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Multi-Institution, Prospective Randomized Trial for Efficacy and Safety of Single Incision Laparoscopic Surgery (SILS) Versus Conventional Laparoscopic Hysterectomy for the Treatment of Uterine Myoma or Adenomyosis
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Abstracts / Journal of Minimally Invasive Gynecology 20 (2013) S50–S94 Video Session 8dLaparoscopy (3:03 PMd3:11 PM)
Strategies to Minimize Blood Loss during a Myomectomy Soto E, Uy-Kroh MJ, Falcone T. Obstetrics, Gynecology and Women’s Health, Cleveland Clinic, Cleveland, Ohio Myomectomy is common gynecologic procedure performed for the conservative management of leiomyomas. The surgical removal of myomas can be associated with a considerable amount of intra-operative blood loss, which represents an important morbidity that may be associated with the procedure. The purpose of this video presentation is to demonstrate various preoperative and intraoperative measures that may decrease blood loss during a myomectomy. A particular emphasis was placed on demonstrating the evidence-based strategies that have been shown to decrease blood loss in minimally-invasive abdominal myomectomies. The strategies that are covered in this video presentation include the preoperative use of medications, temporary and permanent uterine artery occlusion, injection of vasopressin and use of barbed suture for closure of the uterine defect.
278
Open Communications 16dHysterectomy (3:20 PMd3:25 PM)
Multi-Institution, Prospective Randomized Trial for Efficacy and Safety of Single Incision Laparoscopic Surgery (SILS) Versus Conventional Laparoscopic Hysterectomy for the Treatment of Uterine Myoma or Adenomyosis Kim T-J,1 Cho C-H,2 Kwon SH,2 Sung SJ,3 Hur S,4 Kim Y-M,5 Lee S-W,5 Kim YT,6 Nam EJ,6 Kim YB,7 Lee JR,7 Roh H-J.8 1Samsung Medical Center, Sungkyunkwan Univ. School of Medicine, Seoul, Korea; 2Dongsan Hospital, Keimyung University, Daegu, Korea; 3CHA Gangnam Medical Center, Seoul, Korea; 4Seoul St. Mary’s Hospital, Seoul, Korea; 5Asan Medical Center, Seoul, Korea; 6Severance Medical Center, Seoul, Korea; 7 Seoul National University Bundang Hospital, Seongnam, Gyunggido, Korea; 8Ulsan University Hospital, Ulsan, Korea Study Objective: A prospective, randomized, multi-center, controlled trialTo compare the operative outcomes of patients undergoing either SILS-port or conventional multiport laparoscopic hysterectomy (LH).The primary outcome is success rate of the planned procedure.The secondary outcomes are postoperative pain measured by numeric rating score and operative scar measured by patient and observer scar assessment scale (POSAS). Design: A prospective, randomized, multi-center, controlled trial. Setting: Eight tertiary teaching hospitals. Patients: Two hundred fifty-six women who were planning laparoscopic hysterectomy for presumed myomas and/or adenomyosis. Intervention: SILS port LH regardless of LAVH or TLH versus 3 or 4 multi-port approach. Measurements and Main Results: The primary outcome is success rate of the planned procedure to demonstrate whether success rate of SILS port LH is not inferior to that of conventional multi- port approach performed by multi-institutional, several surgeons.The secondary outcomes are postoperative pain measured by numeric rating score on postoperative 1 day and 1 week and operative scar measured by patient and observer scar assessment scale (POSAS) on postoperative 1 week and 2 months. Of the 128 women assigned to SILS port surgery, 5 were converted to multi-port surgery due to severe adhesions. However, there is no conversion to open laparotomy.The two surgery groups did not differ in terms of clinical demographics and surgical results, as well as postoperative pain scores.The SILS port group reported significantly lower POSAS at 1 week and 2 months post-surgery compared to that of the multi-port group. Conclusion: SILS port surgery is not only a feasible approach with comparable operative outcomes demonstrated by multi-institutional several surgeons but also has an advantage with cosmetic outcomes compared to multi-port surgery.
279
Open Communications 16dHysterectomy (3:26 PMd3:31 PM)
The Study on Postoperative Pain after Total Laparoscopic and Vaginal Hysterectomy for Benign Gynecologic Disease Kim H. OB & Gy, Kangnam Sacread Heart Hospital Hallym University, Seoul, Korea Study Objective: To evaluate postoperative pain of total laparoscopic hysterectomy (TLH) compared with vaginal hysterectomy (VH). Design: Non-randomized, prospective analysis of 122 patients who performed hysterectomy for benign gynecological disease. Setting: Kangnam Sacred Heart Hospital, Hallym University, Seoul, Korea. Patients: From June 2010 to August 2010, 122 patients were enrolled, of whom 56 underwent total laparoscopic hysterectomy(TLH) and 66 underwent vaginal hysterectomy(VH) for benign disease. Intervention: laparoscopic and vaginal hysterectomy. Measurements and Main Results: Postoperative pain degree was compared and preoperative, intraoperative, postoperative characteristics were considered. Postoperative pain was measured using the visual analog scale (VAS) score at 1-hour, 1-day, 3-day postoperative periods and the additional consumption of analgesic units(vials and tablets) required by patients for pain relief at all hospital stay. For the first 3 postoperative days, the median total consumption of analgesics was considerably lower in the TLH group than in the VH group(pethidine, P\0.05; non-steroidal anti-inflammatory drug(NSAIDs) (Ketorolac Tromethamine), P\0.05). The VAS score also was higher for the VH group than in the TLH group(VAS 1- hour, P\0.05; VAS 1-day, P\0.05; VAS 3-day, P\0.05). No significant difference was found between groups in respect to preoperative, intraoperative and postoperative characteristics except operation time, prior intra-abdominal surgery and pelvic adhesion. Conclusion: Since TLH is a less painful procedure in comparison to VH, TLH may be a good alternative to VH for the benign gynecologic diseases with expert surgeons. 280
Open Communications 16dHysterectomy (3:32 PMd3:37 PM)
Safety of Laparoscopically Assisted Vaginal Hysterectomy for Women with Anterior Wall Adherence after Cesarean Section Ko JH,1 Choi JS,1 Kim KT,1 Bae J,1 Lee WM,1 Koh AR,1 Lee JH,2 Kim JY,2 Hong JH.3 1Obstetrics and Gynecology, Hanyang University College of Medicine, Seoul, Republic of Korea; 2Obstetrics and Gynecology, Kangbuk Samsung Hospital, Seoul, Republic of Korea; 3Obstetrics and Gynecology, Guro Hospital, College of Medicine, Korean Univeristy, Seoul, Republic of Korea Study Objective: To evaluate the safety and surgical outcomes of laparoscopically assisted vaginal hysterectomy (LAVH) for women with anterior wall adherence after Cesarean section. Design: Retrospective clinical study (Canadian Task Force classification III). Setting: University teaching hospital. Patients: Two hundred eighty eight women. Intervention: LAVH with adhesiolysis. Measurements and Main Results: We analyzed a retrospective chart review of two hundred eighty-eight women who had prior Caesarean section history who underwent LAVH from March 2003 to March 2012, selected from a total of 1,967 women who underwent LAVH during that period. We divided the women into Group A, with anterior wall adherence, and Group B, without adherence. There were significant differences of age, number of Cesarean section, and operating time between Group A and B. There were no significant differences of BMI, specimen weight, hemoglobin change, and hospital between two groups. Especially, there was no difference the incidence of anterior wall adherence based on the abdominal skin incision types, Pfannenstiel and low midline incision. There were two intraoperative complications, bladder lacerations, which was repaired laparoscopically. There was no conversion to abdominal hysterectomy.
Abstracts / Journal of Minimally Invasive Gynecology 20 (2013) S50–S94 Video Session 8dLaparoscopy (3:03 PMd3:11 PM)
Strategies to Minimize Blood Loss during a Myomectomy Soto E, Uy-Kroh MJ, Falcone T. Obstetrics, Gynecology and Women’s Health, Cleveland Clinic, Cleveland, Ohio Myomectomy is common gynecologic procedure performed for the conservative management of leiomyomas. The surgical removal of myomas can be associated with a considerable amount of intra-operative blood loss, which represents an important morbidity that may be associated with the procedure. The purpose of this video presentation is to demonstrate various preoperative and intraoperative measures that may decrease blood loss during a myomectomy. A particular emphasis was placed on demonstrating the evidence-based strategies that have been shown to decrease blood loss in minimally-invasive abdominal myomectomies. The strategies that are covered in this video presentation include the preoperative use of medications, temporary and permanent uterine artery occlusion, injection of vasopressin and use of barbed suture for closure of the uterine defect.
278
Open Communications 16dHysterectomy (3:20 PMd3:25 PM)
Multi-Institution, Prospective Randomized Trial for Efficacy and Safety of Single Incision Laparoscopic Surgery (SILS) Versus Conventional Laparoscopic Hysterectomy for the Treatment of Uterine Myoma or Adenomyosis Kim T-J,1 Cho C-H,2 Kwon SH,2 Sung SJ,3 Hur S,4 Kim Y-M,5 Lee S-W,5 Kim YT,6 Nam EJ,6 Kim YB,7 Lee JR,7 Roh H-J.8 1Samsung Medical Center, Sungkyunkwan Univ. School of Medicine, Seoul, Korea; 2Dongsan Hospital, Keimyung University, Daegu, Korea; 3CHA Gangnam Medical Center, Seoul, Korea; 4Seoul St. Mary’s Hospital, Seoul, Korea; 5Asan Medical Center, Seoul, Korea; 6Severance Medical Center, Seoul, Korea; 7 Seoul National University Bundang Hospital, Seongnam, Gyunggido, Korea; 8Ulsan University Hospital, Ulsan, Korea Study Objective: A prospective, randomized, multi-center, controlled trialTo compare the operative outcomes of patients undergoing either SILS-port or conventional multiport laparoscopic hysterectomy (LH).The primary outcome is success rate of the planned procedure.The secondary outcomes are postoperative pain measured by numeric rating score and operative scar measured by patient and observer scar assessment scale (POSAS). Design: A prospective, randomized, multi-center, controlled trial. Setting: Eight tertiary teaching hospitals. Patients: Two hundred fifty-six women who were planning laparoscopic hysterectomy for presumed myomas and/or adenomyosis. Intervention: SILS port LH regardless of LAVH or TLH versus 3 or 4 multi-port approach. Measurements and Main Results: The primary outcome is success rate of the planned procedure to demonstrate whether success rate of SILS port LH is not inferior to that of conventional multi- port approach performed by multi-institutional, several surgeons.The secondary outcomes are postoperative pain measured by numeric rating score on postoperative 1 day and 1 week and operative scar measured by patient and observer scar assessment scale (POSAS) on postoperative 1 week and 2 months. Of the 128 women assigned to SILS port surgery, 5 were converted to multi-port surgery due to severe adhesions. However, there is no conversion to open laparotomy.The two surgery groups did not differ in terms of clinical demographics and surgical results, as well as postoperative pain scores.The SILS port group reported significantly lower POSAS at 1 week and 2 months post-surgery compared to that of the multi-port group. Conclusion: SILS port surgery is not only a feasible approach with comparable operative outcomes demonstrated by multi-institutional several surgeons but also has an advantage with cosmetic outcomes compared to multi-port surgery.
279
Open Communications 16dHysterectomy (3:26 PMd3:31 PM)
The Study on Postoperative Pain after Total Laparoscopic and Vaginal Hysterectomy for Benign Gynecologic Disease Kim H. OB & Gy, Kangnam Sacread Heart Hospital Hallym University, Seoul, Korea Study Objective: To evaluate postoperative pain of total laparoscopic hysterectomy (TLH) compared with vaginal hysterectomy (VH). Design: Non-randomized, prospective analysis of 122 patients who performed hysterectomy for benign gynecological disease. Setting: Kangnam Sacred Heart Hospital, Hallym University, Seoul, Korea. Patients: From June 2010 to August 2010, 122 patients were enrolled, of whom 56 underwent total laparoscopic hysterectomy(TLH) and 66 underwent vaginal hysterectomy(VH) for benign disease. Intervention: laparoscopic and vaginal hysterectomy. Measurements and Main Results: Postoperative pain degree was compared and preoperative, intraoperative, postoperative characteristics were considered. Postoperative pain was measured using the visual analog scale (VAS) score at 1-hour, 1-day, 3-day postoperative periods and the additional consumption of analgesic units(vials and tablets) required by patients for pain relief at all hospital stay. For the first 3 postoperative days, the median total consumption of analgesics was considerably lower in the TLH group than in the VH group(pethidine, P\0.05; non-steroidal anti-inflammatory drug(NSAIDs) (Ketorolac Tromethamine), P\0.05). The VAS score also was higher for the VH group than in the TLH group(VAS 1- hour, P\0.05; VAS 1-day, P\0.05; VAS 3-day, P\0.05). No significant difference was found between groups in respect to preoperative, intraoperative and postoperative characteristics except operation time, prior intra-abdominal surgery and pelvic adhesion. Conclusion: Since TLH is a less painful procedure in comparison to VH, TLH may be a good alternative to VH for the benign gynecologic diseases with expert surgeons. 280
Open Communications 16dHysterectomy (3:32 PMd3:37 PM)
Safety of Laparoscopically Assisted Vaginal Hysterectomy for Women with Anterior Wall Adherence after Cesarean Section Ko JH,1 Choi JS,1 Kim KT,1 Bae J,1 Lee WM,1 Koh AR,1 Lee JH,2 Kim JY,2 Hong JH.3 1Obstetrics and Gynecology, Hanyang University College of Medicine, Seoul, Republic of Korea; 2Obstetrics and Gynecology, Kangbuk Samsung Hospital, Seoul, Republic of Korea; 3Obstetrics and Gynecology, Guro Hospital, College of Medicine, Korean Univeristy, Seoul, Republic of Korea Study Objective: To evaluate the safety and surgical outcomes of laparoscopically assisted vaginal hysterectomy (LAVH) for women with anterior wall adherence after Cesarean section. Design: Retrospective clinical study (Canadian Task Force classification III). Setting: University teaching hospital. Patients: Two hundred eighty eight women. Intervention: LAVH with adhesiolysis. Measurements and Main Results: We analyzed a retrospective chart review of two hundred eighty-eight women who had prior Caesarean section history who underwent LAVH from March 2003 to March 2012, selected from a total of 1,967 women who underwent LAVH during that period. We divided the women into Group A, with anterior wall adherence, and Group B, without adherence. There were significant differences of age, number of Cesarean section, and operating time between Group A and B. There were no significant differences of BMI, specimen weight, hemoglobin change, and hospital between two groups. Especially, there was no difference the incidence of anterior wall adherence based on the abdominal skin incision types, Pfannenstiel and low midline incision. There were two intraoperative complications, bladder lacerations, which was repaired laparoscopically. There was no conversion to abdominal hysterectomy.