A different technique in gasless, laparoendoscopic, single-site myomectomy.
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ABSTRACT: Background
The aim of this study was to introduce a novel technique for gasless, laparoendoscopic, single-site (GLESS) myomectomy and to evaluate its feasibility and safety.Methods
A retrospective observational study was performed at a hospital from Sep 2017 to Nov 2018. 15 patients with symptomatic subserosal or intramural myomas underwent GLESS myomectomy.Results
The mean age and body mass index were 41.73 ± 8.58 years and 22.72 ± 2.27 kg/m2, respectively. 5 patients had a history of abdominal surgery, including four caesarean deliveries and one myomectomy. The mean operative duration, blood loss volume, time to specimen removal, time of bowel activity and postoperative hospitalization duration were 156.47 ± 62.19 min, 57.33 ± 72.35 ml, 29.87 ± 13.6 min, 27.67 ± 10.06 h, and 3.4 ± 0.74 days, respectively. The operation was successful in all patients, there were no surgical or wound complications in any patient, and the histopathological result was leiomyoma in all 15 patients.Conclusion
The procedure is feasible and safe in selected patients with symptomatic myomas.
SUBMITTER: Jin G
PROVIDER: S-EPMC8437916 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:BackgroundThis study sought to compare the surgical results of patients undergoing a laparoendoscopic single-site myomectomy (LESS-M) and a conventional laparoscopic myomectomy (CLM) at our hospital.MethodsThe basic data of 233 patients undergoing LESS-M and 233 patients undergoing CLM at the Obstetrics and Gynecology Hospital Affiliated to Fudan University were collected from January 2018 to January 2020, and the results of the operations were compared by evaluating a number of factors, including operation time, intraoperative bleeding, postoperative fever, and postoperative maximum body temperature.ResultsThe operation times of the LESS-M and CLM groups were 83.9±33.4 and 75.2±26.7 min, respectively; the difference between the groups was statistically significant. The surgical blood loss of the LESS-M group was 86.1±76.9 mL, and that of the CLM group was 83.8±79.9 mL (P>0.05). When the diameter of a fibroid was ≥8 cm, a fibroid was located in the posterior wall or the number of fibroids was ≥4, the operation time of the CLM group was shorter than that of the LESS-M group. When the diameter of a fibroid was ≥8 cm, the blood loss of the CLM group was less than that of the LESS-M group.ConclusionsLESS-M is safe and feasible. If the diameter of a fibroid is ≥8 cm, the fibroid is located in the posterior wall, or the number of fibroids is ≥4, the utility of single-port surgery should be carefully considered.
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Project description:IntroductionTraditional laparaendoscopic surgery using CO2 pneumoperitoneum is associated with complications and the existing gasless laparaendoscopic surgery has shortcomings such as poor visibility in the operation field. To overcome the disadvantages of the current lifting gasless laparaendoscopic operation platforms, we developed an inflatable device for gasless laparoscopic operation field formation (LOFF) that can be internally installed and applied in practice.MethodsWe initially designed operation platforms for gasless laparaendoscopic single-port (GLESP) surgery. Subsequently, a triangular prismatic LOFF device was selected and applied successfully to GLESP cholecystectomy of five pigs. Ultimately, using pigs as a model, three surgical approaches (LOFF-assisted laparaendoscopic single-site (LOFF-LESS), LESS surgery, and traditional lifting (GLESP) were compared, and the advantages and drawbacks of inflatable devices for gasless laparoscopic operation field assessed.ResultsThe use of the LOFF device in GLESP cholecystectomy was first evaluated. The time for surgical space formation (4.4 ± 1.2 and 4.8 ± 1.0), the operating time for gallbladder removal (25.2 ± 4.8 and 25.4 ± 2.7), and the loss of blood (9.4 ± 3.1and 9.2 ± 2.4) was similar between LESS and LOFF, respectively (Table 2). In contrast these parameters were higher in GLESP (6.6 ± 1.0, 30.3 ± 4.4 and 10.1 ± 2.0, respectively. The LOFF-LESS surgery exhibited a clearer exposure of the surgical field and shorter operating time than the GLESP surgery. LESS technology showed less postoperation pain, fast recovery, and extremely high cosmetic satisfaction.ConclusionThe LOFF device provides a safe, effective, and feasible operation platform that can be internally installed and inflated for GLESP surgery during cholescytectomy in animal models.
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Project description:To avoid CO2 pneumoperitoneum-associated cardiopulmonary side-effects during conventional laparoscopic surgeries, we have developed a gasless laparoscopic operation field formation (LOFF) device for laparoendoscopic single-site surgery. The aim of this study is to analyze the safety and efficacy of the LOFF device for laparoendoscopic single-site cholecystectomy and to verify its advantage of avoiding CO2 pneumoperitoneum-associated complications. In this prospective, randomized, observer-blinded clinical trial, eligible participants were randomized in a 1:1 ratio to undergo either conventional CO2 pneumoperitoneum assisted laparoendoscopic single-site cholecystectomy (LESS) or the new gasless LOFF device assisted laparoendoscopic single-site cholecystectomy (LOFF-LESS). Outcomes including intra-operative respiratory and hemodynamic parameters, operation time, conversion rate, complication rate, et al were compared between the two groups. A total of 100 patients were randomized to the LESS group [n = 50; mean (SD) age, 49.5 (13.9) years; 24 (48.0%) women] and the LOFF-LESS group [n = 50, mean (SD) age, 47.4 (13.3) years; 27 (54.0%) women]. Compared with the LOFF-LESS group, the LESS group witnessed significant fluctuations in intra-operative respiratory and hemodynamic parameters. The tracheal extubation time of the LESS group was significantly longer (P = 0.001). The gasless LOFF device is safe and feasible for simple laparoscopic cholecystectomy and has a predominance of avoiding CO2 pneumoperitoneum-associated cardiopulmonary side-effects. Trial registration number: ChiCTR2000033702.
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Project description:BackgroundTo investigate the outcomes of laparoendoscopic single-site adrenalectomy (LESS-A) compared to multi-port laparoendoscopic adrenalectomy (m-LA).MethodsStudies comparing LESS-A with m-LA were identified from PubMed, Embase, and Cochrane Library before June 2020. Post-operative pain, resumption outcomes, and perioperative outcomes were analyzed. We conducted meta-analyses using the Mantel-Haenszel method with random-effects model. Subset analyses were conducted according to peritoneal and retroperitoneal approaches. A small study effect was illustrated using funnel plots and Egger's test.ResultsOne randomized controlled trial (RCT) and nineteen retrospective cohort studies involving 1554 patients were included for analyzed. Pooled analysis showed that LESS-A had significantly lower postoperative pain scores (MD -0.77, 95%CI -1.45 to -0.10) and less pain medication used (RR 0.74, 95%CI 0.60 to 0.91) compared to m-LA. Besides, LESS-A had significantly shorter hospital stays (MD -0.75, 95%CI -1.18 to -0.33), shorter duration of oral intake resumption (MD -0.33, 95%CI -0.60 to -0.06), and better cosmetic satisfaction (SMD 1.15, 95%CI 0.21 to -2.09). As for perioperative outcomes, LESS-A led to significant longer operative time (MD 13.43, 95%CI 4.08 to 22.77). No significant differences were observed in terms of the remaining perioperative outcomes.ConclusionsLESS-A is associated with less post-operative pain and quicker recovery duration. However, the longer operative time of LESS-A compared with m-LA is a drawback.
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Project description:This study introduces and evaluates the feasibility, safety, and surgical outcomes of the in-bag power morcellation technique during single-port assisted (SPA) laparoscopic myomectomy in comparison with manual scalpel morcellation.This is a retrospective review of a total of 58 patients who underwent SPA laparoscopic myomectomy employing in-bag power morcellation (n=27) or manual scalpel morcellation (n=31), performed between December 2014 and December 2016. Surgical outcomes, including total operation time, estimated blood loss, postoperative hemoglobin changes, postoperative hospital stay, postoperative pain (visual analog scale), perioperative and postoperative complications were evaluated.The demographics and patient characteristics were similar between both groups. The median patient age was 34 years and median body mass index was 20.84 kg/m2. The median specimen weight was 110 g. The median operating time was 138 minutes. The median estimated blood loss was 50 mL and the median postoperative hemoglobin change was 2.2 g/dL. The median postoperative hospital stay was 2 days and the median postoperative pain scores were 5 after 6 hours, 3 after 24 hours, and 2 after 48 hours. Occult malignancy was not identified in any patients. There were no intraoperative complications such as LapBag ruptures or gross spillage.In-bag power morcellation for SPA laparoscopic myomectomy is feasible and safe, minimizing the risks of open power morcellation. There were also no statistically significant differences in surgical outcomes.
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Project description:BackgroundFew previous studies have introduced general techniques to overcome the "chopstick effect" in laparoendoscopic single-site surgery (LESS). We aim to investigate and highlight the key ergonomic methodologies for gynaecologic LESS based on the surgeon's hands-on performance.MethodsThe first author surgeon A reviewed and analyzed the LESS procedures performed by herself and how she taught surgeon B from January 2021 to April 2022. The procedures were classified based on technical difficulty and learning periods, and the hands-on technical skills of LESS module were evaluated.ResultsSurgeon A conducted 580 LESS procedures, which were divided into the novice (n = 48) and intermediate (n = 33) periods, and the remaining cases were included in the routine period. We formed a special ergonomic LESS operating methodology: Maintain good LESS laparoscopic spatial sensation, keep hand-eye coordination, well cooperation between the main surgeon and the assistant; Experienced multiport laparoscopy surgery (MPS) skills, improve basic LESS technique: grasp, lift, transfer, place, blunt separating, coagulation and cutting. Coordination location, orientation, movements, and flexion or extension of shoulders, arms, elbow, wrist and finger joints; Maintain strength, tension and ambidexterity postures with joint and muscular efforts to control instruments. Surgeon B learned the above experiences by performing 39 LESS procedures under the guidance of surgeon A.ConclusionThis educational research sheds light on the common challenges faced in LESS and presents the importance of ergonomic hands-on performance skills in improving surgical outcomes, which could serve as a guide for future training and education in LESS.
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Project description:PurposeTo report our initial clinical cases of robotic laparoendoscopic single-site (R-LESS) partial nephrectomy (PN) performed with the use of the novel Da Vinci R-LESS platform.Materials and methodsThree patients underwent R-LESS PN from November 2013 through February 2014. Perioperative and postoperative outcomes were collected and intraoperative difficulties were noted.ResultsOperative time and estimated blood loss volume ranged between 100 and 110 minutes and between 50 and 500 mL, respectively. None of the patients was transfused. All cases were completed with the off-clamp technique, whereas one case required conversion to the conventional (multiport) approach because of difficulty in creating the appropriate scope for safe tumor resection. No major postoperative complications occurred, and all tumors were resected in safe margins. Length of hospital stay ranged between 3 and 7 days. The lack of EndoWrist movements, the external collisions, and the bed assistant's limited working space were noticed to be the main drawbacks of this surgical method.ConclusionsOur initial experience with R-LESS PN with the novel Da Vinci platform shows that even though the procedure is feasible, it should be applied in only appropriately selected patients. However, further improvement is needed to overcome the existing limitations.
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Project description:PurposeTo study the feasibility and safety of the procedure, we present our early experience with laparoendoscopic single-site (LESS) pyelolithotomy performed by use of a Carter-Thomason needle grasper.Materials and methodsFour patients underwent LESS pyelolithotomy for the removal of renal pelvic stones. The patients' mean age was 57.8 years, and their mean body mass index was 23.01. We used a homemade single-port device made with a surgical glove that was inserted into a 2.5-cm periumbilical incision. The operation was performed transperitoneally by using a Carter-Thomason grasper. After removal of the stone, a double-J stent was placed in situ, and laparoscopic intracorporeal suturing was performed. No additional ports were used.ResultsAll surgeries were completed successfully without conversion to conventional laparoscopy or open surgery. The mean operative time was 124.5 minutes, and the mean estimated blood loss was 255.2 mL. There were no significant complications, except in one patient who required a blood transfusion. The mean duration of hospital stay was 8.3 days. The mean stone size was 3.9 cm. Chemical analysis of the stones showed that three patients had calcium-containing stones and one patient had a uric acid stone. Postoperative radiologic study showed a stone clearance rate of 100%.ConclusionsOur results, albeit limited, showed that LESS pyelolithotomy is a feasible and safe procedure. Especially with the use of a Carter-Thomason needle grasper, this operation can be performed without an additional port.
| S-EPMC3604568 | biostudies-literature
Project description:IntroductionTo describe laparoendoscopic single-site simple nephrectomy and reduced port simple nephrectomy for inflammatory nonfunctioning kidney.Case presentationCase 1: a 58-year-old female with fever was referred to our hospital. Computed tomography demonstrated a markedly atrophic right kidney and mild hydronephrosis. Case 2: a 64-year-old male with a history of several intra-abdominal surgeries visited our hospital with a complaint of left back pain and fever. Computed tomography demonstrated left marked hydronephrosis, thinning of renal parenchyma, and duplicated inferior vena cava. After antibiotic treatment, transperitoneal reduced port simple nephrectomy and retroperitoneal laparoendoscopic single-site simple nephrectomy were performed in Case 1 and 2, respectively, because the function of the affected kidney was almost lost on renography. Although adhesion was slightly noted around the renal hilum in Case 1, neither conversion to laparotomy nor placement of additional ports was needed.ConclusionLaparoendoscopic single-site simple nephrectomy and reduced port simple nephrectomy for inflammatory nonfunctioning kidney may be options for experienced laparoscopic surgeons.
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Project description:Magnetic anchoring devices may reduce the number of port sites needed in laparoscopic surgery. In this study, we prospectively assessed the feasibility of using a magnetic anchoring and guidance system (MAGS) in laparoendoscopic single-site (LESS) surgery performed by novices.A total of 10 LESS simple nephrectomies were performed with or without MAGS in a nonsurvival porcine model by 6 operators with no previous LESS surgery experience. After installation of the homemade single port, an intra-abdominal magnet was fixed to the renal parenchyma with suturing and stabilized by an external magnet placed on the flank so that the position of the kidney could be easily changed by moving the external handheld magnet. The length of the procedure and any intraoperative complications were evaluated.Operative time (mean±standard deviation) was shorter in the group using the magnetic anchoring device (M-LESS-N) than in the group with conventional LESS nephrectomy (C-LESS-N) (63±20.8 minutes vs. 82±40.7 minutes, respectively). Although all nephrectomies were completed uneventfully in the M-LESS-N group, renal vein injury occurred during dissection of the renal hilum in two cases of C-LESS-N and was resolved by simultaneous transection of the renal artery and vein with an Endo-GIA stapler.LESS-N using MAGS is a feasible technique for surgeons with no LESS surgery experience. Taking into account the 2 cases of renal vein injury in the C-LESS-N group, the application of MAGS may be beneficial for overcoming the learning curve of LESS surgery.
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