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BACKGROUND: Minimally invasive radical hysterectomy (MIRH) has been increasingly adopted for its benefits of reduced blood loss and shorter hospital stays. This study aims to conduct a meta-analysis to compare the incidence of intraoperative urologic complications, including bladder and ureteral injuries, between MIRH and abdominal radical hysterectomy (ARH). METHOD: We systematically searched PubMed, EMBASE, and the Cochrane Library for studies published up to April 2024. A total of 35 studies were analyzed to compute odds ratios (ORs) for intraoperative urologic complications, bladder injuries, and ureteral injuries, focusing on subgroup evaluations by publication year, study quality, body mass index (BMI), geographic region, and surgical method. RESULTS: The meta-analysis demonstrates that MIRH is associated with higher risks of intraoperative urologic complications (OR=2.412, 95% CI: 1.995-2.916, P<0.001), bladder injuries (OR=2.109, 95% CI: 1.567-2.839, P<0.01), and ureteral injuries (OR=2.549, 95% CI: 1.992-3.262, P<0.001). No publication bias was detected across the studies, ensuring the robustness of the findings. Significant differences in complication rates were also observed across geographic and procedural subgroups. CONCLUSION: The findings confirm that MIRH has a higher rate of intraoperative urologic complications, including bladder and ureteral injuries, compared to ARH. These results provide essential insights that could guide clinical decision-making and influence surgical practice guidelines.
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BACKGROUND: ArtiSential, a class of innovative laparoscopic instrument, has been developed to overcome the limitations of conventional laparoscopic surgery by enabling free, 360°-unrestricted movement of the wrist joint, as in robotic surgery. OBJECTIVE: The aim of the present study was to describe the initial experiences with these devices in myomectomy and to report the surgical outcomes. METHODS: A total of 77 women undergoing laparoscopic or robotic myomectomy between January 2021 and June 2022 were included in this multicenter prospective study. The ArtiSential instruments used by the surgeons were those chosen according to their respective preferences. The baseline characteristics, surgical outcomes, trocar placement options, and operator survey results were scrutinized. RESULTS: The mean age of the patients was 39.9 ± 6.3, and the mean body mass index (BMI, calculated as weight in kilograms divided by the square of height in meters) was 22.4 ± 3.4 kg/m2; 46.8% of the patients underwent robotic surgery, while 53.2% underwent laparoscopic surgery. The number of removed myomas was 3.3 ± 3.0, the size of the largest myoma was 7.1 ± 2.3 cm, and the operative time was 130.0 ± 54.0 min. No transfusions or laparotomy conversions were required. Other than one case of ileus, there were no postoperative complications. In most cases, the instruments were inserted through the umbilicus trocar, and the fenestrated forceps, needle holder, and bipolar fenestrated forceps, in that order, were frequently employed. According to a surgeon survey, 29.9% moderately or strongly agreed that the ArtiSential devices utilized were more convenient than conventional laparoscopic instruments, while only 9.7% moderately or strongly agreed that they were more convenient than robotic instruments. CONCLUSIONS: Myomectomy as performed with an ArtiSential instrument seems to be feasible and safe. Further studies are necessary in order to comparatively assess the outcomes and potential benefits of ArtiSential, robotic, and conventional laparoscopic myomectomy.
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Laparoscopia , Procedimentos Cirúrgicos Robóticos , Miomectomia Uterina , Humanos , Feminino , Estudos Prospectivos , Adulto , Laparoscopia/instrumentação , Laparoscopia/métodos , Miomectomia Uterina/instrumentação , Miomectomia Uterina/métodos , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Robóticos/instrumentação , Procedimentos Cirúrgicos Robóticos/métodos , Neoplasias Uterinas/cirurgia , Leiomioma/cirurgia , Duração da Cirurgia , Resultado do Tratamento , Desenho de EquipamentoRESUMO
OBJECTIVE: Survival outcomes of robotic radical hysterectomy (RRH) remain controversial. Therefore, we performed a meta-analysis to evaluate survival outcomes between RRH) and laparoscopic radical hysterectomy (LRH) in patients with early-stage cervical cancer. METHODS: Studies comparing between RRH and LRH published up to November 2022 were systemically searched in the PubMed, Cochrane Library, Web of Science, ScienceDirect, and Google Scholar databases. Manual searches of related articles and relevant bibliographies of the published studies were also performed. Two researchers independently extracted data. Studies with information on recurrence and death after minimally invasive radical hysterectomy were also included. The extracted data were analyzed using the Stata MP software package version 17.0. RESULTS: Twenty eligible clinical trials were included in the meta-analysis. When all studies were pooled, the odds ratios of RRH for recurrence and death were 1.19 (95% confidence interval [CI]=0.91-1.55; p=0.613; I²=0.0%) and 0.96 (95% CI=0.65-1.42; p=0.558; I²=0.0%), respectively. In a subgroup analysis, the quality of study methodology, study size, country where the study was conducted, and publication year were not associated with survival outcomes between RRH and LRH. CONCLUSION: This meta-analysis demonstrates that the survival outcomes are comparable between RRH and LRH. TRIAL REGISTRATION: International Prospective Register of Systematic Reviews Identifier: CRD42023387916.
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Laparoscopia , Procedimentos Cirúrgicos Robóticos , Neoplasias do Colo do Útero , Feminino , Humanos , Histerectomia/métodos , Laparoscopia/métodos , Estadiamento de Neoplasias , Estudos Retrospectivos , Procedimentos Cirúrgicos Robóticos/métodos , Revisões Sistemáticas como Assunto , Neoplasias do Colo do Útero/patologia , Ensaios Clínicos como AssuntoRESUMO
OBJECTIVE: This study aims to investigate the implementation rate and influencing factors of confirmatory tests for women with abnormal cervical cytology results in the Korean nationwide cervical cancer screening program. METHODS: The National Health Insurance Service (NHIS) database was utilized to identify all Korean women who have participated in the Korean nationwide cervical cancer screening program from January 2011 and December 2021 using the NHIS database. Multiple logistic regression analysis was performed to estimate the multivariate odds ratio and evaluate the patients' characteristics. RESULTS: The rate of abnormal Papanicolaou (Pap) smears showed an initial increase from 2011 to 2015 and subsequently reached a plateau after 2016. When examining specific subcategories, cases of atypical squamous cells of undetermined significance (ASC-US) increased from 28,546 cases (1.1%) in 2011 to 62,850 cases (1.7%) in 2021. In contrast, cases of HSIL and SCC declined from 3,535 cases (0.14%) to 2,763 cases (0.07%) and from 383 cases (0.01%) to 179 cases (0.005%), respectively. Furthermore, the implementation rate of confirmatory tests for women with abnormal cytology increased from 8,865 cases (21.0%) in 2011 to 39,045 cases (51.2%) in 2021. Regarding the specific subcategory of ASC-US, the number of confirmatory tests exhibited a substantial increase from 4,101 cases (14.4%) in 2011 to 30,482 cases (48.5%) in 2021. For SCC, there was no significant change, with 216 cases (56.4%) in 2011 and 102 cases (57.0%) in 2021. The implementation rate of confirmatory tests was found to be significantly associated with results of abnormal Pap smear, age, and residence. Notably, economic status did not emerge as a significant factor affecting the likelihood of undergoing confirmatory tests. CONCLUSIONS: The severity of abnormal Pap smear results is a reliable indicator of the probability of undergoing a confirmatory test. Additional endeavors are required to improve the implementation rate among women who have received abnormal Pap smear results.
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Detecção Precoce de Câncer , Programas Nacionais de Saúde , Teste de Papanicolaou , Neoplasias do Colo do Útero , Esfregaço Vaginal , Humanos , Feminino , Teste de Papanicolaou/estatística & dados numéricos , Adulto , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/patologia , Pessoa de Meia-Idade , República da Coreia/epidemiologia , Detecção Precoce de Câncer/métodos , Detecção Precoce de Câncer/estatística & dados numéricos , Esfregaço Vaginal/estatística & dados numéricos , Idoso , Células Escamosas Atípicas do Colo do Útero/patologia , Bases de Dados Factuais , Adulto Jovem , Displasia do Colo do Útero/diagnóstico , Displasia do Colo do Útero/epidemiologia , Displasia do Colo do Útero/patologiaRESUMO
Laparoscopic surgery has evolved with technological advances in many aspects and increasing demand for its benefits in cosmetics, fast recovery, reduced complication rates and pain. However, it still possesses drawbacks such as limited surgical movement due to the nature of rigid laparoscopic instruments. In order to overcome such limitations, several laparoscopic jointed instruments have been developed. In this prospective multicenter, single-arm cohort study, we investigated the short-term safety and feasibility of the new articulating laparoscopic instruments in benign gynecologic surgery. A total of 113 patients who were diagnosed with benign gynecologic adnexal diseases underwent laparoscopic surgery with articulating laparoscopic instruments. Surgical outcomes, including intra/postoperative complication rates, operation time and estimated blood loss, as well as surgeon's subjective evaluation of the usage of the instruments, were evaluated. The results demonstrated that the articulating laparoscopic instruments had comparable usability and produced similar surgical outcomes to conventional laparoscopic surgery. The objective parameters, such as the operative time and complication rates, as well as the subjective parameters, such as the surgeon's own evaluation of the surgical instruments' usability, demonstrated potential benefits of the instruments in benign gynecological diseases. Overall, the study demonstrated that the use of this novel articulating device is feasible in gynecologic laparoscopic surgery.
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BACKGROUND: Although many studies have reported perioperative complications after radical hysterectomy and pelvic lymph node dissection using robotic and laparoscopic approaches, the risk of perioperative lymphatic complications has not been well identified. The aim of this meta-analysis is to compare the risks of perioperative lymphatic complications after robotic radical hysterectomy and lymph node dissection (RRHND) with laparoscopic radical hysterectomy and lymph node dissection (LRHND) for early uterine cervical cancer. MATERIALS AND METHODS: The authors searched the PubMed, Cochrane Library, Web of Science, ScienceDirect, and Google Scholar databases for studies published up to July 2022 comparing perioperative lymphatic complications after RRHND and LRHND while treating early uterine cervical cancer. Related articles and bibliographies of relevant studies were also checked. Two reviewers independently performed the data extraction. RESULTS: A total of 19 eligible clinical trials (15 retrospective studies and 4 prospective studies) comprising 3079 patients were included in this analysis. Only 107 patients (3.48%) had perioperative lymphatic complications, of which the most common was lymphedema ( n =57, 1.85%), followed by symptomatic lymphocele ( n =30, 0.97%), and lymphorrhea ( n =15, 0.49%). When all studies were pooled, the odds ratio for the risk of any lymphatic complication after RRHND compared with LRHND was 1.27 (95% CI: 0.86-1.89; P =0.230). In the subgroup analysis, study quality, country of research, and publication year were not associated with perioperative lymphatic complications. CONCLUSIONS: A meta-analysis of the available current literature suggests that RRHND is not superior to LRHND in terms of perioperative lymphatic complications.
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Laparoscopia , Procedimentos Cirúrgicos Robóticos , Neoplasias do Colo do Útero , Feminino , Humanos , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Neoplasias do Colo do Útero/cirurgia , Neoplasias do Colo do Útero/patologia , Estudos Retrospectivos , Incidência , Estudos Prospectivos , Laparoscopia/efeitos adversos , Excisão de Linfonodo/efeitos adversos , Histerectomia/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgiaRESUMO
Autoimmune limbic encephalitis (ALE) associated with an anti-N-methyl-D-aspartate receptor (NMDAR) is a rare but occasionally fatal condition that could be accompanied by ovarian teratoma. We report a case of a 27-year-old woman with ALE combined with a mature cystic teratoma that looks like a functional cyst in imaging studies. A single port access laparoscopic left oophorectomy was performed. On the 154th postoperative day, symptoms were fully recovered. Teratoma detection and tumor removal are critical for the management of patients diagnosed with or suspected of ALE.
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Background and Objectives: Laparoscopic surgeries in gynecologic field have been performed under general anesthesia (GA) due to the respiratory changes caused by pneumoperitoneum and Trendelenburg position. Therefore, this study aimed to compared general anesthesia and combined spinal and epidural anesthesia (CSEA) for gasless laparoscopic surgery in gynecologic field. Methods: We matched patients with type of surgery who underwent gasless single port access (SPA) laparoscopic surgery under general anesthesia and CSEA. The medical records of 90 patients between March 1, 2018 and June 30, 2020 were reviewed. Gasless laparoscopic surgery was performed in all patients with a SPA using a J-shaped retractor. Results: No significant differences were observed for age, body mass index, parity, and previous abdominal surgery between GA and CSEA groups. During operation under CSEA, six patients (20%) experienced nausea/vomiting. Hypotension (systolic blood pressure < 90 mmHg) was observed in five patients (16.7%). Intravenous analgesics was administrated in four of the patients (13.3%) who suffered from shoulder pain or abdominal discomfort. One patient developed bradycardia. The duration of hospital admission was shorter in the CSEA group than in the GA group (p = 0.014). There was no difference between the groups in terms of surgery type, surgical specific finding, operation time, estimated blood loss, laparotomy conversion rate and use of additional trocar. No major complications such as urologic, bowel, or vessel injuries were found in both groups. Conclusions: CSEA is a safe and feasible technique for application in nonobese patients undergoing gasless laparoscopic surgery in gynecologic field.
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Anestesia Epidural , Ginecologia , Insuflação , Laparoscopia , Anestesia Geral , Feminino , Humanos , Laparoscopia/métodosRESUMO
Objective: To compare gasless laparoscopy with conventional laparoscopy for the surgical management of postmenopausal patients. Methods: The medical records of 80 postmenopausal patients who underwent laparoscopic surgeries between February 2016 and February 2020 were reviewed. Forty patients underwent gasless laparoscopy and 40 patients underwent conventional single-port access (SPA) laparoscopy. The two groups were compared in terms of surgical outcomes. Results: : Of 80 patients, 42 underwent adnexal surgeries and 38 underwent uterine surgeries such as total hysterectomy or myomectomy. Between the gasless SPA and conventional SPA laparoscopic groups, no significant differences were observed in terms of age, body mass index, parity or history of previous abdominal surgery. The mean retraction setup time from skin incision was 6.8 ± 1.2 min with gasless laparoscopic surgery. There was no significant difference in mean total operation times for the gasless (71.3 ± 31.4 min) and conventional (82.5 ± 36.4 min) groups. There was also no significant difference between the groups in terms of operation type, laparotomy conversion rate or duration of hospitalisation. There were no major complications in either group. Conclusions: Gasless laparoscopy is a safe and feasible alternative to conventional laparoscopy for postmenopausal women.
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OBJECTIVE: To evaluate the risks of symptomatic lymphocele after pelvic lymphadenectomy between the laparoscopic and abdominal approach in uterine cervical and endometrial cancer. METHODS: We searched Ovid Medline, Ovid EMBASE, and the Cochrane library through April 2020. We selected the comparative studies contained information on symptomatic lymphoceles in postoperative complications. All articles searched were independently reviewed and selected by two researchers. A meta-analysis was performed using the Stata MP version 16.0 software package. RESULTS: A total of 33 eligible clinical trials were ultimately enrolled in this meta-analysis. When all studies were pooled, the odds ratios (OR) of the laparoscopic approach for the risk of symptomatic lymphoceles compared to the abdominal approach was 0.58 [95% confidence interval (CI): 0.42-0.81, p = 0.022, I-squared = 0.0%]. The risk of postoperative symptomatic lymphoceles in the laparoscopic group tended to decrease over time in the cumulative meta-analysis. In the subgroup analysis, there was no evidence for an association between cancer type, quality of the study methodology, hysterectomy type, and postoperative symptomatic lymphoceles. However, in a recently published article, being overweight (body mass index ≥ 25) and studies conducted in oriental area were associated with a lower incidence of postoperative symptomatic lymphoceles. CONCLUSION: Laparoscopic lymphadenectomy was associated with a significantly lower risk of postoperative symptomatic lymphoceles than abdominal lymphadenectomy (PROSPERO registration number: CRD 42,020,187,165).
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Laparoscopia , Linfocele , Feminino , Humanos , Incidência , Laparoscopia/efeitos adversos , Excisão de Linfonodo/efeitos adversos , Excisão de Linfonodo/métodos , Linfocele/epidemiologia , Linfocele/etiologia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologiaRESUMO
The aim of this study was to compare the clinical characteristics of patients with tubo-ovarian abscess (TOA) who responded to medical treatment and those who underwent surgical intervention due to medical treatment failure. Electronic medical records were evaluated retrospectively to identify patients who were diagnosed with TOA. Demographic, clinical, and laboratory data including white blood cell (WBC) count, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) were compared between the medical treatment group and the surgical intervention group. Patient age, TOA diameter, WBC count, CRP, and ESR were significantly different between the groups. On multiple regression analysis, significant correlations were identified between age (p = .001), ESR (p = .045), and failure of medical treatment. TOA diameter (p = .065) showed a borderline association with surgical intervention. The risk of needing surgical intervention in TOA patients can be predicted using ESR in addition to age and TOA size as risk factors.IMPACT STATEMENTWhat is already known on this subject? For patients diagnosed with a tubo-ovarian abscess (TOA), the size of TOA and the patient's age are helpful for early identification of patients who are likely to need surgical treatment. Inflammatory markers such as C-reactive protein and white blood cell are also associated with the risk of surgical intervention.What do the results of this study add? Erythrocyte sedimentation rate (ESR) in addition to the size of TOA and the patient's age is a useful marker in determining whether to undergo surgery in patients with TOA.What are the implications of these findings for clinical practice and/or further research? ESR combined with the patient's age and the size of TOA is clinically useful in predicting the need for early surgical intervention in patients with TOA. Large prospective controlled studies are required to establish relationship between inflammatory markers and the risk of surgical intervention.
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Abscesso Abdominal/cirurgia , Doenças das Tubas Uterinas/cirurgia , Procedimentos Cirúrgicos em Ginecologia/estatística & dados numéricos , Testes Hematológicos/estatística & dados numéricos , Doenças Ovarianas/cirurgia , Abscesso Abdominal/sangue , Adulto , Biomarcadores/sangue , Sedimentação Sanguínea , Proteína C-Reativa/análise , Doenças das Tubas Uterinas/sangue , Feminino , Procedimentos Cirúrgicos em Ginecologia/métodos , Testes Hematológicos/métodos , Humanos , Contagem de Leucócitos , Doenças Ovarianas/sangue , Seleção de Pacientes , Valor Preditivo dos Testes , Análise de Regressão , Estudos Retrospectivos , Fatores de RiscoRESUMO
OBJECTIVE: To evaluate the incidence of urologic complications requiring a urologic procedure during the perioperative period and compare the differences between abdominal radical hysterectomy (ARH) and laparoscopic radical hysterectomy (LRH). METHODS: We identified all Korean women who underwent radical hysterectomy (RH) between January 2006 and December 2019 using the National Health Insurance Service database. Complications requiring surgical intervention-based urologic procedures between ARH and LRH were investigated. RESULTS: A total of 12,068 patients were classified into the ARH group and 8,837 patients were classified into the LRH group. Urologic complications requiring urologic procedures occurred in 1,546 of 20,905 patients (7.40%) who underwent RH. The most common urologic procedure was double-J insertion (R326, 5.18%), followed by bladder repair (R3550, 0.90%). There was no significant difference in urologic complications requiring urologic procedures between the ARH and LRH groups (odds ratio [OR]=1.027; 95% confidence interval [CI]=0.925-1.141; p=0.612). The incidence of bladder repair (R3550) was significantly higher in patients who underwent LRH (OR=1.620; 95% CI=1.220-2.171; p<0.001). Urologic complications requiring urologic procedures were statistically higher in the LRH group during the first half (OR=1.446; 95% CI=1.240-1.685; p<0.001), but more in the ARH group during the second half (OR=0.696; 95% CI=0.602-0.804; p<0.001) of the study period. CONCLUSION: There was no difference of urologic complications between ARH and LRH with regard to urologic procedures. The incidence of urologic procedures decreases with time in patients who underwent LRH.
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Laparoscopia , Neoplasias do Colo do Útero , Abdome/patologia , Feminino , Humanos , Histerectomia/efeitos adversos , Incidência , Laparoscopia/efeitos adversos , Estadiamento de Neoplasias , Estudos Retrospectivos , Neoplasias do Colo do Útero/patologiaRESUMO
OBJECTIVE: The aim of this study was to compare gasless single-port access (SPA) laparoscopy using a J-shaped retractor and conventional SPA laparoscopy in patients undergoing adnexal surgery. Study design The medical records of 80 patients who underwent laparoscopic adnexal surgery between May 2017 and April 2019 were reviewed. Of the 80 patients, 40 patients underwent gasless SPA laparoscopy using a J-shaped retractor and 40 underwent conventional SPA laparoscopy. All surgeries were performed by one laparoscopic surgeon. Surgical outcomes were compared between the two groups. RESULTS: There are no significant differences in age, body mass index, parity, previous abdominal surgery, tumor marker, and tumor diameter between the gasless and conventional groups. The median retraction setup time from skin incision was 7 min (range 5-12 min) in gasless SPA laparoscopic adnexal surgery. The median total operation times were 55.5 min (range 30-155 min) in the gasless group and 55 min (range 30-165 min) in the conventional group without a significant difference. Additionally, there were no differences in operation type, conversion rate of laparotomy, use of an additional trocar, and pathological outcomes between the two groups. No major complications, such as urologic, bowel, and vessel injuries, were found in both groups. CONCLUSIONS: Gasless SPA laparoscopy using a J-shaped retractor appears to offer a better alternative to conventional SPA laparoscopy that avoids the potential negative effects of carbon dioxide gas in selected cases.
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Laparoscopia , Feminino , Humanos , Duração da Cirurgia , Gravidez , Estudos Retrospectivos , Instrumentos CirúrgicosRESUMO
OBJECTIVE: A meta-analysis was performed to compare survival outcomes including disease-free survival (DFS) between laparoscopic radical hysterectomy (LRH) and abdominal radical hysterectomy (ARH) in patients with cervical cancer. DATA SOURCES: We searched PubMed, EMBASE, Google scholar, and the Cochrane library for studies published between December 2004 and May 2020. Manual searches of related articles and relevant bibliographies of published studies were also performed. METHODS OF STUDY SELECTION: Two researchers independently extracted the data. Studies with survival outcome information were included. TABULATION, INTEGRATION, AND RESULTS: A total of 36 eligible clinical trials were included in this meta-analysis. When all studies were pooled, the hazard ratio (HR) of LRH for the risk of DFS and overall survival (OS) compared with ARH was 1.24 (95% confidence interval [CI], 1.09-1.41; pâ¯=â¯.001; I2â¯=â¯37.5%) and 1.27 (95% CI, 1.04-1.56; pâ¯=â¯.020; I2â¯=â¯45.5%), respectively. In a subgroup analysis, significant harmful effects of DFS in patients with LRH increased in studies using the HR presented by the article (HR, 1.41; 95% CI, 1.21-1.64; p <.001), matched retrospective design (HR, 1.49; 95% CI, 1.19-1.88; pâ¯=â¯.001), large-scale studies (HR, 1.34; 95% CI, 1.16-1.55; p <.001), and studies published after the Laparoscopic Approach to Cervical Cancer trial (HR, 1.46; 95% CI, 1.25-1.71; p <.001). However, LRH did not affect DFS (HR, 1.04; 95% CI, 0.59-1.81; pâ¯=â¯.898) or OS (HR, 0.57; 95% CI, 0.31-1.05; pâ¯=â¯.073) of patients with cervical cancer with cervical masses <2 cm. CONCLUSION: This meta-analysis demonstrated that LRH was associated with higher recurrence rates than ARH. However, LRH showed similar recurrence and OS among patients with cervical masses <2 cm (Centre for Reviews and Dissemination 42020191713).
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Laparoscopia , Neoplasias do Colo do Útero , Intervalo Livre de Doença , Feminino , Humanos , Histerectomia , Recidiva Local de Neoplasia/cirurgia , Estadiamento de Neoplasias , Estudos Retrospectivos , Resultado do Tratamento , Neoplasias do Colo do Útero/patologia , Neoplasias do Colo do Útero/cirurgiaRESUMO
OBJECTIVE: This study aimed to compare gasless single-port access (SPA) laparoscopic myomectomy using a J-shaped retractor and conventional SPA laparoscopic myomectomy. STUDY DESIGN: The medical records of 60 patients who underwent laparoscopic myomectomy between January 2016 and August 2019 were reviewed. Thirty patients underwent gasless SPA laparoscopic myomectomy using a J-shaped retractor, and 30 patients underwent conventional SPA laparoscopic myomectomy. The 2 groups were compared in terms of surgical outcomes. In gasless laparoscopic myomectomy, closure of the uterine defect after myomectomy was performed using an extracorporeal suture technique with a Kelly clamp and knot pusher. RESULTS: On comparing gasless SPA and conventional SPA laparoscopic myomectomy, no significant differences were observed in age, body mass index, parity, previous abdominal surgery, and size of the dominant uterine myoma. The median retraction setup time from skin incision was 8 minutes (range, 5 to 15 min) with gasless SPA laparoscopic myomectomy. The median total operation times were 105 minutes (range, 62 to 210 min) with gasless SPA myomectomy and 110 minutes (range, 60 to 270 min) with conventional SPA myomectomy, and there was no significant difference (P=0.251). There was no difference between the groups in terms of estimated blood loss. None of the patients experienced laparotomy conversion in both groups. No major complications, such as urologic, bowel, and vessel injuries, were found in both groups. CONCLUSION: Gasless SPA laparoscopic myomectomy using a J-shaped retractor is a safe and feasible approach, which allows for easy and convenient suturing of a uterine defect after myomectomy.
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Laparoscopia/métodos , Leiomioma/cirurgia , Técnicas de Sutura , Miomectomia Uterina/métodos , Neoplasias Uterinas/cirurgia , Adulto , Estudos de Viabilidade , Feminino , Humanos , Laparoscopia/instrumentação , Pessoa de Meia-Idade , Duração da Cirurgia , Estudos Retrospectivos , Suturas , Resultado do Tratamento , Miomectomia Uterina/instrumentação , Adulto JovemRESUMO
OBJECTIVE: This study aimed to assess the risks of intraoperative and postoperative urologic complications between laparoscopic radical hysterectomy (LRH) and abdominal radical hysterectomy (ARH). METHODS: Using the database of the National Health Insurance Service (NHIS) and Health Insurance Review & Assessment (HIRA), we identified all Korean women who underwent radical hysterectomy between 2006 and 2018. Intraoperative and postoperative urologic complications were compared between the ARH and LRH groups. RESULTS: A total of 11,399 patients were identified to ARH and 8435 patients to LRH. Urologic complications occurred in 292 of 19,774 patients (1.48%) who underwent radical hysterectomy. LRH was associated with higher complication rates than ARH, although with a borderline significance (OR: 1.23; 90% CI: 1.02-1.51, p = 0.066). There was no difference in intraoperative urologic complications between the ARH and the LRH groups (OR: 1.1 95% CI: 0.86-1.43, p < 0.435). The incidence of postoperative urologic complications was significantly higher in the LRH group (OR: 2.01; 95% CI: 1.18-3.47, p = 0.009). In terms of postoperative urologic complications, the risk of ureterovaginal fistula was not significant between the two groups (OR: 1.53; 95% CI: 0.54-4.24, p = 0.403), whereas the risk of vesicovaginal fistula was significantly higher in the LRH group (OR: 2.24; 95% CI: 1.09-4.58, p = 0.028). There were no significant differences in the overall and urinary tract-specific complications between ARH and LRH in groups under 40 years of age and during the second half (2013-2018), with 2012 as the boundary. CONCLUSION: Among specific urologic complications, the incidence of vesicovaginal fistula was significantly higher in the LRH group than in the ARH group.
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Histerectomia/estatística & dados numéricos , Doenças Urológicas/epidemiologia , Adulto , Idoso , Feminino , Humanos , Histerectomia/efeitos adversos , Histerectomia/métodos , Incidência , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Laparoscopia/estatística & dados numéricos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etnologia , República da Coreia/epidemiologia , Doenças Urológicas/etiologia , Fístula Vesicovaginal/epidemiologia , Fístula Vesicovaginal/etiologiaRESUMO
BACKGROUND AND OBJECTIVES: Gasless laparoscopy is an alternative method to reduce the number of carbon dioxide (CO2)-insufflated, pneumoperitoneum-related problems including shoulder pain, postoperative nausea/vomiting, and decreased cardiopulmonary function. In this study, we investigated the feasibility of gasless total laparoscopic hysterectomy (TLH) with a newly developed abdominal-wall retraction system. METHODS: Abdominal-wall retraction for gasless laparoscopy was performed using the newly developed J-shape retractor and the Thompson surgical retractor. Surgical outcomes between gasless TLH and conventional CO2-based TLH were compared for each of 40 patients for the period from January 2017 to October 2019. RESULTS: Between gasless TLH and conventional CO2-based TLH, no significant differences were observed for age, body mass index, parity, or surgical indications. The mean retraction setup time from skin incision was 7.4 min (range: 4-12 min) with gasless TLH. The mean total operation times were 87.9 min (range: 65-170) with gasless TLH and 90 min (range: 45-180) with conventional TLH, which showed no significant difference. Estimated blood loss and uterus weight also showed no significant intergroup difference. No major complications related to the ureter, bladder, or bowel were encountered. CONCLUSION: Our new abdominal-wall retraction system for gasless TLH allowed for easy setup and a proper operation field in the performance of laparoscopic hysterectomy.
Assuntos
Parede Abdominal/cirurgia , Histerectomia/instrumentação , Laparoscopia/instrumentação , Doenças Uterinas/cirurgia , Adulto , Idoso , Estudos de Viabilidade , Feminino , Humanos , Histerectomia/métodos , Laparoscopia/métodos , Pessoa de Meia-Idade , Duração da Cirurgia , Estudos Retrospectivos , Doenças Uterinas/patologia , Adulto JovemRESUMO
OBJECTIVE: A meta-analysis was performed to assess risks of intraoperative and postoperative urologic complications in laparoscopic radical hysterectomy (LRH) and abdominal radical hysterectomy (ARH). METHODS: We searched Pubmed, EMBASE, and Cochrane library for studies published up to December, 2018. Manual searches of related articles and relevant bibliographies of published studies were also performed. Two researchers independently performed data extraction. Inclusion criteria of studies were: (1) had information of perioperative complications, and (2) had at least ten patients per group. RESULTS: A total of 38 eligible clinical trials were collected. Intraoperative and postoperative urologic complications were reported by 34 studies and 35 studies, respectively. When all studies were pooled, odd ratios (OR) of LRH for the risk of intraoperative urologic complications compared to abdominal radical hysterectomy (ARH) was 1.40 [95% confidence interval (CI) 1.05-1.87]. The OR of LRH for postoperative complication risk compared to ARH was 1.35 [95% CI 1.01-1.80]. However, significant adverse effects of intraoperative urologic complications in LRH were not observed among articles published after 2012 (OR 1.12, 95% CI 0.77-1.62) in cumulative meta-analysis or subgroup analysis. The incidence of bladder injury was statistically higher than that of ureter injury (p = 0.001). In subgroup analysis, obesity and laparoscopic type (laparoscopic assisted vaginal radical hysterectomy) were associated with intraoperative urologic complications. CONCLUSION: LRH is associated with significantly higher risk of intraoperative and postoperative urologic complications than abdominal radical hysterectomy.
Assuntos
Abdome/cirurgia , Histerectomia/efeitos adversos , Laparoscopia/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Doenças Urológicas/epidemiologia , Adulto , Feminino , Humanos , Histerectomia/métodos , Complicações Intraoperatórias/epidemiologia , Complicações Intraoperatórias/etiologia , Laparoscopia/métodos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Resultado do Tratamento , Bexiga Urinária/lesões , Bexiga Urinária/cirurgia , Doenças Urológicas/etiologiaRESUMO
OBJECTIVE: This study aimed to compare the risks of intraoperative and postoperative urologic complications after robotic radical hysterectomy (RRH) compared with laparoscopic radical hysterectomy (LRH). DATA SOURCES: We searched Pubmed, EMBASE, and the Cochrane Library for studies published up to March 2019. Related articles and relevant bibliographies of published studies were also checked. METHODS OF STUDY SELECTION: Two researchers independently performed data extraction. We selected comparative studies that reported perioperative urologic complications. TABULATION, INTEGRATION, AND RESULTS: Twenty-three eligible clinical trials were included in this analysis. When all studies were pooled, the odds ratio for the risk of any urologic complication after RRH compared with LRH was .91 (95% confidence interval [CI], .64-1.28; pâ¯=â¯.585). The odds ratios for intraoperative and postoperative complications after RRH versus LRH were .86 (95% CI, .48-1.55; pâ¯=â¯.637) and .94 (95% CI, .64-1.38; pâ¯=â¯.767), respectively. In a secondary analysis study quality, study location, and the publication year were not associated with intraoperative or postoperative urologic complications. CONCLUSION: Current evidence suggests that RRH is not superior to LRH in terms of perioperative urologic complications.