Effect of Abdominal Binder after Laparoscopic Treatment on Postoperative Recovery (BELT): A Randomized Controlled Trial.

STUDY OBJECTIVE: To determine the effect of an abdominal binder on recovery after laparoscopic surgery in patients with gynecologic disease. DESIGN: A randomized controlled trial. SETTING: A university hospital. PATIENTS: Patients scheduled for gynecologic laparoscopy were randomly assigned to the abdominal binder (n = 33) and control groups (n = 33). INTERVENTIONS: Use of an abdominal binder after laparoscopic gynecologic surgery. MEASUREMENTS AND MAIN RESULTS: Sixty-six patients scheduled for gynecologic laparoscopy between April and August 2018 were prospectively included in the abdominal binder after laparoscopic treatment (BELT) trial. The primary outcome measure was postoperative pain severity assessed using a visual analogue scale at 12, 24, and 48 hours after surgery. Secondary outcome measures included the ability to walk postoperatively, respiratory function, and degree of comfort, all assessed via the self-reported questionnaire at 48 hours after surgery. Baseline characteristics were similar in both groups. Postoperative pain scores did not significantly differ between groups. Postoperative walking and respiratory function were also statistically similar in both groups. CONCLUSION: The use of an abdominal binder in patients after gynecologic laparoscopy did not enhance recovery in terms of pain, respiratory function, or physical activity.

"Freshman effect" in gynecologic surgery at a teaching hospital.

PURPOSE: The purpose of this study was to determine the existence of the freshman effect in patients who underwent gynecologic surgery at a teaching hospital by comparing surgical outcomes and morbidity rates between the first academic quarter and other quarters. METHODS: All data were collected prospectively. Between January 2015 and March 2018, patients who underwent gynecologic surgeries during the first academic quarter (March, April, and May in Korea) were retrospectively compared with patients who underwent gynecologic surgeries during other academic quarters (June through February). The primary outcome measure was the incidence of operative complication. Secondary outcomes were the operative time, operative blood loss, and length of hospital stay. RESULTS: Among 1241 patients who underwent gynecologic surgery during the study period of 39 months, 1136 patients were analyzed for this study and divided into groups according to the first academic quarter (n = 335) and other academic quarters (n = 801). The baseline characteristics were not different between the groups. No significant difference in operative complications was found between the first and other academic quarters (1.5% versus 3.0%; P = 0.143). Moreover, there was no significant difference in operative time, operative blood loss, and length of hospital stay between the groups. CONCLUSIONS: This study did not demonstrate the existence of a "freshman effect", i.e., an increase in morbidity, at a Korean teaching hospital providing gynecologic surgical care. Patients undergoing gynecologic surgery can be reassured of their safety during the first academic quarter.

Temporary Simultaneous 2 Arterial Occlusions during Laparoscopic Management for Cornual Ectopic Pregnancy.

STUDY OBJECTIVE: To demonstrate a new technique of temporary simultaneous 2 arterial occlusions (TESTOs) of the uterine and ovarian (or utero-ovarian) artery to reduce operative blood loss during laparoscopic cornual resection for cornual ectopic pregnancy. DESIGN: A step-by-step explanation of the surgical procedure using video (Canadian Task Force classification III). This study was approved by the institutional review board. SETTING: A university hospital. PATIENTS: A 41-year-old woman presented with pelvic pain with 7 weeks of amenorrhea. A transvaginal sonogram and laboratory tests revealed left cornual pregnancy. She had a history of left salpingectomy caused by tubal pregnancy and wanted prompt surgical management without a surgical scar. INTERVENTIONS: During the single-port laparoscopy, we found a 3-cm unruptured ectopic mass in the left uterine cornua. The retroperitoneum was opened using a harmonic scalpel (Ethicon Endosurgery, Cincinnati, OH) along the infundibulopelvic ligament. Then, both uterine arteries were temporarily occluded with a bulldog clamp (Aesculap, Tuttlingen, Germany) at the level where they originate from the internal iliac artery. The bulldog clamp, which is a spring-loaded crossover clamp with serrated blades that effectively occlude vessels without slippage or significant crush injury, is the laparoscopic instrument for minimizing blood loss during the surgical procedure. Each ovarian arterial vasculature was also transiently occluded at the utero-ovarian or ovarian pedicle by placing a bulldog clamp. Then, a uterine incision was made in the left cornua using a harmonic scalpel, the gestational conception was expressed through the incision, and corneal resection was completed. The uterine defect was closed using a V-Loc suture (Covidien, Mansfield, MA). In the final step, all vascular clamps were removed for reperfusion. MEASUREMENTS AND MAIN RESULTS: The operative time was 45 minutes. The procedure time for TESTO and the occlusion time (defined as the time that the bilateral uterine and ovarian vessels were occluded by bulldog clamps) were 10 and 12 minutes, respectively. The estimated blood loss was 50 mL, and her postoperative hemoglobin was 11.9 g/dL from 13.0 g/dL preoperatively. No complications occurred in the postoperative course. Her menstruation resumed 2 months after surgery. CONCLUSION: Surgical management of ectopic cornual pregnancy could be performed safely and efficiently under laparoscopy with the TESTO technique.