Minilaparotomy-assisted vaginal hysterectomy.

OBJECTIVES: To determine the feasibility and acceptability of minilaparotomy-assisted vaginal hysterectomy. METHODS: A prospective pilot study in a general hospital was conducted. Twenty patients who were on the waiting list for abdominal hysterectomy were included in the study. All these patients had one or more relative contraindications to vaginal hysterectomy. The hysterectomy procedure was started vaginally in all cases. A minilaparotomy incision was performed to complete the procedure if vaginal hysterectomy was not feasible. Results were analyzed on the intention to treat basis. RESULTS: The procedure was successfully completed as intended in 19/20 patients (95%). Six patients had the procedure completed vaginally (30%). Thirteen patients had the procedure completed with minilaparotomy assistance (65%). The mean operative time was 63+/-24.8 min (+/-S.D.). The median estimated blood loss was 155 ml (range: 20-800). One bladder injury occurred. The overall post-operative complication rate was 35% (7/20). This included urinary retention necessitating catheterization for 24 h (n=3), urinary infection (n=2), vaginal infection (n=1) and wound hematoma (n=1). The mean post-operative pain score on a scale from 1 to 10 was 3.1. The overall patient satisfaction based on a scale from 1 to 10 was 9.23 (range: 8-10). CONCLUSIONS: Minilaparotomy-assisted vaginal hysterectomy is a feasible and safe procedure. Our results suggest that this approach is potentially useful in increasing the proportion of hysterectomies performed vaginally.     

应用小切口方法根治直肠癌

目的:比较小切口方法和传统的直切口方法行直肠癌根治术的预后.方法:从2001年4月至2002年12月对78例直肠癌患者用小切口方法行直肠癌根治术.切口从髂前上嵴与耻骨联合的连线上方2 cm处作一7～10 cm的切口.同一时期有86例按传统的直切口方法行直肠癌根治术,并将其作为对照组.结果:78例患者通过小切口全部成功地行直肠癌根治术;两组患者的一般情况、手术类型、肿瘤的组织类型无显著差别(P>0.05),然而,小切口组的切口长度明显比传统组短(9.38 vs 17.32),小切口组的手术时间、所需止痛药时间、术后第一次排气时间和开始进流质时间,以及术后住院时间均显著性比对照组要短(P<0.05).平均随访25.4个月,未发现肿瘤复发.结论:小切口方法可作为直肠癌根治术的较好选择.     

两种术式治疗老年胆囊结石的效果比较

目的 观察小切口胆囊切除术（MC）与腹腔镜胆囊切除术（LC）治疗老年胆囊结石的临床效果,探讨治疗老年胆囊结石的最佳术式.方法 老年胆囊结石患者798例,采用小切口胆囊切除术治疗的412例为MC组,采用腹腔镜胆囊切除术治疗的386例为LC组,比较两组患者术中、术后及并发症的相关情况.结果 两组在切口长度、手术时间、术中出血量、下床时间、住院时间方面差异均无统计学意义（均P＞0.05）,在治疗费用、术后并发症方面差异均有统计学意义（均P＜0.05）.结论 小切口胆囊切除术适于老年胆囊结石患者治疗,具有治疗费用少、术后并发症发生率低的优点.     

65例胆囊管结石行小切口胆囊切除术的体会

目的探讨胆囊管结石的诊断及行小切口胆囊切除术的技巧。方法回顾性分析65例胆囊管结石行小切口胆囊切除术的临床资料。结果65例全部治愈,无胆管损伤、出血等严重并发症发生。随访1个月～7年,恢复良好。结论重视胆囊管结石的诊断,掌握小切口胆囊切除术的手术技巧,小切口胆囊切除术治疗胆囊管结石是一种安全、有效的手术方式。     

Hybrid laparoscopic flexure takedown and open procedure for rectal resection is associated with significantly shorter length of stay than equivalent open resection

PURPOSE: Laparoscopic-assisted, sphincter-saving resection (largest incision <7 cm) of the middle and distal rectum is technically very difficult and, with regard to cancers, has not been demonstrated to be oncologically safe. The hypothesis of this retrospective study is that a hybrid operation that combines laparoscopic and open methods would be associated with short-term outcome benefits compared with open surgery results for patients undergoing sphincter-saving proctectomy. METHODS: A total of 31 hybrid and 25 fully open rectal resection patients were compared in this retrospective review. All patients had splenic flexure takedown and rectal anastomosis. The hybrid approach consisted of laparoscopic splenic flexure takedown (with or without partial rectal mobilization and devascularization) followed by completion of the procedurevia infraumbilical midline laparotomy. The indication was neoplasm in 87 percent of hybrid patients and in 68 percent of open patients. The majority of tumors were located between 4 and 10 cm from the dentate line. RESULTS: Fifty-eight percent of hybrid and 68 percent of open patients had low anterior or coloanal resections, and 48 percent of hybrid and 64 percent of open patients underwent temporary diversionvia ileostomy. The mean hybrid midline incision length was 11 cm compared with 24 cm for open patients (P <0.0001). The neoplastic specimens were similar with regard to margins and lymph node harvest. Similar complication rates were noted in both groups. Nonsignificant benefits for hybrid patients (0.9–1.2 days) were seen with regard to length of time until toleration of liquid or solid diet and first flatus. Hybrid patients experienced their first bowel movements 4.1 daysvs. 5.7 days for the open group (P=0.03). Mean length of stay was significantly shorter for hybrid patients (6.1. days) than for open patients (11.1 days;P=0.0006). CONCLUSION: This preliminary retrospective study suggests that a combined hybrid laparoscopic and open approach to sphincter-saving proctectomy permits a similar resection as open methods and may be associated with a length-of-stay benefit and more rapid return of bowel function. Prospective studies will be needed before any firm conclusions can be drawn.Presented at the meeting of the American Society of Colon and Rectal Surgeons, Boston, Massachusetts, June 24 to 29, 2000.     

Is Lactation A Risk Factor of IUD- and Sterilization-related Uterine Perforation? - A Hypothesis

A recent article reported a high risk of IUD-related uterine perforation in lactating women in the U.S. This article prompted the authors to examine the large international datasets on IUDs and tubal sterilizations collected by Family Health International. The findings are somewhat suggestive of such a positive association in IUD users as well as in women undergoing laparoscopic or minilaparotomy sterilization. More definitive studies are urged.     

小切口胆囊切除术640例临床分析

目的:为了探讨小切口胆囊切除术的优点。方法:本文作者对640例小切口胆囊切除术进行临床分析,将小切口胆囊切除术(OC)、传统胆囊切除术(MC)、腹腔镜胆囊切除术(LC)进行扼要比较。结果:在"传统胆囊切除术"熟练基础上开展"小切口胆囊切除术"是安全可行的。结论:该术式具有创伤小、痛苦轻、恢复快、瘢痕小、安全性高、并发症少、具有临床推广的价值。     

The Suprapubic Cruciate Incision for Laparoscopic-Assisted Microceliotomy

Objectives:

To introduce cruciate microceliotomy for performing conventional open surgery maneuvers at laparoscopy without conversion to standard laparotomy.

Methods:

Retrospective review of all pelvic operations performed by this method by a single surgical team at one institution from 1993 through 1996.

Results:

We found the cruciate incision to provide excellent exposure for the performance of extensive uterine suture-reconstruction, morcellation, tubal microsurgery, and bowel surgery with excellent cosmetic and convalescent results in a series of 94 patients. No wound-related complications were noted. Postoperative analgesic requirements averaged 4.1 oxycodone/acetaminophen tablets per day, and hospital stay averaged 36 hours.

Conclusion:

In our experience, cruciate microceliotomy represents a useful, minimally-invasive adjunct for the performance of open surgical maneuvers at laparoscopy.     

Minilaparotomy vs Laparoscopic Hysterectomy: Comparison of Length of Hospital Stay

Study ObjectiveTo compare length of hospital stay for minilaparotomy vs laparoscopic hysterectomy.DesignRetrospective cohort study (Canadian Task Force classification II-2).SettingKaiser Permanente Northern California, a large integrated health care delivery system.PatientsWomen >18 years of age undergoing laparoscopic or minilaparotomy hysterectomy because of benign indications from June 2009 through January 2010.InterventionHysterectomy via minilaparotomy or laparoscopy.Measurements and Main ResultsMedical records were reviewed for outcomes of interest including length of stay and surgical and demographic data. Parametric and non-parametric analyses were used to compare the 2 groups. The study was powered to detect a difference of 8 hours in length of stay. Two hundred sixty-three cases were identified as hysterectomy via minilaparotomy (n = 100) or laparoscopy (n = 163). The laparoscopy group demonstrated a significantly shorter mean (SD) length of stay (19 [14] hours vs 42 [20] hours; p < .001) and less blood loss (126 [140] mL vs 241 [238] mL; p < .001). The minilaparotomy group experienced a shorter procedure time (113 [47] minutes vs 197 [124] minutes; p < .001). There was no difference between the groups insofar as patient morbidity including intraoperative and postoperative complications, emergency visits, readmissions, or repeat operations.ConclusionCompared with minilaparotomy, laparoscopic hysterectomy is associated with shorter length of hospital stay, longer operating time, and no increased patient morbidity.     

A comparison of vaginal, laparoscopic-assisted vaginal, and minilaparotomy hysterectomies for enlarged myomatous uteri

Objective

To compare the operative data and early postoperative outcome of vaginal hysterectomy (VH), laparoscopic-assisted vaginal hysterectomy (LAVH), and minilaparotomy hysterectomy (MiniLPT).

Methods

A total of 150 women who required hysterectomy for enlarged myomatous uteri were randomly allocated into 3 treatment groups: VH (n = 50), LAVH (n = 50), and MiniLPT (n = 50). The primary outcome was hospital discharge time. The secondary outcomes were operative time, blood loss, paralytic ileus, postoperative pain, and intraoperative and early postoperative complications.

Results

Mean hospital discharge time was longest with MiniLPT, and shortest with VH (P < 0.01). VH was the fastest operating technique, was associated with less blood loss, and resulted in shortest duration of paralytic ileus (P < 0.01). No intraoperative complications occurred.

Conclusion

VH should be the preferred surgical approach in patients with enlarged myomatous uteri. When VH is not feasible, LAVH should be considered an alternative to MiniLPT. Further controlled prospective studies are required to confirm these results.