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Patient Perception of Laparoendoscopic Single-Site (LESS) Gynecologic Surgery and Preference of Surgical Scar
Abstracts / Journal of Minimally Invasive Gynecology 17 (2010) S1–S24 49
Open Communications 2dLaparoscopy (12:35 PM d 12:40 PM)
Use of Bidirectional Barbed Suture in Laparoscopic Myomectomy: An Evaluation of Perioperative Outcomes, Safety and Efficacy Chavan N, Cohen S, Vellinga T, Suzuki Y, Jonsdottir G, Einarsson JI. Obstetrics and Gynecology, Brigham and Women’s Hospital, Boston, Massachusetts Study Objective: To study perioperative outcomes following laparoscopic myomectomy using bidirectional barbed suture in comparison to the smooth suture. Design: A retrospective analysis of one hundred and thirty-eight consecutive cases of laparoscopic myomectomy performed by a single surgeon over a three year period. Setting: University teaching hospital. Patients: One hundred and thirty eight women undergoing a laparoscopic myomectomy for symptomatic uterine fibroids, pelvic pain and pressure, and/or abnormal uterine bleeding, over a period of three years from February 2007 through April 2010. Intervention: Conventional smooth sutures were used in thirty-one women undergoing laparoscopic myomectomy while the bidirectional barbed suture was used in one hundred and seven patients undergoing this procedure. Measurements and Main Results: The chief indications for undergoing laparoscopic myomectomy in either group were noted to be – pelvic pain/ pressure and abnormal uterine bleeding, in a majority of the patients. The use of bidirectional barbed suture was found to significantly lower the duration of surgery (118 53 minutes v/s 162 69 minutes, p \ 0.05) and reduce the length of hospital stay (0.58 0.46 days v/s 0.97 0.45 days, p \ 0.05). Patients undergoing laparoscopic myomectomy using the bidirectional barbed suture as compared to the smooth suture did not experience a change in the incidence of perioperative complications following surgery. There was no significant difference between the two groups in terms of the estimated blood loss, number or weight of fibroids removed during surgery. Conclusion: The use of bidirectional barbed suture appears to be a safe and effective alternative for closure of the hysterotomy site in laparoscopic myomectomy. 50
Open Communications 2dLaparoscopy (12:41 PM d 12:46 PM)
Patient Perception of Laparoendoscopic Single-Site (LESS) Gynecologic Surgery and Preference of Surgical Scar Gomez NA, Uppal S, Hernandez E, Dandolu V. Department of Obstetrics and Gynecology, Temple University Hospital, Philadelphia, Pennsylvania Study Objective: To understand patients’ perception of Laparoendoscopic Single-Site (LESS) gynecologic surgery and preference of type of surgical scar. Design: A survey was designed and distributed to women at Temple University Hospital and Jeans Temple Hospital. The questionnaire aimed to identify patients’ perceptions on Laparoendoscopic single-site (LESS) gynecologic surgery and preference of surgical scar. The survey included a brief introduction to different approaches to various gynecologic surgeries and pictures illustrating skin incisions immediately after and one-week post surgery. The various surgical techniques discussed were open laparotomy, traditional laparoscopy with multiple ports, and single-port laparoscopy. Setting: Temple University Hospital and Jeans Temple Hospital. Patients: 86 women surveyed. Measurements and Main Results: An overwhelming majority of women (75.6%) prefer a minimally invasive approach and only (10.7%) of women were aware of single port laparoscopy as an option. Most women (60%), when given an option would choose single port laparoscopy only if the outcomes were equivalent to other methods. BMI [p = 0.999], level of education [p = 0.33 ], or level of activity [p = 0.364] did not influence the choice of surgical technique. When we looked at household income, 50% of women below 25,000 reported no influence on decision of surgery based on the scar, however this percentage decreased to 21.4% for income between 25,000-50,000 and to 10.5% for income greater than 50,000 [p = 0.01].
S17
Conclusion: In our study, women were not well informed about different approaches to gynecologic surgery. Social economic status appears to influence the choice of surgical scar, whether this is do to lack of patient education or lack of resources needs to be further explored. As increasing number of surgical techniques become more available for gynecologic surgeries, it is important for us to inform our patients about minimally invasive approaches and make them more available to our patients. 51
Open Communications 2dLaparoscopy (12:47 PM d 12:52 PM)
Single Port Access Gynecologic Surgery: A Three Year Experience with Standard Instrumentation Green MA,1 King SA,1 Curcillo PG II.2 1Dept of OB/GYN, Drexel University College of Medicine, Philadelphia, Pennsylvania; 2Dept of Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania Study Objective: Single port laparoscopy has been practiced in gynecologic surgery for decades with a recent resurgence in interest. Important concerns include not only effects on the patient, but economic costs and ease of adoption as well. Both short and long term results need to be considered. We offer a three year experience applying Single Port Access to gynecologic surgery addressing each of these concerns. Design: Retrospective analysis of 200+ consecutive patients undergoing reduced port laparoscopy. Setting: Academic gynecologic oncology practice. Patients: Patients undergoing reduced port laparoscopic approaches from May 2007 through April 2010. Intervention: All procedures were initiated with the Single Port Access technique. No specialized access devices were used. Procedures included oophorectomy, hysterectomy and staging with omentectomy and lymph node dissections. Attention to operative safety mandated additional reduced port techniques in some patients. Measurements and Main Results: Greater than 50% of procedures were completed with Single Port Access. The remaining procedures were completed with a combination of Single Port Access, needlescopic retraction, transvaginal node dissection and additional port sites if necessary. Results are comparable to prior experiences with similar multiport procedures. Three year follow-up demonstrates no access site hernias. With the use of standard instruments and trocars, we demonstrate reduced costs compared to multiport techniques. A decrease in number of standard trocars and the use of less expensive very low profile trocars allows us to avoid the use of single port access devices. 98% of all procedures were performed using standard rigid instrumentation. Conclusion: We report successful application of Reduced Port Surgery toward the goal of Single Port Access gynecologic surgery over a 3-year period. Current data comparison demonstrates it to be comparable to multiport procedures. We maintain the use of standard, familiar instrumentation to ease adoption into practice and demonstrate lower costs. We have not seen any other improvement compared to multiport surgery other than potentially cosmetics. 52
Open Communications 2dLaparoscopy (12:53 PM d 12:58 PM)
Second Look Hysteroscopy and Laparoscopy Findings in Patients after Myomectomy and Their Reproduction Outcome Kubinova K, Mara M, Kuzel D. Department of Obstetrics and Gynecology, 1st Medical Faculty of Charles University, Praha 2, Praha, Czech Republic Study Objective: To analyze second-look hysteroscopy and laparoscopy findings in patients after laparoscopic or open myomectomy and to asses reproduction outcome of the patients. Design: Retrospective analysis of 100 consecutive second-look hysteroscopy and laparoscopy findings following laparoscopic or open myomectomy.
Open Communications 2dLaparoscopy (12:35 PM d 12:40 PM)
Use of Bidirectional Barbed Suture in Laparoscopic Myomectomy: An Evaluation of Perioperative Outcomes, Safety and Efficacy Chavan N, Cohen S, Vellinga T, Suzuki Y, Jonsdottir G, Einarsson JI. Obstetrics and Gynecology, Brigham and Women’s Hospital, Boston, Massachusetts Study Objective: To study perioperative outcomes following laparoscopic myomectomy using bidirectional barbed suture in comparison to the smooth suture. Design: A retrospective analysis of one hundred and thirty-eight consecutive cases of laparoscopic myomectomy performed by a single surgeon over a three year period. Setting: University teaching hospital. Patients: One hundred and thirty eight women undergoing a laparoscopic myomectomy for symptomatic uterine fibroids, pelvic pain and pressure, and/or abnormal uterine bleeding, over a period of three years from February 2007 through April 2010. Intervention: Conventional smooth sutures were used in thirty-one women undergoing laparoscopic myomectomy while the bidirectional barbed suture was used in one hundred and seven patients undergoing this procedure. Measurements and Main Results: The chief indications for undergoing laparoscopic myomectomy in either group were noted to be – pelvic pain/ pressure and abnormal uterine bleeding, in a majority of the patients. The use of bidirectional barbed suture was found to significantly lower the duration of surgery (118 53 minutes v/s 162 69 minutes, p \ 0.05) and reduce the length of hospital stay (0.58 0.46 days v/s 0.97 0.45 days, p \ 0.05). Patients undergoing laparoscopic myomectomy using the bidirectional barbed suture as compared to the smooth suture did not experience a change in the incidence of perioperative complications following surgery. There was no significant difference between the two groups in terms of the estimated blood loss, number or weight of fibroids removed during surgery. Conclusion: The use of bidirectional barbed suture appears to be a safe and effective alternative for closure of the hysterotomy site in laparoscopic myomectomy. 50
Open Communications 2dLaparoscopy (12:41 PM d 12:46 PM)
Patient Perception of Laparoendoscopic Single-Site (LESS) Gynecologic Surgery and Preference of Surgical Scar Gomez NA, Uppal S, Hernandez E, Dandolu V. Department of Obstetrics and Gynecology, Temple University Hospital, Philadelphia, Pennsylvania Study Objective: To understand patients’ perception of Laparoendoscopic Single-Site (LESS) gynecologic surgery and preference of type of surgical scar. Design: A survey was designed and distributed to women at Temple University Hospital and Jeans Temple Hospital. The questionnaire aimed to identify patients’ perceptions on Laparoendoscopic single-site (LESS) gynecologic surgery and preference of surgical scar. The survey included a brief introduction to different approaches to various gynecologic surgeries and pictures illustrating skin incisions immediately after and one-week post surgery. The various surgical techniques discussed were open laparotomy, traditional laparoscopy with multiple ports, and single-port laparoscopy. Setting: Temple University Hospital and Jeans Temple Hospital. Patients: 86 women surveyed. Measurements and Main Results: An overwhelming majority of women (75.6%) prefer a minimally invasive approach and only (10.7%) of women were aware of single port laparoscopy as an option. Most women (60%), when given an option would choose single port laparoscopy only if the outcomes were equivalent to other methods. BMI [p = 0.999], level of education [p = 0.33 ], or level of activity [p = 0.364] did not influence the choice of surgical technique. When we looked at household income, 50% of women below 25,000 reported no influence on decision of surgery based on the scar, however this percentage decreased to 21.4% for income between 25,000-50,000 and to 10.5% for income greater than 50,000 [p = 0.01].
S17
Conclusion: In our study, women were not well informed about different approaches to gynecologic surgery. Social economic status appears to influence the choice of surgical scar, whether this is do to lack of patient education or lack of resources needs to be further explored. As increasing number of surgical techniques become more available for gynecologic surgeries, it is important for us to inform our patients about minimally invasive approaches and make them more available to our patients. 51
Open Communications 2dLaparoscopy (12:47 PM d 12:52 PM)
Single Port Access Gynecologic Surgery: A Three Year Experience with Standard Instrumentation Green MA,1 King SA,1 Curcillo PG II.2 1Dept of OB/GYN, Drexel University College of Medicine, Philadelphia, Pennsylvania; 2Dept of Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania Study Objective: Single port laparoscopy has been practiced in gynecologic surgery for decades with a recent resurgence in interest. Important concerns include not only effects on the patient, but economic costs and ease of adoption as well. Both short and long term results need to be considered. We offer a three year experience applying Single Port Access to gynecologic surgery addressing each of these concerns. Design: Retrospective analysis of 200+ consecutive patients undergoing reduced port laparoscopy. Setting: Academic gynecologic oncology practice. Patients: Patients undergoing reduced port laparoscopic approaches from May 2007 through April 2010. Intervention: All procedures were initiated with the Single Port Access technique. No specialized access devices were used. Procedures included oophorectomy, hysterectomy and staging with omentectomy and lymph node dissections. Attention to operative safety mandated additional reduced port techniques in some patients. Measurements and Main Results: Greater than 50% of procedures were completed with Single Port Access. The remaining procedures were completed with a combination of Single Port Access, needlescopic retraction, transvaginal node dissection and additional port sites if necessary. Results are comparable to prior experiences with similar multiport procedures. Three year follow-up demonstrates no access site hernias. With the use of standard instruments and trocars, we demonstrate reduced costs compared to multiport techniques. A decrease in number of standard trocars and the use of less expensive very low profile trocars allows us to avoid the use of single port access devices. 98% of all procedures were performed using standard rigid instrumentation. Conclusion: We report successful application of Reduced Port Surgery toward the goal of Single Port Access gynecologic surgery over a 3-year period. Current data comparison demonstrates it to be comparable to multiport procedures. We maintain the use of standard, familiar instrumentation to ease adoption into practice and demonstrate lower costs. We have not seen any other improvement compared to multiport surgery other than potentially cosmetics. 52
Open Communications 2dLaparoscopy (12:53 PM d 12:58 PM)
Second Look Hysteroscopy and Laparoscopy Findings in Patients after Myomectomy and Their Reproduction Outcome Kubinova K, Mara M, Kuzel D. Department of Obstetrics and Gynecology, 1st Medical Faculty of Charles University, Praha 2, Praha, Czech Republic Study Objective: To analyze second-look hysteroscopy and laparoscopy findings in patients after laparoscopic or open myomectomy and to asses reproduction outcome of the patients. Design: Retrospective analysis of 100 consecutive second-look hysteroscopy and laparoscopy findings following laparoscopic or open myomectomy.