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Two Phase Laparoendoscopic Single-Site Cervical Ligament-Sparing Hysterectomy: An Initial Experience in a Single Center
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Abstracts / Journal of Minimally Invasive Gynecology 22 (2015) S1–S253
716 Two Phase Laparoendoscopic Single-Site Cervical Ligament-Sparing Hysterectomy: An Initial Experience in a Single Center Hong M-KM,1 Ding D-CD.2 1Institute of Medical Science, Tzu Chi University, Hualien, Taiwan; 2Department of Obstetrics and Gynecology, Hualien Tzu Chi Hospital, Hualien, Taiwan Study Objective: To introduce a novel method of laparoscopic hysterectomy (laparoendoscopic single-site cervical ligament-sparing hysterectomy, LESS-CLSH) and share our preliminary experience. Design: Compare LESS-CLSH with conventional laparoscopic assisted vaginal hysterectomy (LAVH). Setting: This study was carried out in Tzu Chi Medical Center. Patients: This study included 20 women who underwent LESS-CLSH and 36 women who underwent LAVH because of benign diseases. Intervention: The LESS-CLSH was performed in two phases (figure 1): (1) a laparoscopic approach involving supracervical hysterectomy and conisation through the internal os of the cervix, and (2) wide excision of the cervix through the vagina.
Comparison on clinical outcomes between LESS-CLSH and LAVH Surgery time (mins) Blood loss Complication VAS pain score at 0-4 hrs VAS pain score at 24 hrs VAS pain score at 48 hrs Hospitalisation
LESS-CLSH (n=20) 155.840.7 405.6315.7 0 (0%) 6.52.1 3.31.5 1.20.4 4.01.1
LAVH (n=36) 120.335.5 316.0186.0 7 (1.9%) 8.21.1 5.11.4 2.61.3 5.30.8
p value 0.003 0.446 0.361 \0.001 \0.001 0.0018 \0.001
Data was presented as mean SD or number (%)
loss of LESS-CLSH did not seem to differ from the LAVH group. At 0-4, 24, 48 hours after surgery, the postoperative VAS pain score of LESSCLSH group was consistently lower than that of the LAVH group (6.52.1 v.s. 8.21.1, 3.31.5 v.s. 5.11.4, 1.20.4 v.s. 2.61.3, respectively). Furthermore, the duration of hospitalisation was shorter than LAVH group (4.01.1 v.s. 5.30.8 days). The LESS-CLSH group resumed their sexual life early than LAVH group. Conclusion: LESS-CLSH is minimally invasive, safe and easy method for hysterectomy, that preserves the fundamental supporting structure of the pelvic floor and eliminates the vaginal bleeding or endocervical neoplasia that occurs after subtotal hysterectomy. Ureter or bladder injury is negligible, and LESS-CLSH remarkably reduces the large uterine size limitation associated with laparoscopic hysterectomy and enables maintaining the stability of pelvic floor. Whether LESS-CLSH reduces POP and urinary, anorectal, and sexual dysfunction needed be investigated in future studies.
717 Deep Epigastric Vessel Location in the Gravid Abdomen Rubenacker S,1 Burnett TL,1 Roy S,1 Groesch K,2 Garza-Cavazos A,1 Abrams R,1 Siddique S.1 1Obstetrics & Gynecology, SIU School of Medicine, Springfield, Illinois; 2Obstetrics & Gynecology, Center for Clinical Research, SIU School of Medicine, Springfield, Illinois
Measurements and Main Results: The perioperative outcomes of the 20 women underwent LESS-LSH were compared (table 1) with those of 36 patients who underwent LAVH performed by the same team of surgeons. The surgery time of LESS-CLSH group was longer than LAVH group (155.840.7 v.s. 120.335.5 minutes), while the complication and blood
Study Objective: To map the location of the superior and inferior epigastric vessels (deep epigastric vessels) via color flow Doppler ultrasound in the gravid abdomen, by trimester of pregnancy. While deep epigastric vessel location has been previously described in the non-gravid abdomen, data in the gravid state is lacking. Design: Subjects underwent color Doppler ultrasound assessment of deep epigastric vessel location bilaterally. The deep epigastric vessels were identified at 5 points along the abdomen (pubic symphysis, ASIS, umbilicus, xiphoid and midway from umbilicus to xiphoid), with distance from vessels to midline measured. Setting: Tertiary care academic institution. Patients: Women over the age of 18 with singleton gestations were included in the study. A total of 16 subjects completed the study. Measurements and Main Results: The mean patient age was 26.3 (SD 4.6), mean BMI was 28.16 (SD 9.9) and the majority were parous with at least one prior completed pregnancy. Deep epigastric vessel distances from the midline are noted by trimester in Table 1. A significant difference was noted at the midpoint, umbilicus, ASIS and pubic symphysis in the third trimester when compared to the first and second trimesters, where deep epigastric vessels were found more laterally. There was no statistical difference in vessel location between the first and second trimesters. The most lateral location of the deep epigastric vessels was in the third trimester at the ASIS (14.0 cm). Conclusion: Deep epigastric vessel locations by trimester were described; vessels were located more laterally than previously described in the nongravid abdomen. Vessels are at the greatest distance from the midline in the third trimester.
Abstracts / Journal of Minimally Invasive Gynecology 22 (2015) S1–S253
716 Two Phase Laparoendoscopic Single-Site Cervical Ligament-Sparing Hysterectomy: An Initial Experience in a Single Center Hong M-KM,1 Ding D-CD.2 1Institute of Medical Science, Tzu Chi University, Hualien, Taiwan; 2Department of Obstetrics and Gynecology, Hualien Tzu Chi Hospital, Hualien, Taiwan Study Objective: To introduce a novel method of laparoscopic hysterectomy (laparoendoscopic single-site cervical ligament-sparing hysterectomy, LESS-CLSH) and share our preliminary experience. Design: Compare LESS-CLSH with conventional laparoscopic assisted vaginal hysterectomy (LAVH). Setting: This study was carried out in Tzu Chi Medical Center. Patients: This study included 20 women who underwent LESS-CLSH and 36 women who underwent LAVH because of benign diseases. Intervention: The LESS-CLSH was performed in two phases (figure 1): (1) a laparoscopic approach involving supracervical hysterectomy and conisation through the internal os of the cervix, and (2) wide excision of the cervix through the vagina.
Comparison on clinical outcomes between LESS-CLSH and LAVH Surgery time (mins) Blood loss Complication VAS pain score at 0-4 hrs VAS pain score at 24 hrs VAS pain score at 48 hrs Hospitalisation
LESS-CLSH (n=20) 155.840.7 405.6315.7 0 (0%) 6.52.1 3.31.5 1.20.4 4.01.1
LAVH (n=36) 120.335.5 316.0186.0 7 (1.9%) 8.21.1 5.11.4 2.61.3 5.30.8
p value 0.003 0.446 0.361 \0.001 \0.001 0.0018 \0.001
Data was presented as mean SD or number (%)
loss of LESS-CLSH did not seem to differ from the LAVH group. At 0-4, 24, 48 hours after surgery, the postoperative VAS pain score of LESSCLSH group was consistently lower than that of the LAVH group (6.52.1 v.s. 8.21.1, 3.31.5 v.s. 5.11.4, 1.20.4 v.s. 2.61.3, respectively). Furthermore, the duration of hospitalisation was shorter than LAVH group (4.01.1 v.s. 5.30.8 days). The LESS-CLSH group resumed their sexual life early than LAVH group. Conclusion: LESS-CLSH is minimally invasive, safe and easy method for hysterectomy, that preserves the fundamental supporting structure of the pelvic floor and eliminates the vaginal bleeding or endocervical neoplasia that occurs after subtotal hysterectomy. Ureter or bladder injury is negligible, and LESS-CLSH remarkably reduces the large uterine size limitation associated with laparoscopic hysterectomy and enables maintaining the stability of pelvic floor. Whether LESS-CLSH reduces POP and urinary, anorectal, and sexual dysfunction needed be investigated in future studies.
717 Deep Epigastric Vessel Location in the Gravid Abdomen Rubenacker S,1 Burnett TL,1 Roy S,1 Groesch K,2 Garza-Cavazos A,1 Abrams R,1 Siddique S.1 1Obstetrics & Gynecology, SIU School of Medicine, Springfield, Illinois; 2Obstetrics & Gynecology, Center for Clinical Research, SIU School of Medicine, Springfield, Illinois
Measurements and Main Results: The perioperative outcomes of the 20 women underwent LESS-LSH were compared (table 1) with those of 36 patients who underwent LAVH performed by the same team of surgeons. The surgery time of LESS-CLSH group was longer than LAVH group (155.840.7 v.s. 120.335.5 minutes), while the complication and blood
Study Objective: To map the location of the superior and inferior epigastric vessels (deep epigastric vessels) via color flow Doppler ultrasound in the gravid abdomen, by trimester of pregnancy. While deep epigastric vessel location has been previously described in the non-gravid abdomen, data in the gravid state is lacking. Design: Subjects underwent color Doppler ultrasound assessment of deep epigastric vessel location bilaterally. The deep epigastric vessels were identified at 5 points along the abdomen (pubic symphysis, ASIS, umbilicus, xiphoid and midway from umbilicus to xiphoid), with distance from vessels to midline measured. Setting: Tertiary care academic institution. Patients: Women over the age of 18 with singleton gestations were included in the study. A total of 16 subjects completed the study. Measurements and Main Results: The mean patient age was 26.3 (SD 4.6), mean BMI was 28.16 (SD 9.9) and the majority were parous with at least one prior completed pregnancy. Deep epigastric vessel distances from the midline are noted by trimester in Table 1. A significant difference was noted at the midpoint, umbilicus, ASIS and pubic symphysis in the third trimester when compared to the first and second trimesters, where deep epigastric vessels were found more laterally. There was no statistical difference in vessel location between the first and second trimesters. The most lateral location of the deep epigastric vessels was in the third trimester at the ASIS (14.0 cm). Conclusion: Deep epigastric vessel locations by trimester were described; vessels were located more laterally than previously described in the nongravid abdomen. Vessels are at the greatest distance from the midline in the third trimester.