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Preemptive analgesia in patients undergoing laparoscopy for benign adnexal diseases
Poster Presentations
176. Preemptive Analgesia in Patients Undergoing Laparoscopy for Benign Adnexal Diseases 1M Buttarelli, 1F Ghezzi, 2L Raio, 1A Cromi, 1p Beretta, 3V Bergamini. 1University of Insubria, Varese, Italy; 2University of Berne, Berne, Switzerland; 3University of Verona, Verona, Italy.
Objective. To assess whether local anesthetic administered before skin incision reduces postoperative pain in women undergoing laparoscopic adnexal surgery for benign diseases. Methods. Twenty patients undergoing laparoscopy for various benign adnexal diseases received local infiltration of ropivacaine (naropin) at the surgical site before incision. The amount of postoperative parenteral narcotics or non-steroidal analgesic administered and the time delay to the first analgesic medication were compared to those of 40 patients previously operated without administration of local anesthetic. Only patients operated using a 10-mm umbilical trocar and two 5-mm suprapubic trocars were included in the study. All surgical specimens were removed through the umbilical trocar using a specimen bag. Results. Demographic characteristics, indications for surgery, and operating time were similar between groups. The proportion of patients who required parenteral narcotics and non steroidal analgesia was significantly lower in the group of patients who received local anesthesia at the time of surgery than those who did not. The time delay to the first analgesic medication was longer in those who received local anesthetic administration than in those who did not. Corzclusiorz. The preemptive administration of ropivacaine before laparoscopy seems to decrease postoperative pain and to increase the time delay to first analgesic medication. Further randomized studies are required to validate these findings.
177. Experience of Minilaparotomy in Gynecologic Benign Condition SH Cha, SY Lee. Sungnam Bundang, Kyounggido, Korea.
Objective. We described our experience of minilaparotomy using a self retaining abdominal retractor as alternative to conventional laparotomy. Desigrz. Retrospective analysis of 78 cases of minilaparotomy. Settirzg. Department of obstetric and gynecology, teaching hospital, medical university Patierzts. Seventy-eight patients who underwent minilaparotomy from Feb 2002 to March 2003. There were 41 patients with myoma, 7 adenomyosis, 18 tubal obstruction and 7 with ovarian cysts. lrzterverztiorz. Minilaparotomy using self-retaining abdominal retractor, rotractor (Dexterity Surgical. Inc., USA). Measuremerzts arzd Mairz Results. Minilaparotomy was performed for 30 cases of hysterectomy, 23 of myomectomy, 18 of tubal reanastomosis and 7 of ovarian cystectomy. The length of abdominal skin incision was less than 6cm. The mean operating time was 81.3+30.4 min; 102.2+27.6 min for hysterectomy, 70.6+20.1min for myomectomy,
81. l+19.0min for tubal reanastomosis, and 30.3+10.8min for cystectomy. The mean hospital day was 3.3+1.2 days; 3.9+1.3 days for hysterectomy, 3.1+0.9 days for myomectomy, 2.4+0.5 days for tubal reanastomosis and 3.0+1.4 days for cystectomy. One case of wound hematoma was noted, but there were no major post operative complications. Corzclusiorz. Through our experience, self retaining abdominal retractor proved to provide excellent surgical exposure for small wound without any retraction trauma. And the results suggests that minilaparotomy using it is comparable to conventional laparotomy about short operation time & post operation hospital day and few operative complications.
178. Laparoscopic Treatment of Symptomatic Arteriovenous Malformation of the Uterus After Failure of Embolization CH Cho. Keimyung University Hospital, Oaegu, Korea, Republic of China
Objective. To report a case of symptomatic arteriovenous malformation (AVM) of the uterus after failure of embolization that was successfully treatment by laparoscope Desigrz. Case report. Settirzg. University tertiary center hospital. Patierzt. A 40-year-old woman with symptomatic AVM of the uterus after failure of embolization. Irzterverztiorz. Laparoscopic clipping and bipolar coagulation of uterine vessels and ovarian vessels. Measuremerzts. Clinical symptoms, pelvic magnetic resonance imaging, and color Doppler sonographic examination Results. Remarkable shrinkage of the lesion size and freedom from symptoms. Corzclusiorzs. This modality is an alternative method for the management of patients with symptomatic AVM of the uterus who do not respond to conservative treatment.
179. Laparoscopic Appearance of a Benign Struma Ovari CF Coria, R Assayas. San Juan, San Juan, Argentina.
Objective. To show macroscopic and microscopic aspects of a benign Struma Ovarii as seen during laparoscopy in order to help the gynecologist to recognize this rare tumor during surgery. Desigrz. Our literature search did not find any laparoscopic images of a benign pure, functional struma ovarii. We report here the operative macroscopic view and their histology of a tumor made up entirely of thyroid tissue. Uneventful three years follow-up. Settirzg. Gynecologic-Reproductive Medicine Institute in Western Argentina. Patierzts. A 20 year old female consulted for oligodysmenorrhea. Normal H/P & hormonal studies but the ultrasound reported a non simple left ovarian cyst 41 x 35 x 37 mm with an echogenic mural component. No response to O.C.
$58
176. Preemptive Analgesia in Patients Undergoing Laparoscopy for Benign Adnexal Diseases 1M Buttarelli, 1F Ghezzi, 2L Raio, 1A Cromi, 1p Beretta, 3V Bergamini. 1University of Insubria, Varese, Italy; 2University of Berne, Berne, Switzerland; 3University of Verona, Verona, Italy.
Objective. To assess whether local anesthetic administered before skin incision reduces postoperative pain in women undergoing laparoscopic adnexal surgery for benign diseases. Methods. Twenty patients undergoing laparoscopy for various benign adnexal diseases received local infiltration of ropivacaine (naropin) at the surgical site before incision. The amount of postoperative parenteral narcotics or non-steroidal analgesic administered and the time delay to the first analgesic medication were compared to those of 40 patients previously operated without administration of local anesthetic. Only patients operated using a 10-mm umbilical trocar and two 5-mm suprapubic trocars were included in the study. All surgical specimens were removed through the umbilical trocar using a specimen bag. Results. Demographic characteristics, indications for surgery, and operating time were similar between groups. The proportion of patients who required parenteral narcotics and non steroidal analgesia was significantly lower in the group of patients who received local anesthesia at the time of surgery than those who did not. The time delay to the first analgesic medication was longer in those who received local anesthetic administration than in those who did not. Corzclusiorz. The preemptive administration of ropivacaine before laparoscopy seems to decrease postoperative pain and to increase the time delay to first analgesic medication. Further randomized studies are required to validate these findings.
177. Experience of Minilaparotomy in Gynecologic Benign Condition SH Cha, SY Lee. Sungnam Bundang, Kyounggido, Korea.
Objective. We described our experience of minilaparotomy using a self retaining abdominal retractor as alternative to conventional laparotomy. Desigrz. Retrospective analysis of 78 cases of minilaparotomy. Settirzg. Department of obstetric and gynecology, teaching hospital, medical university Patierzts. Seventy-eight patients who underwent minilaparotomy from Feb 2002 to March 2003. There were 41 patients with myoma, 7 adenomyosis, 18 tubal obstruction and 7 with ovarian cysts. lrzterverztiorz. Minilaparotomy using self-retaining abdominal retractor, rotractor (Dexterity Surgical. Inc., USA). Measuremerzts arzd Mairz Results. Minilaparotomy was performed for 30 cases of hysterectomy, 23 of myomectomy, 18 of tubal reanastomosis and 7 of ovarian cystectomy. The length of abdominal skin incision was less than 6cm. The mean operating time was 81.3+30.4 min; 102.2+27.6 min for hysterectomy, 70.6+20.1min for myomectomy,
81. l+19.0min for tubal reanastomosis, and 30.3+10.8min for cystectomy. The mean hospital day was 3.3+1.2 days; 3.9+1.3 days for hysterectomy, 3.1+0.9 days for myomectomy, 2.4+0.5 days for tubal reanastomosis and 3.0+1.4 days for cystectomy. One case of wound hematoma was noted, but there were no major post operative complications. Corzclusiorz. Through our experience, self retaining abdominal retractor proved to provide excellent surgical exposure for small wound without any retraction trauma. And the results suggests that minilaparotomy using it is comparable to conventional laparotomy about short operation time & post operation hospital day and few operative complications.
178. Laparoscopic Treatment of Symptomatic Arteriovenous Malformation of the Uterus After Failure of Embolization CH Cho. Keimyung University Hospital, Oaegu, Korea, Republic of China
Objective. To report a case of symptomatic arteriovenous malformation (AVM) of the uterus after failure of embolization that was successfully treatment by laparoscope Desigrz. Case report. Settirzg. University tertiary center hospital. Patierzt. A 40-year-old woman with symptomatic AVM of the uterus after failure of embolization. Irzterverztiorz. Laparoscopic clipping and bipolar coagulation of uterine vessels and ovarian vessels. Measuremerzts. Clinical symptoms, pelvic magnetic resonance imaging, and color Doppler sonographic examination Results. Remarkable shrinkage of the lesion size and freedom from symptoms. Corzclusiorzs. This modality is an alternative method for the management of patients with symptomatic AVM of the uterus who do not respond to conservative treatment.
179. Laparoscopic Appearance of a Benign Struma Ovari CF Coria, R Assayas. San Juan, San Juan, Argentina.
Objective. To show macroscopic and microscopic aspects of a benign Struma Ovarii as seen during laparoscopy in order to help the gynecologist to recognize this rare tumor during surgery. Desigrz. Our literature search did not find any laparoscopic images of a benign pure, functional struma ovarii. We report here the operative macroscopic view and their histology of a tumor made up entirely of thyroid tissue. Uneventful three years follow-up. Settirzg. Gynecologic-Reproductive Medicine Institute in Western Argentina. Patierzts. A 20 year old female consulted for oligodysmenorrhea. Normal H/P & hormonal studies but the ultrasound reported a non simple left ovarian cyst 41 x 35 x 37 mm with an echogenic mural component. No response to O.C.
$58