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Sample records for laparoscopic radical hysterectomy

  1. Laparoscopic compared with open radical hysterectomy in obese women with early-stage cervical cancer.

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    Park, Jeong-Yeol; Kim, Dae-Yeon; Kim, Jong-Hyeok; Kim, Yong-Man; Kim, Young-Tak; Nam, Joo-Hyun

    2012-06-01

    To compare the surgical and oncological outcomes of laparoscopic radical hysterectomy and open radical hysterectomy in obese women with early-stage cervical cancer. The medical records of 166 patients with stage IA2-IIA2 cervical cancer and a body mass index of at least 30 who underwent laparoscopic radical hysterectomy (n=54) or open radical hysterectomy (n=112) at the Asan Medical Center between 1998 and 2011 were reviewed. None of the patients in the laparoscopic radical hysterectomy group required conversion to laparotomy. The resection margin was negative in 98.1% of the laparoscopic radical hysterectomy group and 98.2% of the open radical hysterectomy group (P=.976). No difference between the two groups was observed in terms of operating time, perioperative hemoglobin level change, transfusion requirement, or the number of retrieved lymph nodes. Compared with open radical hysterectomy, laparoscopic radical hysterectomy was associated with a significant reduction in the following: interval to return of bowel movements (2 days compared with 2.7 days, Plaparoscopic radical hysterectomy group and 85% for the open radical hysterectomy group (P=.682). The 5-year overall survival rate was 97% for the laparoscopic radical hysterectomy group and 90% for the open radical hysterectomy group (P=.220). Laparoscopic radical hysterectomy was a preferred alternative to open radical hysterectomy in the present cohort of obese women with early-stage cervical cancer because it is associated with a more favorable surgical outcome without compromising survival outcomes. II.

  2. Safety of total laparoscopic modified radical hysterectomy with or without lymphadenectomy for endometrial cancer

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    Masakazu Kitagawa

    2017-02-01

    Conclusion: Total laparoscopic modified radical hysterectomy is safe and feasible for the treatment of early stage endometrial cancer. This procedure can be an alternative to total laparoscopic hysterectomy, especially when the uterus must be removed completely.

  3. Laparoscopic, robotic and open method of radical hysterectomy for cervical cancer: A systematic review

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    Puliyath Geetha

    2012-01-01

    Full Text Available Background : Over the last two decades, numerous studies have indicated the feasibility of minimally invasive surgery for early cervical cancer without compromising the oncological outcome. Objective : Systematic literature review and meta analysis aimed at evaluating the outcome of laparoscopic and robotic radical hysterectomy (LRH and RRH and comparing the results with abdominal radical hysterectomy (ARH. Search Strategy : Medline, PubMed, Embase, Cochrane library and Reference lists were searched for articles published until January 31 st 2011, using the terms radical hysterectomy, laparoscopic radical hysterectomy, robotic radical hysterectomy, surgical treatment of cervical cancer and complications of radical hysterectomy. Selection Criteria : Studies that reported outcome measures of radical hysterectomy by open method, laparoscopic and robotic methods were selected. Data collection and analysis: Two independent reviewers selected studies, abstracted and tabulated the data and pooled estimates were obtained on the surgical and oncological outcomes. Results : Mean sample size, age and body mass index across the three types of RH studies were similar. Mean operation time across the three types of RH studies was comparable. Mean blood loss and transfusion rate are significantly higher in ARH compared to both LRH and RRH. Duration of stay in hospital for RRH was significantly less than the other two methods. The mean number of lymph nodes obtained, nodal metastasis and positive margins across the three types of RH studies were similar. Post operative infectious morbidity was significantly higher among patients who underwent ARH compared to the other two methods and a higher rate of cystotomy in LRH. Conclusions : Minimally invasive surgery especially robotic radical hysterectomy may be a better and safe option for surgical treatment of cervical cancer. The laparoscopic method is not free from complications. However, experience of surgeon may

  4. Urologic complication in laparoscopic radical hysterectomy: meta-analysis of 20 studies.

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    Hwang, Jong Ha

    2012-11-01

    A meta-analysis was done to assess the risk of intraoperative and postoperative urologic complications, and laparoscopic radical hysterectomy (LRH) and lymph node dissection. Pubmed, EMBASE and Cochrane library were searched for studies published to December, 2011, supplemented by manual searches of relevant bibliographies from the retrieved articles. Two researchers independently extracted the data. Eligible studies had reported perioperative complications and a sample size of at least 10 patients. The search yielded 19 retrospective studies and one prospective cohort study (intraoperative urologic complication, 18 studies; postoperative urologic complication, 16 studies). When all studies were pooled, the odds ratio (OR) of LRH for the risk of intraoperative urologic complications compared to abdominal radical hysterectomy (ARH) was 1.97 [95% confidence interval (CI) 1.23-3.13] and the OR of LRH for postoperative complication risk compared to ARH was 1.35 [95% CI 0.84-2.16]. In subgroup analysis, obesity and laparoscopic type (laparoscopic assisted vaginal radical hysterectomy) were associated with intraoperative urologic complications. Laparoscopic radical hysterectomy is associated with a significant increased risk of intraoperative urologic complications. Copyright © 2012. Published by Elsevier Ltd.

  5. Modified uterine manipulator and vaginal rings for total laparoscopic radical hysterectomy.

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    Ramirez, P T; Frumovitz, M; Dos Reis, R; Milam, M R; Bevers, M W; Levenback, C F; Coleman, R L

    2008-01-01

    At present, there is no standard technique that allows surgeons performing total laparoscopic radical hysterectomy to complete the colpotomy and remove an adequate (2-cm) margin of upper vaginal tissue while maintaining adequate pneumoperitoneum. We evaluated the feasibility and safety of using a modified uterine manipulator for total laparoscopic radical hysterectomy in patients with cervical or endometrial cancer. A retrospective review was performed in all patients who underwent total laparoscopic radical hysterectomy using a modified uterine manipulator at our institution during the period April 2004 to December 2006. This analysis included 30 patients who underwent surgery with the modified uterine manipulator. There were no reports of difficulty with placement of the instrument, multiple attempts at placement, difficulty with uterine manipulation, or uterine perforation. In no patient was a vaginal incision or episiotomy required to fit the instrument through the introitus. In no case was there loss of pneumoperitoneum during colpotomy. Additional upper vaginal tissue had to be removed after intraoperative assessment of the adequacy of the surgical specimen in five (16.7%) of 30 patients. Use of the modified uterine manipulator according to our technique is safe and feasible, allowing for adequate vaginal resection and maintenance of pneumoperitoneum.

  6. Outpatient laparoscopic nerve-sparing radical hysterectomy: A feasibility study and analysis of perioperative outcomes.

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    Rendón, Gabriel J; Echeverri, Lina; Echeverri, Francisco; Sanz-Lomana, Carlos Millán; Ramirez, Pedro T; Pareja, Rene

    2016-11-01

    The goal of our study was to report on the feasibility of outpatient laparoscopic radical hysterectomy in patients with early-stage cervical cancer. We included all patients who underwent a laparoscopic radical hysterectomy at the Instituto de Cancerología - Las Americas in Medellin, Colombia, between January 2013 and July 2015. The control group was a similar cohort of patients who were admitted after their surgery. Seventy-six patients were included [outpatient (31) and admitted (45)]. There were no statistically significant differences between groups regarding age, clinical stage, histology, nodal count, need of adjuvant treatment, visual pain scores at discharge or follow up time. All patients underwent a transversus abdominis plane block. The median operative time was 150min (range, 105-240) in the outpatient group vs. 170min (range, 97-300) in the admitted group (p=0.023). The median estimated blood loss was 50ml (range, 20-150) in the outpatient group vs. 120ml (range, 20-1000) in the admitted group (p=0.001). All patients were able to void spontaneously and tolerate a diet before discharge. In patients who were admitted, the median hospital stay was 1day, (range; 1-6), and 39 (87%) were discharged at postoperative day 1. There were 6 postoperative complications, 3 in each group. There were no recurrences in the follow-up period in the outpatient group, and there were 3 (6.6%) recurrences in the admitted group. Outpatient laparoscopic radical hysterectomy is feasible and can be performed safely in a developing country in well-selected patients. Copyright © 2016. Published by Elsevier Inc.

  7. Laparoscopic approach to hysterectomy

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    Hakan Nazik

    2013-04-01

    Full Text Available Modern laparoscopic surgery is widely used throughout the world as it offers greater advantages than open procedures. The laparoscopic approach to hysterectomy has evolved over the last 20 years. Hysterectomies are performed abdominally, vaginally, laparoscopically or, more recently, with robotic assistance. Indications for a total laparoscopic hysterectomy are similar to those for total abdominal hysterectomy, and most commonly include uterine leiomyomata, pelvic organ prolapse, and abnormal uterine bleeding. When hysterectomy is going to be performed, the surgeon should decide which method is safer and more cost-effective. This paper aims to make a review of the indications, techniques and advantages of laparoscopic hysterectomy as well as the criteria to be used for appropriate patient selection.

  8. Early catheter removal following laparoscopic radical hysterectomy for cervical cancer: assessment of a new bladder care protocol.

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    Campbell, Patrick; Casement, Maire; Addley, Susan; Dobbs, Stephen; Harley, Ian; Nagar, Hans

    2017-10-01

    Evidence to support prolonged catheterisation after radical hysterectomy is lacking. We sought to assess feasibility of a new protocol of early post-operative catheter removal following laparoscopic radical hysterectomy for cervical cancer. A retrospective review of post-operative bladder care in patients who underwent laparoscopic radical hysterectomy for cervical cancer was carried out. The post-operative bladder care protocol recommended catheter removal after 24-72 hours. Three consecutive post-void residual scans of less than 150 millilitres (ml) were considered evidence of normal voiding function. First line management of voiding dysfunction was clean intermittent self-catheterisation (CISC). Ninety-eight patients underwent laparoscopic radical hysterectomy for cervical cancer of whom 78 patients had catheter removal 24-72 hours post-operatively. The incidence of post-operative voiding dysfunction in this group was 44%, of whom 88% were managed with CISC and 82% regained normal voiding function. Average hospital stay was 4.2 days. The overall rate of long-term voiding dysfunction was 6%. Early catheter removal after laparoscopic radical hysterectomy appears to be both feasible and effective and compliments the ethos of enhanced patient recovery.

  9. Total Laparoscopic Radical Hysterectomy for Treatment of Uterine Malignant Tumors:Analysis of Short-term Therapeutic Efficacy

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    沈怡; 王泽华

    2010-01-01

    To investigate the efficacy and the clinical value of total laparoscopic radical hysterectomy(TLRH) for the treatment of uterine malignancies,we performed a retrospective review of 87 patients with cervical cancer and 23 patients with endometrial carcinoma who underwent TLRH at Union hospital between June 2008 and September 2009.Data collected included operative time,estimated blood loss,lymph node count,time for the recovery of normal temperature and time to resumption of normal bladder function,intraopera...

  10. Place of Schauta's radical vaginal hysterectomy.

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    Roy, Michel; Plante, Marie

    2011-04-01

    Women affected by early stage invasive cancer of the cervix are usually treated by surgery. Radical abdominal hysterectomy with pelvic lymphadenectomy is the most widely used technique. Because the morbidity of the abdominal approach can be important, the radical vaginal hysterectomy has gained acceptance in gynaecologic oncology. New instrumentation in laparoscopy also opens the possibility of treating cervical cancer by laparoscopically assisted vaginal radical hysterectomy and also total laparoscopic radical hysterectomy. Before these techniques become widely accepted, it has to be shown that safety and efficacy are comparable with the 'standard' abdominal approach. In this chapter, we review the technique of radical vaginal hysterectomy with pelvic lymphadenectomy and evaluate results of published studies, comparing the abdominal, vaginal and laparoscopic approaches.

  11. Robotic versus total laparoscopic radical hysterectomy with pelvic lymphadenectomy for the treatment of early cervical cancer

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    Jagdishwar G Goud

    2014-02-01

    Conclusions: According to our experience, robotic radical hysterectomy appears to be safe and effective therapeutic procedure for managing early-stage cervical cancer without significant differences when compared to TLRH, with respect to operative time, blood loss, hospital stay. Regarding the oncological outcome, Robotic radical hysterectomy is superior in terms of number of lymph nodes and parametrial bulk; although multicenter randomized clinical trials with longer follow-up are necessary to evaluate the overall oncologic outcome. [Int J Reprod Contracept Obstet Gynecol 2014; 3(1.000: 34-39

  12. Surgical and oncological outcome of total laparoscopic radical hysterectomy in obese women with early-stage cervical cancer.

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    Moss, Esther Louise; Balega, Janos; Chan, Kiong K; Singh, Kavita

    2012-01-01

    To evaluate the clinical experience of the total laparoscopic radical hysterectomy (TLRH) for the surgical management of cervical cancer in obese (body mass index [BMI] >30 kg/m) and nonobese (BMI obese, BMI >30 kg/m, or nonobese, BMI hysterectomy cases performed before the introduction of the TLRH. A total of 58 women underwent a TLRH; 15 (25.9%) were obese and 43 (74.1%) were in the nonobese group. There was no significant difference in intraoperative blood loss or median duration of surgery between the obese and nonobese groups. The median hospital stay in both groups was 3 days (range, 2-13 days). Four cases were converted to laparotomy (7%); all were in the nonobese group. Postoperatively, 3 patients developed ischemic ureterovaginal fistulae (5%) between days 5 and 7 after surgery; all were in the nonobese group. There was no significant difference in the parametrial length, maximum vaginal cuff length, and number of lymph nodes excised between the 2 groups. To date, there has been one recurrence during the median follow-up period of 19 months (range, 3-42 months). She belonged to the nonobese group. The TLRH is a surgically safe procedure for early-stage cervical cancer. Obesity did not adversely affect the performance of TLRH or the radicality of the excision. In obese women, TLRH should be the favored route of surgery for all women who require a radical hysterectomy owing to its favorable perioperative outcome and short hospital stay.

  13. Laparoscopic radical hysterectomy with the use of a modified uterine manipulator for the management of stage IB1 cervix cancer.

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    Canton-Romero, J C; Anaya-Prado, R; Rodriguez-Garcia, H A; Mejia-Romo, F; De-Los-Rios, P E; Cortez-Martinez, G; Delgado-Ramirez, R; Quijano, F

    2010-01-01

    We prospectively collected data on all patients with stage IB1 cervical cancer, who underwent total laparoscopic radical hysterectomy with the use of a modified uterine manipulator. From January 2000 to December 2005, 54 patients met the study criteria. The mean age was 41.8 +/- 7.47 years. Average BMI (kg/m(2)) was 27.38 +/- 3.13. Squamous carcinoma and adenocarcinoma were found in 88.88% and 11.11% of the cases, respectively. The average surgical time was 265 +/- 70.8 min. The mean estimated blood loss was 276.11 +/- 123.03 ml. The average patient lymph node count was 19.64 +/- 5.08. Positive malignant lymph nodes were identified in 11.11% of the cases. Surgical margins were free of disease in all patients. The mean hospital stay was 1.5 +/- 1 days. There was no mortality. Total laparoscopic radical hysterectomy can be considered a safe alternative to laparotomy. The use of a uterine manipulator does not pose an increased surgical risk and allows for a simpler and more feasible procedure.

  14. Laparotomy conversion rate of laparoscopic radical hysterectomy for early-stage cervical cancer in a consecutive series without case selection.

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    Park, Jeong-Yeol; Nam, Joo-Hyun

    2014-09-01

    To estimate the feasibility and conversion rate of laparoscopic radical hysterectomy (LRH) in early-stage cervical cancer. Data were collected from the medical records of 260 consecutive patients with stage IA2 to IIA2 cervical cancer who had undergone LRH, regardless of age, body mass index, prior abdominal surgery, uterus size, or tumor size. The median patient age was 48 years (range, 26-78 years), 11.9 % of whom were elderly (≥65 years), 11.2 % were obese (≥30 kg/m(2)), 15.4 % had undergone previous abdominal surgery, and 13.1 % had a tumor larger than 4 cm. Negative-margin resection was feasible in all patients except one. The median operative time and estimated blood loss were 253 min (range, 111-438 min) and 300 mL (range, 80-2000 mL), respectively. Intraoperative and postoperative complications occurred in seven (2.7 %) and 10 patients (3.8 %), respectively. Four patients (1.5 %) required intraoperative conversion to laparotomy, three of which were due to conglomerated metastatic lymph nodes surrounding the aorta (n = 2), the left external iliac vein (n = 1) or the left ureter (n = 1). LRH was still completed in the four conversion patients, and a laparotomy was required for the removal of the conglomerated metastatic lymph nodes and the repair of the injured vessels. The conversion rate to laparotomy among patients undergoing LRH for early-stage cervical cancer was 1.5 % when performed exclusively in consecutive patients. LRH showed comparable feasibility and effectiveness to open radical hysterectomy in the treatment of early-stage cervical cancer.

  15. Feasibility and morbidity of total laparoscopic radical hysterectomy with or without pelvic limphadenectomy in obese women with stage I endometrial cancer.

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    Pellegrino, Antonio; Signorelli, Mauro; Fruscio, Robert; Villa, Annalisa; Buda, Alessandro; Beretta, Pietro; Garbi, Annalisa; Vitobello, Domenico

    2009-05-01

    The aim of this study was to describe the feasibility and morbidity rates associated with total laparoscopic radical hysterectomy (TLRH) with or without pelvic lymphadenectomy for stage I endometrial cancer in obese women. Obese patients with stage I endometrial cancer who underwent total laparoscopic radical surgery at the Department of Obstetrics and Gynecology of San Gerardo Hospital were compared to nonobese patients. The same group of obese patients was compared with patients who underwent radical laparotomic surgery. Obesity was defined as a body mass index more than 30 kg/m(2). Between September 2003 and September 2007, 75 women underwent TLRH. Median age was 54 years and median body mass index was 28 kg/m(2). Thirty-seven women were obese. There were no differences between nonobese and obese women in operative, time length of parametria and pelvic nodes removed and operative or late complications. Blood loss was significantly higher in obese patients. Comparing retrospectively laparoscopy and laparotomy in obese women treated in our center, laparotomy was associated with decreased operative time, but also with increased blood loss, transfusion rate, duration of hospitalization and frequency of post surgical complications. Total laparoscopic radical hysterectomy (with pelvic lymphadenectomy) is a safe option in patients with endometrial cancer. Obesity is not a contraindication to perform a TRLH with no differences in surgical parameters between obese and nonobese population. TLRH show a significant decrease of complications compared to laparotomic radical surgery in obese women.

  16. Adjuvant chemoradiation after laparoscopically assisted radical vaginal hysterectomy (LARVH) in patients with cervical cancer. Oncologic outcome and morbidity

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    Gruen, Arne; Musik, Thabea; Stromberger, Carmen; Budach, Volker; Marnitz, Simone [Charite Univ. Medicine Berlin, Campus Virchow-Klinikum, Berlin (Germany). Dept. of Radiooncology; Koehler, Christhardt; Schneider, Achim [Charite Univ. Medicine Berlin, Campus Mitte- und Benjamim Franklin, Berlin (Germany). Dept. of Gynaecology; Fueller, Juergen; Wendt, Thomas [Jena Univ. Hospital (Germany). Dept. of Radiooncology

    2011-06-15

    Compared to laparotomic surgery, laparoscopically assisted radical vaginal hysterectomy (LARVH) offers decreased blood loss during surgery and faster convalescence of the patient postoperatively, while at the same time delivering similar oncologic results. However, there is no data on outcome and toxicity of LARVH followed by (chemo)radiation. A total of 55 patients (range 28-78 years) with cervical cancer on FIGO stages IB1-IIIA (Tables 1 and 2) with risk factors were submitted to either external beam radiotherapy alone [EBRT, n = 8 (14%), including paraaortic irradiation, n = 4 (2.2%); EBRT and brachytherapy (BT), n = 33 (60%); BT alone, n = 14 (25.5%)] or chemoradiation after LARVH. At a median follow-up of 4.4 years, the 5-year disease-free survival (DFS) was 81.8% with 84.5% overall survival (OS). Acute grade 3 side effects were seen in 4 patients. These were mainly gastrointestinal (GI) and genitourinary (GU) symptoms. Grade 4 side effects were not observed. With similar oncologic outcome data and mostly mild side effects, LARVH followed by (chemo)radiation is a valid alternative in the treatment of cervical cancer patients. (orig.)

  17. [Laparoscopic radical hysterectomy with pelvic lymph node dissection for endometrial cancer in obese patients].

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    Berlev, I V; Urmancheeva, A F; Saparov, A B; Khadzhimba, A B; Nekrasova, E A

    2014-01-01

    The results of treatment of 61 endometrial cancer patients with various forms of obesity are presented. Two groups of patients were compared: the first group comprised 26 patients who had undergone the laparoscopic surgery; the second group included 35 patients who had open surgery. Te laparoscopic approach improved the results of surgical treatment of endometrial cancer in patients with obesity. This technique allowed to reduce intraoperative blood loss, to diminish the duration of analgesics' administration, to shorten the period of bowel function recovery, 3 times to reduce the incidence of postoperative complications.

  18. Lower limb compartment syndrome by reperfusion injury after treatment of arterial thrombosis post-laparoscopic radical hysterectomy and pelvic lymph node dissection for cervical cancer.

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    Yeon, Jihee; Jung, Ye Won; Yang, Shin Seok; Kang, Byung Hun; Lee, Mina; Ko, Young Bok; Yang, Jung Bo; Lee, Ki Hwan; Yoo, Heon Jong

    2017-03-01

    Compartment syndrome is a clinical condition associated with decreased blood circulation that can lead to swelling of tissue in limited space. Several factors including lithotomy position, prolonged surgery, intermittent pneumatic compressor, and reperfusion after treatment of arterial thrombosis may contribute to compartment syndrome. However, compartment syndrome rarely occurs after gynecologic surgery. In this case, the patient was diagnosed as compartment syndrome due to reperfusion injury after treatment of arterial thrombosis, which occurred after laparoscopic radical hysterectomy and pelvic lymph node dissection for cervical cancer. Despite its rarity, prevention and identifying the risk factors of complication should be performed perioperatively; furthermore, gynecologist should be aware of the possibility of complications.

  19. Lower limb compartment syndrome by reperfusion injury after treatment of arterial thrombosis post-laparoscopic radical hysterectomy and pelvic lymph node dissection for cervical cancer

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    Yeon, Jihee; Jung, Ye Won; Yang, Shin Seok; Kang, Byung Hun; Lee, Mina; Ko, Young Bok; Yang, Jung Bo; Lee, Ki Hwan

    2017-01-01

    Compartment syndrome is a clinical condition associated with decreased blood circulation that can lead to swelling of tissue in limited space. Several factors including lithotomy position, prolonged surgery, intermittent pneumatic compressor, and reperfusion after treatment of arterial thrombosis may contribute to compartment syndrome. However, compartment syndrome rarely occurs after gynecologic surgery. In this case, the patient was diagnosed as compartment syndrome due to reperfusion injury after treatment of arterial thrombosis, which occurred after laparoscopic radical hysterectomy and pelvic lymph node dissection for cervical cancer. Despite its rarity, prevention and identifying the risk factors of complication should be performed perioperatively; furthermore, gynecologist should be aware of the possibility of complications. PMID:28344966

  20. Laparoscopic radical trachelectomy.

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    Rendón, Gabriel J; Ramirez, Pedro T; Frumovitz, Michael; Schmeler, Kathleen M; Pareja, Rene

    2012-01-01

    The standard treatment for patients with early-stage cervical cancer has been radical hysterectomy. However, for women interested in future fertility, radical trachelectomy is now considered a safe and feasible option. The use of minimally invasive surgical techniques to perform this procedure has recently been reported. We report the first case of a laparoscopic radical trachelectomy performed in a developing country. The patient is a nulligravid, 30-y-old female with stage IB1 adenocarcinoma of the cervix who desired future fertility. She underwent a laparoscopic radical trachelectomy and bilateral pelvic lymph node dissection. The operative time was 340 min, and the estimated blood loss was 100mL. There were no intraoperative or postoperative complications. The final pathology showed no evidence of residual disease, and all pelvic lymph nodes were negative. At 20 mo of follow-up, the patient is having regular menses but has not yet attempted to become pregnant. There is no evidence of recurrence. Laparoscopic radical trachelectomy with pelvic lymphadenectomy in a young woman who desires future fertility may also be an alternative technique in the treatment of early cervical cancer in developing countries.

  1. Risk profiles and outcomes of total laparoscopic hysterectomy compared with laparoscopically assisted vaginal hysterectomy.

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    Hanwright, Philip J; Mioton, Lauren M; Thomassee, May S; Bilimoria, Karl Y; Van Arsdale, John; Brill, Elizabeth; Kim, John Y S

    2013-04-01

    With the increasing rates of minimally invasive hysterectomy procedures serving as impetus, the aim of this study was to analyze the 30-day risk profiles associated with total laparoscopic hysterectomy and laparoscopically assisted vaginal hysterectomy (LAVH). The American College of Surgeons National Surgical Quality Improvement Program database was queried for patients who underwent a total laparoscopic hysterectomy or LAVH operation between 2006 and 2010. Patient demographics and 30-day complication rates were calculated. Multivariable regression analyses were used to study the effect of hysterectomy approach on outcomes. A total of 6,190 patients underwent laparoscopic hysterectomy, with 66.3% receiving LAVH and 33.7% receiving a total laparoscopic hysterectomy. The patient cohorts were well-matched. Although total laparoscopic hysterectomy procedures were significantly longer than LAVH operations (2.66 hours compared with 2.20 hours; Plaparoscopic hysterectomy populations (7.05% compared with 6.3% for overall morbidity; 1.3% compared with 1.7% for reoperation). Regression analyses revealed that surgical approach was not a significant predictor of overall postoperative morbidity or reoperation in minimally invasive hysterectomy patients. Additionally, obesity did not demonstrate a significant association with morbidity or reoperation rates; however, operative time was found to be a significant predictor of reoperation (odds ratio 1.23, 95% confidence interval 1.07-1.42). Laparoscopic hysterectomy is well-tolerated with total laparoscopic hysterectomy and LAVH, yielding comparable rates of postoperative morbidity and reoperation. On average, LAVH procedures were 28 minutes faster than total laparoscopic hysterectomy. Additionally, increasing body mass index was not associated with higher rates of morbidity. II.

  2. Laparoscopic hysterectomy : predictors of quality of surgery

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    Twijnstra, Andries Roelof Huig

    2013-01-01

    Although hospitals increasingly opt for the laparoscopic over the conventional approach and the decline in diagnostic procedures is well compensated by an increase in numbers of all types of therapeutic procedures, the implementation of laparoscopic hysterectomy in the Netherlands seems to be hamper

  3. Total laparoscopic hysterectomy in the obese patient.

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    Mikhail, Emad; Scott, Lauren; Imudia, Anthony N; Hart, Stuart

    2014-11-01

    Obesity is a challenging health problem that affects surgical decision-making. Obesity has also been associated with an increase in the perioperative complication rate in open abdominal hysterectomy and can increase the level of difficulty in performing a vaginal hysterectomy. Total laparoscopic hysterectomy (TLH) is a route that can offer advantages in obese patients including smaller incisions that are less likely to become infected as well as less post-operative pain and good visualization. With appropriate perioperative planning and techniques, excellent outcomes can be achieved.

  4. TOTAL LAPAROSCOPIC HYSTERECTOMY VERSUS TOTAL ABDOMINAL HYSTERECTOMY: A RETROSPECTIVE STUDY

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    Virupaksha

    2015-10-01

    Full Text Available BACKGROUND: Hysterectomy is a common gynaecological surgery which can be done by abdominal, vaginal or laparoscopic routes or with robotic assistance. Although there were concerns regarding the safety of laparoscopic surgery, a newer technique when compared with abdominal hysterectomy, it is now being reco gnized as a safe procedure in the hands of an experienced surgeon. AIMS: This study was done to compare the intra - operative and post - operative parameters of abdominal and laparoscopic hysterectomy. SETTINGS AND DESIGN: This study was done at JSS Hospital, Mysore between June 2013 and September 2014. It is a retrospective study . MATERIALS AND METHOD S: Patients admitted in the Department of Obstetrics and Gynaecology at JSS Hospital, JSS University, Mysore, with an indication for total abdominal hysterectomy( TAH or total laparoscopic hysterectomy(TLH for benign pathology from June 2013 to September 2014 were included in the study. Exclusion criteria were suspicion of malignancy, vaginal prolapse higher than first degree and those undergoing laparoscopic assi sted vaginal hysterectomy. Baseline characteristics, intraoperative and postoperative parameters were compared between the two groups. STATISTICAL ANALYSIS : The data were analyzed using independent T test, Chi square test and Mann Whitney test. A p value o f <0 . 05 was accepted as significant. RESULTS: The mean time taken to perform TLH was significantly longer, i.e. 113.46 minutes compared with TAH, i.e. 70.44 minutes, with the p value being <0.0001. But the duration of stay in the hospital was shorter for t he women undergoing TLH, mean duration being 3.74 days as opposed to 7.65 days in women undergoing TAH. This difference was also statistically significant with p value being <0.0001. Also, women undergoing TAH required more analgesic doses (mean 3.29 than those undergoing TLH (mean 1.36 and this difference was also statistically significant. CONCLUSION: Although TLH took a

  5. Single-port laparoscopic hysterectomy: preliminary results

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    Renata Assef Tormena

    2015-10-01

    Full Text Available Summary Objective: to describe the initial results of a laparoscopic single port access hysterectomy and also to evaluate the feasibility and safety of this access. Methods: a prospective study was performed at a tertiary university medical center (Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo between March 2013 and June 2014. A total of 20 women, referred for hysterectomy due to benign uterine disease, were included in the study after they had signed an informed consent. Outcome measures, including operating time, blood loss, rate of complications, febrile morbidity, visual analogical pain score and length of hospital stay were registered. Results: mean patient age and body mass index (BMI were 47.8 years and 27.15 kg/m2, respectively. Mean operating time was 165.5 min. Blood loss was minimal, with no blood transfusion. All procedures but one were successfully performed via a single incision and no post-operative complications occurred. We experienced one conversion to multiport laparoscopic hysterectomy due to extensive pelvic adhesions. There was no conversion to “open” total abdominal hysterectomy. None of the patients required narcotics or NSAD post-operatively. Conclusion: single-port hysterectomy is a feasible and safe technique, with no major complications.

  6. [Laparoscopic hysterectomy--brief history, frequency, indications and contraindications].

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    Tomov, S; Gorchev, G; Tzvetkov, Ch; Tanchev, L; Iliev, S

    2012-01-01

    Hysterectomy is the most common gynecological operation after Caesarean section and the laparoscopic access to uterus removal is one of the contemporary methods showing slow but steady growth in time. In reference to indications and contraindications for laparoscopic hysterectomy, the following directions emerge as controversial: malignant gynecological tumors, uterus size, and high body mass index. Laparoscopic hysterectomy can be taken into consideration at the first stage of endometrial, cervical and ovarian cancer. If there is doubt about an uterus sarcoma and a laparoscopic access is accomplished, a conversion to abdominal hysterectomy must be done. Obesity and big uteri are not a contrarindication for that minimally-invasive access. Today, laparoscopic hysterectomy is a reasonable alternative to total abdominal and vaginal hysterectomy.

  7. Quality of laparoscopic radical hysterectomy in developing countries: a comparison of surgical and oncologic outcomes between a comprehensive cancer center in the United States and a cancer center in Colombia.

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    Pareja, Rene; Nick, Alpa M; Schmeler, Kathleen M; Frumovitz, Michael; Soliman, Pamela T; Buitrago, Carlos A; Borrero, Mauricio; Angel, Gonzalo; Reis, Ricardo Dos; Ramirez, Pedro T

    2012-05-01

    To help determine whether global collaborations for prospective gynecologic surgery trials should include hospitals in developing countries, we compared surgical and oncologic outcomes of patients undergoing laparoscopic radical hysterectomy at a large comprehensive cancer center in the United States and a cancer center in Colombia. Records of the first 50 consecutive patients who underwent laparoscopic radical hysterectomy at The University of Texas MD Anderson Cancer Center in Houston (between April 2004 and July 2007) and the first 50 consecutive patients who underwent the same procedure at the Instituto de Cancerología-Clínica las Américas in Medellín (between December 2008 and October 2010) were retrospectively reviewed. Surgical and oncologic outcomes were compared between the 2 groups. There was no significant difference in median patient age (US 41.9 years [range 23-73] vs. Colombia 44.5 years [range 24-75], P=0.09). Patients in Colombia had a lower median body mass index than patients in the US (24.4 kg/m(2) vs. 28.7 kg/m(2), P=0.002). Compared to patients treated in Colombia, patients who underwent surgery in the US had a greater median estimated blood loss (200 mL vs. 79 mL, P<0.001), longer median operative time (328.5 min vs. 235 min, P<0.001), and longer postoperative hospital stay (2 days vs. 1 day, P<0.001). Surgical and oncologic outcomes of laparoscopic radical hysterectomy were not worse at a cancer center in a developing country than at a large comprehensive cancer center in the United States. These results support consideration of developing countries for inclusion in collaborations for prospective surgical studies. Copyright © 2011 Elsevier B.V. All rights reserved.

  8. Single-incision total laparoscopic hysterectomy

    Directory of Open Access Journals (Sweden)

    Sinha Rakesh

    2011-01-01

    Full Text Available Single-incision laparoscopic surgery is an alternative to conventional multiport laparoscopy. Single-access laparoscopy using a transumbilical port affords maximum cosmetic benefits because the surgical incision is hidden in the umbilicus. The advantages of single-access laparoscopic surgery may include less bleeding, infection, and hernia formation and better cosmetic outcome and less pain. The disadvantages and limitations include longer surgery time, difficulty in learning the technique, and the need for specialized instruments. Ongoing refinement of the surgical technique and instrumentation is likely to expand its role in gynecologic surgery in the future. We perform single-incision total laparoscopic hysterectomy using three ports in the single transumbilical incision.

  9. Laparoscopic radical prostatectomy

    Directory of Open Access Journals (Sweden)

    Lipke Michael

    2005-01-01

    Full Text Available Millions of men are diagnosed annually with prostate cancer worldwide. With the advent of PSA screening, there has been a shift in the detection of early prostate cancer, and there are increased numbers of men with asymptomatic, organ confined disease. Laparoscopic radical prostatectomy is the latest, well accepted treatment that patients can select. We review the surgical technique, and oncologic and functional outcomes of the most current, large series of laparoscopic radical prostatectomy published in English. Positive margin rates range from 2.1-6.9% for pT2a, 9.9-20.6% for pT2b, 24.5-42.3% for pT3a, and 22.6-54.5% for pT3b. Potency rates after bilateral nerve sparing laparoscopic radical prostatectomy range from 47.1 to 67%. Continence rates at 12 months range from 83.6 to 92%.

  10. Laparoscopic subtotal hysterectomy in the era of minimally invasive surgery

    Directory of Open Access Journals (Sweden)

    Chia-Jen Wu

    2015-02-01

    Full Text Available According to a nation-wide population-based study in Taiwan, along with the expanding concepts and surgical techniques of minimally invasive surgery, laparoscopic supracervical/subtotal hysterectomy (LSH has been blooming. Despite this, the role of LSH in the era of minimally invasive surgery remains uncertain. In this review, we tried to evaluate the perioperative and postoperative outcomes of LSH compared to other types of hysterectomy, including total abdominal hysterectomy (TAH, vaginal hysterectomy, laparoscopic-assisted vaginal hysterectomy, and total laparoscopic hysterectomy (TLH. From the literature, LSH has a better perioperative outcome than TAH, and comparable perioperative complications compared with laparoscopic-assisted vaginal hysterectomy. LSH had less bladder injury, vaginal cuff bleeding, hematoma, infection, and dehiscence requiring re-operation compared with TLH. Despite this, LSH has more postoperative cyclic menstrual bleeding and re-operations with extirpations of the cervical stump. LSH does, however, have a shorter recovery time than TAH due to the minimally invasive approach; and there is quicker resumption of coitus than TLH, due to cervical preservation and the avoidance of vaginal cuff dehiscence. LSH is therefore an alternative option when the removal of the cervix is not strictly necessary or desired. Nevertheless, the risk of further cervical malignancy, postoperative cyclic menstrual bleeding, and re-operations with extirpations of the cervical stump is a concern when discussing the advantages and disadvantages of LSH with patients.

  11. Nerve plane-sparing radical hysterectomy: a simplified technique of nerve-sparing radical hysterectomy for invasive cervical cancer

    Institute of Scientific and Technical Information of China (English)

    LI Bin; LI Wei; SUN Yang-chun; ZHANG Rong; ZHANG Gong-yi; YU Gao-zhi; WU Ling-ying

    2011-01-01

    Background In order to simplify the complicated procedure of nerve-sparing radical hysterectomy, a novel technique characterized by integral preservation of the autonomic nerve plane has been employed for invasive cervical cancer. The objective of this study was to introduce the nerve plane-sparing radical hysterectomy technique and compare its efficacy and safety with that of nerve-sparing radical hysterectomy.Methods From September 2006 to August 2010, 73 consecutive patients with International Federation of Gynecology and Obstetrics stage IB to IIA cervical cancer underwent radical hysterectomy with two different nerve-sparing approaches. Nerve-sparing radical hysterectomy was performed for the first 16 patients (nerve-sparing radical hysterectomy group). The detailed autonomic nerve structures were identified and separated by meticulous dissection during this procedure. After January 2008, the nerve plane-sparing radical hysterectomy procedure was developed and performed for the next 57 patients (nerve plane-sparing radical hysterectomy group). During this modified procedure, the nerve plane (meso-ureter and its extension) containing most of the autonomic nerve structures was integrally preserved. The patients' clinicopathologic characteristics, surgical parameters, and outcomes of postoperative bladder function were compared between the two groups.Conclusion Nerve plane-sparing radical hysterectomy Is a reproducible and simplified modification of nerve-sparing radical hysterectomy, and may be preferable to nerve-sparing radical hysterectomy for treatment of early-stage invasive cervical cancer.

  12. Robot-assisted laparoscopic hysterectomy vs traditional laparoscopic hysterectomy: five metaanalyses.

    Science.gov (United States)

    Scandola, Michele; Grespan, Lorenzo; Vicentini, Marco; Fiorini, Paolo

    2011-01-01

    To assess differences between laparoscopic hysterectomy performed with or without robot-assistance, we performed metaanalyses of 5 key indices strongly associated with societal and hospital costs, patient safety, and intervention quality. The 5 indexes included estimated blood loss (EBL), operative time, number of conversions to laparotomy, hospital length of stay (LOS), and number of postoperative complications. A search of PubMed, Medline, Embase, and Science citation index online databases yielded a total of 605 studies. After a systematic review, we proceeded with meta-analysis of 14 articles for EBL, with a summary effect of -0.61 (95% confidence interval [CI], -42.42 to 46.20); 20 for operative time, with a summary effect of 0.66 (95% CI, -15.72 to 17.04); 17 for LOS, with a summary effect of -0.43 (95% CI, -0.68 to -0.17); 15 for conversion to laparotomy (odds ratio, 0.50; 95% CI, 0.31 to 0.79 with a random model); and 14 for postoperative complications (odds ratio, 0.69; 95% CI, 0.43 to 1.09 with a random model). In conclusion, compared with traditional laparoscopic hysterectomy, robot-assisted laparoscopic hysterectomy was associated with shorter LOS and fewer postoperative complications and conversions to laparotomy; there were no differences in EBL and operative time. These results confirm that robot-assisted laparoscopy has less deletorious effect on hospital, society, and patient stress and leads to better intervention quality. Copyright © 2011 AAGL. Published by Elsevier Inc. All rights reserved.

  13. Total laparoscopic hysterectomy in obese versus nonobese patients.

    Science.gov (United States)

    Heinberg, Eric M; Crawford, Benjamin L; Weitzen, Sherry H; Bonilla, David J

    2004-04-01

    To estimate the risk of operative and postoperative complications for obese patients undergoing total laparoscopic hysterectomy compared with nonobese patients. A retrospective cohort study was performed for patients undergoing total laparoscopic hysterectomy at Ochsner Clinic Foundation in New Orleans, Louisiana, for a period of 4.3 years. Rates of complications, successful laparoscopic completion, readmission, and reoperation were compared for those patients having a body mass index (BMI) of 30 kg/m(2) or greater with those whose BMI was less than 30 kg/m(2). Of 270 patients who met inclusion criteria, 106 (39.3%) women had a BMI of 30 kg/m(2) or greater. Procedures were completed by using endoscopic technique in 253 cases (93.7%), by using a combined vaginal approach (laparoscopically assisted vaginal hysterectomy) in 7 cases (2.6%), and via laparotomy (total abdominal hysterectomy) in 10 cases (3.7%). Neither the 2-fold risk of conversion to laparoscopically assisted vaginal hysterectomy (relative risk [RR] 2.2; 95% confidence interval [CI] 0.5, 10.1) nor the 4-fold risk of conversion to laparotomy (RR 3.9, 95% CI 1.0, 15.4) associated with obesity was statistically significant. Total laparoscopic hysterectomy for obese patients was 60% more likely to require at least 2 hours to complete (RR 1.6, 95% CI 1.2, 2.0) and was associated with a 3-fold risk of blood loss exceeding 500 mL compared with nonobese patients. Risks of major and minor complications, hospital readmission, and reoperation were similar for both groups. Total laparoscopic hysterectomy can be performed successfully in most obese patients, with complication rates similar to those for nonobese patients. II-2

  14. Two-phase laparoendoscopic single-site cervical ligament-sparing hysterectomy: A novel approach in difficult laparoscopic hysterectomy

    Directory of Open Access Journals (Sweden)

    Mun-Kun Hong

    2016-06-01

    Conclusion: This novel minimal invasive method of hysterectomy makes difficulty laparoscopic hysterectomy easy and safe. Preservation of cervical ligaments retains stability in the pelvic floor and may reduce intraoperative complications and subsequent pelvic floor organ prolapse.

  15. Body Mass Index and Its Role in Total Laparoscopic Hysterectomy.

    Science.gov (United States)

    Bhandari, Shilpa; Agrawal, Pallavi; Singh, Aparna

    2014-01-01

    Objective. To evaluate operative and perioperative outcomes in patients undergoing total laparoscopic hysterectomy according to their body mass index. Method. A retrospective study was performed for patients undergoing total laparoscopic hysterectomy at a tertiary care center for a period of 4 years. Patients were divided into two groups: obese (BMI > 30 Kg/m(2)) and nonobese (BMI laparoscopic completion, and intraoperative complications were compared in two groups. Result. A total of 253 patients underwent total laparoscopic hysterectomy from January 2010 to December 2013. Out of them, 105 women (41.5%) had a BMI of more than 30 kg/m(2). Overall, the mean blood loss was 85.79 ± 54.17 mL; the operative time was 54.17 ± 19.83 min. The surgery was completed laparoscopically in 244 (96.4%) women while laparotomy was done in 4 cases and vaginal suturing and closure of vault were done in 5 cases. Risk of vaginal assistance was higher in obese patients whereas out of the 4 conversions to laparotomy 3 had BMI laparoscopic hysterectomy is a safe and effective procedure for obese patients and can be performed with an efficacy similar to that in nonobese patients.

  16. Total laparoscopic hysterectomy: our 5-year experience (1998-2002).

    Science.gov (United States)

    Bonilla, David J; Mains, Lindsay; Rice, Janet; Crawford, Benjamin

    2010-01-01

    To review our experience performing total laparoscopic hysterectomy since we first introduced this procedure in 1998. A retrospective cohort study was performed for patients undergoing total laparoscopic hysterectomy at Ochsner Clinic Foundation from February 1998 through December 2002. Rates of complications, successful completion, length of hospital stay, readmission, and reoperation were determined for this period. Among 511 patients who underwent attempted total laparoscopic hysterectomy, 487 procedures (95.3%) were completed by laparoscopy. The major intraoperative complication rate was 3.9%, and the major postoperative complication rate was 4.7%. No significant differences were seen in the intraoperative and postoperative complication rates of patients who were morbidly obese (body mass index ≥30 kg/m(2)), patients with enlarged uteri (≥300 g), or patients who underwent concomitant procedures (unilateral or bilateral salpingo-oophorectomy and lysis of adhesions). The readmission rate was 4.1%, and the reoperation rate was 2%. None of the variables studied, including age, medical problems, morbid obesity, concomitant procedures, or enlarged uterus, were found to have an association with readmission or reoperation rates. Total laparoscopic hysterectomy can be performed successfully in most patients with benign indications. Morbidity is comparable to that of other types of hysterectomies, and this technique may be a more reasonable approach under some circumstances.

  17. Total Laparoscopic Hysterectomy: Our 5-Year Experience (1998–2002)

    Science.gov (United States)

    Bonilla, David J.; Mains, Lindsay; Rice, Janet; Crawford, Benjamin

    2010-01-01

    Purpose: To review our experience performing total laparoscopic hysterectomy since we first introduced this procedure in 1998. Methods: A retrospective cohort study was performed for patients undergoing total laparoscopic hysterectomy at Ochsner Clinic Foundation from February 1998 through December 2002. Rates of complications, successful completion, length of hospital stay, readmission, and reoperation were determined for this period. Results: Among 511 patients who underwent attempted total laparoscopic hysterectomy, 487 procedures (95.3%) were completed by laparoscopy. The major intraoperative complication rate was 3.9%, and the major postoperative complication rate was 4.7%. No significant differences were seen in the intraoperative and postoperative complication rates of patients who were morbidly obese (body mass index ≥30 kg/m2), patients with enlarged uteri (≥300 g), or patients who underwent concomitant procedures (unilateral or bilateral salpingo-oophorectomy and lysis of adhesions). The readmission rate was 4.1%, and the reoperation rate was 2%. None of the variables studied, including age, medical problems, morbid obesity, concomitant procedures, or enlarged uterus, were found to have an association with readmission or reoperation rates. Conclusions: Total laparoscopic hysterectomy can be performed successfully in most patients with benign indications. Morbidity is comparable to that of other types of hysterectomies, and this technique may be a more reasonable approach under some circumstances. PMID:21603347

  18. Hematuria at laparoscopic hysterectomy: a 9-year review at Sydney West Advanced Pelvic Surgery, Australia.

    Science.gov (United States)

    Wilson, Matthew; Merkur, Harry

    2008-01-01

    The aim of this study was to estimate the prevalence and significance of hematuria during laparoscopic hysterectomy for benign uterine disease. The review assessed its incidence, risk factors, site of associated urinary tract injuries, methods of diagnosis, management strategies, and most likely intraoperative point at which hematuria occurred during laparoscopic hysterectomies. A retrospective review of 755 cases of laparoscopic-assisted and total laparoscopic hysterectomies from January 1998 through December 2006 was undertaken at Sydney West Advanced Pelvic Surgery, Sydney, Australia.

  19. Effect of extreme obesity on outcomes in laparoscopic hysterectomy.

    Science.gov (United States)

    Siedhoff, Matthew T; Carey, Erin T; Findley, Austin D; Riggins, Lauren E; Garrett, Joanne M; Steege, John F

    2012-01-01

    To estimate the effect of body mass index (BMI) on several outcomes in laparoscopic hysterectomy, in particular in the extremes of obesity. Retrospective cohort study (Canadian Task Force classification II-3). Tertiary-care university-based teaching hospital. Eight hundred thirty-four patients who underwent laparoscopic hysterectomy from January 2007 to October 2011. Laparoscopic hysterectomy for benign indications. Demographic, operative, and postoperative data were abstracted from medical records. The primary outcome was a composite index score that took into account operative time, nonsurgical operating room time, estimated blood loss, length of hospital stay, number of complications, and severity of complications according to the Dindo-Clavien classification. We individually examined elements of the composite index as a secondary outcome. Models were developed to assess the association of BMI with the composite index score and the components of the index, controlling for age, presence of diabetes, tobacco use, surgeon, type of hysterectomy (total vs supracervical), use of robotics, uterine weight, number of additional procedures performed, presence of adhesions requiring lysis, and deeply infiltrating endometriosis as potential confounders. Mean (SD) BMI was 31.4 (8.1). Mean (SD) uterine weight was 345 (388) g. Mean operative time was 150 (61) minutes. Increasing BMI was associated with a worse composite score (p laparoscopic hysterectomy, and the effect is most pronounced in the morbidly obese. These patients may stand to gain the greatest differential benefit from a laparoscopic approach to surgery. However, they should be properly counseled about the challenge that obesity poses to the operation. Copyright © 2012 AAGL. Published by Elsevier Inc. All rights reserved.

  20. Robotic radical hysterectomy in the management of gynecologic malignancies.

    Science.gov (United States)

    Pareja, Rene; Ramirez, Pedro T

    2008-01-01

    Robotic surgery is being used with increasing frequency in gynecologic oncology. To date, 44 cases were reported in the literature of radical hysterectomy performed with robotic surgery. When comparing robotic surgery with laparoscopy or laparotomy in performing a radical hysterectomy, the literature shows that robotic surgery offers an advantage over the other 2 surgical approaches with regard to operative time, blood loss, and length of hospitalization. Future studies are needed to further elucidate the equivalence or superiority of robotic surgery to laparoscopy or laparotomy in performing a radical hysterectomy.

  1. Robotic-assisted laparoscopic hysterectomy: outcomes in obese and morbidly obese patients

    National Research Council Canada - National Science Library

    Gallo, Taryn; Kashani, Shabnam; Patel, Divya A; Elsahwi, Karim; Silasi, Dan-Arin; Azodi, Masoud

    2012-01-01

    To describe patient characteristics and perioperative outcomes among women undergoing roboticassisted laparoscopic hysterectomy and to evaluate the characteristics of nonobese, obese, and morbidly obese patients...

  2. C.I.S.H. Laparoscopic Hysterectomy: The Experience at the "Centro Materno Infantil"

    Science.gov (United States)

    Decunto; Traverso; Gibelli; Harpe

    1994-08-01

    Laparoscopic hysterectomy has been established firmly as a surgical alternative to standard abdominal hysterectomy around the world. In Argentina, we had introduced operative laparoscopy at the Hospital Aleman in May 1993, with a major change from basic diagnostic laparoscopy to advanced operative laparoscopy. A total of 180 major laparoscopic cases have been performed from May 1993 to January 1994, including laparoscopic hysterectomies. Of our first five C.I.S.H. laparoscopic hysterectomies, all had excellent outcomes, with greatly diminished hospital stay and less usage of analgesics postoperatively. The average length of stay was 2.5 days. No major complications occurred.

  3. Effect of obesity on perioperative outcomes of laparoscopic hysterectomy.

    Science.gov (United States)

    Harmanli, Oz; Esin, Sertac; Knee, Alexander; Jones, Keisha; Ayaz, Reyhan; Tunitsky, Elena

    2013-01-01

    To compare the effect of obesity on perioperative outcomes in women undergoing laparoscopic hysterectomy. In this retrospective cohort study, perioperative outcomes of all women who underwent laparoscopic supracervical hysterectomy (LSH) or total laparoscopic hysterectomy (TLH) for benign conditions were compared between obese (body mass index > or = 30 kg/m2) and nonobese women. Baseline characteristics were similar between 320 (33.0%) obese and 550 (67%) nonobese women except for race and the rates of hypertension and diabetes. The adjusted rates of urinary tract injury, vaginal cuff dehiscence, postoperative fever, and ileus were similar between the groups. For obese women, however, bleeding requiring transfusion was almost 3-fold (3.1 vs. 1.1%, adjusted odds ratio [AOR] 2.93, 95% confidence interval [CI] 1.10-7.80) and laparotomy risk was approximately 2-fold (7.5 vs. 3.5%, AOR 2.35, 95% CI 1.30-4.24) increased. The rate of urinary tract injury was 3.2% when obese women had TLH, but it was 0.3% for LSH performed on nonobese women. Of all 7 cuff dehiscences, 5 (71%) occurred in nonobese women undergoing TLH. Obesity increased the risk of bleeding requiring transfusion and conversion to laparotomy but did not influence the other perioperative complications. On subgroup analysis, LSH in nonobese women seems to result in best outcomes.

  4. Assessment of selected perioperative parameters in patients undergoing laparoscopic and abdominal supracervical hysterectomy.

    Science.gov (United States)

    Sokołowski, Jakub; Skręt-Magierło, Joanna; Kluz, Tomasz; Barnaś, Edyta; Sobolewski, Marek; Raś, Renata; Skręt, Andrzej

    2015-12-01

    Subtotal hysterectomy is a method of treatment of patients with mild changes in the uterine body. Laparoscopic methods are increasingly used in surgical gynaecology. One of the limitations of laparoscopy is the proper level of operating surgeon's training, which may be assessed with the use of the learning curve. The aim of the study was to compare data regarding the perioperative period in patients who underwent subtotal hysterectomy with the two methods, and to establish a learning curve for laparoscopic subtotal hysterectomy. One hundred and twenty-seven patients qualified for subtotal hysterectomy due to mild disturbances in the uterine body participated in the study. The study was conducted at the Clinical Department of Gynaecology and Obstetrics of Fryderyk Chopin Provincial Specialist Hospital in Rzeszów in 2012-2013. The time of laparoscopic subtotal hysterectomy is longer than that of the classical surgical procedure. Uterine myomas are the main indication for subtotal hysterectomy. Laparoscopic operation results in lower blood loss compared to the classical surgical method. The mean age of the patients operated due to mild changes in the uterine body is similar in both groups. Patients who are obese or have undergone Caesarean sections are more frequently qualified for the classical surgery. The study revealed a reduction in time of laparoscopic subtotal hysterectomy by ca. 31 minutes (33%). Laparoscopic subtotal hysterectomy is a method chosen by operating surgeons for patients with a lower perioperative risk. The period of the study made it possible to determine a learning curve for laparoscopic subtotal hysterectomy.

  5. Laparoscopically assisted vaginal hysterectomy (LAVH) versus total abdominal hysterectomy (TAH) in endometrial carcinoma: prospective cohort study.

    Science.gov (United States)

    Devaja, Omer; Samara, Ioanna; Papadopoulos, Andreas J

    2010-05-01

    To determine the feasibility and safety of laparoscopically assisted vaginal hysterectomy in the treatment of presumed stage I endometrial cancer. This was a prospective cohort study without randomization of 182 consecutive patients who underwent surgery for early endometrial cancer or atypical hyperplasia at the West Kent Gynaecological Oncology Centre, UK. Seventy-four had laparoscopically assisted vaginal hysterectomy and bilateral salpingo-oophorectomy (BSO), and 108 had a total abdominal hysterectomy and bilateral salpingo-oophorectomy. Lymphadenectomy was performed in 153 patients, and lymph node sampling was performed in 2 patients. Twenty-seven patients with serous papillary endometrial cancer in addition had an omentectomy. The groups were compared for epidemiological and clinical characteristics, surgical outcomes, hospital stay, lymph node harvest, and intraoperative and postoperative complications. The patients in the laparoscopy group had less blood loss, similar number of lymph nodes removed, less need for analgesia, and shorter hospital stay but longer operative time than those treated by laparotomy. In our study, we had 4 conversions (5.4%) from laparoscopy to laparotomy. Twenty-eight (41%) patients who had laparoscopic surgery were obese (body mass index [BMI] >30 kg/m2). Postoperative complications were more common in the laparotomy group (34%) than in the laparoscopy group (6%). No major complications occurred in the laparoscopy group. Wound infection was the most common complication in laparotomy patients, and this invariably happened to obese patients (BMI >30 kg/m2). There were 6 readmissions, all from the laparotomy group. Laparoscopic surgery is a safe and reliable alternative to open surgery in the management of early endometrial cancer patients, with significantly reduced hospital stay and complications, especially in those patients with an elevated BMI.

  6. [Sexual functions after laparoscopically assisted vaginal hysterectomy (LAVH) and total laparoscopic hysterectomy (TLH) in preoperatively asymptomatic women].

    Science.gov (United States)

    Kuzel, D; Weiss, P; Kubínová, K; Masková, L; Sosna, O; Bartosová, L; Horák, P; Tóth, D; Fanta, M; Mára, M

    2009-04-01

    To find the consequences of laparoscopically assisted vaginal hysterectomy (LAVH) and total laparoscopic hysterectomy (TLH) for sexual functions in preoperatively asymptomatic women. Prospective study. Department of Obstetrics and Gynecology, 1st Faculty of Medicine, Charles University and General Teaching Hospital in Prague. In 100 women without subjective complaints hysterectomy was performed for benign uterine pathology. In all the women the uterus weighted less than 250 g, there were no salpingooophorectomies and no perioperative complications. Women were alternativelly assigned for LAVH (n = 50) or TLH (n = 50). Clinical documentation and questionnaires about sexual functions were evaluated in 87 women (in 40 women after LAVH and in 47 after TLH) 18 months after surgery or later. According to our findings the type of surgery did not influence the frequency of sexual activity after surgery, there was no change in sexual manners using during coitus as well as no change in preferred way how to reach the sexual arousal (clitoridally, vaginally or combined). The type of surgery did not influence frequency, quality and duration of orgasm. From all the evaluated parameters there were only two significantly different: the presence of postoperative sexual activity (positive answer in all women from LAVH group and only in 85% women from TLH group, F test, p = 0.009) and the frequency of sexual satisfaction (in terms of both increase and also decrease in TLH group chi2 8,376, p = 0.015). The type of laparoscopic hysterectomy (LAVH or TLH) does not significantly affect the sexual functions (frequency of sexual satisfaction, type of sexual arousability, intensity and duration of orgasm) in preoperatively asymptomatic women.

  7. [A review of 445 cases of laparoscopic hysterectomy: benefits and outcome].

    Science.gov (United States)

    Malzoni, M; Perniola, G; Hannuna, K; Iuele, T; Fruscella, M L; Basili, R; Ebano, V; Marziani, R

    2004-01-01

    Hysterectomy is a major procedure indicated for women with gynaecologic pathologies. After reporting the first laparoscopic hysterectomy (Reich 1989), this technique has recently been considered as a safe and efficient alternative to traditional abdominal hysterectomy in the management of benign uterine pathologies when vaginal route is contraindicated. The laparoscopic approach should not be held to compete with vaginal hysterectomy. From 1995 to 2001 in our institute, the proportion of laparoscopic hysterectomy has increased and laparotomic hysterectomy has decreased. Between January 1999 and January 2001 we carried out 445 total laparoscopic hysterectomies. There were 5 laparotomy conversions for large uterus. The average haemoglobin drop was 1,36 g/dl. Median operative time was 95 +/- 27 min. The mean in postoperative stay was 2.7 +/- 0.8 gg. The postoperative complications were minimal. Laparoscopic approach is less painful, is associated to less blood loss, shorter hospital stay, more rapid recovery and a better assumption by affected women. Some disadvantages are reported too, such as larger operating time, high rate of complication and experience required for performing laparoscopy including a learning curve. A training period is necessary to standardize the operating procedure, to put in place methods of avoiding complication and to reach a plateau of surgical skill. The purpose of this study was to show the role of total laparoscopic hysterectomy and how it can be performed safely with a minimal morbidity after a period of training in which we worked out shrewdness to get a standardized technique with the most effective outcome.

  8. Total laparoscopic hysterectomy in obese and morbidly obese women.

    Science.gov (United States)

    Guraslan, Hakan; Senturk, Mehmet Baki; Dogan, Keziban; Guraslan, Birgul; Babaoglu, Bulent; Yasar, Levent

    2015-01-01

    The study aimed at estimating the effect of body mass index (BMI), used to classify non-obese, obese, and morbidly obese patients, on clinical outcomes in total laparoscopic hysterectomy (TLH) cases. This retrospective cohort study included 153 patients who underwent TLH for benign, premalignant, or malignant conditions between August 2010 and June 2013. Patients were divided into 3 groups according to BMI, and the following variables were analyzed: operation time, conversion rate, blood loss, total complications, and length of hospital stay. The mean BMI was 33.5 kg/m(2) (range, 22-61). Forty-four patients were non-obese (BMI obese (30≤ BMI obese (BMI ≥40). In 138 patients (90.2%), hysterectomy was performed using an endoscopic technique. The rate of conversion to laparotomy (9.8%; 95% confidence interval (CI), 5.1-14.5), blood loss (70.5 ml; range, 10-700), total complications (5.9%), and length of hospital stay (2.9 d; range, 1-8) did not vary according to BMI. Operation time was longer in obese (p = 0.003) and morbidly obese (0.002) patients than in non-obese patients. TLH could be considered a safe and feasible alternative to abdominal hysterectomy in obese and morbidly obese patients. © 2015 S. Karger AG, Basel.

  9. What's the impact of the obesity on the safety of laparoscopic hysterectomy techniques?

    Science.gov (United States)

    Kondo, William; Bourdel, Nicolas; Marengo, Francesca; Botchorishvili, Revaz; Pouly, Jean Luc; Jardon, Kris; Rabischong, Benoit; Mage, Gérard; Canis, Michel

    2012-12-01

    To evaluate the impact of obesity in the safety of laparoscopic hysterectomy. A retrospective study was conducted using a database of 2271 women undergoing laparoscopic hysterectomy for benign diseases between January 1995 and December 2008 at the Centre Hospitalier Universitaire Estaing (Clermont-Ferrand, France). Patients were divided into two groups according to the body mass index: obese patients (P=.89), respectively. The overall postoperative complication rate was 8.81% (n=184) and 7.65% (n=14), respectively. Obesity does not have an adverse effect on the feasibility and safety of laparoscopic hysterectomy in experienced hands.

  10. Pilot study of radical hysterectomy versus radical trachelectomy on sexual distress.

    Science.gov (United States)

    Brotto, Lori A; Smith, Kelly B; Breckon, Erin; Plante, Marie

    2013-01-01

    Radical trachelectomy, which leaves the uterus intact, has emerged as a desirable surgical option for eligible women with early-stage cervical cancer who wish to preserve fertility. The available data suggest excellent obstetrical outcomes with radical trachelectomy, and no differences in sexual responding between radical trachelectomy and radical hysterectomy. There is a need to examine the effect of radical hysterectomy on sexual distress given that it is distinct from sexual function. Participants were 34 women diagnosed with early-stage cervical cancer. The authors report 1-month postsurgery data for 29 women (radical hysterectomy group: n = 17, M age = 41.8 years; radical trachelectomy group: n = 12, M age = 31.8 years), and 6-month follow-up data on 26 women. Whereas both groups experienced an increase in sex-related distress immediately after surgery, distress continued to increase 6 months after surgery for the radical hysterectomy group but decreased in the radical trachelectomy group. There were no between-group differences in mood, anxiety, or general measures of health. The decrease in sex-related distress in the radical trachelectomy but not in the radical hysterectomy group suggests that the preservation of fertility may have attenuated sex-related distress. Care providers should counsel women exploring surgical options for cervical cancer about potential sex distress-related sequelae.

  11. Total laparoscopic hysterectomy as a primary surgical treatment for endometrial cancer in morbidly obese women

    National Research Council Canada - National Science Library

    Yu, C.K.H; Cutner, A; Mould, T; Olaitan, A

    2005-01-01

    To evaluate the feasibility of total laparoscopic hysterectomy as the primary treatment for endometrial cancer in morbidly obese women, an audit was carried out during an 18-month period in a tertiary...

  12. Assessment of selected perioperative parameters in patients undergoing laparoscopic and abdominal supracervical hysterectomy

    Science.gov (United States)

    Skręt-Magierło, Joanna; Kluz, Tomasz; Barnaś, Edyta; Sobolewski, Marek; Raś, Renata; Skręt, Andrzej

    2015-01-01

    Introduction Subtotal hysterectomy is a method of treatment of patients with mild changes in the uterine body. Laparoscopic methods are increasingly used in surgical gynaecology. One of the limitations of laparoscopy is the proper level of operating surgeon's training, which may be assessed with the use of the learning curve. The aim of the study was to compare data regarding the perioperative period in patients who underwent subtotal hysterectomy with the two methods, and to establish a learning curve for laparoscopic subtotal hysterectomy. Material and methods One hundred and twenty-seven patients qualified for subtotal hysterectomy due to mild disturbances in the uterine body participated in the study. The study was conducted at the Clinical Department of Gynaecology and Obstetrics of Fryderyk Chopin Provincial Specialist Hospital in Rzeszów in 2012-2013. Results The time of laparoscopic subtotal hysterectomy is longer than that of the classical surgical procedure. Uterine myomas are the main indication for subtotal hysterectomy. Laparoscopic operation results in lower blood loss compared to the classical surgical method. The mean age of the patients operated due to mild changes in the uterine body is similar in both groups. Patients who are obese or have undergone Caesarean sections are more frequently qualified for the classical surgery. The study revealed a reduction in time of laparoscopic subtotal hysterectomy by ca. 31 minutes (33%). Conclusions Laparoscopic subtotal hysterectomy is a method chosen by operating surgeons for patients with a lower perioperative risk. The period of the study made it possible to determine a learning curve for laparoscopic subtotal hysterectomy. PMID:26848296

  13. Comparison of Nerve-Sparing Radical Hysterectomy and Radical Hysterectomy: a Systematic Review and Meta-Analysis

    Directory of Open Access Journals (Sweden)

    Zhuowei Xue

    2016-05-01

    Full Text Available Background/Aims: Radical hysterectomy (RH for the treatment of cervical cancer frequently caused pelvic organ dysfunctions. This study aimed to compare the results of pelvic organ function and recurrence rate after Nerve sparing radical hysterectomy (NSRH and RH treatment through systematic review and meta-analysis. Methods: PubMed, Web of Science and China Knowledge Resource Integrated Database were searched from inception to 25 February 2015. Studies of cervical cancer which reported radical hysterectomy or nerve sparing radical hysterectomy were included. The quality of included studies was evaluated using the guidelines of Cochrane Handbook for Systematic Reviews of Interventions. Statistical analysis was performed using Review Manager 5.3 software (Cochrane Collaboration. Results: A total of 20 studies were finally included. Meta-analysis demonstrated that NSRH was associated with less bladder and anorectal dysfunction than RH. The time to bladder and anorectal function recovery after NSRH was shorter than RH. Patients undergoing NSRH also scored higher than patients undergoing RH at Female Sexual Function Index (FSFI. On the other hand, the local recurrence and overall recurrence rate were similar between NSRH and RH. Conclusion: NSRH may be an effective technique for lowering pelvic organ dysfunction and improving the function recovery without increasing the recurrence rate of cervical cancer.

  14. Vaginal hysterectomy or laparoscopic assisted vaginal hysterectomy for enlarged myomatous uterus: a randomized clinical trial

    Institute of Scientific and Technical Information of China (English)

    Fan Rong; Zhu Lan; Lang Jing-he; Shi Hong-hui; Gong Xiao-ming

    2011-01-01

    Objective:To compare the intraoperative condition and short-term outcomes of vaginal hysterectomy (VH) and laparoscopic assisted vaginal hysterectomy (LAVH) for enlarged myomatous uterus.Methods:Fifty patients from Peking Union Medical College Hospital (PUMCH) were randomly assigned to two treatment groups:VH (n=23) and LAVH (n=27).All procedures were performed by a single senior surgeon to maintain homogeneity.Results:The baseline characteristics of the two groups were comparable.The operative time for LAVH was significantly longer than for VH (76.7±23.2 vs.57.6±23.5 min,P<0.05),and LAVH costs more money than VH (6,923.07±622.96 vs.5,974.46±1,408.08 RMB,P<0.05).Major complications,uterine weight and the length of hospital stay were comparable between VH and LAVH group.One case of VH was converted to LAVH due to adhesion.Conclusions:Compared with LAVH,VH is a time- and cost-saving operative technique for enlarged myomatous uterus.VH should be the primary method for uterine removal,but LAVH may have advantages when adhesion is present.

  15. Total laparoscopic hysterectomy versus total abdominal hysterectomy for obese women with endometrial cancer.

    Science.gov (United States)

    Obermair, A; Manolitsas, T P; Leung, Y; Hammond, I G; McCartney, A J

    2005-01-01

    Obesity is common in endometrial cancer and surgery for these patients is challenging. We compared total laparoscopic hysterectomy (TLH) with total abdominal hysterectomy (TAH) with respect to feasibility (operating time, estimated blood loss, length of hospital stay, and conversion to laparotomy) and safety (perioperative morbidity and mortality) in a retrospective analysis of 78 morbidly obese patients with endometrial cancer. Analysis is based on the intention to treat. The intention to treat was TLH in 47 patients and it could be successfully completed in 42 patients (89.4%). The mean weight for all patients was 118.7 kg, with patients in the TLH group weighing more and having higher ASA scores. Mean operating time and estimated blood loss were similar in both groups. Mean postoperative hospital stay was 4.4 (+/-3.9) days in the TLH group and 7.9 (+/-3.0) days in the TAH group (P < 0.0001). Wound infections occurred in 15 of 31 patients (48.4%) in the TAH group and in 1 of 47 patients (2.1%) in the TLH group. All other morbidity, as well as patterns of recurrence and survival were similar in both groups. These data justify a prospective randomized trial comparing TLH with TAH for the treatment of endometrial cancer.

  16. Update on Robotic Laparoscopic Radical Prostatectomy

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    Garrett S. Matsunaga

    2006-01-01

    Full Text Available The da Vinci surgical robot has been shown to help shorten the learning curve for laparoscopic radical prostatectomy (LRP for both laparoscopically skilled and na surgeons[1,2]. This approach has shown equal or superior outcomes to conventional laparoscopic prostatectomy with regard to ease of learning, initial complication rates, conversion to open, blood loss, complications, continence, potency, and margin rates. Although the data are immature to compare oncologic and functional outcomes to open prostatectomy, preliminary data are promising.Herein, we review the technique and outcomes of robotic-assisted laparoscopic radical prostatectomy (RALP.

  17. The Retrograde and Retroperitoneal Totally Laparoscopic Hysterectomy for Endometrial Cancer

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    Eugenio Volpi

    2012-01-01

    Full Text Available Introduction. We retrospectively report our experience with the utilization of an original procedure for total laparoscopic hysterectomy based on completely retrograde and retroperitoneal technique for surgical staging and treatment of the endometrial cancer. The surgical, financial, and oncological advantages are here discussed. Methods. The technique used here has been based on a combination of a retroperitoneal approach with a retrograde and lateral dissection of the bladder and retrograde culdotomy with variable resection of parametrium. No disposable instruments and no uterine manipulator were utilized. Results. Intraoperative and postoperative complications were observed in 10% of the cases overall. Operative time length and mean haemoglobin drop value results were 129 min and 125 mL, respectively. Most patients were dismissed on days 3–5 from the hospital. Seventy-eight percent of the patients were alive with no evidence of disease at mean followup of 49 months. Conclusions. Our original laparoscopic technique is based on a retroperitoneal approach in order to rapidly control main uterine vessels coagulation, constantly check the ureter, and eventually decide type and site of lymph nodes removal. This procedure has important cost saving implications and the avoidance of uterine manipulator is of matter in case such as these of uterine malignancy.

  18. Abdominal Hysterectomy: Reduced Risk of Surgical Site Infection Associated with Robotic and Laparoscopic Technique.

    Science.gov (United States)

    Colling, Kristin P; Glover, James K; Statz, Catherine A; Geller, Melissa A; Beilman, Greg J

    2015-10-01

    Hysterectomy is one of the most common procedures performed in the United States. New techniques utilizing laparoscopic and robotic technology are becoming increasingly common. It is unknown if these minimally invasive surgical techniques alter the risk of surgical site infections (SSI). We performed a retrospective review of all patients undergoing abdominal hysterectomy at our institution between January 2011 and June 2013. International Classification of Diseases, Ninth edition (ICD-9) codes and chart review were used to identify patients undergoing hysterectomy by open, laparoscopic, or robotic approach and to identify patients who developed SSI subsequently. Chi-square and analysis of variance (ANOVA) tests were used to identify univariate risk factors and logistic regression was used to perform multivariable analysis. During this time period, 986 patients were identified who had undergone abdominal hysterectomy, with 433 receiving open technique (44%), 116 laparoscopic (12%), 407 robotic (41%), and 30 cases that were converted from minimally invasive to open (3%). Patients undergoing laparoscopic-assisted hysterectomy were significantly younger and had lower body mass index (BMI) and American Society of Anesthesiologists (ASA) scores than those undergoing open or robotic hysterectomy. There were no significant differences between patients undergoing open versus robotic hysterectomy. The post-operative hospital stay was significantly longer for open procedures compared with those using laparoscopic or robotic techniques (5.1, 1.7, and 1.6 d, respectively; physterectomy procedures was 4.2%. More SSI occurred in open cases (6.5%) than laparoscopic (0%) or robotic (2.2%) (pobesity were all associated with increased risk of SSI. Laparoscopic and robotic hysterectomies were associated with a significantly lower risk of SSI and shorter hospital stays. Body mass index, advanced age, and wound class were also independent risk factors for SSI.

  19. Total laparoscopic hysterectomy as a primary surgical treatment for endometrial cancer in morbidly obese women.

    Science.gov (United States)

    Yu, C K H; Cutner, A; Mould, T; Olaitan, A

    2005-01-01

    To evaluate the feasibility of total laparoscopic hysterectomy as the primary treatment for endometrial cancer in morbidly obese women, an audit was carried out during an 18-month period in a tertiary referral centre for gynaecological oncology. Four women who had laparoscopic surgery were compared with a similar cohort who had open surgery. The mean operating time was equivalent, without evidence of excess morbidity with the laparoscopic approach. However, inpatient stay was longer with open versus laparoscopic surgery (11.5 vs 4 days). Laparoscopic surgery is safe to use in morbidly obese women with endometrial cancer.

  20. Urological complications after radical hysterectomy: Incidence rates and predisposing factors

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    Likić-Lađević Ivana

    2007-01-01

    Full Text Available Bacground/Aim. Radical hysterectomy is a surgical approach for stage Ib and IIa of cervical cancer. The incidence of intraoperative injuries of the bladder during radical hysterectomy ranges from 0.4-3.7%. The ureter can be crushed, caught in sutures, transsected, obstructed by angulation, or ischemic by the stippling or periureteric fascia. Vesicovaginal and ureterovaginal fistuls are reported to develop in 0.9-2% of patients after radical abdominal hysterectomy. Fistulas usually become manifested or visible at speculum examination within 14 days following the surgery. The aim of this study was to establish the incidence and predisposing factor of urological complications after radical hysterectomy. Methods. The study included a total of 536 patients with invasive stage Ib to IIb cancer of the cervix uteri who had underwent radical hysterectomy. The special elements considered were: the patient’s age; the International Federation of Ginecology and Obstetrics (FIGO stage after pathohistology; duration of operation; the result of preoperative laboratory tests for diabetes, anemia, hypoproteinemia, or disorders of liver or kidney function; ASA status; postoperative surgical infection. Results. The average age of the patients with complications was 48.68 years. All patients with intraoperative ureteric and bladder injuries had statisticaly significant higher stage of disease and operation lasted more than in others without injury. We noticed 1.3% ureteral injuries and 1.49% bladder injuries, more than 50% of the patients with a previously mentioned injuries were operated on more than 3 hours. We found 2.61% vesicovaginal and 2.43% ureterovaginal fistuls. A total of 50% of the patients with bladder injury and vesicovaginal fistuls and 70% of the patients with ureterovaginal fistuls had diabetes mellitus. Postoperative infection of surgical site is a very important factor for the development of fistule. Half of the patients with vesicovaginal

  1. Synchronous single-port access laparoscopic right hemicolectomy and laparoscopic-assisted vaginal hysterectomy with bilateral salpingo-oophorectomy

    Science.gov (United States)

    Ybañez-Morano, Jessica; Tiu, Andrew C.

    2017-01-01

    Laparoscopic surgery through a single incision is gaining popularity with different stakeholders. The advantages of improved cosmetics, decreased postoperative pain and blood loss continue to attract patients from different surgical fields. Multidisciplinary approach to different surgical entities through a single incision has just been introduced. We report the first case of a synchronous single-port access (SPA) laparoscopic right hemicolectomy and laparoscopic-assisted vaginal hysterectomy with bilateral salpingo-oophorectomy through a single incision above the umbilicus in a 48-year-old female with ascending colon mass and uterine mass with good postoperative outcomes. SPA laparoscopic surgery is feasible for multidisciplinary approach in resectable tumors. PMID:28096321

  2. Laparoscopic hysterectomy in obese women: a clinical prospective study.

    Science.gov (United States)

    Holub, Z; Jabor, A; Kliment, L; Fischlová, D; Wágnerová, M

    2001-09-01

    To compare perioperative and postoperative outcomes of laparoscopic hysterectomy (LH) in surgical management of gynecological conditions in two groups of different weight. A prospective comparative clinical study of 271 LH performed for disease of female pelvic organs in a group of 54 obese patients (over 30 body mass index (BMI)) and in a group of 217 non-obese patients (less than 30 BMI). The following criteria were assessed: patient characteristics, indications for surgery, previous surgery, presence of adhesions, duration of procedure, blood loss, weight of specimen, hospital stay and complications. Statistical analysis was performed using the unpaired t-test and non-parametric Chi-square test when appropriate, with a significance level of P=0.05. Three non-obese patients were converted to laparotomy due to operative complications. Laparoscopy in the remaining 268 patients (98.89%) was completed successfully. There was no significant difference in estimated blood loss, presence and degree of adhesions, weight of specimen, length of hospital stay and postoperative complications between women with high BMI and those with low BMI. The rate of major operative complications (5.55% versus 3.22%) was higher in the obese group. The duration of the operation was longer in obese women. However, the significance of the difference was borderline (P=0.06).

  3. Laparoscopic and vaginal approaches to hysterectomy in the obese.

    Science.gov (United States)

    Bogani, Giorgio; Cromi, Antonella; Serati, Maurizio; Di Naro, Edoardo; Casarin, Jvan; Pinelli, Ciro; Uccella, Stefano; Leone Roberti Maggiore, Umberto; Marconi, Nicola; Ghezzi, Fabio

    2015-06-01

    The aim of the study was to compare surgery-related outcomes between laparoscopic (LH) and vaginal (VH) hysterectomy, performed for benign uterine disease (other than pelvic organs prolapse) in obese women. Data of consecutive obese (BMI≥30) patients undergoing LH and VH, between 2000 and 2013, were compared using a propensity-matched analysis. One hundred propensity-matched patient pairs (200 patients) undergoing LH (n=100) and VH (n=100) represented the study group. Baseline demographic characteristics were similar between groups. Patients undergoing LH experienced similar operative time (87.5 (25-360) vs. 85 (25-240)min; p=0.28), slightly lower blood loss (100 (10-3200) vs. 150 (10-800)ml; p=0.006) and shorter length of hospital stay (1 (1-5) vs. 2 (1-5) days; pobese women affected by benign uterine disease LH and VH should not be denied on the basis of the mere BMI, per se. In this setting, LH upholds effectiveness of VH, improving postoperative outcomes. However, complication rate increases as BMI increase, regardless surgical route. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  4. Transversus abdominis plane (TAP) block after robot-assisted laparoscopic hysterectomy

    DEFF Research Database (Denmark)

    Torup, H; Bøgeskov, M; Hansen, E G

    2015-01-01

    BACKGROUND: Transversus abdominis plane (TAP) block is widely used as a part of pain management after various abdominal surgeries. We evaluated the effect of TAP block as an add-on to the routine analgesic regimen in patients undergoing robot-assisted laparoscopic hysterectomy. METHODS......: In a prospective blinded study, 70 patients scheduled for elective robot-assisted laparoscopic hysterectomy were randomised to receive either TAP block (ropivacaine 0.5%, 20 ml on each side) or sham block (isotonic saline 0.9%, 20 ml on each side). All patients had patient-controlled analgesia (PCA) with morphine...... and Nonsteroidal anti-inflammatory drugs (NSAID) treatment, had no effect on morphine consumption, VAS pain scores, or frequency of nausea and vomiting after robot-assisted laparoscopic hysterectomy compared with paracetamol and NSAID alone....

  5. Laparoscopic Repair of Vaginal Evisceration after Abdominal Hysterectomy for Uterine Corpus Cancer: A Case Report and Literature Review.

    Science.gov (United States)

    Matsuhashi, Tomohiko; Nakanishi, Kazuho; Hamano, Eri; Kamoi, Seiryu; Takeshita, Toshiyuki

    2017-01-01

    Vaginal cuff dehiscence is a rare but serious complication that can develop after hysterectomy. Emergent surgical intervention is required for vaginal cuff dehiscence due to the potential subsequent vaginal evisceration, which may lead to necrosis of the small bowel. A 62-year-old nulliparous woman with a 30-year history of smoking, diabetes mellitus, and rheumatoid arthritis (treated with oral steroids) presented with a vaginal cuff dehiscence. Thirty-eight days before the admission, she had undergone a radical operation including total abdominal hysterectomy for uterine corpus cancer at another hospital. We performed emergent laparoscopic surgery to reduce the prolapsed small bowel into the abdominal cavity and repaired the vaginal cuff with a two-layer continuous closure using absorbable barbed sutures. The patient experienced no postoperative complications, and no recurrence of the vaginal cuff dehiscence occurred. Vaginal cuff dehiscence and evisceration can be surgically managed using an abdominal, vaginal, or laparoscopic approach, and the choice of method should be based on patient characteristics and the surgeon's skills. Laparoscopic vaginal cuff repair with a two-layer continuous closure using absorbable barbed sutures is a minimally invasive technique that is safe and effective for medically stable patients with no small bowel injury or vascular compromise and no pelvic abscess.

  6. Laparoscopic hysterectomy in the overweight and obese: does 3D imaging make a change?

    Science.gov (United States)

    Berlit, Sebastian; Hornemann, Amadeus; Sütterlin, Marc; Weiss, Christel; Tuschy, Benjamin

    2017-01-01

    To evaluate the influence of three-dimensional (3D) high-definition (HD) visualisation in laparoscopic hysterectomy in normal weight, overweight and obese women. A retrospective analysis of 180 patients undergoing total laparoscopic hysterectomy (TLH: n = 90) or laparoscopic supracervical hysterectomy (LASH: n = 90) was performed. The study collective consisted of 90 women (TLH: n = 45, LASH: n = 45), who underwent laparoscopic hysterectomy with a 3D HD laparoscopic system. Ninety matched (uterine weight, previous surgeries) women with hysterectomy (TLH: n = 45, LASH: n = 45) performed by the same surgeon with conventional two-dimensional laparoscopy formed the control group. Statistical analysis was accomplished stratifying patients according to body mass index (BMI) (≤24.9, 25-29.9, ≥30.0 kg/m(2)). In each BMI, collective subtypes of surgery (TLH, LASH) as well as hysterectomies as a whole were analysed. Demographic data and surgical parameters were evaluated. In all BMI subgroups, there were no significant differences concerning demographic parameters. Number of trocar site incisions needed was significantly less in women undergoing 3D compared to 2D laparoscopy independent of BMI. Furthermore, a significantly lower blood loss was revealed using 3D visualisation in LASH subgroups of the normal and overweight collectives. Three-dimensional laparoscopy was additionally associated with a significantly shorter duration of surgery in the TLH subgroup in overweight patients and a lower haemoglobin drop in the LASH subgroup of the obese. The need of less trocar site incisions concerning all weight groups as well.

  7. Vaginal and Laparoscopic hysterectomy as an outpatient procedure: A systematic review.

    Science.gov (United States)

    Dedden, Suzanne J; Geomini, Peggy M A J; Huirne, Judith A F; Bongers, Marlies Y

    2017-09-01

    Laparoscopic and vaginal hysterectomies are common gynaecological procedures. Same-day discharge is usual care in various gynaecological procedures like laparoscopic sterilisation and laparoscopic oophorectomies. In major procedures like vaginal or laparoscopic hysterectomy patients are usually admitted overnight. We systematically reviewed the literature to identify complications, risk factors for (re)admittance, financial consequences and patient satisfaction of same-day discharge after a vaginal or laparoscopic hysterectomy. We systematically searched PubMed, UptoDate, Embase, Cochrane and CINAHL database from inception until July 16th 2016. We selected randomized controlled trials, prospective and retrospective cohort studies assessing the safety and feasibility of same-day discharge after vaginal or laparoscopic hysterectomy. The outcome parameters that were assessed were admission rate, re-admission rate, minor and major complications, patient satisfaction and financial consequences. 27 articles were included in the systematic review. All studies provided data about the admission rate and therefore failure of same-day discharge. Eleven prospective studies were included which compromised a total of 2391 hysterectomies. The percentage of overnight admissions was median 9.3% [0-25%]. Eight retrospective studies, which screened their patients before undergoing an outpatient hysterectomy, showed in 1500 subjects a mean admission rate of 10% [4,4-64%]. Four retrospective studies, which considered a large total cohort of 142,799 hysterectomies had a mean admission rate of 59,7% [48-79%]. The overall re-admission rate was low, varying from 0.73-4.0%. Minor complications were reported in respectively 4,3% and 7,3% in prospective respectively retrospective trials. Major complications were described in 0.7%-3.6% of all cases. Generally high satisfaction rates were reported in the observational trials. Same-day discharge after laparoscopic and vaginal hysterectomy seems

  8. Histologic artifacts in abdominal, vaginal, laparoscopic, and robotic hysterectomy specimens: a blinded, retrospective review.

    Science.gov (United States)

    Krizova, Adriana; Clarke, Blaise A; Bernardini, Marcus Q; James, Sarah; Kalloger, Steve E; Boerner, Scott L; Mulligan, Anna Marie

    2011-01-01

    Total laparoscopic hysterectomy (LH) is a minimally invasive technique, which results in comparable morbidity and better cosmesis compared with total abdominal hysterectomy. The literature is discrepant as to whether it is associated with a higher incidence of positive peritoneal cytology compared with total abdominal hysterectomy and recently, associated artifacts, including vascular pseudoinvasion (VPI), have been described. A retrospective histopathologic review of 266 hysterectomy specimens from 2 centers was performed. The observers, blinded to the surgical technique, assessed for the presence of artifactual changes including disruption of the endometrial lining, nuclear crush artifact, VPI, endomyometrial cleft artifact with or without epithelial displacement, inflammatory debris within vessels, serosal carryover, and intratubal contaminants. In addition, the rates of positive peritoneal washings over a 5-year period, and the use of immunohistochemistry (IHC) to aid in cell typing over a 3-year period, were compared between hysterectomies in which a uterine manipulator (UM) device had and had not (nonmanipulated hysterectomies) been used. The hysterectomies were performed for malignant (n=160) and benign (n=102) uterine disease or for ovarian or cervical disease (n=4), and included total abdominal (n=108), vaginal (n=17), laparoscopy-assisted vaginal (n=24), laparoscopy converted to laparotomy (n=10), nonrobotic laparoscopic (n=51), and robot-assisted laparoscopic (n=56) hysterectomies. One hundred and two (38%) of these hysterectomies involved the use of a UM. Artifactual changes of disruption of the endometrial lining, endomyometrial clefts, intratubal contaminants, nuclear crush artifact, intravascular inflammatory debris, and VPI were significantly more common with LH and with the use of a UM, independent of whether the endometrial pathology was benign or malignant. IHC to aid in endometrial cancer subtyping was more likely to be used in manipulated

  9. Influence of total laparoscopic hysterectomy on the blood viscosity and erythrocyte immune state in patients

    Institute of Scientific and Technical Information of China (English)

    Li Lin; Hong-yan Xu

    2015-01-01

    Objective:To investigate and study the influenced state of total laparoscopic hysterectomy for the blood viscosity and erythrocyte immune state of patients.Methods:A total of 58 patients who were treated with total hysterectomy in our hospital from June 2013 to February 2015 were the study subjects, the 29 cases in the control group were treated with routine open hysterectomy operation according to the operation types, the 29 cases in the observation group were treated with laparoscopic hysterectomy operation, then the preoperative and postoperative blood viscosity and erythrocyte immune state indexes of two groups were compared.Results:The blood viscosity indexes of the observation group at different postoperative time were all lower than the indexes of the control group, the erythrocyte immune state indexes were all better than those of the control group, and the detection results of two groups at the third day after the operation were all obviously worse than those at other times, their differences were statistically significant.Conclusions:The bad influence of total laparoscopic hysterectomy for the blood viscosity and erythrocyte immune state of patients are relatively smaller, and those postoperative indexes in recovery of patients are faster.

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

    Science.gov (United States)

    Bardens, David; Solomayer, Erich; Baum, Sascha; Radosa, Julia; Gräber, Stefan; Rody, Achim; Juhasz-Böss, Ingolf

    2014-04-01

    To investigate the influence of the body mass index (BMI) on laparoscopic hysterectomy, including all intra- and postoperative findings and complications. 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. 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. 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.

  11. Leiomyoma mimicking an incarcerated inguinal hernia: A rare complication of laparoscopic hysterectomy

    Directory of Open Access Journals (Sweden)

    Carlos Apestegui

    2011-01-01

    Full Text Available A 52-year-old, obese, female patient was referred for a right inguinal mass, which appeared seven months after a laparoscopic hysterectomy, which was performed because of myomatosis. Despite several examinations, including ultrasound, computed tomography (CT-Scan, positron emission tomography (PET-CT, and ultrasound-guided biopsy, the diagnosis remained unclear until surgical exploration, which disclosed a well-encapsulated solid tumour corresponding to a fibrotic leiomyoma. Spilling of leiomyoma cells is a rare and unusual complication of laparoscopic surgery. Tumour development in the inguinal canal after laparoscopic gynaecological surgery should be kept in mind in the differential diagnosis of inguinal hernia and other uncommon pathologies.

  12. Can radical parametrectomy be omitted inoccult cervical cancer afterextrafascial hysterectomy?

    Institute of Scientific and Technical Information of China (English)

    Huai-WuLu,; JingLi,; Yun-YunLiu,; Chang-HaoLiu,; Guo-CaiXu,; Ling-LingXie,; Miao-FangWu; Zhong-QiuLin

    2015-01-01

    Background:Occult invasive cervical cancer discovered after simple hysterectomy is not common, radical parame‑trectomy (RP) is a preferred option for young women. However, the morbidity of RP was high. The aim of our study is to assess the incidence of parametrial involvement in patients who underwent radical parametrectomy for occult cervical cancer or radical hysterectomy for early‑stage cervical cancer and to suggest an algorithm for the triage of patients with occult cervical cancer to avoid RP. Methods:A total of 13 patients with occult cervical cancer who had undergone RP with an upper vaginectomy and pelvic lymphadenectomy were included in this retrospective study. Data on the clinicopathologic characteristics of the cases were collected. The published literature was also reviewed, and low risk factors for parametrial involvement in early‑stage cervical cancer were analyzed. Results:Of the 13 patients, 9 had a stage IB1 lesion, and 4 had a stage IA2 lesion. There were four patients with grade 1 disease, seven with grade 2 disease, and two with grade 3 disease. The median age of the entire patients was 41years. The most common indication for extrafascial hysterectomy was cervical intraepithelial neoplasia 3. Three patients had visible lesions measuring 10–30mm, in diameter and ten patients had cervical stromal invasions with depths ranging from 4 to 9mm; only one patient had more than 50% stromal invasion, and four patients had lymph‑vascular space invasion (LVSI). Perioperative complications included intraoperative bowel injury, blood transfusion, vesico‑vaginal ifstula, and ileus (1 case for each). Postoperative pathologic examination results did not show residual disease or parametrial involvement. One patient with positive lymph nodes received concurrent radiation therapy. Only one patient experienced recurrence. Conclusions:Perioperative complications following RP were common, whereas the incidence of parametrial involve‑ment was very low

  13. Effect of body mass index on robotic-assisted total laparoscopic hysterectomy.

    Science.gov (United States)

    Nawfal, A Karim; Orady, Mona; Eisenstein, David; Wegienka, Ganesa

    2011-01-01

    To estimate the impact of body mass index (BMI) on the surgical outcomes of patients undergoing robotic-assisted total laparoscopic hysterectomy. Retrospective cohort study. Henry Ford Health System academic medical center (Henry Ford and Henry Ford West Bloomfield Hospitals) A total of 135 patients who underwent scheduled robotic-assisted total laparoscopic hysterectomy for benign indications, without concomitant urogynecologic procedures between January 2008 and June 2010. Patients underwent robotic-assisted total laparoscopic hysterectomy as the intention to treat. Two cases were converted to laparotomy. MEASUREMENTS & MAIN RESULTS: Electronic medical records of all patients that underwent robotic-assisted total laparoscopic hysterectomy at Henry Ford Health System were reviewed. Data on demographics, BMI (kg/m(2)), estimated blood loss, perioperative hemoglobin change, procedure duration, hospital length of stay, specimen weight, pathology, and postoperative complications were obtained. The women's median age was 45 years (range 30-68), 61.5% were black, and BMI ranged from 14.8-56.2 kg/m2; 23.4% of women were normal weight or less (BMI obese (BMI >30, n = 70) and 36 of these patients (27.1%) were morbidly obese (BMI ≥35). BMI did not correlate with procedure duration (Spearman r = .12, p = .16), length of stay (Spearman r = .10, p = .24), or estimated blood loss (Spearman r = .12, p =.18). Our analysis did not identify any meaningful associations between BMI and absolute change in hemoglobin. In addition BMI was not associated with an increase in major or minor complications. BMI is not associated with blood loss, duration of surgery, length of stay, or complication rates in patients undergoing robotic-assisted total laparoscopic hysterectomy. Robotic assistance may help surgeons overcome adverse outcomes sometimes found in obese patients. Copyright © 2011 AAGL. Published by Elsevier Inc. All rights reserved.

  14. Laparoscopic supracervical hysterectomy with transcervical morcellation and sacrocervicopexy for the treatment of uterine prolapse.

    Science.gov (United States)

    Dessie, Sybil G; Park, Michele; Rosenblatt, Peter L

    2016-01-01

    The objective is to describe our surgical approach for management of uterine prolapse using 5-mm skin incisions and transcervical morcellation. This video presents a novel approach for laparoscopic supracervical hysterectomy, bilateral salpingectomy, and sacrocervicopexy using only 5-mm skin incisions and transcervical morcellation. The procedure begins with a laparoscopic supracervical hysterectomy with bilateral salpingectomy. A classic intrafascial supracervical hysterectomy (CISH) instrument is then used transvaginally to core the endocervical canal. A disposable morcellator is placed through the remaining cervix to morcellate the uterus and fallopian tubes. Following morcellation, the handle of the morcellator is removed, and it is used during the remainder of the surgery as an access cannula for the sacrocervicopexy. The polypropylene mesh is introduced through this cannula. It is secured to the anterior and posterior vaginal fascia with a suture that is also introduced through the transcervical port. At the conclusion of the surgery, a previously placed 0 Vicryl purse-string suture at the ectocervix is tied down as a cerclage around the cervix once the cannula is removed. The transcervical morcellation technique demonstrated in this video allows the surgeon to maintain 5-mm skin incisions and core the endocervical canal during a laparoscopic supracervical hysterectomy with sacrocervicopexy.

  15. Cost-analysis of robotic-assisted laparoscopic hysterectomy versus total abdominal hysterectomy for women with endometrial cancer and atypical complex hyperplasia

    DEFF Research Database (Denmark)

    Herling, Suzanne Forsyth; Palle, Connie; Møller, Ann M

    2016-01-01

    INTRODUCTION: The aim of this study was to analyse the hospital cost of treatment with robotic-assisted laparoscopic hysterectomy and total abdominal hysterectomy for women with endometrial cancer or atypical complex hyperplasia and to identify differences in resource use and cost. MATERIAL...... AND METHODS: This cost analysis was based on two cohorts: women treated with robotic-assisted laparoscopic hysterectomy (n = 202) or with total abdominal hysterectomy (n = 158) at Copenhagen University Hospital, Herlev, Denmark. We conducted an activity-based cost analysis including consumables and healthcare...... professionals' salaries. As cost-drivers we included severe complications, duration of surgery, anesthesia and stay at the post-anesthetic care unit, as well as number of hospital bed-days. Ordinary least-squares regression was used to explore the cost variation. The primary outcome was cost difference...

  16. Laparoscopic hysterectomy is preferred over laparotomy in early endometrial cancer patients, however not cost effective in the very obese

    NARCIS (Netherlands)

    Bijen, Claudia B. M.; de Bock, Geertruida H.; Vermeulen, Karin M.; Arts, Henriette J. G.; ter Brugge, Henk G.; van der Sijde, Rob; Kraayenbrink, Arjen. A.; Bongers, Marlies Y.; van der Zee, Ate G. J.; Mourits, Marian I. E.; van der, Sijde R.

    2011-01-01

    Background: Total laparoscopic hysterectomy (TLH) is safe and cost effective in early stage endometrial cancer when compared to total abdominal hysterectomy (TAH). In non-randomised data it is often hypothesised that older and obese patients benefit most from TLH. Aim of this study is to analyse whe

  17. Vaginal hysterectomy for benign uterine disease in the laparoscopically confirmed frozen pelvis.

    Science.gov (United States)

    Pelosi, M A; Pelosi, M A

    1997-12-01

    Extensive pelvic adhesions present difficulty with access to the uterus, but they may not account for significant symtomatology, although their dissection may account for a significant deal of morbidity. Results of this study are based on a retrospective analysis of operations by a single surgical team. Eight patients with benign uterine pathology and frozen pelvis diagnosed laparoscopically underwent vaginal hysterectomy. The surgeries were accomplished uneventfully and without significant perioperative morbidity. This approach appears to be an efficient surgical option for hysterectomy, which by-passes the need for and the potential morbidity of an extensive intra-abdominal adhesiolysis by laparotomy or laparoscopy.

  18. Safety and Feasibility of Same-Day Discharge in Obese Patients Undergoing Laparoscopic Hysterectomy for Endometrial Intraepithelial Neoplasia and Malignancy [335

    National Research Council Canada - National Science Library

    Katz Eriksen, Jennifer Leigh; Melamed, Alexander; Berkowitz, Ross Stuart; Horowitz, Neil S; Muto, Michael George; Feltmate, Colleen Marie

    2015-01-01

    .... Same-day discharge is safe, cost-saving, and acceptable to patients undergoing laparoscopic hysterectomy, but concerns about increased perioperative risks in obese patients limit the utilization...

  19. Total laparoscopic hysterectomy: A case report from ILE-IFE, Nigeria.

    Science.gov (United States)

    Badejoko, Olusegun O; Ajenifuja, Kayode O; Oluborode, Babawale O; Adeyemi, Adebanjo B

    2012-10-01

    Total laparoscopic hysterectomy (TLH) is an advanced gynecological laparoscopic procedure that is widely performed in the developed world. However, its feasibility in resource-poor settings is hampered by obvious lack of equipments and/or skilled personnel. Indeed, TLH has never been reported from any Nigerian hospital. We present a 50-year-old multipara scheduled for hysterectomy on account of pre-malignant disease of the cervix, who had TLH with bilateral salpingo-oophorectomy in the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, southwestern Nigeria and was discharged home on the first post-operative day. She was seen in the gynecology clinic a week later in stable condition and she was highly pleased with the outcome of her surgery. This case is presented to highlight the attainability of operative gynecological laparoscopy, including advanced procedures like TLH in a resource-constrained setting, through the employment of adequate local adaptation and clever improvisation.

  20. Robot-assisted total laparoscopic hysterectomy in obese and morbidly obese women.

    Science.gov (United States)

    Rebeles, Sonia A; Muntz, Howard G; Wieneke-Broghammer, Carrie; Vason, Emily S; McGonigle, Kathryn F

    2009-10-01

    Total laparoscopic hysterectomy (TLH) in obese patients is challenging. We sought to evaluate whether total laparoscopic hysterectomies using the da Vinci robotic system in obese patients, in comparison with non-obese patients, is a reasonable surgical approach. One-hundred consecutive robot-assisted TLHs were performed over a 17-month period. Obesity was not a contraindication to robotic surgery, assuming adequate respiratory function to tolerate Trendelenburg position and, for cancer cases, a small enough uterus to allow vaginal extraction without morcellation. Data were prospectively collected on patient characteristics, total operative time, hysterectomy time, estimated blood loss, length of stay, and complications. Outcomes with non-obese and obese women were compared. The median age, weight, and BMI of the 100 patients who underwent robot-assisted TLH was 57.6 years (30.0-90.6), 82.1 kg (51.9-159.6), and 30.2 kg/m(2) (19.3-60.2), respectively. Fifty (50%) patients were obese (BMI ≥ 30); 22 patients were morbidly obese (BMI ≥ 40). There was no increase in complications (p = 0.56) or blood loss (p = 0.44) with increasing BMI. While increased BMI was associated with longer operative times (p = 0.05), median time increased by only 36 min when comparing non-obese and morbidly obese patients. Median length of stay was one day for all weight categories (p = 0.42). Robot-assisted TLH is feasible and can be safely performed in obese patients. More data are needed to compare robot-assisted TLH with other hysterectomy techniques in obese patients. Nonetheless, our results are encouraging. Robot-assisted total laparoscopic hysterectomy may be the preferred technique for appropriately selected obese patients.

  1. Multicenter analysis comparing robotic, open, laparoscopic, and vaginal hysterectomies performed by high-volume surgeons for benign indications.

    Science.gov (United States)

    Lim, Peter C; Crane, John T; English, Eric J; Farnam, Richard W; Garza, Devin M; Winter, Marc L; Rozeboom, Jerry L

    2016-06-01

    To compare perioperative outcomes between robotic-assisted benign hysterectomies and abdominal, vaginal, and laparoscopic hysterectomies when performed by high-volume surgeons. A multicenter data analysis compared 30-day outcomes from consecutive robotic-assisted hysterectomies performed by high-volume surgeons (≥60 prior procedures) at nine centers with records retrieved from the Premier Perspective database for abdominal, vaginal, and laparoscopic hysterectomies performed by high-volume gynecologic surgeons. Data on benign hysterectomy disorders from January 1, 2012 to September 30, 2013 were included. Data from 2300 robotic-assisted, 9745 abdominal, 8121 vaginal, and 11 952 laparoscopic hysterectomies were included. The robotic-assisted patient cohort had a significantly higher rate of adhesive disease compared with the vaginal (Plaparoscopic cohorts (Pobesity than the vaginal (Plaparoscopic cohorts (P250g) than the abdominal (Plaparoscopic cohorts (P=0.017). The robotic-assisted cohort experienced significantly fewer intraoperative complications than the abdominal (Physterectomy provided improved outcomes compared with abdominal, vaginal, and laparoscopic hysterectomy. Copyright © 2016 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  2. Comparison of Perioperative Outcomes of Total Laparoscopic and Robotically Assisted Hysterectomy for Benign Pathology during Introduction of a Robotic Program

    Directory of Open Access Journals (Sweden)

    Gokhan Sami Kilic

    2011-01-01

    Full Text Available Study Objective. Prospectively compare outcomes of robotically assisted and laparoscopic hysterectomy in the process of implementing a new robotic program. Design. Prospectively comparative observational nonrandomized study. Design Classification. II-1. Setting. Tertiary caregiver university hospital. Patients. Data collected consecutively 24 months, 34 patients underwent laparoscopic hysterectomy, 25 patients underwent robotic hysterectomy, and 11 patients underwent vaginal hysterectomy at our institution. Interventions. Outcomes of robotically assisted, laparoscopic, and vaginal complex hysterectomies performed by a single surgeon for noncancerous indications. Measurements and Main Results. Operative times were 208.3±59.01 minutes for laparoscopic, 286.2±82.87 minutes for robotic, and 163.5±61.89 minutes for vaginal (<.0001. Estimated blood loss for patients undergoing laparoscopic surgery was 242.7±211.37 cc, 137.4±107.50 cc for robotic surgery, and 243.2±127.52 cc for vaginal surgery (=0.05. The mean length of stay ranged from 1.8 to 2.3 days for the 3 methods. Association was significant for uterine weight (=0.0043 among surgery methods. Conclusion. Robotically assisted hysterectomy is feasible with low morbidity, a shorter hospital stay, and less blood loss. This suggests that robotic assistance facilitates a minimally invasive approach for patients with larger uterine size even during implementing a new robotic program.

  3. Learning Curve Analysis of Different Stages of Robotic-Assisted Laparoscopic Hysterectomy

    Science.gov (United States)

    Tang, Feng-Hsiang

    2017-01-01

    Objective. To analyze the learning curves of the different stages of robotic-assisted laparoscopic hysterectomy. Design. Retrospective analysis. Design Classification. Canadian Task Force classification II-2. Setting. Kaohsiung Medical University Hospital, Kaohsiung, Taiwan. Patient Intervention. Women receiving robotic-assisted total and subtotal laparoscopic hysterectomies for benign conditions from May 1, 2013, to August 31, 2015. Measurements and Main Results. The mean age, body mass index (BMI), and uterine weight were 46.44 ± 5.31 years, 23.97 ± 4.75 kg/m2, and 435.48 ± 250.62 g, respectively. The most rapid learning curve was obtained for the main surgery console stage; eight experiences were required to achieve duration stability, and the time spent in this stage did not violate the control rules. The docking stage required 14 experiences to achieve duration stability, and the suture stage was the most difficult to master, requiring 26 experiences. BMI did not considerably affect the duration of the three stages. The uterine weight and the presence of adhesion did not substantially affect the main surgery console time. Conclusion. Different stages of robotic-assisted laparoscopic hysterectomy have different learning curves. The main surgery console stage has the most rapid learning curve, whereas the suture stage has the slowest learning curve. PMID:28373977

  4. Efficacy of ultrasound-guided transversus abdominis plane block in laparoscopic hysterectomy. Clinical trial.

    Science.gov (United States)

    Guardabassi, D S; Lupi, S; Agejas, R; Allub, J M; García-Fornari, G

    2017-05-01

    Transversus abdominis plane block is a regional anaesthesia technique that has proven to be effective for postoperative pain reduction in different abdominal surgical procedures. This study evaluated its efficacy on post laparoscopic hysterectomy pain intensity and analgesic consumption. Randomized controlled trial which included 40 patients scheduled for laparoscopic hysterectomy, enrolled in 2 groups: transversus abdominis plane block+systemic analgesia (Group 1; n=20), versus systemic analgesia (Group 2; n=20). Opioid consumption within the first 24 postoperative hours, pain intensity scores at 60min, 2, 8 and 24h after surgery, adverse events related to systemic analgesia and time to hospital discharge were evaluated and registered. We found no differences between both groups in opioid consumption (10mg vs. 7mg; P=.2) and pain scores (NVS) within the first 24 postoperative hours, at 60min (3 vs. 5; P=.65), 120min (0 vs. 2; P=.15), 8 and 24h (0 vs. 0; P>.50) for the last 2 points in time analysed. Adverse events related to medication and time to hospital discharge showed similar results. Adding a transversus abdominis plane block technique to opioid PCA does not seem to improve postoperative pain management in laparoscopic hysterectomy. Patient preparation time and costs could be incremented and complications (although rare) related to the technique could appear. Copyright © 2017 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  5. Perioperative surgical outcome of conventional and robot-assisted total laparoscopic hysterectomy.

    Science.gov (United States)

    van Weelden, W J; Gordon, B B M; Roovers, E A; Kraayenbrink, A A; Aalders, C I M; Hartog, F; Dijkhuizen, F P H L J

    2017-01-01

    To evaluate surgical outcome in a consecutive series of patients with conventional and robot assisted total laparoscopic hysterectomy. A retrospective cohort study was performed among patients with benign and malignant indications for a laparoscopic hysterectomy. Main surgical outcomes were operation room time and skin to skin operating time, complications, conversions, rehospitalisation and reoperation, estimated blood loss and length of hospital stay. A total of 294 patients were evaluated: 123 in the conventional total laparoscopic hysterectomy (TLH) group and 171 in the robot TLH group. After correction for differences in basic demographics with a multivariate linear regression analysis, the skin to skin operating time was a significant 18 minutes shorter in robot assisted TLH compared to conventional TLH (robot assisted TLH 92m, conventional TLH 110m, p0.001). The presence or absence of previous abdominal surgery had a significant influence on the skin to skin operating time as did the body mass index and the weight of the uterus. Complications were not significantly different. The robot TLH group had significantly less blood loss and lower rehospitalisation and reoperation rates. This study compares conventional TLH with robot assisted TLH and shows shorter operating times, less blood loss and lower rehospitalisation and reoperation rates in the robot TLH group.

  6. Laparoscopic and robot-assisted hysterectomy for uterine cancer: a comparison of costs and complications.

    Science.gov (United States)

    Zakhari, Andrew; Czuzoj-Shulman, Nicholas; Spence, Andrea R; Gotlieb, Walter H; Abenhaim, Haim A

    2015-11-01

    Increasingly, robotic surgery is being used for total hysterectomy, bilateral salpingo-oophorectomy, and lymph node dissection for uterine cancer. The purpose of this study was to compare the costs and complications among women undergoing robotic and laparoscopic hysterectomy for uterine cancer. We carried out a cohort study using the Nationwide Inpatient Sample (NIS) database between 2008 and 2012 on all women diagnosed with uterine cancer, classifying women as either laparoscopically or robotically treated, excluding laparotomies or vaginal approaches. Logistic regression analyses were used to evaluate the adjusted effect of surgical approach on complication rates. There were 10,347 women who underwent hysterectomies for uterine cancer either laparoscopically (39%) or robotically (61%). The rate of robotic surgery consistently increased over the 5 year period. Women undergoing robotic surgery had more comorbid conditions (diabetes, hypertension, cardiovascular disease, renal disease, obesity or morbid obesity, and pulmonary disease). In adjusted analyses, women undergoing robotic surgery were more likely to have a lymph node dissection (73.01% vs 66.04%; P laparoscopic surgery. The composite endpoint of any complication was similar between both cohorts (20.56% robotic vs 21.00% laparoscopy). In overall and subset analyses, robotic surgery was more costly, with median charges of $38,161.00 compared with $31,476.00 in those undergoing laparoscopic surgery (P < .0001). Despite the considerably greater burden of comorbidities in those undergoing robotic surgery compared with laparoscopy, the former have shorter hospital admissions, a greater rate of lymph node dissection, and similar postoperative morbidity and mortality, albeit at greater total cost. Copyright © 2015 Elsevier Inc. All rights reserved.

  7. Development of Transvaginal Uterus Amputation Device for Laparoscopic Hysterectomies in Gynecologic Surgeries

    Directory of Open Access Journals (Sweden)

    Serkan DİKİCİ

    2015-01-01

    Full Text Available Hysterectomy, that is removal of uterus, is one of the most common major operations in gynecologic surgeries. Laparoscopy technique is preferred in hysterectomy because of its advantages such as lower intra-operative blood loss, decreased surrounding tissue/organ damage, less operating time, lower postoperative infection and frequency of fever, shorter duration of hospitalization and post-operative returning time to normal activity. During total laparoscopic hysterectomy, first uterine vessels and ligaments are cauterized respectively, and then cervicovaginal connections are cauterized and coagulated to remove uterus completely. Uterine manipulators are used during laparoscopy to maximize the endoscopic vision of surgeons by moving related organs. However, conventional uterine manipulators have important drawbacks particularly to move uterus in three dimensions and to show cervicovaginal landmark during laparoscopic circular cauterization and amputation of the uterine cervix. A new transvaginal uterine manipulator may overcome these two important drawbacks of these currently available devices. For this reason, a3D scanned technique was used to get uterus sizes and computer aided design software is used in designing of the new manipulator and then 3D printer was used in prototyping. Special light emitting diodes (LEDs were mounted on the cervical cap of the manipulator to guide light beams from inside of cervicovaginal tissue to abdominal cavity to facilitate the visualization of tissue landmarks. Moreover, performances of different caps and LED systems will be evaluated. Furthermore, after integration of self-cutting and self-suturing mechanisms into our system, final prototype will be produced by using titanium which is biologically and mechanically appropriate. Therefore, aim of this study was to design and produce a new uterine manipulator with three dimensional movements, LED illumination, self-cutting and self-suturing systems to facilitate

  8. Comparison of 3-dimensional versus 2-dimensional laparoscopic vision system in total laparoscopic hysterectomy: a retrospective study.

    Science.gov (United States)

    Usta, Taner A; Karacan, Tolga; Naki, M Murat; Calık, Aysel; Turkgeldi, Lale; Kasimogullari, Volkan

    2014-10-01

    We compare the results of total laparoscopic hysterectomy (TLH) operations conducted using standard 2-D and 3-D high definition laparoscopic vision systems and discuss the findings with regard to the recent literature. Data from 147 patients who underwent TLH operations with 2-D or 3-D high definition laparoscopic vision systems in Department of Obstetrics and Gynecology, Bagcilar Training and Research Hospital, during 2 year period between December 2010 and December 2012, were reviewed retrospectively. TLH operations were divided into two groups as those performed using 2-D, and those performed using 3-D high definition laparoscopic vision systems. A statistically significant difference was found between the two groups in the operation times (p = 0.037  0.05). The operation time among obese patients was significantly shorter in those in the 3-D laparoscopy group than those in the 2-D group (p = 0.041 laparoscopic vision system will help to improve surgical performance and outcome of patients undergoing gynecological minimal invasive surgery.

  9. Application of da Vinci(®) Robot in simple or radical hysterectomy: Tips and tricks.

    Science.gov (United States)

    Iavazzo, Christos; Gkegkes, Ioannis D

    2016-01-01

    The first robotic simple hysterectomy was performed more than 10 years ago. These days, robotic-assisted hysterectomy is accepted as an alternative surgical approach and is applied both in benign and malignant surgical entities. The two important points that should be taken into account to optimize postoperative outcomes in the early period of a surgeon's training are how to achieve optimal oncological and functional results. Overcoming any technical challenge, as with any innovative surgical method, leads to an improved surgical operation timewise as well as for patients' safety. The standardization of the technique and recognition of critical anatomical landmarks are essential for optimal oncological and clinical outcomes on both simple and radical robotic-assisted hysterectomy. Based on our experience, our intention is to present user-friendly tips and tricks to optimize the application of a da Vinci® robot in simple or radical hysterectomies.

  10. Association of body mass index and morbidity after abdominal, vaginal, and laparoscopic hysterectomy.

    Science.gov (United States)

    Shah, Divya Kelath; Vitonis, Allison F; Missmer, Stacey A

    2015-03-01

    To examine the association of body mass index (BMI) and operative time and perioperative morbidity after hysterectomy and determine whether the association varies among abdominal, laparoscopic, and vaginal approaches. Data abstracted from the American College of Surgeons National Safety and Quality Improvement Project registry included 55,409 women who underwent hysterectomy for benign conditions between January 2005 and December 2012. The relationships among BMI, operative time, and morbidity were examined, adjusting for age, race, ethnicity, year of surgery, smoking, diabetes, and American Society for Anesthesiologists physical classification. Adjusted means, incidence rate ratios, or odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using linear, Poisson, or logistic regression, respectively. Body mass index was positively correlated with risk of wound complications and infection in women undergoing abdominal hysterectomy. Compared with those of normal BMI, women with BMIs 40 or higher had five times the odds of wound dehiscence (2.1% compared with 0.3%, crude OR 7.35, CI 3.78-14.30; adjusted OR 5.33, CI 2.63-10.8), five times the odds of wound infection (8.9% compared with 1.4%, crude OR 6.81, CI 5.00-9.27; adjusted OR 5.34, CI 3.85-7.41), and 89% higher odds of sepsis (1.3% compared with 0.6%, crude OR 2.39, CI 1.35-4.24; adjusted OR 1.89, CI 1.01-3.52). The magnitude of the association between wound infection and BMI was smaller after vaginal hysterectomy, and no increased odds of wound complications or sepsis were noted with a laparoscopic approach despite longer operative times. Operative time increased with BMI regardless of surgical approach. No associations were noted between BMI and hospital stay or thromboembolism. Obesity is associated with increased wound complications and infection in women undergoing abdominal hysterectomy and with longer operative times regardless of surgical approach. Vaginal or laparoscopic hysterectomy

  11. Robotic-assisted laparoscopic hysterectomy: outcomes in obese and morbidly obese patients.

    Science.gov (United States)

    Gallo, Taryn; Kashani, Shabnam; Patel, Divya A; Elsahwi, Karim; Silasi, Dan-Arin; Azodi, Masoud

    2012-01-01

    To describe patient characteristics and perioperative outcomes among women undergoing roboticassisted laparoscopic hysterectomy and to evaluate the characteristics of nonobese, obese, and morbidly obese patients. A retrospective review was conducted of 442 cases of women who underwent robotic-assisted laparoscopic hysterectomy for benign and malignant conditions over a 4-y period at an academic and community teaching hospital. Patient demographics, surgical indications, operative outcomes, and complications were evaluated for patients with a body mass index (BMI) obese or morbidly obese, with a BMI of ≥30 kg/m(2). Overall, the median estimated blood loss was 100 mL (range, 10 to 800), the operative time was 135 min (range, 40 to 436), and the length of stay was 1 d (range, 0 to 22). These did not differ significantly by BMI group. Overall, 11.9% of patients experienced complications (7.9% minor, 4.1% major), and this did not differ significantly across BMI groups. Robotic hysterectomy can be performed safely in obese and morbidly obese patients, with surgical outcomes and complications similar to those in nonobese patients.

  12. Total laparoscopic hysterectomy without uterine manipulator at big uterus weight (>280 g).

    Science.gov (United States)

    Mebes, Imke; Diedrich, Klaus; Banz-Jansen, Constanze

    2012-07-01

    The retrospective study included the total laparoscopic hysterectomy without uterus manipulator at big uterus >280 g (Group A), proceeding the same technique as known to show feasibility and safety of its technique, compared with a randomized patient group of a uterus weight below 280 g (Group B). Statistical measurement was proceeded in typical clinical parameters. No statistical differences in age, body mass index, further abdominal surgery, blood loss, and hospital stay were observed. Operating time was significantly different favouring the uterus below 280 g (111.74 min Group A/90.68 min Group B). No increase in intra- or postoperative complications in both groups was observed. Total hysterectomy at big uterus (>280 g) is safe and feasible. Statistical analysis shows a significant shorter operating time only in one parameter (Group B). The technique of hysterectomy without uterus manipulator offers a surgical advancement also at vaginal stenosis, early staged cervix, or endometrial cancer and exhibits an opportunity for laparoscopic advancement in these cases too.

  13. The Experience of Robotic-Assisted Laparoscopic Hysterectomy for Women Treated for Early-Stage Endometrial Cancer

    DEFF Research Database (Denmark)

    Herling, Suzanne Forsyth; Palle, Connie; Moeller, Ann M

    2016-01-01

    BACKGROUND: An increasing number of women are offered robotic-assisted laparoscopic hysterectomy as treatment for early-stage endometrial cancer in the developed world. OBJECTIVE: The aim of this study was to explore how women diagnosed with early-stage endometrial cancer experienced robotic......-assisted laparoscopic hysterectomy. METHODS: Semistructured interviews were carried out with 12 women, and interview data were analyzed by qualitative content analysis. RESULTS: Four overarching themes emerged: "surgery was a piece of cake," "recovering physically after surgery," "going from being off guard to being...... on guard," and "preparing oneself by seeking information." The women had confidence in the robotic technique and experienced fast recovery after robotic-assisted laparoscopic hysterectomy; however, they had uncertainties and unanswered questions concerning the postoperative course. Shortly after discharge...

  14. Hysterectomy

    Science.gov (United States)

    ... however, problems can occur: • Fever and infection • Heavy bleeding during or after surgery • Injury to the urinary tract or nearby organs • ... given medication to relieve pain. You will have bleeding and discharge ... surgery. Constipation is common after most hysterectomies. Some women ...

  15. Hysterectomy

    Science.gov (United States)

    ... cuts in the belly, in order to perform robotic surgery You and your doctor will decide which type ... through the vagina using a laparoscope or after robotic surgery. When a larger surgical cut (incision) in the ...

  16. Surgical approach to hysterectomy for benign gynaecological disease

    NARCIS (Netherlands)

    Aarts, J.W.M.; Nieboer, T.E.; Johnson, N.; Tavender, E.; Garry, R.; Mol, B.W.; Kluivers, K.B.

    2015-01-01

    BACKGROUND: The four approaches to hysterectomy for benign disease are abdominal hysterectomy (AH), vaginal hysterectomy (VH), laparoscopic hysterectomy (LH) and robotic-assisted hysterectomy (RH). OBJECTIVES: To assess the effectiveness and safety of different surgical approaches to hysterectomy

  17. Total laparoscopic hysterectomy for early stage endometrial cancer in obese and morbidly obese women.

    Science.gov (United States)

    Farthing, A; Chatterjee, J; Joglekar-Pai, P; Dorney, E; Ghaem-Maghami, S

    2012-08-01

    This is a retrospective observational study, where we have evaluated the role of total laparoscopic hysterectomy (TLH) in obese and morbidly obese patients with early stage endometrial cancer. Our study illustrates that low conversion rates are achievable when appropriately trained surgeons undertake this procedure. All the women with high BMI were operated on laparoscopically in preference to laparotomy, unless there was an obvious contraindication such as a very large uterus or disseminated disease. We have also shown low conversation and complication rates for our patients, in particular a low rate of wound infection. This is in contrast to the high rate of wound infection and prolonged hospital stay reported for obese patients in the literature. Our study shows that TLH for endometrial cancer in obese women is feasible, safe and is likely to be cost-effective and adds to the weight of evidence for its use in this condition.

  18. The prognostic significance of lymphovascular space invasion in laparoscopic versus abdominal hysterectomy for endometrioid endometrial cancer.

    Science.gov (United States)

    Dewdney, S B; Jiao, Z; Roma, A A; Gao, F; Rimel, B J; Thaker, P H; Powell, M A; Massad, L S; Mutch, D G; Zighelboim, I

    2014-01-01

    Recent reports have suggested that uterine manipulators can induce lymphovascular space involvement (LVSI) by endometrial cancer in laparoscopic hysterectomy specimens. The prognostic significance of this phenomenon known as "vascular pseudo invasion" remains elusive. The authors conducted a retrospective, single institution study of patients who underwent initial surgery for grade 1 and grade 2 endometrioid endometrial cancers with LVSI. Cases were stratified by surgical approach (laparoscopy vs laparotomy). Clinicopathologic and procedure characteristics as well as outcome data were analyzed. Univariate and multivariate analyses were performed. Disease-free survival (DFS) was analyzed using the Kaplan-Meier product limit method. A total of 104 cases (20 laparoscopic, 84 laparotomy) were analyzed. Mean age (65 vs 64 years, respectively), stage distribution, mean number of lymph nodes sampled (18 vs 21, respectively) and use of adjuvant therapy was similar for both groups (p > 0.05). Mean body mass index (BMI) was 30 vs 35 kg/m2, respectively (p = 0.002). Mean follow up was 24 months (range 0.1-102). Univariate analysis demonstrated that LVSI in the laparoscopic setting was associated with worse DFS (p = 0.002). After adjusting for grade the risk of recurrence remained higher for laparoscopic cases (HR: 15.7, 95% CI 1.7-140.0, p = 0.014). Adjusted risk of recurrence associated with LVSI is higher in cases approached laparoscopically arguing against the concept of "vascular pseudo invasion" associated with the use of uterine manipulators and balloons. LVSI should be regarded as a serious risk factor and taken into account for triage to adjuvant therapies, even in laparoscopically treated early-stage endometrial cancer.

  19. Health care cost consequences of using robot technology for hysterectomy

    DEFF Research Database (Denmark)

    Laursen, Karin Rosenkilde; Hyldgård, Vibe Bolvig; Jensen, Pernille Tine

    2017-01-01

    The objective of this study is to examine the costs attributable to robotic-assisted laparoscopic hysterectomy from a broad healthcare sector perspective in a register-based longitudinal study. The population in this study were 7670 consecutive women undergoing hysterectomy between January 2006...... and August 2013 in public hospitals in Denmark. The interventions in the study were total and radical hysterectomy performed robotic-assisted laparoscopic hysterectomy (RALH), total laparoscopic hysterectomy (TLH), or open abdominal hysterectomy (OAH). Service use in the healthcare sector was evaluated 1...... year before to 1 year after the surgery. Tariffs of the activity-based remuneration system and the diagnosis-related grouping case-mix system were used for valuation of primary and secondary care, respectively. Costs attributable to RALH were estimated using a difference-in-difference analytical...

  20. Feasibility and safety of total laparoscopic hysterectomy (TLH) using the Hohl instrument in nonobese and obese women.

    Science.gov (United States)

    Mueller, Andreas; Thiel, Falk; Lermann, Johannes; Oppelt, Peter; Beckmann, Matthias W; Renner, Stefan P

    2010-02-01

    The aim of the present study was to evaluate the feasibility, safety, and complication rates of total laparoscopic hysterectomy (TLH) using the Hohl instrument in nonobese and obese women. A prospective controlled trail (Canadian Task Force classification II-1) was conducted at the Department of Obstetrics and Gynecology, Erlangen University Hospital, Erlangen-Nuremberg, Germany. Two hundred and fifty-seven women underwent total laparoscopic hysterectomy using the Hohl instrument between January 2006 and May 2008. The laparoscopic approach was used when the patient had undergone previous pelvic abdominal operation and/or had a reduced vaginal capacity. Women were classified according to their body mass index (BMI), with a cutoff point of 30 kg/m(2). Total laparoscopic hysterectomy was performed using the Hohl instrument. One ureteral injury, one bladder injury, one vaginal injury, and one injury to the epigastric vessels occurred. Blood transfusion was necessary in one patient. One conversion to abdominal hysterectomy was performed in a woman with a uterus weighing 893 g. In the postoperative phase, suture dehiscence at the vaginal closure occurred in three patients, one patient had bladder infection, one woman developed unexplained fever, and a hematoma without infection at the vaginal vault occurred in one woman. All complications occurred in women with BMI obese patients.

  1. Evolution of the complications of laparoscopic hysterectomy after a decade: a follow up of the Monash experience.

    Science.gov (United States)

    Tan, Jason J; Tsaltas, Jim; Hengrasmee, Pattaya; Lawrence, Anthony; Najjar, Haider

    2009-04-01

    A retrospective review of medical records was performed to assess the incidence and types of significant complications encountered during laparoscopic hysterectomy which would affect the use of a laparoscopic approach versus other routes of hysterectomy. A total of 526 consecutive patients' medical data between January 1994 and August 2007 were reviewed. Two hundred and thirty-two laparoscopic-assisted vaginal hysterectomies and 294 total laparoscopic hysterectomies were performed at Monash Medical Centre, a Melbourne tertiary public hospital, and three Melbourne private hospitals, by or under the supervision of three surgeons. Sixteen significant complications occurred. There were two cases of ureteric fistula, two bladder injuries, two bowel obstructions, four postoperative haematomas, one case of a bladder fistula, four conversions to laparotomy and one superficial epigastric artery injury. Inpatient stay ranged from two to six days. Our complication and inpatient stay rates are consistent with the previously reported rates, although there has been a reduction of incidence of visceral injuries with experience and introduction of new equipment.

  2. 腹腔镜下保留盆腔自主神经平面根治性子宫切除术的初步临床研究%Preliminary clinical study of laparoscopic pelvic autonomic nerve-plane sparing radical hysterectomy

    Institute of Scientific and Technical Information of China (English)

    卢艳; 姚德生; 莫凌昭; 李菲; 潘忠勉

    2012-01-01

    目的 探讨保留盆腔自主神经平面的腹腔镜下根治性子宫切除术的技术要点、可行性及其对降低术后膀胱功能障碍的作用.方法 将2010年1月至2011年5月30例宫颈癌患者分为两组,一组(15例)根据盆腔自主神经的标志性结构行保留“神经平面”法,于腹腔镜下保留盆腔自主神经的根治性子宫切除术(LNSRH),另一组(15例)行腹腔镜下根治性子宫切除术(LRH)作为对照.结果 LNSRH组15例患者中2例因出血较多保留单侧神经,1例为ⅡA期选择性保留病灶对侧盆腔神经,其余成功保留了双侧神经.全组30例患者均顺利完成手术,LNSRH组的手术时间为(301.8±47.6) min,长于LRH组的(178.3±17.0) min(P <0.05).术中出血量、术后肠道恢复时间、切除盆腔淋巴结的数目、宫旁和阴道切除范围两组比较差异无统计学意义(P>0.05).术后LNSRH组的住院时间为(10.9±2.0)d,明显少于LRH组的(15.1±0.8)d(P<0.05).LNSRH组术后拔除尿管的平均时间为(10.8±3.2)d,明显短于LRH组的(17.4±3.2)d(P <0.05).随访3~19个月,全组无复发和转移病例.结论 LNSRH在技术上安全、可行,可明显减少术后膀胱功能障碍,既不降低根治性标准,又有利于患者术后恢复及生活质量提高.%Objective To study the feasibility of laparoscopic pelvic autonomic nerve-plane sparing radical hysterectomy (LN-SRH) technique and its effect on decreasing postoperative bladder dysfunction. Methods From February 2010 to May 2011, 30 consecutive patients with cervical cancer were divided into LNSRH group and laparoscopic radical hysterectomy (LRH) group. We performed 15 LNSRH with the fascia space dissection technique and according to the basic anatomic landmarks of pelvic autonomic nerves and the operating time, operating bleeding and the postoperative recovery of bladder function were assayed. The other 15 patients were in control group under LRH. Results In LNSRH group, 2 cases reserved

  3. [Laparoscopic total hysterectomy after radiochemotherapy in an obese woman with neuroendocrine carcinoma of the cervix: surgical and anesthesiological aspects].

    Science.gov (United States)

    Deffieux, X; Plantevin, F; Castaigne, D; Haie-Meder, C; Lhommé, C; Duvillard, P; Pomel, C

    2005-04-01

    Massive obesity is an important risk factor in gynaecologic surgery. The traumatic effect of traditional laparotomy on the parietal wall is responsible for important perioperative morbidity. We describe the first reported case of an obese woman (Body Mass Index = 55 kg/m2) with stage IIA neuroendocrine carcinoma of the cervix treated by laparoscopy after radiochemotherapy. After a complete response to radiochemotherapy, the patient underwent laparoscopic hysterectomy and bilateral salpingo-oophorectomy. The laparoscopic procedure was performed with a low-pressure pneumoperitoneum. She was discharged at day 2. No major complication was observed. Surgical and anesthesiological laparoscopic management in obese women are discussed.

  4. Surrogate pregnancy in a patient who underwent radical hysterectomy and bilateral transposition of ovaries.

    Science.gov (United States)

    Azem, Foad; Yovel, Israel; Wagman, Israel; Kapostiansky, Rita; Lessing, Joseph B; Amit, Ami

    2003-05-01

    To evaluate IVF-surrogate pregnancy in a patient with ovarian transposition after radical hysterectomy for carcinoma of the cervix. Case report. A maternity hospital in Tel Aviv that is a major tertiary care and referral center. A 29-year-old woman who underwent Wertheim's hysterectomy for carcinoma of the uterine cervix and ovarian transposition before total pelvic irradiation. Standard IVF treatment, transabdominal oocyte retrieval, and transfer to surrogate mother. Outcome of IVF cycle. A twin pregnancy in the first cycle. This is the second reported case of controlled ovarian stimulation and oocyte retrieval performed on a transposed ovary.

  5. 精准-间隙解剖技术在腹腔镜广泛性子宫切除术+腹腔镜下盆腔淋巴结切除术中预防并发症的临床价值%Clinical value of precise-fascia space dissection technique in prevention of complications in laparoscopic radical hysterectomy combined with laparoscopic pelvic lymphadenectomy

    Institute of Scientific and Technical Information of China (English)

    李平军; 嵇振岭; 孟惠吉; 朱委巧; 李霞; 崔晓勇; 李丹; 张新梅; 刘嵩颖

    2014-01-01

    Objective To research the clinical value of precise-fascia space dissection technique in laparoscopic radical hysterectomy (LRH) combined with laparoscopic pelvic lymphadenectomy (LPL).Methods A retrospective analysis for 30 cases with early uterine malignancy operated by LRH + LPL were conducted,each patient was used for precise-fascia space dissection technique.Results All cases were successfully performed LRH + LPL under laparoscopy.The operative time was (253.2 ± 30.5) min,the blood loss in operation was (180.3 ± 83.2) ml,the amount of the excised lymph nodes was (13.2 ± 4.0) pieces,the time of gastrointestinal tract functional rehabilitation was (2.5 ± 0.9) d,the time of keeping urinary catheter was (13 ± 5) d.Three cases occurred lymphatic leakage and recovered after fasting and intravenous nutrition.None occurred ureter,bladder and vascular injury.Followed up for 6-72 months,none occurred recurrence or death.Conclusion LRH + LPL using precise-fascia space dissection technique can avoid ureter,bladder and vascular injury.%目的 探讨精准-间隙解剖技术在腹腔镜广泛性子宫切除术(LRH)+腹腔镜下盆腔淋巴结切除术(LPL)中预防并发症的临床价值.方法 回顾性分析采用精准-间隙解剖技术施行LRH+ LPL治疗的30例早期子宫恶性肿瘤患者的临床资料.结果 30例患者全部成功施行LRH+ LPL,手术时间(253.2±30.5) min,术中出血量(180.3±83.2) ml,切除盆腔淋巴结(13.2士4.0)枚,术后肠功能恢复时间(2.5±0.9)d,术后留置尿管时间(13±5)d;术后发生淋巴漏3例,经禁食和静脉营养治疗痊愈;无输尿管、膀胱及大血管损伤.30例术后随访6 ~ 72个月,未发现复发患者.结论 采用精准-间隙解剖技术施行LRH+ LPL,按层次解剖、间隙分离,可避免输尿管、膀胱及大血管损伤等严重并发症.

  6. Impact on survival and quality of life of laparoscopic radical hysterectomy and pelvic lymphadenectomy to patients with early-stage cervical cancer%腹腔镜下广泛性子宫切除术治疗早期子宫颈癌的疗效及对患者预后和生命质量的影响

    Institute of Scientific and Technical Information of China (English)

    阳志军; 陈艳丽; 姚德生; 张洁清; 李菲; 李力

    2011-01-01

    Objective To compare intraoperative,pathologic,postoperative outcomes and quality of life of laparoscopic radical hysterectomy and pelvic lymphadenectomy ( LRH + LPL) with abdominal radical hysterectomy and pelvic lymphadenectomy ( ARH + APL) for patients with early-stage cervical cancer.Methods The consecutive cases with International Federation of Gynecology and Obstetrics (FIGO) stages Ⅰ a2 - Ⅱ a cervical cancer who underwent surgery from Jan.1,2002 to Jan.1,2011 were documented,including 85 patients underwent LRH + LPL,and 85 patients underwent ARH + APL as control group.The clinical data of intraoperative,pathologic,postoperative outcomes and quality of life were compared between two groups.Survival data were estimated using Kaplan-Meier survival curves and compared with the log-rank test.Cox proportional hazards model was used for multivariate analysis.Results All but 2 surgical procedures were completed laparoscopically because of right common ihac vein vessel injuries.Mean operative time,it was longer for LRH + LPL than that for ARH + APL [ (242 ±74) minutes vs.( 190 ±61 ) minutes,P =0.000 ].Mean recovery time of intestines function was less for LRH + LPL than that for ARH + APL [ (45 ± 7 ) hours vs.(63 ± 1 1 ) hours,P =0.000 ].Mean estimated blood loss was less for LRH + LPL than that for ARH + APL[ (367 ±252) ml vs.(460 ±220) ml,P =0.006].Mean recovery time of urinary function was less that for LRH + LPL than that for ARH + APL [ ( 19 ±4) days vs.(21 ±4) days,P =0.000 ].There were no significant difference in numbers of the pelvic lymph nodes resected,the extent of parametrial tissue,vaginal cuff,negative margins obtained and complications.The median follow-up was 32 months (range 4 to 105 months),there was no significant difference in the recurrence rate (7% vs.5%,P=0.540) and mortality rate (7% vs.5%,P=0.540),5 years disease-free survival(90% vs.94%,P =0.812),5 years over survival ( 90% vs.95%,P =0.532 ).There were not

  7. Combined spinal and general anesthesia is better than general anesthesia alone for laparoscopic hysterectomy

    Directory of Open Access Journals (Sweden)

    Poonam S Ghodki

    2014-01-01

    Full Text Available Context: Spinal anesthesia (SA was combined with general anesthesia (GA for achieving hemodynamic stability in laparoscopic hysterectomy. Aims: The aim of our study was to evaluate the impact of SA combined with GA in maintaining hemodynamic stability in laparoscopic hysterectomy. The secondary outcomes studied were requirement of inhaled anesthetics, vasodilators, and recovery profile. Settings and Design: We conducted a prospective, randomized study in ASAI/II patients posted for laparoscopic hysterectomy, who were willing to participate in the study. Materials and Methods: Patients were randomly assigned to receive SA with GA (group SGA or plain GA (group GA. Group SGA received 10 mg bupivacaine (heavy for SA. GA was administered using conventional balanced technique. Maintenance was carried out with nitrous oxide, oxygen, and isoflurane. Comparison of hemodynamic parameters was carried out during creation of pneumoperitoneum and thereafter. Total isoflurane requirement, need of vasodilators, recovery profile, and regression of SA were studied. Statistical analysis used: Descriptive statistics in the form of mean, standard deviation, frequency, and percentages were calculated for interval and categorical variables, respectively. One-way analysis of variance (ANOVA was applied for noting significant difference between the two groups, with chi-square tests for categorical variables and post-hoc Bonferroni test for interval variables. Comparison of heart rate (HR, mean arterial pressure (MAP, SPO2, and etCO2 was done with Student′s t-test or Mann-Whitney test, wherever applicable. Results: Patients in group SGA maintained stable and acceptable MAP values throughout pneumoperitoneum. The difference as compared to group GA was statistically significant (P < 0.01. Group GA showed additional requirement of metoprolol (53.33% and higher concentration of isoflurane (P < 0.001 to combat the increased MAP. Recovery was early and quick in group SGA as

  8. Laparoscopic hysterectomy with bilateral orchidectomy for Persistent Mullerian duct syndrome with seminoma testes: Case report

    Directory of Open Access Journals (Sweden)

    Senthilnathan Palanisamy

    2015-01-01

    Full Text Available Persistent Mullerian duct syndrome (PMDS is one of the three rare intersex disorders caused by defective anti-mullerian hormone or its receptor, characterized by undescended testes with presence of underdeveloped derivatives of mullerian duct in genetically male infant or adult with normal external genitals and virilization. This population will essentially have normal, 46(XY, phenotype. We hereby present a case of PMDS, presented with incarcerated left inguinal hernia associated with cryptorchidism and seminoma of right testes. Patient underwent laparoscopic hernia repair with bilateral orchidectomy and hysterectomy with uneventful postoperative recovery. Here we highlight the importance of minimal access approach for this scenario in terms of better visualization, less blood loss, combining multiple procedures along with early return to work and excellent cosmetic outcome.

  9. Robotic-assisted laparoscopic hysterectomy seems safe in women with early-stage endometrial cancer

    DEFF Research Database (Denmark)

    Herling, Suzanne Forsyth; Havemann, Maria Cecilie; Palle, Connie

    2015-01-01

    INTRODUCTION: Robotic surgery is increasingly used in the management of endometrial cancer; and although it is known that minimally invasive surgery reduces post-operative morbidity, the outcomes of this novel treatment should be monitored carefully. The aim of this study was to examine...... the incidence of complications according to the Clavien-Dindo scale after robotic-assisted laparoscopic hysterectomy (RALH) for early-stage endometrial cancer and atypical complex hyperplasia. The Clavien-Dindo scale grades the severity of complications. METHODS: This was a retrospective, descriptive cohort...... study of 235 women with endometrial cancer or atypical complex hyperplasia who had RALH. Surgeries were stratified into two groups: with or without pelvic lymphadenectomy. RESULTS: A total of 6% developed a grade 3 or higher complication with no significant difference (p = 0.24) between the groups...

  10. Single-field sterile-scrub, preparation, and dwell for laparoscopic hysterectomy.

    Science.gov (United States)

    O'Hanlan, Katherine A; McCutcheon, Stacey Paris; McCutcheon, John G; Charvonia, Beth E

    2012-01-01

    Type VII laparoscopic hysterectomy is classified as a "clean-contaminated" procedure because the surgery involves contact with both the abdominal and vaginal fields. Because the vulva has traditionally been perceived as a separate but contaminated field, operating room guidelines have evolved to require that surgeons gloved and gowned at the abdominal field either avoid contact with the urethral catheter, the uterine manipulator, and the introitus or change their gloves and even re-gown after any contact with those fields. In the belief that the perception of the vaginal field as contaminated stems from inadequate preoperative preparation instructions, we have developed a rigorous abdomino-perineo-vaginal field preparation technique to improve surgical efficiency and prevent surgical site infections. This thorough scrub, preparation, and dwell technique enables the entire abdomino-perineo-vaginal field to be safely treated as a single sterile field while maintaining a low rate of surgical site infection, and should be further investigated in randomized studies.

  11. Effect of body mass index on clinical outcomes of patients undergoing total laparoscopic hysterectomy.

    Science.gov (United States)

    Morgan-Ortiz, Fred; Soto-Pineda, Juan M; López-Zepeda, Marco A; Peraza-Garay, Felipe de Jesús

    2013-01-01

    To evaluate the effect of normal body mass index (BMI, calculated as weight in kilograms divided by the square of height in meters) and obesity on clinical results among patients who underwent total laparoscopic hysterectomy (TLH). In a prospective study at the Civil Hospital of Culiacan in Sinaloa State, Mexico, data were compared from 209 patients who underwent TLH between July 6, 2009, and December 30, 2011. The following primary variables were analyzed for 77 normal BMI patients, 82 overweight patients, and 50 obese patients: procedure duration, operative bleeding, major and minor trans-operative complications, length of hospital stay, and postoperative pain. The mean duration of surgical procedure (Pobesity groups, respectively (Pobesity (P=0.010). The duration of surgical procedure and operative morbidity were found to increase, mainly owing to major complications, among patients with obesity (BMI ≥ 30). Copyright © 2012 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  12. López-Zepeda uterine manipulator: device description and its application in the total laparoscopic hysterectomy.

    Science.gov (United States)

    López-Zepeda, M A; Morgan, F Ortiz; Reich, Harry

    2010-04-01

    During the total laparoscopic hysterectomy (TLH) operation, small changes in the uterine and vaginal cuff position, provided by an adequate manipulator, may optimize the attack angles to the vulnerable structures involved during the procedure and facilitate their dissection. The uterine manipulators are effective because they raise the uterus when moving it from one place to another, leaving the fixing elements on tension. The Lopez-Zepeda uterine manipulator exposes all the anatomic structures involved in TLH, especially those in the vulnerable areas. It avoids dissection and mobilization of the bladder and therefore its innervation. It takes the ureter away from the risky area by 4 cm. to 5 cm. decreasing the injury risk. Finally, thanks to its anteflexion and anteversion movement, it puts the posterior culdotomy area further away from the ureter, the rectum and the sigmoid colon.

  13. Minilaparoscopic radical hysterectomy (mLPS-RH) vs laparoendoscopic single-site radical hysterectomy (LESS-RH) in early stage cervical cancer: a multicenter retrospective study.

    Science.gov (United States)

    Fagotti, Anna; Ghezzi, Fabio; Boruta, David M; Scambia, Giovanni; Escobar, Pedro; Fader, Amanda N; Malzoni, Mario; Fanfani, Francesco

    2014-01-01

    To compare the perioperative outcomes of laparoendoscopic single-site radical hysterectomy (LESS-RH) and minilaparoscopic radical hysterectomy (mLPS-RH). Retrospective study (Canadian Task Force classification II-2). Seven institutions in Italy. Forty-six patents with early cervical cancer (FIGO stage IA2-IB1/IIA1) were included in the study. Nineteen patients (41.3%) underwent LESS-RH, and 27 (58.7%) underwent mLPS-RH. Pelvic lymph node dissection was performed in all patients. In the LESS-RH group, all surgical procedures were performed through a single umbilical multichannel port. In the mLPS-RH group, the procedure was completed using a 5-mm umbilical optical trocar and 3 additional 3-mm ancillary trocars, placed suprapubically and in the left and right lower abdominal regions. There was no difference in clinicopathologic characteristics at the time of diagnosis between the LESS-RH and mLPS-RH groups. Median operative time was 270 minutes (range, 149-380 minutes) for LESS-RH, and was 180 minutes (range, 90-240 minutes) for mLPS-RH (p = .001). No further differences were detected between the 2 groups insofar as type of radical hysterectomy, number of lymph nodes removed, or perioperative outcomes. In the LESS-RH group, conversion to laparotomy was necessary in 1 patient (5.3%) because of external iliac vein injury, and in another patient, conversion to standard laparoscopy was required because of truncal obesity. In the mLPS-RH group, no conversions were observed; however, a repeat operation was performed to repair a ureteral injury. The percentage of patients discharged 1 day after surgery was significantly higher in the LESS-RH group (57.9%) compared with the mLPS-RH group (25.0%) (p = .03). After a median follow-up of 27 months (range, 9-73 months), only 1 patient, who had undergone mLPS-RH, experienced pelvic recurrence and died of the disease. Both LESS-RH and mLPS-RH are feasible ultra-minimally invasive approaches for performance of radical hysterectomy

  14. Costs and effects of abdominal versus laparoscopic hysterectomy: systematic review of controlled trials.

    Directory of Open Access Journals (Sweden)

    Claudia B M Bijen

    Full Text Available OBJECTIVE: Comparative evaluation of costs and effects of laparoscopic hysterectomy (LH and abdominal hysterectomy (AH. DATA SOURCES: Controlled trials from Cochrane Central register of controlled trials, Medline, Embase and prospective trial registers. SELECTION OF STUDIES: Twelve (randomized controlled studies including the search terms costs, laparoscopy, laparotomy and hysterectomy were identified. METHODS: The type of cost analysis, perspective of cost analyses and separate cost components were assessed. The direct and indirect costs were extracted from the original studies. For the cost estimation, hospital stay and procedure costs were selected as most important cost drivers. As main outcome the major complication rate was taken. FINDINGS: Analysis was performed on 2226 patients, of which 1013 (45.5% in the LH group and 1213 (54.5% in the AH group. Five studies scored > or =10 points (out of 19 for methodological quality. The reported total direct costs in the LH group ($63,997 were 6.1% higher than the AH group ($60,114. The reported total indirect costs of the LH group ($1,609 were half of the total indirect in the AH group ($3,139. The estimated mean major complication rate in the LH group (14.3% was lower than in the AH group (15.9%. The estimated total costs in the LH group were $3,884 versus $3,312 in the AH group. The incremental costs for reducing one patient with major complication(s in the LH group compared to the AH group was $35,750. CONCLUSIONS: The shorter hospital stay in the LH group compensates for the increased procedure costs, with less morbidity. LH points in the direction of cost effectiveness, however further research is warranted with a broader costs perspective including long term effects as societal benefit, quality of life and survival.

  15. Total laparoscopic hysterectomy without uterine manipulator: description of a new technique and its outcome.

    Science.gov (United States)

    Kavallaris, Andreas; Chalvatzas, N; Kelling, K; Bohlmann, M K; Diedrich, K; Hornemann, A

    2011-05-01

    Hysterectomy remains the most common major gynecological operation. This is the first study that describes a new technique of TLH without using any kind of uterine manipulator or vaginal tube (TLHwM) and analyzes the intra- and postoperative surgical outcome of the first 67 cases. Between October 2008 and December 2009, 67 patients underwent TLH without uterine manipulator or vaginal tube. We analyzed the differences in the outcome by using three different kinds of surgical instruments: in 21 cases the TLHwM was performed using conventional 5 mm bipolar and scissors, in 22 cases using Sonosurgical, and in 24 cases using PKS cutting forceps. There was no intra- or postoperative complications. The overall mean operating time was by TLHwM with salpingo-oophorectomy 98 min and without salpingo-oophorectomy, 80 min. The mean operating time using cutting forceps was significantly lower. The mean uterine weight was 263 g. Uterine manipulator seems to be a safe and practical surgical method, especially for patients with vaginal stenosis and in cases of enlarged uterus. With its short operation time and no complication rate, we believe that this method is an enrichment of the laparoscopic hysterectomy techniques.

  16. Laparoscopic radical prostatectomy: omitting a pelvic drain

    Directory of Open Access Journals (Sweden)

    David Canes

    2008-03-01

    Full Text Available PURPOSE: Our goal was to assess outcomes of a selective drain placement strategy during laparoscopic radical prostatectomy (LRP with a running urethrovesical anastomosis (RUVA using cystographic imaging in all patients. Materials and Methods: A retrospective chart review was performed for all patients undergoing LRP between January 2003 and December 2004. The anastomosis was performed using a modified van Velthoven technique. A drain was placed at the discretion of the senior surgeon when a urinary leak was demonstrated with bladder irrigation, clinical suspicion for a urinary leak was high, or a complex bladder neck reconstruction was performed. Routine postoperative cystograms were obtained. RESULTS: 208 patients underwent LRP with a RUVA. Data including cystogram was available for 206 patients. The overall rate of cystographic urine leak was 5.8%. A drain was placed in 51 patients. Of these, 8 (15.6% had a postoperative leak on cystogram. Of the 157 undrained patients, urine leak was radiographically visible in 4 (2.5%. The higher leak rate in the drained vs. undrained cohort was statistically significant (p = 0.002. Twenty-four patients underwent pelvic lymph node dissection (8 drained, 16 undrained. Three undrained patients developed lymphoceles, which presented clinically on average 3 weeks postoperatively. There were no urinomas or hematomas in either group. CONCLUSIONS: Routine placement of a pelvic drain after LRP with a RUVA is not necessary, unless the anastomotic integrity is suboptimal intraoperatively. Experienced clinical judgment is essential and accurate in identifying patients at risk for postoperative leakage. When suspicion is low, omitting a drain does not increase morbidity.

  17. Laparoscopic Versus Open Hysterectomy for Benign Disease in Uteri Weighing >1 kg: A Retrospective Analysis on 258 Patients.

    Science.gov (United States)

    Uccella, Stefano; Morosi, Chiara; Marconi, Nicola; Arrigo, Anna; Gisone, Baldo; Casarin, Jvan; Pinelli, Ciro; Borghi, Camilla; Ghezzi, Fabio

    2017-07-12

    To present a large single-center series of hysterectomies for uteri ≥1 kg and to compare the laparoscopic and open abdominal approach in terms of perioperative outcomes and complications. A retrospective analysis of prospectively collected data (Canadian Task Force classification II-2). An academic research center. Consecutive women who underwent hysterectomy for uteri ≥1 kg between January 2000 and December 2016. Patients with a preoperative diagnosis of uterine malignancy or suspected uterine malignancy were excluded. The subjects were divided according to the intended initial surgical approach (i.e., open or laparoscopic). The 2 groups were compared in terms of intraoperative data and postoperative outcomes. Multivariable analysis was performed to identify possible independent predictors of overall complications. A subanalysis including only obese women was accomplished. Total laparoscopic versus abdominal hysterectomy (±bilateral adnexectomy). Intra- and postoperative surgical outcomes. A total of 258 patients were included; 55 (21.3%) women were initially approached by open surgery and 203 (78.7%) by laparoscopy. Nine (4.4%) conversions from laparoscopic to open surgery were registered. The median operative time was longer in the laparoscopic group (120 [range, 50-360] vs 85 [range, 35-240] minutes, p = .014). The estimated blood loss (150 [range, 0-1700] vs 200 [50-3000] mL, p = .04), postoperative hemoglobin drop, and hospital stay (1 [range, 1-8] vs 3 [range, 1-8] days, p laparoscopic approach was found to be the only independent predictor of a lower incidence of overall complications (odds ratio = 0.42; 95% confidence interval, 0.19-0.9). The overall morbidity of minimally invasive hysterectomy was lower also in the subanalysis concerning only obese patients. In experienced hands and in dedicated centers, laparoscopic hysterectomy for uteri weighing ≥1 kg is feasible and safe. Minimally invasive surgery retains its well

  18. Total laparoscopic hysterectomy in morbidly obese women with endometrial cancer anaesthetic and surgical complications.

    Science.gov (United States)

    O'Gorman, T; MacDonald, N; Mould, T; Cutner, A; Hurley, R; Olaitan, A

    2009-01-01

    To assess the feasibility, associated anaesthetic and surgical morbidity in all morbidly obese women with endometrial cancer treated with total laparoscopic hysterectomy bilateral salpingo-oophorectomy (TLHBSO). Data was collected prospectively and analysed retrospectively on all morbidly obese women who had TLHBSO between February 2003 and January 2007. One case was converted to laparotomy. The mean postoperative stay was 4.04 (3-7) days. The only postoperative surgical complication was an incisional port site hernia. Comorbidities were present in 76% (26/34) of women, 29% (10/34) had a single comorbid condition, and 26% (9/34) had two. A further 21% (7/34) had more than two. There were no major anaesthetic complications. Patients with a BMI > 50 required ventilation with high airway pressure despite using ventilatory strategies to keep them to a minimum. TLHBSO in the obese population is safe in the hands of experienced surgeons and anaesthetists. The safety of a total laparoscopic approach in the surgical management of uterine cancer remains to be demonstrated in prospective randomised trials.

  19. Acupuncture for Preventing Complications after Radical Hysterectomy: A Randomized Controlled Clinical Trial

    Directory of Open Access Journals (Sweden)

    Wei-min Yi

    2014-01-01

    Full Text Available We aimed to investigate the preventive effects of acupuncture for complications after radical hysterectomy. A single-center randomized controlled single-blinded trial was performed in a western-style hospital in China. One hundred and twenty patients after radical hysterectomy were randomly allocated to two groups and started acupuncture from sixth postoperative day for five consecutive days. Sanyinjiao (SP6, Shuidao (ST28, and Epangxian III (MS4 were selected with electrical stimulation and Zusanli (ST36 without electrical stimulation for thirty minutes in treatment group. Binao (LI14 was selected as sham acupuncture point without any stimulation in control group. The main outcome measures were bladder function and prevalence of postoperative complications. Compared with control group, treatment group reported significantly improved bladder function in terms of maximal cystometric capacity, first voiding desire, maximal flow rate, residual urine, and bladder compliance, and decreased bladder sensory loss, incontinence, and urinary retention on fifteenth and thirtieth postoperative days. Treatment group showed significant advantage in reduction of urinary tract infection on thirtieth postoperative day. But no significant difference between groups was observed for lymphocyst formation. By improving postoperative bladder function, early intervention of acupuncture may provide a valuable alternative method to prevent bladder dysfunctional disorders and urinary tract infection after radical hysterectomy.

  20. Total laparoscopic hysterectomy for uterine pathology: impact of body mass index on outcomes.

    Science.gov (United States)

    O'Hanlan, Katherine A; Dibble, Suzanne L; Fisher, Deidre T

    2006-12-01

    We sought to analyze surgical results of women with uterine cancers having TLH+/-staging, stratifying data by body mass index (BMI). This is a retrospective analysis of data from 9 years, using Pearson and Spearman correlations, ANOVA and Fisher's Exact Test with significance at Pobese (30 to 39.9 kg/m2) and morbidly obese (40 kg/m2 or more). Of 702 patients having TLH over 9 years, 90 patients had uterine pathology. Two (2%) procedures were converted to laparotomy due to unsuspected widespread metastasis and excluded from analysis. BMI ranged from 18 to 60 kg/m2, with 31 patients having ideal, 19 having overweight and 38 having obese BMI. Of these, 19 patients had hyperplasia, while 63 had endometrial carcinoma, 1 had both ovarian and endometrial carcinoma and 5 had sarcoma. Of these 88 patients, 61 had TLH while 27 patients had indicated pelvic and aortic node dissection. The mean age was 60 years, and mean parity was 1.5 for all BMI groups. There were no significant differences in mean duration of surgery (150 min), blood loss (129 cm3) and days in hospital (1.7 days) for all BMI groups. There was no significant difference in uterine weight (140 gm) or number of nodes dissected (21 nodes). Complications occurred in 4 patients (4.5%): 1 diverticulitis, 1 ureteral injury, 1 laparotomy for bleeding and 1 incisional hernia. Total laparoscopic hysterectomy is feasible and safe for women with uterine neoplasia for every BMI category and extends the benefits of minimally invasive hysterectomy to more women, regardless of BMI.

  1. Early Experience with Robot-assisted Laparoscopic Radical Prostatectomy

    Directory of Open Access Journals (Sweden)

    Hong Gee Sim

    2004-10-01

    Conclusions: rLRP is feasible in a practice with a low volume of radical prostatectomies. Significant improvement in perioperative parameters occurs after the first eight cases. This technique confers the benefits of enhanced precision and dexterity for complex laparoscopic work in the pelvic cavity.

  2. Comparison of vaginal hysterectomy and laparoscopically assisted vaginal hysterectomy in women with benign uterine disease: a retrospective study

    Directory of Open Access Journals (Sweden)

    Sathiyakala Rajendran

    2016-11-01

    Conclusions: This study shows lesser operative time in VH group when compared to LAVH group and there is no added advantage in performing LAVH other than shorter hospital stay. Hence it is concluded that whenever feasible VH should be the preferred route of hysterectomy. [Int J Reprod Contracept Obstet Gynecol 2016; 5(11.000: 3915-3918

  3. Robotic-assisted laparoscopic hysterectomy seems safe in women with early-stage endometrial cancer

    DEFF Research Database (Denmark)

    Herling, Suzanne Forsyth; Havemann, Maria Cecilie; Palle, Connie;

    2015-01-01

    INTRODUCTION: Robotic surgery is increasingly used in the management of endometrial cancer; and although it is known that minimally invasive surgery reduces post-operative morbidity, the outcomes of this novel treatment should be monitored carefully. The aim of this study was to examine the incid......INTRODUCTION: Robotic surgery is increasingly used in the management of endometrial cancer; and although it is known that minimally invasive surgery reduces post-operative morbidity, the outcomes of this novel treatment should be monitored carefully. The aim of this study was to examine...... the incidence of complications according to the Clavien-Dindo scale after robotic-assisted laparoscopic hysterectomy (RALH) for early-stage endometrial cancer and atypical complex hyperplasia. The Clavien-Dindo scale grades the severity of complications. METHODS: This was a retrospective, descriptive cohort....... CONCLUSION: The types and frequency of complications observed in this study resemble those reported in similar studies of RALH for malignant gynaecologic conditions. Health-care professionals treating and caring for women with early-stage endometrial cancer should know of the types and frequency of post...

  4. Total laparoscopic hysterectomy for benign uterine pathologies: obesity does not increase the risk of complications.

    Science.gov (United States)

    Chopin, Nicolas; Malaret, Jean Marie; Lafay-Pillet, Marie-Christine; Fotso, Adolphe; Foulot, Hervé; Chapron, Charles

    2009-12-01

    This study was designed to investigate the intra-operative characteristics and the risk of intra- and post-operative complications in cases of total laparoscopic hysterectomy (TLH) in overweight, obese and non-obese patients. This cohort study includes all patients undergoing TLH for benign pathologies between January 1993 and June 2007 in Cochin university hospital (Paris). Demographic and surgical data were analysed. A comparison between overweight and obese patients versus non-obese patients and multivariate analyses were performed. Of 1460 patients undergoing TLH, 101 patients (6.9%) had a BMI of 30 or higher and 338 (23.2%) were overweight. After adjustment with respect to the patients' characteristics and past history (age, parity, past history of laparotomies, previous Cesarean section, menopausal status), no significant difference was found whether in terms of intra-operative (haemorrhage, transfusion, thrombosis, ureter, bladder or bowel injuries) or post-operative complications (hyperthermia, infections, fistula). Concerning the intra- and post-operative characteristics of these patients, only a significantly longer operating time was noted in the case of obesity (RR = 1.80; CI 95%: 1.16-2.81). In our experience, provided that the operating technique is meticulous, the intra- and post-operative complications are not increased in the case of obesity, although the operating time is longer.

  5. Total versus subtotal Laparoscopic Hysterectomy: A comparative study in Arash Hospital

    Directory of Open Access Journals (Sweden)

    Samiei H

    2009-09-01

    Full Text Available "n Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 st1":*{behavior:url(#ieooui } /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Arial; mso-bidi-theme-font:minor-bidi;} Background: Over the past 50 years, subtotal or supracervical hysterectomy has come to be viewed as a suboptimal procedure reserved for those rare instances in which when concern over blood loss or anatomic distortion dictates limiting the extent of dissection, the aim of this study was to compare total and subtotal laparoscopic hysterectomy. "n"nMethods: The patients who were candidates for hysterectomy with benign disease, with no contraindication for laparoscopic surgery entered the study in Arash Hospital, from March 2007 to April 2009. By simple randomization 45 patients (25 for TLH and 20 for SLH were selected. Demographic Details and intra and post operative complications, were recorded by the staff and were compared between two groups."n"nResults: The average time for TLH operations look significantly longer than SLH operation (148.6±29.7 minutes; 128.5±25.64 minutes, p=0.03. Although, the hemoglobin (gr/dl drop in TLH was significantly higher than SLH (1.54 Versus 0.9, p<0.05 Blood transfusion were common in SLH (1 case Versus 3 Cases. The total length of hospital stay, was significantly shorter after SLH than TLH (3.6±1.47 day and 2.85±0.59, p=0.04. The drug requirements to

  6. Early-stage cervical carcinoma, radical hysterectomy, and sexual function. A longitudinal study

    DEFF Research Database (Denmark)

    Jensen, Pernille T; Groenvold, Mogens; Klee, Marianne C

    2004-01-01

    BACKGROUND: Limited knowledge exists concerning the impact of radical hysterectomy (RH) alone on the sexual function of patients with early-stage cervical carcinoma. The authors investigated the longitudinal course of self-reported sexual function after RH. METHODS: The current study was comprised...... with an age-matched control group from the general population. RESULTS: Compared with control women, patients experienced severe orgasmic problems and uncomfortable sexual intercourse due to a reduced vaginal size during the first 6 months after RH, severe dyspareunia during the first 3 months, and sexual...

  7. Transvaginal application of a laparoscopic bipolar cutting forceps to assist vaginal hysterectomy in extremely obese endometrial cancer patients.

    Science.gov (United States)

    Fanning, James; Hojat, Rod; Johnson, Jil; Fenton, Bradford

    2010-01-01

    The purpose of this report is to evaluate our experience with transvaginal application of a laparoscopic bipolar cutting forceps to assist vaginal hysterectomy in extremely obese women with endometrial cancer in whom obesity precluded LAVH/BSO and lymphadenectomy and vaginal obesity limited visualization and exposure. We performed a retrospective review and identified 6 consecutive cases. No cases were excluded. A laparoscopic 33-cm Plasma Kinctic (PK) cutting forceps with a 5-mm diameter was applied transvaginally to coagulate and cut the uterosacral and cardinal ligaments, uterine vasculature, and ovarian ligaments. The uterus was delivered vaginally. Staging lymphadenectomy was not performed. Median age was 51 years, median weight was 405 lbs, and median BMI was 66 kg/m². Five of 6 cases were successfully performed vaginally (83%). Median operative time was 1 hour 10 minutes, median blood loss was 500 mL, and pain was only discomforting. All patients were discharged the day after surgery. There were no complications. At median follow-up of 1 year, all patients were alive with no evidence of disease. It is our opinion that the transvaginal application of a laparoscopic bipolar cutting forceps can successfully assist vaginal hysterectomy in extremely obese endometrial cancer patients who cannot tolerate LAVH/BSO and lymphadenectomy and vaginal obesity limits visualization and exposure.

  8. Complications after radiotherapy and radical hysterectomy in early-stage cervical carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Gerdin, E. [Univ. Hospital, Dept. of Obstetrics and Gynecology, and Gynecologic Oncology, Uppsala (Sweden); Cnattingius, S. [Univ. Hospital, Dept. of Social Medicine, Uppsala (Sweden); Johnson, P. [Univ. Hospital, Dept. of Obstetrics and Gynecology, Uppsala (Sweden)

    1995-08-01

    Objective: To evaluate the overall complications, major as well as minor, in patients treated for early-stage cervical carcinoma as related to treatment parameters. Methods: In this retrospective study, 167 consecutive patients with early-stage cervical carcinoma treated with preoperative radiotherapy and radical hysterectomy were investigated. Clinical data were collected from the medical files. Results: Transient or permanent complications appeared in up to half of all patients. Seven percent exhibited intraoperative complications and 35% suffered from early postoperative urinary tract problems; most frequently urinary tract infection. After one year, the urinary tract complications dominated; voidance difficulties and incontinence being most common. Gastrointestinal complications occurred in 15% of patients. Lymphedema appeared during the first year in 21% of the patients but several of the mild or moderate cases improved after the first year. The relative risk of lymphedema was increased with shorter duration of surgery, extensive preoperative irradiation to the bladder and after external postoperative irradiation. Some form of late sequelae remained in every fifth patient, and every fourth patient, aged 23-44 years, periodically suffered from vasomotor symptoms despite estrogen replacement therapy. Conclusion: The complications after radiotherapy and radical hysterectomy in early stage cervical carcinoma suggest that attempts should be made to evaluate effective treatments designed to minimize risk to the patients. (au) 29 refs.

  9. Radical Hysterectomy

    Science.gov (United States)

    ... with your cancer care team about surgery that's right for you. This surgery tends to affect a woman's sex life, but sometimes things can be done ... Life Chemo and Hormone Therapy Can Affect a Woman’s Sex Life Treating Sexual Problems for Women With Cancer Cancer, Sex, and Single Women Questions Women Have ... Site Comments © 2017 American Cancer Society, Inc. All rights reserved. The American Cancer Society is a qualified ...

  10. Radical Hysterectomy

    Science.gov (United States)

    ... than 1 in 10 women noticed problems with lubrication and pain during sex. Almost 8 in 10 ... News and Stories Glossary For Health Care Professionals Programs & Services Breast Cancer Support TLC Hair Loss & Mastectomy ...

  11. Health-related quality of life after robotic-assisted laparoscopic hysterectomy for women with endometrial cancer

    DEFF Research Database (Denmark)

    Herling, Suzanne Forsyth; Møller, Ann M; Palle, Connie

    2016-01-01

    OBJECTIVE: The aim of this prospective cohort study using patient-reported outcome measures (PROMs) was to detect short term changes in functioning, symptoms and health-related quality of life (HRQoL) after robotic-assisted laparoscopic hysterectomy (RALH) for endometrial cancer or atypical complex...... level in a diary during the first 5 weeks after surgery. RESULTS: We found a clinically relevant decrease in HRQoL after 1 week. At 5 weeks postoperatively, HRQoL was again at the preoperative level. Fatigue, pain, constipation, gastrointestinal symptoms, and appetite were all negatively affected 1 week...

  12. Development of an evidence-based training program for laparoscopic hysterectomy on a virtual reality simulator.

    Science.gov (United States)

    Crochet, Patrice; Aggarwal, Rajesh; Knight, Sophie; Berdah, Stéphane; Boubli, Léon; Agostini, Aubert

    2017-06-01

    Substantial evidence in the scientific literature supports the use of simulation for surgical education. However, curricula lack for complex laparoscopic procedures in gynecology. The objective was to evaluate the validity of a program that reproduces key specific components of a laparoscopic hysterectomy (LH) procedure until colpotomy on a virtual reality (VR) simulator and to develop an evidence-based and stepwise training curriculum. This prospective cohort study was conducted in a Marseille teaching hospital. Forty participants were enrolled and were divided into experienced (senior surgeons who had performed more than 100 LH; n = 8), intermediate (surgical trainees who had performed 2-10 LH; n = 8) and inexperienced (n = 24) groups. Baselines were assessed on a validated basic task. Participants were tested for the LH procedure on a high-fidelity VR simulator. Validity evidence was proposed as the ability to differentiate between the three levels of experience. Inexperienced subjects performed ten repetitions for learning curve analysis. Proficiency measures were based on experienced surgeons' performances. Outcome measures were simulator-derived metrics and Objective Structured Assessment of Technical Skills (OSATS) scores. Quantitative analysis found significant inter-group differences between experienced intermediate and inexperienced groups for time (1369, 2385 and 3370 s; p < 0.001), number of movements (2033, 3195 and 4056; p = 0.001), path length (3390, 4526 and 5749 cm; p = 0.002), idle time (357, 654 and 747 s; p = 0.001), respect for tissue (24, 40 and 84; p = 0.01) and number of bladder injuries (0.13, 0 and 4.27; p < 0.001). Learning curves plateaued at the 2nd to 6th repetition. Further qualitative analysis found significant inter-group OSATS score differences at first repetition (22, 15 and 8, respectively; p < 0.001) and second repetition (25.5, 19.5 and 14; p < 0.001). The VR program for LH accrued validity evidence and

  13. Oxycodone versus fentanyl for intravenous patient-controlled analgesia after laparoscopic supracervical hysterectomy

    Science.gov (United States)

    Kim, Nan Seol; Lee, Jeong Seok; Park, Su Yeon; Ryu, Aeli; Chun, Hea Rim; Chung, Ho Soon; Kang, Kyou Sik; Chung, Jin Hun; Jung, Kyung Taek; Mun, Seong Taek

    2017-01-01

    Abstract Background: Oxycodone, a semisynthetic thebaine derivative opioid, is widely used for the relief of moderate to severe pain. The aim of this study was to compare the efficacy and side effects of oxycodone and fentanyl in the management of postoperative pain by intravenous patient-controlled analgesia (IV-PCA) in patients who underwent laparoscopic supracervical hysterectomy (LSH). Methods: The 127 patients were randomized to postoperative pain treatment with either oxycodone (n = 64, group O) or fentanyl group (n = 63, group F). Patients received 7.5 mg oxycodone or 100 μg fentanyl with 30-mg ketorolac at the end of anesthesia followed by IV-PCA (potency ratio 75:1) for 48 hours postoperatively. A blinded observer assessed postoperative pain based on the numerical rating scale (NRS), infused PCA dose, patient satisfaction, sedation level, and side effects. Results: Accumulated IV-PCA consumption in group O was less (63.5 ± 23.9 mL) than in group F (85.3 ± 2.41 mL) during the first 48 hours postoperatively (P = 0.012). The NRS score of group O was significantly lower than that of group F at 4 and 8 hours postoperatively (P dizziness, and drowsiness was significantly higher in group O than in group F. Patient satisfaction was lower in group O than in group F during the 48 hours after surgery (P dizziness, and drowsiness, suggests that the doses used in this study were not equipotent. PMID:28272250

  14. Laparoscopic treatment of post-hysterectomy colovaginal fistula in diverticular disease. Case report.

    Science.gov (United States)

    Finco, C; Sarzo, G; Parise, P; Savastano, S; De Lazzari, F; Polato, F; Merigliano, S

    2004-06-01

    Colonic diverticular disease is a benign condition typical of the Western world, but it is not rare for even the 1st episode of diverticulitis to carry potentially fatal complications. The evolution of a peridiverticular process generally poses problems for medical treatment and exposes patients to repeated episodes of diverticulitis, making surgical treatment necessary in approximately 30% of symptomatic patients. One of the most worrying complications of diverticulosis is internal fistula. The most common types of fistula are colovesical and colovaginal, against which the uterus can act as an important protective factor. The symptoms and the clinical and instrumental management of patients with diverticular fistulas are much the same as for patients with episodes of acute diverticulitis. Staging of the disease (according to Hinchey) should be done promptly so that the necessary action can be taken prior to surgery, implementing total parenteral nutrition (TPN), nasogastric aspiration and broad-spectrum antibiotic treatment. The best surgical approach to adopt in patients with diverticulitis complicated by fistula is still not entirely clear, though the 3-step strategy is currently tending to be abandoned due to its high morbidity and mortality rates. There is a widespread conviction, however, that the 2-step strategy (Hartmann, or resection with protective stomy) and the 1-step alternative should be reserved, respectively, for patients in Hinchey stages 3, 4 and 1, 2 with a situation of attenuated local inflammation. The 1-step approach seems to be safe and effective. This report describes a case of colovaginal fistula in a patient with colonic diverticulosis who had recently undergone hysterectomy, but who, unlike such cases in the past, was treated in a single step using a laparoscopic technique.

  15. Comparing two Uterine Manipulators During Total Laparoscopic Hysterectomy: A Randomized Controlled Trial.

    Science.gov (United States)

    Husslein, Heinrich; Frecker, Helena; Shore, Eliane M; Lefebvre, Guylaine; Latta, Eleanor; Montanari, Eliana; Satkunaratnam, Abheha

    To compare 2 different types of uterine manipulators (i.e., tight fitting vs loose fitting) used for total laparoscopic hysterectomy (TLH). A randomized controlled trial. The primary end points were time for colpotomy, time from skin incision to detachment of the uterus, and histologic assessment of thermal damage to the vagina (Canadian Task Force classification I). A university teaching hospital. All consecutive women scheduled for TLH from May 2014 to December 2015. Patients were excluded if pregnancy or malignancy was suspected or uterine size exceeded 20 weeks' gestation. Patients were randomized to undergo TLH with 1 of the following uterine manipulators: (1) Colpo-Probe Vaginal Fornix Delineator (Cooper Surgical, Inc, Trumbull, CT) or (2) Hohl manipulator (KARL STORZ AG, Tuttlingen, Germany). A total of 91 patients, 49 in the Hohl manipulator group and 42 in the Colpo-Probe group, were included in the final analysis. There was no difference in patient characteristics, uterine weight, or estimated blood loss. The median time for insertion of the manipulator (2 minutes [interquartile range (IQR), 2-5 minutes] vs 6 minutes [IQR, 5-7], p manipulator. Thermal damage to the vagina varied greatly and ranged from 32 μm to 5232 μm but was not significantly different between groups (median maximum thermal damage = 1043 μm [IQR, 682-1934] vs 1522 μm [IQR, 884-2144], p = .211). Use of the Hohl manipulator results in a shorter operative time from skin incision to detachment of the uterus during TLH. Although the colpotomy time is shorter using the Hohl manipulator, this did not translate to less thermal damage to the vaginal cuff. Further studies comparing uterine manipulators are warranted to find the optimal instrument for ease of surgery and decreased thermal spread. Copyright © 2017 AAGL. Published by Elsevier Inc. All rights reserved.

  16. Short-term Clinical Outcomes of Laparoscopic Fertility-preserving Radical Hysterectomy in the Management of Early-stage Cervical Cancer%腹腔镜下保留生育功能宫颈癌根治术治疗早期子宫颈癌的近期临床疗效

    Institute of Scientific and Technical Information of China (English)

    刘开江; 刘青; 韩娜娜; 王娟; 李培全; 茹明芳

    2011-01-01

    Objective To investigate the feasibility and effectiveness of laparoscopic radical trache-lectomy and lymphadenectomy in the treatment of early-stage cervical cancer. Methods The clinical data of 6 patients ( stage I a2 to I bl) , who underwent laparoscopic fertility-preserving radical operation for cervical cancer in our department from February 2009 to October 2010, were retrospectively analyzed in terms of operation duration, intra-operative blood loss, postoperative pathology, complications, and pregnancy. Results Both radical resection of cervical and pelvic lymph node dissection were completed under laparoscopy, and only the cervical and vaginal cuffs were closed from vagina. The operation duration ranged 155-210 min ( mean; 185 min) and the intra-operative blood loss was approximately 60-120 ml (mean: 105 ml). The average length of hospital stay was 18 days without complications, postoperative infection, and bleeding. Postoperative pathology showed no lymph node metastasis, and no ligament, blood vessels, vaginal cutting margin, or upper part of cervix was invaded by tumor cells. During the 8-20-month follow-up, 1 patient had become pregnant for 4 months and no case experienced tumor recurrence. Conclusion Laparoscopic fertility-preserving lymphadenectomy and radical trachelectomy is feasible for patients with early-stage cervical cancer who have strong wish to have a child.%目的 探讨腹腔镜下根治性子宫颈切除术和盆腔淋巴结切除术治疗早期子宫颈癌的可行性和效果.方法 回顾分析6例Ⅰa2~Ⅰb1期行腹腔镜下保留生育功能子宫颈癌根治术患者的临床资料,分析手术时间、出血量、手术后病理、并发症、妊娠情况等.结果 根治性子官颈切除术和盆腔淋巴结清扫术均在腹腔镜下完成,仅宫颈和阴道断端缝合经阴道完成.手术时间155 ~210 min,平均185 min;术中出血量约60~120ml,平均105 ml.术中及术后均无并发症.术后病理学检查未

  17. INFECTION AFTER RADICAL ABDOMINAL HYSTERECTOMY AND PELVIC LYMPHADENECTOMY - PREVENTION OF INFECTION WITH A 2-DOSE PERIOPERATIVE ANTIBIOTIC-PROPHYLAXIS

    NARCIS (Netherlands)

    BOUMA, J

    1993-01-01

    Surgical site-related infections occurred in 21% of 87 consecutive patients undergoing radical hysterectomy with pelvic lymphadenectomy (RHPL) without planned peri-operative prophylaxis. A prospective, randomized double-blind, placebo-controlled study was conducted in 68 consecutive RHPL patients.

  18. Vaginal and pelvic recurrence rates based on vaginal cuff length in patients with cervical cancer who underwent radical hysterectomies.

    Science.gov (United States)

    Kim, K; Cho, S Y; Park, S I; Kim, B J; Kim, M H; Choi, S C; Ryu, S Y; Lee, E D

    2011-09-01

    The objective of this study was to determine the association of vaginal cuff length (VCL) with vaginal and pelvic recurrence rates in patients with cervical cancer who underwent radical hysterectomies. The clinicopathologic characteristics were collected from the medical records of 280 patients with cervical cancer who underwent radical hysterectomies. The association of VCL with 3-year vaginal and pelvic recurrence rates was determined using a Z-test. The association of VCL with other clinicopathologic characteristics was also determined. The VCL was not associated with 3-year vaginal and pelvic recurrence rates. The 3-year vaginal recurrence rate was 0%-2% and the 3-year pelvic recurrence rate was 7%-8%, independent of VCL. The VCL and the age of patients had an inverse relationship. However, the VCL was not associated with histologic type, FIGO stage, clinical tumor size, tumor size in the surgical specimen, depth of invasion, lymphovascular space invasion, parametrial involvement, lymph node involvement, and adjuvant therapy. One-hundred ninety of 280 patients (68%) underwent adjuvant therapies following radical hysterectomies. Although it is limited by the high rate of adjuvant therapy, the current study suggested that the VCL following radical hysterectomy in patients with cervical cancer was not associated with vaginal and pelvic recurrence rates. Copyright © 2011 Elsevier Ltd. All rights reserved.

  19. Laparoendoscopic single-site radical hysterectomy with pelvic lymphadenectomy: initial multi-institutional experience for treatment of invasive cervical cancer.

    Science.gov (United States)

    Boruta, David M; Fagotti, Anna; Bradford, Leslie S; Escobar, Pedro F; Scambia, Giovanni; Kushnir, Christina L; Michener, Chad M; Fader, Amanda Nickles

    2014-01-01

    To describe the feasibility, safety, and outcomes of women with stage I cervical cancer treated with laparoendoscopic single-site surgery radical hysterectomy (LESS-RH). A retrospective descriptive study (Canadian Task Force classification III). Multiple academic teaching hospitals. Women with Fédération Internationale de Gynécologie et d'Obstétrique FIGO stage IA1 to IB1 cervical cancer. LESS-RH as the primary therapy for cervical cancer performed by a gynecologic oncologist with expertise in LESS. A multichannel, single-port access device; a flexible-tipped 5-mm laparoscope; and a multifunctional instrument were used in all cases. Clinicopathologic, surgical, and perioperative outcomes were analyzed. Twenty-two women were identified in whom a LESS-RH was attempted; 20 (91%) successfully underwent the procedure, including 19 in whom pelvic lymphadenectomy (PLND) was completed. Of the 2 converted procedures, 1 patient underwent 2-port laparoscopy secondary to truncal obesity, and 1 patient underwent conversion to laparotomy secondary to external iliac vein laceration during PLND. The median age and body mass index were 46 years and 23.3 kg/m(2), respectively. The median number of pelvic lymph nodes removed was 22. One patient experienced an intraoperative complication, and no patient required reoperation. The margins of excision were negative. One patient with 2 positive pelvic nodes and 1 patient with microscopic parametrial disease received adjuvant chemosensitized radiation; 3 additional patients received adjuvant radiation therapy secondary to an intermediate risk for recurrence. After a median follow up of 11 months, no recurrences were detected. LESS-RH/PLND is feasible and safe for select patients with stage I cervical cancer. Larger studies are needed to confirm whether the increased technical difficulty of this procedure justifies its use in routine gynecologic oncology practice. Copyright © 2014 AAGL. Published by Elsevier Inc. All rights reserved.

  20. Early stage cervical cancer, radical hysterectomy and sexual function: a longitudinal study

    DEFF Research Database (Denmark)

    Jensen, Pernille Tine

    Background: Limited knowledge exists regarding the impact of treatment on the sexual function of early stage cervical cancer patients. We investigated the longitudinal course of self-reported sexual function after radical hysterectomy (RH) alone. Methods: 173 patients with lymph node-negative early......-surgery, the patients completed an extended version of the questionnaire with additional items assessing the patient’s perception of changes in sexual function compared with before the cancer diagnosis. Results: Compared with control women, patients experienced severe orgasmic problems and uncomfortable sexual...... intercourse due to a reduced vaginal size during the first 6 months after RH, severe dyspareunia during the first 3 months, and sexual dissatisfaction during the first 5 weeks after RH. A persistent lack of sexual interest and insufficient vaginal lubrication were reported throughout the first 2 years after...

  1. Radical abdominal hysterectomy using the ENDO-GIA stapler: report of 150 cases and literature review.

    Science.gov (United States)

    Patsner, B

    1998-01-01

    Over a seven-year period from 1990-1997 150 consecutive patients underwent Type III radical abdominal hysterectomy using the ENDO-GIA stapler on the cardinal and uterosacral ligaments. Compared to prior patients operated on with standard suturing methods, the stapler patients had shorter operating times, lower blood loss and infection rates, and shorter hospital stays without any increase in recurrence rate. The equipment failure rate was 3%. Although not all improvements in surgical and post-operative morbidity are likely due to use of the ENDO-GIA stapler, the use of the stapler clearly lowered operating times, blood loss, surgical morbidity, hospital stay with no adverse effect on patient survival.

  2. Fast access and early ligation of the renal pedicle significantly facilitates retroperitoneal laparoscopic radical nephrectomy procedures: modified laparoscopic radical nephrectomy

    Directory of Open Access Journals (Sweden)

    Yang Qing

    2013-01-01

    Full Text Available Abstract Background The objective of this study was to develop a modified retroperitoneal laparoscopic nephrectomy and compare its results with the previous technique. Methods One hundred retroperitoneal laparoscopic nephrectomies were performed from February 2007 to October 2011. The previous technique was performed in 60 cases (Group 1. The modified technique (n = 40 included fast access to the renal pedicle according to several anatomic landmarks and early ligation of renal vessels (Group 2. The mean operation time, mean blood loss, duration of hospital stay conversion rate and complication rate were compared between the groups. Results No significant differences were detected regarding mean patient age, mean body mass index, and tumor size between the two groups (P >0.05. The mean operation time was 59.5 ± 20.0 and 39.5 ± 17.5 minutes, respectively, in Groups 1 and 2 (P P P >0.05. Conclusions Early ligature using fast access to the renal vessels during retroperitoneal laparoscopic radical nephrectomy contributed to less operation time and intraoperative blood loss compared with the previous technique. In addition, the modified technique permits the procedure to be performed following the principles of open radical nephrectomy.

  3. Outcomes after robot-assisted laparoscopic radical prostatectomy

    Institute of Scientific and Technical Information of China (English)

    Declan G.Murphy; Benjamin J.Challacombe; Anthony J.Costello

    2009-01-01

    Robot-assisted laparoscopic radical prostatectomy (RALRP) using the da Vinci surgical system is now in widespread use in many countries where economic conditions allow the installation of this expensive technology.Controversy has surrounded the procedure since it was first performed in 2000,with many critics highlighting the lack of evidence to support its use.However,despite the lack of level I evidence,many large studies of patients have confirmed that the procedure is feasible and safe,with low morbidity.Available longer-term oncological data seem to show that outcomes from the robotic approach at least match those of traditional open radical prostatectomy.Functional outcomes also seem satisfactory,although randomized controlled trials are lacking.This paper reviews the current status of RALRP with respect to perioperative data and complications and oncologic and functional outcomes.

  4. Prevalence of prognostic factors for cancer of the uterine cervix after radical hysterectomy

    Directory of Open Access Journals (Sweden)

    Marília Buenos Aires Cabral Tavares

    Full Text Available CONTEXT AND OBJECTIVE: Cancer of the uterine cervix is still very common in Brazil. It is important to evaluate factors that influence its prognosis. The aim here was to analyze the prevalence of prognostic anatomoclinical factors among patients with carcinoma of the uterine cervix undergoing radical hysterectomy. DESIGN AND SETTING: Cross-sectional study on 301 patients with invasive carcinoma of the uterine cervix who underwent Level III Piver-Rutledge hysterectomy surgery at São Marcos Hospital. METHODS: The following variables were analyzed: age, histological type, degree of differentiation, invasion of lymphatic, vascular and perineural space, lymph node metastasis, distance to nearest margin, tumor invasion depth, vaginal cuff size, largest diameter of the tumor, presence of necrosis and surgical margin involvement. Descriptive statistics, multiple regression analysis, Kaplan-Meier survival curves and the log-rank test were performed. A significance level of 5% was used. RESULTS: The mean age was 48.27 years. The following were not important for the prognosis, in relation to survival analysis: degree of differentiation and tumor invasion depth; presence of lymphatic, blood and perineural invasions; distance to nearest margin; and vaginal cuff size. Tumor size (P < 0.036, presence of lymph node metastasis (P < 0.0004, necrosis (P < 0.05 and surgical margin involvement (P < 0.0015 presented impacts on survival. The overall survival with 98 months of follow-up was 88.35%. CONCLUSION: The most prevalent prognostic factors were the presence of lymph node metastasis, tumor size and surgical margin involvement.

  5. A Comparison of Outcomes Following Laparoscopic and Open Hysterectomy With or Without Lymphadenectomy for Presumed Early-Stage Endometrial Cancer: Results From the Medical Research Council ASTEC Trial.

    Science.gov (United States)

    Kyrgiou, Maria; Swart, Anne-Marie; Qian, Wendi; Warwick, Jane

    2015-10-01

    Laparoscopic hysterectomy (LH) is increasingly used for the management of endometrial malignancy. Its benefits may be particularly pronounced as these women are more likely to be older or obese. The aim of this study was to determine whether outcomes for LH are comparable to the open hysterectomy (OH). This was a prospective cohort study nested within the multicenter ASTEC (A Study in the Treatment of Endometrial Cancer) randomized controlled trial (1998-2005). Women with presumed early endometrial cancer were included. Laparoscopic hysterectomy was compared with OH with or without systematic lymphadenectomy. Overall survival, time to first recurrence, complication rates, and surgical outcomes were the main outcome measures. Of 1408 women, 1309 (93%) received OH, and 99 (7%) had LH. LH was associated with longer operating time (median, LH 105 minutes [interquartile range (IQR), 60-150] vs OH 80 minutes [IQR, 60-95]; P Laparoscopic hysterectomy for early endometrial cancer is safe. Although it requires longer operating time it is associated with shorter hospital stay and favorable morbidity profile. Further studies are required to assess the long-term safety.

  6. Single plus one port laparoscopic radical prostatectomy:a report of 8 cases in one center

    Institute of Scientific and Technical Information of China (English)

    GAO Yi; XU Dan-feng; LIU Yu-shan; CUI Xin-gang; CHE Jian-ping; YAO Ya-cheng; YIN Lei

    2011-01-01

    Laparoscopic radical prostatectomy is considered the first treatment of choice for local prostate cancer due to its minimal invasion advantage. To further achieve the goal of minimal invasion, single port laparoscopic radical prostatectomy has been developed to minimize the complications associated with puncture tracks. The aim of this study was to illustrate the technique for single port laparoscopic radical prostatectomy and evaluate its efficacy and safety. We reported 8 cases of radical prostatectomy with excellent early outcome carried out in Shanghai Changzheng Hospital from June 2009 to August 2009 using a home-made multiple instrument access port and adding an additional small incision at McBumey point.

  7. A retrospective study of neoadjuvant chemotherapy plus radical hysterectomy versus radical hysterectomy alone in patients with stage II cervical squamous cell carcinoma presenting as a bulky mass

    Directory of Open Access Journals (Sweden)

    Takatori E

    2016-09-01

    Full Text Available Eriko Takatori, Tadahiro Shoji, Anna Takada, Takayuki Nagasawa, Hideo Omi, Masahiro Kagabu, Tatsuya Honda, Fumiharu Miura, Satoshi Takeuchi, Toru Sugiyama Department of Obstetrics and Gynecology, Iwate Medical University School of Medicine, Iwate, Japan Objective: In order to evaluate the usefulness of neoadjuvant chemotherapy (NAC for stage II cervical squamous cell carcinoma with a bulky mass, we retrospectively compared patients receiving NAC followed by radical hysterectomy (RH; NAC group with patients who underwent RH without NAC (Ope group. Patients and methods: The study period was from June 2002 to March 2014. The subjects were 28 patients with a stage II bulky mass in the NAC group and 17 such patients in the Ope group. The chi-square test was used to compare operative time, volume of intraoperative blood loss, use of blood transfusion, and time from surgery to discharge between the two groups. Moreover, the log-rank test using the Kaplan–Meier method was performed to compare disease-free survival (DFS and overall survival (OS between the groups. Results: There were no statistically significant differences between the two groups in operative time, volume of intraoperative blood loss, or use of blood transfusion. However, the time from surgery to discharge was 18 days (14–25 days in the NAC group and 25 days (21–34 days in the Ope group; the patients in the NAC group were discharged earlier (P=0.032. The hazard ratio for DFS in the NAC group as compared with that in the Ope group was 0.36 (95% CI 0.08–0.91, and the 3-year DFS rates were 81.2% and 41.0%, respectively (P=0.028. Moreover, the hazard ratio for OS was 0.39 (95% CI 0.11–1.24, and the 3-year OS rates were 82.3% and 66.4%, respectively (P=0.101. Conclusion: NAC with cisplatin and irinotecan was confirmed to prolong DFS as compared with RH alone. The results of this study suggest that NAC might be a useful adjunct to surgery in the treatment of stage II squamous

  8. Adjuvant radiotherapy after radical hysterectomy of the cervical cancer. Prognostic factors and complications

    Energy Technology Data Exchange (ETDEWEB)

    Chatani, Masashi; Nose, Takayuki; Masaki, Norie [Osaka Univ. Medical School (Japan). Dept. of Radiation Therapy; Inoue, Toshihiko [Osaka Univ. Medical School (Japan). Dept. of Radiation Oncology

    1998-10-01

    Aim: To investigate prognostic factors and complications after radical hysterectomy followed by postoperative radiotherapy for carcinoma of the uterine cervix. Patients and Methods: One hundred twenty-eight patients with T1b-2b carcinoma of the uterine cervix following radical hysterectomy with bilateral pelvic lymphadenectomy and postoperative radiation therapy were reviewed. Pathologic and treatment variables were assessed by multivariate analysis for local recurrence, distant metastases and cause specific survival. Results: The number of positive nodes (PN) in the pelvis was the strongest predictor of pelvic recurrence and distant metastases. These 2 failure patterns independently affect the cause specific survival. The 5-year cumulative local and distant failure were PN(0): 2% and 12%, PN(1-2): 23% and 25%, PN(2<): 32% and 57%, respectively (p=0.0029 and p=0.0051). The 5-year cause specific survival rates were PN(0): 90%, PN(1-2): 59% and PN(2<): 42% (p=0.0001). The most common complication was lymphedema of the foot experienced by one-half of the patients (5-year: 42%, 10-year: 49%). Conclusion: These results suggest that patients with pathologic T1b-T2b cervix cancer with pelvic lymph node metastases are at high risk of recurrence or metastases after radical hysterectomy with pelvic lymphadenectomy and postoperative irradiation. (orig.) [Deutsch] Ziel: Untersuchung der prognostischen Faktoren und Komplikationen der adjuvanten Radiotherapie nach radikaler Hysterektomie bei Patienten mit Zervixkarzinom. Patienten und Methoden: In dieser Studie wurden 128 Patientinnen mit Zervixkarzinom untersucht, bei denen die pathologische Untersuchung nach radikaler Hysterektomie mit gleichzeitiger bilateraler pelvischer Lymphadenektomie und postoperativer Radiotherapie die Klassifikation als T1b-T2b-Karzinome ergab. Dabei wurden pathologische und therapeutische Parameter auf der behandelten Seite mit Hilfe der Multivarianzanalyse auf lokale Rezidive und Fernmetastasen

  9. Laparoscopic hysterectomy is preferred over laparotomy in early endometrial cancer patients, however not cost effective in the very obese.

    Science.gov (United States)

    Bijen, Claudia B M; de Bock, Geertruida H; Vermeulen, Karin M; Arts, Henriëtte J G; ter Brugge, Henk G; van der Sijde, Rob; Kraayenbrink, Arjen A; Bongers, Marlies Y; van der Zee, Ate G J; Mourits, Marian J E

    2011-09-01

    Total laparoscopic hysterectomy (TLH) is safe and cost effective in early stage endometrial cancer when compared to total abdominal hysterectomy (TAH). In non-randomised data it is often hypothesised that older and obese patients benefit most from TLH. Aim of this study is to analyse whether data support this assumption to advice patients, clinicians and policy makers. Data of 283 patients enrolled in a randomised controlled trial comparing TAH versus TLH in early stage endometrial cancer were re-analysed. Randomisation by sequential number generation was done centrally, with stratification by trial centre. Using multivariate analysis, predictors of major complications and conversions to laparotomy were assessed. For the cost effectiveness analysis, subgroups of patients were constructed based on age and body mass index (BMI). For each subgroup, costs per major complication-free patient were estimated, using incremental cost effect ratios (extra costs per additional effect). Older (odds ratio (OR): 1.05; 1.01-1.09) and obese (OR: 1.05; 1.01-1.10) patients had a higher risk to develop complications, for both groups. In obese (OR: 1.17; 1.09-1.25) patients and patients with a previous laparotomy (OR: 3.45; 1.19-10.04) a higher risk of conversion to laparotomy was found. For patients>70 years of age and patients with a BMI over 35 kg/m2, incremental costs per major complication-free patients were €16 and €54 for TLH compared to TAH, respectively. In general, TLH should be recommended as the standard surgical procedure in early stage endometrial cancer, also in patients>70 years of age. In obese patients with a BMI>35 kg/m2 TLH is not cost effective because of the high conversion rate. A careful consideration of laparoscopic treatment is needed for this subgroup. Surgeon experience level may influence this choice. Copyright © 2011 Elsevier Ltd. All rights reserved.

  10. Robotic-assisted laparoscopic radical cystectomy: history, techniques and outcomes.

    Science.gov (United States)

    Liss, Michael A; Kader, A Karim

    2013-06-01

    Robotic-assisted radical cystectomy (RARC) is a less invasive means of performing the radical cystectomy operation, which holds promise for improved patient morbidity. We review the history, technique and current literature pertaining to RARC and place the current results in context with the open procedure. All articles regarding RARC found in PubMed after January 2000 were examined. We selected articles that appeared in high-impact journals, had large patient population size (>80 patients), or were novel in technique or findings. We chose key laparoscopic articles to give reference to the history in transition to robotic radical cystectomy. In addition, we chose classic articles from open radical cystectomy to give reference regarding the newer robotic perioperative outcomes. Studies suggest that a 20-patient learning curve is needed to reach an operative time of 6.5 h, with 30 surgeries performed to reach lymph node counts in excess of 20 (International Robotic Cystectomy Consortium). The only randomized surgical trial comparing open and robotic techniques showed equivalent lymph node yield, which may be surgeon and volume dependent. Literature demonstrates lower estimated blood loss, transfusion rates, early return of bowel function and decreased complications in early small series. RARC and urinary diversion are still early in development and limited to centers with extensive robotic experience and volume, although adoption of the robotic approach is becoming more common. Early studies have shown promise to reduce complications with equivalent oncologic results.

  11. Laparoscopic Radical Prostatectomy in the ERA of Robot-Assisted Technology

    Directory of Open Access Journals (Sweden)

    Iason Kyriazis

    2014-05-01

    Full Text Available In this work the outcomes of laparoscopic radical prostatectomy (LRP with regard to perioperative morbidity, oncological effectiveness, as well as postoperative continence and potency preservation are being reviewed and compared with the gold standard open radical prostatectomy. In addition, the limitations of LRP are being presented in contrast to the advancement offered by the emerging robotic assisted radical prostatectomy in an attempt to reveal whether laparoscopic approach still has a role in the era of robot-assisted technology.

  12. Metastatic adenocarcinoma after laparoscopic supracervical hysterectomy with morcellation: A case report.

    Science.gov (United States)

    Turner, Taylor; Secord, Angeles Alvarez; Lowery, William J; Sfakianos, Gregory; Lee, Paula S

    2013-01-01

    •Uterine morcellation is common in minimally invasive hysterectomy but should be performed with caution due to risk of unsuspected malignancy.•Intraoperative techniques should be considered to minimize dissemination of endometrial tissue during morcellation.•Strategies to ensure accurate pathologic evaluation of morcellated specimens and to improve preoperative risk stratification before morcellation procedures are necessary.

  13. Morbidity and survival patterns in patients after radical hysterectomy and postoperative adjuvant pelvic radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Fiorica, J.V.; Roberts, W.S.; Greenberg, H.; Hoffman, M.S.; LaPolla, J.P.; Cavanagh, D. (Univ.ersity of South Florida College of Medicine, Tampa (USA))

    1990-03-01

    Morbidity and survival patterns were reviewed in 50 patients who underwent radical hysterectomy, pelvic lymphadenectomy, and adjuvant postoperative pelvic radiotherapy for invasive cervical cancer. Ninety percent of the patients were FIGO stage IB, and 10% were clinical stage IIA or IIB. Indications for adjuvant radiotherapy included pelvic lymph node metastasis, large volume, deep stromal penetration, lower uterine segment involvement, or capillary space involvement. Seventy-two percent of the patients had multiple high-risk factors. An average of 4700 cGy of whole-pelvis radiotherapy was administered. Ten percent of the patients suffered major gastrointestinal complications, 14% minor gastrointestinal morbidity, 12% minor genitourinary complications, one patient a lymphocyst, and one patient lymphedema. Of the five patients with major gastrointestinal morbidity, all occurred within 12 months of treatment. Three patients required intestinal bypass surgery for distal ileal obstructions and all are currently doing well and free of disease. All of the patients who developed recurrent disease had multiple, high-risk factors. The median time of recurrence was 12 months. All patients recurred within the radiated field. Actuarial survival was 90% and disease-free survival 87% at 70 months. It is our opinion that the morbidity of postoperative pelvic radiotherapy is acceptable, and benefit may be gained in such a high-risk patient population.

  14. Robotic-assisted laparoscopic hysterectomy for women with endometrial cancer - complications, women´s experiences, quality of life and a health economic evaluation

    DEFF Research Database (Denmark)

    Herling, Suzanne Forsyth

    2016-01-01

    . These changes should be addressed in the preoperative information and at the post-operative follow-up. It is difficult imagining a RCT of robotic-assisted laparoscopic hysterectomy being conducted in the future due to reluctance towards randomisation to open surgery. However, it would be advisable continuously...... to monitor relevant surgical and patient-reported outcomes as indications for robotic surgery may alter, experiences may develop and further technical advances may change robotic surgery for women with endometrial cancer in the future.......This thesis contains four studies all focusing on women with endometrial cancer undergoing robotic-assisted laparoscopic hysterectomy (RALH). Women with endometrial cancer are typically elderly with co-morbidities. RALH is a relatively new treatment option which has been introduced and adopted over...

  15. Does Laparoscopic Hysterectomy Increase the Risk of Vaginal Cuff Dehiscence? An Analysis of Outcomes from Multiple Academic Centers and a Review of the Literature.

    Science.gov (United States)

    Mikhail, Emad; Cain, Mary Ashley; Shah, Madhvi; Solnik, M Jonathon; Sobolewski, Craig J; Hart, Stuart

    2015-11-01

    Vaginal cuff dehiscence represents a serious, but infrequent complication after hysterectomy, with a reported increased incidence following a laparoscopic approach. Various risk factors have been proposed including laparoscopically placed suture, surgical experience, use of electrosurgery, surgical indication, and obesity. Technical aspects of the procedure itself have also been questioned such as the variable use of monopolar electrosurgery during colpotomy and the suture type or number of layers chosen to reapproximate the vaginal cuff. Nothwithstanding the tendency for cuff dehiscence to occur following laparoscopic approach, there remains a paucity of high-quality data that supports or refutes this finding or clearly defines the mechanism(s) by which this event occurs allowing for the proposal of objective guidelines for reducing risk. Various techniques have been proposed to decrease the risk of vaginal cuff dehiscence during endoscopic hysterectomy, including use of monopolar current on cutting mode, achievement of cuff hemostasis with sutures rather than electrocoagulation, use of a two-layer cuff closure with polydioxanone suture, and use of bidirectional barbed suture for cuff closure. The authors experience at three university-based minimally invasive gynecologic surgery programs showed a low rate of vaginal cuff dehiscence in their own practices. Large randomized controlled trials are needed to truly determine whether there is a difference in vaginal cuff dehiscence between surgical modalities for hysterectomy as well as to determine the true risk factors.

  16. Histerectomia vaginal: o laparoscópico é necessário? Vaginal hysterectomy: is the laparoscope necessary?

    Directory of Open Access Journals (Sweden)

    Octacílio Figueiredo Netto

    1998-10-01

    pode ser realizada na grande maioria dos casos.Purpose: the laparoscope can be used to convert an abdominal into a vaginal hysterectomy when there are contraindications for the vaginal approach, and not as a substitute for simple vaginal hysterectomy. The purpose of the present study is to discuss the role of laparoscopy in vaginal hysterectomy. Methods: between February 1995 and September 1998, 400 patients were considered candidates for vaginal hysterectomy.Exclusion criteria included uterine prolapse, adnexal tumor and uterine immobility. The Heaney technique was used, and different morcellation procedures were employed for the removal of enlarged uteri. Results: the mean age and parity was 46.9 years and 3.2 deliveries, respectively. Twenty-nine patients (7.2% were nulliparous, and 104 (26.0% had never delivered vaginally. Three hundred and three patients (75.7% had a history of previous pelvic surgery, the most common being cesarean section (48.7%. The most frequent indication was leiomyoma (61.2%, and the mean uterine volume was 239.9 cm³ (30-1228 cm³. Vaginal hysterectomy was successfully performed in 396 patients (99.0%, and 73 surgeries (18.2% were done by residents. The mean operative time was 45 min. Diagnostic/operative laparoscopy was performed in 16 patients (4.0%. Intraoperative complications included 6 cystotomies (1.5% and one rectal laceration (0.2%. There were four conversions (1.0% to the abdominal route. Postoperative complications occurred in 24 patients (6.0%. Two hundred and eighty-one patients (70.2% were discharged 24 h after surgery. Conclusions: the laparoscope does not seem to be necessary in cases were the uterus is mobile and there is no adnexal tumor. The main role of the laparoscope may be to increase the awareness of gynecologists to the possibility of a simple vaginal hysterectomy in the majority of cases.

  17. Adjuvant radiotherapy following radical hysterectomy for patients with stage IB and IIA cervical cancer

    Energy Technology Data Exchange (ETDEWEB)

    Soisson, A.P.; Soper, J.T.; Clarke-Pearson, D.L.; Berchuck, A.; Montana, G.; Creasman, W.T. (Duke Univ. Medical Center, Durham, NC (USA))

    1990-06-01

    From 1971 through 1984, 320 women underwent radical hysterectomy as primary therapy of stage IB and IIA cervical cancer. Two hundred forty-eight patients (78%) were treated with surgery alone and 72 patients (22%) received adjuvant postoperative external-beam radiotherapy. Presence of lymph node metastasis, large lesion (greater than 4 cm in diameter), histologic grade, race (noncaucasian), and age (greater than 40 years) were significant poor prognostic factors for the entire group of patients. Patients treated with surgery alone had a better disease-free survival than those who received combination therapy (P less than 0.001). However, patients receiving adjuvant radiation therapy had a higher incidence of lymphatic metastases, tumor involvement of the surgical margin, and large cervical lesions. Adjuvant pelvic radiation therapy did not improve the survival of patients with unilateral nodal metastases or those who had a large cervical lesion with free surgical margins and the absence of nodal involvement. Radiation therapy appears to reduce the incidence of pelvic recurrences. Unfortunately, 84% of patients who developed recurrent tumor after combination therapy had a component of distant failure. The incidence of severe gastrointestinal or genitourinary tract complications was not different in the two treatment groups. However, the incidence of lymphedema was increased in patients who received adjuvant radiation therapy. Although adjuvant radiation therapy appears to be tolerated without a significant increase in serious complications, the extent to which it may improve local control rates and survival in high-risk patients appears to be limited. In view of the high incidence of distant metastases in high-risk patients, consideration should be given to adjuvant systemic chemotherapy in addition to radiation therapy.

  18. Role of pelvic and para-aortic lymphadenectomy in abandoned radical hysterectomy in cervical cancer.

    Science.gov (United States)

    Barquet-Muñoz, Salim Abraham; Rendón-Pereira, Gabriel Jaime; Acuña-González, Denise; Peñate, Monica Vanessa Heymann; Herrera-Montalvo, Luis Alonso; Gallardo-Alvarado, Lenny Nadia; Cantú-de León, David Francisco; Pareja, René

    2017-01-14

    Cervical cancer (CC) occupies fourth place in cancer incidence and mortality worldwide in women, with 560,505 new cases and 284,923 deaths per year. Approximately, nine of every ten (87%) take place in developing countries. When a macroscopic nodal involvement is discovered during a radical hysterectomy (RH), there is controversy in the literature between resect macroscopic lymph node compromise or abandonment of the surgery and sending the patient for standard chemo-radiotherapy treatment. The objective of this study is to compare the prognosis of patients with CC whom RH was abandoned and bilateral pelvic lymphadenectomy and para-aortic lymphadenectomy was performed with that of patients who were only biopsied or with removal of a suspicious lymph node, treated with concomitant radiotherapy/chemotherapy in the standard manner. A descriptive and retrospective study was conducted in two institutions from Mexico and Colombia. Clinical records of patients with early-stage CC programmed for RH with an intraoperative finding of pelvic lymph, para-aortic nodes, or any extracervical involvement that contraindicates the continuation of surgery were obtained. Between January 2007 and December 2012, 42 clinical patients complied with study inclusion criteria and were selected for analysis. In patients with CC whom RH was abandoned due to lymph node affectation, there is no difference in overall survival or in disease-free period between systematic lymphadenectomy and tumor removal or lymph node biopsy, in pelvic lymph nodes as well as in para-aortic lymph nodes, when these patients receive adjuvant treatment with concomitant radiotherapy/chemotherapy. This is a hypothesis-generator study; thus, the recommendation is made to conduct randomized prospective studies to procure better knowledge on the impact of bilateral pelvic and para-aortic lymphadenectomy on this group of patients.

  19. Comparison of remifentanil and fentanyl in patients undergoing modified radical mastectomy or total hysterectomy

    Institute of Scientific and Technical Information of China (English)

    郭向阳; 易杰; 叶铁虎; 罗爱伦; 黄宇光; 任洪智

    2003-01-01

    Objective To compare the efficacy and safety of remifentanil and fentanyl in patients undergoing a modified radical mastectomy or total hysterectomy.Methods Fifty-four patients were evenly randomised into remifentanil group and fentanyl group. Anesthesia was induced by propofol (1-2 mg/kg) and either remifentanil (2 μg/kg) or fentanyl (2.5 μg/kg), and was maintained with inhalation of nitrous oxide in oxygen (2∶1) and continuous infusion of either remifentanil (0.2 μg*kg-1*min-1) or fentanyl(0.03 μg*kg-1*min-1). Results The number of patients exhibiting light anesthesia responses in the remifentanil group during intubation and the maintenance of anesthesia was significantly less than that in the fentanyl group. Both systolic and diastolic blood pressures in the fentanyl group were significantly higher than those in the remifentanil group during intubation, skin incision, maintenance of anesthesia and extubation. The time to opening eyes on command and the time for extubation after surgery was comparable between the two groups. More patients in the remifentanil group (25 patients) required bolus injection of morphine for postoperative pain relief than those in the fentanyl group (5 patients, P<0.05). There was no significant difference between the two groups in terms of side effects.Conclusions Under the condition of this study protocol, the anesthetic and analgesic effects of remifentanil are more potent than those of fentanyl. Remifentanil can offer superior intraoperative hemodynamic stability in comparison with fentanyl, and has no compromising recovery from anesthesia.

  20. Laparoscopic hysterectomy and transabdominal hysterectomy complication comparative study%腹腔镜全子宫切除术与经腹全子宫切除术并发症比较研究

    Institute of Scientific and Technical Information of China (English)

    黄巧玲

    2015-01-01

    Objective To compare the laparoscopic hysterectomy and transabdominal hysterectomy complications, and to explore effective prevention method summary.Method select 2011 July -2013 year in July to 108 cases of laparoscopic hysterectomy patients in our hospital (laparoscopic group) and 92 cases by abdominal hysterectomy patients (laparotomy group) as the research object, the two groups were observed after operation complications.Results the patients in the laparoscopic group postoperative urinary tract infection in 10 cases (9.26%), 9 cases of cesarean section group (9.78%); 11 cases of vaginal stump hemorrhage (10.19%), 9 cases of cesarean section group (9.78%),P0.05;腹腔镜组患者术后出现腹部切口愈合不良3例(2.78%),剖腹组11例(11.96%),P<0.05。长期随访后发现腹腔镜组患者出现阴道干涩和性欲下降13例(12.04%),而剖腹组47例(51.09%),P<0.05。两组患者围绝经期症状差异无统计学意义,腹腔镜组患者出现宫颈残鞘囊肿的比率为27例(25.0%)。结论腹腔镜全子宫切除术治疗子宫肌瘤具有创口小、出血少,患者手术后恢复快、并发症少等特点,是临床上一种效果较好的全子宫切除术,手术医师掌握手术指征,具有娴熟的手术技巧是减少患者出现并发症的关键。

  1. Clinical analysis of laparoscopic hysterectomy in 80 cases%腹腔镜全子宫切除术80例的临床分析

    Institute of Scientific and Technical Information of China (English)

    张凤翱

    2015-01-01

    Objective:To explore the clinical effect of laparoscopic hysterectomy.Methods:80 patients with laparoscopic hysterectomy were selected from January 2012 to January 2013.The clinical data were retrospectively analyzed.Results:All patients completed the surgery with laparoscopic surgery.The average time was (169.5±47.7)min.The amount of bleeding was 50 to 500 mL.Postoperative hospital stay time was 5 to 8 days.After operation,1 case had uretero vaginal fistula.Conclusion:Laparoscopic hysterectomy is a safe,effective operation.Surgical trauma is small.Haemorrhage is little.Postoperative recovery is fast.Complication is little.%目的:探讨腹腔镜全子宫切除术的临床应用效果。方法:2012年1月-2013年1月收治行腹腔镜全子宫切除患者80例,回顾性分析其临床资料。结果:所有患者均于腹腔镜下完成手术,手术平均时间(169.5±47.7)min,出血量50~500 mL;术后住院时间5~8 d;术后发生输尿管阴道瘘1例。结论:腹腔镜全子宫切除术是一种安全、有效的手术方式,手术创伤小、出血少、术后恢复快,并发症少。

  2. Pedagogic approach in the surgical learning: The first period of “assistant surgeon” may improve the learning curve for laparoscopic robotic-assisted hysterectomy.

    Directory of Open Access Journals (Sweden)

    Angeline Favre

    2016-11-01

    Full Text Available Background: Hysterectomy is the most frequently surgery done with robotic assistance in the world and has been widely studied since its emergence. The surgical outcomes of the robotic hysterectomy are similar to those obtained with other minimally invasive hysterectomy techniques (laparoscopic and vaginal and appear as a promising surgical technique in gynaecology surgery. The aim of this study was to observe the learning curve of robot-assisted hysterectomy in a French surgical center, and was to evaluate the impact of the surgical mentoring.Methods: We retrospectively collected the data from the files of the robot-assisted hysterectomies with the Da Vinci® Surgical System performed between March 2010 and June 2014 at the Foch hospital in Suresnes (France. We first studied the operative time according to the number of cases, independently of the surgeon to determine two periods: the initial learning phase (Phase 1 and the control of surgical skills phase (Phase 2. The phase was defined by mastering the basic surgical tasks. Secondarily we compared these two periods for operative time, blood losses, Body Mass Index (BMI, days of hospitalisations and uterine weight. We finally studied the difference of the learning curve between an experimented surgeon (S1 who practised the first the robot-assisted hysterectomies and a less experimented surgeon (S2 who first assisted S1 and then operated on his own patients.Results: 154 robot-assisted hysterectomies were analysed. 20 procedures were necessary to access to the control of surgical skills phase. There was a significant decrease of the operative time between the learning phase (156.8 minutes compared to the control of surgical skills phase (125.8 minutes, p=0.003. No difference between these two periods for blood losses, BMI, days of hospitalisations and uterine weight were demonstrated. The learning curve of S1 showed 20 procedures to master the robot-assisted hysterectomies with a significant

  3. Clinical analysis of 30 cases of laparoscopic hysterectomy%腹腔镜下大子宫切除术30例临床分析

    Institute of Scientific and Technical Information of China (English)

    巩苏

    2016-01-01

    目的:探讨腹腔镜下子宫>12孕周患者全子宫切除术的临床效果,并比较子宫<12孕周患者腹腔镜下全子宫切除术。方法:收治子宫>12孕周行腹腔镜全子宫切除术患者30例,作为观察组;另选取同期子宫<12孕周行腹腔镜全子宫切除术患者30例,作为对照组。比较两组患者的手术及术后康复情况。结果:两组手术顺利,均无中转开腹病例,无盆腔脏器损伤。观察组手术时间长于对照组、子宫重量重于对照组(P<0.05)。结论:大子宫全切除术效果较好,对盆底功能的损害小,安全性较高。%Objective:To explore the clinical effect of laparoscopic complete hysterectomy in patients more than 12 weeks of pregnancy,and to compare laparoscopic complete hysterectomy in patients less than 12 weeks of pregnancy.Methods:30 patients more than 12 weeks of pregnancy with laparoscopic complete hysterectomy were selected as the observation group.30 patients less than 12 weeks of pregnancy with laparoscopic complete hysterectomy were selected as the control group.The operation and postoperative recovery of the two groups were compared.Results:The surgeries of two groups were successful,and there was no conversion to open surgery and no pelvic organ injury.The operation time of the observation group was longer than that of the control group,and the uterine weight was more than that of the control group(P<0.05).Conclusion:The complete hysterectomy has better effect.It has small harm on the pelvic floor function,and the safety is higher.

  4. [Quality of life and sexual function of cervical cancer patients following radical hysterectomy and vaginal extension].

    Science.gov (United States)

    Ye, Shuang; Yang, Jiaxin; Cao, Dongyan; Zhu, Lan; Lang, Jinghe; Shen, Keng

    2014-08-01

    To investigate the quality of life and sexual function of cervical cancer patients following radical hysterectomy (RH) and vaginal extension. Case-control and questionnaire- based method was employed in this study. Thirty-one patients of early-stage (I b1-I b2) cervical cancer who had undergone vaginal extension following classic RH in Peking Union Medical College Hospital from December 2008 to September 2012 were included in study group, while 28 patients with matching factors and RH only during the same period were allocated to control group. There was no significant difference between two groups in terms of clinical and demographic variables including age at diagnosis, tumor stage and follow-up time (P > 0.05). Patients were assessed retrospectively by validated self-reported questionnaires the European Organization for Research and Treatment of Cancer Cervix Cancer Module Questionnaire (EORTC QLQ-CX24) mainly for quality of life and sexual function for cervical cancer patients; the Sexual Function and Vaginal Changes Questionnaire (SVQ) further investigates sexual function and vaginal changes of patients with gynecologic malignancy at least 6 months after treatment. Vaginal length acquired by pelvic examination by gynecologic oncologists during follow-up visits was (10.0 ± 1.3) cm and (5.9 ± 1.0)cm in study group and control group respectively (P = 0.000). Sixty-eight percent (21/31) of cases in study group and 64% (18/28) of cases in control group had resumed sexual activity at the time of interview, and the time interval between treatment and regular sexual activity was mean 6 months (range 3-20 months) and mean 5 months (range 1-12 months) in study and control group respectively, in which there was not statistical significance (P > 0.05). No difference was observed regarding pelvic floor symptoms (P > 0.05) while difficulty emptying bladder, incomplete emptying and constipation were most commonly reported. Both group presented with hypoactive sexual desire

  5. Risk model in stage IB1-IIB cervical cancer with positive node after radical hysterectomy

    Directory of Open Access Journals (Sweden)

    Chen Z

    2016-05-01

    Full Text Available Zhilan Chen,1,2,* Kecheng Huang,1,* Zhiyong Lu,1,3 Song Deng,1,4 Jiaqiang Xiong,1 Jia Huang,1 Xiong Li,5 Fangxu Tang,1 Zhihao Wang,6 Haiying Sun,1 Lin Wang,1 Shasha Zhou,1 Xiaoli Wang,1 Yao Jia,1 Ting Hu,1 Juan Gui,7 Dongyi Wan,1 Ding Ma,1 Shuang Li,1 Shixuan Wang11Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Techonology, Wuhan, 2Department of Obstetrics and Gynecology, Wuhan General Hospital of Guangzhou Military Command, Wuhan, 3Hubei Key Laboratory of Embryonic Stem Cell Research, Tai-He Hospital, Hubei University of Medicine, Shiyan, Hubei, 4Department of Obstetrics and Gynecology, University Hospital of Hubei University for Nationalities, Enshi, Hubei, 5Department of Obstetrics and Gynecology, Wuhan Central Hospital, Wuhan, 6Department of Pathology and Pathophysiology, Key Laboratory of Ministry of Education of China for Neurological Disorders, Huazhong University of Science and Techonology, Wuhan, 7Department of Obstetrics and Gynecology, Renmin Hospital, Wuhan University, Wuhan, People’s Republic of China*These authors contributed equally to this workAbstract: The purpose of this study was to identify risk factors in patients with surgically treated node-positive IB1-IIB cervical cancer and to establish a risk model for disease-free survival (DFS and overall survival (OS. A total of 170 patients who underwent radical hysterectomy and bilateral pelvic lymphadenectomy as primary treatment for node-positive International Federation of Gynaecology and Obstetrics (FIGO stage IB1-IIB cervical cancer from January 2002 to December 2008 were retrospectively analyzed. Five published risk models were evaluated in this population. The variables, including common iliac lymph node metastasis and parametrial invasion, were independent predictors of outcome in a multivariate analysis using a Cox regression model. Three distinct prognostic groups (low, intermediate, and high risk

  6. Application of gene expression programming and neural networks to predict adverse events of radical hysterectomy in cervical cancer patients.

    Science.gov (United States)

    Kusy, Maciej; Obrzut, Bogdan; Kluska, Jacek

    2013-12-01

    The aim of this article was to compare gene expression programming (GEP) method with three types of neural networks in the prediction of adverse events of radical hysterectomy in cervical cancer patients. One-hundred and seven patients treated by radical hysterectomy were analyzed. Each record representing a single patient consisted of 10 parameters. The occurrence and lack of perioperative complications imposed a two-class classification problem. In the simulations, GEP algorithm was compared to a multilayer perceptron (MLP), a radial basis function network neural, and a probabilistic neural network. The generalization ability of the models was assessed on the basis of their accuracy, the sensitivity, the specificity, and the area under the receiver operating characteristic curve (AUROC). The GEP classifier provided best results in the prediction of the adverse events with the accuracy of 71.96 %. Comparable but slightly worse outcomes were obtained using MLP, i.e., 71.87 %. For each of measured indices: accuracy, sensitivity, specificity, and the AUROC, the standard deviation was the smallest for the models generated by GEP classifier.

  7. Initial consecutive 125 cases of robotic assisted laparoscopic radical prostatectomy performed in Ireland's first robotic radical prostatectomy centre.

    LENUS (Irish Health Repository)

    Bouchier-Hayes, D M

    2012-03-01

    We examined the patient characteristics, operative proceedings and the outcomes of the initial series of 125 cases of robot-assisted laparoscopic radical prostatectomy (RALRP) in an independent hospital in Ireland, performed by two surgeons using the da Vinci(®) surgical system.

  8. Quality improvement: single-field sterile scrub, prep, and dwell for laparoscopic hysterectomy.

    Science.gov (United States)

    O'Hanlan, Katherine A; McCutcheon, Stacey Paris; McCutcheon, John G; Charvonia, Beth E

    2013-05-01

    The vulva and vaginal interior are considered a contaminated surgical area, and current OR guidelines require surgeons who are gloved and gowned at the abdominal field to avoid contact with the urethral catheter, the uterine manipulator, and the introitus or to change their gloves and even regown if contact occurs. It is our belief that the perception of the vaginal field as contaminated reflects a lack of specific standards for the preoperative cleansing of the deeper vagina and a lack of preoperative prep instructions for the combined fields. We developed a comprehensive single-field prep technique designed to improve surgical efficiency and prevent contamination of the sterile field. Combining a methodical scrub, prep, and dwell, this technique allows the entire abdomino-perineovaginal field to be treated as a single sterile field for laparoscopic procedures. Our surgical site infection rate of 1.8% when using this single-field prep technique and the subsequent surgical treatment of the abdominal, vaginal, and perineal fields as a single sterile field is well within reported norms.

  9. Characteristics of positive surgical margins in robotic-assisted radical prostatectomy, open retropubic radical prostatectomy, and laparoscopic radical prostatectomy: a comparative histopathologic study from a single academic center.

    Science.gov (United States)

    Albadine, Roula; Hyndman, Matthew E; Chaux, Alcides; Jeong, J Y; Saab, Shahrazad; Tavora, Fabio; Epstein, Jonathan I; Gonzalgo, Mark L; Pavlovich, Christian P; Netto, George J

    2012-02-01

    Studies detailing differences in positive surgical margin among open retropubic radical prostatectomy, laparoscopic radical prostatectomy, and robotic-assisted laparoscopic radical prostatectomy are lacking. A retrospective review of all prostatectomies with positive surgical margin performed at our center in 2007 disclosed 99 cases, 6 (5%) of which were reinterpreted cases as having negative margins. Ninety-three cases were, therefore, included, corresponding to 37 retropubic radical prostatectomies, 19 laparoscopic radical prostatectomies, and 37 robotic-assisted laparoscopic radical prostatectomies. The relationship of positive surgical margin characteristics to clinicopathologic parameters and biochemical recurrence was assessed. The most commonly found positive surgical margin site was the apex/distal third in all groups (62% retropubic prostatectomies, 79% laparoscopic prostatectomies, 60% robotic-assisted prostatectomies). Total linear length of positive surgical margin sites was significantly correlated with preoperative prostate-specific antigen, preoperative prostate-specific antigen density, pT stage, and tumor volume (P ≤ .001). We found no significant differences among the 3 groups with respect to total linear length, number of foci, laterality, or location of positive surgical margin. The rate of biochemical recurrence was also comparable in the 3 groups. On univariate analyses, biochemical recurrence was significantly associated with preoperative prostate-specific antigen values, preoperative prostate-specific antigen density, Gleason score, number of positive surgical margins, and total linear length of positive surgical margin (P ≤ .02). Only preoperative prostate-specific antigen density and number of positive surgical margin foci were statistically significant (P ≤ .03) independent predictors of biochemical recurrence. We found no significant difference in positive surgical margin characteristics or biochemical recurrence among the 3

  10. Optic Nerve Sheath Diameter Remains Constant during Robot Assisted Laparoscopic Radical Prostatectomy

    NARCIS (Netherlands)

    Verdonck, Philip; Kalmar, Alain F.; Suy, Koen; Geeraerts, Thomas; Vercauteren, Marcel; Mottrie, Alex; De Wolf, Andre M.; Hendrickx, Jan F. A.

    2014-01-01

    Background: During robot assisted laparoscopic radical prostatectomy (RALRP), a CO2 pneumoperitoneum (CO2PP) is applied and the patient is placed in a head-down position. Intracranial pressure (ICP) is expected to acutely increase under these conditions. A non-invasive method, the optic nerve sheath

  11. Comparison of robot-assisted total laparoscopic hysterectomy and total abdominal hysterectomy for treatment of endometrial cancer in obese and morbidly obese patients.

    Science.gov (United States)

    Nevadunsky, N; Clark, R; Ghosh, S; Muto, M; Berkowitz, R; Vitonis, A; Feltmate, C

    2010-12-01

    The objective of our study was to compare clinical and pathologic outcomes of robot-assisted and open abdominal techniques for treatment of uterine cancer in obese patients. Institutional review board approval was obtained. Patient demographic data, pathological data, and surgical data were collected by retrospective chart review. Data were analyzed using SAS statistical software. One-hundred and eighty-nine consecutive cases of suspected uterine cancer were identified from October 2003 until January 2009. Of these, 116 patients (61%) had a body mass index (BMI) over 30. There were 66 completed robot-assisted hysterectomies (RAHs), 43 total abdominal hysterectomies (TAHs), and seven patients that were converted from RAH to open abdominal hysterectomy. There were no significant differences in preoperative patient demographics, including body mass index (BMI), medical co-morbidities, or preoperative cytology, except for parity. There were no differences in postoperative grade, stage, lymph vascular space invasion, positive pelvic washings, mean number of pelvic lymph nodes, or proportion of patients undergoing pelvic lymphadenectomy. Length of stay and estimated blood loss were lower for the robotic technique; RAHs had a significantly longer operative time, however. Postoperative blood transfusions and wound infections were more frequent in the TAH group. Of the RAH group there were seven conversions to TAH (10%). Differences in surgical times with and without lymphadenectomy were least in patients in the largest BMI category of >50. Length of time required for RAH was significantly longer then TAH in obese and morbidly obese patients, however benefits to patients of a minimally invasive approach included reduced incidence of wound infections, reduced transfusion rates, reduced blood loss, and shortened length of stay. These data also suggest the greatest advantage of robotic technology over laparotomy in patients with BMI over 50.

  12. Operative outcomes of single-port-access laparoscopy-assisted vaginal hysterectomy compared with single-port-access total laparoscopic hysterectomy

    Directory of Open Access Journals (Sweden)

    Bo Sung Yoon

    2014-12-01

    Conclusion: SPA-TLH with laparoscopic vaginal suture required the longest operating time, and hemoglobin changes were smaller in the SPA-LAVH group than in the other groups. In patients undergoing SPA laparoscopy, we recommend the SPA-LAVH procedure.

  13. Total Laparoscopic Hysterectomy: Evaluation of an Evidence-Based Educational Strategy Using a Novel Simulated Suture and Knot-Tying Challenge, the “Holiotomy”

    Directory of Open Access Journals (Sweden)

    Katherine A. O'Hanlan

    2012-01-01

    Full Text Available Objective. The purpose of this study was to evaluate perceptions of skills and practice patterns of gynecologists attending a course on total laparoscopic hysterectomy (TLH. This course employed extensive use of pelvic trainer boxes to accomplish the Holiotomy Challenge. The “Holiotomy Challenge” entailed suturing two plastic pieces with six figure-of-N sutures tied with four square knots each. Methods. A survey was administered before the course and 3 months later. Data were analyzed by paired t-tests, McNemar’s Chi Squares, and ANCOVAs with significance set P<.05. Results. At baseline, 216 surgeons and at 3 months 102 surgeons returned the survey. Surgeons’ self-perceptions of their skills significantly increased from 6.24 to 7.28. Their reports of their surgical practice at home revealed significantly increased rates of minimally invasive procedures, from 42% to 54%. Significantly more surgeons reported having the ability to close the vagina, or a small cystotomy or enterotomy. Participation in the cadaver lab and presence of their practice partner did not impact these rates. Conclusions. A comprehensive course employing laparoscopic surgical simulation focused on basic surgical skills essential to TLH has a positive impact on attendees' self-rated skill level and rate of laparoscopic approaches. Many had begun performing TLH after the course.

  14. Management of pelvic lymphoceles following robot-assisted laparoscopic radical prostatectomy

    Directory of Open Access Journals (Sweden)

    Omer A Raheem

    2012-01-01

    Full Text Available Pelvic lymphocele is a potential complication of radical prostatectomy. Although lymphoceles often regress spontaneously, many may progress, precipitate clinical symptoms, and ultimately require intervention. To date, the best treatment of pelvic lymphoceles has not yet been fully defined. However, laparoscopic marsupialization is a definitive and efficacious surgical alternative to percutaneous drainage. It is effective, results in minimal patient morbidity, and allows for rapid recovery. We report our experience with management of clinically symptomatic pelvic lymphoceles following robotic-assisted prostatectomy using laparoscopic marsupialization.

  15. Systematic review of the limited evidence for different surgical techniques at benign hysterectomy

    DEFF Research Database (Denmark)

    Sloth, Sigurd Beier; Schroll, Jeppe Bennekou; Settnes, Annette

    2017-01-01

    laparoscopic hysterectomy for non-prolapsed uteri when feasible (⊕ΟΟΟ). ↓ Robot-assisted laparoscopic hysterectomy should only be preferred over conventional laparoscopic hysterectomy after careful consideration because the beneficial effect is uncertain and because of the longer operating time (⊕⊕ΟΟ...

  16. Comparison of the effect of laparoscopic hysterectomy and abdominal hysterectomy on ovarian function%腹腔镜与开腹全子宫切除术对女性卵巢功能影响的比较

    Institute of Scientific and Technical Information of China (English)

    姜琦; 朱福梅

    2014-01-01

    目的:探讨腹腔镜下与开腹全子宫切除术对中青年女性卵巢功能的影响。方法选择60例未绝经的子宫良性疾病并需行子宫切除术的中青年患者,随机分为腹腔镜组和开腹组,每组各30例,比较两组患者围手术期指标、性激素水平及围绝经期综合征情况。结果腹腔镜组术中出血量、术后肛门排气时间均显著少于开腹组,差异有统计学意义( t值分别为4.27和3.11,P<0.05);术后6个月,两组患者卵泡刺激素(FSH)、黄体生成素(LH)、雌二醇(E2)、孕酮(P)水平相比,差异均无统计学意义(t值分别为0.69、0.95、0.67、-0.33,均P>0.05);术后12个月两组患者FSH、LH、E2、P水平差异也均无统计学意义(t值分别为0.88、-0.21、1.65、0.20,均P>0.05);两组患者术后围绝经期综合征发生率比较差异无统计学意义(χ2=0.10,P>0.05)。结论腹腔镜子宫切除术具有对机体创伤小、术后恢复快的优点,与传统子宫切除术相比不会增加对卵巢功能的损伤。%Objective To investigate the effect of laparoscopic hysterectomy ( LH) and abdominal hysterectomy ( AH) on ovarian function of young and middle-aged women.Methods Totally 60 young and middle-aged premenopausal patients with benign uterine disease were going to undergo hysterectomy .They were randomly divided into LH group and AH group with 30 cases in each .The perioperative indexes , sexual hormone level and perimenopausal syndrome were compared between two groups .Results The blood loss and postoperative flatus in LH group were significantly less than AH group , and the differences were significant (t value was 4.27 and 3.11, respectively, both P0.05).There were not significant differences in the serum levels of FSH , LH, E2 and P in 12 months after surgery ( t value was 0.88, -0.21, 1.65 and 0.20, respectively, all P >0.05 ).The incidence of

  17. Sentinel lymph node identification in patients with early stage cervical cancer undergoing radical hysterectomy and pelvic lymphadenectomy

    Institute of Scientific and Technical Information of China (English)

    李斌; 章文华; 刘琳; 吴令英; 张蓉; 李宁

    2004-01-01

    Background In general, sentinel lymph node (SLN) can reflect the whole state of the entire drainage area. The present study evaluated the clinical significance of sentinel lymph node identification in the treatment of early stage cervical cancer.Methods Twenty-eight patients with early stage (Ia-Iia) cervical cancer undergoing radical hysterectomy and pelvic lymphadenectomy were included in this study. At two locations 8 hours before operation, 0.4 ml 37 Mbq technicium-99 labeled dextran was injected intracervically. After that, preoperative lymphoscintigraphy was performed to detect SLNs. During the operation, lymph nodes were detected ex vivo by a γ-counter to identify SLNs. The samples of SLNs and non-SLNs were used for pathological examination separately and compared with the final results. Results SLNs were identified in 27 of 28 (96.4%) patients. A total of 123 SLNs were identified from 814 nodes. Six patients had altogether 11 positive lymph nodes, which were all SLNs. No patient had false-negative sentinel node. Conclusion SLNs can successfully predict the lymphatic metastasis in patients with cervical cancer. The clinical validity of this technique should be evaluated prospectively.

  18. Robot-assisted laparoscopic hysterectomy in obese and morbidly obese women: surgical technique and comparison with open surgery.

    Science.gov (United States)

    Geppert, Barbara; Lönnerfors, Celine; Persson, Jan

    2011-11-01

    Comparison of surgical results on obese patients undergoing hysterectomy by robot-assisted laparoscopy or laparotomy. University hospital. All women (n=114) with a BMI ≥30 kg/m(2) who underwent a simple hysterectomy as the main surgical procedure between November 2005 and November 2009 were identified. Robot-assisted procedures (n=50) were separated into an early (learning phase) and a late (consolidated phase) group; open hysterectomy was considered an established method. Relevant data was retrieved from prospective protocols (robot) or from computerized patient charts (laparotomy) until 12 months after surgery. Complications leading to prolonged hospital stay, readmission/reoperation, intravenous antibiotic treatment or blood transfusion were considered significant. The surgical technique used for morbidly obese patients is described. Women in the late robot group (n=25) had shorter inpatient time (1.6 compared to 3.8 days, plaparoscopic hysterectomy in a consolidated phase in obese women is associated with shorter hospital stay, less bleeding and fewer complications compared to laparotomy but, apart from women with BMI ≥35, a longer operative time. © 2011 The Authors Acta Obstetricia et Gynecologica Scandinavica© 2011 Nordic Federation of Societies of Obstetrics and Gynecology.

  19. ACOG Committee Opinion No. 444: choosing the route of hysterectomy for benign disease.

    Science.gov (United States)

    2009-11-01

    Hysterectomies are performed vaginally, abdominally, or with laparoscopic or robotic assistance. When choosing the route and method of hysterectomy, the physicians should take into consideration how the procedure may be performed most safely and cost-effectively to fulfill the medical needs of the patient. Evidence demonstrates that, in general, vaginal hysterectomy is associated with better outcomes and fewer complications than laparoscopic or abdominal hysterectomy. When it is not feasible to perform a vaginal hysterectomy, the surgeon must choose between laparoscopic hysterectomy,robot-assisted hysterectomy, or abdominal hysterectomy. Experience with robot-assisted hysterectomy is limited at this time; more data are necessary to determine its role in the performance of hysterectomy. The decision to electively perform a salpingoophorectomy should not be influenced by the chosen route of hysterectomy and is not a contraindication to performing a vaginal hysterectomy.

  20. 腹腔镜辅助下阴式全子宫切除术的应用分析%Clinical analysis of laparoscopic assisted vaginal hysterectomy

    Institute of Scientific and Technical Information of China (English)

    关冰

    2012-01-01

    目的 探讨腹腔镜辅助下阴式全子宫切除术(LAVH)的疗效.方法 回顾性分析148例行经腹全子宫切除术(TAH)、69例阴式全子宫切除术(VH)、81 LAVH患者的临床资料,比较分析3组患者的手术时间、术中出血量、术后肛门排气时间、住院费用、住院时间及并发症发生情况.结果 LAVH的术中出血量为(122.0±40.2) mL,少于TAH(P<0.05);术后肛门排气时间和住院时间分别为(21.6±3.8)h、(5.5±1.9)d,短于TAH(P <0.05).LAVH的中转开腹率为0%,低于VH (P<0.05).结论 LAVH集合了TAH和VH的优点,是一种有效的子宫切除术,值得临床推广应用.%Objective To investigate the clinical effectiveness of laparoscopically assisted vaginal hysterectomy ( LAVH). Methods The clinical data of 148 cases of total abdominal hysterectomy (TAH) , 69 cases of vaginal hysterectomy (VH) , 81 cases of LAVH were analyzed retrospectively. The operation time, blood loss, postoperative anus exhaust recover)' time, medical costs, length of stay and incidence of complication were compared in this observation. Results The blood loss, postoperative anus exhaust recovery time, length of stay of LAVH were ( 122. 0 ±40. 2) mL, (21. 6 ±3. 8) h, (5. 5 ± 1. 9) d, and were lower than those of TAH (P < 0. 05). The rate of converted -to -laparoto-my of LAVH was 0% , and was lower than that of VH (P < 0. 05). Conclusions LAVH has the advantages of TAH and VH, is effective hysterectomy.

  1. Intra-operative prostate motion tracking using surface markers for robot-assisted laparoscopic radical prostatectomy

    Science.gov (United States)

    Esteghamatian, Mehdi; Sarkar, Kripasindhu; Pautler, Stephen E.; Chen, Elvis C. S.; Peters, Terry M.

    2012-02-01

    Radical prostatectomy surgery (RP) is the gold standard for treatment of localized prostate cancer (PCa). Recently, emergence of minimally invasive techniques such as Laparoscopic Radical Prostatectomy (LRP) and Robot-Assisted Laparoscopic Radical Prostatectomy (RARP) has improved the outcomes for prostatectomy. However, it remains difficult for the surgeons to make informed decisions regarding resection margins and nerve sparing since the location of the tumor within the organ is not usually visible in a laparoscopic view. While MRI enables visualization of the salient structures and cancer foci, its efficacy in LRP is reduced unless it is fused into a stereoscopic view such that homologous structures overlap. Registration of the MRI image and peri-operative ultrasound image using a tracked probe can potentially be exploited to bring the pre-operative information into alignment with the patient coordinate system during the procedure. While doing so, prostate motion needs to be compensated in real-time to synchronize the stereoscopic view with the pre-operative MRI during the prostatectomy procedure. In this study, a point-based stereoscopic tracking technique is investigated to compensate for rigid prostate motion so that the same motion can be applied to the pre-operative images. This method benefits from stereoscopic tracking of the surface markers implanted over the surface of the prostate phantom. The average target registration error using this approach was 3.25+/-1.43mm.

  2. Robotic-assisted radical prostatectomy learning curve for experienced laparoscopic surgeons: does it really exist?

    Science.gov (United States)

    Tobias-Machado, Marcos; Mitre, Anuar Ibrahim; Rubinstein, Mauricio; da Costa, Eduardo Fernandes; Hidaka, Alexandre Kyoshi

    2016-01-01

    ABSTRACT Background Robotic-assisted radical prostatectomy (RALP) is a minimally invasive procedure that could have a reduced learning curve for unfamiliar laparoscopic surgeon. However, there are no consensuses regarding the impact of previous laparoscopic experience on the learning curve of RALP. We report on a functional and perioperative outcome comparison between our initial 60 cases of RALP and last 60 cases of laparoscopic radical prostatectomy (LRP), performed by three experienced laparoscopic surgeons with a 200+LRP cases experience. Materials and Methods Between January 2010 and September 2013, a total of 60 consecutive patients who have undergone RALP were prospectively evaluated and compared to the last 60 cases of LRP. Data included demographic data, operative duration, blood loss, transfusion rate, positive surgical margins, hospital stay, complications and potency and continence rates. Results The mean operative time and blood loss were higher in RALP (236 versus 153 minutes, p<0.001 and 245.6 versus 202ml p<0.001). Potency rates at 6 months were higher in RALP (70% versus 50% p=0.02). Positive surgical margins were also higher in RALP (31.6% versus 12.5%, p=0.01). Continence rates at 6 months were similar (93.3% versus 89.3% p=0.43). Patient’s age, complication rates and length of hospital stay were similar for both groups. Conclusions Experienced laparoscopic surgeons (ELS) present a learning curve for RALP only demonstrated by longer operative time and clinically insignificant blood loss. Our initial results demonstrated similar perioperative and functional outcomes for both approaches. ELS were able to achieve satisfactory oncological and functional results during the learning curve period for RALP. PMID:27136471

  3. Self-Reported Long-Term Autonomic Function After Laparoscopic Total Mesometrial Resection for Early-Stage Cervical Cancer: A Multicentric Study.

    Science.gov (United States)

    Lucidi, Alessandro; Windemut, Swetlana; Petrillo, Marco; Dessole, Margherita; Sozzi, Giulio; Vercellino, Giuseppe Filiberto; Baessler, Kaven; Vizzielli, Giuseppe; Sehouli, Jalid; Scambia, Giovanni; Chiantera, Vito

    2017-09-01

    This multicentric retrospective study investigates the early and long-term self-reported urinary, bowel, and sexual dysfunctions in early-stage cervical cancer patients who submitted to laparoscopic total mesometrial resection (L-TMMR), total laparoscopic radical hysterectomy, vaginal-assisted laparoscopic radical hysterectomy, and laparoscopic-assisted radical vaginal hysterectomy. Cervical cancer patients, FIGO (International Federation of Gynecology and Obstetrics) stage IA2-IB1/IIA1 who submitted to nerve-sparing radical hysterectomy were recruited. Pelvic functions were assessed within 30 days (early outcome) and 12 months after surgery (long-term outcome). Two hundred thirteen subjects receiving nerve-sparing radical hysterectomy were enrolled. Laparoscopic total mesometrial resection was performed in 46 patients (21.6%), total laparoscopic radical hysterectomy in 65 patients (30.5%), vaginal-assisted laparoscopic radical hysterectomy in 54 patients (25.4%), and laparoscopic-assisted radical vaginal hysterectomy in 48 women (22.5%). Operative time was significantly lower in the L-TMMR group (240 minutes; range, 120-670 minutes; P = 0.001). The overall perioperative complication rate was 11.3%, with no statistically significant differences among the 4 groups. Stress incontinence and sensation of bladder incomplete emptying were detected, respectively, in 54 patients (25.6%) and 65 patients (30.7%) with a significantly lower prevalence among those in the L-TMMR group, which resulted, respectively, in 11.1% (P = 0.022) and 13.3% (P = 0.036). The prevalence rates of constipation, sensation of incomplete bowel emptying, and effort during evacuation were significantly higher among those in the L-TMMR group, resulting in, respectively, 37% (P = 0.001), 42.3% (P = 0.012), and 50% (P = 0.039). One hundred forty-nine patients (70%) were sexually active. Fifty-eight women (38.9%) reported low enjoyment, 83 women (55.7%) medium enjoyment, and 8 women (5.4%) reported high

  4. Comparing lymphadenectomy during radical nephroureterectomy: open versus laparoscopic.

    Science.gov (United States)

    Busby, J Erik; Brown, Gordon A; Matin, Surena F

    2008-03-01

    Laparoscopic nephroureterectomy (LNU) is an accepted treatment for tumors of the ureter and renal pelvis, although the ability to perform a regional lymphadenectomy has been criticized. We compared the quality of lymphadenectomy with LNU with that involving open nephroureterectomy (ONU) to determine whether oncologic principles are maintained. We searched our institutional database for patients who had undergone ONU from 1990 to 2005. These were compared with a series of patients from January 2003 to April 2007 who underwent LNU. From each patient's medical records, we assessed the number of lymph nodes removed, the number of positive nodes removed, and the density of positive nodes. The differences between groups were analyzed using the Wilcoxon rank sum statistical test. We identified 106 patients who underwent ONU with lymphadenectomy and 28 who underwent LNU with lymphadenectomy. The median number of nodes removed, median number of positive nodes, and median density of positive nodes were, respectively, 3, 0, and 0 for the ONU group; and 6, 0, and 0, for the LNU group. There was a statistically significant difference between groups with respect to the number of nodes removed (P = 0.01) but not with respect to the number of positive nodes removed (P = 0.61) or the lymph node density (P = 0.42). Offsetting the benefits of laparoscopy could be a flawed oncologic technique. We have demonstrated that lymphadenectomy, which is a potentially important component of nephroureterectomy, can be performed as well during LNU as it is with ONU when a dedicated effort is made.

  5. Management of low-risk early-stage cervical cancer: Should conization, simple trachelectomy, or simple hysterectomy replace radical surgery as the new standard of care?

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    Ramirez, Pedro T.; Pareja, Rene; Rendón, Gabriel J.; Millan, Carlos; Frumovitz, Michael; Schmeler, Kathleen M.

    2014-01-01

    The standard treatment for women with early-stage cervical cancer (IA2-IB1) remains radical hysterectomy with pelvic lymphadenectomy. In select patients interested in future fertility, the option of radical trachelectomy with pelvic lymphadenectomy is also considered a viable option. The possibility of less radical surgery may be appropriate not only for patients desiring to preserve fertility but also for all patients with low-risk early-stage cervical cancer. Recently, a number of studies have explored less radical surgical options for early-stage cervical cancer, including simple hysterectomy, simple trachelectomy, and cervical conization with or without sentinel lymph node biopsy and pelvic lymph node dissection. Such options may be available for patients with low-risk early-stage cervical cancer. Criteria that define this low-risk group include: squamous carcinoma, adenocarcinoma, or adenosquamous carcinoma, tumor size <2 cm, stromal invasion <10mm, and no lymph-vascular space invasion. In this report, we provide a review of the existing literature on the conservative management of cervical cancer and describe ongoing multi-institutional trials evaluating the role of conservative surgery in selected patients with early-stage cervical cancer. PMID:24041877

  6. Brachytherapy versus radical hysterectomy after external beam chemoradiation: a non-randomized matched comparison in IB2-IIB cervical cancer patients

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    Flores Vladimir

    2009-02-01

    Full Text Available Abstract Background A current paradigm in the treatment of cervical cancer with radiation therapy is that intracavitary brachytherapy is an essential component of radical treatment. This is a matched retrospective comparison of the results of treatment in patients treated with external beam chemoradiation (EBRT-CT and radical hysterectomy versus those treated with identical chemoradiation followed by brachytherapy. Methods In this non-randomized comparison EBRT-CT protocol was the same in both groups of 40 patients. In the standard treated patients, EBRT-CT was followed by one or two intracavitary Cesium (low-dose rate applications within 2 weeks of finishing external radiation to reach a point A dose of at least 85 Gy. In the surgically treated patients, radical hysterectomy with bilateral pelvic lymph node dissection and para-aortic lymph node sampling were performed within 7 weeks after EBRT-CT. Response, toxicity and survival were evaluated. Results A total of 80 patients were analyzed. The patients receiving EBRT-CT and surgery were matched with the standard treated cases. There were no differences in the clinicopathological characteristics between groups or in the delivery of EBRT-CT. The pattern of acute and late toxicity differed. Standard treated patients had more chronic proctitis while the surgically treated had acute complications of surgery and hydronephrosis. At a maximum follow-up of 60 months, median follow-up 26 (2–31 and 22 (3–27 months for the surgery and standard therapy respectively, eight patients per group have recurred and died. The progression free and overall survival are the same in both groups. Conclusion The results of this study suggest that radical hysterectomy can be used after EBRT-CT without compromising survival in FIGO stage IB2-IIB cervical cancer patients in settings were brachytherapy is not available. A randomized study is needed to uncover the value of surgery after EBRT-CT.

  7. The Feasibility of Societal Cost Equivalence between Robotic Hysterectomy and Alternate Hysterectomy Methods for Endometrial Cancer

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    Neel T. Shah

    2011-01-01

    Full Text Available Objectives. We assess whether it is feasible for robotic hysterectomy for endometrial cancer to be less expensive to society than traditional laparoscopic hysterectomy or abdominal hysterectomy. Methods. We performed a retrospective cohort analysis of patient characteristics, operative times, complications, and hospital charges from all (=234 endometrial cancer patients who underwent hysterectomy in 2009 at our hospital. Per patient costs of each hysterectomy method were examined from the societal perspective. Sensitivity analysis and Monte Carlo simulation were performed using a cost-minimization model. Results. 40 (17.1% of hysterectomies for endometrial cancer were robotic, 91 (38.9%, were abdominal, and 103 (44.0% were laparoscopic. 96.3% of the variation in operative cost between patients was predicted by operative time (=0.963, <0.01. Mean operative time for robotic hysterectomy was significantly longer than other methods (<0.01. Abdominal hysterectomy was consistently the most expensive while the traditional laparoscopic approach was consistently least expensive. The threshold in operative time that makes robotic hysterectomy cost equivalent to the abdominal approach is within the range of our experience. Conclusion. It is feasible for robotic hysterectomy to be less expensive than abdominal hysterectomy, but unlikely for robotic hysterectomy to be less expensive than traditional laparoscopy.

  8. Clinical Behaviors and Outcomes for Adenocarcinoma or Adenosquamous Carcinoma of Cervix Treated by Radical Hysterectomy and Adjuvant Radiotherapy or Chemoradiotherapy

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    Huang, Yi-Ting; Wang, Chun-Chieh; Tsai, Chien-Sheng [Department of Radiation Oncology, Chang Gung Memorial Hospital, Lin-Kou, Chang Gung University, Taoyuan, Taiwan (China); Department of Medical Imaging and Radiological Science, Chang Gung University, Taoyuan, Taiwan (China); Lai, Chyong-Huey; Chang, Ting-Chang; Chou, Hung-Hsueh [Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Lin-Kou, Chang Gung University, Taoyuan, Taiwan (China); Lee, Steve P. [Department of Radiation Oncology, University of California, Los Angeles School of Medicine, Los Angeles, CA (United States); Hong, Ji-Hong, E-mail: jihong@adm.cgmh.org.tw [Department of Radiation Oncology, Chang Gung Memorial Hospital, Lin-Kou, Chang Gung University, Taoyuan, Taiwan (China); Department of Medical Imaging and Radiological Science, Chang Gung University, Taoyuan, Taiwan (China)

    2012-10-01

    Purpose: To compare clinical behaviors and treatment outcomes between patients with squamous cell carcinoma (SCC) and adenocarcinoma/adenosquamous carcinoma (AC/ASC) of the cervix treated with radical hysterectomy (RH) and adjuvant radiotherapy (RT) or concurrent chemoradiotherapy (CCRT). Methods and Materials: A total of 318 Stage IB-IIB cervical cancer patients, 202 (63.5%) with SCC and 116 (36.5%) with AC/ASC, treated by RH and adjuvant RT/CCRT, were included. The indications for RT/CCRT were deep stromal invasion, positive resection margin, parametrial invasion, or lymph node (LN) metastasis. Postoperative CCRT was administered in 65 SCC patients (32%) and 80 AC/ASC patients (69%). Patients with presence of parametrial invasion or LN metastasis were stratified into a high-risk group, and the rest into an intermediate-risk group. The patterns of failure and factors influencing survival were evaluated. Results: The treatment failed in 39 SCC patients (19.3%) and 39 AC/ASC patients (33.6%). The 5-year relapse-free survival rates for SCC and AC/ASC patients were 83.4% and 66.5%, respectively (p = 0.000). Distant metastasis was the major failure pattern in both groups. After multivariate analysis, prognostic factors for local recurrence included younger age, parametrial invasion, AC/ASC histology, and positive resection margin; for distant recurrence they included parametrial invasion, LN metastasis, and AC/ASC histology. Compared with SCC patients, those with AC/ASC had higher local relapse rates for the intermediate-risk group but a higher distant metastasis rate for the high-risk group. Postoperative CCRT tended to improve survival for intermediate-risk but not for high-risk AC/ASC patients. Conclusions: Adenocarcinoma/adenosquamous carcinoma is an independent prognostic factor for cervical cancer patients treated by RH and postoperative RT. Concurrent chemoradiotherapy could improve survival for intermediate-risk, but not necessarily high-risk, AC/ASC patients.

  9. [Impact of obesity on laparoscopic-assisted radical gastrectomy for gastric cancer].

    Science.gov (United States)

    Chen, Jian-xin; Huang, Chang-ming; Zheng, Chao-hui; Li, Ping; Xie, Jian-wei; Wang, Jia-bin; Lin, Jian-xian

    2011-10-01

    To study the impact of obesity on the short-term outcomes after laparoscopic-assisted radical gastrectomy. A total of 531 gastric cancer patients underwent radical resection at the Fujian Medical University Union Hospital between May 2007 and June 2010. There were 83 patients with BMI ≥ 25 kg/m(2) (obese group) and 448 patients with BMIobese group). Intraoperative and postoperative parameters, and short-term survival rates between the two groups were compared. There was no significant difference between obese and non-obese patients in terms of conversion rate (2.4% vs. 1.8%, P>0.05). The operative time in obese group was (224.7 ± 57.3) min, which was significantly longer than that in non-obese group [(210.0 ± 57.9) min, Pobese and non-obese groups in terms of blood loss, blood transfusion rate, elevated leukocyte and granulocyte count on the first postoperative day, time to temperature recovery, first flatus, and postoperative hospital stays(P>0.05). The mean number of retrieved lymph nodes in obese group was (24.8 ± 8.4), and was significantly less than that of non-obese group[(29.9 ± 10.2), Pobese and non-obese groups in postoperative complication rate (16.8% vs. 10.2%, P>0.05), postoperative mortality(1.2% vs. 0.4%, P>0.05), and 3-year overall survival (68.8% vs. 74.0%, P>0.05). Obesity is associated with prolonged operative time for laparoscopic radical gastrectomy. However, the short-term outcomes after the laparoscopic radical gastrectomy is not influenced by obesity.

  10. Robotic-assisted laparoscopic radical cystectomy: surgical and oncological outcomes

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    Adrian Treiyer

    2012-06-01

    Full Text Available PURPOSE:Our first 91 consecutive cases undergoing a robotic assisted cystectomy were analyzed regarding perioperative outcomes, pathological stages and surgical complications. MATERIALS AND METHODS: Between 2007 and 2010 a total of 91 patients (76 male and 15 female, 86 with clinically localized bladder cancer and 5 with non-urothelial tumors underwent a radical robotic assisted cystectomy. We analyzed the perioperative factors, length of hospital stay, pathological outcomes and complication rates. RESULTS: Mean age was 65.6 years (range 28 to 82. Among the 91 patients, 68 were submitted to an ileal conduit and 23 to a neobladder procedure for urinary diversion. Mean operating time was 412 min (range: 243-618 min. and mean blood loss was 294 mL (range: 50-2000 mL. In 29% of the cases with urothelial carcinoma the T-stage was pT1 or less, 38% were pT2; 26% and 7% were classified as pT3 and pT4, respectively. 14% of cases had lymph node positive disease. Mean number of lymph nodes removed was 15 (range 4 to 33. Positive surgical margins occurred in 2 cases (2.1%. Mean days to flatus were 2.13, bowel movement 2.88 and inpatient stay 18.8 (range: 10-33. There were 45 postoperative complications with 11% major (Clavien grade 3 or higher. At a mean follow-up of 15 months 10 patients had disease recurrence and 6 died of the disease. CONCLUSIONS: Our experience demonstrates that robotic assisted radical cystectomies for the treatment of bladder cancers seems to be very promising regarding surgical and oncological outcomes.

  11. Radical hysterectomy in surgical treatment of invasive cervical cancer at the Department of gynecology and obstetrics in Novi Sad in the period 1993-2013.

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    Đurđević Srđan

    2015-01-01

    Full Text Available Introduction. During the period from 1993 - 2013, 175 women with invasive cervical cancer underwent radical hysterectomy sec. Wertheim-Meigs at the Department of Gynecology and Obstetrics, Clinical Center of Vojvodina in Novi Sad. Indications for radical hysterectomy comprise histopathologically confirmed invasive cervical cancer in stages I B 1 - II B according to the International Federation of Gynecology and Obstetrics. Material and Methods. Stage of the disease or extent of the disease spread to the adjacent structures was assessed in accordance with the International Federation of Gynecology and Obstetrics staging system from 2009. Exclusion criteria were all other stages of this disease: I A and stages higher than II B, as well as the absence of definite histological confirmation of the cervical cancer (primary endometrial or vaginal cancer which infiltrates the uterine cervix. Prior the operation, the following had to be done: the imaging of pelvis and abdomen, chest X-ray in two directions, electrocardiography, internist and anesthesiological examination. Results. The patients’ age ranged from 24-79 years (x : 46 years, and the operation duration was 120-300 minutes (x : 210 min.. Stage I B 1 was found in 64.6% of operated patients, 14.8% of the patients were in stage I B 2, 9.1% were in stage II A and 11.4 % were in stage II B. Blood loss during the operation ranged from 50-800 ml (on average 300 ml, and the number of removed lymph nodes per operation was 14-75 (x : 32. Intraoperative and postoperative complications developed in 6.8% of and 17.7% of patients, respectively. Recurrence was reported in 22 (12.5% patients, most often in paraaortic lymph nodes (3.4% and parametria (2.8%, while the overall 5-year survival rate was 87% until 2008. Concluision. Wertheim-Meigs radical hysterectomy is a basic surgical technique for the treatment of initial stages of invasive cervical cancer.

  12. Total pelvic floor reconstruction during non-nerve-sparing laparoscopic radical prostatectomy: impact on early recovery of urinary continence.

    Science.gov (United States)

    Hoshi, Akio; Nitta, Masahiro; Shimizu, Yuuki; Higure, Taro; Kawakami, Masayoshi; Nakajima, Nobuyuki; Hanai, Kazuya; Nomoto, Takeshi; Usui, Yukio; Terachi, Toshiro

    2014-11-01

    To develop a modified technique of "total pelvic floor reconstruction" during non-nerve-sparing laparoscopic radical prostatectomy, and to determine its effect on postoperative urinary outcomes. A total of 128 patients who underwent non-nerve-sparing laparoscopic radical prostatectomy were evaluated, including 81 with total pelvic floor reconstruction and 47 with non-total pelvic floor reconstruction. Nerve-sparing cases were excluded. Urinary outcomes were assessed with self-administrated questionnaires (Expanded Prostate Cancer Index Composite) at 1, 3, 6 and 12 months after laparoscopic radical prostatectomy. The total pelvic floor reconstruction technique included two concepts involving posterior and anterior reconstructions. In posterior reconstruction, Denonvilliers' fascia was approximated to the bladder neck and the median dorsal raphe by slipknot. The anterior surface of the bladder-neck was approximated to the anterior detrusor apron and the puboprostatic ligament collar for anterior reconstruction. There were no significant differences between the two groups in the patients' characteristics, and in perioperative and oncological outcomes. In the total pelvic floor reconstruction group, the continence rates at 3, 6 and 12 months after laparoscopic radical prostatectomy were 45.7%, 71.4%, and 84.6%, respectively. In the non-total pelvic floor reconstruction group, the continence rates were 26.1%, 46.8% and 60.9%, respectively. The total pelvic floor reconstruction technique resulted in significantly higher continence rates at 3, 6 and 12 months after laparoscopic radical prostatectomy, respectively (all P floor reconstruction group (mean 7.7 months) than in the non-total pelvic floor reconstruction group (mean 9.8 months; P = 0.0003). The total pelvic floor reconstruction technique allows preservation of the blood supply to the urethra and physical reinforcement of the pelvic floor. Therefore, this technique is likely to improve urinary continence

  13. Robotic-assisted laparoscopic hysterectomy for women with endometrial cancer - complications, women´s experiences, quality of life and a health economic evaluation.

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    Herling, Suzanne Forsyth

    2016-07-01

    This thesis contains four studies all focusing on women with endometrial cancer undergoing robotic-assisted laparoscopic hysterectomy (RALH). Women with endometrial cancer are typically elderly with co-morbidities. RALH is a relatively new treatment option which has been introduced and adopted over the last decade without randomised controlled trials (RCTs) to prove superiority over other surgical alternatives. The purpose of the thesis was to explore and describe patient and health economic outcomes of RALH for women with endometrial cancer using different research approaches. The first study was a retrospective descriptive cohort study with 235 women. The aim was to explore types and incidence of post-operative complications within 12 months after RALH reported with the Clavien-Dindo scale. We found that 6% had severe complications and that women with lymphadenectomy did not have an increased rate of complications. Urinary tract and port site infections were the most frequent complications. The second study was a qualitative interview study where we explored the experience of undergoing RALH. Using content analysis, we analysed semi-structured interviews with 12 women who had undergone RALH on average 12 weeks earlier. The women were positive towards the robotic approach and felt recovered shortly after. They expressed uncertainty with the normal course of bleeding and bowel movement post-operatively as well as with the new anatomy. The third study was an economic evaluation; an activity-based costing study including 360 women comparing total abdominal hysterectomy (TAH) to RALH. This study showed that for women with endometrial cancer, RALH was cheaper compared to TAH, mainly due to fewer complications and shorter length of stay (LOS) that counterbalanced the higher robotic expenses. When including all cost drivers the analysis showed that the RALH procedure was more than 9.000 Danish kroner (DKK) cheaper than the TAH. Increased age and Type 2 diabetes appeared

  14. On the measurement of recovery following hysterectomy

    NARCIS (Netherlands)

    Kluivers, K.B.

    2007-01-01

    Hysterectomy is the most frequently performed major gynaecologic surgical procedure, with millions of procedures performed annually throughout the world. Hysterectomy can be performed by a vaginal, abdominal or laparoscopic approach, and there is an overlap in indications for either choice. In gener

  15. Use of vaginal hysterectomy in Denmark

    DEFF Research Database (Denmark)

    Nielsen, Sidsel Lykke; Daugbjerg, Signe B; Gimbel, Helga

    2011-01-01

    To describe the use of vaginal, abdominal and laparoscopic hysterectomy in Denmark from 1999 to 2008, the influence of national guidelines and the patient and procedure-related characteristics associated with the choice of vaginal hysterectomy. Design. Nationwide register-based cohort study....

  16. The influence of number of high risk factors on clinical outcomes in patients with early-stage cervical cancer after radical hysterectomy and adjuvant chemoradiation

    Science.gov (United States)

    Lim, Soyi; Lee, Seok-Ho; Park, Chan-Yong

    2016-01-01

    Objective The purpose of this study was to evaluate the prognosis according to the number of high risk factors in patients with high risk factors after radical hysterectomy and adjuvant chemoradiation therapy for early stage cervical cancer. Methods Clinicopathological variables and clinical outcomes of patients with FIGO (International Federation of Gynecology and Obstetrics) stage IB1 to IIA cervical cancer who had one or more high risk factors after radical hysterectomy and adjuvant chemoradiation therapy were retrospectively analyzed. Patients were divided into two groups according to the number of high risk factors (group 1, single high risk factor; group 2, two or more high risk factors). Results A total of 93 patients were enrolled in the present study. Forty nine out of 93 (52.7%) patients had a single high risk factor, and 44 (47.3%) had two or more high risk factors. Statistically significant differences in stage and stromal invasion were observed between group 1 and group 2. However, age, histology, tumor size, and lymphovascular space invasion did not differ significantly between the groups. Distant recurrence occurred more frequently in group 2, and the probability of recurrence and death was higher in group 2. Conclusion Patients with two or more high risk factors had worse prognosis in early stage cervical cancer. For these patients, consideration of new strategies to improve survival may be worthwhile. Conduct of further clinical trials is warranted for development of adjuvant treatment strategies individualized to each risk group. PMID:27200308

  17. Pure laparoscopic radical heminephrectomy for a large renal-cell carcinoma in a horseshoe kidney.

    Science.gov (United States)

    Rebouças, Rafael B; Monteiro, Rodrigo C; Souza, Thiago N; Barbosa, Paulyana F; Pereira, George G; Britto, Cesar A

    2013-01-01

    Horseshoe Kidneys are the most common renal fusion anomaly. When surgery is contemplated for renal-cell carcinoma in such kidneys, aberrant vasculature and isthmusectomy are the major issues to consider. We describe a case of a pure laparoscopic radical heminephrectomy with hand-sewn management of the isthmus for a 11 cm tumour in a horseshoe kidney. A 47-year-old man complaining of palpable left flank mass for two months. Magnetic resonance of the abdomen revealed a 11 cm renal mass arising from the left moiety of an incidentally discovered horseshoe kidney. Preoperative CT angiography revealed a dominant anterior renal artery feeding the upper and midpole, with two other arteries feeding the lower pole and isthmus. The patient was placed in a modified flank position. A four-port transperitoneal technique was used, the colon was reflected. Renal pedicle was dissected and the renal arteries and renal vein were secured with polymer clips. The kidney was fully mobilized and a Satinsky clamp was placed on the isthmus for its division. A running 2-0 vicryl hand-sewn was used for parenchyma hemostasis. The specimen was extracted intact in a plastic bag through an inguinal incision. The operative time was 220 minutes, and the estimated blood loss was 200 mL. There were no immediate or delayed complications. The patient resumed oral intake on postoperative day 1 and was discharged on postoperative day 2. Pathologic examination of the specimen confirmed a 11 cm organ-confined chromophobe renal-cell carcinoma, with negative margins. Laparoscopic oncologic surgery in patients with horseshoe kidneys can be technically challenging. The presence of a large cancer in a horseshoe kidney should not preclude a purely laparoscopic approach. With the aid of a Satinsky clamp, the isthmus can be sharply divided and sutured in a fashion similar to the open technique. To our knowledge, this report represents the largest cancer (11 cm) removed laparoscopically in the context of a

  18. Robotics and telesurgery--an update on their position in laparoscopic radical prostatectomy.

    Science.gov (United States)

    Rassweiler, J; Safi, K C; Subotic, S; Teber, D; Frede, T

    2005-01-01

    Laparoscopy is handicapped by the reduction of the range of motion from six to only four degrees of freedom. In complicated cases (i.e. radical prostatectomy), there is often a crossing of the hands of surgeon and assistant. Finally, standard laparoscopes allow only 2D-vision. This has a major impact on technically difficult reconstructive procedures such as laparoscopic radical prostatectomy. Solutions include the understanding of the geometry of laparoscopy, but also newly developed surgical robots. During the last five years, there has been an increasing development and experience with robotics in urology. This article reviews the actual results focussing on the benefits and problems of robotics in laparoscopic radical prostatectomy. Own experiences with robot-assisted surgery include more than 1200 laparoscopic radical prostatectomies using a voice-controlled camera-arm (AESOP) as well as six telesurgical interventions with the da Vinci-system. Substantial experimental studies have been performed focussing on the geometry of laparoscopy and new training concepts such as perfused pelvitrainers and models for simulation of urethrovesical anastomosis. The recent literature on robotics in urology has been reviewed based on a MEDLINE/PUBMED research. The geometry of laparoscopy includes the angles between the instruments which have to be in a range of 25 degrees to 45 degrees ; the angles between the instrument and the working plane that should not exceed 55 degrees ; and the bi-planar angle between the shaft of the needle holder and the needle which has to be adapted according to the anatomical situation in range of 90 degrees to 110 degrees . 3-D-systems have not yet proved to be effective due to handling problems such as shutter glasses, video helmets or reduced brightness. At the moment, there are only two robotic surgical systems (AESOP, da Vinci) in clinical use, of which only the da Vinci provides stereovision and all six degrees of freedom (DOF). To date

  19. Laparoscopic radical nephrectomy versus open radical nephrectomy in T1-T3 renal tumors: An outcome analysis

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    Arvind P Ganpule

    2008-01-01

    Full Text Available Aims: To compare laparoscopic radical nephrectomy (LRN with open radical nephrectomy (ORN in T1-T3 renal lesions. Materials and Methods: The records of 65 patients who underwent LRN between January 2002 and December 2006 were entered prospectively in a database. The patients were compared with 56 patients who had undergone ORN between January 2000 and December 2005. The two groups were comparable in terms of age, body mass index (BMI and tumor size. LRN was compared with ORN in terms of operative room time, blood loss, complications , analgesic requirement, hospital stay and start of oral intake. The oncologic efficacy was evaluated in stages T1 and T2 in terms of cancer-free and overall survival. Results: The laparoscopy group had a significantly shorter hospital stay (5.72, range 3-23 days vs. 9.18, range 4-23 days, p value: < 0.0001, analgesia requirement (175.65, range 50-550 mg vs. 236, range 0-1100 mg of tramadol, p value: < 0.03, hemoglobin decline (1.55, range 0.1 to 4.4 mg/dl vs. 2.25, range 0.2 - 7 mg/dL, p value: < 0.001 and hematocrit drop (4.83, range 0.3 - 12.9 vs. 7.06 range 2 -18, p value: < 0.0001. The majority of specimens showed renal cell carcinoma. In the laparoscopy group, 29 tumors were T1 stage, 18 were T2, while eight were T3. In the open surgery group, 25 tumors were T1, 19 were T2 and 12 were T3. The cancer-free survival rate at 24 months for ORN and LRN in T1 lesions was 91.7% and 93.15% respectively and the patient survival rate was 100% in both groups. The cancer-free survival rate at 24 months for ORN and LRN in T2 lesions was 88.9% and 94.1%, respectively and the patient survival was 100% and 94%, respectively. After LRN, there was one instance of port site metastasis, local recurrence and distant metastasis. All recurrences were distant after ORN. Conclusion: Laparoscopic radical nephrectomy has advantages in terms of shorter hospitalization and a lower analgesia requirement. It is feasible and produces effective

  20. Comparison of Clinical Effects Between Vaginal Hysterectomy and Laparoscopically Assisted Vaginal Hysterectomy%阴式子宫切除术与腹腔镜辅助阴式子宫切除术的术式比较

    Institute of Scientific and Technical Information of China (English)

    鲁春雁

    2011-01-01

    Objective To evaluate clinical effects between vaginal hysterectomy (TVH) and laparoscopic assisted vaginal hysterectomy (LAVH). Methods From January to December 2010, a total of 86 patients with TVH (TVH group) and 92 patients with LAVH (LAVH group) were recruited into this study. Their clinical data before and after the operation were statistically analyzed. The study protocol was approved by the Ethical Review Board of Investigation in Human Being of Luoyang No. 3 People s Hospital. Informed consent was obtained from all participants. There were no statistical difference on pelvic operation history, gravidity, parity, anemia during pregnancy, and hysterauxesis (P^>0. 05). Results The operation time, blood loss volume and operation cost of TVH group was shorter, less, and lower than those of LAVH group (P 0. 05). None of serious complication was occurred. Conclusion Compared with LAVH, TVH has the advantage of shorter operative time, less blood loss and lower cost, but it is more adapted to whom the uterus is in 4-month pregnancy and without pelvic adhesions. LAVH expanded TVH s adaptation. We should choose appropriate way according to different clinical conditions for the best therapeutic effects.%目的 探讨阴式子宫切除术(TVH)和腹腔镜辅助阴式子宫切除术(LAVH)的临床效果及应用价值.方法 回顾性分析2007年1月至2010年12月在本院行TVH的86例患者(TVH组)与同期行LAVH的92例患者(LAVH组)的临床资料,对两组患者术中、术后情况进行统计学分析(本研究遵循的程序符合本院人体试验委员会制定的伦理学标准,得到该委员会批准,并与其签署临床研究知情同意书).两组患者既往盆腔手术史、孕次、产次,合并贫血及子宫增大(相应孕周)情况比较,差异无统计学意义(P>0.05).结果 TVH组患者手术时间、术中出血量及手术费用均较LAVH组短、少和低,两组比较,差异有统计学意义(P0.05).所有患者无一例中转开腹及

  1. Laparoscopic radical nephrectomy with inferior vena cava thrombectomy: highlight of key surgical steps

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    A. Sim

    Full Text Available ABSTRACT Objective: Vascular involvement in the form of renal vein (RV or inferior vena cava (IVC thrombus can be seen in 4-10% of patients presented with RCC. In patients without presence of metastasis, surgical treatment in the form of radical nephrectomy remains the treatment of choice with 5-year survival rates of 45-70%. Open surgery is still the first treatment option of choice at the moment for RCC patients with IVC thrombus. Materials and Methods: In our study, we are reporting a case of patient with RCC and level I IVC thrombus treated with laparoscopy. Our patient is a 72 years old man with underlying co-morbidity of hypertension and chronic kidney disease (CKD presented with right-sided RCC. The CT scan done showed a large right renal upper pole tumor measuring 8.4x5.2cm with level I IVC thrombus (Figure-1. There were no regional lymphadenopathy and the staging scans were negative. Results: The operative time was 124 minutes and blood loss was minimal. The patient was progressed to diet on POD 1 with bowel movement on POD 2. There was no significant change in the pre and post-operative glomerular filtration rate (GFR. The surgical drain was removed on POD2. The patient was discharged well on POD 5. There were no perioperative complications. The pathology was pT3bN0M0 Fuhrman grade II clear cell RCC. Conclusions: As a conclusion, laparoscopic radical nephrectomy and IVC thrombectomy is a complex and technically demanding surgery. With advancement of surgical skills as well as technology, more cases of minimally invasive laparoscopic radical nephrectomy and IVC thrombectomy can performed to improve the perioperative outcomes of carefully selected patients in a high volume center.

  2. Robotically assisted total laparoscopic radical trachelectomy for fertility sparing in stage IB1 adenosarcoma of the cervix.

    Science.gov (United States)

    Geisler, John P; Orr, Curtis J; Manahan, Kelly J

    2008-10-01

    Adenosarcomas are rare cervical tumors with unknown optimal treatment, which often affects young women. A 23-year-old woman was found to have a stage IB1 adenosarcoma of the cervix. She underwent a robotically assisted total laparoscopic radical trachelectomy with the placement of abdominal cerclage for the sparing of fertility.

  3. Robotic-assisted hysterectomy: patient selection and perspectives

    Directory of Open Access Journals (Sweden)

    Smorgick N

    2017-03-01

    Full Text Available Noam Smorgick Departments of Obstetrics and Gynecology, Assaf Harofe Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel Abstract: Minimally invasive hysterectomy via the laparoscopic or vaginal approach is beneficial to patients when compared with laparotomy, but has not been offered in the past to all women because of the technical difficulties and the long learning curve required for laparoscopic hysterectomy. Robotic-assisted hysterectomy for benign indications may allow for a shorter learning curve but does not offer clear advantages over conventional laparoscopic hysterectomy in terms of surgical outcomes. In addition, robotic hysterectomy is invariably associated with increased costs. Nevertheless, this surgical approach has been widely adopted by gynecologic surgeons. The aim of this review is to describe specific indications and patients who may benefit from robotic-assisted hysterectomy. These include hysterectomy for benign conditions in cases with high surgical complexity (such as pelvic adhesive disease and endometriosis, hysterectomy and lymphadenectomy for treatment of endometrial carcinoma, and obese patients. In the future, additional evidence regarding the benefits of single-site robotic hysterectomy may further modify the indications for robotic-assisted hysterectomy. Keywords: robotic-assisted hysterectomy, single-site laparoscopy, minimally invasive hysterectomy

  4. Pentafecta rates of three-dimensional laparoscopic radical prostatectomy: our experience after 150 cases.

    Science.gov (United States)

    Benelli, Andrea; Varca, Virginia; Simonato, Alchiede; Terrone, Carlo; Gregori, Andrea

    2017-04-28

    Three-dimensional (3D) laparoscopy with a flexible camera was developed to overcome the main limitation of traditional laparoscopic surgery, which is two-dimensional (2D) vision.The aim of our article is to present the largest casistic of 3D laparoscopic radical prostatectomy (LRP) available in literature and evaluate our results in terms of pentafecta and compare it with the literature. We retrospectively evaluated consecutive patients who underwent LRP with 3D technology between March 2014 and December 2015. Total operative time (TOT), anasthomosis time (AT), blood loss and complications were registered. All patients presented at least 3 months of follow-up. Surgical outcome was evaluated in terms of Pentafecta. One hundred fifty consecutive patients underwent 3D LRP. Mean follow-up was 16.9 months. Mean age was 67.7 ± 8.3 years (range 50-76). Mean preoperative PSA value was 8.3 ± 5.8 ng/ml and mean bioptic Gleason Score (GS) was 6.6. We had a mean TOT of 158 ± 23 minutes and a mean AT of 25 ± 12.6. Mean blood loss was 240 ± 40 ml. Eighteen (12%) postoperative complications occurred. Pathologic results: pT2 in 91 patients (58%) and pT3 in 59 (39.3%). Pentafecta was reached by 31.3% of patients at 3 months and 51.6% at 12 months. Our oncological and functional results are comparable to those present in literature for laparoscopic and robotic surgery. We believe that our findings can encourage the use of 3D laparoscopy especially considering the increasing attention to healthcare costs.

  5. Health care cost consequences of using robot technology for hysterectomy: a register-based study of consecutive patients during 2006-2013.

    Science.gov (United States)

    Laursen, Karin Rosenkilde; Hyldgård, Vibe Bolvig; Jensen, Pernille Tine; Søgaard, Rikke

    2017-07-10

    The objective of this study is to examine the costs attributable to robotic-assisted laparoscopic hysterectomy from a broad healthcare sector perspective in a register-based longitudinal study. The population in this study were 7670 consecutive women undergoing hysterectomy between January 2006 and August 2013 in public hospitals in Denmark. The interventions in the study were total and radical hysterectomy performed robotic-assisted laparoscopic hysterectomy (RALH), total laparoscopic hysterectomy (TLH), or open abdominal hysterectomy (OAH). Service use in the healthcare sector was evaluated 1 year before to 1 year after the surgery. Tariffs of the activity-based remuneration system and the diagnosis-related grouping case-mix system were used for valuation of primary and secondary care, respectively. Costs attributable to RALH were estimated using a difference-in-difference analytical approach and adjusted using multivariate linear regression. The main outcome measure was costs attributable to OAH, TLH, and RALH. For benign conditions RALH generated cost savings of € 2460 (95% CI 845; 4075) per patient compared to OAH and non-significant cost savings of € 1045 (95% CI -200; 2291) when compared with TLH. In cancer patients RALH generated cost savings of 3445 (95% CI 415; 6474) per patient when compared to OAH and increased costs of € 3345 (95% CI 2348; 4342) when compared to TLH. In cancer patients undergoing radical hysterectomy, RALH generated non-significant extra costs compared to OAH. Cost consequences were primarily due to differences in the use of inpatient service. There is a cost argument for using robot technology in patients with benign disease. In patients with malignant disease, the cost argument is dependent on comparator.

  6. Nerve sparing can preserve orgasmic function in most men after robotic-assisted laparoscopic radical prostatectomy.

    Science.gov (United States)

    Tewari, Ashutosh; Grover, Sonal; Sooriakumaran, Prasanna; Srivastava, Abhishek; Rao, Sandhya; Gupta, Amit; Gray, Robert; Leung, Robert; Paduch, Darius A

    2012-02-01

    •  To investigate orgasmic outcomes in patients undergoing robotic-assisted laparoscopic radical prostatectomy (RALP) and the effects of age and nerve sparing on these outcomes. •  Between January 2005 and June 2007, 708 patients underwent RALP at our institution. •  We analysed postoperative potency and orgasmic outcomes in the 408 men, of the 708, who were potent, able to achieve orgasm preoperatively and available for follow-up. •  Of men aged ≤60 years, 88.4% (198/224) were able to achieve orgasm postoperatively in comparison to 82.6% (152/184) of older men (P function after RALP. •  Men ≤60 years old and those who undergo BNS are most likely to maintain normal sexual function. © 2011 THE AUTHORS. BJU INTERNATIONAL © 2011 BJU INTERNATIONAL.

  7. Oncological outcomes of laparoscopic radical nephrectomy for renal cancer Resultados oncológicos da nefrectomia radical laparoscópica no tratamento do carcinoma renal

    Directory of Open Access Journals (Sweden)

    Jose R. Colombo Jr.

    2007-01-01

    Full Text Available PURPOSE: To report the 5-year oncological outcomes of patients undergoing laparoscopic radical nephrectomy for renal cancer compared to a cohort of patients undergoing open radical nephrectomy. METHODS: We retrospectively analyzed the data of 88 patients undergoing radical nephrectomy for renal cell carcinoma prior to January 2000. Of these, 45 patients underwent laparoscopic radical nephrectomy, and 43 patients underwent open radical nephrectomy. Inclusion criteria comprised clinically organ-confined tumors of 15 cm or less in size without concomitant lymphadenopathy or vena cava thrombus. Oncological follow-up data were obtained from charts, radiological reports, and phone calls to patients or their families, and were calculated from the date of surgery to the date of last appointment with physician or date of death. RESULTS: All laparoscopic procedures were completed without open conversion. On comparing the laparoscopic radical nephrectomy and open radical nephrectomy groups, mean tumor size was 5. 8 vs 6.2 cm (P = . 44, mean blood loss was 183 vs 461 mL (P = . 004, and mean operative time was 2.8 vs 3.7 hrs (P OBJETIVO: Relatar os resultados oncológicos após 5 anos de seguimento em pacientes submetidos a nefrectomia radical laparoscópica para tratamento do câncer renal, comparando esses com os resultados obtidos com um grupo de pacientes submetidos a nefrectomia radical aberta. MÉTODOS: Foram analisadas retrospectivamente as informações obtidas de 88 pacientes submetidos a nefrectomia radical para o tratamento do carcinoma renal realizadas previamente a Janeiro de 2000. Destes pacientes, 45 foram tratados com nefrectomia radical laparoscópica e 43 com nefrectomia radical aberta. Foram incluídos pacientes com tumores localizados com tamanho máximo de 15 cm, sem adenopatia ou sinal de envolvimento de veia renal na avaliação radiologica pré-operatória. As informações sobre o seguimento dos pacientes foram obtidas a partir de

  8. Impact of obesity on outcomes of hysterectomy.

    Science.gov (United States)

    McMahon, Megan D; Scott, Dana Marie; Saks, Erin; Tower, Amanda; Raker, Christina A; Matteson, Kristen A

    2014-01-01

    To evaluate the impact of obesity on complications of hysterectomy. Retrospective cohort study (Canadian Task Force II-2). The Department of Obstetrics and Gynecology, Women and Infants Hospital of Rhode Island, Providence, RI. Patients who had a hysterectomy at WIH between July 2006 and January 2009. Hysterectomy by any mode. We collected data from medical records of all laparoscopic hysterectomies during the time period and collected data from a random subset of abdominal and vaginal hysterectomies. The independent variable, body mass index, was grouped according to World Health Organization guidelines. A composite of surgical complications was generated. Multivariable logistic regression was used to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs). We collected data from 907 hysterectomies, and 29.9% (n = 267) of the population was obese. Eighteen percent of patients (n = 154) had at least 1 complication. Compared to non-obese women, obese women were at increased odds of having any complication (OR 1.62, 95% CI 1.12-2-34). Performing subgroup analyses by mode of hysterectomy and controlling for confounding factors, we were unable to detect differences odds of complications between obese and non-obese women who underwent either an abdominal, vaginal, or laparoscopic hysterectomy. In our study, we found that among women who had a hysterectomy, obese women had a higher rate of complications than nonobese women. Copyright © 2014 AAGL. Published by Elsevier Inc. All rights reserved.

  9. Pure Laparoscopic Radical Heminephrectomy for a Large Renal-Cell Carcinoma in a Horseshoe Kidney

    Directory of Open Access Journals (Sweden)

    Rafael B Reboucas

    2013-07-01

    Full Text Available Introduction Horseshoe Kidneys are the most common renal fusion anomaly. When surgery is contemplated for renal-cell carcinoma in such kidneys, aberrant vasculature and isthmusectomy are the major issues to consider. We describe a case of a pure laparoscopic radical heminephrectomy with hand-sewn management of the isthmus for a 11 cm tumour in a horseshoe kidney. Presentation A 47-year-old man complaining of palpable left flank mass for two months. Magnetic resonance of the abdomen revealed a 11 cm renal mass arising from the left moiety of an incidentally discovered horseshoe kidney. Preoperative CT angiography revealed a dominant anterior renal artery feeding the upper and midpole, with two other arteries feeding the lower pole and isthmus. The patient was placed in a modified flank position. A four-port transperitoneal technique was used, the colon was reflected. Renal pedicle was dissected and the renal arteries and renal vein were secured with polymer clips. The kidney was fully mobilized and a Satinsky clamp was placed on the isthmus for its division. A running 2-0 vicryl hand-sewn was used for parenchyma hemostasis. The specimen was extracted intact in a plastic bag through an inguinal incision. Results The operative time was 220 minutes, and the estimated blood loss was 200 mL. There were no immediate or delayed complications. The patient resumed oral intake on postoperative day 1 and was discharged on postoperative day 2. Pathologic examination of the specimen confirmed a 11 cm organ-confined chromophobe renal-cell carcinoma, with negative margins. Discussion Laparoscopic oncologic surgery in patients with horseshoe kidneys can be technically challenging. The presence of a large cancer in a horseshoe kidney should not preclude a purely laparoscopic approach. With the aid of a Satinsky clamp, the isthmus can be sharply divided and sutured in a fashion similar to the open technique. To our knowledge, this report represents the largest

  10. A robotic needle driver to facilitate vescico-urethral anastomosis during laparoscopic radical prostatectomy.

    Science.gov (United States)

    Varca, Virginia; Benelli, Andrea; Pietrantuono, Francesco; Suardi, Nazareno; Gregori, Andrea; Gaboardi, Franco

    2017-06-19

    The completion of the vescico-urethral anastomosis (VUA) represents the most critical step of laparoscopic radical prostatectomy (LRP), and it can often discourage the use of minimally invasive surgery in less experienced laparoscopic surgeons. The aim of this paper is to evaluate the usefulness of a new robotic needle driver named Dextérité in performing the VUA after LRP. This prospective randomized clinical study enrolled 40 consecutive patients eligible for LRP, which were randomized into four groups: group A, patients undergoing LRP done by an expert surgeon; group B, patients undergoing robotic-assisted radical prostatectomy (RARP) performed by the same expert surgeon; group C, patients undergoing LRP performed by a young surgeon at the beginning of the learning curve; group D, patients undergoing LRP performed by another young surgeon at the beginning of the learning curve with the aid of Dextérité needle driver for completion of the VUA. The two young urologists performed the same steps of LRP so that they are at the same step of the learning curve. All the anastomosis were performed with the same technique in order to be comparable. We use interrupted sutures with Vicryl 2/0 and a 5/8 needle; we performed the Rocco stitch technique before all the anastomosis (6) and we applied bladder neck sparing technique. All patients underwent an ultrasound control of the anastomosis on the seventh postoperative day, as we usually do (9, 10). We consider continent who utilised no pad. Operative VUA completion time was 24.9 vs. 25 vs. 86.7 vs. 61 minutes, respectively. When comparing VUA completion time in group 3 and 4, the use of the Dextérité needle driver resulted in a reduction in VUA time. Urinary leakage was seen in zero out of 10 patients in groups 1 and 2 and in three out of 10 and one in 10 patients, respectively, in groups 3 and 4. All urinary leakages were managed conservatively. One-year continence rates were 95%, 97%, 93% and 95%, respectively. Only

  11. Laparoscopic radical cystectomy with orthotopic ileal neobladder: report of 33 cases

    Institute of Scientific and Technical Information of China (English)

    HUANG Jian; XU Ke-wei; YAO You-sheng; GUO Zheng-hui; XIE Wen-lian; JIANG Chun; HAN Jin-li; LI Si-yao

    2005-01-01

    Background The laparoscopic radical cystectomy (LRC) with orthotopic ileal neobladder is now applied to treat invasive bladder cancer, however, it has not been well codified and illustrated. We describe in this paper a technique step by step that we have developed in 33 patients and achieved excellent results.Methods The surgical procedure can be divided into eight steps: laparoscopic pelvic lymphadenectomy and mobilization of the distal ureters; exposing Denonvillier's space and the posterior aspect of prostate; exposing retropubic space and anterior surface of the bladder; dividing the lateral pedicles of the bladder and the prostate; dividing the apex of the prostate; extracorporeal formation of the ileal pouch; extracorporeal implantation of the ureters; and laparoscopic urethra-neobladder anastomosis. This operation was performed in 33 patients, 29 males and 4 females, with muscle invasive bladder cancer between December 2002 and September 2004.Results The operating time was 5.5-8.5 hours with an average of 6.5 hours; the estimated blood loss was 200-1000 ml with an average of 460 ml. The surgical margins of the bladder specimen were negative in all patients. There was no evidence of local recurrence at follow-up of 1-21 months in all the patients. However lymph node metastases were found in one case at 9 months postoperatively. Most of patients achieved urine control 1 to 3 months after surgery. The daytime continence rate was 94% (31 cases) and nighttime continence rate was 88% (29 cases). Urodynamic evaluation was performed between 3 and 6 months postoperatively for all cases. The mean value of neobladder capacity was (296±37) ml. The mean value of maximum flow rate was (18.7±7.1) ml/s. The mean residual urine volume was (32±19) ml. In all cases, excretory urography at 1 to 2 months postoperatively demonstrated slightly dilated upper urinary tracts without ureteral obstruction, which resolved at follow up. Cystography showed neobladders being similar in

  12. Effect on changes of blood coagulation function, cytokines and immune function in patients undergoing laparoscopic radical gastrectomy for gastric cancer

    Institute of Scientific and Technical Information of China (English)

    Jia-Qi Liu; Shao-Jun Yang; Jie-Qing Chen; Ru-Kui Su; Zhong Huang; Yin-Zhuo Qi

    2017-01-01

    Objective:To explore the changes of coagulation function, cytokines and T lymphocyte in patients undergoing laparoscopic radical gastrectomy for gastric cancer and its clinical significance.Methods: 40 cases of laparoscopic radical gastrectomy for gastric cancer patients and 40 cases of open radical gastrectomy for gastric cancer patients in our hospital were selected to detect and investigate the perioperative coagulation function [APTT (activated partial thromboplastin time), FIB (fibrinogen), and PLT (platelet)], cytokines [CRP (C reactive protein), IL-6 (IL-6) and TNF-alpha (Tumor necrosis factor-alpha)] and T lymphocytes (CD4+, CD8+ and CD4+/CD8+) changes and clinical meaning of patients in the two groups.Results: The coagulation function related indicators, cytokines and T lymphocytes of the two groups before treatment did not change significantly (P>0.05). 1 d after operation, blood coagulation, TNF-alpha, CD4+ and CD4+/CD8+ levels were significantly lower than that before operation in two groups of patients (P<0.05), while IL-6, CRP and CD8+ were significantly higher than that before the operation (P<0.05), and the index change in open group was more obvious. 3 d after surgery, the APTT, IL-6, CRP, CD4+, CD8+ and PLT levels in two group patients were significantly lower than that 1 d after surgery, while FIB, TNF-alpha and CD4+/CD8+ were significantly higher than that 1 d after surgery; blood coagulation index, TNF-alpha and CD4+ and CD4+/CD8+ were significantly lower in the laparotomy group patients than in laparoscopic group, while IL-6, CRP and CD8+ were significantly higher than the laparoscopic group (P<0.05). 5 d after operation, the APTT, TNF-alpha, FIB, CD4+, CD4+/CD8+ and PLT in two groups were significantly higher than that 3 d after surgery (P<0.05), while IL-6, CRP and CD8+ levels were significantly lower than that of 3 d after surgery (P<0.05); blood coagulation index, TNF-alpha and CD4+ and CD4+/CD8+ in the laparotomy group patients were

  13. 腹腔镜辅助阴式全子宫切除术112报告%The clinical analysis of 112 cases of laparoscopically assisted vaginal hysterectomy

    Institute of Scientific and Technical Information of China (English)

    李荣

    2012-01-01

    目的:探讨腹腔镜辅助阴式全子宫切除术(laparoscopiclly assisted vaginal hysterectomy,LAVH)的临床疗效及安全性.方法:回顾分析为112例有子宫切除指征的患者行LAVH的临床资料,术后应用抗生素规范治疗.观察术中、术后患者一般情况、手术时间、出血量、住院时间、并发症及术后随访等.结果:112例均顺利完成手术,无一例中转开腹,术后患者临床症状完全消失.6例术后阴道残端出血,经再缝扎宫颈残端后治愈;无一例发生术后腹壁切口感染、泌尿系感染、膀胱及直肠破裂、尿路刺激症状、尿潴留、术后阴道膀胱瘘等并发症.远期随访效果均满意.结论:LAVH治疗妇科良性疾病临床疗效显著,安全性高,是目前较理想的治疗方法,值得推广应用.%Objective:To explore the clinical efficacy and safety of laparoscopically assisted vaginal hysterectomy. Methods; Laparoscopically assisted vaginal hysterectomy was carried out in 112 patients who were analyzed retrospectively with hysteromyoma, u-terine adenomyoma,ovarian tumor,cervical intraepithelial neoplasia grade Ⅲ ,or atypical hyperplasia of endometrium, which were all indications for uterus resection and treated with antibiotic standard treatment. The intraoperative and postoperative general condition of patients ,surgical time,blood loss,hospital stay,complications and postoperative follow-up were observed. Results;All operations were successful , no one conveij to laparotomy and clinical symptoms disappeared post operation. Postoperative vaginal bleeding occurred in 6 cases and disappeared after suture cervical residual sheath cure. Other complications including postoperative abdominal wall wound infection , urinary tract infection, rupture of the bladder and rectum, urinary irritation symptoms, urinary retention and postoperative vaginal bladder fistula complications were not occurred. The long-term follow-up were satisfying. Conclusions: Using

  14. Hysterectomy in women with obesity: complications related to surgical site.

    Science.gov (United States)

    Naveiro-Fuentes, Mariña; Rodríguez-Oliver, Antonio; Maroto-Martín, María T; González-Paredes, Aida; Aguilar-Romero, María T; Mozas-Moreno, Juan

    2017-02-01

    The aim of this study was to describe the trends in surgical routes in obese women who underwent hysterectomy for benign disease at our center and compare complications in different groups. Retrospective study done between 2011 and 2015 in women with a Body Mass Index≥30 who underwent hysterectomy for benign disease at Virgen de las Nieves Universitary Hospital in Granada, Spain. We studied three groups based on the surgical route chosen for hysterectomy: vaginal, abdominal or laparoscopic. The rates of intraoperative and postoperative complications, major complications, reintervention and days of hospital stay were compared. Abdominal hysterectomy was associated with the highest risk of postoperative complications and the longest hospital stay. Laparoscopic hysterectomy had a higher risk than vaginal hysterectomy of major complications. There were no significant differences between groups for any of the other variables. In obese women vaginal hysterectomy was associated with the lowest morbidity, and should be the approach of choice whenever feasible.

  15. Risk factors of postoperative complications in patients undergoing laparoscopic hysterectomy%腹腔镜下全子宫切除术术后并发症发生的相关因素分析

    Institute of Scientific and Technical Information of China (English)

    姚国荣

    2015-01-01

    目的探讨腹腔镜下全子宫切除术患者术后并发症发生的相关因素。方法回顾性分析106例腹腔镜下全子宫切除术患者的临床资料。结果106例患者术后并发症发生率为14.15%,发生率最高的是皮下气肿(3.77%),其次是残端感染(2.88%)、盆腔包裹性积液(2.88%),盆腔手术史(P=0.037)、术前贫血(P=0.03)、子宫>孕12周大小(P=0.022)、手术时间>120min (P=0.033)、手术出血量>100ml(P=0.013)为术后并发症发生的危险因素,其中术前贫血(OR=9.939,P=0.048)、手术时间>120min (OR=6.120,P=0.038)为术后并发症发生的独立危险因素。结论术前贫血、手术时间>120min为患者术后并发症发生的独立危险因素。%Objective To assess the risk factors of postoperative complications in patients undergoing laparoscopic hysterectomy. Methods Clinical data of 106 patients undergoing laparoscopic total hysterectomy were analyzed retrospectively. Results Incidence rate of postoperative complications of 106 patients was 14.15%. The complication with highest incidence was subcutaneous emphysema (3.77%), fol owed by the vaginal wound infection (2.88%), pelvic cavity effusion (2.88%). History of pelvic surgery (P=0.037), preoperative anemia(P=0.03), uterine size>12w of pregnancy(P=0.022), operation time>120 min (P=0.033), intraoperative blood loss>100 ml (P=0.013) were associated with postoperative complications in laparoscopic total hys-terectomy. Preoperative anemia (OR=9.939, P=0.048) and operation time>120min(OR=6.120, P=0.038) are the independent risk factors of complications for laparoscopic total hysterectomy. Conclusion Preoperative anemia and operation time>120min are related to the incidence of complications for laparoscopic total hysterectomy.

  16. Robotic-assisted laparoscopic radical prostatectomy: initial 15 cases in Japan.

    Science.gov (United States)

    Yoshioka, K; Hatano, T; Nakagami, Y; Ozu, C; Horiguchi, Y; Yonou, H; Tachibana, M; Coughlin, G; Patel, V R

    2008-07-01

    Recently, we have introduced robotic-assisted laparoscopic radical prostatectomy (RALP) in Japan. This article describes the details of a training program to shorten the learning curve in the absence of an urologist with expertise in robotic surgery. Five months after a 2-day training course of robotic surgery, RALP was first performed in Japan, and a total of 15 cases were performed in the subsequent 4 months. Our training program consisted of: (1) image training using surgical operation videos, (2) dry lab training using a sham pelvic cavity model, and (3) intraoperative mentoring. The operative procedure was divided into five consecutive stages, and time required to complete each stage was recorded. Robotic radical prostatectomy was completed in all patients without conversion to open surgery, except for the first patient in whom a restriction to a 2-h operation had been imposed by the ethics committee. The mean console time and the mean intraoperative blood loss (including urine) reduced from 264.2 min and 459.4 ml, respectively, in the first 11 cases, to 151 min and 133.3 ml, respectively, in the last three cases. With direct intraoperative guidance by the mentor during cases 13 and 14, the operation time was reduced at all five stages of the operative procedure. Our training program proved remarkably effective in reducing the learning curve of RALP in Japan, where there is no person with expertise in robotic surgery.

  17. Natural orifice transendoluminal surgery and laparoendoscopic single-site surgery: the future of laparoscopic radical prostatectomy.

    Science.gov (United States)

    Barret, Eric; Sanchez-Salas, Rafael; Ercolani, Matthew C; Rozet, Francois; Galiano, Marc; Cathelineau, Xavier

    2011-03-01

    Techniques for minimally invasive radical prostatectomy (RP) have been carefully reviewed by surgical teams worldwide in order to identify possible weaknesses and facilitate further improvement in their overall performance. The initial plan of action has been to carefully study the best-practice techniques for open RP in order to reproduce and standardize performance from the laparoscopic perspective. Similar to open surgery, the learning curve of minimally invasive RP has been well documented in terms of objective evaluation of outcomes for cancer control and functional results. Natural orifice transluminal endoscopic surgery (NOTES) and laparoendoscopic single-site surgery (LESS) have recently gained momentum as feasible techniques for minimal access urological surgery. NOTES-LESS drastically limit the surgeon's ability to choose the site of entry for operative instruments; therefore, the advantages of NOTES-LESS are gained with the understanding that the surgical procedure is more technically challenging. There are several key elements in RP techniques (in particular, dorsal vein control, apex exposure and cavernosal nerve sparing) that can have significant implications on oncologic and functional results. These steps are hard to perform in a limited working field. LESS radical prostatectomy can clearly be facilitated by using robotic technology.

  18. Robot-assisted laparoscopic radical cystectomy with complete intracorporeal urinary diversion

    Directory of Open Access Journals (Sweden)

    Jason M. Sandberg

    2016-07-01

    Full Text Available Robot-assisted radical cystectomy with intracorporeal urinary diversion (RARC-ICUD has only recently been explored as a viable surgical option for patients with muscle-invasive bladder cancer seeking satisfactory oncologic control while benefiting from minimally invasive surgical techniques. Inspired by earlier open and laparoscopic work, initial descriptions of RARC-ICUD were published in 2003, and have since been followed by multiple larger case series which have suggested promising outcomes for our patients. However, the rate of adoption has remained relatively slow when compared to other robot-assisted procedures such as the radical prostatectomy, likely owing to longer operative times, operative complexity, costs, and uncertainty regarding oncologic efficacy. The operative technique for RARC-ICUD has evolved over the past decade and several high-volume centers have shared tips to improve efficiency and make the operation possible for a growing number of urologists. Though there are still questions regarding economic costs, effectiveness, and generalizability of outcomes reported in published data, a growing dataset has brought us ever closer to the answers. Here, we present our current operative technique for RARC-ICUD and discuss the state of the literature so that the urologist may hold an informed discussion with his or her patients.

  19. Clinical Analysis of Laparoscopic Hysterectomy for Gigantic Uterus (Report of 178 cases)%178例腹腔镜巨大子宫全切术临床分析

    Institute of Scientific and Technical Information of China (English)

    李玲玲; 岳青芬

    2015-01-01

    目的:探讨巨大子宫经腹腔镜切除的安全性、手术技巧和临床价值。方法分析该院178例行经腹腔镜巨大子宫切除术(子宫跃孕12周)的临床资料。结果所有手术均经腹腔镜完成,无一例手术并发症发生。手术时间院(89.4±31.6)min;出血量院(94.5±48.3)mL。平均住院时间4.8 d。结论经腹腔镜巨大子宫切除术安全可行,但应选好适应症,术者具备较高的腹腔镜操作水平。%Objective To investigate the clinical value and operating techniques of laparoscopic hysterectomy for gigantic uter. Methods 178 patients whose uteris were larger than twelve-weeks pmgnant uteri accepted aparoscopic hysterectomy and their clinical data were analyzed retrospectively. Results All operations were performed successfully under laparoseopy. No operating complication happened in any cases.The operating time was (89.4±31.6)min,blood loss in operation was (94.5±48.3)mL and the average hospitalization time was 4.8 days.Conclusion On the basis of proper indication and good operating techniques of the oper-ators, laparoscopic hysterectomy for gigantic uteri is safe and feasible.

  20. Endolaparoscopic left hemicolectomy and synchronous laparoscopic radical nephrectomy for obstructive carcinoma of the descending colon and renal cell carcinoma.

    Science.gov (United States)

    Ng, Simon S M; Yiu, Raymond Y C; Li, Jimmy C M; Chan, Chi Kwok; Ng, Chi Fai; Lau, James Y W

    2006-06-01

    Colorectal self-expandable metal stents (SEMS) have been used successfully as preoperative bridges to surgery for obstructive left-sided colorectal carcinoma. Endoscopic relief of the obstruction allows for full bowel preparation and accurate preoperative staging. A laparoscopic approach, considered by many to be contraindicated in the presence of obstruction, becomes feasible after endoscopic decompression. We present a case of obstructive carcinoma of the descending colon successfully treated with endoscopic decompression with colorectal SEMS. Subsequent staging with computed tomography revealed a renal cell carcinoma in the left kidney. Synchronous laparoscopic resection of the two carcinomas was performed, with no morbidity. To the best of our knowledge, this is the first report of endolaparoscopic left hemicolectomy and synchronous laparoscopic radical nephrectomy for obstructive carcinoma of the descending colon and renal cell carcinoma. The advantages of colorectal SEMS and the endolaparoscopic approach in managing obstructive colorectal carcinoma are discussed.

  1. 机器人辅助腹腔镜子宫全切术41例报告%Robotic-assisted Laparoscopic Hysterectomy: Report of 41 Cases

    Institute of Scientific and Technical Information of China (English)

    何晓琴; Mukesh Parekh

    2011-01-01

    Objective To investigate the techniques of robotic-assisted laparoscopic hysterectomy. Methods With the patients at dorsal lithotomy position, under general anesthesia, we placed a colpotomy ring and uterine manipulator to delineate the vaginal fornices, and then inserted a colpo-pneumo occluder. With an digital video system prepared, we determined one port for camera, and two ports for instrument arms, and one port for assistant trocars. A patient cart was positioned between the patient' s legs and locked, the camera arm and remained instrument arms were then docked, HotShears (Monopolar Curved Scissors) and PK Dissect Forceps were fixed at each side. When suturing, needle drivers was used at the both sides. Assistant trocar was used to help exposing surgical field and suction. By controlling the robotic arms, we completed the operation. Results The mean operation time was (82.5 ± 9.5) minutes [ console time (61.9 ± 7.9) minutes, docking time (7.0 ± 1.5 ) minutes ]; and intraoperative blood loss was (55.0 ± 12.8) ml. No intraoperative complications occurred. Two patients developed postoperative complications: hypertension in one and urological infection at 3 days postoperation in the other. Both cases were cured by conservative therapies. Follow-up was available in 41 cases for 42 days, during which no vaginal bleeding or abdominal pain was complained. Conclusions Robot-assisted hysterectomy is safe and reliable with few complications and quick recovery.%目的 探讨机器人辅助腹腔镜子宫全切术的临床应用.方法 全麻后取截石位,放置阴道环切环、子宫操纵器及阴道封堵球囊,准备数字电视摄像系统,确定一个内镜端口、2个器械端口及一个助手端口的位置并置入套管,自动操作仪器置于患者两腿间,对接自动操作仪器和内镜摄像臂,一侧端口安装双极电凝钳,一侧端口安装单极电剪.缝合时两侧端口均安装针持器.助手端口置入普通腔镜器械,由手术

  2. Life-threatening rupture of an external iliac artery pseudoaneurysm caused by necrotizing fasciitis following laparoscopic radical cystectomy: a case report

    OpenAIRE

    Hata, Shinro; Satoh, Ryuta; Shin, Toshitaka; Mori, Kenichi; Sumino, Yasuhiro; Satoh, Fuminori; Mimata, Hiromitsu

    2014-01-01

    Background Pseudoaneurysms are caused by trauma, tumors, infections, vasculitis, atherosclerosis and iatrogenic complications. In this paper, we report about a patient with rupture of an external iliac artery pseudoaneurysm, which lead to hemorrhagic shock, after undergoing laparoscopic radical cystectomy and extended pelvic lymphadenectomy. Case presentation The patient was a 68-year-old Japanese male diagnosed with invasive bladder cancer. Laparoscopic radical cystectomy and extended pelvic...

  3. Oncological outcomes after laparoscopic and open radical nephroureterectomy: results from an international cohort.

    Science.gov (United States)

    Walton, Thomas J; Novara, Giacomo; Matsumoto, Kazumasa; Kassouf, Wassim; Fritsche, Hans-Martin; Artibani, Walter; Bastian, Patrick J; Martínez-Salamanca, Juan I; Seitz, Christian; Thomas, Stephen A; Ficarra, Vincenzo; Burger, Maximilian; Tritschler, Stefan; Karakiewicz, Pierre I; Shariat, Shahrokh F

    2011-08-01

    • To compare oncological outcomes in patients undergoing open radical nephroureterectomy (ONU) with those in patients undergoing laparoscopic radical nephroureterectomy (LNU). • A total of 773 patients underwent radical nephroureterectomy at nine centres worldwide; 703 patients underwent ONU and 70 underwent LNU. • Demographic, perioperative and oncological outcome data were collected retrospectively. • Statistical analysis of data was performed using chi-squared, Mann-Whitney U- and log-rank tests, and Cox regression analyses. • The median (interquartile range) follow-up for the cohort was 34 (15-65) months. • The two groups were well matched for tumour stage, presence of lymphovascular invasion (LVI) and concomitant carcinoma in situ (CIS). • There were more high-grade tumours (77.1% vs. 56.3%; P ONU and LNU groups, respectively (P= 0.124) and estimated 5-year cancer-specific survival (CSS) was 75.4% and 75.2% for the ONU and LNU groups, respectively (P= 0.897). • On multivariable analyses, which included age, gender, race, previous endoscopic treatment for bladder cancer, technique for distal ureter management, tumour location, pathological stage, grade, lymph node status, LVI and concomitant CIS, the procedure type (LNU vs. ONU) was not predictive of RFS (Hazard ratio [HR] 0.80; P= 0.534) or CSS (HR 0.96; P= 0.907). • The present study is the second large, independent, multicentre cohort to show oncological equivalence between ONU and LNU for well selected patients with upper urinary tract urothelial cancer, and the first to suggest parity for the techniques in patients with unfavourable disease. © 2010 THE AUTHORS. BJU INTERNATIONAL © 2010 BJU INTERNATIONAL.

  4. The natural history of voiding function after robot-assisted laparoscopic radical prostatectomy.

    Science.gov (United States)

    Wang, Lushun; Chung, Stephanie Fook-Chong Man; Yip, Sidney Kam Hung; Lau, Weber Kam On; Cheng, Christopher Wai Sam; Sim, Hong Gee

    2011-01-01

    We report the natural history of voiding function in men with clinically localized prostate cancer after robot-assisted laparoscopic radical prostatectomy (RLRP), describing the trend of functional recovery, which is currently not well described using the robot-assisted laparoscopic approach. We determined the impact on voiding function by prospectively evaluating 100 consecutive men who underwent RLRP between May 2005 and December 2006 and compared their reported International Prostate Symptom Score (IPSS) and Quality of Life (QOL) scores at 3, 6, and 12 months with preoperative scores after surgery. Patients with preoperative IPSS of 0-7 and 8-35 were defined as having mild lower urinary tract symptoms (LUTS) and moderate to severe LUTS, respectively. Continence was achieved in 82%, 87%, and 91% of men at 3, 6, and 12 months after RLRP, respectively. There were statistically and clinically significant improvements in both IPSS and QOL preoperative scores at all studied time points for patients with moderate to severe preexisting LUTS. The mean IPSS scores for these patients preoperatively and at 3, 6, and 12 months after surgery were 14.1, 5.2, 3.0, and 2.9, respectively and the corresponding mean QOL scores were 3.4, 2.1, 1.6, and 1.6, respectively. Patients with mild preexisting LUTS showed no statistically significant improvement in IPSS at 3 and 6 months after surgery but significant improvement was found at 1 year (P = 0.04). Good continence recovery is expected in most patients undergoing RLRP. Patients with moderate to severe preexisting LUTS can expect early and clinically significant symptom and QOL improvements after RLRP. Patients with mild preexisting LUTS show significant symptom improvement at 1 year. Copyright © 2011 Elsevier Inc. All rights reserved.

  5. A matched-pair comparison between bilateral intrafascial and interfascial nerve-sparing techniques in extraperitoneal laparoscopic radical prostatectomy

    Institute of Scientific and Technical Information of China (English)

    Tao Zheng; Xu Zhang; Xin Ma; Hong-Zhao Li; Jiang-Pin Gao; Wei Cai; Jun Dong

    2013-01-01

    The aim of this study was to validate the advantages of the intrafascial nerve-sparing technique compared with the interfascial nerve-sparing technique in extraperitoneal laparoscopic radical prostatectomy.From March 2010 to August 2011,65 patients with localized prostate cancer (PCa) underwent bilateral intrafascial nerve-sparing extraperitoneal laparoscopic radical prostatectomy.These patients were matched in a 1:2 ratio to 130 patients with localized PCa who had undergone bilateral interfascial nerve-sparing extraperitoneal laparoscopic radical prostatectomy between January 2008 and August 2011.Operative data and oncological and functional results of both groups were compared.There was no difference in operative data,pathological stages and overall rates of positive surgical margins between the groups.There were 9 and 13 patients lost to follow-up in the intrafascial group and interfascial group,respectively.The intrafascial technique provided earlier recovery of continence at both 3 and 6 months than the interfascial technique.Equal results in terms of continence were found in both groups at 12 months.Better rates of potency at 6 months and 12 months were found in younger patients (age ≤65 years) and overall patients who had undergone the intrafascial nerve-sparing extraperitoneal laparoscopic radical prostatectomy.Biochemical progression-free survival rates 1 year postoperatively were similar in both groups.Using strict indications,compared with the interfascial nerve-sparing technique,the intrafascial technique provided similar operative outcomes and short-term oncological results,quicker recovery of continence and better potency.The intrafascial nerve-sparing technique is recommended as a preferred approach for young PCa patients who are clinical stages cT1 to cT2a and have normal preoperative Potency.

  6. Ocular parameters before and after steep Trendelenburg positioning for robotic-assisted laparoscopic radical prostatectomy

    Directory of Open Access Journals (Sweden)

    Mizumoto K

    2017-09-01

    Full Text Available Kyoichi Mizumoto,1 Masahiko Gosho,2 Masayoshi Iwaki,1 Masahiro Zako3 1Department of Ophthalmology, Aichi Medical University, Nagakute, Aichi, Japan; 2Department of Clinical Trial and Clinical Epidemiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan; 3Department of Ophthalmology, Asai Hospital, Seto, Aichi, Japan Purpose: Intraocular pressure (IOP increases in patients in a steep Trendelenburg position during robotic-assisted laparoscopic radical prostatectomy (RALP. We hypothesized that a steep Trendelenburg position during RALP, an unusual systemic condition involving a transiently increased IOP, may induce ocular pathology that can be detected by detailed evaluations long after the surgery. This study aims to explore ocular structural and functional parameters in patients before and in the long term after the surgery. Patients and methods: A comparative observational study was performed. A total of 44 eyes of 22 male patients scheduled for RALP at Aichi Medical University from August 2012 to July 2013 were included. Clinical parameters before and after RALP were compared. Peri­operative IOP was measured immediately post-induction of anesthesia in the flat supine position (T1, immediately post-steep Trendelenburg position (T2, and prior to returning to a flat supine position while in a steep Trendelenburg position (T3. The thicknesses of the peripapillary retinal nerve fiber layer, ganglion cell complex (GCC, and central fovea were measured with spectral domain optical coherence tomography. Humphrey perimetry was performed before and at 3 and 6 months after surgery. Results: The average IOPs (mmHg at each stage were T1=10.4, T2=21.7, and T3=29.6, and differed significantly. The mean visual acuity (logarithm of the minimal angle of resolution, IOP, mean deviation, and pattern standard deviation measured by the Humphrey field analyzer showed no statistically significant difference before and after surgery. The ganglion

  7. Hysterectomy (image)

    Science.gov (United States)

    Hysterectomy is surgical removal of the uterus, resulting in inability to become pregnant. This surgery may be done for a variety of reasons including, but not restricted to, chronic pelvic inflammatory disease, uterine fibroids and ...

  8. Vaginal hysterectomy as a primary route for morbidly obese women.

    Science.gov (United States)

    Sheth, Shirish S

    2010-07-01

    Vaginal hysterectomy is a least invasive and the choicest route when hysterectomy is possible by recourse to all the three available techniques. However in obese women, the common method is by the more invasive abdominal or laparoscopic route, with attendant morbidity. Vaginal hysterectomy was reviewed in 102 morbidly obese women (body mass index, BMI > or = 40) and compared with 50 comparable morbidly obese women who underwent abdominal hysterectomy and with vaginal hysterectomy in 200 normal weight women (BMI hysterectomy was slightly but significantly longer in the morbidly obese compared to those of normal weight, while the abdominal approach was significantly longer in the morbidly obese. Hospital stay was significantly longer for the abdominal operations in the obese. Surgical and anesthetic complications did not differ. In the absence of specific contraindications for vaginal hysterectomy it is recommended that the surgeon should perform hysterectomy vaginally and consider obesity as a contraindication for taking the abdominal route.

  9. Robotic-assisted hysterectomy: patient selection and perspectives

    Science.gov (United States)

    Smorgick, Noam

    2017-01-01

    Minimally invasive hysterectomy via the laparoscopic or vaginal approach is beneficial to patients when compared with laparotomy, but has not been offered in the past to all women because of the technical difficulties and the long learning curve required for laparoscopic hysterectomy. Robotic-assisted hysterectomy for benign indications may allow for a shorter learning curve but does not offer clear advantages over conventional laparoscopic hysterectomy in terms of surgical outcomes. In addition, robotic hysterectomy is invariably associated with increased costs. Nevertheless, this surgical approach has been widely adopted by gynecologic surgeons. The aim of this review is to describe specific indications and patients who may benefit from robotic-assisted hysterectomy. These include hysterectomy for benign conditions in cases with high surgical complexity (such as pelvic adhesive disease and endometriosis), hysterectomy and lymphadenectomy for treatment of endometrial carcinoma, and obese patients. In the future, additional evidence regarding the benefits of single-site robotic hysterectomy may further modify the indications for robotic-assisted hysterectomy. PMID:28356774

  10. Effect of laparoscope and open radical resection on immunological and stress levels in patients with advanced gastric cancer

    Institute of Scientific and Technical Information of China (English)

    Xia-Fei Sun; Zi-Rui He

    2016-01-01

    Objective:To explore the effect of laparoscope and open radical resection of gastric cancer on the immunological and stress levels in patients with advanced gastric cancer.Methods:A total of 80 patients with advanced gastric cancer who were admitted in our hospital from May, 2015 to May, 2016 were included in the study and divided into the laparoscope group and open group according to different treatment protocols. The morning fasting venous blood 1 d before operation, and 1 d, 3 d, and 5 d after operation in the two groups was collected, and centrifuged for the serum. The scatter turbidimetry was used to detect CRP. ELISA was used to detect IL-6. FCM was used to detect CD4+ and CD8+. CD4+/CD8+ were calculated.Results:The comparison of CRP and IL-6 levels before operation between the two groups was not statistically significant (P>0.05). CRP and IL-6 levels 1 d after operation were significantly elevated, and were gradually reduced 3 d and 5 d after operation. CRP and IL-6 levels 3 d and 5d after operation in the laparoscope group were significantly lower than those in the open group (P0.05). CD4+ 1 d after operation reached the peak, while CD8+ and CD4+/CD8+ were reduced to the lowest. CD4+, CD8+, and CD4+/CD8+ 3 d and 5 d after operation were gradually recovered, and the recovered degree of the above indicators in the laparoscope group were significantly superior to that in the open group (P<0.05).Conclusions:Due to the significant advantage of small effect on the stress reaction and immunosuppression, the laparoscopic radical gastrectomy should be preferred.

  11. 盐酸戊乙奎醚用于腹腔镜下全子宫切除时对呼吸力学的影响%Effects of Penehyclidine Hydrochloride injection on respiratory mechanics during Laparoscopic total hysterectomy

    Institute of Scientific and Technical Information of China (English)

    李刚; 孙东辉

    2012-01-01

    目的 观察盐酸戊乙奎醚(长托宁)用于腹腔镜下全子宫切除时对肺顺应性(Ct)、气道峰压(Ppeak)、氧分压(PaO2)的影响.方法 选择40例腹腔镜下全子宫切除的患者.随机分为长托宁组、对照组.分别观察两组在给药前和给药后10、20、30 min时的ct、Ppeak、PaO2的变化.结果 长托宁组在给药后10、20、30 min时Ct、PaO2数值明显高于给药前,与给药前比较有统计学差异(P<0.05),而Ppeak明显低于给药前(P<0.05);对照组给药(生理盐水)后10、20、30min时Ct、Ppeak、PaO2与给药前比较无统计学差异(P>0.05).两组给药后10、20、30 min时Ct、Ppeak、PaO2数值比较有统计学差异(P<0.05).结论 长托宁用于腹腔镜下全子宫切除时可增加ct、PaO2,降低Ppeak.%Objective To observe the effects of Penehyclidine Hydrochloride injection on the total compliance ( Ct), peak pressure ( Ppeak) and pressure of oxygen (PaO2) during laparoscopic total hysterectomy. Methods 40 cases of laparoscopic total hysterectomy were randomly divided into Penehyclidine Hydrochloride group and control group. The changes of Ct, Ppeak and PaO2 before and 10, 20, 30min after the medication were observed in two groups. Results The values of Ct and PaO2 10, 20, 30min after the medication were significantly higher than that before the medication in Penehyclidine Hydrochloride group with a statistical difference (P 0.05). There were significant difference in the values of Ct, Ppeak and PaO210, 20, 30min after the medication in two groups. Conclusion Penehyclidine can increase Ct and PaO2 and reduce Ppeak during laparoscopic total hysterectomy.

  12. Prostate Cancer Biochemical Recurrence Rates After Robotic-Assisted Laparoscopic Radical Prostatectomy

    Science.gov (United States)

    Ginzburg, Serge; Nevers, Thomas; Staff, Ilene; Tortora, Joseph; Champagne, Alison; Kesler, Stuart S.; Laudone, Vincent P.

    2012-01-01

    Background and Objectives: To determine prostate cancer biochemical recurrence rates with respect to surgical margin (SM) status for patients undergoing robotic-assisted laparoscopic radical prostatectomy (RALP). Methods: IRB-approved radical prostatectomy database was queried. Patients were stratified as low, intermediate, and high risk according to D’Amico's risk classification. Postoperative prostate-specific antigen (PSA) values were obtained every 3 mo for the first year, then biannually and annually thereafter. Biochemical recurrence was defined as ≥0.2ng/mL. Patients receiving adjuvant or salvage treatment were included. Positive surgical margin was defined as presence of cancer cells at inked resection margin in the final specimen. Margin presence (negative/positive), margin multiplicity (single/multiple), and margin length (≤3mm focal and >3mm extensive) were noted. Kaplan-Meier curves of biochemical recurrence-free survival (BRFS) as a function of SM were generated. Forward stepwise multivariate Cox regression was performed, with preoperative PSA, Gleason score, pathologic stage, prostate gland weight, and SM as covariates. Results: At our institution, 1437 patients underwent RALP (2003-2009). Of these, 1159 had sufficient data and were included in our analysis. Mean follow-up was 16 mo. Kaplan-Meier curves demonstrated significant increase in BRFS in low-risk and intermediate-risk groups with negative SM. Overall BRFS at 5 y was 72%. Gleason score, pathologic stage, and SM status were significant prognostic factors in multivariate analysis. Conclusions: Negative surgical margins resulted in lower biochemical recurrence rates for low-risk and intermediate-risk groups. Multifocal and longer positive margins were associated with higher biochemical recurrence rates compared with unifocal and shorter positive margins. Documenting biochemical recurrence rates for RALP is important, because this treatment for localized prostate cancer is validated. PMID

  13. A Literature-Based Analysis of the Learning Curves of Laparoscopic Radical Prostatectomy

    Directory of Open Access Journals (Sweden)

    Daniel W. Good

    2014-05-01

    Full Text Available There is a trend for the increased adoption of minimally invasive techniques of radical prostatectomy (RP – laparoscopic (LRP and robotic assisted (RARP – from the traditional open radical retropubic prostatectomy (ORP, popularised by Partin et al. Recently there has been a dramatic expansion in the rates of RARP being performed, and there have been many early reports postulating that the learning curve for RARP is shorter than for LRP. The aim of this study was to review the literature and analyse the length of the LRP learning curves for the various outcome measures: perioperative, oncologic, and functional outcomes. A broad search of the literature was performed in November 2013 using the PubMed database. Only studies of real patients and those from 2004 until 2013 were included; those on simulators were excluded. In total, 239 studies were identified after which 13 were included. The learning curve is a heterogeneous entity, depending entirely on the criteria used to define it. There is evidence of multiple learning curves; however the length of these is dependent on the definitions used by the authors. Few studies use the more rigorous definition of plateauing of the curve. Perioperative learning curve takes approximately 150-200 cases to plateau, oncologic curve approximately 200 cases, and the functional learning curve up to 700 cases to plateau (700 for potency, 200 cases for continence. In this review, we have analysed the literature with respect to the learning curve for LRP. It is clear that the learning curve is long. This necessitates centralising LRP to high volume centres such that surgeons, trainees, and patients are able to utilise the benefits of LRP.

  14. Transvesical Laparoendoscopic Single-Site Management of Distal Ureter During Laparoscopic Radical Nephroureterectomy.

    Science.gov (United States)

    Nunez Bragayrac, Luciano A; Machuca, Victor; Saenz, Eric; Cabrera, Marino; de Andrade, Robert; Sotelo, Rene J

    2014-09-11

    Abstract Objective: To describe the management of the distal ureter during radical nephroureterectomy with the transvesical laparoendoscopic single-site surgery (T-LESS) approach. Methods: Between January 2010 and October 2013, five patients underwent laparoscopic radical nephroureterectomy for upper urinary tract carcinoma (UTUC) with the T-LESS approach. Patients were placed in the supine position. A 2.5-cm skin incision was made in the line between the pubis and the umbilicus. The bladder was identified and a multiport was inserted into the bladder. The patients were repositioned to a lateral decubitus position; pneumovesicum was established and the ureteral openings were identified. We marked the bladder cuff with electrocautery all the way through to the extravesical fat. The bladder defect was sealed with sutures. After checking for any leak or bleeding, the multiport was removed and the bladder was closed. At this point, we continued with nephrectomy by standard laparoscopy or LESS. A 18F Foley catheter was placed into the bladder. Results: The mean age was 70 years (range 58-81 years), the mean operative time was 198 minutes (range 115-390 minutes), the mean time for the management of the distal ureter was 35 minutes (range 27-45 minutes), the mean estimated blood loss was 234 mL (range 60-850 mL), and the mean hospital stay was 3.8 days (range 2-8 days). In all patients the bladder cuff was free of disease. Conclusion: The transvesical laparoendoscopic single-site approach to the distal ureter for UTUC appears safe and reproducible, with faster closure of the bladder defect and improved cosmesis.

  15. [Techniques of autonomic nerve preservation in laparoscopic radical resection for rectal cancer].

    Science.gov (United States)

    Wei, Hongbo; Zheng, Zongheng

    2015-06-01

    Pelvic autonomic nerve is a three-dimensional structure surrounding the rectum. There are several key points related to nerve injury during laparoscopic radical resection for rectal cancer. Hypogastric nerve has close relation with the upper and middle part of the rectum. Combined with S2-S4 pelvic splanchnic nerve, hypogastric nerve forms pelvic plexus. Incorrect operation in pelvic parietal peritoneum during dissection of upper rectum will lead to nerve injury. When performing dissection of inferior mesenteric artery, bilateral nerve tracts should be pushed to posterior abdominal wall and anterior fascia of the abdominal aorta should be well protected to avoid nerve injury. Pelvic plexus fibers located lateral to the rectum of pelvic floor, as well as neurovascular bundle closed to Denonvillier's fascia, also have close relations with nerve injury. Dissection of either lateral or anterior wall of rectum should be performed behind the Denonvillier's fascia and in front of the proper fascia of rectum. Sharp dissection should be performed closed to the mesorectum to protect branches of pelvic plexus.

  16. Does route of hysterectomy affect outcome in obese and nonobese women?

    Science.gov (United States)

    Brezina, Paul R; Beste, Todd M; Nelson, Keith H

    2009-01-01

    Our objective was to compare the surgical outcomes of obese women having hysterectomy according to the route (abdominal, vaginal, or laparoscopic) of the procedure. A chart review of 293 hysterectomy procedures was performed. Data were collected including operative and anesthesia time, estimated blood loss, change in hematocrit, hospital stay, complications, conversion to laparotomy, transfusion, and body mass index. An analysis of variance and a Newman-Keuls Multiple Comparison test were performed. Obese women experienced a significant decrease in hospital days (2.5 versus 4.2) and reported blood loss (204 mL versus 455 mL) in the laparoscopic hysterectomy and vaginal hysterectomy groups compared with the abdominal hysterectomy group. No significant difference was found in obese women between laparoscopic and abdominal hysterectomy for time spent in surgery and under anesthesia. For obese and normal weight women, vaginal hysterectomy offered the shortest surgery, anesthesia times, and hospital stays. For normal and obese women, vaginal hysterectomy offered the shortest hospital stay and surgery time. In obese patients for whom vaginal hysterectomy is not possible, laparoscopic hysterectomy should be considered before abdominal hysterectomy, because the laparoscopic route reduced hospital time and blood loss.

  17. The McCarus-Volker ForniSee®: A Novel Trans-illuminating Colpotomy Device and Uterine Manipulator for Use in Conventional and Robotic-Assisted Laparoscopic Hysterectomy.

    Science.gov (United States)

    Gutierrez, Melissa M; Pedroso, Jasmine D; Volker, K Warren; Howard, David L; McCarus, Steven D

    2017-07-25

    The purpose of this paper is to introduce a novel trans-illuminating culdotomy and uterine manipulator device. The study was a prospective, non-randomized, non-blinded observational clinical study involving 50 female patients undergoing total laparoscopic hysterectomy (TLH) or laparoscopic supracervical hysterectomy (LSH) for benign indications. The surgeries were performed from March through May 2012 at two institutions. The primary study objectives were to demonstrate the safety and adequate clinical performance of the uterine manipulator device and to illustrate its potential widespread future use in minimally invasive gynecologic procedures. Average patient age was 45.1 years and, of the 50 patients, 33 had undergone previous intra-abdominal surgery. There were no reports of adverse events, difficulty with placement of the instrument, multiple attempts at placement, or difficulty with uterine manipulation. There was only one device-related uterine perforation, and pneumoperitoneum was maintained in all cases during culdotomy. Vaginal tissue left on subjects was less than 5mm. Overall, there were no ureteral injuries, there were two reported incidental cystotomies, and average blood loss was 99.0cc. Postoperative courses were normal for all patients, with only two reported postoperative complications: a possible vaginal cuff abscess and a 2cm vaginal mucosal cuff separation. The McCarus-Volker ForniSee® (LSI Solutions, Inc., Victor, New York) is a novel trans-illuminating culdotomy device and uterine manipulator that is safe, efficient, functional, and easy to use. Trans-illumination additionally delineates and enhances identification of critical anatomic planes, such as the vesicovaginal junction and cervicovaginal junction.

  18. Comparison of peritoneal free gastric cancer cells' detecting rates between laparoscopically assisted and open radical gastrectomy

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    Objective: To compare laparoscopic gastrectomy and conventional surgery on the dissemination and seeding of tumor cells. Methods:Intraoperative peritoneal lavage cytologic examination was performed in 65 patients with gastric cancer, during laparoscopic gastrectomy (n=34) and conventional surgery (n=31). Cytology was examined twice, immediately after opening the peritoneal cavity and just before closing the abdomen. Saline was poured into the peritoneal cavity, and 100 ml fluid was retrieved after irrigation. Laparoscopic instruments were lavaged after surgery with 100 ml saline. Carbon dioxide (CO2) was derived through the trocar side orifice after pneumoperitoneum during laparoscopic gastrectomy and filtered through 100 ml saline. Cytologic examination of the filtrate was performed after the filtration process. Results: The incidence of positive cytology during laparoscopic surgery was 32.26% in the preoperative lavage and 22.58% in the postoperative lavage. The incidence of positive cytology during conventional surgery was 41.18% before lavage and 26.47% after lavage. Only one positive cytology was detected in the CO2 filtrate gas. The incidence of positive cytology in the lavage of the instruments during laparoscopic surgery was 6.45%. Conclusion: During gastric laparoscopic surgery, CO2 pneumoperitoneum does not affect tumor cell dissemination and seeding. In this study, laparoscopic techniques used in gastric cancer surgery were not associated with a higher risk for intraperitoneal dissemination of cancer cells than the conventional surgery.

  19. THE SAFETY AND EXPEDIENCY OF USING A TRANSPERITONEAL LAPAROSCOPIC ACCESS TO RADICAL NEPHRECTOMY FOR CLINICALLY LOCALIZED KIDNEY CANCER

    Directory of Open Access Journals (Sweden)

    V. B. Matveev

    2013-01-01

    Full Text Available Objective: to compare immediate, oncological, and functional results, as well as quality of life in patients undergoing open and laparoscopic transperitoneal radical nephrectomy (RNE for clinically localized kidney cancer (KC.Subjects and methods. Data from 426 cT1-2N0M0 KC patients after radical nephrectomy in 1991 to 2011 were retrospectively selected. Their median age was 57 years. The male/female ratio was 1.1:1. The median highest tumor diameter was 5.0±2.2 cm. RNE was carried out in all 426 patients: in 211 (49.5 % patients through open access and in 215 (50.5 % through transperitoneal laparoscopic one. The patient groups operated on via different accesses were matched for major signs; however, the laparoscopy group displayed a preponderance of cT1a tumors. The median follow-up was 50.0±12.3 months.Results. There were no significant differences in the frequency of intraoperative and postoperative complications of laparoscopic and open nephrectomies. The five-year overall, specific, and relapse-free survival rates in the patients who had undergone open nephrectomy were 95.4, 98.4, and 92.2 %, respectively; those in the patients who had laparoscopic nephrectomy were 94.5, 100.0, and 93.6 %, respectively (p > 0.05 for all. The incidence of acute renal dysfunction and its distribution according to the RIFLE classes, the rate of acute dialysis and that of a decrease and a continued reduction in glomerular filtration rate, as well as the distribution of patients according to the stages of chronic kidney disease after RNE did not depend on the surgical access (p > 0.05 for all. The QLQ-30 survey data show that the laparoscopic access versus the laparotomic one improves quality of life within 1 month after RNE.Conclusion. Laparoscopic transperitoneal RNE is a safe alternative to open surgery that can improve quality of life in the patients with clinically localized kidney cancer within one month after surgical intervention.

  20. Robot assisted laparoscopic radical prostatectomy: assistant's seniority has no influence on perioperative course.

    Science.gov (United States)

    Abu-Ghanem, Yasmin; Erlich, Tomer; Ramon, Jacob; Dotan, Zohar; Zilberman, Dorit E

    2016-11-09

    An experienced surgical team, in general, and the surgeon assistant in particular are believed to play a critical role in the operation's safety and success. We sought to explore whether the assistant's seniority influences perioperative course following robot assisted laparoscopic radical prostatectomy (RALP). We reviewed our prospective registry database of RALP cases performed by a single surgeon who during the study period was beyond his learning curve. The following parameters were documented and analyzed: patient's age, body mass index (BMI), associated comorbidities, previous abdominal surgeries, assistant's identity, total and skin-to-skin operative time (tOT, ssOT, respectively), estimated blood loss (EBL), immediate post-operative complications, length of stay (LOS), and prostate weight per final pathology report. Univariate analysis and Spearman's correlation test were used to evaluate whether the assistant's seniority influenced perioperative course. Between the years 2011-2015, 106 consecutive cases were retrieved and analyzed. Prostate weight was found to be associated with longer tOT (Spearman's ρ = 0.34, p < 0.001), ssOT (0.3, p < 0.01) and increased EBL (0.28, p < 0.01). Patient's age, BMI, associated comorbidities, and previous abdominal surgeries were found to have no influence on neither tOT, ssOT nor EBL. Three assistants' subgroups were identified (seniors, PGY 1-3, PGY 4-6). The assistant's seniority was found to have no influence on tOT, ssOT, EBL, immediate post-operative complications and LOS. Same results were obtained following prostate size adjustments. The assistant's seniority has no influence on perioperative course following RALP. Consequently, given a highly experienced primary surgeon, a less experienced assistant can be safely incorporated into this procedure.

  1. Pathologic outcomes during the learning curve for robotic-assisted laparoscopic radical prostatectomy

    Directory of Open Access Journals (Sweden)

    Amul Shah

    2008-03-01

    Full Text Available OBJECTIVE: We report our initial experience with 62 patients undergoing robotic-assisted laparoscopic prostatectomy (RALP, focusing on the primary parameter of positive surgical margins. The authors demonstrate that excellent oncologic outcomes can be attained with a less steep learning curve than previously hypothesized. MATERIALS AND METHODS: The first 62 patients undergoing RALP by a single physician (DPD at our institution between November 2005 and August 2007 were retrospectively assessed. Surgical pathology records were reviewed for Gleason score, pathologic tumor stage, nodal status, location of prostate cancer within the specimen, extracapsular extension, surgical margin status, presence of perineural invasion, tumor volume, and weight of the surgical specimen. Margin status was determined using surgical specimens only, and not intraoperative frozen sections. All cases in this series were completed using the four-arm da Vinci Robotic System (Intuitive Surgical, Sunnyvale, California. RESULTS: Sixty-one patients had prostate cancer on their final surgical pathology specimens. Pathologic stage T2 and stage T3 patients were 88.7% and 9.7% of all cases, respectively. The pathologic Gleason score was 7 or greater in 62.3%. Our overall positive surgical margin rate was 3.3%. Patients with pathologic T2 and T3 disease had a positive surgical margin rate of 1.8% and 16.7%, respectively. CONCLUSIONS: Our study suggests that RALP can have equal if not better pathologic outcomes compared to open radical prostatectomy even during the initial series of cases. We argue that the learning curve for RALP is shorter than previously thought with respect to oncologic outcomes, and concerns asserting that lack of tactile feedback leads to poor oncologic outcomes are unfounded.

  2. Laparoscopic Radical Cystectomy: a 5-year review of a single institute's operative data and complications and a systematic review of the literature

    Directory of Open Access Journals (Sweden)

    Omar M. Aboumarzouk

    2012-06-01

    Full Text Available OBJECTIVE: We aim to evaluate our experience and results with laparoscopic radical cystectomy and conduct a systematic review of studies reporting on 50 or more procedures. MATERIALS AND METHODS: Between February 2006 and March 2011, a prospective study in a single institute on patients with bladder cancer who underwent laparoscopic radical cystectomy was conducted. A search of the Cochrane Library, PubMed, Medline, and Scopus databases was conducted for studies reporting on 50 or more laparoscopic radical cystectomy procedures to compare with our results. RESULTS: Sixty men and five women underwent laparoscopic radical cystectomy during the 5-year study period. Thirty-nine patients were submitted to ileal conduits, 24 to neobladders, and two patients to ureterocutaneostomies. The mean operative time was 294 ± 27 minutes, the mean blood loss was 249.69 ± 95.59 millilitres, the mean length of hospital stay was 9.42 ± 2 days, the mean morphine requirement was 3.69 ± 0.8 days. The overall complication rate was 44.6% (29/65. However, the majority of the patients with complications (90% (26/29 had minor complications treated conservatively with no further surgical intervention needed. The literature search found seven studies, which reported on their institutions' laparoscopic radical cystectomy results of 50 or more patients. Generally, our results were similar to other reported studies of the same calibre. CONCLUSION: Laparoscopic radical cystectomy is a safe and efficient modality of treatment of bladder cancer. However, it comes with a steep learning curve, once overcome, can provide an alternative to open radical cystectomy.

  3. Total Laparoscopic Hysterectomy Versus Total Abdominal Hysterectomy:a Retrospective Comparison of Clinical Effects and Sexual Functions%腹腔镜与开腹全子宫切除术的临床疗效和对性功能影响的比较

    Institute of Scientific and Technical Information of China (English)

    周莹莹; 应小燕

    2014-01-01

    Objective To investigate two different hysterectomy ( total abdominal hysterectomy and total laparoscopic hysterectomy ) on short-term efficacy and influence on sexual functions . Methods The retrospective records of 100 cases of total laparoscopic hysterectomy ( TLH) and 100 cases of total abdominal hysterectomy ( TAH) from January 2009 to December 2012 were reviewed.The operation time, intraoperative blood loss, postoperative hospital stay, and sexual satisfaction at 12 months postoperatively were compared between the two groups . Results The operation time was longer in the TLH Group than that in the TAH Group [(128 ±11) min vs.(87 ±33) min, t=-11.787, P=0.000].The intraoperative blood loss was less in the TLH Group than that in the TAH Group [(108 ±37) ml vs.(155 ±28) ml, t=-10.129, P=0.000].The hospital stay was shorter in the TLH Group than that in the TAH Group [(5.5 ±1.9) d vs.(8.2 ±1.6) d, t =-10.870, P =0.000].There were no significant differences between the two groups in sexual frequency (Z=-1.300, P=0.193), libido (Z=-0.564, P=0.573), achievement of orgasm (Z =-1.591, P=0.112), sexual intercourse disorder (Z =-0.478, P =0.633), and the overall satisfaction (Z=-0.083, P=0.934).Extent of dyspareunia was worse in the TLH Group than in the TAH Group (Z=-3.752, P=0.000). Conclusions TLH has less blood loss and shorter hospitalization time than TAH .Hysterectomy has a certain influence on sex functions .Differences in the sexual satisfaction are not statistically significant between the two procedures .%目的:比较腹腔镜下全子宫切除术( total laparoscopic hysterectomy ,TLH)和开腹全子宫切除术( total abdominal hysterectomy ,TAH)的临床效果及对性功能的影响。方法回顾性分析2009年1月~2012年12月TLH和TAH各100例的临床资料,比较2组手术时间、术中出血量、住院时间及术后12个月性生活满意度等。结果 TLH手术时间明显长于TAH组[(128±11)min vs.(87±33

  4. The new era of minimally invasive interventions for prostate cancer: robot-assisted laparoscopic radical prostatectomy and focal therapy

    Directory of Open Access Journals (Sweden)

    Schatloff O

    2011-10-01

    Full Text Available Oscar Schatloff1, Alyssa S Louis2, Uri Lindner21Global Robotics Institute, Florida Hospital Celebration Health, Celebration, FL, USA; 2Division of Urology, Department of Surgical Oncology, University Health Network, Toronto, ON, CanadaAbstract: Prostate cancer remains a common but highly treatable disease. Innovations in prostate cancer treatment have allowed a transition toward minimally invasive approaches in an attempt to avoid treatment-related morbidities. In the middle of the treatment spectrum between radical open surgeries and active surveillance lies robot-assisted laparoscopic radical prostatectomy (RALP and focal therapy (FT. This review sets out the most current information on RALP and FT (including laser ablation, cryotherapy, high-intensity focused ultrasound, photodynamic therapy, and irreversible electroporation.Keywords: PCa, RALP, FT, laser ablation, cryotherapy, high-intensity focused ultrasound, photodynamic therapy, irreversible electroporation

  5. The "halo effect" in Korea: change in practice patterns since the introduction of robot-assisted laparoscopic radical prostatectomy.

    Science.gov (United States)

    Sung, Ee-Rah; Jeong, Wooju; Park, Sung Yul; Ham, Won Sik; Choi, Young Deuk; Hong, Sung Joon; Rha, Koon Ho

    2009-03-01

    Acquisition of the da Vinci surgical system (Intuitive Surgical, Mountain View, USA) has enabled robot-assisted surgery to become an acceptable alternative to open radical prostatectomy (ORP). Implementation of robotics at a single institution in Korea induced a gradual increase in the number of performances of robot-assisted laparoscopic radical prostatectomy (RALP) to surgically treat localized prostate cancer. We analyzed the impact of robotic instrumentation on practice patterns among urologists and explain the change in value in ORP and RALP-the standard treatment and the new approach or innovation of robotic technology. The overall number of prostatectomies has increased over time because the number of RALPs has grown drastically whereas the number of OPRs did not decrease during the period of evaluation. Our experience emphasizes the potential of RALP to become the gold standard in the treatment of localized prostate cancer in various parts of the world.

  6. Fast-track surgery protocol in elderly patients undergoing laparoscopic radical gastrectomy for gastric cancer: a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Liu G

    2016-06-01

    Full Text Available Guozheng Liu,1 Fengguo Jian,2 Xiuqin Wang,2 Lin Chen1 1Department of General Surgery, Chinese PLA General Hospital, Beijing, People’s Republic of China; 2Second Department of General Surgery, Changyi People’s Hospital, Shandong, People’s Republic of China Aim: To study the efficacy of the fast-track surgery (FTS program combined with laparoscopic radical gastrectomy for elderly gastric cancer (GC patients.Methods: Eighty-four elderly patients diagnosed with GC between September 2014 and August 2015 were recruited to participate in this study and were divided into four groups randomly based on the random number table as follows: FTS + laparoscopic group (Group A, n=21, FTS + laparotomy group (Group B, n=21, conventional perioperative care (CC + laparoscopic group (Group C, n=21, and CC + laparotomy group (Group D, n=21. Observation indicators include intrasurgery indicators, postoperative recovery indicators, nutritional status indicators, and systemic stress response indicators.Results: Preoperative and intraoperative baseline characteristics showed no significant differences between patients in each group (P>0.05. There were no significant differences between each group in nausea and vomiting, intestinal obstruction, urinary retention, incision infection, pulmonary infection, and urinary tract infection after operation (P>0.05. Time of first flatus and postoperative hospital stay time of FTS Group A were the shortest, and total medical cost of this group was the lowest. For all groups, serum albumin, prealbumin, and transferrin significantly decreased, while CRP and interleukin 6 were significantly increased postoperative day 1. From postoperative day 4–7, all indicators of the four groups gradually recovered, but compared with other three groups, those of Group A recovered fastest.Conclusion: FTS combined with laparoscopic surgery can promote faster postoperative recovery, improve early postoperative nutritional status, and more

  7. Evaluating the oncologic outcomes in 152 patients undergoing extraperitoneal laparoscopic radical prostatectomy

    Institute of Scientific and Technical Information of China (English)

    LI Xun-gang; QU Fa-jun; WANG Jun-kai; CHEN Ming; CHEN Jie; CHEN Lu; WANG Kai; ZHANG Dong-xu; CUI Xin-gang; XU Dan-feng; HONG Yi; LI Yao; GAO Yi; LIU Yu-shan; YIN Lei

    2012-01-01

    Background Although many midterm oncologic data have been reported for extraperitoneal laparoscopic radical prostatectomy (ELRP) in westem countries,few oncologic data of the extraperitoneal procedure was published in China.The aim of the study was to evaluate the oncologic outcomes of patients treated with ELRP in China.Methods From January 2005 to March 2010,a total of 152 consecutive patients diagnosed with clinically localized prostate cancer were included in this study and treated with ELRP.The patients were staged according to the TNM (tumor,nodes,metastases) system.Median and mean postoperative follow-up were 28.1 months and 27.0 months,respectively.The patients were retrospectively analyzed for progression-free survival.Results One hundred and twelve cases (73.7%) were postoperatively diagnosed as pT2 in,and 40 cases (26.3%) as pT3.Positive lymph nodes were shown in 5 patients (3.3%).Gleason score was <7 in 49 men (32.2%),7 in 69 men (45.4%),and >7 in 34 men (22.4%).Positive surgical margins (PSM) were observed in 15 patients (9.9%),which included 32.0% of all pT3a cases and 46.7% of all pT3b cases,respectively.The overall prostate-specific antigen recurrence-free survival rate was 86% in all patients.The recurrence-free survival rates were 91.8% and 62.2% in pT2N0 patients and pT3N0 patients,respectively.Preoperative prostate-specific antigen,surgical margins,tumor stage,and lymph nodal status were identified as independent predictors of biochemical recurrence-free survival using multivariate Cox proportional hazard model.Conclusions ELRP is a precise,safe and effective procedure at this particular Chinese institution.The prognostic power of prostate-specific antigen relapse after ELRP is not identical to that described previously with transperitoneal or open retropubic approaches.

  8. Incidence of pelvic organ prolapse repair subsequent to hysterectomy

    DEFF Research Database (Denmark)

    Lykke, Rune; Blaakær, Jan; Ottesen, Bent

    2017-01-01

    INTRODUCTION AND HYPOTHESIS: The aim of this study was to compare the incidence of subsequent pelvic organ prolapse (POP) repair in women following radical hysterectomy versus total abdominal hysterectomy. METHODS: From the Danish National Patient Registry, we collected data on all radical...

  9. Clinical comparison of robotic-assisted and traditional laparoscopic hysterectomy%机器人及传统腹腔镜全子宫切除术的临床比较

    Institute of Scientific and Technical Information of China (English)

    孙小单; 袁勇

    2015-01-01

    Objective To compare the clinical data of robotic-assisted laparoscopic hysterectomy (RALH)and traditional laparoscopic hysterectomy (LH)and to explore the advantages of robotic surgery system.Methods A retrospective analysis of patients in Jilin Province Tumor Hospital Department 2 of Gynecologic Oncology from Oct.2014 to Dec.2014 undergoing RALH (n =30)was carried out.A matched group of 30 patients undergoing LH (n =30)was selected as the control group.The operating time,blood loss,postoperative 24 hours drainage,postoperative bowel recovery time and postoperative hospitalization length were observed.Results The blood loss was significantly less in patients with robotic laparoscopic group,postoperative bowel recovery time and hospital stay were shorter than the laparoscopic group,The operating time was slightly longer than the laparoscopic group,the two sets of data were significantly different (P 0.05).Conclusion Robotic-assisted laparoscopy is feasible and safe,worthy of promotion for less bleeding,less damage,faster recovery,less pain for patients and shortens the mean length of stay.%目的:比较机器人辅助与传统腹腔镜两种手术方式行全子宫切除术的临床资料,探讨机器人手术系统的优势。方法回顾性分析吉林省肿瘤医院妇科肿瘤二科2014年10月至2014年12月使用机器人辅助腹腔镜下全子宫切除术(RALH)30例(机器人组),并选取同期与之匹配的采用传统腹腔镜全子宫切除术(LH)30例为腹腔镜组,观察数据包括两组的手术时间、术中出血量、术后24 h 引流量、术后首次排气时间及术后住院天数等。结果两组比较,机器人组术中出血量明显少于腹腔镜组,术后首次排气时间及住院时间均短于腹腔镜组,手术时间略长于腹腔镜组,差异有统计学意义(P <0.05);术后24 h 引流量比较,差异无统计学意义(P >0.05)。结论机器人辅助腹腔镜手术具备术中

  10. Comparison of oncological results and functional outcomes of radical prostatectomy techniques – retropubic, laparoscopic and robot-assisted

    Directory of Open Access Journals (Sweden)

    E. A. Prilepskaya

    2015-01-01

    Full Text Available Radical prostatectomy (RP continues to be the «gold standard» in the treatment of localized prostate cancer (PC for patients with a life expectancy of 10 years.The purpose of this article is to review pertinent literature to the several surgical approaches for PC and compare both functional outcomes and oncological results of radical retropubic prostatectomy (RRP, laparoscopic radical prostatectomy (LRP and robot-assisted radical prostatectomy (RARP. We chose and systematically reviewed 44 articles published between 1999 and 2013. Comparison analysis showed that the mean blood loss during RRP, LRP and RARP was 935, 442 and 191 ml respectively. Intraoperative transfusion required 19,9; 6,3 and 4,6 % patients respectively. We’d like to outline in our functional outcomes that within the 6-months and 12-months period of follow-up acute urinary retention experienced 89,1 and 92,7 % patients undergoing RARP.However, lack of certain data and absence of standard assessment methods made objective evaluation of erectile function quite complex. Oncologic results revealed that positive surgical margin rates were higher for RARP in comparison to patients after RRP and LRP (the difference was statistically significant.Nevertheless, the absence of randomized approach in an overwhelming majority of cases, as well as the short follow-up period are serious deterrents limiting the number of such trials. Therefore it’s still impossible today to draw certain conclusions about the superiority of any surgical approach for RP

  11. Clinical assessment for three routes of hysterectomy

    Institute of Scientific and Technical Information of China (English)

    ZHU Lan; LANG Jing-he; LIU Chun-yan; SHI Hong-hui; SUN Zhi-jing; FAN Rong

    2009-01-01

    Background Hysterectomy is a very common surgery in gynecology. Ideal surgery for hysterectomy is microinvasive with few complications. There are three major routes of hysterectomy that are currently used. The aim of this study was to identify the differences of peri-operative outcome among the patients who underwent the three different approaches.Methods One hundred and one women undergoing hysterectomy for myoma had the procedure performed by laparoscopic assisted vaginal hysterectomy (LAVH), total vaginal hysterectomy (TVH) or total abdominal hysterectomy (TAH) in a randomized study. We compared the course of peri-operative and post-operative outcome for the three different approaches. Results were evaluated by linear regression analysis, Fishers exact test and Student's t test for independent samples.Results The operation time among the three procedures was not significantly different (P >0.05). The amount of blood loss in the TVH group was less than in the LAVH and TAH groups (P<0.05). The pain score 3 hours after operation in the LAVH group was significantly lower than in the TAH and TVH groups (P<0.001). The pain scores in the LAVH and TVH groups were lower than in the TAH group at 24 and 48 hours after operation (P<0.01). The women who underwent LAVH and TVH had a shorter hospitalization stay (P <0.001). The highest body temperature after operation in the TAH group was higher than that in LAVH and TVH groups (P <0.001).Conclusions LAVH and TVH are better procedures for women requiring hysterectomy. The peri-operative and post-operative courses of TVH are better than LAVH, excluding the pain score 3 hours after operation. Vaginal hysterectomy is the most cost-effective approach but the final choice for the route of hysterectomy can depend on many factors such as gynecological disease, patients' health status and experiences of the gynecologist.

  12. An unexpected resident in the ileum detected during robot-assisted laparoscopic radical cystoprostatectomy and intracorporeal Studer pouch formation: Taenia saginata parasite.

    Science.gov (United States)

    Canda, Abdullah Erdem; Asil, Erem; Balbay, Mevlana Derya

    2011-02-01

    A case of moving ileal Taenia saginata parasites is presented with demonstrative images. We came across the parasites surprisingly while performing robot-assisted laparoscopic radical cystoprostatectomy with intracorporeal Studer pouch urinary diversion. We recommend stool sample evaluation in the preoperative period for possible presence of intestinal parasitic diseases, particularly in patients with bladder cancer who are admitted from areas with an increased incidence of intestinal parasitic diseases, before opening the bowel segments during surgery to perform radical cystectomy and urinary diversion.

  13. Quality of life and sexuality in disease-free survivors of cervical cancer after radical hysterectomy alone: A comparison between total laparoscopy and laparotomy.

    Science.gov (United States)

    Xiao, Meizhu; Gao, Huiqiao; Bai, Huimin; Zhang, Zhenyu

    2016-09-01

    The aim of the present study was to evaluate the possible differences between total laparoscopy and laparotomy regarding their impact on postoperative quality of life and sexuality in disease-free cervical cancer survivors who received radical hysterectomy (RH) and/or lymphadenectomy alone and were followed for >1 year.We reviewed all patients with cervical cancer who had received surgical treatment in our hospital between January 2001 and March 2014. Consecutive sexually active survivors who received RH and/or lymphadenectomy for early stage cervical cancer were enrolled and divided into 2 groups based on surgical approach. Survivors were interviewed and completed validated questionnaires, including the European Organization for Research Treatment of Cancer Quality-of-Life Core Questionnaire including 30 items, the Cervical Cancer-Specific Module of European Organization for Research Treatment of Cancer Quality-of-Life Questionnaire including 24 items (EORTC QLQ-CX24), and the Female Sexual Function Index (FSFI).In total, 273 patients with histologically confirmed cervical cancer were retrospectively reviewed. However, only 64 patients had received RH and/or lymphadenectomy alone; 58 survivors meeting the inclusion criteria were enrolled, including 42 total laparoscopy cases and 16 laparotomy cases, with an average follow-up of 46.1 and 51.2 months, respectively. The survivors in the 2 groups obtained good and similar scores on all items of the European Organization for Research Treatment of Cancer Quality-of-Life Core Questionnaire including 30 items and Cervical Cancer-Specific Module of European Organization for Research Treatment of Cancer Quality-of-Life Questionnaire including 24 items, without significant differences after controlling for covariate background characteristics. To the date of submission, 21.4% (9/42) of cases in the total laparoscopy group and 31.2% (5/16) of cases in the laparotomy group had not resumed sexual behavior after RH. Additionally

  14. A comparison of radical perineal, radical retropubic, and robot-assisted laparoscopic prostatectomies in a single surgeon series.

    Science.gov (United States)

    Mirza, Moben; Art, Kevin; Wineland, Logan; Tawfik, Ossama; Thrasher, J Brantley

    2011-01-01

    Objective. We sought to compare positive surgical margin rates (PSM), estimated blood loss (EBL), and quality of life outcomes (QOL) among perineal (RPP), retropubic (RRP), and robot-assisted laparoscopic (RALP) prostatectomies. Methods. Records from 463 consecutive men undergoing RPP (92), RRP (180), or RALP (191) for clinically localized prostate cancer were retrospectively reviewed. Age, percent tumor volume, Gleason score, stage, EBL, PSM, and QOL using the expanded prostate cancer index composite (EPIC) were compared. Results. PSM were similar when adjusted for stage, grade, and volume. EBL was significantly less in the RALP (189 ml) group compared to both RPP (475 ml) and RRP (999 ml) groups. When corrected for nerve sparing, there were no differences in erectile function and sexual function amongst the three groups. Urinary summary and pad usage scores showed no significant differences. Conclusion. RPP, RRP, and RALP offer similar surgical and QOL outcomes. RALP and RPP demonstrate less EBL compared to RRP.

  15. Pediatric robot-assisted laparoscopic radical adrenalectomy and lymph-node dissection for neuroblastoma in a 15-month-old.

    Science.gov (United States)

    Uwaydah, Nabeel I; Jones, Alex; Elkaissi, Mahmoud; Yu, Zhongxin; Palmer, Blake W

    2014-09-01

    Neuroblastoma (NB) is the most common extra-cranial solid tumor in children and the most common malignancy in infants, with complete resection being curative in low-stage disease. The previous standard of treatment for many abdominal NBs involving the adrenal gland had been open surgery; however, there have been numerous descriptions of the safety and feasibility of a laparoscopic approach to resect adrenal masses in the pediatric population in benign and malignant disease, including improved cosmetic results, decreased length of stay, decreased surgical morbidity, and comparable oncological outcomes to open surgery. Despite these reported advantages over open surgery, the newer robot-assisted laparoscopy (RAL) offers benefits over the conventional laparoscopic approach that could further improve outcomes and expand the use of minimally invasive surgical approaches for pediatric adrenal masses. RAL offers many additional advantages over conventional laparoscopy, such as 3D visualization, increased range of motion of surgical instruments, tremor control, and a shorter learning curve compared with traditional laparoscopic surgery, while still maintaining the advantages of minimally invasive surgery. The body of literature concerning robot-assisted oncological surgery involving the adrenal gland in children is quite small, and to our knowledge no case reports have been published describing robot-assisted removal of an adrenal NB in a pediatric patient. We present our experience and technique of an RAL approach for lymph-node dissection and radical resection of a low-stage NB involving the adrenal gland with no image-defined risk factors in a 15-month-old infant.

  16. Factors influencing women's decision making in hysterectomy.

    Science.gov (United States)

    Janda, Monika; Armfield, Nigel R; Page, Katie; Kerr, Gayle; Kurz, Suzanne; Jackson, Graeme; Currie, Jason; Weaver, Edward; Yazdani, Anusch; Obermair, Andreas

    2017-09-12

    To explore factors influencing how well-informed women felt about hysterectomy, influences on their decision making, and on them receiving a less-invasive alternative to open surgery. Online questionnaire, conducted in 2015-2016, of women who had received a hysterectomy in Australia, in the preceding two years. Questionnaires were completed by 2319/6000 women (39% response). Most women (n=2225; 96%) felt well-informed about hysterectomy. Women were more aware of the open abdominal approach (n=1798; 77%), than of less-invasive vaginal (n=1552; 67%), laparoscopic (n=1540; 66%), laparoscopic-assisted (n=1303; 56%), and robotic approaches (n=289; 12%). Most women (n=1435; 62%) reported their gynaecologist was the most influential information source. Women who received information about hysterectomy from a GP (OR=1.47; 95% CI 1.15-1.90), or from a gynaecologist (OR=1.3; 95% CI 1.06-1.58), were more likely to feel better informed (p<0.01). This study is important because it helps clinicians, researchers and health policy makers to understand why many women still receive an open abdominal approach despite many learned societies recommending to avoid it if possible. Additional information, or education about avoiding open abdominal approach where possible may lead to a greater number of women receiving less-invasive types of hysterectomy in the future. Crown Copyright © 2017. Published by Elsevier B.V. All rights reserved.

  17. Laparoscopic repair of vesicovaginal fistula

    Directory of Open Access Journals (Sweden)

    Miłosz Wilczyński

    2011-06-01

    Full Text Available A vesicovaginal fistula is one of the complications that a gynaecologist is bound to face after oncological operations, especially in postmenopausal women. Over the years there have been introduced many techniques of surgical treatment of this entity, including transabdominal and transvaginal approaches.We present a case of a 46-year-old patient who suffered from urinary leakage via the vagina due to the presence of a vesicovaginal fistula that developed after radical abdominal hysterectomy and subsequent radiotherapy. The decision was made to repair it laparoscopically due to retracted, fibrous and scarred tissue in the vaginal apex that precluded a transvaginal approach. A small cystotomy followed by an excision of fistula borders was performed. After six-month follow-up no recurrence of the disease has been noted.We conclude that laparoscopy is an interesting alternative to traditional approaches that provides comparable results.

  18. Clinical Application of Laparoscopic Subtotal Hysterectomy on Uterine Myoma%腹腔镜下子宫次全切除术治疗子宫肌瘤的临床应用

    Institute of Scientific and Technical Information of China (English)

    吴淑卿; 黄锦华; 李芸

    2011-01-01

    Objective: To evaluate the clinical value of laparoscopic subtotal hysterectomy (LSH) on u-terine myoma. Method: A retrospective cohort study was conduted using existing data on 83 cases of LSH, and 65 cases of ASH were performed on patients with uterine myoma from Oct. 2005 to Oct. 2010 in our hospital. The operation time, blood loss , fart time , the use of the PCA pumps, hospital stay were compared between the two groups. Result: No significant difference was found in the average operating time between the LSH group and ASH group ( P > 0.05 ). While the LSH group had advantages of less blood loss, less use of the PCA pumps , shorter hospital stay and fart time than the ASH group (P<0.01 ). No major complication occurred in both groups. Both of the groups had one case of CIN in two years after the operations. Conclusion: LSH is an effective and safe procedure for the treatment of uterine myoma.%目的:探讨腹腔镜子宫次全切除术(laparoscopic subtotal hysterectomy,LSH)治疗子宫肌瘤的临床应用价值.方法:对2005年10月至2010年10月因子宫肌瘤在我院行腹腔镜下子宫次全切除术或腹式子宫次全切除术(abdominal subtotal hysterectomy,ASH)患者作回顾性分析,观察组为腹腔镜下子宫次全切除术患者83例,对照组为同期行腹式子宫次全切除术患者65例,比较两组患者手术时间、术中出血量、肛门排气时间、术后镇痛泵使用率、术后住院时间、术中脏器损伤情况.结果:两组患者手术时间无显著差异(P>0.05),研究组术中出血量较少、术后镇痛泵使用率较低,术后肛门排气时间较早,术后住院时间较短,与对照组相比较均有统计学差异(P<0.01),两组术中均无脏器损伤,术后2年内各有1例宫颈CIN病变.结论:腹腔镜下子宫次全切除术是一种安全、可靠的手术方式,适用于子宫肌瘤的手术治疗.

  19. A comparison of abdominal and vaginal hysterectomies in Benghazi, Libya.

    Science.gov (United States)

    Agnaeber, K; Bodalal, Z

    2013-08-01

    We performed a comparative study between abdominal and vaginal hysterectomies using clinical data from Al-Jamhouria hospital (one of the largest maternity hospitals in Eastern Libya). Various parameters were taken into consideration: the rates of each type (and their subtypes); average age of patients; indications; causes; postoperative complications; and duration of stay in the hospital afterwards. Conclusions and recommendations were drawn from the results of this study. In light of the aforementioned parameters, it was found that: (1) abdominal hysterectomies were more common than vaginal hysterectomies (p < 0.001); (2) patients admitted for abdominal hysterectomies are younger than those admitted for vaginal hysterectomies (p < 0.001); (3) the most common indication for an abdominal hysterectomy was menstrual disturbances, while for vaginal hysterectomies it was vaginal prolapse; (4) the histopathological cause for abdominal and vaginal hysterectomies were observed and the most common were found to be leiomyomas and atrophic endometrium; (5) there was no significant difference between the two routes in terms of postoperative complications; (6) patients who were admitted for abdominal hysterectomies spent a longer amount of time in the hospital (p < 0.01). It was concluded that efforts should be made to further pursue vaginal and laparoscopic hysterectomies as a viable option to the more conventional abdominal route.

  20. Perioperative outcome of initial 190 cases of robot-assisted laparoscopic radical prostatectomy - A single-center experience

    Directory of Open Access Journals (Sweden)

    P N Dogra

    2012-01-01

    Full Text Available Objective: To analyze the perioperative outcome of the first 190 cases of robot-assisted laparoscopic radical prostatectomy performed at our center from July 2006 to December 2010. Materials and Methods: Operative and recovery data for men with localized prostate cancer undergoing robot-assisted radical prostatectomy at our center were reviewed. All surgeries were performed using the 4-arm da Vinci-S surgical robot. Preoperative data included age, body mass index (BMI, prostate specific antigen (PSA level, prostate weight, biopsy Gleason score and TNM staging, while operative and recovery data included total operative time, estimated blood loss, complications, hospital stay and catheter time. These parameters were evaluated for the safety and efficacy of this procedure in our center. Results: The mean age of our patients was 65 ± 1.2 years. The mean BMI was 25.20 ± 2.88 and the median PSA was 14.8 ng/ml. Majority of our patients belonged to clinical stage T2 (51.58%. The mean total operative time was 166.44 ± 11.5 min. Six patients required conversion to open procedure and there was one rectal injury. The median estimated blood loss was 302 ± 14.45 ml and the median duration of hospital stay was 4 days. The overall margin positivity rate was 12.63%. Conclusion: Despite our limited robotic surgery experience, our perioperative outcome and complication rate is comparable to most contemporary series. Robot-assisted laparoscopic prostatectomy (RALP is easy to learn and provides the patient with the benefits of minimally invasive surgery with minimal perioperative morbidity.

  1. Cranial-to-caudal approach for radical lymph node dissection along the surgical trunk in laparoscopic right hemicolectomy.

    Science.gov (United States)

    Matsuda, Takeru; Iwasaki, Takeshi; Mitsutsuji, Masaaki; Hirata, Kenro; Maekawa, Yoko; Tanaka, Tomoko; Shimada, Etsuji; Kakeji, Yoshihiro

    2015-04-01

    Complete mesocolic excision with central vascular ligation is considered to contribute to superior oncological outcomes after colon cancer surgery [1]. For advanced right-sided colon cancer, this surgery sometimes requires lymph node (LN) dissection along the superior mesenteric vein (SMV), with division of the middle colic vessels, or their right branches, at origin [2]. Here, we present cranially approached radical LN dissection along the surgical trunk during laparoscopic right hemicolectomy. The omental bursa is first opened wide, and the gastrocolic trunk of Henle is exposed, using the right gastroepiploic vessels and the accessory right colic vein (ARCV) as landmarks. After division of ARCV, SMV and middle colic vein (MCV) are identified. After dividing MCV at its root, LN dissection along SMV is conducted in a cranial-to-caudal manner. Concurrently, the middle colic artery, or its right branch, is exposed and divided at origin. The transverse colon is then raised ventrally, and LN dissection along SMV using a cranial-to-caudal approach is again performed. The ileocolic and right colic vessels are divided at origin. The ascending and transverse mesocolon, including the pedicles, are then separated from the retroperitoneal tissues, pancreatic head, and duodenum, using a medial approach. The key characteristics in this procedure consist of easy access to pancreas, early division of ARCV and middle colic vessels at origin, and easy dissection along SMV. We performed a laparoscopic colectomy using this approach for 18 patients with right-sided colon cancer. The mean operative time and blood loss were 288 min and 83 ml, respectively. The mean number of harvested LNs was 24. There were 6 cases with positive LN metastasis. There were no recurrent cases at a median follow-up period of 24 months. We consider this approach to be safe and useful for radical LN dissection along SMV for right-sided colon cancers.

  2. Robotic-assisted laparoscopic radical prostatectomy: The Ohio State University technique.

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    Patel, Vipul R; Shah, Ketul K; Thaly, Rahul K; Lavery, Hugh

    2007-03-01

    Robotic radical prostatectomy is a new innovation in the surgical treatment of prostate cancer. The technique is continuously evolving. In this article we demonstrate The Ohio State University technique for robotic radical prostatectomy. Robotic radical prostatectomy is performed using the da Vinci surgical system. The video demonstrates each step of the surgical procedure. Preliminary results with robotic prostatectomy demonstrate the benefits of minimally invasive surgery while also showing encouraging short-term outcomes in terms of continence, potency and cancer control. Robotic radical prostatectomy is an evolving technique that provides a minimally invasive alternative for the treatment of prostate cancer. Our experience with the procedure now stands at over 1,300 cases.

  3. Synchronous Laparoscopic Radical Nephrectomy Left and Contralateral Right Hemicolectomy during the Same Endoscopic Procedure

    OpenAIRE

    2011-01-01

    Synchronous renal cell carcinoma in patients with colorectal carcinoma is reported in various percentages ranging from 0.03 up to 4.85% (Halak et al. (2000), Capra et al. (2003)). When surgical treatment is indicated usually two separate operations are planned for resection. In open surgery, in such cases simultaneous resection is recommended if possible. Few reports have described the resection of colorectal and renal cell carcinoma in a single laparoscopic procedure. We have shown that comb...

  4. Perioperative outcomes of laparoscopic radical nephrectomy for renal cell carcinoma in patients with dialysis-dependent end-stage renal disease.

    Science.gov (United States)

    Yamashita, Kaori; Ito, Fumio; Nakazawa, Hayakazu

    2012-06-01

    The aims of this study were: (i) to analyze the perioperative outcomes of laparoscopic radical nephrectomy for renal cell carcinoma in patients with dialysis-dependent end-stage renal disease and (ii) to reveal perioperative management problems that are unique to these patients. Between June 2004 and June 2011, laparoscopic radical nephrectomy was performed in 39 patients who had renal cell carcinoma and dialysis-dependent end-stage renal disease. The operative outcomes of these patients were compared with the operative outcomes of 104 non-end-stage renal disease patients with sporadic renal cell carcinoma who underwent laparoscopic radical nephrectomy during the same period. Laparoscopic surgery was completed in thirty-eight end-stage renal disease patients. One patient was converted to open surgery because of an intraoperative injury to the inferior vena cava. This patient was excluded from the analysis. The mean operative time was 240 min; blood loss, 157 mL; and postoperative hospital stay, 9.6 days. Postoperative complications were observed in six patients, as follows: retroperitoneal hematoma and abscess in one patient, thrombosis of the arteriovenous fistula in three patients, pneumonia in one patient, and gastrointestinal bleeding in one patient. Eleven patients required blood transfusions. There was no significant difference between the end-stage renal disease patients and the non-end-stage renal disease patients in the mean operative time or the amount of blood loss. In conclusion, laparoscopic radical nephrectomy is feasible for dialysis-dependent end-stage renal disease patients, as well as for non-end-stage renal disease patients; however, end-stage renal disease patients may have a higher probability of experiencing non-life-threatening complications.

  5. A Comparison of Radical Perineal, Radical Retropubic, and Robot-Assisted Laparoscopic Prostatectomies in a Single Surgeon Series

    Directory of Open Access Journals (Sweden)

    Moben Mirza

    2011-01-01

    Full Text Available Objective. We sought to compare positive surgical margin rates (PSM, estimated blood loss (EBL, and quality of life outcomes (QOL among perineal (RPP, retropubic (RRP, and robot-assisted laparoscopic (RALP prostatectomies. Methods. Records from 463 consecutive men undergoing RPP (92, RRP (180, or RALP (191 for clinically localized prostate cancer were retrospectively reviewed. Age, percent tumor volume, Gleason score, stage, EBL, PSM, and QOL using the expanded prostate cancer index composite (EPIC were compared. Results. PSM were similar when adjusted for stage, grade, and volume. EBL was significantly less in the RALP (189 ml group compared to both RPP (475 ml and RRP (999 ml groups. When corrected for nerve sparing, there were no differences in erectile function and sexual function amongst the three groups. Urinary summary and pad usage scores showed no significant differences. Conclusion. RPP, RRP, and RALP offer similar surgical and QOL outcomes. RALP and RPP demonstrate less EBL compared to RRP.

  6. Study on the change of metabolic indexes and digestive enzymes of patients with laparoscopic radical gastrectomy for gastric cancer during the perioperative period

    Institute of Scientific and Technical Information of China (English)

    Wen-Tao He; Jun Huang; Na Hu

    2016-01-01

    Objective:To investigate the influence degree of laparoscopic radical gastrectomy for gastric cancer on the related body indexes during the perioperative period, including metabolic indexes and digestive enzymes.Methods:A total of 70 patients with gastric cancer who received treatment during the time of January 2014 to November 2015 in our hospital were divided into two groups by the method of random number table, 35 patients with gastric cancer in control group were treated with open radical gastrectomy, 35 patients with gastric cancer in observation group were treated with laparoscopic radical operation, then the proteometabolism and digestive enzymes indexes at different time before and after the operations of two groups were detected and compared.Results:The differences of detection results of two groups before the operation were not obvious, while the related indexes of proteometabolism of observation group at first, third, seventh and fourteenth day after the operation were all higher than those of control group, and the related indexes of digestive enzymes were all better than those of control group, which were all obviously different.Conclusion: The influence of laparoscopic radical gastrectomy on the fluctuation of the metabolic indexes and digestive enzymes of patients during the perioperative period are relatively smaller, and the postoperative recovery of patients are relatively better.

  7. Effect of serum testosterone and percent tumor volume on extra-prostatic extension and biochemical recurrence after laparoscopic radical prostatectomy

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    Eu Chang Hwang

    2016-01-01

    Full Text Available Several studies have revealed that the preoperative serum testosterone and percent tumor volume (PTV predict extra-prostatic extension (EPE and biochemical recurrence (BCR after radical prostatectomy. This study investigated the prognostic significance of serum testosterone and PTV in relation to EPE and BCR after laparoscopic radical prostatectomy (LRP. We reviewed 520 patients who underwent LRP between 2004 and 2012. PTV was determined as the sum of all visually estimated tumor foci in every section. BCR was defined as two consecutive increases in the postoperative prostate-specific antigen (PSA >0.2 ng ml−1 . The threshold for serum total testosterone was 3.0 ng ml−1 . Multivariate logistic regression was used to define the effect of variables on the risk of EPE and BCR. A low serum testosterone (<3.0 ng ml−1 was associated with a high serum PSA, Gleason score, positive core percentage of the prostate biopsy, PTV, and all pathological variables. On multivariate analysis, similar to previous studies, the serum PSA, biopsy positive core percentage, Gleason score, and pathological variables predicted EPE and BCR. In addition, low serum testosterone (<3.0 ng ml−1 , adjusted OR, 8.52; 95% CI, 5.04-14.4, P= 0.001 predicted EPE and PTV (adjusted OR, 1.02; 95% CI, 1.01-1.05, P= 0.046 predicted BCR. In addition to previous predictors of EPE and BCR, low serum testosterone and PTV are valuable predictors of EPE and BCR after LRP.

  8. Histerectomia Laparoscópica em um Hospital Geral Comunitário Experiência Inicial e Comparação de Custos Hospitalares Laparoscopic Hysterectomy in a Community General Hospital Initial Experience and Comparison of Hospital Costs

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    Randal Henrique de Oliveira

    2000-03-01

    Full Text Available Objetivo: comparar os custos hospitalares entre a histerectomia vaginal assistida por laparoscopia (HVAL e a histerectomia total abdominal (HTA, relatando a experiência inicial com a nova abordagem em um hospital geral comunitário. Pacientes e Métodos: foram comparados 11 casos de HVAL e 23 de HTA, realizados de setembro de 1998 a julho de 1999. Prontuários e demonstrativos das despesas hospitalares de cada paciente foram revistos para coletar as variáveis analisadas. Resultados: não houve diferença estat��stica entre os grupos quanto à idade, paridade e cirurgia abdominal prévia. A principal indicação cirúrgica para ambos os grupos foi leiomiomatose uterina. O grupo das HVAL apresentou tempo de internação menor, com mediana de 1 dia e o das HTA, de 2 dias (pPurpose: to compare hospital costs between laparoscopically assisted vaginal hysterectomy (LAVH and total abdominal hysterectomy (TAH, reporting the initial experience with the new approach in a communitary general hospital. Patients and Methods: eleven cases of LAVH and 23 of TAH, carried out from September 1998 to July 1999, were compared. Each patient's records and hospital charges were reviewed to collect the analyzed variables. Results: there was no statistical difference between the groups in relation to age, parity, and previous abdominal surgery. The main surgical indication for both groups was uterine leiomyomatosis. The LAVH group presented a shorter hospital stay with a median of one day, and the TAH group, of two days (p<0.01. LAVH showed to be 40.2% more expensive than TAH (p<0.01. Operating room charges contributed to the major part of hospital costs for both groups, corresponding to 79.8 and 57.9% of the total, for LAVH and TAH, respectively. LAVH infirmary charges were smaller than for TAH, with a statistically significant difference (p = 0.002. Conclusion: with shorter hospital stay and smaller infirmary costs, we demonstrated that LAVH provides better

  9. Initial validation of a training program focused on laparoscopic radical nephrectomy.

    Science.gov (United States)

    Enciso, S; Díaz-Güemes, I; Serrano, Á; Bachiller, J; Rioja, J; Usón, J; Sánchez-Margallo, F M

    2016-05-01

    To assess a training model focused on laparoscopic nephrectomy. 16 residents participated in the study, who attended a training program with a theoretical session (1hour) and a dry (7hours) and a wet lab (13hours). During animal training, the first and last nephrectomies were assessed through the completion time and the global rating scale "Objective and Structured Assessment of Technical Skills" (OSATS). Before and after the course, they performed 3 tasks on the virtual reality simulator LAPMentor (1) eye-hand coordination; 2) hand-hand coordination; and 3) transference of objects), registering time and movement metrics. All participants completed a questionnaire related to the training components on a 5-point rating scale. The participants performed the last nephrectomy faster (P<.001) and with higher OSATS scores (P<.001). After the course, they completed the LAPMentor tasks faster (P<.05). The number of movements decreased in all tasks (1) P<.001, 2) P<.05, and 3) P<.05), and the path length in tasks 1 (P<.05) and 2 (P<.05). The movement speeds increased in tasks 2 (P<.001) and 3 (P<.001). With regards to the questionnaire, the usefulness of the animal training and the necessity of training on them prior to their laparoscopic clinical practice were the questions with the highest score (4.92±.28). The combination of physical simulation and animal training constitute an effective training model for improving basic and advanced skills for laparoscopic nephrectomy. The component preferred by the urology residents was the animal training. Copyright © 2015 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

  10. Robot-assisted hysterectomy for endometrial and cervical cancers: a systematic review.

    Science.gov (United States)

    Nevis, Immaculate F; Vali, Bahareh; Higgins, Caroline; Dhalla, Irfan; Urbach, David; Bernardini, Marcus Q

    2017-03-01

    Total and radical hysterectomies are the most common treatment strategies for early-stage endometrial and cervical cancers, respectively. Surgical modalities include open surgery, laparoscopy, and more recently, minimally invasive robot-assisted surgery. We searched several electronic databases for randomized controlled trials and observational studies with a comparison group, published between 2009 and 2014. Our outcomes of interest included both perioperative and morbidity outcomes. We included 35 observational studies in this review. We did not find any randomized controlled trials. The quality of evidence for all reported outcomes was very low. For women with endometrial cancer, we found that there was a reduction in estimated blood loss between the robot-assisted surgery compared to both laparoscopy and open surgery. There was a reduction in length of hospital stay between robot-assisted surgery and open surgery but not laparoscopy. There was no difference in total lymph node removal between the three modalities. There was no difference in the rate of overall complications between the robot-assisted technique and laparoscopy. For women with cervical cancer, there were no differences in estimated blood loss or removal of lymph nodes between robot-assisted and laparoscopic procedure. Compared to laparotomy, robot-assisted hysterectomy for cervical cancer showed an overall reduction in estimated blood loss. Although robot-assisted hysterectomy is clinically effective for the treatment of both endometrial and cervical cancers, methodologically rigorous studies are lacking to draw definitive conclusions.

  11. Laparoscopic versus open radical cystectomy for elderly patients over 75-year-old: a single center comparative analysis.

    Directory of Open Access Journals (Sweden)

    Shuxiong Zeng

    Full Text Available PURPOSE: To explore the morbidity, mortality and oncological results of laparoscopic radical cystectomy (LRC in the elderly patients over 75-year-old in contrast with open radical cystectomy (ORC. MATERIALS AND METHODS: We analyzed 46 radical cystectomies from January 2009 to December 2013 in patients over 75-year-old in our institute, 21 patients in the LRC group and 25 in the ORC group. Demographic parameters, operative variables and perioperative outcome were retrospectively collected and analyzed between the two groups. Perioperative morbidity and mortality were categorized as early (within 90 days after surgery or late (more than 90 days according to the time of occurrence. RESULTS: Patients in both groups had comparable preoperative characteristics. A significant longer operative time (418 vs. 337 min, p = 0.018 and less estimated blood loss (400 vs. 500 ml p = 0.038 were observed in LRC group compared with ORC group. Infection and ileus were the most common early complications after surgery. Patients underwent ORC suffered from significantly more postoperative ileus (28.0% vs. 4.8%, P = 0.038 and infection (40% vs. 9.5%, P = 0.019 than LRC group within 90 days after surgery. The mortality rate was 4.7% (1/21 and 4% (1/25 for LRC group and ORC group respectively. At a median follow-up of 21 months (range 2-61 months, the Kaplan-Meier survival curves and log-rank analysis demonstrate that there were no significant differences between the LRC and ORC groups in the 3-year overall, cancer-specific, or recurrence-free survival rates. CONCLUSIONS: It is suggested that LRC should be recommended as the primary intervention to treat muscle invasive or high risk non-muscle invasive bladder cancer in elderly patients with a relative long life expectancy.

  12. Robot-assisted laparoscopic radical prostatectomy with early retrograde release of the neurovascular bundle and endopelvic fascia sparing

    Science.gov (United States)

    de Albuquerque, George Augusto Monteiro Lins; Guglielmetti, Giuliano Betoni; Cordeiro, Maurício Dener; Nahas, William Carlos; Coelho, Rafael Ferreira

    2017-01-01

    ABSTRACT Introduction Robotic-assisted radical prostatectomy (RAP) is the dominant minimally invasive surgical treatment for patients with localized prostate cancer. The introduction of robotic assistance has the potential to improve surgical outcomes and reduce the steep learning curve associated with conventional laparoscopic radical prostatectomy. The purpose of this video is to demonstrate the early retrograde release of the neurovascular bundle without open the endopelvic fascia during RAP. Materials and Methods A 51-year old male, presenting histological diagnosis of prostate adenocarcinoma, Gleason 6 (3+3), in 4 cores of 12, with an initial PSA=3.41ng/dl and the digital rectal examination demonstrating a prostate with hardened nodule in the right lobe of the prostate base (clinical stage T2a). Surgical treatment with the robot-assisted technique was offered as initial therapeutic option and the critical technical point was the early retrograde release of the neurovascular bundle with endopelvic fascia preservation, during radical prostatectomy. Results The operative time was of 89 minutes, blood loss was 100ml. No drain was left in the peritoneal cavity. The patient was discharged within 24 hours. There were no intraoperative or immediate postoperative complications. The pathological evaluation revealed prostate adenocarcinoma, Gleason 6, with free surgical margins and seminal vesicles free of neoplastic involvement (pathologic stage T2a). At 3-month-follow-up, the patient lies with undetectable PSA, continent and potent. Conclusion This is a feasible technique combining the benefits of retrograde release of the neurovascular bundle, the preservation of the pubo-prostatic collar and the preservation of the antero-lateral cavernous nerves. PMID:27802002

  13. Anastomotic complications after robot-assisted laparoscopic and open radical prostatectomy

    DEFF Research Database (Denmark)

    Jacobsen, André; Berg, Kasper Drimer; Iversen, Peter

    2016-01-01

    Objective Anastomotic complications are well known after radical prostatectomy (RP). The vesicourethral anastomotic technique is handled differently between open and robotic RP. The aim of the study was to investigate whether the frequency of anastomotic leakages and strictures differed between...... patients undergoing retropubic radical prostatectomy (RRP) and robot-assisted radical prostatectomy (RARP) and to identify risk factors associated with these complications. Materials and methods The study included 735 consecutive patients who underwent RRP (n = 499) or RARP (236) at the Department...... of Urology, Rigshospitalet, Denmark, in a complete 3 year period from 2010 to 2012. Univariate and multivariate logistic regression analysis was used to analyse associations between surgical procedure (RRP vs RARP) and anastomotic complications. Analyses included age, smoking status, diabetes, hypertension...

  14. Emergency peripartum hysterectomy

    DEFF Research Database (Denmark)

    Jakobsson, Maija; Tapper, Anna Maija; Colmorn, Lotte Berdiin

    2015-01-01

    OBJECTIVE: To assess the prevalence and risk factors of emergency peripartum hysterectomy. DESIGN: Nordic collaborative study. POPULATION: 605 362 deliveries across the five Nordic countries. METHODS: We collected data prospectively from patients undergoing emergency peripartum hysterectomy withi...

  15. Transperitoneal versus extraperitoneal laparoscopic radical prostatectomy during the learning curve: does the surgical approach affect the complication rate?

    Directory of Open Access Journals (Sweden)

    Tiberio M. Siqueira Jr.

    2010-08-01

    Full Text Available Purpose: To compare the perioperative complication rate obtained with the transperitoneal laparoscopic radical prostatectomy (TLRP and with the extraperitoneal LRP (ELRP during the learning curve (LC. Materials and Methods: Data of the initial 40 TLRP (Group 1 were retrospectively compared with the initial 40 ELRP (Group 2. Each Group of patients was operated by two different surgeons. Results: The overall surgical time (175 min x 267.6 min; p < 0.001 and estimated blood loss (177.5 mL x 292.4 mL; p < 0.001 were statistically better in the Group 1. Two intraoperative complications were observed in Group 1 (5% represented by one case of bleeding and one case of rectal injury, whereas four complications (10% were observed in Group 2, represented by two cases of bleeding, one bladder and one rectal injuries (p = 0.675. Open conversion occurred once in each Group (2.5%. Overall postoperative complications were similar (52.5% x 35%; p = 0.365. Major early postoperative complications occurred in three and in one case in Group 1 and 2, respectively. Group 1 had two peritonitis (fecal and urinary, leading to one death in this group. Conclusions: No statistical differences in overall complication rates were observed. The transperitoneal approach presented more serious complications during the early postoperative time and this fact is attributed to the potential chance of intraperitoneal peritonitis not observed with the extraperitoneal route.

  16. Role of short-term antibiotic therapy at the moment of catheter removal after laparoscopic radical prostatectomy.

    Science.gov (United States)

    Pinochet, Rodrigo; Nogueira, Lucas; Cronin, Angel M; Katz, Darren; Rabbani, Farhang; Guillonneau, Bertrand; Touijer, Karim

    2010-01-01

    To assess the role of short-term antibiotic therapy (ABT) in preventing urinary tract infection (UTI) after catheter removal following laparoscopic radical prostatectomy (LRP). 729 consecutive patients underwent LRP by one of two surgeons. One surgeon systematically prescribed a 3-day course of ABT (ciprofloxacin) starting the day before catheter removal; the other surgeon did not. The groups were compared for the incidence of symptomatic UTI occurring within 6 weeks after catheter removal. ABT was given to 261 of 713 patients (37%), while the remaining 452 patients (63%) did not receive ABT. After catheter removal, UTI was observed less frequently among patients receiving ABT: 3.1 vs. 7.3% in those not receiving ABT (p = 0.019). A number needed to treat to prevent 1 UTI is 24. Hospital readmission for febrile UTI was observed only in patients who did not receive ABT (n = 5, 1.1 vs. 0%, p = 0.16). One would need to prescribe ABT for 91 LRP patients to prevent 1 case of febrile UTI. ABT at the time of catheter removal reduced the risk of postoperative UTI after LRP. One would need to prescribe ABT to 24 patients to prevent 1 case of UTI. Copyright © 2010 S. Karger AG, Basel.

  17. Laparoscopic vs open radical nephroureterectomy for upper urinary tract urothelial cancer: oncological outcomes and 5-year follow-up.

    Science.gov (United States)

    Greco, Francesco; Wagner, Sigrid; Hoda, Rashid M; Hamza, Amir; Fornara, Paolo

    2009-11-01

    To compare the oncological outcomes of laparoscopic radical nephroureterectomy (LNU) vs open NU (ONU) for upper urinary tract transitional cell carcinoma (TCC). Between July 1999 and January 2003, we performed 70 LNUs and 70 ONUs for TCC of the upper urinary tract. ONU was reserved for patients with previous abdominal surgery or with severe cardiac and/or pulmonary problems. Demographic data, tumour staging and histological grading and rates of metastasis were recorded and compared. For LNU and ONU the mean operative durations were 240 min and 190 min, respectively. The definitive pathology showed a high incidence of tumour stage pT2 G2 in both LNU and ONU groups. The median follow-up was 60 months. In the LNU group, the 5-year disease-free survival (DFS) was 75%: 100% for pTa, 88% for pT1, 78% for pT2, and 35% for pT3 (P ONU group, the 5-year DFS was 73% (LNU vs ONU, P = 0.037): 100% for pTa, 89% for pT1, 75% for pT2 and 31% for pT3 (P ONU in the therapy of upper urinary tract urothelial cancer.

  18. Current Issues with Hysterectomy.

    Science.gov (United States)

    Barker, Matthew A

    2016-09-01

    Hysterectomy is one of the most common gynecologic surgeries. Early adoption of surgical advancements in hysterectomies has raised concerns over safety, quality, and costs. The risk of potential leiomyosarcoma in women undergoing minimally invasive hysterectomy led the US Food and Drug Administration to discourage the use of electronic power morcellator. Minimally invasive hysterectomies have increased substantially despite lack of data supporting its use over other forms of hysterectomy and increased costs. Health care reform is incentivizing providers to improve quality, improve safety, and decrease costs through standardized outcomes and process measures.

  19. Laparoscopic radical lymph node dissection for advanced colon cancer close to the hepatic flexure.

    Science.gov (United States)

    Uematsu, Dai; Akiyama, Gaku; Sugihara, Takehiko; Magishi, Akiko; Yamaguchi, Takuya; Sano, Takayuki

    2017-02-01

    Complete mesocolic excision is currently recognized as a standard procedure for colon cancer. Gastroepiploic, infrapyloric, and superficial pancreatic head lymph node metastases in the gastrocolic ligament have been reported for colon cancer close to the hepatic flexure. We sought to investigate metastases in the gastrocolic ligament in colon cancer close to the hepatic flexure. This was a single-center retrospective study. All patients with T2 or deeper invasive colon cancer in the relevant tumor location who underwent laparoscopic right hemicolectomy or extended right hemicolectomy at our institution between 1 April 2011 and 31 March 2015 were included. Lymph node dissection in the gastrocolic ligament was performed in 35 cases. Complications occurred in 11 patients (31%) and were grades I and II according to the Clavien-Dindo classification. Lymph node metastases in the gastrocolic ligament were found in only three patients (9%). Each metastasis was larger than 9 mm. Metastases in the gastrocolic ligament occurred in 9% of patients with T2 or deeper invasive colon cancer close to the hepatic flexure. Laparoscopy was feasible and useful during gastrocolic ligament resection. This study included a small sample and lacked an extended follow-up. Further studies are needed to determine the clinical relevance of this finding, particularly in terms of recurrence and long-term survival. © 2016 Japan Society for Endoscopic Surgery, Asia Endosurgery Task Force and John Wiley & Sons Australia, Ltd.

  20. Association Between Body Mass Index, Uterine Size, and Operative Morbidity in Women Undergoing Minimally Invasive Hysterectomy.

    Science.gov (United States)

    Shah, Divya K; Van Voorhis, Bradley J; Vitonis, Allison F; Missmer, Stacey A

    Although the selection of an approach to minimally invasive hysterectomy is relatively straightforward in an ideal patient scenario, it is more difficult in patients who pose operative challenges such as high body mass index (BMI) and enlarged uteri. The objective of this study was to explore the association between surgical approach and operative morbidity after minimally invasive hysterectomy and examine whether the association varies based on patient BMI and uterine size. Retrospective cohort (Canadian Task Force classification II-2). Data abstracted from the American College of Surgeons National Safety and Quality Improvement Project registry. Thirty-six thousand seven hundred fifty-seven women undergoing vaginal, laparoscopic-assisted vaginal, or total laparoscopic hysterectomy for benign indications between January 2005 and December 2012. Associations between surgical approach, BMI, and operative morbidity were examined, stratifying by uterine size (250 g) and adjusting for covariates. Adjusted means, rate ratios, or odds ratios with 95% confidence intervals (CI) were calculated using linear, Poisson, or logistic regression. Operative times were shortest in women undergoing vaginal hysterectomy regardless of BMI or uterine size (all p hysterectomy; increasing BMI had a minimal impact on operative time with small uteri 250 g. Compared with vaginal hysterectomy, total laparoscopic hysterectomy had lower odds of blood transfusion (all p obese women with small uteri; women with uteri 40 kg/m(2) had 76% lower odds of blood transfusion (95% CI, 0.10-0.54) and 18% shorter hospitalization (95% CI, 0.75-0.90) after laparoscopic hysterectomy compared with vaginal hysterectomy. Major operative morbidity after minimally invasive hysterectomy is rare regardless of the surgical approach. A vaginal approach to hysterectomy is associated with the shortest operative times, but increasing BMI results in a rapid escalation of operative time in women with large uteri

  1. Changes in pathologic outcomes and operative trends with robot-assisted laparoscopic radical prostatectomy

    Directory of Open Access Journals (Sweden)

    Aaron Bernie

    2014-01-01

    Full Text Available Introduction: We hypothesized that there is a reverse stage migration, or a shift toward operating on higher-risk prostate cancer, in patients undergoing robot-assisted laparoscopic prostatectomy (RALP. We therefore evaluated the stage of disease at the time of surgery for patients with prostate cancer at a large tertiary academic medical center. Materials and Methods: After institutional review board approval, we reviewed all patients that had undergone robotic prostatectomy. These patients were separated into three categories: An early era of 2005-2008, intermediate era of 2009-2010, and a current era of 2011-2012. Results: A total of 3451 patients underwent robotic prostatectomy from 2005 to 2012. The proportion men with clinical T1 tumors declined from 88.3% in the early era to 72.2% in the current era (P < 0.0001. Men with preoperative biopsy Gleason 6 disease decreased from the early to the current era (P < 0.0001, while men with preoperative biopsy Gleason ≥ 8 showed the opposite trend, increasing from the early to the current era (P = 0.0002. From the early to the current era, the proportion of patients with National Comprehensive Cancer Network (NCCN low risk prostate cancer decreased, while those with NCCN intermediate and high-risk disease increased. The proportion of pathologic T3 disease increased from 15.5% in the early to 30.6% in the current era (P < 0.0001. On the other hand, the proportion of pathologic T2/+ SMS (surgical margin status decreased from 6.6% in the early era to 3.1% in the current era (P = 0.0002. Conclusions: We have demonstrated a reverse stage migration in men undergoing robotic prostatectomy. Despite the increasing proportion of men with extra-capsular disease undergoing RALP, the surgical margin status has remained similar. This could reflect both the changing dynamics of the population opting for surgery as well as the learning curve of the surgeons.

  2. Unidirectional barbed suture versus standard monofilament for urethrovesical anastomosis during robotic assisted laparoscopic radical prostatectomy

    Directory of Open Access Journals (Sweden)

    Marc Manganiello

    2012-02-01

    Full Text Available PURPOSE: V-LocTM180 (Covidien Healthcare, Mansfield, MA is a new unidirectional barbed suture that may reduce loss of tension during a running closure. We evaluated the use of the barbed suture for urethrovesical anastomosis (UVA during robotic assisted laparoscopic prostatectomy (RALP. Time to completion of UVA, post-operative anastomotic leak rate, and urinary incontinence were compared in patients undergoing UVA with 3-0 unidirectional-barbed suture vs. 3-0 MonocrylTM (Ethicon, Somerville, NJ. MATERIALS AND METHODS: Data were prospectively collected for 70 consecutive patients undergoing RALP for prostate cancer between November 2009 and October 2010. In the first 35 patients, the UVA was performed using a modified running van Velthoven anastomosis technique using two separate 3-0 monofilament sutures. In the subsequent 35 patients, the UVA was performed using two running novel unidirectional barbed sutures. At 7-12 days postoperatively, all patients were evaluated with a cystogram to determine anastomotic integrity. Urinary incontinence was assessed at two months and five months by total daily pad usage. Clinical symptoms suggestive of bladder neck contracture were elicited. RESULTS: Age, PSA, Gleason score, prostate size, estimated blood loss, body mass index, and clinical and pathologic stage between the 2 groups were similar. Comparing the monofilament group and V-LocTM180 cohorts, average time to complete the anastomosis was similar (27.4 vs. 26.4 minutes, p = 0.73 as was the rate of urinary extravasation on cystogram (5.7 % vs. 8.6%, p = 0.65. There were no symptomatic bladder neck contractures noted at 5 months of follow-up. At 2 months, the percentage of patients using 2 or more pads per day was lower in the V-LocTM180 cohort (24% vs. 44%, p < 0.02. At 5 months, this difference was no longer evident. CONCLUSIONS: Time to complete the UVA was similar in the intervention and control groups. Rates of urine leak were also comparable

  3. [First 24 Japanese cases of robotic-assisted laparoscopic radical prostatectomy using the daVinci Surgical System].

    Science.gov (United States)

    Yoshioka, Kunihiko; Hatano, Tadashi; Nakagami, Yoshihiro; Ozu, Choichiro; Horiguchi, Yutaka; Sakamoto, Noboru; Yonov, Hiroyuki; Ohno, Yoshio; Ohori, Makoto; Tachibana, Masaaki; Patel, Vipul R

    2008-05-01

    In Japan, as of September 2007, prostatectomy is conducted with open surgical procedures in more than 90% of the cases. Following the first reported robotic prostatectomy by Binder, et al. in 2000, a robotic-assisted laparoscopic radical prostatectomy (RALP) using the daVinci Surgical System (Intuitive Surgical, Inc., Sunnyvale, California, USA) has been extensively used as a standard procedure with gratifying results in the United States. In the Asian region, in contrast, RALP is still in an introductory phase. Recently, we introduced RALP in Japan. A total of 24 patients received robotic surgery within a year since August 2006. RALP was completed in all patients without conversion to open surgery, except for the first patient in whom a restriction to a 2-hour operation had been imposed by the Ethical Committee. The mean operative time using the daVinci device and the mean estimated blood loss were 232.0 (range; 136-405) minutes and 313.0 (range; 10-1,000) ml, respectively. The training program we recently developed proved remarkably effective in reducing the learning curve of robotic surgery in Japan, where there is no person with expertise in this operating procedure. In particular, the intraoperative guidance given by the expert was useful after relevant problematic points were delineated by operators who received comprehensive video-based image training and actually performed robot surgery in several cases. With direct intraoperative guidance by the mentor during cases 13 and 14, both the operation time and estimated blood loss was markedly reduced.

  4. Effect of deep anesthesia on blood gas and immune function in patients undergoing laparoscopic radical gastrectomy for gastric cancer

    Institute of Scientific and Technical Information of China (English)

    Zhen Wang; Xiao-Fan Li; Hui Wang; Zhi-Jun Mao; Tong Xue; Rui Yang

    2016-01-01

    Objective:To investigate the effects of deep anesthesia on blood gas and immune function in patients undergoing laparoscopic radical gastrectomy for gastric cancer. Methods:A total of 84 gastric cancer patients in our hospital were randomly divided into observation group (42 cases) and control group (42 cases). Patients in observation group were treated by deep anesthesia, while the control group was treated with shallow anesthesia. The blood gas was observed and compared before and after CO2 pneumoperitoneum, and the immune function was observed and compared before anesthesia, after operation and 72 h post-operation. Results:The PaCO2 and pH level of patients in the two groups had no significant difference before pneumoperitoneum;Compared with before pneumoperitoneum, no obvious blood gas change was observed in the observation group, the difference had no statistically significant;Blood gas level of control group was significantly higher than that of before pneumoperitoneum , the difference was statistically significant, pH (7.26±0.07) was statistically decreased;After pneumoperitoneum, the level of PaCO2 and pH was significantly different in both groups , the difference was statistically significant. Indexes of the patients in the observation and control group of CD3+, CD4+, CD4+/CD8+, NK level had no significant difference before anesthesia, the difference was not statistically significant;The immunology index of CD3+, CD4+, CD4+/CD8+and NK cell levels of the postoperative patients in both groups were significantly lower than before anesthesia, and the differences were statistically significant, but each index in the observation group decreased significantly less than that of the control group, the difference was statistically significant;The immunological indexes can be restored to before anesthesia postoperative 72 h with two groups, and had no significant difference. Conclusion:The blood gas analysis index was stable and the immune function was suppressed in

  5. Utility of anteroposterior diameter ratio of tumor and abdomen for laparoscopic approach for radical nephrectomy in large renal masses.

    Science.gov (United States)

    Yadav, Priyank; Srivastava, Devarshi; Arakere, Sachin; Gupta, Shashikant; Aga, Pallavi; Mandhani, Anil

    2017-08-07

    Laparoscopic radical nephrectomy (LRN) is now increasingly done for tumors larger than 10 cm. Despite selection of favorable cases, LRN may not be successful due to lack of adequate working space with large tumors. We describe a new feature on Contrast Enhanced Computed Tomography (CECT) abdomen to predict feasibility of LRN for large renal masses between 10 and 15 cm. From January 2005 to December 2015, renal tumors between 10 and 15 cm were selected retrospectively for LRN. Patients with retroperitoneal lymphadenopathy, Inferior vena cava (IVC) thrombus and involvement of adjacent organs were excluded. Anteroposterior (AP) diameter ratio of renal tumor and abdomen (APROTA) was calculated by dividing the maximum AP diameter of tumor along with normal renal parenchyma, by the AP diameter of abdomen on CECT. The patients were stratified into two groups: Group A (successful LRN) and Group B (conversion to open surgery) and outcomes were compared. The reasons for conversion were also noted. Of 29 patients, 16 (55.2%) had successful LRN (Group A), while 13 (44.8%) had conversion to open surgery (group B). The median tumor size in Group A was 11.3 ± 1.8 cm and in Group B was 13.6 ± 1.26 cm. Eleven of 13 patients had conversion due to large tumor size causing failure to progress. Two conversions were due to bleeding and injury to the colon each. There was a significant difference in the APROTA in group A and B [0.43 ± 0.09 in group A and 0.64 ± 0.14 in group B (p = 0.0001)]. Patients with APROTA of more than 0.65 are unlikely to have successful outcome with LRN.

  6. Impact of prior abdominal surgery on the outcomes after robotic - assisted laparoscopic radical prostatectomy: single center experience

    Directory of Open Access Journals (Sweden)

    Nozomu Kishimoto

    Full Text Available ABSTRACT Purpose: To evaluate the influence of prior abdominal surgery on the outcomes after robotic-assisted laparoscopic radical prostatectomy (RALP. Materials and Methods: We retrospectively analyzed patients with prostate cancer who underwent RALP between June 2012 and February 2015 at our institution. Patients with prior abdominal surgery were compared with those without prior surgery while considering the mean total operating, console, and port-insertion times; mean estimated blood loss; positive surgical margin rate; mean duration of catheterization; and rate of complications. Results: A total of 203 patients who underwent RALP during the study period were included in this study. In all, 65 patients (32% had a prior history of abdominal surgery, whereas 138 patients (68% had no prior history. The total operating, console, and port-insertion times were 328 and 308 (P=0.06, 252 and 242 (P=0.28, and 22 and 17 minutes (P=0.01, respectively, for patients with prior and no prior surgery. The estimated blood losses, positive surgical margin rates, mean durations of catheterization, and complication rates were 197 and 170 mL (P=0.29, 26.2% and 20.2% (P=0.32, 7.1 and 6.8 days (P=0.74, and 12.3% and 8.7% (P=0.42, respectively. Furthermore, whether prior abdominal surgery was performed above or below the umbilicus or whether single or multiple surgeries were performed did not further affect the perioperative outcomes. Conclusions: Our results suggest that RALP can be performed safely in patients with prior abdominal surgery, without increasing the risk of complications.

  7. Chronic pain after hysterectomy

    DEFF Research Database (Denmark)

    Brandsborg, B.; Nikolajsen, L.; Kehlet, H.;

    2008-01-01

    BACKGROUND: Chronic pain is a well-known adverse effect of surgery, but the risk of chronic pain after gynaecological surgery is less established. METHOD: This review summarizes studies on chronic pain following hysterectomy. The underlying mechanisms and risk factors for the development of chronic...... post-hysterectomy pain are discussed. RESULTS AND CONCLUSION: Chronic pain is reported by 5-32% of women after hysterectomy. A guideline is proposed for future prospective studies Udgivelsesdato: 2008/3...

  8. Chronic pain after hysterectomy

    DEFF Research Database (Denmark)

    Brandsborg, B; Nikolajsen, L; Kehlet, Henrik;

    2008-01-01

    BACKGROUND: Chronic pain is a well-known adverse effect of surgery, but the risk of chronic pain after gynaecological surgery is less established. METHOD: This review summarizes studies on chronic pain following hysterectomy. The underlying mechanisms and risk factors for the development of chronic...... post-hysterectomy pain are discussed. RESULTS AND CONCLUSION: Chronic pain is reported by 5-32% of women after hysterectomy. A guideline is proposed for future prospective studies. Udgivelsesdato: 2008-Mar...

  9. Clinical Value of Laparoscopic Radical Parametrectomy in the Treatment of Unexpected Cervical Cancer%腹腔镜广泛宫旁切除术治疗意外发现宫颈癌

    Institute of Scientific and Technical Information of China (English)

    赵佳佳; 王武亮; 王晨阳

    2016-01-01

    Objective To investigate the safety and clinical effect of laparoscopic radical parametrectomy in the treatment of unexpected cervical cancer . Methods A retrospective analysis was made on clinical characteristics of 15 patients who were diagnosed as unexpected cervical cancer from January 2008 to December 2014.The age of the patients was between 29 and 67 years old, with an average of 43.9 years old.The indications for hysterectomy were cervical intraepithelial neoplasia (CIN) grade 2-3 in 7 cases, uterine myoma in 3 cases, dysfunctional uterine bleeding in 2 cases, uterine prolapse in 2 cases and adenomyosis in 1 case. Pathological results after the hysterectomy included 13 cases of cervical squamous carcinoma and 2 cases of adenocarcinoma .The lesions were all confined to the cervix , with 4 cases of stage ⅠA2 disease and 11 cases of stage ⅠB1 .The lymph-vascular space invasion was found in 4 cases.The operation interval between the two operations was 3-7 d (mean, 4.6 d).They were all given laparoscopic radical parametrectomy . Results The operation time was 212-285 min (mean, 249.6 min), and the blood loss was 250-500 ml ( mean, 376 ml) .Postoperative pathological findings showed no residual disease .Only one patient had left pelvic lymph node mestastasis .Two patients had intraoperative complications , including 1 bladder injury and 1 ureteral injury .There were 3 cases of postoperative complications , including 2 cases of uroschesis and 1 case of lymphocyst .The follow-up time was 6-84 months ( median, 48 months).No recurrence was seen.The 1-, 3-, 5-year survival rates were 100%, 93.3%, 86.7%, respectively. Conclusions Laparoscopic radical parametrectomy in the treatment of unexpected cervical cancer is difficult to perform and has more complications . This surgical method is applicable to those who refused postoperation radiotherapy or required retaining ovarian function .%目的:探讨腹腔镜广泛宫旁切除术

  10. [Hysterectomy for benign pathology: Guidelines for clinical practice].

    Science.gov (United States)

    Deffieux, X; de Rochambeau, B; Chêne, G; Gauthier, T; Huet, S; Lamblin, G; Agostini, A; Marcelli, M; Golfier, F

    2015-12-01

    The objective of the study was to provide guidelines for clinical practice from the French college of obstetrics and gynecology (CNGOF), based on the best evidence available, concerning hysterectomy for benign pathology. Each recommendation for practice was allocated a grade which depends on the level of evidence (guidelines for clinical practice method). Hysterectomy should be performed by a high volume surgeon (>10 procedures of hysterectomy per year) (grade C). Rectal enema stimulant laxatives are not recommended prior to hysterectomy (grade C). It is recommended to carry out vaginal disinfection using povidone iodine solution prior to an hysterectomy (grade B). Antibioprophylaxis is recommended during a hysterectomy, regardless of the surgical route (grade B). The vaginal or the laparoscopic routes are recommended for hysterectomy for benign pathology (grade B), even if the uterus is large and/or the patient is obese (grade C). The choice between these two surgical approaches depends on others parameters, such as the surgeon's experience, the mode of anesthesia and organizational constraints (operative duration and medico economic factors). Hysterectomy by vaginal route is not contraindicated in nulliparous women (grade C) or in women with previous c-section (grade C). No specific technique to achieve hemostasis is recommended with a view to avoid urinary tract injuries (grade C). In the absence of ovarian pathology and personal or family history of breast/ovarian carcinoma, it is recommended to conserve ovaries in pre-menopausal women (grade B). Subtotal hysterectomy is not recommended in order to diminish the risk of per- or postoperative complications (grade B). The application of these recommendations should minimize risks associated with hysterectomy. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  11. Effect of minimizing tension during robotic-assisted laparoscopic radical prostatectomy on urinary function recovery.

    Science.gov (United States)

    Kowalczyk, Keith J; Huang, Andy C; Hevelone, Nathanael D; Lipsitz, Stuart R; Yu, Hua-yin; Lynch, John H; Hu, Jim C

    2013-06-01

    Although most prostatectomy studies emphasize optimal nerve-sparing dissection planes, subtle technical variation also affects functional outcomes. The impact of minimizing assistant/surgeon tension on urinary function has not been quantified. We assess urinary function after attenuating neurovascular bundle (NVB) and rhabdosphincter tension during robotic-assisted radical prostatectomy (RARP). Retrospective study of prospectively collected data for 268 (RARP-T) versus 342 (RARP-0T) men with versus without tension on the NVB and rhabdosphincter during RARP. Outcomes compared include Expanded Prostate Cancer Index (EPIC) urinary function, estimated blood loss (EBL), operative time, and positive surgical margins (PSM). In unadjusted analysis, men undergoing RARP-T versus RARP-0T were older, had higher biopsy and pathologic Gleason grade, and higher preoperative prostate specific antigen (all p ≤ 0.023). Baseline urinary function was similar. Postoperatively, RARP-0T versus RARP-T was associated with higher 5-month urinary function scores (69.7 versus 64, p = 0.049). In adjusted analyses, RARP-0T versus RARP-T was associated with improved 5-month urinary function [Parameter Estimate (PE) 7.37, Standard Error (SE) 2.67, p = 0.006], while bilateral versus non-/unilateral nerve-sparing was associated with improved 12-month urinary function and continence (both p ≤ 0.035). RARP-0T versus RARP-T was associated with shorter operative times (PE 6.66, SE 1.90, p = 0.001) and higher EBL (PE 20.88, SE 6.49, p = 0.001). There were no significant differences in PSM. While the use of tension aids in dissection of anatomic planes, avoidance of NVB counter-traction and minimizing tension on the rhabdosphincter during apical dissection attenuates neuropraxia and leads to earlier urinary function recovery. Bilateral versus non-/unilateral nerve-sparing also improves urinary function recovery.

  12. 腹腔镜下子宫切除术治疗子宫腺肌病的临床疗效分析%Clinical Analysis of Laparoscopic Hysterectomy in the Treatment of Adenomyosis

    Institute of Scientific and Technical Information of China (English)

    余洋; 王和

    2013-01-01

    目的 探讨腹腔镜下子宫次全切除术(LSH)和子宫全切除术(LTH)治疗子宫腺肌病的临床疗效.方法 选取2010年1月至2011年9月,于本院行腹腔镜下子宫切除术治疗子宫腺肌病患者200例为研究对象.按照不同手术方式,将其分为LSH组(n=100)和LTH组(n=100).两组患者的年龄、合并症等比较,差异无统计学意义(P>0.05)(本研究遵循的程序符合本院人体试验委员会制定的伦理学标准,得到该委员会批准,分组征得受试对象同意,并与之签署临床研究知情同意书).对两组患者的手术指标(手术时间、术中出血量及术后输血情况),术后短期恢复指标(术后留置导尿管时间、安置负压引流量、肛门排气时间、术后疼痛评分及住院时间),远期随访指标(术后痛经缓解状况、性生活质量评价、日常生活质量评价、盆底组织支撑情况、宫颈残端病变及恶变率,以及是否存在术后持续周期性阴道少量出血)等进行对比分析,评价LSH和LTH治疗子宫腺肌病的疗效.结果 LSH组患者手术时间、术中出血量均较LTH组明显减少,两组比较,差异有统计学意义(P0.001);两组患者术后性生活质量及日常生活质量评价比较,差异亦无统计学意义(P>0.05).经腹腔镜治疗后,两组患者痛经症状均有效缓解,术后并发症发生率均较低.结论 LSH治疗子宫腺肌病优于LTH.%Objective To evaluate the clinic effects of laparoscopic subtotal hysterectomy (LSH) and laparoscopic total hysterectomy ( LTH) in treating adenomyosis. Methods From January 2010 to September 2011, a total of 200 cases with adenomyosis were included into this study. They were divided into two groups according to different operation methods, LSH group (n= 100) and LTH group (n= 100). There had no significant difference on age and complications between two groups (P>0. 05). The study protocol was approved by the Ethical Review Board of Investigation in Human Being of

  13. Laparoscopic assisted radical cystoprostatectomy with Y-shaped orthotopic ileal neobladder constructed with non-absorbable titanium staples through a 5 cm Pfannensteil incision

    Directory of Open Access Journals (Sweden)

    Sidney C. Abreu

    2005-08-01

    Full Text Available INTRODUCTION: We performed a laparoscopic radical cystoprostatectomy followed by constructing a Y-shaped reservoir extra-corporeally with titanium staples through a 5-cm muscle-splitting Pfannenstiel incision. SURGICAL TECHNIQUE: Upon completion of the extirpative part of the operation, the surgical specimen was entrapped and removed intact through a 5-cm Pfannenstiel incision. Through the extraction incision, the distal ileum was identified and a 40 cm segment isolated. With the aid of the laparoscope, the ureters were brought outside the abdominal cavity and freshened and spatulated for approximately 1.5-cm. Bilateral double J ureteral stents were then inserted up to the renal pelvis and the ureters were directly anastomosed to the open ends of the limbs of the neobladder. Following this, the isolated intestinal segment was arranged in a Y shape with two central segments of 14 cm and two limbs of 6 cm. The two central segments were brought together and detubularized, with two sequential firings of 80 x 3.5 mm and 60 x 3.5 mm non-absorbable mechanical stapler (Multifire GIA - US Surgical inserted through an opening made at the lowest point of the neobladder on its anti-mesenteric border. The neobladder was reinserted inside the abdominal cavity and anastomosed to the urethra with intracorporeal laparoscopic free-hand suturing. CONCLUSION: Although this procedure is feasible and the preliminary results encouraging, continued surveillance is necessary to determine the lithiasis-inducing potential of these titanium staples within the urinary tract.

  14. THE CLINICAL STUDY ON LAPAROSCOPIC RADICAL GASTRECTOMY FOR GASTRIC CANCER%腹腔镜胃癌根治手术的临床研究

    Institute of Scientific and Technical Information of China (English)

    李俊; 谭忆广; 周志涛; 毛常青; 吕培标; 钟国英; 王存川

    2011-01-01

    [目的]探讨腹腔镜胃癌根治手术的安全性、可行性及肿瘤根治性.[方法]选择2005年12月~2010年12月普外科行腹腔镜胃癌D2根治术35例为腹腔镜组,并选择同期开腹胃癌根治术40例为对照组,比较两组手术相关指标、肿瘤根治性指标及术后随访患者的生存率.[结果]腹腔镜组手术时间较对照组长,术中出血量较对照组少,切口长度较对照组短.差异具有统计学意义(均P<0.05);腹腔镜组术后排气时间、首次进流质时间及术后住院时间明显较对照组缩短(P<0.05),两组总并发症发生率比较差异无统计学意义(P>0.05);腹腔镜组肿瘤根治性指标淋巴结清扫数目、近远端切缘距离及1、3、5年生存率均与对照组差异无统计学意义(P>0.05).[结论]腹腔镜胃癌D2根治术是安全、可行的,能达到与开腹根治性全胃切除术相同的肿瘤根治性,且比开腹手术更具微创优势.%[Objective] To study the safety, feasibility and curative result of laparoscopic radical gastrectomy for gastric cancer. [Methods] 35 cases of laparoscopic radical gastrectomy for gastric cancer and 40 cases of open D2 radical gastrectomy were operated in our department from December 2005 to December 2010. The operative index, curative result index and survival rate in two groups were compared. [ Results] The operation time was longer, volume of bleeding was less, and the length of incision was shorter in laparoscopic radical gastrectomy group (P < 0.05) ; postoperative time of farting, the time of eating fluid and hospital stay were shorter in laparoscopic group compared to those in control group (P < 0.05). There was no significant difference in the rates of postoperative complications. The clear number of lymph node dissection , the proximal and distal margin from tumor and the 1-, 3-and 5-Y survival rate between the two groups were not different (P > 0.05). [ Conclusion] The laparoscopic D2 radical

  15. Safe laparoscopic removal of a 3200 gram fibroid uterus.

    Science.gov (United States)

    Demir, Richard H; Marchand, Gregory J

    2010-01-01

    Hysterectomy using minimally invasive techniques yields fewer complications, less blood loss, and quicker recovery time compared with traditional abdominal hysterectomy. Despite these advantages, 65% of all hysterectomies in the United States are still performed using traditional laparotomy, and many clinicians still exclude patients with a history of prior abdominal surgery, significant obesity, or a large fibroid uterus from these procedures. Among physicians skilled in minimally invasive surgery, the prior largest uteri removed included a 2421g uterus removed vaginally, and a 2418g uterus removed via hand-assisted laparoscopic hysterectomy. We performed a laparoscopic-assisted hysterectomy on a significantly obese 50-year-old woman with a 3200g uterus. The patient required a 2-day hospital stay and recovered unremarkably. The patient was able to return to work within one week and quickly returned to activities of daily life. In the hands of experienced minimally invasive surgeons, laparotomy can be avoided in almost all instances of hysterectomy for benign disease.

  16. Perioperative differences in open radical prostatectomy versus laparoscopic radical prostatectomy%开放和经腹腔镜前列腺癌根治术围手术期的临床差异分析

    Institute of Scientific and Technical Information of China (English)

    李雪梅; 季惠翔; 潘进洪; 方强; 周占松; 陈志文

    2013-01-01

    目的 探讨经腹腔镜前列腺癌根治术较开放性前列腺癌根治术围手术期的优点.方法 回顾分析2006年1月至2012年2月我科收治的75例前列腺癌患者的临床资料,对比开放性前列腺癌根治术与经腹腔镜前列腺癌根治术两组患者围术期的临床特征及并发症等.结果 经腹腔镜前列腺癌根治术组的患者术中出血量和总输血量以及住院时间显著低于开放性前列腺癌根治术组(P<0.05).开放性前列腺癌根治术组与经腹腔镜前列腺癌根治术组的总并发症分别为38.7%和18.2% (P <0.05),其中重度并发症分别为6.5%和4.5%(P>0.05).结论 经腹腔镜前列腺癌根治术因创伤小,术中出血量和围手术期输血量显著减少,总并发症率显著减少,最终可能节约了医疗资源.%Objective To determine the perioperative advantages in laparoscopic radical prostatectomy compared with open radical prostatectomy.Methods The perioperative clinical characteristics in both groups of laparoscopic radical prostatectomy and open radical prostatectomy were reviewed and statistically investigated.The complications related to operations were recorded and graded according to the severity grading system of surgical complications.Results The blood loss,transfusion and days of hospital stay were significantly less in the group of laparoscopic radical prostatectomy than in the group of open radical prostatectomy.The incidences of total complications were 38.7% vs 18.2%,and the incidences of severe complications were 6.5% vs 4.5% in the groups of open radical prostatectomy and laparoscopic radical prostatectomy,respectively.Conclusion The blood loss,transfusion,complications and days of hospital stay are decreased significantly in minimally invasive prostate cancer surgery.Thus the medical resource is saved eventually.

  17. Robotic hysterectomy strategies in the morbidly obese patient.

    Science.gov (United States)

    Almeida, Oscar D

    2013-01-01

    The purpose of this study was to present strategies for performing computer-enhanced telesurgery in the morbidly obese patient. This was a prospective, institutional review board-approved, descriptive feasibility study (Canadian Task Force classification II-2) conducted at a university-affiliated hospital. Twelve class III morbidly obese women with a body mass index of 40 kg/m(2) or greater were selected to undergo robotic-assisted total laparoscopic hysterectomy. Robotic-assisted total laparoscopic hysterectomy, classified as type IVE, with complete detachment of the cardinal-uterosacral ligament complex, unilateral or bilateral, with entry into the vagina was performed. The median estimated blood loss was 146.3 mL (range, 15-550 mL), the mean length of stay in the hospital was 25.3 hours (range, 23- 48 hours), and the complication rate was 0%. The rate of conversion to laparotomy was 8%. The median surgical time was 109.6 minutes (range, 99 -145 minutes). Robotic-assisted total laparoscopic hysterectomy can be a safe and effective method of performing hysterectomies in select morbidly obese patients, allowing them the opportunity to undergo minimally invasive surgery without increased perioperative complications.

  18. Laparoscopic radical cystectomy with orthotopic ileal neobladder:report of 9 cases%腹腔镜根治性膀胱切除及回肠原位新膀胱术(附9例报告)

    Institute of Scientific and Technical Information of China (English)

    卢猛; 程欢; 陈家存; 温儒民; 李望; 毛立军; 刘俊杰

    2013-01-01

    目的 性.术后9例日间尿控均良好,2例存在夜间尿失禁.术后随访2~8个月,1例出现新膀胱腹壁瘘,1例发生新膀胱前假性尿液囊肿,2例出现肾盂肾炎.结论 腹腔镜根治性膀胱切除加回肠原位新膀胱术具有切口小、损伤少、疼痛轻、出血少、术后恢复快等优势,将成为肌层浸润性膀胱癌的标准手术方式.%Objective To summarize the experience and benefits of laparoscopic radical cystectomy with orthotopic ileal neobladder for bladder cancer. Methods 9 patients with bladder cancer underwent laparoscopic radical eystectomy with orthotopic ileal neobladder. The surgical procedure included standard laparoscopic pelvic lymphadenectomy , radical resection of bladder , extracorporeal formation of ileal pouch , extracorporeal implantation of ureters , and laparoscopic urethra - neobladder anastomosis. Results Laparoscopic radical cystectomy was successfully performed in 9 patients with orthotopic ileal neobladder. No operations were converted to open surery and there was no peri -operative mortality. The mean operation time was 370 min and mean blood loss was 650 ml. No involvement of incisional edge was found in all the patients. Continence in all patients receiving neobladder was fully satisfactory during the day , 2 patients had urinary incontinence at night. The follow -up of 2 -8 months showed complications including 1 fistula between neobladder and abdominal wall, 1 secondary urinoma anterior neobladde and 2 pyelonephritis. Conclusion Laparoscopic radical cystectomy has the advantage of being minimally invasive , decreased blood loss and postoperative pain , as well as a shorter hospital stay and recovery. It will become a standard treatment of muscle -invasive bladder cancer.

  19. 通过腹腔镜子宫切除术(LH)和改良小切口经腹子宫切除术(MAH)切除巨大子宫的回顾性分析——子宫切除术手术路径的再评价%A Retrospective Series of Laparoscopic Hysterectomy (LH) and Modified Mini-laparotomy Abdominal Hysterectomy(MAH) for the Management of Enlarged Uterus-a Reappraisal of the Surgical Approach for Hysterectomy

    Institute of Scientific and Technical Information of China (English)

    Felix Wong; Eric Lee; 应小燕

    2011-01-01

    腹腔镜子宫切除术(laparoscopic hysterectomy,LH)自1989年引入临床,已经成为除了传统的经腹子宫切除术(abdominal hysterectomy,AH)的广泛的可以接受的另一种选择.一些随机对照试验表明LH与AH相比有它的优点,如恢复快、疼痛轻、住院时间短、近期生活质量高,而AH的优点在于手术时间短,若腹腔镜手术失败可作为一个后备的手术方案.通过对盆腔解剖有很好的了解而充分的术前评估,加之技术的成熟,作者(Felix Wong)用改良的小切口经腹子宫切除术(modified mini-laparotomy approach for abdominal hysterectomy,MAH)处理巨大子宫,体会在处理有潜在较复杂的病例中MAH可能更加适宜,如非常大的子宫平滑肌瘤或子宫重量超过500 g,尤其是当LH很难操作时或LH可能导致不适当的并发症时.在2006~2008年的回顾性分析中,MAH手术具有时间短、手术后止痛剂的使用少、术后感染率低的优点,尽管与LH相比,在做巨大子宫切除术时,MAH仍存在术中出血稍增加、手术后住院时间平均延长1.5 d的缺点.MAH伤口更小,疼痛更轻.本文显示MAH治疗增大的子宫的操作技术可以安全完成,不伴有任何器官损伤,手术时间更短.因此,在行巨大子宫切除术时,MAH可以作为一种备选的手术方法.%Since the introduction of laparoscopic hysterectomy (LH) in 1989, it has become a widely accepted alternative to traditional abdominal hysterectomy (AH). While several randomised controlled trials showed that LH has its advantages over AH such as faster recovery, less pain, shorter hospital stay and better short-term quality of life,AH offers a shorter operation time and remains the fallback option if the uterus cannot be removed by LH. With advancing skill and better preoperative judgment through understanding of the pelvic pathology, a modified minilaparotomy approach for abdominal hysterectomy (MAH) was used by the author (FW) to manage enlarged uterus

  20. Optimal timing for performing hysterectomy according to different phase of menstrual cycle: Which is best?

    Science.gov (United States)

    Kim, Jeong Jin; Kang, Jun Hyeok; Lee, Kyo Won; Kim, Kye Hyun; Song, Taejong

    2017-05-01

    The aim of this study was to determine whether the different phases of the menstrual cycle could affect operative bleeding in women undergoing laparoscopic hysterectomy. This was a retrospective comparative study. Based on the adjusted day of menstrual cycle, 212 women who underwent laparoscopic hysterectomy were classified into three groups: the follicular phase (n = 51), luteal phase group (n = 125), and menstruation group (n = 36). The primary outcome measure was the operative bleeding. There was no difference in the baseline characteristics of the patients belonging to the three groups. For the groups, there were no significant differences in operative bleeding (p = .469) and change in haemoglobin (p = .330), including operative time, length of hospital stay and complications. The menstrual cycle did not affect the operative bleeding and other parameters. Therefore, no phase of the menstrual cycle could be considered as an optimal timing for performing laparoscopic hysterectomy with minimal operative bleeding. Impact statement What is already known on this subject: the menstrual cycle results in periodic changes in haemostasis and blood flow in the reproductive organs. What the results of this study add: the menstrual cycle did not affect the operative bleeding and other operative parameters during laparoscopic hysterectomy. What the implications are of these findings for clinical practice and/or further research: no phase of the menstrual cycle could be considered as an optimal timing for performing laparoscopic hysterectomy with minimal operative bleeding.

  1. Hybrid approach of retractor-based and conventional laparoscopy enabling minimally invasive hysterectomy in a morbidly obese patient: case report and review of the literature.

    Science.gov (United States)

    Hoellen, Friederike; Rody, Achim; Ros, Andrea; Bruns, Angela; Cirkel, Christoph; Bohlmann, Michael K

    2014-06-01

    Minimally invasive hysterectomy in obese patients may be limited by laparoscopic sight on the one hand and by intraoperative complications related to reduced ventilation due to pneumoperitoneum on the other. Retractor-based laparoscopy offers an operative technique reducing anesthesia risks. We report the case of laparoscopic hysterectomy in an obese patient of short stature. Laparoscopic supracervical hysterectomy was performed by a hybrid approach of a retractor system exerting its effects on lifting the abdominal wall through gravity and conventional laparoscopy, thus bypassing the adverse effects of pneumoperitoneum on ventilation.

  2. A Novel Technique of Uterine Manipulation in Laparoscopic Pelvic Oncosurgical Procedures: “The Uterine Hitch Technique”

    Directory of Open Access Journals (Sweden)

    S. P. Puntambekar

    2010-01-01

    Full Text Available Aim. To describe a new technique of uterine manipulation in laparoscopic management of pelvic cancers. Material and Methods. We used a novel uterine hitch technique in 23 patients from May 2008 to October 2008. These patients underwent pelvic oncologic surgery including laparoscopic radical hysterectomy (n=7, laparoscopic anterior resection (n=4, laparoscopic abdominoperineal resection (n=3, laparoscopic posterior exenteration (n=4, or laparoscopic anterior exenteration (n=5. The uterus was hitched to the anterior abdominal.wall by either a single suture in the fundus or by sutures through the round ligaments. Results. The uterine hitch technique was successfully accomplished in all procedures. It was performed in less than 5 minutes in all cases. It obviated the need for vaginal manipulation. An extra port for retraction could be avoided. There were no intraoperative complications. Conclusion. A practical, cheap and reproducible method for uterine manipulation, during pelvic oncologic surgery is described. It improves the stability of the uterus and also obviates the need for keeping an additional assistant for vaginal manipulation in any of the procedures.

  3. "STUDY OF CONCURRENT CISPLATIN AND EXTERNAL RADIOTHERAPY PRIOR TO RADICAL HYSTERECTOMY AND LYMPHADENECTOMY IN PATIENTS WITH STAGE IB-IIB CERVICAL CANCER"

    Directory of Open Access Journals (Sweden)

    M. Modares Gilani

    2004-06-01

    Full Text Available The purpose of this study was to describe the feasibility of a combined preoperative chemoradiation program Ib-IIa, bulky and suspicious IIb by radical surgery in patients with stage Ib-IIb cervical cancer. From September 1999 to April 2002, 30 patients with carcinoma of the cervix were treated with preoperative external beam radiotherapy of 45 Gy in 5 weeks. Patients received concurrent continuous infusion of cisplatin 50 mg/m2 for one day in week during 5 weeks of radiation. Radical surgery was performed 4-6 weeks after completion of the preoperative treatment. Toxicity with chemoradiation was usually mild. Two patients developed vesicovaginal fistula, and four developed long-term hydronephrosis that needed ureteral stenting. Clinical response was observed in 100% of the patients (23.7% complete response. The analysis of the surgical specimens revealed complete pathological response in 43.3% of the cases and partial pathological response in 56.7%. The degree of pathological response was not predictable by the degree of clinical response. Thirty months disease-free survival and overall survival were 66.3% and 77.31%, respectively. Patients with complete and partial pathological response were not significantly different in terms of disease-free survival (p= 0.08 and overall survival (p= 0.3. Cisplatin in preoperative chemoradiation is effective and usually welltolerated in bulky cervical cancer and parametrial invasion, inducing a high rate of clinical and pathological complete responses. When this therapy is followed by radical surgery, disease-free and overall survival rates are higher. The latter may be possible only through extensive surgical resection with a parallel increase in complication rates.

  4. EMERGENCY PERIPARTUM HYSTERECTOMY

    African Journals Online (AJOL)

    2001-02-02

    Feb 2, 2001 ... complications that give rise to emergency hysterectomy should decrease maternal and fetal morbidity ... labour and early recourse to Caesarean section, the clinical ... insertion of prostaglandin, the patient was found to be in.

  5. Laparoscopic Partial Nephrectomy

    Directory of Open Access Journals (Sweden)

    Ender Özden

    2015-03-01

    Full Text Available Patients with renal tumors <7 cm and those at risk for a significant loss of renal function should be managed with a partial nephrectomy if it is technically feasible. Partial nephrectomy (PN results in similar oncologic outcomes with radical nephrectomy. With advent of the technology and increase utilization of laparoscopic surgery, laparoscopic approach is considered as one of the option for partial nephrectomy. However laparoscopic partial nephrectomy is technically very difficult procedure and should be performed only by physicians with extensive experience using this approach. In this section, we aimed to present the technical steps of laparoscopic partial nephrectomy

  6. Efficacy of biofeedback combined with electrical stimulation therapy for retention after radical hysterectomy%生物反馈联合电刺激治疗宫颈癌根治术后尿潴留的疗效分析

    Institute of Scientific and Technical Information of China (English)

    傅琦博; 吕坚伟; 蒋晨; 吕婷婷; 李震东; 邱丰; 黄翼然

    2015-01-01

    ABSTRACT:Objective To investigate the efficacy of biofeedback combined with electrical stimulation therapy for reten‐tion after radical hysterectomy .Methods A total of 38 cases with retention after radical hysterectomy treated during June 2012 to May 2014 were randomly divided into two groups .The trial group was treated with pelvic floor biofeedback with elec‐trical stimulation AM800B for 20 to 30 minutes once daily for a week ,while the control group was treated with traditional blad‐der training .Results After one week of trement ,the effective rate for the trial group was 89 .47% (17/19) ,which was higher than 52 .63% (10/19) ,the rate for the control group (P0 .05 ) .Conclusions Pelvic floor biofeedback with electrical stimulation therapy can improve the urinary function effectively within a short period of time .It is worth clinical application .%目的:评估生物反馈联合电刺激治疗宫颈癌根治术后尿潴留的疗效。方法2012年6月至2014年5月共收治38例宫颈癌根治术后尿潴留患者,随机分成2组,治疗组采用生物反馈治疗仪进行生物反馈联合电刺激治疗,治疗时间约为20~30 min ,1次/d ,疗程1周;对照组采用传统膀胱功能训练进行治疗,对比两组间的疗效。结果1周后疗效比较,治疗组有效率89.47%(17/19),对照组52.63%(10/19),治疗组疗效明显优于对照组( P<0.05);2周后疗效比较,治疗组有效率达到94.74%(18/19),对照组89.47%(17/19),两组间统计学无明显差异( P>0.05)。结论采用生物反馈联合电刺激治疗宫颈癌根治术后尿潴留能明显缩短恢复患者排尿功能的时间,且创伤小,无明显不良反应,容易被患者接受,值得临床推广。

  7. Histopathological Analysis of 422 Nononcological Hysterectomies in a University Hospital

    Directory of Open Access Journals (Sweden)

    Seda Ates

    2016-04-01

    Full Text Available Aim: The aim of the study was to evaluate the surgical indications, routes of surgery and the correlation between preoperative diagnosis and histopathological examination of hysterectomy specimens. Material and Method: Medical records and histopathological findings were reviewed and analyzed retrospectively, in 422 consecutive women who underwent hysterectomy over a two-year period from 2011 to 2014. Those with confirmed malignancy before operation were excluded. Cohen kappa statistics were used to measure agreement between preoperative clinical and postoperative histopathological diagnosis which was found to be fair with %u043A value being 0.4. Results: The mean age of our patients was 51.5 ± 8 years. The abdominal route was used in 378 cases (85.5%, the vaginal route in 55 patients (12.4% and the laparoscopic-assisted vaginal hysterectomy in 9 cases (2%. Abnormal uterine bleeding (28.9 % was the most common indication for hysterectomy. The histopathology of the endometrium prior to hysterectomy was reported in 75% of the cases and the most common finding was a secretory or proliferative endometrium. Leiomyomatous uterus was the most frequently encountered pathology (43.7% followed by coexistence of leiomyoma and adenomyosis (17.4% in hysterectomy specimens. Hysterectomy specimens may be unremarkable histopathologically, most of which are vaginal hysterectomies done for uterine prolapsed (kappa=0,407. Discussion: The correlation between the preoperative clinical and the pathological diagnosis were poor in cases with abdominal pain, abnormal uterine bleeding and fibroids. But there was a high correlation in cases with adnexial mass.

  8. Laparoscopic treatment of genitourinary fistulae.

    Science.gov (United States)

    Garza Cortés, Roberto; Clavijo, Rafael; Sotelo, Rene

    2012-09-01

    We present the laparoscopic management of genitourinary fistulae, mainly five types of fistulae, vesicovaginal, ureterovaginal, vesicouterine, rectourethral and rectovesical fistula. Vesicovaginal fistula (VVF) is mostly secondary to urogynecologic procedures in developed countries, abdominal hysterectomy being the main cause of this condition; they represent 84.9% of the genitourinary fistulae (1).Management has been described for this type of fistula, where low success rate (7-12%) has been reported. Ureterovaginal fistulas may occur following pelvic surgery, particularly gynecological procedures, or as a result of vaginal foreign bodies or stone fragments after shock wave lithotripsy, patients typically present with global and persistent urine leakage through the vagina, this causes patient discomfort, distress, and typically protection is used to stay dry, the initial management is often conservative but typically fails. Vesicouterine fistula is a rare condition that only occurs in 1 to 4% of genitourinary fistulas, the primary cause is low segment cesareansection, and clinically presents in three different forms, which will be described. Treatment of this type of fistulae has been conservative,with hormone therapy and surgery, depending on the presenting symptoms. Recto-urinary (rectovesical and rectourethral) fistulae (RUF) are uncommon and can be difficult to manage clinically. Although they may develop in patients with inflammatory bowel disease and perirectal abscesses, rectourethral fistula frequently result as an iatrogenic complication of extirpative or ablative prostate procedures. Rectovesical fistula usually develops following radical prostatectomy, and occurs along the vesicourethral anastomotic line or along the suture line of a posterior "racquet-handle" closure of the bladder. Conservative management consisting of urinary diversion, broad-spectrum antibiotics and parenteral nutrition is often initially attempted but these measures often fail

  9. Hem-o-lok clip: a neglected cause of severe bladder neck contracture and consequent urinary incontinence after robot-assisted laparoscopic radical prostatectomy.

    Science.gov (United States)

    Cormio, Luigi; Massenio, Paolo; Lucarelli, Giuseppe; Di Fino, Giuseppe; Selvaggio, Oscar; Micali, Salvatore; Carrieri, Giuseppe

    2014-02-20

    Hem-o-lok clips are widely used during robot-assisted and laparoscopic radical prostatectomy to control the lateral pedicles. There are a few reports of hem-o-lok clip migration into the bladder or vesico-urethral anastomosis and only four cases of hem-o-lok clip migration resulting into bladder neck contracture. Herein, we describe the first case, to our knowledge, of hem-o-lok clip migration leading to severe bladder neck contracture and subsequent stress urinary incontinence. A 62-year-old Caucasian man underwent robot-assisted laparoscopic radical prostatectomy for a T1c Gleason 8 prostate cancer. One month after surgery the patient was fully continent; however, three months later, he presented with acute urinary retention requiring suprapubic drainage. Urethroscopy showed a hem-o-lok clip strongly attached to the area between the vesico-urethral anastomosis and the urethral sphincter and a severe bladder neck contracture behind it. Following cold-knife urethral incision and clip removal, the bladder neck contracture was widely resected. At 3-month follow-up, the patient voided spontaneously with a peak flow rate of 9.5 ml/sec and absence of post-void residual urine, but leaked 240 ml urine at the 24-hour pad test. To date, at 1-year follow-up, his voiding situation remains unchanged. The present report provides further evidence for the risk of hem-o-lok clip migration causing bladder neck contracture, and is the first to demonstrate the potential of such complication to result into stress urinary incontinence.

  10. Long-term outcomes of radical vaginal trachelectomy and laparoscopic pelvic lymphadenectomy after neoadjuvant chemotherapy for the IB1 cervical cancer: A series of 60 cases.

    Science.gov (United States)

    Yan, Hong; Liu, Zhongyu; Fu, Xiaoyu; Li, Yan; Che, Hongzhi; Mo, Rui; Song, Lei

    2016-05-01

    The present study sought to analyze the long-time clinical outcomes of the stage IB1 cervical cancer patients who had received the radical vaginal trachelectomy (RVT) and laparoscopic lymphadenectomy after neoadjuvant chemotherapy (NACT). This is a prospective study of 60 patients potentially selected for RVT for a clinical and radiologic cervical cancer (stages IB 1) less than 2 cm. These patients were treated with surgery combined with preoperative NACT in the Department of Obstetrics and Gynecology, PLA General Hospital. We collected the patients' general clinical information, surgical characteristics and obstetric data, and then assessed their long-term oncological outcomes. The average operative time of the enrolled cases was 204 min and the average blood loss was 443 mL. The average postoperative hospitalization time was 10.6 days. The postoperative pathologic results indicated that the average parametrical width was 1.99 cm; the average length of removed of cervical was 2.6 cm; the average number of excised pelvic lymph node was 20. The median of the follow-up was 43 months (range between 13month and 12 years). Only one case of recurrence was found. Thus far, totally 42 women had tried to conceive, and 36 of them had live births. The live birth pregnancy rate was 86% (36/42). The radical vaginal trachelectomy in combination with the laparoscopic lymphadenectomy surgical is a safe and effective therapeutic strategy for the for IB 1 cervical cancer. Copyright © 2016 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

  11. Single port robotic hysterectomy technique improving on multiport procedure

    Directory of Open Access Journals (Sweden)

    John R Lue

    2012-01-01

    Full Text Available The benefits of laparoscopic surgery over conventional abdominal surgery have been well documented. Reducing postoperative pain, decreasing postoperative morbidity, hospital stay duration, and postoperative recovery time have all been demonstrated in recent peer-review literature. Robotic laparoscopy provides the added dimension of increased fine mobility and surgical control. With new single port surgical techniques, we have the added benefit of minimally invasive surgery and greater patient aesthetic satisfaction, as well as all the other benefits laparoscopic surgery offers. In this paper, we report a successful single port robotic hysterectomy and the simple process by which this technique is performed.

  12. Implementation of a Robotic Surgical Program in Gynaecological Oncology and Comparison with Prior Laparoscopic Series

    Directory of Open Access Journals (Sweden)

    Natalia Povolotskaya

    2015-01-01

    Full Text Available Background. Robotic surgery in gynaecological oncology is a rapidly developing field as it offers several technical advantages over conventional laparoscopy. An audit was performed on the outcome of robotic surgery during our learning curve and compared with recent well-established laparoscopic procedure data. Method. Following acquisition of the da Vinci Surgical System (Intuitive Surgical, Inc., Sunnyvale, California, USA, we prospectively analysed all cases performed over the first six months by one experienced gynaecologist who had been appropriately trained and mentored. Data on age, BMI, pathology, surgery type, blood loss, morbidity, return to theatre, hospital stay, and readmission rate were collected and compared with a consecutive series over the preceding 6 months performed laparoscopically by the same team. Results. A comparison of two consecutive series was made. The mean age was somewhat different, 55 years in the robotic versus 69 years in the laparoscopic group, but obesity was a feature of both groups with a mean of BMI 29.3 versus 28.06, respectively. This difference was not statistically significant (P=0.54. Three subgroups of minimal access surgical procedures were performed: total hysterectomy and bilateral salpingooophorectomy (TH + BSO, total hysterectomy and bilateral salpingooophorectomy plus bilateral pelvic lymphadenectomy (TH + BSO + BPLND, and radical hysterectomy plus bilateral pelvic lymphadenectomy (RH + BPLND. The mean time taken to perform surgery for TH + BSO was longer in the robotic group, 151.2 min compared to 126.3 min in the laparoscopic group. TH + BSO + BPLND surgical time was similar to 178.3 min in robotic group and 176.5 min in laparoscopic group. RH + BPLND surgical time was similar, 263.6 min (robotic arm and 264.0 min (laparoscopic arm. However, the numbers in this initial analysis were small especially in the last two subgroups and do not allow for statistical analysis. The rate of

  13. Implementation of a robotic surgical program in gynaecological oncology and comparison with prior laparoscopic series.

    Science.gov (United States)

    Povolotskaya, Natalia; Woolas, Robert; Brinkmann, Dirk

    2015-01-01

    Robotic surgery in gynaecological oncology is a rapidly developing field as it offers several technical advantages over conventional laparoscopy. An audit was performed on the outcome of robotic surgery during our learning curve and compared with recent well-established laparoscopic procedure data. Following acquisition of the da Vinci Surgical System (Intuitive Surgical, Inc., Sunnyvale, California, USA), we prospectively analysed all cases performed over the first six months by one experienced gynaecologist who had been appropriately trained and mentored. Data on age, BMI, pathology, surgery type, blood loss, morbidity, return to theatre, hospital stay, and readmission rate were collected and compared with a consecutive series over the preceding 6 months performed laparoscopically by the same team. A comparison of two consecutive series was made. The mean age was somewhat different, 55 years in the robotic versus 69 years in the laparoscopic group, but obesity was a feature of both groups with a mean of BMI 29.3 versus 28.06, respectively. This difference was not statistically significant (P = 0.54). Three subgroups of minimal access surgical procedures were performed: total hysterectomy and bilateral salpingooophorectomy (TH + BSO), total hysterectomy and bilateral salpingooophorectomy plus bilateral pelvic lymphadenectomy (TH + BSO + BPLND), and radical hysterectomy plus bilateral pelvic lymphadenectomy (RH + BPLND). The mean time taken to perform surgery for TH + BSO was longer in the robotic group, 151.2 min compared to 126.3 min in the laparoscopic group. TH + BSO + BPLND surgical time was similar to 178.3 min in robotic group and 176.5 min in laparoscopic group. RH + BPLND surgical time was similar, 263.6 min (robotic arm) and 264.0 min (laparoscopic arm). However, the numbers in this initial analysis were small especially in the last two subgroups and do not allow for statistical analysis. The rate of complications necessitating intervention

  14. Predictors of surgical site infection in women undergoing hysterectomy for benign gynecologic disease: a multicenter analysis using the national surgical quality improvement program data.

    Science.gov (United States)

    Mahdi, Haider; Goodrich, Sarah; Lockhart, David; DeBernardo, Robert; Moslemi-Kebria, Mehdi

    2014-01-01

    To estimate the rate and predictors of surgical site infection (SSI) after hysterectomy performed for benign indications and to identify any association between SSI and other postoperative complications. Retrospective cohort study (Canadian Task Force classification II-2). National Surgical Quality Improvement Program data. Women who underwent abdominal or laparoscopic hysterectomy performed for benign indications from 2005 to 2011. Univariable and multivariable logistic regression analyses were used to identify predictors of SSI and its association with other postoperative complications. Odds ratios were adjusted for patient demographic data, comorbidities, preoperative laboratory values, and operative factors. Of 28 366 patients, 758 (3%) were diagnosed with SSI. SSI occurred more often after abdominal than laparoscopic hysterectomy (4% vs 2%; p hysterectomy, predictors of SSI included diabetes, smoking, respiratory comorbidities, overweight or obesity, American Society of Anesthesiologists class ≥ 3, perioperative blood transfusion, and operative time >180 minutes. Among those who underwent laparoscopic hysterectomy, predictors of SSI included perioperative blood transfusion, operative time >180 minutes, serum creatinine concentration ≥ 2 mg/dL, and platelet count ≥ 350 000 cells/mL(3). For patients with deep or organ/space SSI, significant predictors included perioperative blood transfusion and American Society of Anesthesiologists class ≥ 3 for abdominal hysterectomy, and non-white race, renal comorbidities, preoperative or perioperative blood transfusion, and operative time >180 minutes for laparoscopic hysterectomy. SSI was associated with longer hospital stay and higher rates of repeat operation, sepsis, renal failure, and wound dehiscence. SSI was not associated with increased 30-day mortality. SSI occurred more often after abdominal hysterectomy than laparoscopic hysterectomy performed to treat benign gynecologic disease. SSI was associated with

  15. Salvage interstitial brachytherapy based on computed tomography for recurrent cervical cancer after radical hysterectomy and adjuvant radiation therapy: case presentations and introduction of the technique.

    Science.gov (United States)

    Liu, Zhong-Shan; Guo, Jie; Zhao, Yang-Zhi; Lin, Xia; Chen, Bin; Zhang, Ming; Li, Jiang-Ming; Ren, Xiao-Jun; Zhang, Bing-Ya; Wang, Tie-Jun

    2016-10-01

    Locally recurring cervical cancer after surgery and adjuvant radiotherapy remains a major therapeutic challenge. This paper presents a new therapeutic technique for such patients: interstitial brachytherapy (BT) guided by real-time three-dimensional (3D) computed tomography (CT). Sixteen patients with recurrent cervical cancer after radical surgery and adjuvant external-beam radiotherapy (EBRT) were included in this study. These patients underwent high-dose-rate (HDR) interstitial BT with free-hand placement of metal needles guided by real-time 3D-CT. Six Gy in 6 fractions were prescribed for the high-risk clinical target volume (HR-CTV). D90 and D100 for HR-CTV of BT, and the cumulative D2cc for the bladder, rectum, and sigmoid, including previous EBRT and present BT were analyzed. Treatment-related complications and 3-month tumor-response rates were investigated. The mean D90 value for HR-CTV was 52.5 ± 3.3 Gy. The cumulative D2cc for the bladder, rectum, and sigmoid were 85.6 ± 5.8, 71.6 ± 6.4, and 69.6 ± 5.9 Gy, respectively. The mean number of needles was 6.1 ± 1.5, with an average depth of 3.5 ± 0.9 cm for each application. Interstitial BT was associated with minor complications and passable tumor-response rate. Interstitial BT guided by real-time 3D-CT for recurrent cervical cancer results in good dose-volume histogram (DVH) parameters. The current technique may be clinically feasible. However, long-term clinical outcomes should be further investigated.

  16. Comparing Prognosis Situation of Radical Resection of Laparoscopic Rectal Cancer and Open Radical Operation%直肠癌根治术在腹腔镜与开腹预后情况的比较

    Institute of Scientific and Technical Information of China (English)

    徐立伟

    2015-01-01

    Objective:To compare the prognosis situation of radical resection of laparoscopic rectal cancer and open radical operation. Method:100 cases of cancer patients were selected in our hospital from August 2012 to May 2013. According to the different treatment methods,they were divided into the observation group and control group,50 cases in each group. The observation group was performed laparoscopic resection,the control group with traditional open operation treatment,clinical parameters,resection of the recurrence after operation,postoperative complications and survival rate were compared.Result:In the observation group,the amount of bleeding during the operation,incision size,intestinal function recovery time,hospitalization time and other clinical parameters were significantly better than the control group, the differences were statistically significant(P0.05);the postoperative complication rates between observation group and control group were respectively 6% and 16%,the observation group was significantly better than the control group,the difference was statistically significant(P0.05). Conclusion:Survival rate and recurrence rate of rectal cancer by laparoscopic and open radical resection of rectal cancer are not significant difference,but the laparoscopic radical resection of rectal cancer with rapid recovery of disease,height of minimally invasive and reliable safety,the preferred solution can be used as the surgical treatment of rectal cancer,it is worth the clinical promotion.%目的:探析直肠癌根治术在腹腔镜与开腹预后情况的比较。方法:选取本院2012年8月-2013年5月直肠癌患者100例,按治疗方式的不同分为观察组与对照组,每组各50例。观察组进行腹腔镜切除术,对照组经传统开腹手术疗法,比较手术的临床各项参数指标、术后复发情况、术后并发症情况及存活率。结果:观察组的术中出血量、切口大小、肠功能恢复时间、

  17. 经后腹膜腔途径和经腹腔途径腹腔镜下根治性肾切除术安全性和疗效的Meta分析%Retroperitoneal laparoscopic radical nephrectomy versus transperitoneal laparoscopic radical nephrectomy: a meta-analysis of safety and efficiency

    Institute of Scientific and Technical Information of China (English)

    赵强; 张骞; 金杰

    2014-01-01

    目的 对经后腹膜腔途径与经腹腔途径腹腔镜下根治性肾切除术的相关文献进行Meta分析,以比较两种术式的安全性和疗效. 方法 检索2000年1月至2012年10月关于腹腔镜下根治性肾切除术的相关文献.国外文献选用Pubmed、Embase、Cochrane library数据库,以transperitoneal,retroperitoneal,laparoscopy,radical nephrectomy为关键词.国内文献选用中国生物医学文献数据库、中国期刊全文数据库、维普中文科技期刊数据库和万方中文数据库,以经腹腔、经后腹膜腔、根治性肾切除、腹腔镜作为关键词.由2名评价者共同评价纳入研究的质量,并采用Cochrane协作网提供的Revman 5.0统计软件对纳入文献进行Meta分析. 结果 共有9篇临床对照研究符合纳入标准,包括7篇国外文献和2篇中文文献,基线资料具有可比性.共纳入患者1 306例,其中经后腹膜腔途径组520例,经腹腔途径组786例.在手术时间(OR=16.23,95%CI 1.62~30.84)和术后并发症发生率(OR=2.44,95%CI 1.35 ~4.41)方面,经后腹膜腔途径显著优于经腹腔途径,差异均有统计学意义(P<0.05).在手术切口长度、术中出血量、住院时间、中转开放率、5年无复发生存率和5年总体生存率等方面两者比较差异均无统计学意义(P>0.05). 结论 经后腹膜腔途径腹腔镜下根治性肾切除术在手术时间和术后并发症方面显著优于经腹腔途径,但两种术式的疗效无显著差异,各中心可根据自身习惯选择手术方式.%Objective To compare the safety and efficiency of retroperitoneal laparoscopic and transperitoneal laparoscopic radical nephrectomy by meta-analysis.Methods A systematic review of the literature about laparoscopic radical nephrectomy was performed,searching Medline,Embase,Cochrane library,CBM,CNKI,VIP and Wan Fang database from January 2000 to October 2012.The key words were transperitoneal,retroperitoneal,laparoscopy,radical nephrectomy

  18. Novel technique to enhance bladder neck dissection with traction of Foley catheter during extraperitoneal laparoscopic radical prostatectomy

    Directory of Open Access Journals (Sweden)

    Henry Y. Lin

    2015-03-01

    Conclusion: Improved bladder neck enhancement provides a clearer vision during bladder neck dissection. Similar functional results and cancer control rates were also encountered during modified extraperitoneal radical prostatectomy. This novel technique is a feasible method for performing endoscopic radical prostatectomy using four ports instead of five.

  19. A different technique in gasless laparoendoscopic single-site hysterectomy.

    Science.gov (United States)

    Demirayak, Gökhan

    2017-07-01

    The aim of this study was to show a different technique for a gasless laparoendoscopic single-site (LESS) hysterectomy and to present advantages and limitations of this technique. Women undergoing gasless LESS hysterectomy with a different technique were evaluated. A total of 14 LESS hysterectomies were performed using this gasless technique and rigid laparoscopic instruments by one surgeon. The mean age of the patients was 48.6 (±4.6). The average blood loss was 80 ± 35 ml. The average time between an umbilical incision and starting hysterectomy was 5 (±2,1) min. The time between starting hysterectomy and umbilical incision closure was 120 (±24) min in the laparoscopic suture group and 88 (±16) min in the vaginal suture group. The mean uterus weight was 188 (±95) g. In conclusion, this different technique is feasible and low cost, especially in non-obese patients. But further studies with large participants are needed to elucidate the safety. Impact statement Conventional CO2 pneumoperitoneum has many adverse effects on cardiopulmonary function, haemodynamic, metabolic and neurologic systems due to high-intraperitoneal pressure. The usage of gasless technique eliminates these adverse effects and postoperative shoulder pain. The satisfaction of patients is higher in laparoendoscopic single-site (LESS) hysterectomy due to improved cosmesis and reduced postoperative analgesic requirements. In the literature, there are a few studies showing techniques combining LESS and gasless laparoscopy for hysterectomy. In this study, a different approach for creating operational space in gasless laparoscopy is described. Creation of intraabdominal operational space is convenient and takes a short time in this technique. The average time between an umbilical incision and starting a hysterectomy is five minutes. Additional training is not needed for experienced surgeons in LESS. Also, cost-effectiveness is one of important advantages. It is quite safe, no possibility of

  20. Robot-assisted laparoscopic radical prostatectomy%机器人辅助腹腔镜前列腺癌根治术

    Institute of Scientific and Technical Information of China (English)

    沈周俊; 王先进

    2010-01-01

    @@ 前列腺癌是老年男性最常见的泌尿生殖系统恶性肿瘤之一,严重威胁着患者的生命健康和生活质量.前列腺癌的治疗方法包括随访观察、经尿道前列腺切除术(TURP)、根治性前列腺切除术、放射治疗、冷冻治疗、内分泌治疗、综合治疗等.根治性前列腺切除术目前仍然是治疗前列腺癌的最佳方法,主要包括开放性耻骨后前列腺癌根治术(retropubic radical pro-statectomy,RRP)、腹腔镜前列腺癌根治术(laparos-copic radical prostatectomy,LRP)、机器人辅助腹腔镜前列腺癌根治术(Robot-assisted laparoscopic radicalprostatectomy,RLRP)等.

  1. Risk Factors Analysis and Prevention Measures on Lower Extremity Venous Thrombosis after Laparoscopic Total Hysterectomy%腹腔镜全子宫切除术后下肢静脉血栓形成危险因素分析及预防对策

    Institute of Scientific and Technical Information of China (English)

    张海英; 张惠云

    2016-01-01

    Objective:To explore the risk factors and countermeasures for the formation of lower extremity venous thrombosis (DVT) after laparoscopic total hysterectomy.Method:A total of 159 cases of laparoscopic total hysterectomy from May 2013 to April 2015 in our hospital were selected as the research objects,they were divided into the DVT group of 56 cases and non DVT group of 103 cases according to whether or not happen DVT,the risk factors of DVT in two groups were analyzed by multiple factors logistic analysis,the corresponding countermeasures were put forward.Result:Compared with non DVT group,DVT group operation time was longer, general anesthesia was higher,lower extremity venous puncture rate was higher and postoperative activity time was less than 3 h,the differences were statistically significant(P<0.05).Logistic regression analysis showed that:anesthesia methods,DVT disease history,patient age, hyperlipemia, increased platelet and long sedentary were risk factor for DVT.Conclusion: Laparoscopic hysterectomy resection surgery should shorten the operation time,try to choose local anesthesia,reduce lower extremity venous puncture times and encourage patients to activities. For patients with high risk factors should be good prevention,follow-up work,it is conducive to prevent the formation of DVT.%目的:探讨腹腔镜全子宫切除术后下肢静脉血栓(DVT)形成的危险因素及对策。方法:选取2013年5月-2015年4月本院收治的行腹腔镜全子宫切除术治疗患者159例作为研究对象,按照术后是否出现DVT分为DVT组56例和非DVT组103例,采用多因素Logistic分析法分析两组患者发生DVT的危险因素并提出相应的对策。结果:与非DVT组比较,DVT组患者手术时间较长,全麻率高,下肢静脉反复穿刺率高,术后活动时间<3 h,比较差异均有统计学意义(P<0.05);Logistic回归分析显示:麻醉方式、DVT疾病史、患者年龄、高脂血症、血小板升高

  2. Laparoscopic surgery for intestinal and urinary endometriosis.

    Science.gov (United States)

    Redwine, D B; Sharpe, D R

    1995-12-01

    Intestinal and urinary tract involvement by endometriosis may be symptomatic, particularly when invasive disease is present. Even in expert hands, complete excision of all invasive disease cannot be accomplished laparoscopically in every case. The practitioner must balance enthusiasm for the advantages of a laparoscopic approach with limitations of time and skill. Laparoscopy should be abandoned in a particular case if a better job can be performed by laparotomy. Hysterectomy with castration may not relieve symptoms due to invasive disease.

  3. Laparoscopic dissection of the pararectal space

    Directory of Open Access Journals (Sweden)

    Sami M Walid

    2011-01-01

    Full Text Available Pelvic adhesions affecting the uterine adnexa or cul-de-sacs are a common finding in gynaecological surgery. We present a referred patient with a history of laparoscopic hysterectomy and right salpingo-oophorectomy and an unresected left ovarian mass causing ovarian retention syndrome. The left ovarian complex was hidden in the left pararectal space. The laparoscopic technique for dealing with such a rare case is explained.

  4. Novel Port Placement and 5-mm Instrumentation for Robotic-Assisted Hysterectomy

    OpenAIRE

    Nezhat, Ceana H.; Katz, Adi; Dun, Erica C; Kho, Kimberly A.; Wieser, Friedrich A.

    2014-01-01

    Background and Objectives: The value of robotic surgery for gynecologic procedures has been critically evaluated over the past few years. Its drawbacks have been noted as larger port size, location of port placement, limited instrumentation, and cost. In this study, we describe a novel technique for robotic-assisted laparoscopic hysterectomy (RALH) with 3 important improvements: (1) more aesthetic triangular laparoscopic port configuration, (2) use of 5-mm robotic cannulas and instruments, an...

  5. Multivariate analysis of the prognostic factors of squamous cell cervical cancer treated by radical hysterectomy or combined radiation therapy; Carcinoma espinocelular do colo uterino submetido a cirurgia radical isolada ou em combinacao com radioterapia

    Energy Technology Data Exchange (ETDEWEB)

    Coelho, Francisco Ricardo Gualda; Kowalski, Luiz Paulo; Abrao, Fauzer Simao [Fundacao Antonio Prudente, Sao Paulo, SP (Brazil). Hospital A.C. Camargo; Franco, Eduardo Luiz [McGill Univ., Montreal, PQ (Canada). Dept. of Oncology; Zeferino, Luiz Carlos [Universidade Estadual de Campinas, SP (Brazil). Faculdade de Medicina; Brentani, Maria Mitzi [Sao Paulo Univ., SP (Brazil). Faculdade de Medicina

    1996-04-01

    Six hundred and nine cases of invasive squamous cell carcinoma of the cervix uteri in a retrospective analysis (1953-1982) at the A.C. Camargo Hospital, Antonio Prudente Foundation, Sao Paulo, Brazil. The patients were submitted to radical surgery and radiation therapy, individually or in combination. A multivariate analysis of the different variables were performed according to the Cox`s regression method. The variables of prognosis value, in decreasing order of importance, were: the decade of patient`s admission, the modality of therapy employed, the presence of residual tumor in the surgical specimens and the clinical stage of the disease. Other variables like ethnic group, age of first menstrual flux, menopause, number of pregnancy, kind of delivery, number and kind of abortion, were found to be of no prognostic importance. The decade of admission was of independent prognostic significance. The presence of residual tumor in the surgical specimens was more important than lymph nodes spreading, but the overall survival was affected by the increase in the number of positive lymph nodes. Patient`s age was a weak prognostic factor accounting for a reduction in the survival time among cases with age upper to 45 years old. Radiation therapy sterilizes a considerable number of lymph nodes but not all of them in every patient. There are a specific group of patients where the radical surgery is necessary in order to carry a complete debulking of the disease. (author) 82 refs., 10 figs.

  6. Laparoscopic surgical staging of endometrial cancer: does obesity influence feasibility and perioperative outcome?

    Science.gov (United States)

    Litta, P; Fabris, A M; Breda, E; Bartolucci, C; Conte, L; Saccardi, C; Nappi, L

    2013-01-01

    Laparoscopic treatment of early-stage endometrial cancer is the gold standard to reduce perioperative morbidity. Obesity is a well-known risk factor for endometrial cancer and anesthesiological and surgical complications. The authors' aim was to examine the effect of body mass index (BMI) on perioperative parameters and complications in laparoscopically-treated patients with endometrial cancer. A consecutive series of patients affected by endometrial cancer and their demographic and clinicopathological data were collected. Patients were divided in 41 non-obese (BMI obese (BMI >or= 30) groups. All patients had been preoperatively evaluated with hysteroscopic procedures and toraco-abdominal computed tomography (CT) and had been submitted to laparoscopic radical hysterectomy according to Querleu-Morrow, pelvic lymphadenectomy, peritoneal washing, and bilateral adnexectomy. There was no statistically significant difference in blood loss, number of lymph nodes removed, and hospital stay between the groups, but there was a trend towards a lengthening of surgical time in the obese women. There were no major intraoperative and postoperative complications. This study demonstrates that laparoscopic approach is feasible and safe in obese women evaluating the anesthesiological risk.

  7. Total versus subtotal hysterectomy

    DEFF Research Database (Denmark)

    Gimbel, Helga; Zobbe, Vibeke; Andersen, Anna Birthe;

    2005-01-01

    The aim of this study was to compare total and subtotal abdominal hysterectomy for benign indications, with regard to urinary incontinence, postoperative complications, quality of life (SF-36), constipation, prolapse, satisfaction with sexual life, and pelvic pain at 1-year postoperative. Eighty...

  8. The morbidity of laparoscopic radical cystectomy: analysis of postoperative complications in a multicenter cohort by the European Association of Urology (EAU)-Section of Uro-Technology.

    Science.gov (United States)

    Albisinni, Simone; Oderda, Marco; Fossion, Laurent; Varca, Virginia; Rassweiler, Jens; Cathelineau, Xavier; Chlosta, Piotr; De la Taille, Alexandre; Gaboardi, Franco; Piechaud, Thierry; Rimington, Peter; Salomon, Laurent; Sanchez-Salas, Rafael; Stolzenburg, Jens-Uwe; Teber, Dogu; Van Velthoven, Roland

    2016-02-01

    To analyze postoperative complications after laparoscopic radical cystectomy (LRC) and evaluate its risk factors in a large prospective cohort built by the ESUT across European centers involved in minimally invasive urology in the last decade. Patients were prospectively enrolled, and data were retrospectively analyzed. Only oncologic cases were included. There were no formal contraindications for LRC: Also patients with locally advanced tumors (pT4a), serious comorbidities, and previous major abdominal surgery were enrolled. All procedures were performed via a standard laparoscopic approach, with no robotic assistance. Early and late postoperative complications were graded according to the modified Clavien-Dindo classification. Multivariate logistic regression was performed to explore possible risk factors for developing complications. A total of 548 patients were available for final analysis, of which 258 (47%) experienced early complications during the first 90 days after LRC. Infectious, gastrointestinal, and genitourinary were, respectively, the most frequent systems involved. Postoperative ileus occurred in 51/548 (9.3%) patients. A total of 65/548 (12%) patients underwent surgical re-operation, and 10/548 (2%) patients died in the early postoperative period. Increased BMI (p = 0.024), blood loss (p = 0.021), and neoadjuvant treatment (p = 0.016) were significantly associated with a greater overall risk of experiencing complications on multivariate logistic regression. Long-term complications were documented in 64/548 (12%), and involved mainly stenosis of the uretero-ileal anastomosis or incisional hernias. In this multicenter, prospective, large database, LRC appears to be a safe but morbid procedure. Standardized complication reporting should be encouraged to evaluate objectively a surgical procedure and permit comparison across studies.

  9. 机器人结直肠癌根治术的学习曲线%Learning curve of robot-assisted laparoscopic radical resection for colorectal carcinoma

    Institute of Scientific and Technical Information of China (English)

    刘东宁; 唐城; 江群广; 李太原

    2016-01-01

    目的:评估机器人结直肠癌根治术不同阶段的手术效果,探讨机器人结直肠癌根治术学习曲线问题。方法分析2014年12月至2015年8月由同一组医师完成的75例腹腔镜结直肠癌根治术,按手术先后次序分3组(A、B、C),每组25例,比较各组机器人安装时间、手术时间、出血量、肛门排气时间、术后住院天数、术后并发症和3站淋巴结清扫数目及其总数的差异。结果 A组机器人安装时间(38±5)min,显著长于B组(22±4)min和C组(21±2)min(P均<0.05);A组手术时间(201±39)min,显著长于B组(160±42)min和C组(156±43)min(P均<0.05);A 组出血量(142±35)ml,显著多于B组(105±28)ml和C组(102±28)ml(P均<0.05)。3组肛门排气时间、术后住院天数、术后并发症和3站淋巴结清扫数目及其总数无显著性差异(P>0.05)。A组手术25例在4个月内完成,平均每月6.3台手术,B组和C组均在2个月内完成,平均每月12.5台手术。结论有丰富腹腔镜结直肠癌手术经验的外科医师行机器人结直肠癌根治术的学习曲线大约为25例,手术频度为平均每月6.3例。%ObjectiveTo evaluate the outcomes of robot-assisted laparoscopic radical colorectal resection and to define the learning curve of robot-assisted laparoscopic radical colorectal resections. MethodsClinical data of 75 cases underwent robot-assisted laparoscopic radical resection for colorectal cancer were reviewed form December 2014 to August 2015.The patients were divided into 3 groups (groups A, B and C) by operative sequence.The robotic set-up time, operating time, bleeding volume, postoperative aerofluxus time, hospital stay, postoperative complications, number of removed lymphatic nodes were compared among the 3 groups.ResultsThe robotic set-up time in group A was significantly longer than that in group B and C [ (38± 5) min vs. (22± 4) min,P0.05). The

  10. Robotic-assisted laparoscopic radical nephrectomy using the Da Vinci Si system: how to improve surgeon autonomy. Our step-by-step technique.

    Science.gov (United States)

    Davila, Hugo H; Storey, Raul E; Rose, Marc C

    2016-09-01

    Herein, we describe several steps to improve surgeon autonomy during a Left Robotic-Assisted Laparoscopic Radical Nephrectomy (RALRN), using the Da Vinci Si system. Our kidney cancer program is based on 2 community hospitals. We use the Da Vinci Si system. Access is obtained with the following trocars: Two 8 mm robotic, one 8 mm robotic, bariatric length (arm 3), 15 mm for the assistant and 12 mm for the camera. We use curved monopolar scissors in robotic arm 1, Bipolar Maryland in arm 2, Prograsp Forceps in arm 3, and we alternate throughout the surgery with EndoWrist clip appliers and the vessel sealer. Here, we described three steps and the use of 3 robotic instruments to improve surgeon autonomy. Step 1: the lower pole of the kidney was dissected and this was retracted upwards and laterally. This maneuver was performed using the 3rd robotic arm with the Prograsp Forceps. Step 2: the monopolar scissors was replaced (robotic arm 1) with the robotic EndoWrist clip applier, 10 mm Hem-o-Lok. The renal artery and vein were controlled and transected by the main surgeon. Step 3: the superior, posterolateral dissection and all bleeders were carefully coagulated by the surgeon with the EndoWrist one vessel sealer. We have now performed 15 RALRN following these steps. Our results were: blood loss 300 cc, console time 140 min, operating room time 200 min, anesthesia time 180 min, hospital stay 2.5 days, 1 incisional hernia, pathology: (13) RCC clear cell, (1) chromophobe and (1) papillary type 1. Tumor Stage: (5) T1b, (8) T2a, (2) T2b. We provide a concise, step-by-step technique for radical nephrectomy (RN) using the Da Vinci Si robotic system that may provide more autonomy to the surgeon, while maintaining surgical outcome equivalent to standard laparoscopic RN.

  11. Implementing an Advanced Laparoscopic Procedure by Monitoring with a Visiting Surgeon

    NARCIS (Netherlands)

    Briet, Justine M.; Mourits, Marian J. E.; Kenkhuis, Monique J. A.; van der Zee, Ate G. J.; de Bock, Geertruida H.; Arts, Henriette J. G.

    2010-01-01

    Study Objective: To investigate the feasibility of safely implementing a total laparoscopic hysterectomy (LH) in established gynecologists' practices with on-site coaching and monitoring of the learning curve by an experienced visiting surgeon. Design: Multicenter prospective feasibility and impleme

  12. A Critical Analysis of the Learning Curve and Postlearning Curve Outcomes of Two Experience- and Volume-Matched Surgeons for Laparoscopic and Robot-Assisted Radical Prostatectomy.

    Science.gov (United States)

    Good, Daniel W; Stewart, Grant D; Laird, Alexander; Stolzenburg, Jens-Uwe; Cahill, Declan; McNeill, S Alan

    2015-08-01

    There remains equipoise with regard to whether laparoscopic radical prostatectomy (LRP) or robot-assisted radical prostatectomy (RARP) has any benefit over the other. Despite this, there is a trend for the increasing adoption of RARP at great cost to health services across the world. The aim was to critically analyze the learning curve and outcomes for LRP and RARP for two experience- and volume-matched surgeons who have completed the learning curve for LRP and RARP. Two experience- and volume-matched LRP and RARP surgeons who have completed the learning curve were compared with respect to their learning curve and outcomes for RARP and LRP. There were 531 RARP and 550 LRPs analyzed from April 2003 until January 2012 at two relatively high-volume United Kingdom centers. Outcome measures included operative time, blood loss, complication rate (Clavien-Dindo grade III), positive surgical margin (PSM) rate, and early continence rate. Learning curves for blood loss, operative times, and complication rate were similar between groups. The overall PSM rate and pT2 PSM rate learning curves were longer for RARP compared with LRP but shorter for early continence. Apical PSM showed no learning curve for RARP; however, a long learning curve for LRP and the rate was lower for RARP than for LRP (P=learning curves. Despite the long learning curve for RARP, significant benefits in lower PSM rates and better early continence in comparison with LRP exist. There are benefits to patients with RARP over LRP, especially those linked to better apical dissection (apical PSM and early continence).

  13. Nosocomial infection after laparoscopic radical resection of rectal cancer and related nursing strategies%腹腔镜下直肠癌根治术后医院感染的临床分析及护理对策

    Institute of Scientific and Technical Information of China (English)

    刘圣芳; 刘新国

    2014-01-01

    Objective To analyze the factors causing nosocomial infection after laparoscopic radical resection of rectal caner ,and to summarize relevant nursing strategies .Methods A total of 152 patients with nosocomial infection after laparoscopic radical resection of rectal caner (observation group) and 150 patients without nosocomial infection after laparoscopic radical resection of rectal caner (control group) were enrolled and the related clinical data were ret-rospectively analyzed .Results The main factors causing nosocomial infection after laparoscopic radical resection of rectal caner included age (more than 60 years old ,accounting for 88 .2% ) ,primary disease (accounting for 69 .1% ) and surgery time (more than 3 h ,accounting for 71 .1% ) .Conclusion Advanced age ,primary disease and surgery time could be main factors causing nosocomial infection after laparoscopic radical resection of rectal caner ,and targe-ted treatment and care should be taken to reduce the incidence rate of nosocomial infection .%目的:观察分析腹腔镜下直肠癌根治术后医院感染情况及感染因素,总结相关护理对策。方法选取奉节县人民医院直肠癌医院感染患者152例为观察组。选择同期没有并发医院感染的150例腹腔镜直肠癌根治术手术患者作为对照组,比较两组患者临床资料。结果导致腹腔直肠癌根治术后医院感染的高危因素包括:年龄大于60岁占88.2%,具有基础疾病占69.1%,手术时间超过3 h占71.1%。结论高龄、具有基础疾病、住院时间长、手术时间长等是导致腹腔镜直肠癌根治术患者发生医院感染的高危因素,临床治疗中应针对上述高危因素采取针对性治疗护理措施,以期降低医院感染率。

  14. Vesico-urethral anastomosis (VUA) evaluation of short- and long-term outcome after robot-assisted laparoscopic radical prostatectomy (RARP): selective cystogram to improve outcome.

    Science.gov (United States)

    Tillier, C; van Muilekom, H A M; Bloos-van der Hulst, J; Grivas, N; van der Poel, H G

    2017-01-12

    The role of a cystogram to assess the vesico-urethral anastomosis (VUA) after robot-assisted laparoscopic radical prostatectomy (RARP) has been debated. Early catheter removal without cystogram was reported to be associated with a trend towards an increased risk of acute urinary retention (AUR). In two cohorts we studied the effects of VUA leakage on cystogram and functional outcome after RARP. Cohort A contained 1390 consecutive men that routinely underwent a cystogram after RARP. Transurethral catheter (TUC) was removed in the absence of VUA leakage or minimal leakage on subsequent repeat cystogram. Outcome was compared to a group of 120 men that underwent cystography 7-10 days after RARP but had the TUC removed independent of cystography findings (cohort B). Outcome was assessed by early clinical follow-up and quality of life (QOL) questionnaires at 6 months. Men in cohort B had an increased risk of AUR and 6 months voiding complaints when compared to cohort A. The incidence of AUR and voiding complaints was associated with grade 2-3 leakage on cystography in cohort B but not in cohort A. Grade 2-3 leakage on cystogram was more likely in men with larger prostates larger and preoperative voiding complaints. Selective cystogram in men with larger prostates and preoperative lower urinary tract symptoms (LUTS) may prevent early AUR and voiding complaints after RARP when prolonged TUC use is applied.

  15. Outcomes of obese versus non-obese subjects undergoing robotic-assisted hysterectomy: a multi-institutional study.

    Science.gov (United States)

    Davenport, W B; Lowe, M P; Chamberlin, D H; Kamelle, S A; Johnson, P R; Tyndall, M; Tillmanns, T D

    2013-03-01

    The goal of our study was to determine whether there was a difference in operative outcomes in obese versus non-obese subjects undergoing robotic-assisted hysterectomies of varying levels of difficulty. Secondarily, we sought to analyze the published outcomes between robotic-assisted hysterectomy and total laparoscopic hysterectomy in obese women at each of these levels of difficulty. This was a multi-institutional retrospective cohort study of all patients undergoing robotic-assisted hysterectomy by five gynecologic oncologists at four geographically separate locations from April 2003 to March 2008. The cohort was stratified into obese vs. non-obese groups, and defined surgical outcomes compared between groups, then further divided into three subgroups based on case difficulty level. Univariate analysis and regression analysis using SAS 9.1 was performed. We then conducted a literature search of total laparoscopic hysterectomy outcomes in obese women, dividing the resulting studies into three comparative subgroups based on surgical difficulty levels for comparison with our robotic-assisted hysterectomy results. Our cohort had 228 obese and 323 non-obese subjects. Overall, the obese group had higher blood loss and longer operative time. When further stratified by level of difficulty, obese subjects also had a higher average blood loss and longer operative time in the hysterectomy-alone subgroup. No clinically significant differences in operative outcomes exist between obese and non-obese women when utilizing the da Vinci robotic system to perform a hysterectomy, independent of case difficulty level. More prospective, controlled studies which compare the two surgical approaches of robotic-assisted and laparoscopic hysterectomy approaches are needed.

  16. Comparison of robotic surgery and laparoscopy to perform total hysterectomy with pelvic adhesions or large uterus

    Directory of Open Access Journals (Sweden)

    Li-Hsuan Chiu

    2015-01-01

    Full Text Available Background: Currently, benefits of robotic surgery in patients with benign gynecological conditions remain unclear. In this study, we compared the surgical outcome of robotic and laparoscopic total hysterectomies and evaluated the feasibility of robotic surgery in cases with pelvic adhesions or large uterus. Materials and Methods: A total of 216 patients receiving total hysterectomy via robotic or laparoscopic approach were included in this study. Of all 216 patients, 88 underwent robotic total hysterectomy and 128 underwent laparoscopic total hysterectomy. All cases were grouped by surgical type, adhesion score, and uterine weight to evaluate the interaction or individual effect to the surgical outcomes. The perioperative parameters, including operation time, blood loss, postoperative pain score, time to full diet resumption, length of hospital stay, conversion rate, and surgery-related complications were compared between the groups. Results: Operation time and blood loss were affected by both surgical type and adhesion score. For cases with severe adhesions (adhesion score greater than 4, robotic surgery was associated with a shortened operation time (113.9 ± 38.4 min versus 164.3 ± 81.4 min, P = 0.007 and reduced blood loss (187.5 ± 148.7 mL versus 385.7 ± 482.6, P=0.044 compared with laparoscopy. Moreover, robotic group showed a lower postoperative pain score than laparoscopic group, as the effect was found to be independent of adhesion score or uterine weight. The grade-II complication rate was also found to be lower in the robotic group. Conclusions: Comparing to laparoscopic approach, robotic surgery is a feasible and potential alternative for performing total hysterectomy with severe adhesions.

  17. An audit of indications and complications associated with elective hysterectomy at SVMCH and RC, Ariyur, Pondicherry

    Directory of Open Access Journals (Sweden)

    Nidhi Bansal, Hiremath PB, Meenal C, Vishnu Prasad

    2013-04-01

    Full Text Available Background: Hysterectomy is the most common gynaecological surgery performed worldwide Menorrhagia secondary to uterine fibroids and abnormal menstrual bleeding are the two most common indications for hysterectomy. An important factor impacting on the incidence of complications of hysterectomy, apart from the indication for surgery, is the surgical approach. Most surgeons perform up to 80% of procedures by the abdominal route. The incidence of LAVH performed for benign lesions has progressively increased in recent years. Methods : Surgical indications and details, histological findings, and postoperative course were reviewed and analysed for 340 patients who underwent hysterectomy in 2011 and 2012.Results : In our study, fibroid uterus (27.9 % was the leading indication for performing hysterectomies followed by a DUB (22.9% and uterovaginal prolapse (UVP-21.8%. During the study period (2011-2012, most hysterectomies were performed abdominally (54.4%. Overall post operative complications including major and minor, are significantly higher in the abdominal surgery group as compared to the vaginal and laparoscopic group ( p value= 0.001 . Conclusion: We need to ensure that trainees acquire competency in performing hysterectomies vaginally, which is clearly safer than the abdominal approach.

  18. Vaginal Migration of Ventriculoperitoneal Shunt Catheter and Cerebrospinal Fluid Leak as a Complication of Hysterectomy.

    Science.gov (United States)

    Houten, John K; Smith, Shiela; Schwartz, Amit Y

    2017-08-01

    Ventriculoperitoneal (VP) shunting is a common neurosurgical procedure to treat hydrocephalus that diverts cerebrospinal fluid from the cerebral ventricles to the peritoneal cavity for reabsorption. The distal catheter may potentially migrate through any potential or iatrogenic opening in the peritoneal cavity. Increasingly successfully management of childhood hydrocephalus and adult-onset conditions leading to hydrocephalus, such as subarachnoid hemorrhage, is leading many adult female patients harboring VP shunts needing to undergo hysterectomy. Hysterectomy creates a potential defect though which a VP shunt catheter may migrate. It is not known whether the hysterectomy cuff closure technique may affect the likelihood of distal catheter migration though the repair site. We report the case of a 38-year-old woman with a VP shunt who underwent laparoscopic hysterectomy via an open vaginal cuff technique who subsequently presented with vaginal cerebrospinal fluid leakage secondary to migration of the distal shunt catheter through the hysterectomy cuff. Vaginal migration of the distal VP shunt catheter is a possible complication of hysterectomy. The authors postulate that an open cuff hysterectomy closure technique may increase the risk of catheter migration, an issue that may be better understood with further investigation. Copyright © 2017 Elsevier Inc. All rights reserved.

  19. Obesity and older age as protective factors for vaginal cuff dehiscence following total hysterectomy.

    Science.gov (United States)

    Donnellan, Nicole M; Mansuria, Suketu; Aguwa, Nancy; Lum, Deirdre; Meyn, Leslie; Lee, Ted

    Studies have shown an increased risk of vaginal cuff dehiscence following total laparoscopic hysterectomy (TLH). Patient variables associated with dehiscence have not been well described. This study aims to identify factors associated with dehiscence following varying routes of total hysterectomy. This is a retrospective, matched, case-control study of women who underwent a total hysterectomy at a large, urban, university-based teaching hospital from January 2000 to December 2011. Women who underwent a total hysterectomy and had a dehiscence (n = 31) were matched by surgical mode to the next five total hysterectomies (n = 155). Summary statistics and conditional logistic regression were performed to compare cases to controls. Obese women (BMI ≥ 30) were 70 % less likely than normal weight women (BMI hysterectomy route, obese women were 86 % less likely to have a dehiscence following robotic-assisted total hysterectomy (RAH) and TLH than normal weight women (p = 0.04). Further, increasing age was protective of dehiscence in this subgroup of women (p = 0.02). Older age and obesity were associated with a decreased risk of dehiscence following RAH and TLH but not following other routes. Increased risk of dehiscence following TLH observed in previous studies may be partially due to patient characteristics.

  20. Effect of the transvaginal total laparoscopic rectal cancer radical resection on female sexual dysfunction%经阴道完全腹腔镜直肠癌根治术对女性性功能障碍的影响

    Institute of Scientific and Technical Information of China (English)

    朱畅; 潘凯; 谢海慧; 夏利刚

    2015-01-01

    目的::探讨经阴道腹腔镜直肠癌根治术对女性性功能的影响。方法:选取64例女性直肠癌患者,观察组31例经阴道完全腹腔镜直肠癌根治术,对照组33例常规腹腔镜直肠癌根治术,分别于术后6、12个月进行问卷调查或电话随访,记录患者术后的性功能变化情况,比较2种手术方式对女性患者性功能的影响。结果:术后6个月观察组患者阴道湿润度、性交痛和性生活满意度均差于对照组(P0.05)。结论:阴道完全腹腔镜直肠癌根治术后由于阴道干燥,短期内会对女性性功能造成一定影响,但随时间推移可恢复到与行常规腹腔镜手术相同的水平。%Objective:To explore the effects of the transvaginal total laparoscopic rectal cancer radical resection on female sexual dysfunction. Methods:Sixty-four female rectal cancer patients were randomly divided into the experimental group(31 cases) and control group(33 cases). The experimental group and control group were treated with the transvaginal total laparoscopic and conventional laparoscopic rectal cancer radical resection,respectively. All patients were followed up using questionnaire survey or call after 6 and 12 months of operation,the sexual function of patients was recorded. The effects of two kinds of operation methods on sexual function were compared. Results:The vaginal moisture,pain during sex and sexual satisfaction in experimental group were worse than those in control group after 6 months of operation(P 0. 05). Conclusions:Because of the vaginal dryness,the transvaginal total laparoscopic rectal cancer radical resection has certain effects on female sexual function. With the time over,the female sexual function can recover the level of the patients treated with conventional laparoscopic rectal cancer radical resection.

  1. 完全腹腔镜胆囊癌根治术的临床疗效%Clinical effect of totally laparoscopic radical resection for gallbladder cancer

    Institute of Scientific and Technical Information of China (English)

    徐鋆耀; 姜海; 喻志敏; 闵军; 陈亚进

    2016-01-01

    Objective To investigate the safety and feasibility of totally laparoscopic radical resection of gallbladder cancer.Methods The retrospective cross-sectional descriptive study was adopted.The clinical data of 30 patients who underwent laparoscopic radical resection of gallbladder cancer at the Sun Yat-sen Memorial Hospital of Sun Yat-sen University from January 2013 to August 2015 were collected.The patients received synchronous hepatic segmental or extrahepatic bile duct resection according to the conditions of patients,and choledochojejunostomy was applied to patients undergoing extrahepatic bile duct resection.The patients accepted postoperative adjuvant chemotherapy according to the results of postoperative pathological examination.Observation indicators included (1) operation situations,including surgical procedures,operation time,volume of intraoperative blood loss and number of lymph node dissected,(2) postoperative situations,including time for outoff-bed activity,time for diet intake,time of drainage tube removal,occurrence of complications and duration of hospital stay,(3) results of postoperative pathological examination,including tumor stage and surgical margin,(4) postoperative adjuvant treatment,(5) follow-up situation including the survival of patients,tumor recurrence and metastasis.The follow-up using outpatient examination and telephone interview was performed to detect the survival of patients and tumor recurrence and metastasis up to December 2015.Count data were represented as average (range).Results All the 30 patients underwent successful laparoscopic radical resection of gallbladder cancer combined with hepatic S4b and S5 resection + lymph node dissection at N1 region.Six patients with obstructive jaundice caused by tumor invaded to extrahepatic bile duct underwent combined laparoscopic extrahepatic bile duct resection + Roux-en-Y hepaticojejunostomy,without perioperative death.The average operation time,average volume of intraoperative

  2. 七氟烷和丙泊酚麻醉对腹腔镜全子宫切除术患者白细胞介素-6和白细胞介素-10的影响%The effect of sevoflurane and propofol anesthetic techniques on interleukin-6 and interleukin-10 in patients with laparoscopic hysterectomy

    Institute of Scientific and Technical Information of China (English)

    邓超; 代志刚; 陈咏今; 董希伟

    2013-01-01

    Objective To study the effect of sevoflurane and propofol anesthetic techniques on interleukin (IL)-6 and IL-10 in patients with laparoscopic hysterectomy.Methods Fifty elective laparoscopic hysterectomy patients were randomly divided into sevoflurane group (25 patients) and propofol group (25 patients) who received either sevoflurane or propofol for their anesthesia.After induction,adjusted the sevoflurane inhalation concentration in sevoflurane group and propofol pumping speed in propofol group.Maintained the Bispectral index (BIS) value at 50 +5.Recorded heart rate (HR),mean arterial blood pressure (MAP),BIS,IL-6,IL-10 on 5 min before anesthesia (T1),10 min after pneumoperitoneum (T2),40 min after pneumoperitoneum (T3) and 5 ain before the end of the operation (T4),and compared.Results The level of BIS,HR,MAP in two groups and between two groups had no significant difference (P > 0.05).The level of IL-6,IL-10 on T2-T4 were significantly higher than those on T1 [sevoflurane group:(31.0 ± 9.0),(33.0 ± 11.0),(34.0 ± 16.0) ng/L vs.(29.0 ± 8.0) ng/L and (19.3 ± 1.7),(24.0 ± 2.8),(27.0 ± 8.0) ng/L vs.(2.0 + 0.4) ng/L; propofol group:(38.0 ± 9.0),(40.0 + 12.0),(45.0 ± 18.0) ng/L vs.(29.0 + 11.0) ng/L and (8.2 ± 2.3),(11.0 ± 4.2),(18.0 ± 7.0) ng/L vs.(2.0 ± 0.3) ng/L] (P < 0.05).The level of IL-6,IL-10 on T1 between two groups had no significant difference (P > 0.05).The level of IL-6 on T2-T4 in sevoflurane group was significantly lower than that in propofol group and the level of IL-10 on T2-T4 in sevoflurane group was significantly higher than that in propofol group (P< 0.05).Conclusions At maintaining the balance of cytokines in laparoscopic hysterectomy,the effect of sevoflurane is better than propofol.Sevoflurane is more suitable for maintenance of anesthesia for laparoscopic gynecologic operation.%目的 探讨七氟烷和丙泊酚对腹腔镜全子宫切除术患者白细胞介素(IL)-6、IL-10的影响.方法 将50例择期行腹腔镜全

  3. Depression, anxiety, hostility and hysterectomy.

    Science.gov (United States)

    Ewalds-Kvist, S Béatrice M; Hirvonen, Toivo; Kvist, Mårten; Lertola, Kaarlo; Niemelä, Pirkko

    2005-09-01

    Sixty-five women (aged 32 - 54 yrs) were assessed at 2 months before to 8 months after total abdominal hysterectomy on four separate occasions. Beck's Depression Inventory (BDI), Taylor's Manifest Anxiety Scale (TMAS), the Buss-Durkee Hostility Inventory (BDHI), Measurement of Masculinity-Femininity (MF), Likert scales and semantic differentials for psychological, somatic and sexual factors varied as assessment tools. High-dysphoric and low-dysphoric women were compared with regard to hysterectomy outcomes. Married nulliparae suffered from enhanced depression post-surgery. Pre-surgery anxiety, back pain and lack of dyspareunia contributed to post-surgery anxiety. Pre-surgery anxiety was related to life crises. Pre- and post-surgery hostility occurred in conjunction with poor sexual gratification. Post-hysterectomy health improved, but quality of sexual relationship was impaired. Partner support and knowledge counteracted hysterectomy aftermath. Post-hysterectomy symptoms constituted a continuum to pre-surgery signs of depression, anxiety or hostility.

  4. The surgical learning curve for robotic-assisted laparoscopic radical prostatectomy:experience of a single surgeon with 500cases in Taiwan, China

    Institute of Scientific and Technical Information of China (English)

    YenChuan Ou; ChunKuang Yang; KuanghSi Chang; John Wang; SiuWan Hung; MinChe Tung; Ashutosh K Tewari; Vipul R Patel

    2014-01-01

    To analyze the learning curve for cancer control from an initial 250cases(GroupI) and subsequent 250cases(GroupII) of robotic‑assisted laparoscopic radical prostatectomy(RALP) performed by a single surgeon. Five hundred consecutive patients with clinically localized prostate cancer received RALP and were evaluated. Surgical parameters and perioperative complications were compared between the groups. Positive surgical margin(PSM) and biochemical recurrence(BCR) were assessed as cancer control outcomes. Patients in GroupII had signiifcantly more advanced prostate cancer than those in GroupI(22.2%vs 14.2%, respectively, with Gleason score 8–10,P=0.033; 12.8%vs 5.6%, respectively, with clinical stage T3,P=0.017). The incidence of PSM in pT3 was decreased signiifcantly from 49% in GroupI to 32.6% in GroupII. Ameaningful trend was noted for a decreasing PSM rate with each consecutive group of 50cases, including pT3 and high‑risk patients. Neurovascular bundle(NVB) preservation was signiifcantly inlfuenced by the PSM in high‑risk patients(84.1% in the preservation groupvs 43.9% in the nonpreservation group). The 3‑year, 5‑year, and 7‑year BCR‑free survival rates were 79.2%, 75.3%, and 70.2%, respectively. In conclusion, the incidence of PSM in pT3 was decreased signiifcantly after 250cases. There was a trend in the surgical learning curve for decreasing PSM with each group of 50cases. NVB preservation during RALP for the high‑risk group is not suggested due to increasing PSM.

  5. Intraoperative prognostic factors and atypical patterns of recurrence in patients with upper urinary tract urothelial carcinoma treated with laparoscopic radical nephroureterectomy.

    Science.gov (United States)

    Carrion, Albert; Huguet, Jorge; García-Cruz, Eduard; Izquierdo, Laura; Mateu, Laura; Musquera, Mireia; Ribal, Maria José; Alcaraz, Antonio

    2016-08-01

    Objective The aims of this study were to identify clinical, intraoperative and pathological prognostic factors for predicting extraurothelial recurrence and cancer-specific survival (CSS) in patients with upper urinary tract urothelial carcinoma (UTUC) who had undergone laparoscopic radical nephroureterectomy (LRNU), and to investigate the site-specific patterns of recurrence and the associated outcomes. Materials and methods A retrospective revision was undertaken of 117 consecutive patients who had undergone transperitoneal LRNU for UTUC between 2007 and 2012. Univariate and multivariate Cox regression analyses were used to identify prognostic factors and Kaplan-Meier was used to estimate CSS. Results With a median follow-up of 20 months, 36 patients (30%) developed extraurothelial recurrence (local and/or distant). In the multivariate analysis, entering the urinary tract during LRNU was related to local recurrence (p = 0.04), management of the distal ureter to CSS (p = 0.003), pathological stage and positive margins to local (p = 0.001, p = 0.013), distant (p = 0.028, p = 0.009) and global recurrence (p = 0.05, p = 0.012) and CSS (p = 0.011, p = 0.042), and multifocality to distant recurrence (p = 0.024). Median time to recurrence was 11.4 months after LRNU. Of 36 patients with progression, 23 (64%) had simultaneous local and distant recurrence and eight had atypical metastases: two port-site metastases, five peritoneal, two subcutaneous and two abdominal wall implants. The 5 year CSS was 61% for all patients with UTUC and 9% for those with recurrence. Conclusions Intraoperative events could have a negative impact on the oncological outcomes of patients with UTUC treated with LRNU. The use of laparoscopy for advanced UTUC may be related to atypical ways of spreading.

  6. Prophylactic antibiotic treatment following laparoscopic robot-assisted radical prostatectomy for the prevention of catheter-associated urinary tract infections: did the AUA guidelines make a difference?

    Science.gov (United States)

    Haifler, Miki; Mor, Yoram; Dotan, Zohar; Ramon, Jacob; Zilberman, Dorit E

    2016-12-16

    We sought to evaluate the effectiveness of the American Urological Association (AUA) antibiotic prophylaxis guidelines in patients undergoing robot-assisted laparoscopic radical prostatectomy (RALP). Our prospective registry database was reviewed for all RALP cases. The following variables were evaluated: age, associated comorbidities, body mass index (BMI), total operative time, length of stay (LOS), prostate weight, pathological grade and stage. Until 11/2011, RALP patients were treated with antibiotics administered in the operating room and continued until urethral catheter removal. Since 11/2011, all patients were treated with a single intravenous dose of Cephalosporin and Aminoglycoside given within 30 min of surgical incision. The rate of catheter-associated urinary tract infection (CAUTI) was evaluated in both groups. 229 RALP patients were identified. The first 60 patients (26.2%) were treated according to the old protocol (Group 1) while the remaining 169 (73.8%) were treated according to the new protocol (Group 2). Group match was identified in all categories but LOS. Moreover, LOS was found to be longer in Group 1 compared with Group 2 (5.8 vs. 4.5 days, p < 0.001). CAUTI rate was similar in both groups (8.3 vs. 8.9%, respectively, p = 0.89). Logistic regression analysis did not demonstrate any association between treatment protocol and potential risk for CAUTI. Therefore, a single preoperative dose of antibiotics does not increase the rate of CAUTI following RALP compared with prolonged antibiotic treatment. Moreover, it was found to be associated with shorter LOS. Complying with the AUA guidelines may reduce morbidity and medical costs.

  7. Laparoscopic and robotic nephroureterectomy

    DEFF Research Database (Denmark)

    Azawi, Nessn H; Berg, Kasper Drimer; Thamsborg, Andreas Key Milan

    2017-01-01

    nephroureterectomy between January 2008 and December 2014 was conducted. Outcome measures were OS and CSM. RESULTS: In total, 298 patients underwent robot-assisted or laparoscopic radical nephroureterectomy with a final histological diagnosis of UTUC. LND was performed in 46 (15.4%). One hundred and seventy...

  8. Sexuality after total vs. subtotal hysterectomy

    DEFF Research Database (Denmark)

    Zobbe, Vibeke Bahn; Gimbel, Helga Margrethe Elisabeth; Andersen, Birthe Margrethe;

    2004-01-01

    The effect of hysterectomy on sexuality is not fully elucidated and until recently total and subtotal hysterectomies have only been compared in observational studies.......The effect of hysterectomy on sexuality is not fully elucidated and until recently total and subtotal hysterectomies have only been compared in observational studies....

  9. Sexuality after total vs. subtotal hysterectomy

    DEFF Research Database (Denmark)

    Zobbe, Vibeke Bahn; Gimbel, Helga Margrethe Elisabeth; Andersen, Birthe Margrethe

    2004-01-01

    The effect of hysterectomy on sexuality is not fully elucidated and until recently total and subtotal hysterectomies have only been compared in observational studies.......The effect of hysterectomy on sexuality is not fully elucidated and until recently total and subtotal hysterectomies have only been compared in observational studies....

  10. Regaining Candidacy for Heart Transplantation after Robotic Assisted Laparoscopic Radical Prostatectomy in Left Ventricular Assist Device Patient

    Directory of Open Access Journals (Sweden)

    Tariq A. Khemees

    2012-01-01

    Full Text Available Several factors may highlight the relevance of prostate cancer to the pre-heart-transplant population. First, the expansion in candidate selection criteria led to increased number of men over the age of fifty to be considered for heart transplantation. With the introduction of left ventricular assist device (LVAD therapy, waiting-list mortality has dramatically declined over the past decade. Additionally, transplant candidates are diligently screened for preexisting neoplasm while on the waiting list. Taken together, screening-detected prostate cancer may increasingly be diagnosed in patients on the waiting list. If discovered, it will pose unique challenge to clinicians as to date there has been no universally accepted management guideline. We report a case of LVAD-treated heart transplant candidate diagnosed with prostate cancer while on the waiting list. Patient screening demonstrated PSA elevation which prompted prostate biopsy. Low-risk clinically localized prostate cancer was confirmed and led to removal of patient from transplant list. When counseled regarding management of his cancer, the patient elected to undergo radical prostatectomy in a hope to regain candidacy for heart transplantation. Despite being of high surgical risk, multidisciplinary team approach led to successful management of prostate cancer and the patient eventually received heart transplant one year following prostatectomy.

  11. Prostatectomía radical laparoscópica: primeros dos casos realizados por urólogos costarricenses Laparoscopic Radical Prostatectomy: First Two Cases Performed by Costa Rican Urologists

    Directory of Open Access Journals (Sweden)

    Roy López-Arias

    2010-12-01

    Full Text Available Se reportan los primeros dos casos de prostatectomía radical laparoscópica (PRL realizada por urólogos costarricenses. La PRL se realizó con colocación de 4 trócares luego de poner la cámara en cicatriz umbilical. El tiempo operatorio total fue de 240 y 205 minutos, la pérdida de sangre estimada fue de 150 y 100 ml respectivamente. Se extrajeron las próstatas con vesículas seminales por una incisión umbilical de 3 cm. Un dreno cerrado con succión se externalizó por una de las incisiones de los trócares de 5mm. No hubo complicaciones trans ni post operatorias. La estadia hospitalaria post operatoria fue de 3 y 2 días, el dreno se retiró al tercer y segundo día post operado y las sondas Foley se retiraron a los 14 días. Las próstatas pesaron 27 y 23 gramos, los puntajes Gleason fueron de (3+4 y (3+3 ambos tuvieron márgenes negativos, sin infiltración vascular ni nerviosa. La PRL es un procedimiento mínimamente invasivo para hombres con cáncer de próstata órgano confinado realizable, seguro y reproducible. Con mejor resultado cosmético y menor dolor posoperatorio.We herein report the first two cases of laparoscopic radical prostatectomy (LRP performed by Costarican Urologists. Two 50 and 64-year-old patients respectively, with an adenocarcinoma of the prostate with Gleason scores (3+ 3 6, diagnosed trough transrectal ultrasonografic guided biopsies, indicated by an elevation of the prostate specific antigen (PSA or abnormal rectal digital examination (DRE. The LRP was performed transperitonealy with Montsouris technique using standard laparoscopy instruments and high definition laparoscopic video tower. After placing a 10mm camera port through the umbilicus, the procedure was accomplished with 4 trocars. The entire operative time was 240 and 205 minutes, whereas the blood loss was 150 and 100 ml respectively. The extraction of the specimens with seminal vesicles was through a 3 cm. umbilical incision. A closed drainage

  12. Application Value of Laparoscopically Assisted Vaginal Hysterectomy in the Treatment of Huge Leiomyoma Uterus%腹腔镜辅助阴式全子宫切除术在巨大子宫肌瘤治疗中的应用价值

    Institute of Scientific and Technical Information of China (English)

    李文霞; 陈德娟; 颜爱华; 殷金凤; 付琼

    2015-01-01

    目的:研究腹腔镜辅助阴式全子宫切除术(Laparoscopic assisted vaginal hysterectomy,LAVH)在巨大子宫肌瘤(Huge leiomyoma uterus,HLU)治疗中的应用价值.方法:从2012年9月到2013年9月,选择在我院接受手术治疗的HLU患者130例作为研究对象.根据手术方案进行分组,其中LAVH组65例,TAH组65例,对比两组手术情况,术后并发症情况以及两组患者疼痛情况.结果:LAVH组的肛门排气时长、下床活动时长、住院时长均显著少于TAH组,但手术时长大于TAH组,差异均有统计学意义(均P<0.05).两组在术中出血量方面对比,差异无统计学意义(P>0.05).LAVH组的术后并发症与TAH组相比,差异无统计学意义(P>0.05).LAVH组的VAS评分及VDS评分均显著低于TAH组,差异均有统计学意义(均P<0.05).结论:LAVH术式在HLU中具有较大的应用价值,临床上应重视其适应证,优先选择此类术式,效果显著,值得临床关注.%Objective:To study the application value of laparoscopically assisted vaginal hysterectomy in the treatment of huge leiomyoma uterus.Methods:130 HLU patients undergoing surgery from September 2012 to September 2013 in our hospital were chosen for the study and were devided into the LAVH group,with 65 patients,and the TAH group with 65 cases,according to the surgery programs.Surgery,postoperative complications and patients'pain conditions were compared between the two groups.Results:LAVH group's time of anal exhaust,ambulation and hospitalization were significantly shorter than that of TAH group respectively,but surgery time in TAH surgery group was longer,and the differences were statistically significant (P <0.05).The blood loss in the two groups presented no statistically significant difference (P> 0.05).Difference in postoperative complications was not statistically significant when compared between the two groups (P> 0.05).LAVH group's VAS score and VDS scores were significantly lower than those of TAH group

  13. Health resource utilization and costs during the first 90 days following robot-assisted hysterectomy.

    Science.gov (United States)

    Dandolu, Vani; Pathak, Prathamesh

    2017-08-07

    To compare health resource utilization, costs and readmission rates between robot-assisted and non-robot-assisted hysterectomy during the 90 days following surgery. The study used 2008-2012 Truven Health MarketScan data. All patients admitted as inpatients with a CPT code for hysterectomy between January 2008 and September 2012 were identified and the first hysterectomy-related admission in each patient was included. Patients were categorized based on the route of their hysterectomy and the use of laparoscopy as: total abdominal hysterectomy, vaginal hysterectomy (VH), laparoscopy-assisted supracervical hysterectomy, laparoscopy-assisted vaginal hysterectomy' and total laparoscopic hysterectomy (TLH). Hospitalization costs, including hospital, physician, pharmacy and facility costs, were calculated for the index admissions and for the 90-day follow-up periods. Health resource utilization was determined in terms of inpatient readmissions, outpatient visits, and emergency room visits, RESULTS: There were 302,923 hysterectomies performed over 5 years for benign indications in the inpatient setting (55% abdominal, 17% vaginal, and 28% laparoscopic). Concurrent use of robot assistance steadily increased and was reported in 50% of TLH procedures in 2012. The rates of readmission overall were 4.9% for robot-assisted procedures and 4.3% for procedures without robot assistance (OR 0.89, CI 0.82-0.97). Readmission rates were lowest for VH (3.2%) and highest for TLH (5.6%). Following robot-assisted hysterectomy and VH, 8.3% and 4.6% of patients, respectively, had more than ten outpatient visits in the 90-day follow-up period. The average total cost for 90 days was $16,820 for robot-assisted hysterectomy and $13,031 for procedures without robot assistance. Of the additional costs for robot-assisted surgery, 25% were incurred in the 90-day follow-up period. The study using private insurance data found that robot-assisted hysterectomy was associated with higher health

  14. Laparoscopic management of fallopian tube prolapse masquerading as adenocarcinoma of the vagina in a hysterectomized woman

    Directory of Open Access Journals (Sweden)

    Kucuk Mustafa

    2002-01-01

    Full Text Available Abstract Background Fallopian tube prolapse as a complication of abdominal hysterectomy is a rare occurrence. A case with fallopian tube prolapse was managed by a combined vaginal and laparoscopic approach and description of the operative technique is presented. Case presentation A 39-year-old woman with vaginal prolapse of the fallopian tube after total abdominal hysterectomy presented with an incorrect diagnosis of adenocarcinoma of the vaginal apex. The prolapsed tube and cystic ovary were removed by vaginal and laparoscopic approach. The postoperative course went well. Conclusions Early or late fallopian tube prolapse can occur after total abdominal hysterectomy and vaginal hysterectomy. Symptoms consist of persistent blood loss or leukorrhea, dyspareunia and chronic pelvic pain. Vaginal removal of prolapsed tube with laparoscopic surgery may be a suitable treatment. The abdominal or vaginal approach used in surgical correction of prolapsed tubes must be decided in each case according to the patient's individual characteristics.

  15. Analysis of Quality of Life of Patients with Cervical Cancer After Laparoscopic Radical Resection%腹腔镜下宫颈癌根治术后患者生存质量的调查分析

    Institute of Scientific and Technical Information of China (English)

    蔡颖; 赵健; 张顺仓; 李东红

    2016-01-01

    目的:探讨腹腔镜下宫颈癌根治术后患者的生存质量。方法收集500例宫颈癌患者,并对其进行生存质量问卷调查。问卷采用生存质量核心量表中文版(quality of life core questionaire,QLQ—C30)。结果腹腔镜下宫颈癌根治术后患者的生存质量与多种因素有关,分别为文化水平、收入水平、职业状态、就医费用来源、临床病理分期、治疗手段以及术后患者性生活质量。结论对腹腔镜下宫颈癌根治术后的患者给予积极的社会支持,并提供相关的健康教育知识,对于提高患者的生存质量有积极的意义。%Objective To investigate the quality of life of patients with cervical cancer after laparoscopic radical opera -tion.Methods 500 patients with cervical cancer were selected ,and the quality of life questionnaire survey was conducted (quali-ty of life core questionaire,QLQ—C30).Results Educational level,income level,occupational status,source of medical expen-ses,clinical and pathological stage ,therapeutic tools ,and postoperative sexual life quality were related to the quality of life in pa-tients with cervical cancer after laparoscopic radical resection .Conclusion Active social support and relevant health education knowledge can help improve the quality of life of cervical cancer patients after laparoscopic radical resection .

  16. The Impact of Individual Surgeon Volume on Hysterectomy Costs

    Science.gov (United States)

    Shepherd, Jonathan P.; Kantartzis, Kelly L.; Lee, Ted; Bonidie, Michael J.

    2017-01-01

    Background and Objective: Hysterectomy is one of the most common surgical procedures women will undergo in their lifetime. Several factors affect surgical outcomes. It has been suggested that high-volume surgeons favorably affect outcomes and hospital cost. The objective is to determine the impact of individual surgeon volume on total hospital costs for hysterectomy. Methods: This is a retrospective cohort of women undergoing hysterectomy for benign indications from 2011 to 2013 at 10 hospitals within the University of Pittsburgh Medical Center System. Cases that included concomitant procedures were excluded. Costs by surgeon volume were analyzed by tertile group and with linear regression. Results: We studied 5,961 hysterectomies performed by 257 surgeons: 41.5% laparoscopic, 27.9% abdominal, 18.3% vaginal, and 12.3% robotic. Surgeons performed 1–542 cases (median = 4, IQR = 1–24). Surgeons were separated into equal tertiles by case volume: low (1–2 cases; median total cost, $4,349.02; 95% confidence interval [CI] [$3,903.54–$4,845.34]), medium (3–15 cases; median total cost, $2,807.90; 95% CI [$2,693.71–$2,926.93]) and high (>15 cases, median total cost $2,935.12, 95% CI [$2,916.31–$2,981.91]). ANOVA analysis showed a significant decrease (P < .001) in cost from low-to-medium– and low-to-high–volume surgeons. Linear regression showed a significant linear relationship (P < .001), with a $1.15 cost reduction per case with each additional hysterectomy. Thus, if a surgeon performed 100 cases, costs were $115 less per case (100 × $1.15), for a total savings of $11,500.00 (100 × $115). Conclusion: Overall, in our models, costs decreased as surgeon volume increased. Low-volume surgeons had significantly higher costs than both medium- and high-volume surgeons.

  17. Robotic assisted hysterectomy in obese patients: a systematic review.

    Science.gov (United States)

    Iavazzo, Christos; Gkegkes, Ioannis D

    2016-06-01

    Robotic hysterectomy is an alternative approach to the management of female genital tract pathology. A systematic literature review was performed to evaluate the till now available literature evidence on robotic assisted hysterectomy in obese and morbidly obese patients. In total, robotic assisted hysterectomy was performed on 2769 patients. The most frequent indication for robotic hysterectomy was endometrial carcinoma (1832 out of 2769 patients, 66.2 %). Hypertension, diabetes mellitus, obstructive sleep apnea, chronic obstructive pulmonary disease and venous thromboembolism were the most common comorbidities reported. The conversion rate to laparotomy was 92 out of 2226 patients (4.1 %). The most frequent intraoperative complications for robotic hysterectomy were gastrointestinal injury (17 out of 2769 patients, 0.6 %), haemorrhage (five out of 2769 patients, 0.2 %) and bladder injury (five out of 2769 patients, 0.2 %). Wound infections/dehiscence (66 out of 2769 patients, 2.4 %), fever (56 out of 2769 patients, 2 %), pulmonary complications (55 out of 2769 patients, 1.9 %), urogenital complications (36 out of 2769 patients, 1.3 %) and postoperative ileus (28 out of 2769 patients, 1 %) were the most common postoperative complications. Death was reported in three out of 2769 patients (0.1 %). The ICU admitted patients were eight of 2226 patients (0.4 %). The robotic technique, especially in obese, can optimize the surgical approach and recovery of such patients with equally if not better outcomes compared to open and/or laparoscopic techniques.

  18. Association between obesity and the trends of routes of hysterectomy performed for benign indications.

    Science.gov (United States)

    Mikhail, Emad; Miladinovic, Branko; Velanovich, Vic; Finan, Michael A; Hart, Stuart; Imudia, Anthony N

    2015-04-01

    To estimate the association between obesity and the recent trends of routes chosen for hysterectomy performed for benign indications in the United States. Using the American College of Surgeons-National Surgical Quality Improvement Project's database, patients who underwent hysterectomy for benign indications from 2005 to 2011 were identified by International Classification of Diseases, 9th Revision codes and were categorized into total abdominal hysterectomy (TAH), total vaginal hysterectomy (TVH), laparoscopically assisted vaginal hysterectomy (LAVH), and total laparoscopic hysterectomy (TLH). The patients were divided into four subgroups according to body mass index (BMI) (less than 25, 25-29.9, 30-39.9, and 40 or greater). The data were analyzed using Student's t test or χ2 and Fisher's exact test. A total of 18,810 patients underwent hysterectomy for benign indications during the study period: 9,852 (52.4%) were TAH, 5,146 (27.4%) TVH, 2,296 (12.2%) LAVH, and 1,516 (8.0%) TLH. The rates of TAH increased from 45.7% in patients with ideal body weight to 62% in morbidly obese patients (Pobese patients, respectively (Physterectomy. The rates of superficial and deep wound infections were higher with increasing BMI in patients undergoing TAH (Physterectomy performed for benign indications, increasing BMI was associated with increased rate of TAH and decreased rate of TVH and LAVH, but not the rate of TLH. Increasing BMI was associated with increased operative time for all subgroups and increased surgical site infection in the TAH group.

  19. An audit of indications, complications, and justification of hysterectomies at a teaching hospital in India.

    Science.gov (United States)

    Pandey, Deeksha; Sehgal, Kriti; Saxena, Aashish; Hebbar, Shripad; Nambiar, Jayaram; Bhat, Rajeshwari G

    2014-01-01

    Objective. Aim of this audit was to analyze indications, complications, and correlation of preoperative diagnosis with final histopathology report of all hysterectomies, performed in a premier teaching hospital. Methods. Present study involved all patients who underwent hysterectomy at a premier university hospital in Southern India, in one year (from 1 January, 2012, to 31 December, 2012). Results. Most common surgical approach was abdominal (74.7%), followed by vaginal (17.8%), and laparoscopic (6.6%) hysterectomy. Most common indication for hysterectomy was symptomatic fibroid uterus (39.9%), followed by uterovaginal prolapse (16.3%). Overall complication rate was 8.5%. Around 84% had the same pathology as suspected preoperatively. Only 6 (5 with preoperative diagnosis of abnormal uterine bleeding and one with high grade premalignant cervical lesion) had no significant pathology in their hysterectomy specimen. Conclusion. Hysterectomy is used commonly to improve the quality of life; however at times it is a lifesaving procedure. As any surgical procedure is associated with a risk of complications, the indication should be carefully evaluated. With the emergence of many conservative approaches to deal with benign gynecological conditions, it is prudent to discuss available options with the patient before taking a direct decision of surgically removing her uterus.

  20. An Audit of Indications, Complications, and Justification of Hysterectomies at a Teaching Hospital in India

    Directory of Open Access Journals (Sweden)

    Deeksha Pandey

    2014-01-01

    Full Text Available Objective. Aim of this audit was to analyze indications, complications, and correlation of preoperative diagnosis with final histopathology report of all hysterectomies, performed in a premier teaching hospital. Methods. Present study involved all patients who underwent hysterectomy at a premier university hospital in Southern India, in one year (from 1 January, 2012, to 31 December, 2012. Results. Most common surgical approach was abdominal (74.7%, followed by vaginal (17.8%, and laparoscopic (6.6% hysterectomy. Most common indication for hysterectomy was symptomatic fibroid uterus (39.9%, followed by uterovaginal prolapse (16.3%. Overall complication rate was 8.5%. Around 84% had the same pathology as suspected preoperatively. Only 6 (5 with preoperative diagnosis of abnormal uterine bleeding and one with high grade premalignant cervical lesion had no significant pathology in their hysterectomy specimen. Conclusion. Hysterectomy is used commonly to improve the quality of life; however at times it is a lifesaving procedure. As any surgical procedure is associated with a risk of complications, the indication should be carefully evaluated. With the emergence of many conservative approaches to deal with benign gynecological conditions, it is prudent to discuss available options with the patient before taking a direct decision of surgically removing her uterus.

  1. Peri operative nursing progress on patients undergoing laparoscopic radical cystectomy and orthotopic ileal neo-bladder%腹腔镜根治性膀胱切除原位回肠新膀胱术病人的围术期护理进展

    Institute of Scientific and Technical Information of China (English)

    张珊; 温贤秀; 雷花; 杨显芳; 祝玲; 匡玲

    2016-01-01

    It reviewed the peri operative nursing progress on patients undergoing laparoscopic radical cystecto-my and orthotopic ileal neobladder,so as to provide references for the nursing model of patients undergoing the robot assisted robotic assisted laparoscopic radical cystectomy and orthotopic ileal neobladder.%综述腹腔镜根治性膀胱切除原位回肠新膀胱术围术期护理进展,为机器人辅助腹腔镜根治性膀胱切除原位回肠新膀胱术护理模式的建立提供参考。

  2. Preoperative teaching and hysterectomy outcomes.

    Science.gov (United States)

    Oetker-Black, Sharon L; Jones, Susan; Estok, Patricia; Ryan, Marian; Gale, Nancy; Parker, Carla

    2003-06-01

    This study used a theoretical model to determine whether an efficacy-enhancing teaching protocol was effective in improving immediate postoperative behaviors and selected short- and long-term health outcomes in women who underwent abdominal hysterectomies. The model used was the self-efficacy theory of Albert Bandura, PhD. One hundred eight patients in a 486-bed teaching hospital in the Midwest who underwent hysterectomies participated. The participation rate was 85%, and the attrition rate was 17% during the six-month study. The major finding was that participants in the efficacy-enhancing teaching group ambulated significantly longer than participants in the usual care group. This is an important finding because the most prevalent postoperative complications after hysterectomy are atelectasis, pneumonia, paralytic ileus, and deep vein thrombosis, and postoperative ambulation has been shown to decrease or prevent all of these complications. This finding could affect the overall health status of women undergoing hysterectomies.

  3. LAPAROSCOPIC GYNAEC SURGERIES – A RETROSPECTIVE STUDY

    Directory of Open Access Journals (Sweden)

    Hiremath

    2013-10-01

    Full Text Available ABSTRACT : BACKGROUND: There has been a rapid worldwide adoption of laparoscopic procedures across many surgical specialt ies, most notably in Gynaecology. Unfortunately, the increased adoption of laparoscopic surgery has also been accompanied by a corresponding rise in the rates and types of complications reported. AIMS : To audit the different types of laparoscopic surgerie s and their complications and comparison with other routes of surgery. METHODS & MATERIALS : We have retrospectively analysed 285 laparoscopic surgeries and 306 other routes of surgery which were done at our institute from July 2011 to April 2013.We admit t he patients 1 - 2 days prior to surgery and a complete medical work - up of the patient is done for elective laparoscopic surgery .We defer laparoscopy for malignant conditions, uterine size more than 20 weeks, cervix flushed to the vagina or with history of m ore than 2 pelvic surgeries. Sub - fertile women, after an initial workup, are subjected to diagnostic laparoscopy with chromopertubation. For laparoscopic cystectomies, patients with ultrasono graphy findings suggestive of benign tumours are selected. RESULT S : We have performed 285 laparoscopic procedures over this time period till date. Majority of these cases are Laparoscopic Assisted Vaginal Hysterectomies (LAVH [111 – 38.9%], followed by laparoscopic surgeries for various benign ovarian conditions ( BOC [62 – 21%] and Diagnostic Laparoscopies ( DL with or without laparoscopic ovarian drilling ( LOD [59 cases – 20.7%]. Out of 111 LAVH, 3 patients had bladder injury [2.7%] ; Out of 285 cases that underwent laparoscopic procedures, 5 [1.75%] required conversi on to laparotomy. Overall operative complications including major and minor, are significantly higher in the abdominal surgery group as compared to the laparoscopic group ( p value= 0.001 CONCLUSION : Laparoscopy is a safe route for conventional surgery, with lesser intraoperative, immediate post

  4. Comparative cost-effectiveness of robot-assisted and standard laparoscopic prostatectomy as alternatives to open radical prostatectomy for treatment of men with localised prostate cancer: a health technology assessment from the perspective of the UK National Health Service.

    Science.gov (United States)

    Close, Andrew; Robertson, Clare; Rushton, Stephen; Shirley, Mark; Vale, Luke; Ramsay, Craig; Pickard, Robert

    2013-09-01

    Robot-assisted laparoscopic prostatectomy is increasingly used compared with a standard laparoscopic technique, but it remains uncertain whether potential benefits offset higher costs. To determine the cost-effectiveness of robotic prostatectomy. We conducted a care pathway description and model-based cost-utility analysis. We studied men with localised prostate cancer able to undergo either robotic or laparoscopic prostatectomy for cure. We used data from a meta-analysis, other published literature, and costs from the UK National Health Service and commercial sources. Care received by men for 10 yr following radical prostatectomy was modelled. Clinical events, their effect on quality of life, and associated costs were synthesised assuming 200 procedures were performed annually. Over 10 yr, robotic prostatectomy was on average (95% confidence interval [CI]) £1412 (€1595) (£1304 [€1473] to £1516 [€1713]) more costly than laparoscopic prostatectomy but more effective with mean (95% CI) gain in quality-adjusted life-years (QALYs) of 0.08 (0.01-0.15). The incremental cost-effectiveness ratio (ICER) was £18 329 (€20 708) with an 80% probability that robotic prostatectomy was cost effective at a threshold of £30 000 (€33 894)/QALY. The ICER was sensitive to the throughput of cases and the relative positive margin rate favouring robotic prostatectomy. Higher costs of robotic prostatectomy may be offset by modest health gain resulting from lower risk of early harms and positive margin, provided >150 cases are performed each year. Considerable uncertainty persists in the absence of directly comparative randomised data. Copyright © 2013 European Association of Urology. Published by Elsevier B.V. All rights reserved.

  5. Effect of a risk-stratified grade of nerve-sparing technique on early return of continence after robot-assisted laparoscopic radical prostatectomy.

    Science.gov (United States)

    Srivastava, Abhishek; Chopra, Sameer; Pham, Anthony; Sooriakumaran, Prasanna; Durand, Matthieu; Chughtai, Bilal; Gruschow, Siobhan; Peyser, Alexandra; Harneja, Niyati; Leung, Robert; Lee, Richard; Herman, Michael; Robinson, Brian; Shevchuk, Maria; Tewari, Ashutosh

    2013-03-01

    The impact of nerve sparing (NS) on urinary continence recovery after robot-assisted laparoscopic radical prostatectomy (RALP) has yet to be defined. To evaluate the effect of a risk-stratified grade of NS technique on early return of urinary continence. Data were collected from 1546 patients who underwent RALP by a single surgeon at a tertiary care center from December 2008 to October 2011. Patients were categorized preoperatively by a risk-stratified approach into risk grades 1-4, with risk grade 1 patients more likely to receive NS grade 1 or complete hammock preservation. This categorization was also conducted for risk grades 2-4, with grade 4 patients receiving a non-NS procedure. Risk-stratified grading of NS RALP. Univariate and multivariate analysis identified predictors of early return of urinary continence, defined as no pad use at ≤ 12 wk postoperatively. Early return of continence was achieved by 791 of 1417 men (55.8%); of those, 199 of 277 (71.8%) were in NS grade 1, 440 of 805 (54.7%) were in NS grade 2, 132 of 289 (45.7%) were in NS grade 3, and 20 of 46 (43.5%) were in NS grade 4 (preturn of urinary continence when NS grade 1 was the reference variable compared with NS grade 2 (preturn of urinary continence. Positive surgical margin rates were 7.2% (20 of 277) of grade 1 cases, 7.6% (61 of 805) of grade 2 cases, 7.6% (22 of 289) of grade 3 cases, and 17.4% (8 of 46) of grade 4 cases (p=0.111). Extraprostatic extension occurred in 6.1% (17 of 277) of NS grade 1 cases, 17.5% (141 of 805) of NS grade 2 cases, 42.5% (123 of 289) of NS grade 3 cases, and 63% (29 of 46) of NS grade 4 cases (prisk-stratified grade of NS technique and early return of urinary continence as patients with a lower grade (higher degree) of NS achieved an early return of urinary continence without compromising oncologic safety. Copyright © 2012 European Association of Urology. Published by Elsevier B.V. All rights reserved.

  6. Erectile Function and Oncologic Outcomes Following Open Retropubic and Robot-assisted Radical Prostatectomy: Results from the LAParoscopic Prostatectomy Robot Open Trial.

    Science.gov (United States)

    Sooriakumaran, Prasanna; Pini, Giovannalberto; Nyberg, Tommy; Derogar, Maryam; Carlsson, Stefan; Stranne, Johan; Bjartell, Anders; Hugosson, Jonas; Steineck, Gunnar; Wiklund, Peter N

    2017-09-04

    Whether surgeons perform better utilising a robot-assisted laparoscopic technique compared with an open approach during prostate cancer surgery is debatable. To report erectile function and early oncologic outcomes for both surgical modalities, stratified by prostate cancer risk grouping. In a prospective nonrandomised trial, we recruited 2545 men with prostate cancer from seven open (n=753) and seven robot-assisted (n=1792) Swedish centres (2008-2011). Clinometrically-validated questionnaire-based patient-reported erectile function was collected before, 3 mo, 12 mo, and 24 mo after surgery. Surgeon-reported degree of neurovascular-bundle preservation, pathologist-reported positive surgical margin (PSM) rates, and 2-yr prostate-specific antigen-relapse rates were measured. Among 1702 preoperatively potent men, we found enhanced erectile function recovery for low/intermediate-risk patients in the robot-assisted group at 3 mo. For patients with high-risk tumours, point estimates for erectile function recovery at 24 mo favoured the open surgery group. The degree of neurovascular bundle preservation and erectile function recovery were greater correlated for robot-assisted surgery. In pT2 tumours, 10% versus 17% PSM rates were observed for open and robot-assisted surgery, respectively; corresponding rates for pT3 tumours were 48% and 33%. These differences were associated with biochemical recurrence in pT3 but not pT2 disease. The study is limited by its nonrandomised design and relatively short follow-up. Earlier recovery of erectile function in the robot-assisted surgery group in lower-risk patients is counterbalanced by lower PSM rates for open surgeons in organ-confined disease; thus, both open and robotic surgeons need to consider this trade-off when determining the plane of surgical dissection. Robot-assisted surgery also facilitates easier identification of nerve preservation planes during radical prostatectomy as well as wider dissection for pT3 cases. For

  7. A Simple Laparoscopic Procedure to Restore a Normal Vaginal Length After Colpohysterectomy With Large Upper Colpectomy for Cervical and/or Vaginal Neoplasia.

    Science.gov (United States)

    Leblanc, Eric; Bresson, Lucie; Merlot, Benjamin; Puga, Marco; Kridelka, Frederic; Tsunoda, Audrey; Narducci, Fabrice

    2016-01-01

    Colpohysterectomy is sometimes associated with a large upper colpectomy resulting in a shortened vagina, potentially impacting sexual function. We report on a preliminary experience of a laparoscopic colpoplasty to restore a normal vaginal length. Patients with shortened vaginas after a laparoscopic colpohysterectomy were considered for a laparoscopic modified Davydov's procedure to create a new vaginal vault using the peritoneum of the rectum and bladder. From 2010 to 2014, 8 patients were offered this procedure, after informed preoperative consent. Indications were 2 extensive recurrent vaginal intraepithelial neoplasias grade 3 and 6 radical hysterectomies for cervical cancer. Mean vaginal length before surgery was 3.8 cm (standard deviation, 1.6). Median operative time was 50 minutes (range, 45-90). Blood loss was minimal (50-100 mL). No perioperative complications occurred. Median vaginal length at discharge was 11.3 cm (range, 9-13). Sexual intercourse could be resumed around 10 weeks after surgery. At a median follow-up of 33.8 months (range, 2.4-51.3), 6 patients remained sexually active but 2 had stopped. Although this experience is small, this laparoscopic modified Davydov's procedure seems to be an effective procedure, adaptable to each patient's anatomy. If the initial postoperative regular self-dilatation is carefully observed, vaginal patency is durably restored and enables normal sexual function.

  8. 机器人辅助腹腔镜下低位直肠癌根治术的护理配合%Nursing cooperation in robot-assisted radical resection of low rectal carcinoma under laparoscope

    Institute of Scientific and Technical Information of China (English)

    许晓晓; 张秋玲; 李凤云

    2014-01-01

    目的:探讨机器人辅助腹腔镜下低位直肠癌根治术的护理配合方法,提高护士的手术配合质量。方法对48例机器人辅助腹腔镜下低位直肠癌根治术的手术配合进行总结分析。结果48例机器人辅助腹腔镜下低位直肠癌根治术均顺利完成。结论充分的术前准备和完善的术中护理管理是保障手术顺利进行的关键。%Objective To probe into ways of nursing cooperation in robot-assisted radical resection of low rectal carcinoma under laparoscope, thus improve the quality of nursing cooperation. Methods Summarize and analyze 48 cases of nursing cooperation in robot-assisted radical resection of low rectal carcinoma under laparoscope. Results All the 48 cases have been performed successfully. Conclusion The full preoperative preparation and sound intraoperative nursing management are the guarantees of the smooth operation.

  9. 腹腔镜根治性前列腺切除术后控尿功能的影响因素%Factors influencing urinary continence after laparoscopic radical prostatectomy

    Institute of Scientific and Technical Information of China (English)

    黄建林; 邱敏; 马潞林

    2013-01-01

    Radical prostatectomy is one of the most effective treatments for men with clinically localized prostate cancer.Though technical innovations,especially laparoscopic techniques,have developed rapidly for the last decade,urinary incontinence remains one of the most troubling side effects of the operation.While the injury of urethral sphincter and its innervations was considered as the most important reason for incontinence,factors influencing postoperative continence that have been considered include clinical features of patients,such as the patient' s age,size of the prostate,prior prostatic surgery and features of the surgical technique itself,such as preservation of full functional-length urethra,preservation of the neurovascular bundles,bladder neck preservation or reconstruction and pelvic floor muscle training during the early phase after the surgery.Nonetheless,many factors above have not been clearly established,and controversy goes on among different studies.This article reviews factors that may influence urinary continence after laparoscopic radical prostatectomy.

  10. 达芬奇机器人辅助腹腔镜前列腺癌根治术的手术要点(附光盘)%Surgical techniques of Da Vinci robot-assisted laparoscopic radical prostatectomy

    Institute of Scientific and Technical Information of China (English)

    沈周俊; 王先进; 何威; 王晓晶; 钟山

    2013-01-01

    达芬奇机器人手术系统在泌尿外科领域的广泛应用和发展是当今世界临床医学发展的里程碑.达芬奇机器人辅助腹腔镜前列腺癌根治术(robot-assisted laparoscopic radical prostatectomy,RLRP)是所有泌尿外科机器人手术中,与开放和传统腹腔镜手术相比最具明显优势的微创手术.目前在前列腺癌高发的欧美国家,RLRP几乎成为治疗局限性前列腺癌的金标准,在国内RLRP也已取得快速发展.本文就机器人手术系统的国内外发展状况和发展趋势,RLRP的适应证和禁忌证、手术步骤和技巧、优缺点等做一概述.%The wide application and development of Da Vinci surgical system in the urology is a milestone in the development of clinical medicine. Da Vinci robot-assisted laparoscopic radical prostatectomy(RLRP)has the most obvious advantages of minimally invasive surgery among all robotic surgeries in urology compared to the laparoscopic surgeries. In the developed regions with high incidence of prostate cancer,RLRP has almost become the gold standard for the treatment of localized prostate cancer. Rapid development of RLRP has also been achieved in China. This review gives a brief account of the current situation and development trend of robotic surgical system and summarizes the main aspects of RLRP including the indications and contraindications, surgical procedures and techniques, ad vantages and disadvantages and so on.

  11. Laparoscopic surgery for early endometrial cancer

    DEFF Research Database (Denmark)

    Bennich, Gitte; Rudnicki, M.; Lassen, P. D.

    2016-01-01

    IntroductionThe purpose of the present study was to evaluate learning curves and short-term outcomes following laparoscopic surgery for early endometrial cancer in women of different body mass index (BMI) classes. Material and methodsData from 227 women planned for laparoscopic surgery for presumed...... stage I endometrial cancer were collected retrospectively from a Danish gynecologic oncology unit. Surgery included laparoscopic hysterectomy and bilateral salpingo-oophorectomy with or without pelvic lymphadenectomy (PLA). ResultsMedian length of operations was 60 min (range, 30-197) and 120 min (range...... peri- and postoperative outcomes were independent of BMI classes. ConclusionsOur data suggest that laparoscopic surgery for early endometrial cancer is feasible and safe. With increasing surgeon's experience there is a significant decrease in operative time and increase in the number of lymph nodes...

  12. 子宫切除联合阴道延长手术对Ⅰb1~Ⅰb2期宫颈癌患者婚姻质量的影响%Quality of marriage and sexual function of cervical cancer patients following radical hysterectomy and vaginal extension

    Institute of Scientific and Technical Information of China (English)

    陈红; 张友忠

    2015-01-01

    Objective To investigate the quality of marriage and sexual function of cervical cancer patients following radical hysterectomy and vaginal extension.Methods Case-control and questionnairebased methods were used in this study.Forty patients of early-stage (Ⅰ b 1 ~ Ⅰ b2) cervical cancer who had undergone vaginal extension following classic radical hysterectomy were included in the observation group,while 40 patients with matching factors and radical hysterectomy only during the same period were included in the control group.The quality of marriage and sexual function were compared with OLSON marriage prolapse and incontinence sexual function questionnaire Shon Fonn (PISQ-12).Results The operation time and postoperative vaginal length in the observation group were higher than those in the control group (P < 0.05 or P < 0.01).The emotional,physical,and total scores during postoperation were lower than those during preoperation (P < 0.01).The emotional,physical,and total scores in the control group were lower than those in the observation group (P < 0.01).The marital satisfaction,husband and wife communication,conflict resolution methods,extracurricular activities and sex scores in the observation group were higher than those in the control group (P < 0.05 or P < 0.01).Conclusions Patients with peritoneovaginoplasty following radical hysterectomy had much longer vagina and less self-perceived short vagina.Vaginal extension following radical hysterectomy does not worsen the pelvic floor symptoms.%目的 探讨子宫切除联合阴道延长手术对Ⅰb1~Ⅰb2期宫颈癌患者婚姻质量、生活质量及性生活的影响.方法 选择本院住院经宫腔细胞学及宫颈活组织病理学确诊的Ⅰb1~Ⅰb2期宫颈癌患者80例为研究对象,采用随机数字表法分为观察组和对照组,每组40例,两组分别给予腹腔镜子宫切除联合阴道延长手术与单独腹腔镜子宫切除手术治疗.观察患者术

  13. Laparoscopic rectocele repair using polyglactin mesh.

    Science.gov (United States)

    Lyons, T L; Winer, W K

    1997-05-01

    We assessed the efficacy of laparoscopic treatment of rectocele defect using a polyglactin mesh graft. From May 1, 1995, through September 30, 1995, we prospectively evaluated 20 women (age 38-74 yrs) undergoing pelvic floor reconstruction for symptomatic pelvic floor prolapse, with or without hysterectomy. Morbidity of the procedure was extremely low compared with standard transvaginal and transrectal approaches. Patients were followed at 3-month intervals for 1 year. Sixteen had resolution of symptoms. Laparoscopic application of polyglactin mesh for the repair of the rectocele defect is a viable option, although long-term follow-up is necessary.

  14. Laparoscopic Nephrectomy for Wilms Tumor

    OpenAIRE

    Andolfi C; Randi B; Ruggeri G.; Lima M.

    2014-01-01

    Wilms tumor is the most frequent primary renal malignancy in children. The surgical resection is traditionally performed through laparotomy. The advent of laparoscopic surgery for benign renal lesions has led the surgeon to use a minimal invasive approach for the nephroblastoma. We describe a 9-months-old girl who presented with a left renal mass. A laparoscopic resection of the tumor with left radical nephroureterectomy was performed. The specimens were removed in an endoscopic bag through a...

  15. A comparison of postoperative analgesic effects with preoperative injection of the different doses of butorphanol in patients undergoing laparoscopically hysterectomy%预注不同剂量布托啡诺对妇科腹腔镜患者术后镇痛效果的比较

    Institute of Scientific and Technical Information of China (English)

    黄龙; 袁世荧; 王开俊; 任俏

    2011-01-01

    目的 比较不同剂量布托啡诺静脉预注用于腹腔镜子宫切除术( laparoscopically hysterectom,LH)对患者术后镇痛作用的影响.方法 48例行全麻下择期LH患者,年龄35岁~60岁,ASA Ⅰ ~Ⅱ级,采用随机数字表法随机分为4组(每组12例),B1组、B2组、B3组分别于切皮前10 min缓注布托啡诺0.01、0.02、0.03 mg/kg(生理盐水稀释至20 ml),C组为对照组,静注生理盐水20 ml,分别记录4组患者术毕苏醒时间、术后视觉模拟(visual analogue scale,VAS)评分、镇静(Ramsay)评分及副作用.所有患者的全麻药用量差异无统计学意义,术后加用镇痛药的病例予以剔除.结果 B3组术毕苏醒时间(18.9±0.87)s较其他3组[(6.3±0.38)、(7.0±0.37)、(5.5±0.03)s]明显延长(P<0.05);各实验组术后VAS评分比C组明显降低(P<0.05),实验组间,B2组、B3组术后VAS评分比B1组明显降低(P<0.05);与C组相比,各实验组术后Ramsay评分明显升高(P<0.05),与B1组、B2组比较,B3组在术后2、4、6h的Ramsay评分明显升高(P<0.05).B3组术后的头晕发生率(41.6%)明显高于其他3组(P<0.05).结论 布托啡诺0.02 mg/kg静脉预注具有良好的术后镇痛效果及较少副作用,是用于妇科腹腔镜手术超前镇痛的适宜剂量.%Objective To investigate and compare postoperative analgesia effects with preoperative injection of butorphanol at different doses in patients undergoing laparoscopically hysterectomy.Methods 48 patients received general anesthesia undergoing laparoscopically hysterectomy,ASA Ⅰ -Ⅱ grade,were randomly divided into 4 groups(n=12):butorphanol 0.01,0.02,0.03 mg/kg was given slowly over 10 min before skin incision to patients in B1,B2 and B3 groups respectively; saline was injected into C (control) group.Pain and sedation were assessed using visual analogue scale(VAS) and Ramsay score at 2,4,6,12 h and 24 h after surgery.The time to regain consciousness and the adverse reactions (nausea

  16. 腹腔镜辅助阴式子宫切除术与阴式子宫切除术258例临床分析%A comparison study on laparoscopic assisted vaginal hysterectomy and total vaginal hysterectomy——clinical analysis of 258 cases

    Institute of Scientific and Technical Information of China (English)

    张泽莉; 王艳; 廖玲; 张士玲; 王倩

    2013-01-01

    Objective To investigate the clinical effects of laparoscopic assisted vaginal hysterectomy ( LAVH) and total vaginal hysterec-tomy(TVH)on patients with non-prolapsed uterus. Methods The clinical data of 258 patients undergoing total hysterectomy( 156 cases in LAVH group, 102 cases in TVH group) from October 2007 to August 2010 were analyzed retrospectively. Analysis was made of surgical indications ,operational time,postoperative anal exhaust time,incidence of complication,the bleeding and postoperative hospital stays. Results The operations in both groups were all successful. Operation time of LAVH group was slightly longer than that of TVH group (90.2 ±15. 6) vs (77. 5 ± 17.3)min,P0. 05) . Conclusion Both TVH and LAVH are safe and minimally invasive surgery. Compared with TVH, LAVH has obvious advantages for the patients with the uterus with more than 12 weeks or uterine fibroids merger accessories benign tumor,pelvic adhesion,which has prospects of wide application and development.%目的 探讨非脱垂子宫腹腔镜辅助阴式子宫切除术(LAVH)与阴式子宫切除术(TVH)的临床效果.方法 回顾性分析2007年10月-2010年8月行LAVH 156例、TVH 102例患者的临床资料.比较两组手术适应证、手术时间、出血量、术后住院时间.结果 LAVH组手术时间略长于TVH组[(90.2±15.6)vs(77.5±17.3)]min,P<0.05)、并发症发生率显著低于TVH组(0.007% vs 0.089%,P<0.05);LAVH组与TVH组术中出血量[(88.4±11.2)vs(93.1±13.7)]ml、术后肛门排气时间(12.8±1.9)vs(13.7±1.2)h、住院时间(5.7±0.4)vs(5.6±0.6)d比较,差异无显著意义(P>0.05).结论 LAVH较TVH术式具有更高的安全性,切除子宫大于孕12周或子宫肌瘤合并附件良性肿瘤、盆腔重度粘连的患者处理上明显优于TVH,具有广阔的应用及发展情景.

  17. 腹腔镜下膀胱根治性切除-原位回肠新膀胱术108例分析%Laparoscopic radical cystectomy with orthotopic Heal neobladder: report of 108 cases

    Institute of Scientific and Technical Information of China (English)

    林天歆; 郭正辉; 尹心宝; 董文; 黄健; 许可慰; 江春; 黄海; 韩金利; 张彩霞; 姚友生; 谢文练

    2008-01-01

    Objective To analyze the effects, complication, and outcome of laparoscopic radical cystectomy. Methods 108 patients with bladder cancer, 96 males and 12 females, aged 61 (36 -81) underwent laparoscopic radical cystectomy with orthotopic ileal neobladder. Five-port transperitoneal approach was applied. The surgical procedure included standard laparoscopic pelvic lymphadenectomy, radical resection of bladder, extracorporeal formation of ileal pouch; extracorporeal implantation of ureters; and laparoscopic urethra-neobladder anastomosis. Erectile nerve sparing procedure was performed for 26 cases. The patients were followed up for 1 -53 months. Results The median operation time was 330 min, and the median blood loss was 320 ml. Conversion to open surgery was not necessary in any of the patients. There was no peri-operative mortality. The complication rate was 18.5% (20/108). Surgical margins were tumor free for all cases. The day-time and night-time continence rates were 90.7% and 82.6% respectively in 6 months postoperatively. 10 of the 26 patients undergoing erectile nerve-sparing procedure had potency for intercourse. Follow-up showed 5 cases with local recurrence, 1 case with trocar site seeding and 6 cases with distant metastasis, 8 of the patients died of tumor-related disease and 3 died of diseases not related to tumor. Conclusion Laparoscopic radical cystectomy with extracorporeal formation of orthotopic ileal neobladder is a feasible technique with low morbidity and acceptable neobladder function.%目的 报道108例腹腔镜下膀胱根治性切除-原位回肠新膀胱术手术资料及术后并发症、性功能、控尿功能和肿瘤根治情况.方法 2002年12月至2007年5月,108例膀胱癌患者施行了腹腔镜下膀胱根治性切除-原位回肠新膀胱术,其中男96例,女12例.采用5孔经腹入路,首先进行完全腹腔镜下标准的双侧盆腔淋巴结清扫及根治性膀胱切除,然后行体外回肠新膀胱的构建和输尿管

  18. Effect of epidural anesthesia combined with remifentanil-propofol in radical hysterectomy for cervical cancer%硬膜外阻滞复合雷米芬太尼-丙泊酚应用于宫颈癌根治术的效果观察

    Institute of Scientific and Technical Information of China (English)

    李秀满; 王立祥

    2011-01-01

    目的 探讨硬膜外麻醉复合雷米芬太尼-丙泊酚应用于宫颈癌根治术的麻醉效果.方法 56例ASAⅠ~Ⅱ行宫颈癌根治术患者随机分成雷米芬太尼组(R组,n=28)和杜氟合剂组(D组,n=28),R组在硬膜外麻醉后缓慢静注丙泊酚1 mg/kg后用丙泊酚2.0 mg/kg.h+雷米芬太尼0.1ug/kg.min靶控输注,D组用杜冷丁50 mg+氟哌啶2.5 mg后,靶控输注丙泊酚2.0 mg/kg.h.记录5个时间点的血压和心率;记录术中体动反应及术毕呼之睁眼时间,恶心呕吐等评级及患者满意度.结果 ①两组在给药后SBP、DBP、HR较给药前降低(P<0.05〉,切皮时有增高,但D组升高较R组明显(P<0.05〉;②术后D组眩晕、头痛、躁动及患者满意度与R组相比,差异有统计学意义(P<0.05〉.结论 硬膜外复合雷米芬太尼适合在宫颈癌根治术中使用,与复合杜氟合剂相比较,在苏醒程度上更为优良,患者更为舒适.%Objective To explore clinical effect of cpidural anesthesia combined with remifentanil-propofol undergoing radical hysterectomy in patients with cervical cancer. Methods 56 ASA Ⅰ~Ⅱ cases with radical hysterectomy were randomly divided into two groups, Remifentanil group (group R, n= 28), target controlled infusion (TCI) propofol 2.0 mg/kg.h concentration + Remifentanil 0.1 ug/kg. Min after lmg/kg propofol injected slowly by the intraverous route, and Dolantin- droperidol mixture group (group D, n= 28), VCI propofol 2.0 mg/kg.h concentration after Dolantin50mg + droperidol 2.5mg injected slowly by the intravenous route. All patients were oxygenated by nasal cannula. The HR and BP were recorded at five time points respectively. Body reaetion of interoperation, the time of opening eyes, nausea and vomiting rating and patient satisfaction of post operation were observed respectively. Results ① In both groups, patients' HR dropped after drug intravenous injection and inereased when operation was started (P< 0.05 ), in which HR in group

  19. Peripartum hysterectomy in Denmark 1995-2004

    DEFF Research Database (Denmark)

    Sakse, Abelone Elisabeth; Weber, Tom; Nickelsen, Carsten Nahne Amtof

    2007-01-01

    BACKGROUND: Severe postpartum hemorrhage (PPH) is a potentially life-threatening situation that sometimes requires a hysterectomy. We examined the national incidence, risk factors, indications, outcomes and complications of peripartum hysterectomy following vaginal and caesarean delivery. METHODS...

  20. 子宫颈癌患者广泛子宫切除术后下泌尿道尿动力学特点%The low urethra urethral dynamics characteristics after cervical cancer radical hysterectomy postoperative

    Institute of Scientific and Technical Information of China (English)

    戴森戈; 雷鸣; 詹丽飞

    2013-01-01

    Objective To investigate a wide range of uterine cervical cancer after hysterectomy for lower urinary tract urinary dynamics characteristics.Methods Cervical cancer Ib Ⅱ a via ablominal extensive hysterectomy in 25 cases were analyzed retrospectively,which had the type of operation in 7 cases,type Ⅲ Procedures for 18 cases,respectively,at 1 month after operation and 1 urethral urodynamic studies.Results The patients showed varying degrees of voiding dysfunction and urine storage dysfunction,maximum urinary flow rate decreased significantly (10.01 ml/min),the average decrease in urinary flow rate(6.44ml/min),voiding time 77.63s,residual urine volume 103.16ml,maximum bladder capacity 288.68ml,postoperative beard had the aid of abdominal pressure urination.Conclusion Extensive hysterectomy can occur after different degree of voiding dysfunction and urine storage dysfunction,and duration is longer,the main manifestation of impaired detrusor function,bladder sensory dysfunction,urethral dynamics can contribute to early diagnosis,early treatment,to prevent serious complications of the urinary system.%目的 探讨子宫颈癌广泛子宫切除术后下泌尿道尿动力学的特点.方法 回顾性分性因子宫颈癌Ib~Ⅱa期行经腹广泛子宫切除术的患者25例,其中Ⅱ型术式7例、Ⅲ型术式18例,分别于术后1个月至1年间行尿道动力学检查.结果 患者术后均显示不同程度的排尿功能障碍及储尿功能障碍,最大尿流率明显下降(10.01 ml/min),平均尿流率下降(6.44 ml/min),排尿时间77.63 s,残余尿量103.16 ml,最大膀胱容量288.68ml,术后须借助腹压排尿.结论 广泛子宫切除术后可发生不同程度的排尿功能障碍及储尿功能障碍,且持续时间较久,其主要表现为逼尿肌功能受损、膀胱感觉功能减退,尿道动力学可有助于早期诊断、早期治疗,以预防严重的泌尿系统并发症.

  1. Respiratory dynamics and dead space to tidal volume ratio of volume-controlled versus pressure-controlled ventilation during prolonged gynecological laparoscopic surgery.

    Science.gov (United States)

    Lian, Ming; Zhao, Xiao; Wang, Hong; Chen, Lianhua; Li, Shitong

    2016-12-30

    Laparoscopic operations have become longer and more complex and applied to a broader patient population in the last decades. Prolonged gynecological laparoscopic surgeries require prolonged pneumoperitoneum and Trendelenburg position, which can influence respiratory dynamics and other measurements of pulmonary function. We investigated the differences between volume-controlled ventilation (VCV) and pressure-controlled ventilation (PCV) and tried to determine the more efficient ventilation mode during prolonged pneumoperitoneum in gynecological laparoscopy. Twenty-six patients scheduled for laparoscopic radical hysterectomy combined with or without laparoscopic pelvic lymphadenectomy were randomly allocated to be ventilated by either VCV or PCV. Standard anesthesic management and laparoscopic procedures were performed. Measurements of respiratory and hemodynamic dynamics were obtained after induction of anesthesia, at 10, 30, 60, and 120 min after establishing pneumoperitoneum, and at 10 min after return to supine lithotomy position and removal of carbon dioxide. The logistic regression model was applied to predict the corresponding critical value of duration of pneumoperitoneum when the Ppeak was higher than 40 cmH2O. Prolonged pneumoperitoneum and Trendelenburg position produced significant and clinically relevant changes in dynamic compliance and respiratory mechanics in anesthetized patients under PCV and VCV ventilation. Patients under PCV ventilation had a similar increase of dead space/tidal volume ratio, but had a lower Ppeak increase compared with those under VCV ventilation. The critical value of duration of pneumoperitoneum was predicted to be 355 min under VCV ventilation, corresponding to the risk of Ppeak higher than 40 cmH2O. Both VCV and PCV can be safely applied to prolonged gynecological laparoscopic surgery. However, PCV may become the better choice of ventilation after ruling out of other reasons for Ppeak increasing.

  2. Influence of the modifiable life-style factors body mass index and smoking on the outcome of hysterectomy.

    Science.gov (United States)

    Bohlin, Katja S; Ankardal, Maud; Stjerndahl, Jan-Henrik; Lindkvist, Håkan; Milsom, Ian

    2016-01-01

    The aim of this study was to study the impact of body mass index (BMI) and smoking on the outcome of hysterectomy and whether effects of these factors vary between abdominal, laparoscopic and vaginal hysterectomy. Pre-, per- and postoperative (8 weeks) data were retrieved from the Swedish National Register for Gynecological Surgery on 28 537 hysterectomies performed because of a benign indication between 2004 and 2013. Multivariable logistic regression analyses were used to identify independent factors affecting the rate of complications, presented as adjusted odds ratios (adjOR) with 95% confidence intervals (CI). Overweight and obesity had the strongest impact on complications in the abdominal hysterectomy group. In women with a BMI ≥ 30 an increased adjOR could be seen for bleeding >1000 mL (2.90; 95% CI 2.23-3.77), peroperative complications (1.54; 95% CI 1.26-1.88), operation time >120 min (2.67; 95% CI 2.33-3.03), postoperative complications (1.21; 95% CI 1.08-1.34) and postoperative infections (1.73; 95% CI 1.50-1.99). With vaginal hysterectomy, the effect of BMI ≥ 30 could be seen in relation to excessive bleeding >500 mL (1.63; 95% CI 1.22-2.17) and operative time >120 min (2.00; 95% CI 1.60-2.50). With laparoscopic hysterectomy (LH), a BMI ≥ 30 had a higher adjOR for prolonged surgery (1.71; 95% CI 1.30-2.26). Smokers had an increased risk of postoperative infection in the abdominal hysterectomy (1.23; 95% CI 1.07-1.40) and vaginal hysterectomy groups (1.21; 95% CI 1.02-1.43) but not in the LH group. Body mass index and smoking had a negative effect with all hysterectomy approaches but to a lesser extent in vaginal and laparoscopic hysterectomies. This should be taken into consideration in advance of surgery to improve outcome. © 2015 Nordic Federation of Societies of Obstetrics and Gynecology.

  3. Peripartum hysterectomy: an evolving picture.

    LENUS (Irish Health Repository)

    Turner, Michael J

    2012-02-01

    Peripartum hysterectomy (PH) is one of the obstetric catastrophes. Evidence is emerging that the role of PH in modern obstetrics is evolving. Improving management of postpartum hemorrhage and newer surgical techniques should decrease PH for uterine atony. Rising levels of repeat elective cesarean deliveries should decrease PH following uterine scar rupture in labor. Increasing cesarean rates, however, have led to an increase in the number of PHs for morbidly adherent placenta. In the case of uterine atony or rupture where PH is required, a subtotal PH is often sufficient. In the case of pathological placental localization involving the cervix, however, a total hysterectomy is required. Furthermore, the involvement of other pelvic structures may prospectively make the diagnosis difficult and the surgery challenging. If resources permit, PH for pathological placental localization merits a multidisciplinary approach. Despite advances in clinical practice, it is likely that peripartum hysterectomy will be more challenging for obstetricians in the future.

  4. The Diagnosis and Treatment of Rare Hernia After Laparoscopic Radical Resection for Rectal Carcinoma%腹腔镜直肠癌根治术后少见疝的诊断和治疗

    Institute of Scientific and Technical Information of China (English)

    程龙庆; 彭翔; 邓建中

    2013-01-01

    Objective To approach the causes, prevention methods, diagnosis and treatment of rare hernia after laparoscopic radical resection for rectal carcinoma. Methods 10 cases of herniation after laparoscopic radical resection for rectal carcinoma were retrospectively analyzed in our department. Results 6 case of 12-mm trocar hernia, 2 cases of postsigmoidostomic hernia, 1 case of pelvi-peritoneal hernia and 1 case of lateral umbilical fold hernia were observed. All patients were performed emergency operation,2 cases were performed small bowel resection because of intestine necrosis, 1 case had incisional infection after second operation. Conclusion 12-mm trocar site, pelvic peritoneal hole, lateral umbilical fold hole and left paracolic sulci gap are the artificial defects after laparoscopic radical resection for rectal carcinoma, abdominal and intraperitoneal hernias are rare postoperative complication, emergency operation is necessary in order to avoiding intestine necrosis.%  目的探讨腹腔镜直肠癌根治术后少见疝发生的原因、预防和诊治。方法对我科1999年7月至2012年12月发生的10例围手术期少见疝的临床资料进行回顾性分析。结果6例主操作孔疝,2例乙状结肠造口旁沟疝,1例盆底腹膜裂孔疝,1例脐外侧襞裂孔疝,患者均需行急诊手术,有2例发生小肠坏死需行肠管部分切除术,1例出现切口感染。结论主操作孔、盆底腹膜裂孔、脐外侧襞裂孔和左结肠旁沟间隙是腹腔镜直肠癌手术后留下的人为缺损,可能发生腹壁疝或腹内疝,一旦发生应尽早手术以避免肠坏死的吧发生。

  5. 达芬奇机器人辅助腹腔镜前列腺癌根治术患者围手术期护理%Perioperative nursing of patients undergoing laparoscopic radical prostatectomy with Da Vinci robot

    Institute of Scientific and Technical Information of China (English)

    王芸; 李萍

    2016-01-01

    Objective:To summarize the perioperative nursing methods of Da Vinci robot assisted laparoscopic radical prostatectomy to improve the quality of nursing. Methods:Selected 60 cases of patients undergoing laparoscopic radical prostatectomy assisted with Da Vinci robot dated from July December in 2015 were selected as observation objects in this study. The preoperative nutritional diet, preoperative preparation and psychological nursing were strengthened. Make sure good coordination was conducted during the operation. Postoperative monitoring and good prevention and care of complications were conducted af-ter the operation. Results:Perioperative nursing was performed and 60 patients safely passed the perioperative period. Conclusion:Effective care measures for patients during robot-assisted laparoscopic radical prostatectomy can effectively improve the quality of nursing and promote patient rehabilitation.%目的::总结达芬奇机器人辅助腹腔镜前列腺癌根治术围手术期的护理方法,以提高护理质量。方法:选取我科2015年7~12月60例实施达芬奇机器人辅助腹腔镜前列腺癌根治术的患者作为观察对象,加强患者术前营养饮食、术前准备及心理护理,术中做好手术配合,术后严密监测,做好并发症的预防及护理。结果:通过做好围术手期的护理措施,60例患者均安全度过围手术期。结论:对机器人辅助腹腔镜前列腺癌根治术的患者,采取有效的护理措施,可有效提高护理质量,促进患者康复。

  6. 机器人结直肠癌根治术的初步应用体会%Early experience of robot-assisted laparoscopic radical resection for colorectal carcinoma

    Institute of Scientific and Technical Information of China (English)

    王首寒; 王斌; 陈佳祺; 孙小单

    2016-01-01

    Objective To investigate early experience of Da Vinci robot-assisted laparoscopic radical resection for colorectal carcinoma. Methods The clinical outcomes of 63 colorectal cancer patients undergoing robot-assisted laparoscopic radical resection from October 2014 to May 2016 were retrospectively collected and analyzed. Results All operations were completed successfully. There were no conversions to open surgery and no postoperative mortality. The robot docking time was (15.24±5.69) min. The operative time was (176.43±59.39) min. The blood loss was (28.65±22.36) ml. The number of lymph nodes harvested was (14.47±5.67). The recover time of bowel function was(51.43±12.96) hours. The postoperative hospital stay was (8.22±1.52) days. Conclusions Da Vinci robot-assisted laparoscopic radical resection for colorectal carcinoma is safe and feasible. The robotic system is suitable for clinical application.%目的:探讨达芬奇机器人手术系统应用于结直肠癌手术的初步体会。方法回顾性收集吉林省肿瘤医院腹部肿瘤科2014年10月至2016年5月的63例结直肠癌行机器人手术患者临床数据,进行整理分析。结果63例手术均顺利完成,无一例中转开腹,无术后并发症,机器人安装时间为(15.24±5.69)min,手术时间为(176.43±59.39)min,术中出血量(28.65±22.36)mL,清扫淋巴结数(14.47±5.67)枚,术后排气时间(51.43±12.96)h,术后住院日(8.22±1.52)d。结论达芬奇机器人手术系统应用于结直肠癌的手术治疗安全可行,手术效果好,术后恢复快,适合临床应用。

  7. 6 cases of erectile-function preserving laparoscopic radical cystectomy with orthotopic neobladder%保留勃起功能的腹腔镜原位回肠膀胱术6例

    Institute of Scientific and Technical Information of China (English)

    赵行兵; 张先觉; 田学章

    2011-01-01

    目的:观察保留勃起功能的腹腔镜原位回肠膀胱术在年轻膀胱癌患者中的应用及疗效.方法:6例膀胱移行细胞癌患者在腹腔镜下行保留神经血管束和前列腺远端包膜的膀胱切除,切取肠管缝制成新膀胱,分别与输尿管和前列腺包膜吻合,实现原位尿流改道.结果:6例手术均成功,手术时间为280~410 min,平均310 min.随访24~40个月,6例均存活,无尿道复发,无转移及前列腺癌.术后1个月均有自发性阴茎勃起现象.术后6~24个月,5例患者可顺行射精,1例顺行和逆行射精共存.结论:保留勃起功能的腹腔镜原位回肠膀胱术可较好维持年轻膀胱癌患者勃起功能,提高患者生活质量.%Objective: To evaluate the application and efficacy of erectile function-preserving laparoscopic radical cystec -tomy with orthotopic neobladder in young patients with bladder cancer. Methods: 6 patients with bladder transitional cell carcinoma were undertaken laparoscopic radical cystectomy with orthotopic neobladder keeping the neurovascular bundles and distal diolame of prostate. A segment of intestine was divided to make neobladder, and then the neobladder was coin -cided with bilateral ureters and distal diolame of prostate to realize orthotopic urinary division. Results: All the operations were successful. The operative time was 280-410 min, 310 min in average. During the follow-up of 24-40 months, all patients were alive without urethral recurrence, metastasis and prostatic cancer. 6 patients retained the normal erection within 1 month after operation. 5 patients had anterograde ejaculation and one gained intermittent anterograde and retrograde e -jaculation at 6 to 24 months of postoperation. Conclusion: Erectile-function preserving laparoscopic radical cystectomy with orthotopic neobladder can improve the continence and voiding functions of the orthotopic neobladder, maintain the erectile function, and improve the quality of life of young

  8. Short bowel syndrome after laparoscopic procedures.

    Science.gov (United States)

    McBride, Corrigan L; Oleynikov, Dmitry; Sudan, Debra; Thompson, Jon S

    2014-04-01

    Short bowel syndrome (SBS) is a potential postoperative complication after intra-abdominal procedures. Whether the laparoscopic approach is as likely to result in SBS or the causative mechanisms are similar to open procedures is unknown. Our aim was to evaluate potential mechanisms of SBS after laparoscopic procedures. The records of 175 adult patients developing SBS as a postoperative complication were reviewed. One hundred forty-seven patients had open procedures and 28 laparoscopic. Colectomy (39%), hysterectomy (11%), and appendectomy (11%) were the most common open procedures. SBS followed laparoscopic gastric bypass (46%) and cholecystectomy (32%) most frequently. The mechanisms of SBS were different: adhesive obstruction (57 vs 22%, P < 0.05) was more common in the open group, whereas volvulus (18 vs 46%, P < 0.05) was more common after laparoscopy. Overall, ischemia (25 vs 32%) was similar but significantly more laparoscopic patients had postoperative hypoperfusion (32 vs 67%, P < 0.05). Eleven of the 13 laparoscopic bariatric procedures had internal hernias and volvulus. Of the nine patients undergoing cholecystectomy, four developed ischemia early postoperatively presumably secondary to pneumoperitoneum. SBS is an increasingly recognized complication of laparoscopic procedures. The mechanisms of intestinal injury differ from open procedures with a higher incidence of volvulus and more frequent ischemia from hypoperfusion.

  9. Prospective comparative study of laparoscopic-assisted and open radical gastrectomy for gastric cancer%胃癌腹腔镜与开腹手术的前瞻性对照临床研究

    Institute of Scientific and Technical Information of China (English)

    岑庆; 张军; 蔡军; 吴国聪; 金岚; 王康里; 张忠涛

    2013-01-01

    Objective Through the prospective comparative study of laparoscopic-assistcd and open radical gastrectomy for gastric cancer,to evaluate the safety,feasibility,radical and postoperative short-term efficacy of laparoscopic-assisted gastrectomy.Methods From May 2010 to December 2011,29 gastric cancer patients matching the inclusion criteria were chosen as the laparoscopic group.According to the same inclusion criteria,29 gastric cancer patients with the same or similar clinical T stage (AJCC 7th edition) were extracted as the open group.Then the two groups information was carried out a comparative study.Results The mean operation time of the laparoscopic group was longer[(210.34 ± 44.76) min vs (151.55 ± 42.28) min,P =0.000] and the mean hospitalization costs were higher[(61 251 ±17 226) yuan vs (52 016 ±27 767) yuan,P=0.000],while the mean incision length was shorter[(5.83 ± 1.10) cm vs (15.93 ± 1.39) cm,P =O.000] than the open group.There was no significant difference on blood loss,of dissected lymph nodes number,proximal and distal resection margins,the first flatus time,the first liquid diet time,postoperative hospital stay,postoperative complications and cumulative survival rates between the two groups.Conclusion The laparoscopic-assisted gastrectomy for gastric cancer is safe and feasible,can achieve equivalent radical and short-term efficacy with the open surgery.%目的 通过对胃癌腹腔镜与开腹手术的前瞻性对照临床研究,评估前者的安全可行性、根治性及术后近期疗效.方法 2010年8月-2011年12月,选择符合人选标准的胃癌患者29例列为腹腔镜组,同时按照同一入组标准选择相同或相似临床T分期(AJCC第7版)的胃癌患者29例作为开腹对照组,对以上两组进行对比研究.结果 腹腔镜组手术时间长于开腹组[(210.34 ±44.76) min vs (151.55±42.28) min,P=0.000],住院总费用高于开腹组[(61 251±17 226)元vs(52 016 ±27 767)元,P=0.000],切口长度小于开腹组[(5

  10. Port-site metastasis as a primary complication following retroperitoneal laparoscopic radical resection of renal pelvis carcinoma or nephron-sparing surgery: A report of three cases and review of the literature

    Science.gov (United States)

    WANG, NING; WANG, KAI; ZHONG, DACHUAN; LIU, XIA; SUN, JI; LIN, LIANXIANG; GE, LINNA; YANG, BO

    2016-01-01

    The present study reports the clinical data of two patients with renal pelvis carcinoma and one patient with renal carcinoma who developed port-site metastasis following retroperitoneal laparoscopic surgery. The current study aimed to identify the cause and prognosis of the occurrence of port-site metastasis subsequent to laparoscopic radical resection of renal pelvis carcinoma and nephron-sparing surgery. Post-operative pathology confirmed the presence of high-grade urothelial cell carcinoma in two patients and Fuhrman grade 3 renal clear cell carcinoma in one patient. Port-site metastasis was initially detected 1–7 months post-surgery. The two patients with renal pelvis carcinoma succumbed to the disease 2 and 4 months following the identification of the port-site metastasis, respectively, whereas the patient with renal carcinoma survived with no disease progression during the targeted therapy period. The occurrence of port-site metastasis may be attributed to systemic and local factors. Measures to reduce the development of this complication include strict compliance with the operating guidelines for tumor surgery, avoidance of air leakage at the port-site, complete removal of the specimen with an impermeable bag, irrigation of the laparoscopic instruments and incisional wound with povidone-iodine when necessary, and enhancement of the body's immunity. Close post-operative follow-up observation for signs of recurrence or metastasis is essential, and systemic chemotherapy may be required in patients with high-grade renal pelvis carcinoma and renal carcinoma in order to prolong life expectancy. PMID:27313720

  11. Feasibility of prophylactic laparoscopic appendectomy in obese patients.

    Science.gov (United States)

    Wang, H; Lu, C; Zhao, J; Gao, L; Li, X; Hou, J; Zhou, A

    2016-01-01

    To investigate the feasibility of prophylactic laparoscopic appendectomy in obese patients. A retrospective study was performed in obese patients undergoing total laparoscopic hysterectomy (TLH) along (66 patients, TLH group) or in combination (55 patients, THL+LA group) with laparoscopic appendectomy (LA) between 2007 and 2012. Operation time, intraoperative bleeding volume, postoperative exhaust time, analgesic use, and the incidence of major complications, hospital stay and cost of hospitalization were compared. The operation time was longer in THL+LA group than in TLH group (p obese patients to undergo simultaneous LA and prophylactic appendectomy, and the combined procedure does not increase the risk of infection of hysterectomy and avoids reoperation of patients due to the recurrence of appendicitis.

  12. Hysterectomy at a Canadian tertiary care facility: results of a one year retrospective review

    Directory of Open Access Journals (Sweden)

    Gorwill R Hugh

    2004-11-01

    Full Text Available Abstract Background The purpose of this study was to investigate the indications for and approach to hysterectomy at Kingston General Hospital (KGH, a teaching hospital affiliated with Queen's University at Kingston, Ontario. In particular, in light of current literature and government standards suggesting the superiority of vaginal versus abdominal approaches and a high number of concurrent oophorectomies, the aim was to examine the circumstances in which concurrent oophorectomies were performed and to compare abdominal and vaginal hysterectomy outcomes. Methods A retrospective chart audit of 372 consecutive hysterectomies performed in 2001 was completed. Data regarding patient characteristics, process of care and outcomes were collected. Data were analyzed using descriptive statistics, t-tests and linear and logistic regression. Results Average age was 48.5 years, mean body mass index (BMI was 28.6, the mean length of stay (LOS was 5.2 days using an abdominal approach and 3.0 days using a vaginal approach without laparoscopy. 14% of hysterectomies were performed vaginally, 5.9% were laparoscopically assisted vaginal hysterectomies and the rest were abdominal hysterectomies. The most common indication was dysfunctional or abnormal uterine bleeding (37%. The average age of those that had an oophorectomy (removal of both ovaries was 50.8 years versus 44.3 years for those that did not (p Conclusions A significant reduction in LOS was found using the vaginal approach. Both the patient and the health care system may benefit from the tendency towards an increased use of vaginal hysterectomies. The audit process demonstrated the usefulness of an on-going review mechanism to examine trends associated with common surgical procedures.

  13. The decline of hysterectomy for benign disease.

    LENUS (Irish Health Repository)

    Horgan, R P

    2012-01-31

    Hysterectomy is one of the most common gynaecological surgical procedures performed but there appears to be a decline in the performance of this procedure in Ireland in recent times. We set out to establish the extent of the decline of hysterectomy and to explore possible explanations. Data for hysterectomy for benign disease from Ireland was obtained from the Hospital In-Patient Enquiry Scheme (HIPE) section of the Economic and Social Research Institute for the years 1999 to 2006. The total number of hysterectomies performed for benign disease showed a consistent decline during this time. There was a 36% reduction in the number of abdominal hysterectomy procedures performed.

  14. Laparoscopic repair of urogenital fistulae: A single centre experience

    Directory of Open Access Journals (Sweden)

    Sumit Sharma

    2014-01-01

    Full Text Available Context: Sparse literature exists on laparoscopic repair of urogenital fistulae (UGF. Aims: The purpose of the following study is to report our experience of laparoscopic UGF repair with emphasis on important steps for a successful laparoscopic repair. Settings And Design: Data of patients who underwent laparoscopic repair of UGF from 2003 to 2012 was retrospectively reviewed. Materials and Methods: Data was reviewed as to the aetiology, prior failed attempts, size, number and location of fistula, mean operative time, blood loss, post-operative storage/voiding symptoms and episodes of urinary tract infections (UTI. Results: Laparoscopic repair of 22 supratrigonal vesicovaginal fistulae (VVF (five recurrent and 31 ureterovaginal fistulae (UVF was performed. VVF followed transabdominal hysterectomy (14, lower segment caesarean section (LSCS (7 and oophrectomy (1. UVF followed laparoscopy assisted vaginal hysterectomy (18, transvaginal hysterectomy (2 and transabdominal hysterectomy (10 and LSCS (1. Mean VVF size was 14 mm. Mean operative time and blood loss for VVF and UVF were 140 min, 75 ml and 130 min, 60 ml respectively. In 20 VVF repairs tissue was interposed between non-overlapping suture lines. Vesico-psoas hitch was done in 29 patients of urterovaginal fistulae. All patients were continent following surgery. There were no urinary complaints in VVF patients and no UTI in UVF patients over a median follow-up of 3.2 years and 2.8 years respectively. Conclusion: Laparoscopic repair of UGF gives easy, quick access to the pelvic cavity. Interposition of tissue during VVF repair and vesico-psoas hitch during UVF repair form important steps to ensure successful repair.

  15. Peripartum hysterectomy in Denmark 1995-2004

    DEFF Research Database (Denmark)

    Sakse, Abelone Elisabeth; Weber, Tom; Nickelsen, Carsten Nahne Amtoft;

    2007-01-01

    BACKGROUND: Severe postpartum hemorrhage (PPH) is a potentially life-threatening situation that sometimes requires a hysterectomy. We examined the national incidence, risk factors, indications, outcomes and complications of peripartum hysterectomy following vaginal and caesarean delivery. METHODS......: Peripartum hysterectomy was defined as a hysterectomy after birth until 1 month after delivery using the codes for hysterectomy from the NOMESCO classification (1995). National data from the period 1995-2004 were extracted from the Danish Medical Birth Register and linked to the Danish National Hospital...... Register followed by registration of relevant data from the medical records of all the patients. RESULTS: We found 152 hysterectomies corresponding to an incidence of 0.24/1,000 deliveries. The risk of peripartum hysterectomy increased 11-fold following caesarean compared to vaginal delivery. Placenta...

  16. Hysterectomy does not cause constipation

    NARCIS (Netherlands)

    Roovers, Jan-Paul; van der Bom, Johanna G.; van der Vaart, C. Huub

    PURPOSE: This study was designed to evaluate the risk on development and persistence of constipation after hysterectomy. METHODS: We conducted a prospective, observational, multicenter study with three-year follow-up in 13 teaching and nonteaching hospitals in the Netherlands. A total of 413 females

  17. Hysterectomy does not cause constipation

    NARCIS (Netherlands)

    Roovers, Jan-Paul; van der Bom, Johanna G.; van der Vaart, C. Huub

    2008-01-01

    PURPOSE: This study was designed to evaluate the risk on development and persistence of constipation after hysterectomy. METHODS: We conducted a prospective, observational, multicenter study with three-year follow-up in 13 teaching and nonteaching hospitals in the Netherlands. A total of 413 females

  18. Benign paroxysmal positional vertigo secondary to laparoscopic surgery

    Science.gov (United States)

    Shan, Xizheng; Wang, Amy; Wang, Entong

    2017-01-01

    Objectives: Benign paroxysmal positional vertigo is a common vestibular disorder and it may be idiopathic or secondary to some conditions such as surgery, but rare following laparoscopic surgery. Methods: We report two cases of benign paroxysmal positional vertigo secondary to laparoscopic surgery, one after laparoscopic cholecystectomy in a 51-year-old man and another following laparoscopic hysterectomy in a 60-year-old woman. Results: Both patients were treated successfully with manual or device-assisted canalith repositioning maneuvers, with no recurrence on the follow-up of 6 -18 months. Conclusions: Benign paroxysmal positional vertigo is a rare but possible complication of laparoscopic surgery. Both manual and device-assisted repositioning maneuvers are effective treatments for this condition, with good efficacy and prognosis. PMID:28255446

  19. Laparoscopic repair of high rectovaginal fistula: Is it technically feasible?

    Directory of Open Access Journals (Sweden)

    Parthasarathi Ramakrishnan

    2005-10-01

    Full Text Available Abstract Background Rectovaginal fistula (RVF is an epithelium-lined communication between the rectum and vagina. Most RVFs are acquired, the most common cause being obstetric trauma. Most of the high RVFs are repaired by conventional open surgery. Laparoscopic repair of RVF is rare and so far only one report is available in the literature. Methods We present a case of high RVF repaired by laparoscopy. 56-year-old female who had a high RVF following laparoscopic assisted vaginal hysterectomy was successfully operated laparoscopically. Here we describe the operative technique and briefly review the literature. Results The postoperative period of the patient was uneventful and after a follow up of 6 months no recurrence was found. Conclusion Laparoscopic repair of high RVF is feasible in selected patients but would require proper identification of tissue planes and good laparoscopic suturing technique.

  20. Laparoscopic assisted radical resection of left colon cancer located at splenic lfexure%结肠脾曲癌之腹腔镜辅助左半结肠癌根治术(附视频)

    Institute of Scientific and Technical Information of China (English)

    杨梓锋; 吴德庆; 李勇

    2016-01-01

    Laparoscopic technique has advantages of local ampliifcation, clear imaging features. Most of the domestic minimally invasive centers are in the rational use of advanced endoscopic equipment and familiar with the anatomic structure, they pay attention to new technology development and team coordination training, all schools of thoughts contend for attention, they learned from each other, and to promote the progress of the endoscopic techniques. In recent years, the long-term curative effect of laparoscopic radical resection of left colon cancer has gradually been recognized, and the CME in the colon is playing an important role. Due to the left half colon cancer radical surgery involves complicated anatomy, the surgical plan has not yet formed a consensus, the dififculty of the laparoscopic surgery, high technical requirements, thus, early operation need to be careful.%腹腔镜技术具有局部放大、清晰显像的功能,国内大部分微创中心在合理利用先进的腔镜器械及熟悉解剖结构基础上,重视新技术的发展及团队配合训练,百家争鸣,相互借鉴及学习,促进了国内腔镜技术的进步。近年来,腹腔镜左半结肠癌根治术的近远期疗效逐渐得到认可,完全结肠系膜切除(complete mesocolic excision, CME)原则在其中发挥着重要的作用。因左半结肠癌根治术解剖结构复杂、手术方案尚未形成共识,腹腔镜手术难度大,技术要求高,早期开展需慎重。

  1. Hand-assisted laparoscopic radical nephrectomy in the treatment of a renal cell carcinoma with a level ii vena cava thrombus

    Directory of Open Access Journals (Sweden)

    Jason R. Kovac

    2010-06-01

    Full Text Available Excision of renal cell carcinoma (RCC with corresponding vena cava thrombus is a technical challenge requiring open resection and vascular clamping. A 58 year old male with a right kidney tumor presented with a thrombus extending 1 cm into the vena cava. Using a hand-assisted transperitoneal approach through a 7 cm gel-port, the right kidney was dissected and the multiple vascular collaterals supplying the tumor were identified and isolated. The inferior vena cava was mobilized 4 cm cephalad and 4 cm caudal to the right renal vein. Lateral manual traction was applied to the right kidney allowing the tumor thrombus to be retracted into the renal vein, clear of the vena cava. After laparoscopic ultrasonographic confirmation of the location of the tip of the tumor thrombus, an articulating laparoscopic vascular stapler was used to staple the vena cava at the ostium of the right renal vein. This allowed removal of the tumor thrombus without the need for a Satinsky clamp. The surgery was completed in 243 minutes with no intra-operative complications. The entire kidney and tumor thrombus was removed with negative surgical margins. Estimated blood loss was 300 cc. We present a laparoscopic resection of a renal mass with associated level II thrombus using a hand-assisted approach. In patients with minimal caval involvement, our surgical approach presents an option to the traditional open resection of a renal mass.

  2. Contemporary Radical Prostatectomy

    Directory of Open Access Journals (Sweden)

    Qiang Fu

    2011-01-01

    Full Text Available Purpose. Patients diagnosed with clinically localized prostate cancer have more surgical treatment options than in the past. This paper focuses on the procedures' oncological or functional outcomes and perioperative morbidities of radical retropubic prostatectomy, radical perineal prostatectomy, and robotic-assisted laparoscopic radical prostatectomy. Materials and Methods. A MEDLINE/PubMed search of the literature on radical prostatectomy and other new management options was performed. Results. Compared to the open procedures, robotic-assisted radical prostatectomy has no confirmed significant difference in most literatures besides less blood loss and blood transfusion. Nerve sparing is a safe means of preserving potency on well-selected patients undergoing radical prostatectomy. Positive surgical margin rates of radical prostatectomy affect the recurrence and survival of prostate cancer. The urinary and sexual function outcomes have been vastly improved. Neoadjuvant treatment only affects the rate of positive surgical margin. Adjuvant therapy can delay and reduce the risk of recurrence and improve the survival of the high risk prostate cancer. Conclusions. For the majority of patients with organ-confined prostate cancer, radical prostatectomy remains a most effective approach. Radical perineal prostatectomy remains a viable approach for patients with morbid obesity, prior pelvic surgery, or prior pelvic radiation. Robot-assisted laparoscopic prostatectomy (RALP has become popular among surgeons but has not yet become the firmly established standard of care. Long-term data have confirmed the efficacy of radical retropubic prostatectomy with disease control rates and cancer-specific survival rates.

  3. Radical prostatectomy

    DEFF Research Database (Denmark)

    Fode, Mikkel; Sønksen, Jens; Jakobsen, Henrik

    2014-01-01

    OBJECTIVE: The aim of this study was to compare oncological and functional outcomes between robot-assisted laparoscopic radical prostatectomy (RALP) and retropubic radical prostatectomy (RRP) during the initial phase with RALP at a large university hospital. MATERIAL AND METHODS: Patient and tumour...... surgery and at follow-up and they were asked to report their use of pads/diapers. Potency was defined as an IIEF-5 score of at least 17 with or without phosphodiesterase-5 inhibitors. Patients using up to one pad daily for security reasons only were considered continent. Positive surgical margins, blood...... loss and functional outcomes were compared between groups. RESULTS: Overall, 453 patients were treated with RRP and 585 with RALP. On multivariate logistic regression analyses, the type of surgery did not affect surgical margins (p = 0.96) or potency at 12 months (p = 0.7). Patients who had undergone...

  4. Sentinel Lymph Node Mapping With Near-Infrared Fluorescent Imaging Using Indocyanine Green: A New Tool for Laparoscopic Platform in Patients With Endometrial and Cervical Cancer.

    Science.gov (United States)

    Buda, Alessandro; Bussi, Beatrice; Di Martino, Giampaolo; Di Lorenzo, Paolo; Palazzi, Sharon; Grassi, Tommaso; Milani, Rodolfo

    2016-02-01

    Indocyanine green (ICG) represents a feasible alternative to the more traditional methods of sentinel lymph node (SLN) mapping, and interest in this promising tracer is growing. This report outlines our experience with ICG in a minimally invasive laparoscopic approach in women with endometrial cancer and cervical cancer using the Storz SPIES ICG near-infrared fluorescence imaging technology. A total of 49 patients with clinical stage I endometrial cancer (n = 40) or stage I cervical cancer (n = 9) were retrospectively reviewed. All patients had undergone simple or radical laparoscopic hysterectomy with pelvic and/or aortic lymphadenectomy and SLN mapping by means of an intracervical injection of ICG dye at the 3 o'clock and 9 o'clock locations after the induction of general anesthesia. The detection rate of ICG was 100% (49 of 49). The rate of bilateral SLN detection was 86% (42 of 49). Positive lymph nodes were found in 6 patients (12%), with at least 1 positive SLN. The sensitivity and negative predictive value of SLN detection were 100%. All procedures were successfully completed without conversion to open laparotomy, and no intraoperative or postoperative complications occurred. In our preliminary experience, ICG showed a high overall detection rate, and bilateral mapping appears to be a feasible alternative to the more traditional methods of SLN mapping in patients with endometrial cancer and cervical cancer. Laparoscopic SLN mapping with ICG appears to be safe, easy, and reproducible, with a positive impact on patient management.

  5. Effect analysis of three-dimensional and two-dimensional imaging systems in laparoscopic radical resection of rectal cancer%3D与2D腹腔镜直肠癌根治术的疗效分析

    Institute of Scientific and Technical Information of China (English)

    费秉元; 姜俊男; 房学东; 季福建

    2016-01-01

    Objective To compare the clinical effect of three-dimensional(3D)and two-dimensional(2D)imaging systems in laparoscopic radical resection of rectal cancer.Methods The retrospective cohort study was adopted.The clinical data of the 97 patients who underwent laparoscopic radical resection of rectal cancer at the Xinmin Branch of the China-Japan Union Hospital of Jilin University between May 2012 and December 2014 were collected.Of 97 patients,47 undergoing 3D laparoscopic radical resection of rectal cancer were allocated into the 3D group and 50 undergoing 2D laparoscopic radical resection of rectal cancer were allocated into the 2D group.The operation followed strictly tumor-free and total mesorectal excision principles.Observation indicators included:(1)surgical situations:operation time,time of deep lymph nodes dissected,volume of intraoperative blood loss,bleeding volume of obturator lymph nodes dissected,number of lymph nodes dissected,postoperative complications and duration of hospital stay.(2)Follow-up situations:follow-up using outpatient examination and telephone interview was performed to detect the survival of patients and tumor recurrence and metastasis up to December 2015.Measurement data with normal distribution were presented as-x±s and comparison between groups was analyzed using the t test.Count data were analyzed using the chi-square test.Results(1)Surgical situations:all the patients underwent successful laparoscopic radical resection of rectal cancer,without conversion to open surgery.Operation time,time of deep lymph nodes dissected,volume of intraoperative blood loss,bleeding volume of obturator lymph nodes dissected,number of lymph nodes dissected and duration of postoperative hospital stay were(134.6±18.5)minutes,(21.2±2.7)minutes,(65±20)mL,(16±3)mL,23.6±3.5,(8.2±2.3)days in the 3D group and(157.4±17.8)minutes,(25.2±2.5)minutes,(89±27)mL,(23±5)mL,20.5±2.8,(9.4±2.1)days in the 2D group,respectively,with statistically significant

  6. Changes in incontinence after hysterectomy

    DEFF Research Database (Denmark)

    Kruse, Anne Raabjerg; Jensen, Trine Dalsgaard; Lauszus, Finn Friis

    2017-01-01

    . Sample size calculation indicated that 102 women had to be included. The incontinence status was estimated by a Danish version of the ICIG questionnaire; further, visual analogue scale, dynamometer for hand grip, knee extension strength and balance were applied. Work capacity was measured ergometer cycle...... together with lean body mass by impedance. Quality of life was assessed using the SF-36 questionnaire. Patients were examined preoperatively and twice postoperatively. Results: In total 41 women improved their incontinence after hysterectomy and 10 women reported deterioration. Preoperative stress...... patients undergoing planned hysterectomy were compared pre- and postoperatively. In a sub-study of the prospective follow-up study the changes in incontinence, postoperative fatigue, quality of life, physical function, and body composition were evaluated preoperatively, 13 and 30 days postoperatively...

  7. Antibiotic prophylaxis for abdominal hysterectomy.

    Science.gov (United States)

    Mele, G; Loizzi, P; Greco, P; Gargano, G; Varcaccio Garofalo, G; Belsanti, A

    1988-01-01

    Three different regimens of antibiotic treatment have been employed in order to evaluate their efficacy as a profilaxis for abdominal hysterectomy. Two short term administrations (Cephtriaxone and Cephamandole plus Tobramycine) and a conventional full dose treatment (Cephazoline) have been compared over a group of homogeneous patients. No significant differences, except a reduction in postoperative time spent in hospital, have been found among the groups. A reduction in urinary tract infection has also been reported with a single-dose antibiotic prophylaxis.

  8. Total laparoscopic hysterectomy : retrospective analysis of 262 cases

    OpenAIRE

    Silva, Cristina Nogueira; Ribeiro, Samuel Santos; Barata, Sónia; Alho, Conceição; Osório, Filipa; Jorge, Carlos Calhaz

    2014-01-01

    Introdução: A histerectomia é a cirurgia ginecológica major mais frequentemente realizada nos países desenvolvidos, considerando- -se três principais vias de abordagem: vaginal, abdominal e laparoscópica. Apesar de múltiplas vantagens, a histerectomia totalmente laparoscópica tem-se associado a controvérsia relativamente à taxa de complicações. Objectivos: Análise da nossa casuística de histerectomia totalmente laparoscópica e avaliação da taxa de complicações. Material e Métodos:...

  9. [Total laparoscopic hysterectomy: retrospective analysis of 262 cases].

    Science.gov (United States)

    Nogueira-Silva, Cristina; Santos-Ribeiro, Samuel; Barata, Sónia; Alho, Conceição; Osório, Filipa; Calhaz-Jorge, Carlos

    2014-01-01

    Introdução: A histerectomia é a cirurgia ginecológica major mais frequentemente realizada nos países desenvolvidos, considerando-se três principais vias de abordagem: vaginal, abdominal e laparoscópica. Apesar de múltiplas vantagens, a histerectomia totalmente laparoscópica tem-se associado a controvérsia relativamente à taxa de complicações.Objectivos: Análise da nossa casuística de histerectomia totalmente laparoscópica e avaliação da taxa de complicações.Material e Métodos: Análise retrospetiva dos processos clínicos das doentes submetidas a histerectomia totalmente laparoscópica no nosso departamento, pela mesma equipa cirúrgica, entre abril de 2009 e março de 2013 (n = 262).Resultados: As doentes tinham em média 48,9 ± 9 anos e 49,2% tinha antecedentes de cirurgia abdomino-pélvica. O índice de massa corporal médio era 26,5 ± 4,5 kg/m2, sendo que 42% eram obesas ou tinham excesso de peso. O tempo operatório médio para realização da histerectomia totalmente laparoscópica foi 77,7 ± 27,5 minutos, diminuindo significativamente com o aumento da experiência da equipa cirúrgica. O peso médio da peça operatória foi 241 ± 168,4g e a duração média do internamento após a cirurgia foi 1,49 ±0,9 dias. A diferença entre a hemoglobina pré e pós-operatória foi 1,5 ± 0,8g/dL. A morbilidade major foi 1,5% (n = 4) e a minor 11,5% (n = 30). Salienta-se um caso de conversão para laparotomia e dois casos de deiscência da cúpula vaginal. Não ocorreu nenhuma lesão urinária ou gastrointestinal grave.Conclusões: Esta série demonstra que, se realizada por uma equipa cirúrgica adequadamente treinada, a histerectomia totalmente laparoscópica é segura e associada a baixa taxa de complicações.

  10. Deep neuromuscular blockade and low insufflation pressure during laparoscopic hysterectomy

    DEFF Research Database (Denmark)

    Madsen, Matias Vested; Istre, Olav; Springborg, Henrik Halvor

    2017-01-01

    NMB group) or single-bolus NMB and 12 mmHg pneumoperitoneum (standard NMB group). NMB was established with rocuronium and reversed with sugammadex. Two gynaecologists registered episodes of sudden abdominal contractions, alarms from the insufflator due to increased intraabdominal pressure...

  11. Socioeconomic factors may influence the surgical technique for benign hysterectomy

    DEFF Research Database (Denmark)

    Daugbjerg, Signe B; Ottesen, Bent; Diderichsen, Finn

    2012-01-01

    Owing to significantly improved outcomes, vaginal hysterectomy is the recommended standard approach when feasible in preference to abdominal hysterectomy. It is, however, not clear whether the use of vaginal hysterectomy varies with the women's socioeconomic background....

  12. Socioeconomic factors may influence the surgical technique for benign hysterectomy

    DEFF Research Database (Denmark)

    Daugbjerg, Signe B; Ottesen, Bent; Diderichsen, Finn

    2012-01-01

    Owing to significantly improved outcomes, vaginal hysterectomy is the recommended standard approach when feasible in preference to abdominal hysterectomy. It is, however, not clear whether the use of vaginal hysterectomy varies with the women's socioeconomic background....

  13. Potentially Avoidable Peripartum Hysterectomies in Denmark

    DEFF Research Database (Denmark)

    Colmorn, Lotte Berdiin; Krebs, Lone; Langhoff-Roos, Jens

    2016-01-01

    to minimize the number of unnecessary peripartum hysterectomies, obstetricians and anesthesiologists should investigate individual cases by structured clinical audit, and disseminate and discuss the results for educational purposes. An international collaboration is warranted to strengthen our recommendations......OBJECTIVE: To audit the clinical management preceding peripartum hysterectomy and evaluate if peripartum hysterectomies are potentially avoidable and by which means. MATERIAL AND METHODS: We developed a structured audit form based on explicit criteria for the minimal mandatory management...

  14. Potentially avoidable peripartum hysterectomies in Denmark

    DEFF Research Database (Denmark)

    Colmorn, Lotte Berdiin; Krebs, Lone; Langhoff-Roos, Jens

    2016-01-01

    to minimize the number of unnecessary peripartum hysterectomies, obstetricians and anesthesiologists should investigate individual cases by structured clinical audit, and disseminate and discuss the results for educational purposes. An international collaboration is warranted to strengthen our recommendations......Objective: To audit the clinical management preceding peripartum hysterectomy and evaluate if peripartum hysterectomies are potentially avoidable and by which means. Material and Methods: We developed a structured audit form based on explicit criteria for the minimal mandatory management...

  15. Length of Catheter Use After Hysterectomy as a Risk Factor for Urinary Tract Infection.

    Science.gov (United States)

    Karp, Natalie E; Kobernik, Emily K; Kamdar, Neil S; Fore, Amanda M; Morgan, Daniel M

    2017-09-13

    The aims of this study were to determine the effect of length of postoperative catheterization on risk of urinary tract infection (UTI) and to identify risk factors for postoperative UTI. This was a retrospective case-control study. Demographic and perioperative data, including duration of indwelling catheter use and postoperative occurrence of UTI within 30 days of surgery, were analyzed for hysterectomies using the Michigan Surgical Quality Collaborative database. Catheter exposure was categorized as low-no catheter placed/catheter removed the day of surgery, intermediate-catheter removed postoperative day 1, high-catheter removal on postoperative day 2 or later, or highest-patient discharged home with catheter. A multivariable logistic regression model was developed to identify factors associated with UTI. An interaction term was included in the final model. Overall, UTI prevalence was 2.3% and increased with duration of catheter exposure (low: 1.3% vs intermediate: 2.1% vs high: 4.1% vs highest: 6.5%, P < 0.0001). High (odds ratio [OR] = 2.54 [1.51-4.27]) and highest (OR = 3.39 [1.86-6.17]) catheter exposure, operative time (OR = 1.15 [1.03-1.29]), and dependent functional status (OR = 4.62 [1.90-11.20]) were independently associated with UTI. Women who had a vaginal hysterectomy with sling/pelvic organ prolapse repair were more likely to have a UTI than those who had a vaginal hysterectomy alone (OR = 2.58 [1.10-6.07]) and more likely to have a UTI than women having an abdominal or laparoscopic hysterectomy with a sling/pelvic organ prolapse repair (OR = 2.13 [1.12-4.04]). Length of catheterization and operative time are modifiable risk factors for UTI after hysterectomy. An interaction between vaginal hysterectomy and concomitant pelvic reconstruction increases the odds of UTI.

  16. 腹腔镜直肠癌根治术对病人生活质量影响的分析%Quality-of-life analyses for patients with rectal cancer underwent radical laparoscopic surgery

    Institute of Scientific and Technical Information of China (English)

    许菡; 胡艳艳; 金艳; 奚蓓华; 施晓群; 吴蓓雯

    2012-01-01

    目的:比较腹腔镜直肠癌根治术与传统开腹手术对病人术后生活质量(quality of life,QOL)的影响.方法:对照研究25例腹腔镜直肠癌根治术(腹腔镜组)和29例开腹直肠癌根治术(开腹组),采用欧洲癌症研究与治疗组织的癌症病人QOL评价量表QLQ-C30,评价和比较手术前后QOL的变化特征.结果:两组病人在年龄、性别、肿瘤与肛缘距离、TNM分期方面差异均无统计学意义.两组病人术后早期除情绪功能和认知功能以外的QOL总体评价较术前均明显下降,术后3~6个月,各项功能分值呈逐渐恢复趋势,腹腔镜组恢复显著早于开腹组(P<0.05).总体健康状况量表的评价结果显示,腹腔镜组病人QOL恢复到中等以上水平的时间也显著早于开腹组.结论:腹腔镜直肠癌根治术不但创伤小、痛苦少、恢复快,且病人术后QOL恢复较开腹手术佳.%Objective To compare the impacts of radical laparoscopic surgery and conventional laparotomy on the quality of life (QOL) in patients with rectal cancer. Methods Quality of life questionnaire module, European Organisation for Research and Treatment of Cancer QLQ-C30, was used to evaluate the quality of life for all enrolled rectal cancer patients peri-operatively. Results No significant difference was observed in terms of age, gender, tumor location, as well as TNM staging between the groups. Overall QOL early after operation decreased significantly in both groups of patients comparing with preoperative data, except for emotional function and cognitive function. The trend of QOL recovery was observed in both groups 3—6 months after operation. Furthermore, the QOL recovery was earlier in laparoscopic group than in open group (P<0.05). Overall rating scales of health condition showed that recovery was earlier for patients underwent laparoscopic surgery than for patients underwent conventional open laparotomy. Conclusions Laparoscopic rectal surgery is safe

  17. 3-dimensional versus conventional laparoscopy for benign hysterectomy: protocol for a randomized clinical trial.

    Science.gov (United States)

    Hoffmann, Elise; Bennich, Gitte; Larsen, Christian Rifbjerg; Lindschou, Jannie; Jakobsen, Janus Christian; Lassen, Pernille Danneskiold

    2017-09-07

    Hysterectomy is one of the most common surgical procedures for women of reproductive age. Laparoscopy was introduced in the 1990es and is today one of the recommended routes of surgery. A recent observational study showed that operative time for hysterectomy was significantly lower for 3-dimensional compared to conventional laparoscopy. Complication rates were similar for the two groups. No other observational studies or randomized clinical trials have compared 3-dimensional to conventional laparoscopy in patients undergoing total hysterectomy for benign disease. The objective of the study is to determine if 3D laparoscopy gives better quality of life, less postoperative pain, less per- and postoperative complications, shorter operative time, or a shorter stay in hospital and a faster return to work or normal life, compared to conventional laparoscopy for benign hysterectomy. The design is a randomised multicentre clinical trial. Participants will be 400 women referred for laparoscopic hysterectomy for benign indications. Patients will be randomized to 3-dimensional or conventional laparoscopic hysterectomy. Operative procedures will follow the same principles and the same standard whether the surgeon's vision is 3-dimensional or conventional laparoscopy. Primary outcomes will be the impact of surgery on quality of life, assessed by the SF 36 questionnaire, and postoperative pain, assessed by a Visual Analogue scale for pain measurement. With a standard deviation of 12 points on SF 36 questionnaire, a risk of type I error of 3.3% and a risk of type II error of 10% a sample size of 190 patients in each arm of the trial is needed. Secondarily, we will investigate operative time, time to return to work, length of hospital stay, and - and postoperative complications. This trial will be the first randomized clinical trial investigating the potential clinical benefits and harms of 3-dimensional compared to conventional laparoscopy. The results may provide more evidence

  18. Comparative study of laparoscope and laparotomy D2 radical gastrectomy in the treatment of distal gastric cancer%腹腔镜与开腹远端胃癌D2根治术的对比研究

    Institute of Scientific and Technical Information of China (English)

    何洪生; 曾文龙; 朱柏炼; 杜永御; 赖扬城

    2014-01-01

    目的:通过对比腹腔镜与开腹远端胃癌D2根治术的疗效及安全性,探讨腹腔镜辅助远端胃癌D2根治术的临床价值。方法221例行远端胃癌D2根治术患者,分为两组。其中腹腔镜组115例,开腹组106例,对两组手术时间、术中出血量、术后排气时间、首次进流质时间、淋巴结清扫数目、术后住院天数、并发症进行比较。结果腹腔镜组手术时间、淋巴结清扫数与开腹组差异无统计学意义(P>0.05),而腹腔镜组术中出血量少,术后肛门排气时间早,首次进流质时间早,术后住院时间短,并发症发生率低(P0.05). However, the laparoscope group had fewer intraoperative bleeding volumes, earlier postoperative anal exhaust time, earlier first time of liquid diet, shorter postoperative hospital stays and lower incidence of complications (P<0.05). Conclusion Laparoscope assisted D2 radical gastrectomy in the treatment of distal gastric cancer has small trauma, few bleeding, quick recovery and less complications. The recent curative effect is similar as that of laparotomy, and the treatment is safe and feasible, and worthy of clinical promotion.

  19. The perioperative nursing of robot-assisted laparoscopic radical surgery for prostate cancer%机器人辅助腹腔镜前列腺癌根治术围手术期护理

    Institute of Scientific and Technical Information of China (English)

    丁华; 赵明; 赵姗

    2009-01-01

    目的 探讨机器人辅助腹腔镜前列腺癌根治术围手术期护理.方法 采取术前针对性的心理护理,充分做好肠道准备和详细术后的功能训练指导;术后严密观察生命体征和腹部情况的变化,做好引流管的观察和护理,指导制订合理的饮食.结果 14例患者术后1年随访恢复良好,无并发症发生.结论 围手术期有针对性的系统护理,对机器人辅助腹腔镜前列腺癌治术患者早日康复有重要作用.%Objective To discuss the perioperative nursing of the robot-assisted laparoscopic radical surgery for prostate cancer. Methods The pre-operative mental nursing was adopted. Preparations of intestinal tract and detailed guidelines of postoperative function exercises were fully did. The vital signs and the changes of situations in abdomen were closely observed. Good observation and care for drainage tube were did. And a reasonable diet was constituted. Results 14 patients had good recovery after a year with no complications, through a follow-up visit of one year after the operation. Conclusions Systemic nursing for individuals during peri-operation plays an important role in the speedy recovery of robotic-assisted laparoscopic surgery for patients with prostate cancer.

  20. 手助腹腔镜胃癌 D2根治术的团队配合%Teamwork Cooperation in Hand-assisted Laparoscopic D2 Radical Gastrectomy

    Institute of Scientific and Technical Information of China (English)

    周均; 曹永宽; 宋亚宁; 王永华; 张国虎; 王培红; 李旭

    2014-01-01

    目的:探讨手助腹腔镜胃癌D2根治术的团队配合技巧及重要性。方法对我中心2010年12月~2013年6月180例手助腹腔镜胃癌D2根治术的临床资料进行回顾性总结。术者及助手相对固定,只需术者及扶镜手两人相互配合,就能完成肿瘤的根治性切除及淋巴结清扫。结果180例均在手助腹腔镜下完成手术,全胃切除术84例,远端胃切除术81例,近端胃切除术15例。手术切口长度(6.9±0.5)cm;术中出血量(226.1±127.0)ml;手术时间(172.2±34.1)min;病检获淋巴结数(17.3±5.0)枚;术后住院时间(9.3±2.0) d。围手术期死亡1例,手术残端癌残留2例。手术相关并发症率6%(11/180)。术后随访1~24个月,失访12例(失访率7%),同时性肝转移4例,异时性淋巴结转移2例,局部复发1例,未发生切口和穿刺口种植。结论良好的团队配合是保证手助腹腔镜胃癌D2根治术的必备条件,对肿瘤的根治程度、手术时间及术后并发症的发生起着至关重要的作用。%Objective To discuss the importance of teamwork coorperation in hand-assisted laparoscopic D2 radical gastrectomy. Methods Clinical materials of 180 patients with gastric cancer undergoing hand-assisted laparoscopic D2 radical gastrectomy from December 2010 to June 2013 were summarized retrospectively.The lymph nodes dissection and radical tumor excision were performed by two persons of cooperation that the operator surgeon worked with camera assistant in a relatively fixed mode in the operation. Results The hand-assisted laparoscopic D2 radical gastrectomy was accomplished in all the patients.Among the 180 patients, gastrectomy was performed in 84 cases, distal gastrectomy in 81 cases, and proximal gastrectomy in 15 cases.The average length of incision was (6.9 ±0.5) cm, the blood loss was (226.1 ±127.0) ml, the operative time was (172.2 ±34.1) min, the number

  1. 超声刀结合单极电凝应用于腹腔镜胃癌根治术的评价%Ultrasonic Scalpel and Monopolar Electrocoagulation in Laparoscopic-assisted Radical Gastrectomy for Gastric Carcinoma

    Institute of Scientific and Technical Information of China (English)

    鱼国盛; 汤黎明; 钱峻; 朱杰

    2011-01-01

    Objective To evaluate the outcome of ultrasonic scalpel combined with monopolar electrocoagulation in laparoscopic-assisted radical gastrectomy for gastric carcinoma. Methods From January 2010 to March 2011, 75 patients with curable gastric carcinoma underwent laparoscopic-assisted radical gastrectomy, of which 39 patients were treated solely by ultrasonic scalpel, the other 36 patients underwent ultrasonic scalpel combined with monopolar electrocoagulation. The operation time, intraoperative blood loss, number of resected lymph nodes, and postoperative drainage volume and complications were analyzed retrospectively and compared between the two groups. Results The mean operation time and blood loss of ultrasonic scalpel group were significantly more than that in the study group [ (347 ±38) min vs. (310 ±23) min, t =5. 049, P = 0. 000, and (274 ± 122) ml vs. (186 ± 90) ml, t = 3. 530, P = 0. 000]. The number of harvested lymph nodes, postoperative drainage volume and the incidence rate of complications were comparable between the two groups ( P > 0.05). Conclusion By combining ultrasonic scalpel with monopolar electrocoagulation in laparoscopic-assisted radical gastrectomy for gastric carcinoma, the advantages of the both methods can be utilized so that to reduce operation time and blood loss,and make lymph nodes resection easier.%目的 评价腹腔镜胃癌根治术中联合应用超声刀及单极电凝的效果.方法 回顾分析2010年1月~2011年3月75例腹腔镜胃癌D2根治术的临床资料,前39例单纯使用超声刀(超声刀组),后36例联合应用超声刀与单极电凝(联合组).比较2组手术时间、术中出血量、平均清扫淋巴结个数、术后引流量及术后并发症方面的差异.结果 与超声刀组相比,联合组术中出血少[(274±122)ml vs.(186±90) ml,t=3.530,P=0.000],手术时间短[(347±38)min vs.(310±23) min,t=5.049,P=0.000],2组清扫淋巴结个数、术后引流量及并发症

  2. Nursing coordination measures exploration in laparoscopic radical resection of rectal cancer%腹腔镜下直肠癌根治术中的护理配合措施探究

    Institute of Scientific and Technical Information of China (English)

    周荣杰

    2016-01-01

    Objective:To explore the nursing coordination measures exploration in laparoscopic radical resection of rectal cancer. Methods:80 cases of rectal cancer patients were selected.They were randomly divided into the control group and the observation group.The control group used the conventional nursing measures,and the observation group was given the whole course nursing coordination measures,then we observed the anxiety and nursing satisfaction of two groups were before and after the operation. Results:After the operation,the anxiety,depression and nursing satisfaction if the observation group were significantly better than those of the control group(P<0.05).Conclusion:The implementation of whole course nursing care in the laparoscopic radical operation of rectal cancer has significant clinical significance,which can relieve patients with anxiety and depression effectively, and improve patients' satisfaction.%目的:探讨腹腔镜下直肠癌根治术中的护理配合措施。方法:收治直肠癌患者80例,随机分为对照组与观察组,对照组采用常规护理措施,观察组采用全程护理配合措施,观察两组患者术前术后焦虑情况及护理满意度。结果:观察组患者术后焦虑、抑郁及护理满意度明显优于对照组(P<0.05)。结论:实施全程护理配合措施在腹腔镜下直肠癌根治手术中具有显著的临床意义,能够有效地缓解患者的焦虑、抑郁等不良情绪,提高患者的护理满意度。

  3. 机器人辅助腹腔镜根治性膀胱切除正位新膀胱术的护理%Nursing study for robotic-assisted laparoscopic radical cystectomy and orthotopic bladder

    Institute of Scientific and Technical Information of China (English)

    周秀彬; 胡英娜; 安娜; 付清清; 张玲

    2011-01-01

    目的 分析应用da Vinci S机器人系统完成机器人辅助腹腔镜根治性膀胱切除(RARC)正位新膀胱术的疗效,探讨其围手术期临床护理体会.方法 2008年12月至2010年2月,4例男性患者接受RARC+正位新膀胱术.手术均获成功.术前着重于心理护理、肠道准备,术后进行严密的生命体征监测、引流管护理、新膀胱锻炼等护理的同时,采取积极预防措施预防并发症的发生.结果 全体患者术后恢复顺利,无严重并发症发生,疗效满意.结论 机器人辅助腹腔镜根治性膀胱切除(RARC)加正位膀胱术创伤小,安全可靠,患者术后康复快,疤痕少,值得推广、应用,但须严格护理过程.%Objective To analyze the efficacy of using da Vinci S robot system to complete the robotassisted laparoscopic radical cystectomy (RARC) orthotopic neobladder and explore the peri-operative nursing care.Methods December 2008 February 2010,four cases of male patients RARC + orthotopic neobladder.Procedure was successful. Focusing on the psychological care before surgery, bowel preparation, and postoperative care focuses on the monitoring of vital signs,drainage tube care,exercise and the new bladder,while actively preventing complications.Results All patients recovered well,without serious complications and with satisfactory effect.Conclusions Robot-assisted laparoscopic radical cystectomy (RARC) + orthotopic bladder was less trauma, safer, reliable, rapid postoperative rehabilitation, scars less, and worthy of application,but subjected to strict nursing process.

  4. Laparoscopic Nephrectomy for Wilms Tumor

    Directory of Open Access Journals (Sweden)

    Andolfi C

    2014-02-01

    Full Text Available Wilms tumor is the most frequent primary renal malignancy in children. The surgical resection is traditionally performed through laparotomy. The advent of laparoscopic surgery for benign renal lesions has led the surgeon to use a minimal invasive approach for the nephroblastoma. We describe a 9-months-old girl who presented with a left renal mass. A laparoscopic resection of the tumor with left radical nephroureterectomy was performed. The specimens were removed in an endoscopic bag through a low suprapubic incision. The patient had an uncomplicated recovery. Minimally invasive techniques may be considered for resection of nephroblastoma if oncologic principles are carefully followed.

  5. The Danish Hysterectomy and Hysteroscopy Database

    DEFF Research Database (Denmark)

    Topsøe, Märta Fink; Ibfelt, Else Helene; Settnes, Annette

    2016-01-01

    AIM OF THE DATABASE: The steering committee of the Danish Hysterectomy and Hysteroscopy Database (DHHD) has defined the objective of the database: the aim is firstly to reduce complications, readmissions, reoperations; secondly to specify the need for hospitalization after hysterectomy; thirdly...

  6. Laparoscopic cytoreduction for primary advanced ovarian cancer.

    Science.gov (United States)

    Fanning, James; Hojat, Rod; Johnson, Jil; Fenton, Bradford

    2010-01-01

    We evaluated the feasibility of laparoscopic cytoreduction for primary advanced ovarian cancer. All patients with presumed stage 3/4 primary ovarian cancer underwent attempted laparoscopic cytoreduction. All patients had CT evidence of omental metastasis and ascites. A 5-port (5-mm) transperitoneal approach was used. A bilateral salpingo-oophorectomy, supracervical hysterectomy, and omentectomy were performed with PlasmaKinetic (PK) cutting forceps. A laparoscopic 5-mm Argon-Beam Coagulator was used to coagulate tumor in the pelvis, abdominal peritoneum, intestinal mesentery, and diaphragm. Nine of 11 cases (82%) were successfully debulked laparoscopically without conversion to laparotomy. Median operative time was 2.5 hours, and median blood loss was 275 mL. All tumors were debulked to <2 cm and 45% had no residual disease. Stages were 1-3B, 7-3C, and 1-4. Median length of stay was one day. Median VAS pain score was 4 (discomforting). Two of 11 patients (18%) had postoperative complications. Laparoscopic cytoreduction was successful and resulted in minimal morbidity. Because of our small sample size, additional studies are needed.

  7. Laparoscopic Surgery

    Science.gov (United States)

    ... surgeon’s perspective, laparoscopic surgery may allow for easier dissection of abdominal scar tissue (adhesions), less surgical trauma, ... on Facebook About ACG ACG Store ACG Patient Education & Resource Center Home GI Health and Disease Recursos ...

  8. Risks and benefits of opportunistic salpingectomy during vaginal hysterectomy: a decision analysis.

    Science.gov (United States)

    Cadish, Lauren A; Shepherd, Jonathan P; Barber, Emma L; Ridgeway, Beri

    2017-06-12

    Fallopian tubes are commonly removed during laparoscopic and open hysterectomy to prevent ovarian and tubal cancer but are not routinely removed during vaginal hysterectomy because of perceptions of increased morbidity, difficulty, or inadequate surgical training. We sought to quantify complications and costs associated with a strategy of planned salpingectomy during vaginal hysterectomy. We created a decision analysis model using TreeAgePro. Effectiveness outcomes included ovarian cancer incidence and mortality as well as major surgical complications. Modeled complications included transfusion, conversion to laparotomy or laparoscopy, abscess/hematoma requiring intervention, ileus, readmission, and reoperation within 30 days. We also modeled subsequent benign adnexal surgery beyond the postoperative window. Those whose procedures were converted from a vaginal route were assumed to undergo bilateral salpingectomy, regardless of treatment group, following American College of Obstetricians and Gynecologists guidelines. Costs were gathered from published literature and Medicare reimbursement data, with internal cost data from 892 hysterectomies at a single institution used to estimate costs when necessary. Complication rates were determined from published literature and from 13,397 vaginal hysterectomies recorded in the National Surgical Quality Improvement Program database from 2008 through 2013. Switching from a policy of vaginal hysterectomy alone to a policy of routine planned salpingectomy prevents a diagnosis of ovarian cancer in 1 of every 225 women having surgery and prevents death from ovarian cancer in 1 of every 450 women having surgery. Overall, salpingectomy was a less expensive strategy than not performing salpingectomy ($7350.62 vs $8113.45). Sensitivity analysis demonstrated the driving force behind increased costs was the increased risk of subsequent benign adnexal surgery among women retaining their tubes. Planned opportunistic salpingectomy had

  9. Association of Previous Cesarean Delivery With Surgical Complications After a Hysterectomy Later in Life.

    Science.gov (United States)

    Lindquist, Sofie A I; Shah, Neel; Overgaard, Charlotte; Torp-Pedersen, Christian; Glavind, Karin; Larsen, Thomas; Plough, Avery; Galvin, Grace; Knudsen, Aage

    2017-08-09

    In recent decades, the global rates of cesarean delivery have rapidly increased. Nonetheless, the influence of cesarean deliveries on surgical complications later in life has been understudied. To investigate whether previous cesarean delivery increases the risk of reoperation, perioperative and postoperative complications, and blood transfusion when undergoing a hysterectomy later in life. This registry-based cohort study used data from Danish nationwide registers on all women who gave birth for the first time between January 1, 1993, and December 31, 2012, and underwent a benign, nongravid hysterectomy between January 1, 1996, and December 31, 2012. The dates of this analysis were February 1 to June 30, 2016. Cesarean delivery. Reoperation, perioperative and postoperative complications, and blood transfusion within 30 days of a hysterectomy. Of the 7685 women (mean [SD] age, 40.0 [5.3] years) who met the inclusion criteria, 5267 (68.5%) had no previous cesarean delivery, 1694 (22.0%) had 1 cesarean delivery, and 724 (9.4%) had 2 or more cesarean deliveries. Among the 7685 included women, 3714 (48.3%) had an abdominal hysterectomy, 2513 (32.7%) had a vaginal hysterectomy, and 1458 (19.0%) had a laparoscopic hysterectomy. In total, 388 women (5.0%) had a reoperation within 30 days after a hysterectomy. Compared with women having vaginal deliveries, fully adjusted multivariable analysis showed that the adjusted odds ratio of reoperation for women having 1 previous cesarean delivery was 1.31 (95% CI, 1.03-1.68), and the adjusted odds ratio was 1.35 (95% CI, 0.96-1.91) for women having 2 or more cesarean deliveries. Perioperative and postoperative complications were reported in 934 women (12.2%) and were more frequent in women with previous cesarean deliveries, with adjusted odds ratios of 1.16 (95% CI, 0.98-1.37) for 1 cesarean delivery and 1.30 (95% CI, 1.02-1.65) for 2 or more cesarean deliveries. Blood transfusion was administered to 195 women (2.5%). Women having

  10. Short term effects of transanal endoscopic radical resection for rectal carcinoma with laparoscopic as-sistance%腹腔镜辅助经肛内镜直肠癌根治术的近期疗效

    Institute of Scientific and Technical Information of China (English)

    陈远光; 陈劲松; 柯传烽; 梁剑荣; 胡明; 雷建; 黄炯强; 成武; 王荣; 曾毅克; 夏同义

    2013-01-01

    Objective To investigate the safety, feasibility and short-term outcomes of transanal endo-scopic radical resection for rectal carcinoma with laparoscopic assistance, and to determine if synchronous use is superior to sequential use of transanal endoscopic and transabdominal laparoscopic procedure. Methods The clinical data of 19 patients with rectal carcinoma treated with the procedure were retrospectively analyzed,and the results of synchronous group (the latter 10 cases) were compared to what of sequential group (the former 9 cases). Results Among 19 consecutive patients, two cases were conversed to laparoscopic procedure. The mean operative time, median blood loss, mean number of lymph nodes harvested, mean time of first ambula-tion, mean time of anal function recovery were ( 3.85 ± 0.98)h, 80(50, 120)ml, (21.89 ± 9.21), (2.09 ± 0.94) d, (7.95 ± 3.49)d, respectively. Macroscopic evaluation of 16 specimens were classified as complete, 3 as nearly complete. Two patients developed postoperative anastomotic leakage. One patient encounted local recurrence and was treated with local R0 resection. There were no ureteral injury, presacral hemorrhage, abdominal infec-tion and mortality. Compared to sequential group,the synchronous group showed significant decrease of opera-tive time (3.39 ± 0.96 vs. 4.36 ± 0.75 h,P<0.05)and mean time of first ambulation (2.10 ± 0.99 vs. 3.78 ± 1.56 d,P<0.05). Conclusion Transanal endoscopic radical resection for rectal carcinoma with laparoscopic Assistance is safe, feasible and radical, synchronous use is superior to sequential use of transanal endoscopic and transabadominal laparoscopic procedure.%目的探讨腹腔镜辅助经肛内镜直肠癌根治术的安全性、可行性及近期效果,并探讨经肛内镜和经腹腹腔镜两者同步使用是否优于序贯使用。方法回顾性分析19例中下段直肠癌患者腹腔镜辅助经肛内镜直肠癌根治术及术后恢复情况,并将经肛内镜和经腹腹

  11. Laparoscopic hemicolectomy in a patient with situs inversus totalis

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    As among persons with normal anatomy, occasional patients with situs inversus develop malignant tumors. Recently, several laparoscopic operations have been reported in patients with situs inversus.We describe laparoscopic hemicolectomy with radical lymphadenectomy in such a patient. Careful consideration of the mirror-image anatomy permitted safe operation using techniques not otherwise differing from those in ordinary cases. Thus, curative laparoscopic surgery for colon cancer in the presence of situs inversus is feasible and safe.

  12. Risk Factors Analysis for Positive Surgical Margins in Laparoscopic Radical Prostatectomy%腹腔镜根治性前列腺切除术后切缘阳性的相关因素分析

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    阎乙夫; 黄毅; 马潞林

    2011-01-01

    Objective:To analysis the risk factors for positive surgical margins in laparoscopic radical prostatectomy. Methods: We retrospectively analyzed the clinical and pathological data of 188 cases, who received laparoscopic radical prostatectomy from Jan. 2004 to Dec. 2010 in our hospital. The patients average 72 years old. All patients were dignosised by pathology before prostatectomy, and no metastasis was found before surgery. Univari-able analyse were used to estimate the relationship between the parameters and surgical margin status. Multivari-able logistic regression analyse were used to determine relative risk factors for positive surgical margins. Results; Except that two patients were converted to open surgery, laparoscopic radical prostatectomy was successfully applied in other 186 patients. The operating time was average 246 min, the blood loss during operation was average 309 ml. 76 cases (40. 5%) had positive surgical margin. Result from univariable analyse showed there were significance difference between positive and negtive surgical margins patients on biopsy Gleason score, number of positive biopsy cores, surgical Gleason score, and pathological stage. On multivariable logistic regression analyses, surgical Gleason score and pathological stage were independent factor of positive surgical margins. A surgical Gleason score more than 7 was associated with a 17. 1-fold higher chance of positive surgical margin than a surgical Gleason score not more than 6 (OR:17. 131, 95%CI:5. 237-56. 037,F<0. 001). A pathological stage of T3 was associated with a 9. 0-fold higher risk of positive surgical margin than a psthology stage of T2 (OR:8. 970, 95%CI: 4. 128-19. 493,P<0. 001). Conclusions; Surgical Gleason score and pathological stage were independent factors of positive surgical margins in laparoscopic radical prostatectomy. Patients with surgical Gleason score more than 7 and pathological stage of T3 had a higher rate of positive surgical margins.%目的:分析

  13. Elective cesarean hysterectomy vs elective cesarean section followed by remote hysterectomy: reassessing the risks.

    Science.gov (United States)

    Bost; Rising; Bost

    1998-07-01

    Objective: The purpose of this study was to compare the risks of elective cesarean hysterectomy with the risks of elective cesarean section followed by remote hysterectomy.Methods: A census of elective cesarean hysterectomies (n = 31) and a random sample of 200 cesarean sections and 200 hysterectomies performed by the authors between 1987 and 1996 were evaluated. Only elective repeat and primary cesarean section patients without labor were selected for study (n = 86). Total abdominal hysterectomies were drawn from the sample (n = 60), excluding cancer cases, patients over 50 years old, and those with ancillary procedures other than adnexectomy and lysis of adhesions. General probability theory was used to calculate a predicted complication rate of cesarean section followed by TAH from the complication rates of the component procedures done independently. This predicted combined complication rate was then compared to the observed rate of complications from cesarean hysterectomy to evaluate the risks of the two alternative treatment regimens.Results: Elective cesarean section and total abdominal hysterectomy had complication rates of 12.8% and 13.4%, respectively. The predicted combined complication rate for elective cesarean section followed by TAH was 24.5%. The observed rate of complications for elective cesarean hysterectomy was much lower (16.1%). Although bleeding complications were similar for the two regimens, the rate of transfusion was higher for cesarean hysterectomy (13.0%) than for cesarean section (0%) and TAH (3.4%) alone. Eighty percent of the cesarean hysterectomy patients would have been candidates for autologous blood donation, had it been available.Conclusions: Elective cesarean hysterectomy has a lower risk of complications than elective cesarean section followed by remote abdominal hysterectomy and should be preferred. Transfusion risks are higher for cesarean hysterectomy but can be decreased by the use of autologous blood.

  14. A Pilot Study of Laparoscopic Doppler Ultrasound Probe to Map Arterial Vascular Flow within the Neurovascular Bundle during Robot-Assisted Radical Prostatectomy

    Directory of Open Access Journals (Sweden)

    Ketan K. Badani

    2013-01-01

    Full Text Available Purpose. To report on the feasibility of a new Laparoscopic Doppler ultrasound (LDU technology to aid in identifying and preserving arterial blood flow within the neurovascular bundle (NVB during robotic prostatectomy (RARP. Materials and Methods. Nine patients with normal preoperative potency and scheduled for a bilateral nerve-sparing procedure were prospectively enrolled. LDU was used to measure arterial flow at 6 anatomic locations alongside the prostate, and signal intensity was evaluated by 4 independent reviewers. Measurements were made before and after NVB dissection. Modifications in nerve-sparing procedure due to LDU use were recorded. Postoperative erectile function was assessed. Fleiss Kappa statistic was used to evaluate inter-rater agreement for each of the 12 measurements. Results. Analysis of Doppler signal intensity showed maintenance of flow in 80% of points assessed, a decrease in 16%, and an increase in 4%. Plane of NVB dissection was altered in 5 patients (56% on the left and in 4 patients (44% on the right. There was good inter-rater reliability for the 4 reviewers. Use of the probe did not significantly increase operative time or result in any complications. Seven (78% patients had recovery of erections at time of the 8-month follow-up visit. Conclusions. LDU is a safe, easy to use, and effective method to identify local vasculature and anatomic landmarks during RARP, and can potentially be used to achieve greater nerve preservation.

  15. Body mass and risk of complications after hysterectomy on benign indications.

    Science.gov (United States)

    Osler, Merete; Daugbjerg, Signe; Frederiksen, Birgitte Lidegaard; Ottesen, Bent

    2011-06-01

    This study examines BMI in relation to risk of complications after hysterectomy on benign indications, and explores whether any associations vary by route of surgery. In this cohort study, we included data on health and lifestyle collected prospectively for all hysterectomy referrals for benign indications in Denmark from 2004 to 2009. Logistic regression was used to investigate relationship between BMI and complications reported at surgery or during the first 30 days after surgery. RESULTS; Of the 20 353 women with complete data, 6.0% had a BMI obese). The overall rate of complications was 17.6%, with bleeding being the most common specific complication (6.8%). After adjustment for age, ethnicity, education, indication for surgery, uterus weight, use of prophylaxis, American Society of Anaesthesiologists classification, co-morbidity status and route of hysterectomy, obesity was associated with an increased risk of heavy bleeding during surgery [odds ratio (OR) = 3.64 (2.90-4.56)], all bleeding complications [OR = 1.27 (1.08-1.48)] and infection [OR = 1.47 (1.23-1.77)]. The risk of all bleeding complications [OR = 1.48 (1.28-1.82)] and re-operation [OR = 1.66 (1.26-2.17)] were also increased among women with a BMI hysterectomy (AH)]. The risk of infections was elevated among women with BMIlaparoscopic surgery [laparoscopic hysterectomy (LH)]. CONCLUSIONS; Obesity increases the risks of bleeding and infections after AH. A BMI below 20 seems to increase the risks of bleeding and infection after AH and LH, respectively.

  16. The Incidence of Concomitant Precancerous Lesions in Cases Who Underwent Hysterectomy for Prolapse

    Directory of Open Access Journals (Sweden)

    Serdar Aydin

    2016-09-01

    Full Text Available Aim: The aim of the study was is to assess the incidence of unexpected gynecological cancers and pre-cancerous lesions following hysterectomy for pelvic organ prolapse to better understand the risks of uterine sparing surgery. Material and Method: This was a retrospective analysis of histopathology findings after hysterectomy for uterine prolapse surgery who underwent preoperative diagnostic work including cervical cytology, transvaginal ultrasonography and endometrial histopathological examination for a high risk group (Postmenopausal women with an endometrial thickness of %u22655 mm and premenopausal women with abnormal bleeding. Patients with a history of endometrial, cervical and/or adnexal precancerous or cancerous pathological conditions and with incomplete medical records were excluded.Results: Results were taken from 106 women who underwent hysterectomy. The abdominal route was used in 22 cases (21.7 %, the vaginal route in 82 patients (77.4 % and laparoscopic-assisted vaginal route in two (1.9 % women. Oophorectomy was performed in 35 (33 % cases. None of the patients had malignant histopathology specimens from hysterectomy. Total premalignant pathology incidence was 7.5 % (8/106. Six (5.7% patients had simple endometrial hyperplasia and 2 patients (1.9 % had cervical intraepithelial neoplasia. Discussion: The incidence of unexpected endometrial, cervical or ovarian malignancy among women who underwent hysterectomy after preoperative diagnostic workup including transvaginal ultrasonograhy, endometrial pathological examination to high risk cases was negligible. The inclusion of low risk endometrial and cervical precancerous lesions increased the incidences. Our results could provide precious data to extrapolate to similar populations with uterine prolapse who desire surgical correction sparing uterus.

  17. The effects of preoperative anxiety on postoperative pain and opioid consumption in patients undergoing laparoscopic hysterectomy%术前焦虑对腹腔镜下子宫切除患者术后疼痛及阿片类药物用量的影响

    Institute of Scientific and Technical Information of China (English)

    罗晶; 梁雁冰; 张鸿飞; 李凤仙; 雷洪伊; 徐世元

    2016-01-01

    Objective To evaluate the effect of preoperative anxiety on the dosage of opioid drugs in perioperative period.Methods Fourty female patients who aged 18-65 years,ASA Ⅰ or Ⅱ, undergoing laparoscopic hysterectomy were enrolled during November 2014 to August 2015.Demo-graphic characteristics of the patients were recorded.The patients were separated into two groups ac-cording to their state anxiety inventory (SAI).The patients with SAI>37 score were included in the high-anxious patients group (group H,n=22)while the other patients with SAI≤37 were enrolled in the low-anxious patients group (group L,n=18).All patients received the SAI test at the day be-fore surgery.The anesthesia time,intraoperative remifentanil consumption,duration of the first time giving analgesia after surgery,consumption of sufentanil at 1(T1 ),2(T2 ),4(T3 ),6(T4 ),24(T5 ) and 48 hours(T6 )after operation were recorded.Visual analogue scale (VAS)scores,the times of pressing PCIA and the side effects of opioid 48 h after the surgery were recorded.Results In group H, the time for first dose of opioid after surgery was significantly shorter than group L (P <0.05).The con-sumption of sufentanil in group H was significantly more than group L at T1-T6 (P <0.05).The times of pressing PCIA at the T5 time point after operation in group H was more than group L (P<0.05).No sta-tistically difference was found in the incidence of nausea or vomit between the two groups.There were no re-spiratory depression, pruritus or urinary retention in all patients.Conclusion Patients with high preoperative anxiety level perceive needed more opioids in postoperative pain control.%目的:评价术前焦虑状态对腹腔镜下子宫切除患者术后疼痛及围手术期阿片类药物用量的影响。方法选择南方医科大学珠江医院妇产科2014年11月~2015年8月择期行腹腔镜下子宫切除术患者40例,年龄18~65岁,ASA Ⅰ或Ⅱ级,术前1 d 行状态焦

  18. Influence of sevoflurane or propofol composite with remifentanil on stress reaction in patients accepted laparoscopically hysterectomy%七氟醚或丙泊酚复合瑞芬太尼麻醉在腹腔镜子宫切除术中的应用及对患者应激反应的影响

    Institute of Scientific and Technical Information of China (English)

    杨晓瑞; 葛静; 周迪兰

    2015-01-01

    目的:比较七氟醚和丙泊酚复合瑞芬太尼麻醉在腹腔镜子宫切除术( LH)中的应用及对患者应激反应的影响。方法选取拟行LH的患者110例随机分为七氟醚组和丙泊酚组,均以瑞芬太尼进行麻醉诱导,七氟醚组麻醉维持采用七氟醚1%~3%复合吸入而丙泊酚组采取丙泊酚4~8mg/( kg·h)静脉输注。观察并比较两组患者手术时间,麻醉时间,恢复状况,术后不良反应发生率及麻醉前(T0)、气腹后10 min(T1)、手术结束后10 min(T2)的血糖(GLU)、皮质醇(CRO)、肾上腺素(NE)、去甲肾上腺素(NA)、心率(HR)、平均动脉压(MAP)、血氧饱和度(SpO2)。结果两组患者手术时间、麻醉时间、不良反应发生率、各时间点SpO2无显著性差异( P ﹥0.05),七氟醚组自主呼吸恢复时间、睁眼时间、言语应答时间、定向力恢复时间、拔管时间均显著低于丙泊酚组( P ﹤0.05,P ﹤0.01);丙泊酚组T1时HR、MAP、血浆GLU 水平,T1、T2时COR、NA、NE水平均较T0时显著增高( P ﹤0.05,P ﹤0.01),而七氟醚组上述指标较T0时无显著变化( P ﹥0.05),两组间比较各项指标均有显著性差异( P ﹤0.05,P ﹤0.01)。结论七氟醚复合瑞芬太尼用于LH麻醉时可很好地抑制麻醉过程引起的应激反应,值得临床推广。%Objective To compare the influence of sevoflurane or propofol composite with remifentanil on stress reaction in patients accepted laparoscopically hysterectomy( LH). Methods 110 patients planned to accept LH in our hospital were randomly divided into sevoflurane and propo-fol groups. All patientsˊanesthesia induction were implemented by remifentanil and sevoflurane group receiving sevoflurane suction with concentration 1% ~ 3% and Propofol group took propofol 4~8 mg/( kg · h)by intravenous infusion to maintain narcotism. The operation time,anesthesia time, recovery

  19. 经阴道联合腹腔镜下根治性女性全膀胱切除原位回肠新膀胱术%Transvaginal laparoscopic radical cystectomy with orthotopic ileal neobladder in the female

    Institute of Scientific and Technical Information of China (English)

    吴刚; 靳风烁; 叶锦; 张尧; 郭建新; 白巍; 梁平; 王鹏; 周波; 李黔生

    2010-01-01

    目的 探讨经阴道联合腹腔镜下根治性女性全膀胱切除及原位回肠新膀胱的手术方法.方法浸润性膀胱癌患者6例,平均年龄61(55~73)岁.5孔法先行腹腔镜下手术:游离输尿管后分侧清扫盆腔淋巴结;举宫器配合下,用血管闭合器LigaSure切断子宫相关韧带及膀胱两侧血管蒂;电凝钩分离子宫直肠陷窝及膀胱前间隙;LigaSure切断阴蒂背血管复合体;超声刀切开膀胱颈尿道后游离膀胱颈后壁至阴道前穹窿部.阴道手术:直视下剪开阴道前后穹窿,于阴道取出标本,缝合阴道.回肠新膀胱术:下腹正中4~5 cnl切口,将回肠拉出切口外,游离30~40 cm回肠,剖开后w形折叠缝合形成贮尿囊;插入法植入输尿管后将贮尿囊还纳腹腔.缝合切口后重新开启气腹,腔镜下行新膀胱尿道吻合. 结果 手术时间平均6.2(4~8)h;出血量平均665(400~1200)ml.术后1~3个月患者均恢复较满意的控尿功能,IVU显示双肾功能良好,无膀胱输尿管反流及梗阻.新膀胱最大容量平均427(300~600)ml.无新膀胱阴道瘘等需要手术处理的严重并发症.术后平均随访16(9~30)个月,6例均存活.1例术后8个月发现肝转移. 结论 经阴道联合腹腔镜下根治性女性全膀胱切除回肠新膀胱术治疗女性浸润性膀胱癌可行、有效,应用举宫器及经阴道直视下手术可一定程度上降低腹腔镜下全膀胱切除术的手术难度、缩短手术时间.由于阴道切口整齐、缝合确切,新膀胱阴道瘘等并发症的发生机会减少.%Objective To present the initial experience and results of laparoscopic transvaginal radical cystectomy (LATRC) with orthotopic ileal neobladder. Methods Six female patients with muscle invasive bladder carcinoma underwent LATRC with orthotopic ileal neobladder. The mean age was 61 years (range 55 to 73 years) . The LATRC with orthotopic ileal neobladder consisted of 4 major steps, namely laparoscopic cystectomy

  20. Radical cystectomy for bladder cancer: сomparison of early surgical complications during laparoscopic, open-access, and video-assisted surgery

    Directory of Open Access Journals (Sweden)

    A. K. Nosov

    2015-01-01

    Full Text Available Objectives. To evaluate peri- and postoperative morbidity and functional results of LRC in a single-site cohort of patients, comparing it with standard open approach (ORC and laparoscopic cystectomy with open urinary diversion (HALRC.Subjects and methods. A prospective analysis was performed in 51 muscle-invasive and locally advanced BCa patients who underwent RC between February 2012 and March 2014 in N. N. Petrov Research Institute of Oncology, Saint-Petersburg. The final cohort included 21 ORC, 21 LRC and 9 HALRC patients. Mean patients age was 64 (38–81 years old and did not differ in all groups. Pathological stage were similar in all groups. Multivariable logistic and median regression was performed to evaluate operating time, perioperative and postoperative complications (30-d and 90-d, readmission rates, length of stay (LOS – totally and in ICU.Results. Operating time during LRC and HALRC was longer than that of ORC (398 min vs 468 min vs 243 min, respectively. Despite that, there was no statistically significant influence of type of surgery on intraoperative complications – 14.3 % in ORC group, 11.1 % in HALRC and 4.7 % in LRC patients. Major complication rates (Clavien grade  3; 23.8 % vs 33.3 % vs 19.4 % were similar between all groups. However, LRC had 4,0 times lower rate of minor complications (Clavien grade 1–2 compared to ORC (4.7 % vs 19.0 %. LRC had a significantly shorter LOS (27.8 d vs 32.6 d vs 22.6 d in ORC, HALRC and LRC groups, respectively, but no significant differences in ICU stay existed (5.1 d vs 3.1 d vs 2.1 d. Morbidity were present by one patient in each group (medium rate 5,8 %. The common transfusion rate during and after surgical intervention was 19.6 % and was higher in ORC group (33.3 % vs 4.7 % in LRC; as well, intraoperative bleeding was lower in minimally invasive techniques – the average volume of blood loss was 285 ml in LRC and did not differ between HALRC and ORC groups – 468