- Email: [email protected]
Laparoendoscopic single-site surgery for total hysterectomy
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BRIEF COMMUNICATIONS
Table 1 Association between knowledge about reproductive health issues and personal aspirations.a Age
Age
Knowledge about infertility rate 0.01 Knowledge about male:female causes N 0.05 Knowledge about miscarriage rate N 0.05 Knowledge about all aspects of reproduction 0.07 Expected age at childbirth b 0.01 (late) Knowledge of reproductive time limit Over 40 years of age 0.06 Yes 25.4 ± 6.9 No 24.8 ± 6.5 a b
Considering marriage
Considering career
Considering childbirth
b0.01 Yes 26.8 ± 7.4 No 23.7 ± 5.9 b0.01 N0.05 N0.05 0.04 0.07 (late) N0.05 N0.05
N 0.05 Yes 25.7 ± 7.0 No 24.1 ± 6.4 0.07 0.05 0.04 N 0.05 N 0.05 N 0.05 N 0.05
b0.01 Yes 26.4 ± 7.4 No 24.4 ± 6.3 0.03 N0.05 N0.05 0.03 N0.05 N0.05 N0.05
School teachers Expected age Knowledge of Over 40 years listed as source at childbirth reproductive of age of knowledge time limit
N 0.05 N 0.05 N 0.05 N 0.05 0.10 (early) N 0.05 N 0.05
0.08 (late) 0.07 (late) N 0.05 0.09 (late)
N0.05 0.01 (late) N0.05 N0.05
N 0.05 N 0.05 N 0.05 N 0.05
Values are given as mean ± SD or P values. P b 0.05 was considered statistically significant.
References [1] Gilbert WM, Nesbitt TS, Danielsen B. Childbearing beyond age 40: pregnancy outcome in 24,032 cases. Obstet Gynecol 1999;93(1):9–14. [2] Menken J, Trussell J, Larsen U. Age and infertility. Science 1986;233(4771): 1389–94.
[3] Centers for Disease Control and Prevention, American Society for Reproductive Medicine, Society for Assisted Reproductive Technology, RESOLVE. 1999 Assisted Reproductive Technology Success Rates. Atlanta, GA: Centers for Disease Control and Prevention; 2001.
0020-7292/$ – see front matter © 2009 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijgo.2009.10.020
Laparoendoscopic single-site surgery for total hysterectomy Francesco Fanfani ⁎, Anna Fagotti, Giovanni Scambia Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Catholic University of the Sacred Heart, Rome, Italy
a r t i c l e
i n f o
Article history: Received 22 September 2009 Received in revised form 16 October 2009 Accepted 5 November 2009 Keywords: Hysterectomy Laparoscopy Laparoendoscopic single-site surgery (LESS) Single-port access
Single-access laparoscopic procedures, such as laparoendoscopic single-site surgery (LESS) and natural orifice transluminal endoscopic surgery (NOTES), are new techniques for less invasive surgical procedures. Our experience with LESS for surgical management of benign adnexal diseases showed encouraging results for complication rate, postoperative pain, duration of hospitalization, and cosmetic appearance [1]. Other authors have also demonstrated the feasibility of this approach to perform laparoscopic-assisted vaginal hysterectomy [2] and LESS hysterectomy using an additional 5-mm ancillary trocar [3].
⁎ Corresponding author. Department of Obstetrics and Gynecology, Catholic University, L.go A. Gemelli 8, 00168, Rome, Italy. Tel.: +39 0635508736. E-mail address: [email protected] (F. Fanfani).
We describe a LESS procedure used to perform total hysterectomy in a 42-year-old nulliparous woman for an atypical glandular endometrial hyperplasia. The procedure was performed via a multi-channel single trocar (Olympus Winter & IBE GMBH, Hamburg, Germany) inserted into the umbilicus through an open access cutaneous incision of approximately 1.5–2 cm. Standard straight 5-mm instruments, such as graspers, cold scissors, suction/irrigation instruments, and a multifunctional device that grasps, coagulates, and transects simultaneously (PKS Cutting Forceps; Gyrus ACMI, Hamburg, Germany) were inserted into the remaining 2 ports. A combination of one standard 33-cm-long instrument with a 43-cm-long instrument plus a 5-mm 30° laparoscope was used to prevent clashing between the instruments and the surgeon's hands. Changes in the position of the instruments and the optic were made according to the needs of the surgeon. An intrauterine manipulator was positioned. After coagulation and section of the round ligament had been performed to permit entry to the retroperitoneal space, the ureter was visualized and a hemostatic clip was positioned at the origin of the uterine artery (Fig. 1). An adequate margin of the vagina was ensured before colpectomy was performed using a bipolar hook. The vaginal vault was closed using an extracorporeal knotting technique. No vascular or visceral injuries, loss of pneumoperitoneum, or intraoperative port-site bleeding occurred. Operative time was 120 minutes with an estimated blood loss of 20 mL. There was no wound hematoma, wound infection, or delayed bleeding postoperatively. The patient reported complete satisfaction with the cosmetic appearance and postoperative pain control. She was discharged home the day after the procedure with only optional analgesic therapy, and no early (within 30 days) postoperative complications were reported.
BRIEF COMMUNICATIONS
77
Conflict of interest The authors declare that there are no conflicts of interest. References [1] Fagotti A, Fanfani F, Marocco F, Rossitto C, Gallotta V, Scambia G. Laparoendoscopic single-site surgery (LESS) for ovarian cyst enucleation: report of first 3 cases. Fertil Steril 2009;92(3):1168.e13-6. [2] Lee YY, Kim TJ, Kim CJ, Kang H, Choi CH, Lee JW, et al. Single-port access laparoscopicassisted vaginal hysterectomy: a novel method with a wound retractor and a glove. J Minim Invasive Gynecol 2009;16(4):450–3. [3] Fader AN, Escobar PF. Laparoendoscopic single-site surgery (LESS) in gynecologic oncology: Technique and initial report. Gynecol Oncol 2009;114(2):157–61.
Fig. 1. Laparoendoscopic single-site surgery (LESS): (A) internal view; (B) external view. After coagulation and section of the right round ligament to permit entry to the retroperitoneal space, the ureter (U) was visualized and a hemostatic clip was positioned at the origin of the uterine artery (UA).
The present case highlights the feasibility of LESS for total hysterectomy. Larger prospective studies are needed to confirm these results and to compare the procedure with conventional multi-access laparoscopic procedures.
0020-7292/$ – see front matter © 2009 Published by Elsevier Ireland Ltd. on behalf of International Federation of Gynecology and Obstetrics. doi:10.1016/j.ijgo.2009.10.010
BRIEF COMMUNICATIONS
Table 1 Association between knowledge about reproductive health issues and personal aspirations.a Age
Age
Knowledge about infertility rate 0.01 Knowledge about male:female causes N 0.05 Knowledge about miscarriage rate N 0.05 Knowledge about all aspects of reproduction 0.07 Expected age at childbirth b 0.01 (late) Knowledge of reproductive time limit Over 40 years of age 0.06 Yes 25.4 ± 6.9 No 24.8 ± 6.5 a b
Considering marriage
Considering career
Considering childbirth
b0.01 Yes 26.8 ± 7.4 No 23.7 ± 5.9 b0.01 N0.05 N0.05 0.04 0.07 (late) N0.05 N0.05
N 0.05 Yes 25.7 ± 7.0 No 24.1 ± 6.4 0.07 0.05 0.04 N 0.05 N 0.05 N 0.05 N 0.05
b0.01 Yes 26.4 ± 7.4 No 24.4 ± 6.3 0.03 N0.05 N0.05 0.03 N0.05 N0.05 N0.05
School teachers Expected age Knowledge of Over 40 years listed as source at childbirth reproductive of age of knowledge time limit
N 0.05 N 0.05 N 0.05 N 0.05 0.10 (early) N 0.05 N 0.05
0.08 (late) 0.07 (late) N 0.05 0.09 (late)
N0.05 0.01 (late) N0.05 N0.05
N 0.05 N 0.05 N 0.05 N 0.05
Values are given as mean ± SD or P values. P b 0.05 was considered statistically significant.
References [1] Gilbert WM, Nesbitt TS, Danielsen B. Childbearing beyond age 40: pregnancy outcome in 24,032 cases. Obstet Gynecol 1999;93(1):9–14. [2] Menken J, Trussell J, Larsen U. Age and infertility. Science 1986;233(4771): 1389–94.
[3] Centers for Disease Control and Prevention, American Society for Reproductive Medicine, Society for Assisted Reproductive Technology, RESOLVE. 1999 Assisted Reproductive Technology Success Rates. Atlanta, GA: Centers for Disease Control and Prevention; 2001.
0020-7292/$ – see front matter © 2009 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijgo.2009.10.020
Laparoendoscopic single-site surgery for total hysterectomy Francesco Fanfani ⁎, Anna Fagotti, Giovanni Scambia Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Catholic University of the Sacred Heart, Rome, Italy
a r t i c l e
i n f o
Article history: Received 22 September 2009 Received in revised form 16 October 2009 Accepted 5 November 2009 Keywords: Hysterectomy Laparoscopy Laparoendoscopic single-site surgery (LESS) Single-port access
Single-access laparoscopic procedures, such as laparoendoscopic single-site surgery (LESS) and natural orifice transluminal endoscopic surgery (NOTES), are new techniques for less invasive surgical procedures. Our experience with LESS for surgical management of benign adnexal diseases showed encouraging results for complication rate, postoperative pain, duration of hospitalization, and cosmetic appearance [1]. Other authors have also demonstrated the feasibility of this approach to perform laparoscopic-assisted vaginal hysterectomy [2] and LESS hysterectomy using an additional 5-mm ancillary trocar [3].
⁎ Corresponding author. Department of Obstetrics and Gynecology, Catholic University, L.go A. Gemelli 8, 00168, Rome, Italy. Tel.: +39 0635508736. E-mail address: [email protected] (F. Fanfani).
We describe a LESS procedure used to perform total hysterectomy in a 42-year-old nulliparous woman for an atypical glandular endometrial hyperplasia. The procedure was performed via a multi-channel single trocar (Olympus Winter & IBE GMBH, Hamburg, Germany) inserted into the umbilicus through an open access cutaneous incision of approximately 1.5–2 cm. Standard straight 5-mm instruments, such as graspers, cold scissors, suction/irrigation instruments, and a multifunctional device that grasps, coagulates, and transects simultaneously (PKS Cutting Forceps; Gyrus ACMI, Hamburg, Germany) were inserted into the remaining 2 ports. A combination of one standard 33-cm-long instrument with a 43-cm-long instrument plus a 5-mm 30° laparoscope was used to prevent clashing between the instruments and the surgeon's hands. Changes in the position of the instruments and the optic were made according to the needs of the surgeon. An intrauterine manipulator was positioned. After coagulation and section of the round ligament had been performed to permit entry to the retroperitoneal space, the ureter was visualized and a hemostatic clip was positioned at the origin of the uterine artery (Fig. 1). An adequate margin of the vagina was ensured before colpectomy was performed using a bipolar hook. The vaginal vault was closed using an extracorporeal knotting technique. No vascular or visceral injuries, loss of pneumoperitoneum, or intraoperative port-site bleeding occurred. Operative time was 120 minutes with an estimated blood loss of 20 mL. There was no wound hematoma, wound infection, or delayed bleeding postoperatively. The patient reported complete satisfaction with the cosmetic appearance and postoperative pain control. She was discharged home the day after the procedure with only optional analgesic therapy, and no early (within 30 days) postoperative complications were reported.
BRIEF COMMUNICATIONS
77
Conflict of interest The authors declare that there are no conflicts of interest. References [1] Fagotti A, Fanfani F, Marocco F, Rossitto C, Gallotta V, Scambia G. Laparoendoscopic single-site surgery (LESS) for ovarian cyst enucleation: report of first 3 cases. Fertil Steril 2009;92(3):1168.e13-6. [2] Lee YY, Kim TJ, Kim CJ, Kang H, Choi CH, Lee JW, et al. Single-port access laparoscopicassisted vaginal hysterectomy: a novel method with a wound retractor and a glove. J Minim Invasive Gynecol 2009;16(4):450–3. [3] Fader AN, Escobar PF. Laparoendoscopic single-site surgery (LESS) in gynecologic oncology: Technique and initial report. Gynecol Oncol 2009;114(2):157–61.
Fig. 1. Laparoendoscopic single-site surgery (LESS): (A) internal view; (B) external view. After coagulation and section of the right round ligament to permit entry to the retroperitoneal space, the ureter (U) was visualized and a hemostatic clip was positioned at the origin of the uterine artery (UA).
The present case highlights the feasibility of LESS for total hysterectomy. Larger prospective studies are needed to confirm these results and to compare the procedure with conventional multi-access laparoscopic procedures.
0020-7292/$ – see front matter © 2009 Published by Elsevier Ireland Ltd. on behalf of International Federation of Gynecology and Obstetrics. doi:10.1016/j.ijgo.2009.10.010