Ureteral catheter placement for prevention of ureteral injury during laparoscopic hysterectomy

AIM: Ureteral injury is among the most devastating complications of gynecologic surgery. Estimated incidence of ureteral injury during laparoscopic hysterectomy is 2.6-35 times (0.2-6.0%) that in abdominal hysterectomy. We investigated preoperative ureteral catheter (UC) placement as a way to prevent ureteral injury in laparoscopic hysterectomy. METHODS: Clinical records of 94 women who underwent laparoscopic hysterectomy between February 2006 and January 2007 in Yazaki Hospital, Kanagawa, Japan, were reviewed retrospectively. Thirty-four patients between February and June 2006 underwent the surgery without ureteral catheterization and 60 patients between July 2006 and January 2007 underwent surgery with ureteral catheterization. Clinical outcomes were statistically compared between the two groups. RESULTS: The average time required for catheter insertion was 9.35 min. The ureter in which the catheter was placed was visualized clearly. In one patient, whose left ureter was deviated by a massive myoma, catheter insertion was not possible. No complications arose from catheter placement except for minor complaints including low back pain, urinary discomfort, and transient hematuria. While one injury occurred in a patient without ureteral catheterization (1/34), no ureteral injury occurred in any patient with ureteral catheterization (0/60). Operative time, total blood loss, and hospital stay were not significantly different between the two groups. CONCLUSIONS: UC placement is simple, helping to prevent ureteral injury during laparoscopic hysterectomy and enhancing safety of this procedure.     

Definitive diagnosis of primary adenocarcinoma of the appendix by laparoscopic appendectomy

We report a 62-year-old woman with a primary adenocarcinoma of the appendix mimicking ovarian tumor. We had diagnosed it definitively by laparoscopic appendectomy, and additional surgery was required in this case. However, the present case suggests that, in some cases, if cancer of the appendix can be diagnosed early, laparotomy can be avoided and the cancer treated with minimally invasive laparoscopic surgery alone.     

Comparison of the use of electrothermal bipolar vessel sealer with harmonic scalpel in total laparoscopic hysterectomy

AIM: The aim of the present study was to compare the use of electrothermal bipolar vessel sealer (EBVS) with harmonic scalpel (HS) during total laparoscopic hysterectomy with respect to operation time, estimated blood loss and related complications. METHODS: A retrospective study was conducted in the university hospital. Forty patients who underwent total laparoscopic hysterectomy and bilateral salpingo-oophorectomy were enrolled. Nineteen hysterectomies were performed with HS and in 21 patients the same surgeons used EBVS. Data about the characteristics of the patients, operation time, estimated blood loss, uterine weights, related complications and length of hospital stay were registered and compared. RESULTS: Mean procedure time and estimated blood loss were significantly less in the EBVS arm (59.57 +/- 3.71 vs 90.95 +/- 5.73 min, P < 0.001; 87.76 +/- 25.48 vs 152.63 +/- 60.90 mL; P < 0.001, respectively). The change in hemoglobin and hematocrit values was found to be more significant in the HS group. CONCLUSION: EBVS was found to be less time-consuming and caused less bleeding when compared with HS.     

Laparoscopic salpingectomy in tubal pregnancy: prospective randomized trial using endoloop versus electrocautery

AIM: Ectopic pregnancy is conventionally managed by laparoscopic salpingectomy. Electrocautery has been used widely to secure hemostasis during salpingectomy. However, this method is associated with a risk of thermal injury to the visceral organs. Endoloop, a pre-tied suture used in laparoscopic surgery may be an alternative treatment tool and its potential use in the management of ectopic pregnancy is explored here. Our study aims to compare the effectiveness of the endoloop technique to electrocautery during laparoscopic salpingectomy for tubal pregnancy. METHODS: A prospective randomized controlled study was conducted over 24 months at the Hospital Universiti Kebangsaan Malaysia. One hundred and two patients with tubal pregnancy were randomized into two treatment groups: those treated with endoloop and those treated with electrocautery during laparoscopic salpingectomy. RESULTS: The use of an endoloop was associated with a shorter operating time (48.85 min +/- 21.019 vs 61.14 min +/- 22.603, 95% CI -20.864 to -3.724), lower visual analog scores for postoperative pain at day 1 (2.02 +/- 0.960 vs 2.74 +/- 0.828, 95% CI -1.074 to -0.368) and day 7 (0.85 +/- 0.802 vs 1.44 +/- 0.837, 95% CI -0.916 to -0.272), and lesser total analgesia required by patients at day 7 after the operation (7.65 +/- 6.119 vs 15.32 +/- 8.326, 95% CI -10.529 to -4.804). There was no significant difference in the ability to secure hemostasis when both techniques were compared. Duration of hospitalization (2.37 days +/- 0.817 vs 2.34 days +/- 0.519, 95% CI -0.245 to -0.296) and interval from operation to discharge were similar. CONCLUSION: The endoloop appeared to be as effective as electrocautery and is a safe alternative to electrocautery for laparoscopic salpingectomy in tubal pregnancy.     

Is laparoscopically assisted radical vaginal hysterectomy for cervical carcinoma safe? A case control study with follow up

Objective  To compare a new surgical approach, laparoscopically assisted radical vaginal hysterectomy (LARVH) with open radical hysterectomy in women with cervical cancer. Can selected women benefit from the minimally invasive approach without compromising safety (recurrence rate) and morbidity (complications)?
Design  Retrospective case control study.
Setting  A tertiary referral unit for gynaecological malignancies.
Population  Thirty women undergoing LARVH were included and compared with 30 women undergoing open radical surgery. The control group was matched for age, body mass index and disease stage.
Methods  Retrospective collection of data from patient files and follow up.
Main outcome measures  Recurrence rate, complication rate, hospital stay, nodal counts, blood loss, operating time.
Results  Recurrence rates were equal (6.7%). There was one death, in the LARVH group. Follow up was mean 31 months in the LARVH group and 30.9 months in the open group. Blood loss as measured by mean drop in haemoglobin was greater in the open group (2.03 versus 3.01 g/dl, P = 0.02). Transfusions were given in 40% of women in the open group and 16.7% in the LARVH group. Hospital stay was significantly less in the LARVH group (5.9 versus 7.8 nights, P = 0.003). Mean operating time was longer in the LARVH group (131 versus 187 minutes P = 0.0001). Mean nodal counts did not differ significantly (17.4 in open vs 14.8 in LARVH, P > 0.05). There were seven perioperative complications in the open group and four in the LARVH group. There have been two recurrences in each group (6.67%) at mean follow up of 31 (LARVH) and 30.9 (open) months.
Conclusions  The first 30 LARVH procedures performed in this unit are comparable in terms of safety (recurrence rate and complication rate) and economic factors (shorter hospital stay mitigating longer operating time). Further development of this technique is warranted.     

Uterine artery embolization should not be recommended without careful consideration in the treatment of symptomatic uterine fibroids

AIM: To evaluate convalescence and the incidence of adverse symptoms associated with uterine artery embolization (UAE) in the treatment of uterine fibroids, several parameters after UAE were compared with those after laparoscopic surgery. METHODS: For the treatment of uterine fibroids, 78 patients underwent UAE and 58 received laparoscopic surgery (31 were laparoscopic myomectomy [LM] and 27 were laparoscopy-assisted myomectomy [LAM]) during the period July 2001 to July 2004. The length of hospitalization, and the periods until the beginning of a normal daily life, work and exercise, long-term follow up data in the UAE and laparoscopy groups were compared, and the incidence of adverse symptoms after each procedure was compared. RESULTS: The length of hospitalization for the UAE group 2.1 +/- 0.1 (mean +/- S.E) was significantly shorter than those for the LM and LAM groups (2.6 +/- 0.1 and 3.8 +/- 0.2 days, respectively; P < 0.0001 and P < 0.0001). The period until beginning of normal daily life and work were similar between the UAE and LM groups. The degree of improved symptoms after each procedure were similar among the three groups, but the incidence of adverse symptoms after UAE was significantly higher than after laparoscopic surgery. CONCLUSIONS: The UAE group showed a significantly shorter period of hospitalization, but the convalescence of the UAE group was similar to the LA group, with a higher incidence of adverse symptoms than laparoscopic surgeries. Therefore, UAE should not be recommended without careful consideration, in the treatment of symptomatic uterine fibroids.     

七氟醚与异氟醚吸入麻醉对腹腔镜胆囊切除术患者麻醉后苏醒及认知功能的影响

目的探讨七氟醚与异氟醚吸入麻醉对腹腔镜胆囊切除术患者麻醉后苏醒及认知功能的影响。方法 100例腹腔镜胆囊切除术患者随机分为观察组与对照组,分别采用七氟醚和异氟醚吸入麻醉。结果观察组自主呼吸恢复时间、睁眼时间、拔管时间和定向力恢复时间均短于对照组（P〈0.05或P〈0.01）,苏醒期躁动发生率低于对照组（χ^25.01,P〈0.05）。两组患者麻醉后MMSE评分均较麻醉前下降（P〈0.05或P〈0.01）。两组T1时MMSE评分均较麻醉前明显降低（P〈0.05或P〈0.01）,且对照组降低幅度较观察组更明显（P〈0.05）;对照组T2时MMSE评分较T0时及观察组T2时均明显降低（P〈0.05）,两组T3时MMSE评分与麻醉前比较差异均无统计学意义（P〉0.05）。两组治疗期间无明显药物不良反应。结论腹腔镜胆囊切除术患者采用七氟醚吸入麻醉具有苏醒更快,睁眼、拔管时间更短,苏醒期躁动发生率低,安全性较好等优点。     

经脐单孔腹腔镜胆囊切除术与传统腹腔镜胆囊切除术的比较研究

目的探讨经脐单孔法腹腔镜胆囊切除术的安全性和可行性。方法将80例需行腹腔镜胆囊切除患者随机单盲分为经脐单孔组和传统三孔法组（各40例）,比较两组手术中转率、手术时间、术中出血量、术后下床活动时间和术后住院时间等指标。采用视觉模拟评分法评估术后切口疼痛程度。结果两组患者术中出血量、切口疼痛程度、术后下床活动时间、术后进食时间、住院时间比较,差异均无统计学意义（P〉0．05）;经脐单孔组手术时间较传统三孔法组显著延长,分别为（62±15．5）min和（34±7．8）min（P〈0．001）。经脐单孔组术后腹部无可视瘢痕。结论经脐单孔法腹腔镜胆囊切除术安全可行,可满足患者术后无可视瘢痕的求。     

阿托品对胆囊切除术心率变异性的影响

目的 观察腹腔镜胆囊切除时心率变异性(HRV)变化及阿托品预防心动过缓时对HRV的影响。方法 21例胆囊切除术病人按术前心电图诊断分为心动过缓组和非心动过缓组,心动过缓病人麻醉诱导前加用阿托品0.5mg,术中监测HRV和心率。结果 两组病人胆囊切除中低频率/高频率(LF/HF)均显著低于术前基础值(P<0.05)。心动过缓组诱导后HF无明显变化,胆囊切除中显著降低(P<0.01);非心动过缓组则显著升高(P<0.01)。结论 胆囊切除术中,心动过缓者预防性使用阿托品可阻止迷走神经兴奋性增加,但并不能恢复植物神经系统的平衡。     

常用静脉麻醉药对腹腔镜胆囊切除术后呕吐的影响

目的观察常用静脉全麻药异丙酚、硫喷妥钠及依托咪酯对腹腔镜胆囊切除术后恶心呕吐的影响。方法将330例行腹腔镜胆囊切除术患者随机分为三组,每组110例,分别以异丙酚2mg/kg、硫喷妥钠5mg/kg、依托咪酯0.4mg/kg诱导麻醉,其他药物及麻醉方式均相同。结果术后0～6h内,异丙酚组恶心呕吐的发生率及平均发生次数明显低于硫喷妥钠组及依托咪酯组(P0.05),硫喷妥钠组与依托咪酯组比较差异无统计学意义(P0.05);术后6～48h的时间段内,三组患者恶心呕吐的发生率及发生次数比较差异无统计学意义(P0.05)。结论异丙酚在腹腔镜胆囊切除术后早期抗呕吐作用明显。