Instrument usage in laparoscopic gynecologic surgery: a prospective clinical trial.

PURPOSE: To evaluate instrumental usage in laparoscopic gynecological surgeries and to develop key timesets of a laparoscopic operation, which allows categorization of the operation time into different sections. METHODS: In this prospective clinical observational study, frequency of instrument usage, time for instrument switches, and instrument utilization time were recorded in a standardized manner for laparoscopic surgeries in 103 endoscopic surgeries. RESULTS: A standard equipment (including atraumatic grasping forceps, irrigation and suction device, bipolar clamp, and laparoscopic scissors) was used for nearly all interventions. Bipolar clamps and scissors were changed most frequently. The tool used for the longest amount of time was the atraumatic grasping forceps. Laparoscopic instruments were switched 51 times per surgery (range 2-250 times). One instrument switch lasted for a median of 0.13 min (0.08-1.2 min). Median time for instrument switch for a single surgery added up to 6.83 min. Instrument switches required 10.5% of the overall operation time. CONCLUSION: We analyzed the current instrument usage in laparoscopic gynecological surgeries. The results of our standardized investigation suggest ways to reduce the time required for surgery and provide starting points for the standardization of the work routine.

Trastuzumab (herceptin): a retrospective analysis of the effects of long-term application in a series of patients with breast cancer.

INTRODUCTION: About 20 % of all mamma carcinomas are HER2 positive. The overexpression of HER2 is considered to be a negative prognostic factor. Trastuzumab is a monoclonal anti-HER2 antibody developed to target HER2 overexpressing tumor cells. So far, there is only little data available on long-term effects of trastuzumab. This is why we analyzed the medical records of our patient collective with respect to tolerability and oncological outcomes of long-term trastuzumab treatment. MATERIALS AND METHODS: Our retrospective observational study included all patients of the Saarland University Hospital with breast cancer who received trastuzumab for more than 18 months between 2003 and 2012. We analyzed the medical records with respect to oncological outcome, tolerability and cardiac side effects. RESULTS: A total of n = 15 patients had been treated with trastuzumab for over 18 months with a mean therapy duration of 57.2 months (range 18-119 months). The mean follow-up time was 113.5 months (range 50-240 months). Three of the patients had a treatment interruption for an average of 2.6 months (range 3-5), which was not due to side effects. The left ventricular ejection fraction (LVEF) was controlled at regular intervals in all of the patients. Upon the beginning of the trastuzumab treatment, the mean LVEF was 68 %. In one patient, the trastuzumab treatment was discontinued after 41 months because of a decrease of the LVEF below normal levels. CONCLUSION: Trastuzumab is well tolerated even during long-term use. Patients with HER2 overexpression and metastases can be treated well with trastuzumab for up to 119 months.

The impact of the body mass index (BMI) on laparoscopic hysterectomy for benign disease.

PURPOSE: To investigate the influence of the body mass index (BMI) on laparoscopic hysterectomy, including all intra- and postoperative findings and complications. METHODS: We reviewed and analyzed the medical records of 200 patients who underwent laparoscopic hysterectomy for benign disease at the Saarland University Hospital. The patient collective was subdivided into four weight groups on the basis of the current WHO BMI classification. Data analysis was carried out by a professional statistician. RESULTS: Over half of the women screened were overweight or obese. The operating times increased together with the BMI (p = 0.017). Blood losses differed significantly between the weight groups (p = 0.027), but ranged to a maximum of only 300 ml. One laparoconversion had to be performed. No other intraoperative complications occurred. During our follow-up time of 13.2 ± 5.4 months, the overall rate of postoperative complications differed significantly between the weight groups (p = 0.008). The group of overweight women had the highest rate of complications and the group of obese women had the lowest. However, the rate of women who required readmission and reoperation was not elevated in the overweight group. CONCLUSION: Laparoscopic hysterectomy is a safe and feasible method even in obese and morbidly obese patients. Overweight and obesity increase the time needed to perform laparoscopic hysterectomy but do not seem to relevantly influence the rate of major intra- or postoperative complications.

Five minutes of extended assisted ventilation with an open umbilical trocar valve significantly reduces postoperative abdominal and shoulder pain in patients undergoing laparoscopic hysterectomy.

OBJECTIVE: Residual carbon dioxide contributes substantially to pain following laparoscopic surgery. We evaluated the effects of extended assisted ventilation (EAV) with an open umbilical trocar valve for five additional minutes following laparoscopic hysterectomy on postoperative abdominal and shoulder pain levels. We also examined whether a combination of EAV and trocar site infiltration (TSI) with lidocaine could further reduce postoperative pain levels. STUDY DESIGN: In this prospective randomized trial, the effectiveness of EAV and EAV/TSI in reducing postoperative abdominal and shoulder pain were compared with that of a standard treatment regime in 283 patients undergoing laparoscopic hysterectomy (total or supracervical). Pain levels were evaluated by self-assessment questionnaire using a numeric rating scale (NRS) and by postoperative piritramid requirement, a surrogate parameter for postoperative analgesic drug requirement. The incidence of nausea and vomiting was also assessed. RESULTS: Compared with the standard treatment regime, EAV reduced abdominal pain levels significantly at 3h (NRS score, 3.21 ± 1.56 vs. 4.73 ± 1.71) and 24h (3.82 ± 1.49 vs. 4.95 ± 1.68) postoperatively (both p < 0.01). EAV also significantly reduced shoulder pain at 24h (EAV vs. control, 4.28 ± 1.51 vs. 5.14 ± 1.49) and 48 h (3.64 ± 1.66 vs. 4.22 ± 1.43) postoperatively (both p < 0.01). Patients in the EAV group had significantly lower piritramid requirements compared with standard treatment at 3h post-operatively (4.28 ± 2.09 mg vs. 6.31 ± 2.21 mg; p<0.01). EAV/TSI showed no additional benefit in terms of pain reduction compared with EAV alone. Incidences of postoperative nausea and vomiting were not reduced by EAV or EAV/TSI. CONCLUSION: EAV was found to be an effective and safe method to reduce postoperative pain levels in patients undergoing laparoscopic hysterectomy.