss, operative time, postoperative hospital stay, total number of lymph nodes cleaning, exhaust time, time to get out of bed, hospitalization expenses, VAS score and postoperative complications between the two groups were observed and compared.And the survival rates of the two groups were compared. Results .The operative incision length of laparoscopic group was shorter than laparotomy group((4.20±1.15) cm vs.(16.53±4.62) cm), the intraoperative blood loss was less than laparotomy group((167.43±16.24) ml vs.(220.74±22.53) ml), postoperative hospital stay, exhaust time, time to get out of bed were shorter than laparotomy group((8.26±2.09) d vs.(13.52±2.97) d, (3.24±1.42) d vs.(4.23±1.60) d, (3.07±0.84) d vs.(4.23±1.29) d), the hospitalization expenses was higher than laparotomy group(all P 0.05). The 5 year overall survival rate of laparoscopic group was 52.6%, the laparotomy group was 47.4%, there was no significant difference between the two groups(χ2=0.465, P>0.05). Conclusion The clinical efficacy of laparoscopic and traditional open surgery in the rectal cancer surgery are the same, and laparoscopic radical surgery is safe and effective, it has the advantages of less trauma, less complications and quick recovery, is worth popularizing. Key words: Laparoscope; Traditional open surgery; Rectal cancer; Clinical efficacy; Complication

Methods for specimen removal from the peritoneal cavity after laparoscopic excision

Key content Mini laparotomy (suprapubic, transumbilical, ancillary port‐site) and posterior colpotomy are methods that have been used for the removal of specimens excised laparoscopically, with the use of morcellators and endoscopic bags growing in popularity in recent years. The size, cystic versus solid component and the risk of malignancy are essential factors influencing the route of specimen retrieval. The risk of spillage (especially in suspected early malignancy) has to be considered during excision and retrieval. Natural orifice transluminal endoscopy (NOTES) may be the operative and retrieval route of the future. Learning objectives To be aware of the different methods and routes of retrieving laparoscopically excised specimens. To be aware of the risks associated with each method and route. To review the factors that will influence the optimal choice of route and method. Ethical issues In the age of specialisation, a clinician who is not specially trained in operative laparoscopic surgery should not be practicing it. To minimise complications, the excision and retrieval of specimens via minimally invasive incisions should be limited to specially trained individuals.

Effect of body habitus and parity on insufflated CO 2 volume at various intraabdominal pressures during laparoscopic access in women

Study objective To determine height, weight, body mass index (BMI), parity, and age effect on the volume of CO 2 pneumoperitoneum during laparoscopic access in women. Design Prospective observational cohort study (Canadian Task Force classification II-1). Setting University-affiliated teaching hospital. Patients From January through June 2004, 100 healthy women underwent operative laparoscopic surgery consecutively by the senior author (GAV). Indications were: chronic pelvic pain (CPP, n = 66), pelvic mass (n = 7), CPP and pelvic mass (n = 4), infertility (n = 23). Median (range) height, weight, BMI, parity and age were 1.65 m (1.45–1.85m), 70 kg (43–118 kg), 25.5 kg/m 2 (17–39 kg/m 2), 1.1 (0–5), and 34 years (19–58 years), respectively. Interventions While in supine position, patients received general endotracheal anesthesia and muscle relaxants. Pneumoperitoneum was established by reusable Veres needle. The insufflated CO 2 volume was serially recorded at intraperitoneal insufflation pressures (IPIPs) of 10, 15, 20, 25, and 30 mm Hg. The primary 10-mm trocar was introduced at IPIP of 30 mm Hg. Upon entering the peritoneal cavity, the abdominal contents were visualized with the laparoscope to ensure there was no injury, and the IPIP was immediately reduced back to the operating pressure of 15 mm Hg before switching the patient to the Trendelenburg position. Measurements and main results The mean (SD) insufflated CO 2 volumes at 10, 15, 20, 25, and 30 mm Hg were 1.7 (0.74) L, 3.1 (0.9) L, 3.96 (1.05) L, 4.42 (1.1) L and 4.72 (1.14) L, respectively. Using multivariate analysis, we demonstrated that at 20 to 30 mm Hg the insufflated CO 2 volume correlated positively with the height, weight and BMI of women. Parity correlated positively at all pressures. There was no correlation with age at any pressure. Conclusions Higher CO 2 volume is required to establish appropriate pneumoperitoneum in tall, overweight, and parous women at 20 to 30 mm Hg. Setting the IPIP at 20 to 30 mm Hg before primary trocar insertion eliminates the need to monitor CO 2 insufflated volume regardless of women’s age, parity, and body habitus.

Energy Sources for Laparoscopic Colectomy: A Prospective Randomized Comparison of Conventional Electrosurgery, Bipolar Computer-Controlled Electrosurgery and Ultrasonic Dissection. Operative Outcome and Costs Analysis

The development of operative laparoscopic surgery is linked to advances in ancillary surgical instrumentation. Ultrasonic energy devices avoid the use of electricity and provide effective control of small- to medium-sized vessels. Bipolar computer-controlled electrosurgical technology eliminates the disadvantages of electrical energy, and a mechanical blade adds a cutting action. This instrument can provide effective hemostasis of large vessels up to 7 mm. Such devices significantly increase the cost of laparoscopic procedures, however, and the amount of evidence-based information on this topic is surprisingly scarce. This study compared the effectiveness of three different energy sources on the laparoscopic performance of a left colectomy. The trial included 38 nonselected patients with a disease of the colon requiring an elective segmental left-sided colon resection. Patients were preoperatively randomized into three groups. Group I had electrosurgery; vascular dissection was performed entirely with an electrosurgery generator, and vessels were controlled with clips. Group II underwent computer-controlled bipolar electrosurgery; vascular and mesocolon section was completed by using the 10-mm Ligasure device alone. In group III, 5-mm ultrasonic shears (Harmonic Scalpel) were used for bowel dissection, vascular pedicle dissection, and mesocolon transection. The mesenteric vessel pedicle was controlled with an endostapler. Demographics (age, sex, body mass index, comorbidity, previous surgery and diagnoses requiring surgery) were recorded, as were surgical details (operative time, conversion, blood loss), additional disposable instruments (number of trocars, EndoGIA charges, and clip appliers), and clinical outcome. Intraoperative economic costs were also evaluated. End points of the trial were operative time and intraoperative blood loss, and an intention-to-treat principle was followed. The three groups were well matched for demographic and pathologic features. Surgical time was significantly longer in patients operated on with conventional electrosurgery vs the Harmonic Scalpel or computed-based bipolar energy devices. This finding correlated with a significant reduction in intraoperative blood loss. Conversion to other endoscopic techniques was more frequent in Group I; however, conversion to open surgery was similar in all three groups. No intraoperative accident related to the use of the specific device was observed in any group. Immediate outcome was similar in the three groups, without differences in morbidity, mortality, or hospital stay. Analysis of operative costs showed no significant differences between the three groups. High-energy power sources specifically adapted for endoscopic surgery reduce operative time and blood loss and may be considered cost-effective when left colectomy is used as a model.

Lasers in the surgical management of endometriosis

Endometriosis affects millions worldwide. Its symptoms include non-cyclical pelvic pain, dysmenorrhoea, dyspareunia and subfertility. The diagnosis is made by laparoscopy, and operative laparoscopic surgery for endometriosis is also possible. As well as conventional laparoscopic techniques, lasers have been used in laparoscopic surgery for the past two decades. The main advantages of lasers are that they allow surgeons to perform operative surgery via the minimally invasive approach of laparoscopy, the operation is largely bloodless, the injury to the surrounding tissue is highly controllable and postoperative adhesion formation has been shown to be no greater than with conventional methods. The CO 2 laser is the most precise laser for the division of adhesions and the accurate and safe vapourization of deposits of endometriosis. Several types of operative procedure to treat endometriosis have been carried out with the CO 2 laser laparoscope. This article provides an overview of laser physics, the effects on the tissues, the clinical use of lasers, the appearance of endometriotic lesions and the management of endometriosis of the peritoneum, ovary, rectovagina, ureter and bladder by laser laparoscopic techniques.

A prospective randomized trial of closing laparoscopic trocar wounds by transcutaneous versus subcuticular suture or adhesive papertape

Several methods for closure of trocar wounds are known in laparoscopic surgery. The choice of technique (mostly transcutaneous or subcuticular suture or adhesive papertape) is often based on the surgeon's personal experience. Thus, the objective of this trial was to assess the impact of these closure methods on potential complications of wound healing, cosmetic outcome, and patient satisfaction. Sixty patients undergoing operative laparoscopic surgery for gynecologic indications were enrolled in this prospective randomized trial. Five-millimeter port-site incisions were closed either with subcuticular or transcutaneous absorbable sutures (4-0 polyglactin 910) or with adhesive papertape. Postoperative complications, pain, and patient satisfaction with scars were evaluated at 3-month follow-up after operation using a questionnaire. Data from 52 patients who returned the questionnaire were analyzed. Dissatisfying cosmetic results were reported significantly more frequently after subcuticular sutures (p < 0.05). Assessment of patient satisfaction with cosmetic outcome on a visual-analogue scale revealed significantly better results after transcutaneous skin closure than with other approaches (p < 0.05). Adverse wound healing (e.g., infections and dehiscence) was observed most frequently in the subcuticular suture group. Also, the rate of painful scars was highest with this technique. Transcutaneous closure with absorbable suture material seems to be the most suitable technique for closure of laparoscopic port-site incisions.

A prospective randomized trial of closing laparoscopic trocar wounds by transcutaneous versus subcuticular suture or adhesive papertape

Several methods for closure of trocar wounds are known in laparoscopic surgery. The choice of technique (mostly transcutaneous or subcuticular suture or adhesive papertape) is often based on the surgeon’s personal experience. Thus, the objective of this trial was to assess the impact of these closure methods on potential complications of wound healing, cosmetic outcome, and patient satisfaction. Sixty patients undergoing operative laparoscopic surgery for gynecologic indications were enrolled in this prospective randomized trial. Five-millimeter port-site incisions were closed either with subcuticular or transcutaneous absorbable sutures (4–0 polyglactin 910) or with adhesive papertape. Postoperative complications, pain, and patient satisfaction with scars were evaluated at 3-month follow-up after operation using a questionnaire. Data from 52 patients who returned the questionnaire were analyzed. Dissatisfying cosmetic results were reported significantly more frequently after subcuticular sutures (p < 0.05). Assessment of patient satisfaction with cosmetic outcome on a visual–analogue scale revealed significantly better results after transcutaneous skin closure than with other approaches (p < 0.05). Adverse wound healing (e.g., infections and dehiscence) was observed most frequently in the subcuticular suture group. Also, the rate of painful scars was highest with this technique. Transcutaneous closure with absorbable suture material seems to be the most suitable technique for closure of laparoscopic port-site incisions.

Laparoscopy in pediatric urology.

Laparoscopic surgery in pediatric urology is beginning to accelerate in its application and this has been reflected in increasing series of progressively more complex procedures. To review these, and assess the character of this evolution, articles dealing with diagnostic and operative laparoscopic surgery from mid 2002 to late 2003 have been reviewed. Several important trends can be seen, including the emergence of increasing numbers of multi-center studies, comparative assessments between properly matched open procedures, as well as comparisons between various laparoscopic techniques. The role of diagnostic laparoscopy in cryptorchidism seems well established, although attempts at being more selective in its application have been published. Operative procedures are being performed to include not only simple removal of tissues, but also reconstructive procedures such as pyeloplasty in more than anecdotal numbers. A strong emphasis has been placed on retroperitoneal access, which is inherently more attractive, but the challenges of this technique are evident. Ultimately it should become more efficient with experience. There has been a steady and progressively more widespread application of laparoscopic techniques in pediatric urology, which has been somewhat slow to develop compared with adult laparoscopy. It seems likely that this progression will continue to accelerate.

Bladder Injury During Laparoscopic Surgery

The objective of this review is to present the incidence of iatrogenic bladder injury associated with diagnostic and/or operative laparoscopic surgery; to determine the type of primary laparoscopic operation, the time at which the reported injuries occurred, the location of injuries, and the method(s) used to repair those injuries; to decide which laparoscopic procedure carries the highest risk for bladder injury; and to establish the most frequent surgical instruments with which injuries happened. World literature published between 1970 and 1996 was reviewed. The appropriate Medical Subject Heading (MeSH) terms were selected and used in a search of the MEDLINE, ACOGNET, OVID Compact Disk Version database. A total of 1372 articles on laparoscopic surgery complications were reviewed. Of that number, a total of 77 articles identified bladder injuries, and these were analyzed for the objectives of this study. There are a wide range of bladder injuries during laparoscopic procedures. In the studied articles, the incidence of bladder injury during laparoscopic procedures ranged from 0.02 to 8.3 percent of cases. Most frequently, these injuries occurred during laparoscopic-assisted vaginal hysterectomy. Sharp electrosurgical dissection was the leading instrument causing injury. An intraoperative diagnosis of bladder injury was made in 53.24 percent of all bladder injury cases. The bladder dome was the most commonly injured structure. Less than half (29.87 percent) of the bladder injuries were corrected laparoscopically.

Intraperitoneal bupivacaine vs. tramadol for pain relief following day case laparoscopic surgery

ObjectivesTo record the severity of pain following operative laparoscopic surgery and to assess the effectiveness of either intraperitoneal infusion of bupivacaine or intravenous tramadol for postoperative pain relief.DesignA prospective randomized study.SettingGynaecologic Endoscopy Unit, Assiut University Hospital, Assiut, Egypt.Subjects90 patients undergoing day case laparoscopic surgery where a standard anaesthetic technique was used.InterventionsPatients were randomly allocated to one of three groups according to the analgesia provided in the postoperative period. Group B received intraperitoneal bupivacaine (20 ml, 0.25%) through the laparoscopic cannula and another 5 ml which was injected around the incision sites. Group T received intravenous tramadol hydrochloride slowly in a dose of 2 mg/kg, after the end of the procedure and group P received placebo saline, 20 ml intraperitoneally and 5 ml at the incision sites, and a placebo saline 2‐ml intravenous injection.Main outcome measuresEach patient recorded the site of pain, and its severity using a 4‐point verbal rating scale (0 = no pain to 3 = severe pain), at 30, 60, 120 and 240 min postoperatively. We also recorded the maximum pain score, the need for fentanyl and the time to first analgesia in minutes. The suitability for same‐ or next‐day discharge was also assessed in all patients.ResultsThe trial showed a statistically significant reduction in pain scores up to 4 h postoperatively in groups T and B compared with group P (P &lt; 0.05). Also, the time to first analgesia was prolonged and there was less need for fentanyl and earlier discharge in groups T and B.ConclusionsWe concluded that both of the analgesic regimens used were satisfactory, but intraperitoneal bupivacaine showed better analgesic outcomes and is a useful contribution to analgesia in the immediate postoperative period after day‐case laparoscopic surgery.

Bladder injury during laparoscopic surgery.

The objective of this review is to present the incidence of latrogenic bladder injury associated with diagnostic and/or operative laparoscopic surgery; to determine the type of primary laparoscopic operation, the time at which the reported injuries occurred, the location of injuries, and the method(s) used to repair those injuries; to decide which laparoscopic procedure carries the highest risk for bladder injury; and to establish the most frequent surgical instruments with which injuries happened. World literature published between 1970 and 1996 was reviewed. The appropriate Medical Subject Heading (MeSH) terms were selected and used in a search of the MEDLINE, ACOGNET, OVID Compact Disk Version database. A total of 1372 articles on laparoscopic surgery complications were reviewed. Of that number, a total of 77 articles identified bladder injuries, and these were analyzed for the objectives of this study. There are a wide range of bladder injuries during laparoscopic procedures. In the studied articles, the incidence of bladder injury during laparoscopic procedures ranged from 0.02 to 8.3 percent of cases. Most frequently, these injuries occurred during laparoscopic-assisted vaginal hysterectomy. Sharp electrosurgical dissection was the leading instrument causing injury. An intraoperative diagnosis of bladder injury was made in 53.24 percent of all bladder injury cases. The bladder dome was the most commonly injured structure. Less than half (29.87 percent) of the bladder injuries were corrected laparoscopically.

Operative laparoscopy for management of ectopic pregnancy in patients with hypovolemic shock

To determine the safety of operative laparoscopy in the management of ectopic pregnancy in women with hypovolemic shock. Retrospective chart review. University-affiliated hospital. Two hundred eleven women with tubal pregnancy, of whom 33 were suffering from hypovolemic shock, based on a combination of signs and symptoms including hypotension, tachycardia, anxiety, thirst, tachypnea, and slow capillary refill. Laparoscopic surgery. Mean +/- SEM intraabdominal blood loss was significantly (p <0.01) higher in women with hypovolemic shock, 1369 +/- 149 versus 114 +/- 14 ml. Blood transfusions were given to 88% and 0.5%, respectively (p <0. 01). Laparoscopic salpingectomy was performed in all hemodynamically compromised women compared with 87% of stable women. Conversion to laparotomy was required in three patients in the hypovolemic shock group and five in the stable group. All patients had an uncomplicated postoperative course and made a full recovery. The availability of optimal anesthesia and advanced cardiovascular monitoring, and the ability to convert rapidly to laparotomy if required, allow safe performance of operative laparoscopic surgery in most women in hypovolemic shock. In fact, the superior exposure of laparoscopy, providing rapid diagnosis and control of the source of bleeding, makes it a highly suitable approach.

Is operative laparascopy contraindicated in women with ectopic pregnancy and hypovolemic shock?

We evaluated the safety of operative laparoscopy for the management of ectopic pregnancy in 119 women with hypovolemic shock. In 19 (16.0%) of these women hypovolemic shock was based on a combination of signs and symptoms including hypotension, tachycardia, anxiety, thirst, tachypnea, and slow capillary refill. The table below presents the results (mean &plusmn; SEM; ap <0.01). One case in each group was converted to laparotomy, and all patients made full recovery. Laparoscopy allows rapid diagnosis and control of the source of bleeding, making it highly suitable for the surgical management of a ruptured ectopic pregnancy. The availability of appropriate anesthesia and advanced cardiovascular monitoring, and ability to convert rapidly to a laparotomy if necessary, allow safe performance of operative laparoscopic surgery in women with hypovolemic shock.

Operative laparoscopic management of adnexal cysts: initial experience at the Royal Women's Hospital 1991-1994.

The introduction of operative laparoscopic surgery for benign adnexal cysts had led to shorter postoperative hospitalization (mean stay of 2.0 days) in association with a low rate of major complications (1.6%). A planned laparoscopic approach was successful in 95.2% (179/188) of patients. The majority of women were premenopausal (93.6%) and the most common procedure performed was an ovarian cystectomy (73.5% of cysts). Three ovarian cysts that were thought to be benign by preoperative and intraoperative assessment were subsequently found to be ovarian tumours of low malignant potential after histological examination. Operative laparoscopy has become the preferred mode of treatment for benign adnexal cysts at the Royal Women's Hospital. It confers a wide range of benefits to patients, reduces health-care costs and appears to be a safe and effective treatment modality.

Home-made videoscopic trainer for operative laparoscopic surgery.

The author has used this home made videoscopic trainer for more than 12 months and found it very helpful and practical for refining laparoscopic skills. It is strongly recommended to all surgeons and trainees embarking on laparoscopic work.

Simple equipment to facilitate operative laparoscopic surgery (or how to avoid a spaghetti junction).

BJOG: An International Journal of Obstetrics & GynaecologyVolume 102, Issue 6 p. 495-497 Simple equipment to facilitate operative laparoscopic surgery (or how to avoid a spaghetti junction) Paul Curtis, Paul Curtis Lecturer Consultant Minimally Invasive Therapy Unit, Royal Free Hospital, LondonSearch for more papers by this authorNikolaos Bournas, Nikolaos Bournas Research Fellow Consultant Minimally Invasive Therapy Unit, Royal Free Hospital, LondonSearch for more papers by this authorAdam Magos, Corresponding Author Adam Magos Consultant Minimally Invasive Therapy Unit, Royal Free Hospital, LondonCorrespondence: Mr A. Magos, Minimally Invasive Therapy Unit, Royal Free Hospital, University Department of Obstetrics and Gynaecology, London NW3 2QG, UK.Search for more papers by this author Paul Curtis, Paul Curtis Lecturer Consultant Minimally Invasive Therapy Unit, Royal Free Hospital, LondonSearch for more papers by this authorNikolaos Bournas, Nikolaos Bournas Research Fellow Consultant Minimally Invasive Therapy Unit, Royal Free Hospital, LondonSearch for more papers by this authorAdam Magos, Corresponding Author Adam Magos Consultant Minimally Invasive Therapy Unit, Royal Free Hospital, LondonCorrespondence: Mr A. Magos, Minimally Invasive Therapy Unit, Royal Free Hospital, University Department of Obstetrics and Gynaecology, London NW3 2QG, UK.Search for more papers by this author First published: June 1995 https://doi.org/10.1111/j.1471-0528.1995.tb11327.xCitations: 3Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Citing Literature Volume102, Issue6June 1995Pages 495-497 RelatedInformation

Laparoscopic Management of Interstitial Pregnancy

Abstract Background: Interstitial pregnancy (IP) accounts for two to four percent of all ectopic pregnancies. There have been two accepted surgical methods of treatment for IP in the past; either cornual resection or hysterectomy. Recently, less radical surgery by means of hysterotomy or laparoscopic excision has been described. Cases: We report here three cases of unruptured interstitial pregnancy and describe a new laparoscopic technique for the conservative management of IP. The elements of the technique are: infiltration with vasopressor solution, sharp incision of the myometrium, and healing by secondary intention. Conclusion: Our study suggests that the principles of operative laparoscopic surgery may be applied, as one would for a linear salpingotomy, to properly selected patients with unruptured interstitial pregnancies with consistency and safety. This needs to be confirmed in subsequent studies. Introduction: Les grossesses interstitielles (GI) représentent 2 à 4 pour 100 des grossesses ectopiques. Deux méthodes de traitement chirurgical étaient acceptées jusqu’ici en cas de GI: la résection de la corne utérine et l’hystérectomie. On a décrit récemment des méthodes chirurgicales moins radicales: l’hystérotomie et l’excision laparoscopique. Cas: Les auteurs rapportent ici trois cas de grossesses interstitielles sans rupture et décrivent une nouvelle technique laparoscopique conservatrice pour le traitement des GI. Les éléments de la technique sont les suivants: infiltration par une solution de vasopresseur, incision du myomètre et cicatrisation par deuxième intention. Conclusion: L’étude suggère qu’il est possible d’appliquer les principes de la chirurgie laparoscopique, comme pour une salpingotomie linéaire, à des patientes sélectionnées avec soin présentant une grossesse interstitielle sans rupture, de manière constante et en toute sécurité. D’autres études seront nécessaires pour le confirmer.