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Porcine model for training in laparoscopic pelvic lymphadenectomy
Abstracts
patients and strictly maintaining criteria for each procedure.
thesia requirements are required for successful procedures.
153. Comparison of Two Methods of Hysterectomy
155. Evaluation of Laparoscopic Insufflation Techniques
NH Park, YB Kiln, CM Lee, JW Kim, YS Song, SH Kim, SY Moon, SB Kang, JY Lee, HP Lee. Seoul National University Hospital, Seoul, Korea.
R Pasic, WM Wolfe, Jr, RL Levine. University of Louisville, Louisville, Kentucky.
Objective. To compare short-term clinical results of LH and TVH. Measurements and Main Results. Of 88 women with indications for hysterectomy other than uterine prolapse or pelvic relaxation, 58 underwent LH and 30 TVH; LH included 40 cases of LAVH and 18 of TLH. Groups did not differ in mean age, parity, uterine weight, previous operations, time to recovery, and length of hospital stay. The LHs required longer operating time, but additional pelvic pathologies, such as adnexal mass, endometriosis, and adhesions, were managed in 15 women. No major complications occurred in either group. Conclusion. Although TVH may be a first choice for hysterectomy, LH has an advantage in detecting and treating additional pelvic pathologies.
Objective. To assess the effectiveness and safety of different insuffiation techniques in laparoscopic surgery. Measurements and Main Results. Standard transumbilical insuffiation technique was used in 2032 patients, 280 of whom had transuterine and 139 left upper quadrant subcostal insuffiation. Direct cannula insertion was used in 219 patients and open laparoscopy in 137. Eight women failed all techniques and required open laparatomy. Conclusion. Left upper quadrant subcostal and transuterine insufflation techniques had fewer failures, especially in obese patients (BMI >30) and would be the preferred methods of insuffiation for these women and those in whom problems establishing pneumoperitoneum are anticipated.
156. Hysteroscopic Management of Menstrual Disorders and Evaluation of the Accuracy of Different Preoperative Diagnostic Tools
154. Porcine Model for Training in Laparoscopic Pelvic Lymphadenectomy NH Park, J Rho, Y Kim, C Lee, SKim, S Moon, S Kang, H Lee. Seoul National University Hospital, Seoul, Korea.
EB Pasqualotto, H Margossian, LD Bradley. Cleveland Clinic Foundation, Cleveland, Ohio.
Objective. To review preoperative diagnoses, complications, and surgical findings in patients treated by operative hysteroscopy, with accuracy of preoperative assessment by TVUS, saline-infusion sonography (SIS), diagnostic hysteroscopy (Hyst), and endometrial biopsy compared with final pathology. Measurements and Main Results. Four hundred women (mean age 50 yrs, range 15-88 yrs) underwent operative hysteroscopy. Main indications were postmenopausal bleeding (160, 40.2%) and AUB (203, 47.7%). Operative findings were endometrial polyps (58.5%), submucosal fibroids (30.3%), and abnormal endometrium (7.3%). Histologic abnormalities of endometrial polyps were detected in 18 (9.2%) patients: complex hyperplasia (12) and atypical hyperplasia (6). One case of leiomyosarcoma was found. The sensitivity of the preoperative assessment tools for fibroids and polyps, respectively, were TVUS 35% and 16.7%, SIS 82.4% and 82.7%, Hyst 91.9% and 88.6%, and
Objective. To develop a porcine animal model for training in advanced laparoscopic surgery, especially pelvic lymphadenectomy. Measurements and Main Results. Female pigs weighing 20 to 25 kg were used. Sedation and anesthesia induction were done with ketamine 250 mg intramuscularly and pentothal 1A intravenously in an ear vein. Pigs were intubated with a 6.5-mm diameter tube and straight laryngoscope. Laparoscopic pelvic lymphadenectomieswere done under general anesthesia with N20-O2-halothane 0.8 L/minute-l.5 L/minute2 vol %. Tidal volume was 200 ml, respiratory rate was 20/minute. Porcine pelvic anatomy was identified, and four laparoscopic pelvic lymphadenectomies were done successfully. Conclusion. Porcine model can be used for training in advanced laparoscopic surgery and endoscopic research. Understanding the pig's anatomy and anes-
$44
patients and strictly maintaining criteria for each procedure.
thesia requirements are required for successful procedures.
153. Comparison of Two Methods of Hysterectomy
155. Evaluation of Laparoscopic Insufflation Techniques
NH Park, YB Kiln, CM Lee, JW Kim, YS Song, SH Kim, SY Moon, SB Kang, JY Lee, HP Lee. Seoul National University Hospital, Seoul, Korea.
R Pasic, WM Wolfe, Jr, RL Levine. University of Louisville, Louisville, Kentucky.
Objective. To compare short-term clinical results of LH and TVH. Measurements and Main Results. Of 88 women with indications for hysterectomy other than uterine prolapse or pelvic relaxation, 58 underwent LH and 30 TVH; LH included 40 cases of LAVH and 18 of TLH. Groups did not differ in mean age, parity, uterine weight, previous operations, time to recovery, and length of hospital stay. The LHs required longer operating time, but additional pelvic pathologies, such as adnexal mass, endometriosis, and adhesions, were managed in 15 women. No major complications occurred in either group. Conclusion. Although TVH may be a first choice for hysterectomy, LH has an advantage in detecting and treating additional pelvic pathologies.
Objective. To assess the effectiveness and safety of different insuffiation techniques in laparoscopic surgery. Measurements and Main Results. Standard transumbilical insuffiation technique was used in 2032 patients, 280 of whom had transuterine and 139 left upper quadrant subcostal insuffiation. Direct cannula insertion was used in 219 patients and open laparoscopy in 137. Eight women failed all techniques and required open laparatomy. Conclusion. Left upper quadrant subcostal and transuterine insufflation techniques had fewer failures, especially in obese patients (BMI >30) and would be the preferred methods of insuffiation for these women and those in whom problems establishing pneumoperitoneum are anticipated.
156. Hysteroscopic Management of Menstrual Disorders and Evaluation of the Accuracy of Different Preoperative Diagnostic Tools
154. Porcine Model for Training in Laparoscopic Pelvic Lymphadenectomy NH Park, J Rho, Y Kim, C Lee, SKim, S Moon, S Kang, H Lee. Seoul National University Hospital, Seoul, Korea.
EB Pasqualotto, H Margossian, LD Bradley. Cleveland Clinic Foundation, Cleveland, Ohio.
Objective. To review preoperative diagnoses, complications, and surgical findings in patients treated by operative hysteroscopy, with accuracy of preoperative assessment by TVUS, saline-infusion sonography (SIS), diagnostic hysteroscopy (Hyst), and endometrial biopsy compared with final pathology. Measurements and Main Results. Four hundred women (mean age 50 yrs, range 15-88 yrs) underwent operative hysteroscopy. Main indications were postmenopausal bleeding (160, 40.2%) and AUB (203, 47.7%). Operative findings were endometrial polyps (58.5%), submucosal fibroids (30.3%), and abnormal endometrium (7.3%). Histologic abnormalities of endometrial polyps were detected in 18 (9.2%) patients: complex hyperplasia (12) and atypical hyperplasia (6). One case of leiomyosarcoma was found. The sensitivity of the preoperative assessment tools for fibroids and polyps, respectively, were TVUS 35% and 16.7%, SIS 82.4% and 82.7%, Hyst 91.9% and 88.6%, and
Objective. To develop a porcine animal model for training in advanced laparoscopic surgery, especially pelvic lymphadenectomy. Measurements and Main Results. Female pigs weighing 20 to 25 kg were used. Sedation and anesthesia induction were done with ketamine 250 mg intramuscularly and pentothal 1A intravenously in an ear vein. Pigs were intubated with a 6.5-mm diameter tube and straight laryngoscope. Laparoscopic pelvic lymphadenectomieswere done under general anesthesia with N20-O2-halothane 0.8 L/minute-l.5 L/minute2 vol %. Tidal volume was 200 ml, respiratory rate was 20/minute. Porcine pelvic anatomy was identified, and four laparoscopic pelvic lymphadenectomies were done successfully. Conclusion. Porcine model can be used for training in advanced laparoscopic surgery and endoscopic research. Understanding the pig's anatomy and anes-
$44