Surgical Pain Control With Ropivacaine by Atomized Delivery (Spray): A Randomized Controlled Trial.

STUDY OBJECTIVE: To investigate the role of intraoperative atomized intraperitoneal ropivacaine (AIR) as an adjuvant to anesthetic agents at the time of minimally invasive pelvic surgery. DESIGN: Double-blind, randomized controlled trial. CLASSIFICATION: Randomized controlled trial (Canadian Task Force classification I). SETTING: Tertiary care teaching hospital. PARTICIPANTS: Fifty-five patients who underwent laparoscopic and robotic gynecologic procedures. INTERVENTION: Patients received AIR or atomized intraperitoneal saline (AIS) (dose, 2 mg/kg) immediately after the initiation of pneumoperitoneum. MEASUREMENTS AND MAIN RESULTS: Visual analog scale (VAS) pain scores and narcotic use (in morphine equivalents) were collected and recorded at 2, 4, 8, and 12 hours postoperatively. RESULTS: Fifty-five patients completed the study protocol and data collection, with 30 patients allocated to the AIS group and 25 patients allocated to the AIR group. Demographic and surgical variables did not vary between the groups, with the exception of median operative duration. Postoperative VAS scores at 2, 4, 8, and 12 postoperative hours were higher in the AIS group, but the difference failed to reach statistical significance. Narcotic use was also similar in the 2 groups. CONCLUSION: The use of intraperitoneal ropivacaine was not associated with a statistically significant difference in patients' postoperative VAS scores. Thus, in contrast to findings of similar studies performed in general surgery, AIR might not confer a benefit in women undergoing minimally invasive gynecologic procedures.

Fellowship learning curve associated with completing a robotic assisted total laparoscopic hysterectomy.

OBJECTIVE: To describe the learning curve associated with training fellows in completing robotic assisted total laparoscopic hysterectomies. METHODS: All patients scheduled to undergo a robotic procedure at our institution from 5/15/07 to 5/22/12 were identified. Fellow participation per procedure was documented. The learning curve of fellows for the time to complete a hysterectomy (from initiation of developing the retroperitoneal space to the completion of the colpotomy) was analyzed. RESULTS: Of the 1754 planned robotic cases, 1626 were completed robotically and 128 were converted to laparotomy. Fifty-seven fellows participated in 99.7% of the cases. Eleven gynecologic oncology fellows completed at least 1 robotic assisted total laparoscopic hysterectomy. From 7/7/08 to 5/21/12, 981 hysterectomies were completed robotically, 254 of these (25.9%) by the 11 fellows. Prior to completing a hysterectomy, the median number of hysterectomies in which a fellow participated was 16 (range, 11-40). Median amount of time for a fellow to complete a hysterectomy decreased from 60 min in 2009 (N=27 cases) to 31 min in 2011 (N=148 cases). Based on the recorded completion times in which the 11 fellows completed a hysterectomy, it required ~33 cases per fellow to be able to perform the hysterectomy and overcome the learning curve. CONCLUSIONS: The learning curve associated with hysterectomy requires completion of ~33 cases by the fellow after an initial median experience of 16 cases. Our data suggest that a minimum of 50 total cases is required during fellowship to complete a robotic hysterectomy.

Evaluation of Silicon Phthalocyanine 4 Photodynamic Therapy Against Human Cervical Cancer Cells In Vitro and in Mice.

BACKGROUND: Cervical cancer is the second most common cancer in women worldwide [1]. Photodynamic therapy has been used for cervical intraepithelial neoplasia with good responses, but few studies have used newer phototherapeutics. We evaluated the effectiveness of photodynamic therapy using Pc 4 in vitro and in vivo against human cervical cancer cells. METHODS: CaSki and ME-180 cancer cells were grown as monolayers and spheroids. Cell growth and cytotoxicity were measured using a methylthiazol tetrazolium assay. Pc 4 cellular uptake and intracellular distrubtion were determined. For in vitro Pc 4 photodynamic therapy cells were irradiated at 667nm at a fluence of 2.5 J/cm2 at 48 h. SCID mice were implanted with CaSki and ME-180 cells both subcutaneously and intracervically. Forty-eight h after Pc 4 photodynamic therapy was administered at 75 and 150 J/cm2. RESULTS: The IC50s for Pc 4 and Pc 4 photodynamic therapy for CaSki and ME-180 cells as monolayers were, 7.6µM and 0.016µM and >10µM and 0.026µM; as spheroids, IC50s of Pc 4 photodynamic therapy were, 0.26µM and 0.01µM. Pc 4 was taken up within cells and widely distributed in tumors and tissues. Intracervical photodynamic therapy resulted in tumor death, however mice died due to gastrointestinal toxicity. Photodynamic therapy resulted in subcutaneous tumor death and growth delay. CONCLUSIONS: Pc 4 photodynamic therapy caused death within cervical cancer cells and xenografts, supporting development of Pc 4 photodynamic therapy for treatment of cervical cancer. Support: P30-CA47904, CTSI BaCCoR Pilot Program.