scholarly journals Gynecologists May Underestimate the Amount of Blood Loss during Total Laparoscopic Hysterectomy

2018 ◽  
Vol 2018 ◽  
pp. 1-5 ◽  
Author(s):  
Masakazu Sato ◽  
Minako Koizumi ◽  
Kei Inaba ◽  
Yu Takahashi ◽  
Natsuki Nagashima ◽  
...  
Keyword(s):  
Laparoscopic Surgery ◽  
Blood Loss ◽  
Laboratory Testing ◽  
Ovarian Tumor ◽  
Open Surgery ◽  
Laparoscopic Hysterectomy ◽  
Total Laparoscopic Hysterectomy ◽  
Before And After

Background. We considered the possibility of underestimation of the amount of bleeding during laparoscopic surgery, and we investigated comparing the amount of bleeding between laparoscopic surgery and open surgery by considering the concentration of hemoglobin before and after surgery as indicators. Methods. The following procedures were included: A, surgery for ovarian tumor; B, myomectomy; and C, hysterectomy either by laparoscopic surgery or open surgery. Patients who underwent the above procedures in between January 1, 2010, and December 31, 2017, were enrolled. We identified 1749 cases (A: 90, B: 105, and C: 325 of open surgery and A: 667, B: 437, and C: 125 of laparoscopic surgery). We considered the sum as an estimation of blood loss during surgery and the change in the value of hemoglobin in laboratory testing one day before and after surgery. Results. During laparoscopic surgery, the measurements of blood loss included the following: A: 59.8 ml; B: 168.6 ml; and C: 206.8 ml. During open surgery, measurements of blood loss included the following: A: 130.7 ml; B: 236.7 ml; and C; 280.9 ml. The reduction of hemoglobin after surgery compared with that before surgery was less in laparoscopic surgery than that in open surgery in A and B; however, this reduction was not significantly different in C. Conclusion. Our results suggest that the estimation of the bleeding in A and B was appropriate; however, the estimation might be underestimated in C during laparoscopic surgery.

scholarly journals Two cases of giant peritoneal inclusion cysts requiring treatment after total laparoscopic hysterectomy

2020 ◽  
Vol 2020 (12) ◽  
Author(s):  
Katsumi Kozasa ◽  
Yuki Takemoto ◽  
Takeshi Goto ◽  
Mariya Kobayashi ◽  
Hitomi Sakaguchi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Abdominal Pain ◽  
Laparoscopic Surgery ◽  
Open Surgery ◽  
Abdominal Cavity ◽  
Laparoscopic Hysterectomy ◽  
Total Laparoscopic Hysterectomy ◽  
Strong Adhesion

Abstract Peritoneal inclusion cysts (PICs) often develop in post-operative patients. Since the incidence of adhesions is lower with laparoscopic surgery than with open surgery, PICs are less likely to occur in the former. Although post-operative adhesions or PICs rarely develop after laparoscopic surgery (such as total laparoscopic hysterectomy: TLH), we encountered two cases of giant PICs with abdominal pain after TLH. In Case 1, strong adhesion was already present when TLH was performed. Therefore, this case may have been predisposed to the development of adhesions in the abdominal cavity. However, no adhesions were observed during TLH in case 2, and there were no risk factors, such as pre-operative adhesions and endometriosis. Therefore, adhesions and PICs may develop even after TLH, and approaches need to be considered for their prevention.

scholarly journals Total Laparoscopic Hysterectomy with Prior Uterine Artery Ligation at Its Origin

2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
Author(s):  
Vidyashree Ganesh Poojari ◽  
Vidya Vishwanath Bhat ◽  
Ravishankar Bhat
Keyword(s):  
Blood Loss ◽  
Uterine Artery ◽  
Laparoscopic Hysterectomy ◽  
Total Laparoscopic Hysterectomy ◽  
Artery Ligation ◽  
Uterine Arteries ◽  
Uterine Artery Ligation ◽  
Duration Of Surgery ◽  
Group A ◽  
Group B

We compared the duration of surgery, blood loss, and complications between patients in whom both uterine arteries were ligated at the beginning of total laparoscopic hysterectomy (TLH) and patients in whom ligation was done after cornual pedicle. Using a prospective study in a gynecologic laparoscopic center, a total of 52 women who underwent TLH from June 2013 to January 2014 were assigned into two groups. In group A, uterine arteries were ligated after the cornual pedicles as done conventionally. In group B, TLH was done by ligating both uterine arteries at the beginning of the procedure. All the other pedicles were desiccated using harmonic scalpel or bipolar diathermy. Uterus with cervix was removed vaginally or by morcellation. The indication for TLH was predominantly dysfunctional uterine bleeding and myomas in both groups. In group A, the average duration of surgery was 71 minutes, when compared to 60 minutes in group B(P<0.001). In group A, the total blood loss was 70 mL, when compared to 43#x2009;mL in group B (Pvalue < 0.001). There were no major complications in both groups. To conclude, prior uterine artery ligation at its origin during TLH reduces the blood loss and surgical duration as well as the complications during surgery.

Laparoscopic versus open surgery for gastrointestinal stromal tumor in esophagogastric junction: A multi-center, retrospective cohort analysis with propensity score matching.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 11534-11534
Author(s):  
Wenjun Xiong ◽  
Tao Chen ◽  
Xingyu Feng ◽  
Yuting Xu ◽  
Jin Wan ◽  
...  
Keyword(s):  
Laparoscopic Surgery ◽  
Propensity Score ◽  
Blood Loss ◽  
Gastrointestinal Stromal Tumor ◽  
Propensity Score Matching ◽  
Open Surgery ◽  
Esophagogastric Junction ◽  
Operative Time ◽  
Liquid Intake

11534 Background: Laparoscopic resection is increasingly performed for Gastrointestinal stromal tumor (GIST). Nevertheless, laparoscopic approach for the GIST located in the esophagogastric junction (EGJ-GIST) represent a surgical challenge. This study aims to investigate the efficacy of laparoscopic surgery and open procedure for EGJ-GIST through the propensity score matching (PSM) method. Methods: Between April 2006 and April 2018, 1824 patients underwent surgery were finally diagnosed with primary gastric GIST at four medical centers in South China. EGJ-GIST was defined as a GIST with an upper border of less than 5 cm from the EG line. Among them, 228 patients were identified and retrospectively reviewed with regard to clinicopathological characteristics, operative information and long-term outcomes. The PSM methods was used to eliminate the selection bias. Results: After PSM, 102 cases, consisted of 51 laparoscopic (LA) and 51 open surgery (OP), were enrolled. The match factors contained year of surgery, gender, age, BMI, tumor size, mitotic rate, recurrence risk and adjuvant tyrosine kinase inhibitors treatment. The LA group was superior to the OP group in operative time (108.5±56.5 vs. 169.3±79.0 min, P <0.001), blood loss (54.6±81.9 vs. 104.9±156.4 ml, P = 0.042), time to liquid intake (3.1±1.8 vs. 4.3±2.2 d, P = 0.003), hospital stay (6.0±2.3 vs. 9.9±8.1, P = 0.001), and postoperative complication (5.9% vs. 25.5%, P = 0.006). The median follow-up was 55 (range, 2-153) months in the entire cohort. No significant differences were detected in either the relapse-free survival (RFS, P = 0.109) or overall survival (OS, P = 0.113) between two groups. The 1-, 3-, and 5-year RFS in the LA and OP groups were 100.0%, 95.5%, 91.0% and 100.0%, 90.8%, 85.7%, respectively. The 1-, 3-, and 5-year OS in the LA and OP group were 100%, 95.6%, 91.3% and 100.0%, 91.1%, 85.4%, respectively. Conclusions: Laparoscopic surgery for EGJ-GIST is associated with the advantages of shorter operative time, reduced blood loss, shorter time to liquid intake and shorter length of stay, all without compromising post-operative outcomes and long-term survival.

scholarly journals Comparison between Laparoscopic Hysterectomy and Abdominal Hysterectomy

2014 ◽  
Vol 9 (1) ◽  
pp. 26-28
Author(s):  
R Shrestha ◽  
LH Yu
Keyword(s):  
Blood Loss ◽  
Hospital Stay ◽  
Laparoscopic Hysterectomy ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Total Laparoscopic Hysterectomy ◽  
Short Hospital Stay ◽  
Early Recovery ◽  
Duration Of Hospital Stay ◽  
Operative Recovery

Aims: Hysterectomy can be performed by abdominal, vaginal and laparoscopic methods. Laparoscopic hysterectomy has been reported as an alternative to traditional abdominal hysterectomy with benefit of early recovery, short hospital stay and less operative complications. This study compared laparoscopic versus abdominal hysterectomy in terms of surgery time, blood loss, post-operative recovery, and duration of hospital stay. Methods: This is a retrospective comparative study among sixty patients who underwent laparoscopic or abdominal hysterectomy for various indications in the Department of Obstetrics and Gynaecology of the Third affiliated hospital of Zhengzhou University from January to March 2007. The data of the patients meeting the set criteria were obtained from the hospital records and hospital based computerized coding system. Enrolled cases were divided in two groups with thirty in each arm. Group TLH (total laparoscopic hysterectomy) was designated for patients who underwent total laparoscopic hysterectomy and group TAH (total abdominal hysterectomy) for those who underwent total abdominal hysterectomy. Results: There was comparatively less blood loss in TLH group (60.2±5.17 ml versus 75.7±7.12 ml) but it was statistically insignificant (p=0.12). The laparoscopic hysterectomy took longer time (107.6±32.4 min versus 74.9±31.1 min) than the abdominal (p<0.001). There was early recovery among TLH group 1.6±0.6 days versus 2.1±0.5 days in TAH group (p=0.001). Mean duration of hospital stay was significantly shorter in TLH group 7.6±1.9 days versus 10.1±2.1 days in TAH group (p<0.001). Conclusions: Laparoscopic hyserectomy is an effective alternative to abdominal hysterectomy with the advantage of less intra-operative blood loss, fast recovery and short hospital stay. DOI: http://dx.doi.org/10.3126/njog.v9i1.11183 NJOG 2014 Jan-Jun; 2(1):26-28

Comparison of Clinical Efficacy and Complications Between Laparoscopic Versus Open Surgery for Low Rectal Cancer

2019 ◽  
Vol 22 (3) ◽  
pp. 179-186 ◽  
Author(s):  
Jian Dai ◽  
Zhou Yu
Keyword(s):  
Rectal Cancer ◽  
Laparoscopic Surgery ◽  
Blood Loss ◽  
Hospital Stay ◽  
Complication Rate ◽  
Open Surgery ◽  
Operation Time ◽  
Lower Rectal Cancer ◽  
Surgery Group ◽  
Stay Time

Aim: To compare the surgical outcomes of laparoscopic surgery for lower rectal cancer with open surgery. Methods: The multiple databases including PubMed, Springer, EMBASE, EMBASE, OVID were adopted to search for the relevant studies, and full-text articles involving the comparison of unilateral and bilateral PVP surgery were reviewed. Review Manager 5.0 was adopted to estimate the effects of the results among the selected articles. Forest plots, sensitivity analysis and bias analysis for the articles included were also conducted. Results: Finally, 1186 patients were included in the 10 studies, which eventually satisfied the eligibility criteria, and laparoscopic and open surgery group were 646 and 540, respectively. The meta-analysis suggested that there was no significant difference of the operation time between laparoscopic and open surgery group, while the time to solid intake, hospital stay time, blood loss and complication rate of laparoscopic group are much less than those of open surgery. Conclusion: Although both these two punctures provide similar operation time, we encourage the use of the laparoscopic surgery as the preferred surgical technique for treatment of lower rectal cancer due to less time to solid intake, hospital stay time, blood loss and lower complication rate.

scholarly journals The Learning Curve of Total Laparoscopic Hysterectomy in a Rural Hospital

2019 ◽  
pp. 1
Author(s):  
İsmail Biyik ◽  
Mustafa Albayrak ◽  
Fatih Keskin ◽  
Ayse Nur Usturali Mut
Keyword(s):  
Online Education ◽  
Learning Curve ◽  
Operation Time ◽  
Laparoscopic Hysterectomy ◽  
Total Laparoscopic Hysterectomy ◽  
Certification Programs ◽  
Transfusion Requirements ◽  
Before And After ◽  
Group 2 ◽  
Group 1

<p><strong>OBJECTIVES:</strong> Online education and certification programs which help most gynecologic surgeons to advance, improve and prove their skills. However, the benefits of such distant programs in terms of complication rate and operation time has not been evaluated so far. The aim of this study was to report the improvement of a single surgeon’s learning curve in total laparoscopic hysterectomy who had no previous mentorship/fellowship education, working in a rural district hospital before and after the completion of a distant on-line education and certification program - Gynaecological Endoscopic Surgical Education and Assessment.<br /><strong></strong></p><p><strong>STUDY DESIGN:</strong> Medical records of patients who underwent total laparoscopic hysterectomy between May 2015 and December 2018 were retrospectively reviewed and grouped based on the certification date of the surgeon, Group 1 before and Group 2 after certification. Groups were compared for variables that impact the learning curve (operation time, complications and conversion to laparotomy)<br /><strong></strong></p><p><strong>RESULTS:</strong> Of the 57 women eligible for evaluation 30 had total laparoscopic hysterectomy in Group 1 and 27 had total laparoscopic hysterectomy in Group 2. BMI, number of vaginal/cesarean births, previous abdominal/pelvic surgeries, operation indications, uterine weight, adnexectomy, and adhesiolysis rates, transfusion requirements, and the decrease in hemoglobin before and after operation were similar between the groups (p&gt;0.05). Operation time was significantly shorter in Group 2 (83 min vs.116 min, p&lt;0.0001). <br /><strong></strong></p><p><strong>CONCLUSION:</strong> Thirty total laparoscopic hysterectomy operations seem enough to reach a plateau in the learning curve for gynecologists working in rural areas with limited facilities who cannot afford lengthily and expensive fellowship/mentorship programs, after completing distant online certification programs.</p>

scholarly journals Body Mass Index and Its Role in Total Laparoscopic Hysterectomy

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Shilpa Bhandari ◽  
Pallavi Agrawal ◽  
Aparna Singh
Keyword(s):  
Body Mass Index ◽  
Blood Loss ◽  
Body Mass ◽  
Operative Time ◽  
Intraoperative Complications ◽  
Laparoscopic Hysterectomy ◽  
Total Laparoscopic Hysterectomy ◽  
Perioperative Outcomes ◽  
Obese Patients ◽  
Duration Of Surgery

Objective. To evaluate operative and perioperative outcomes in patients undergoing total laparoscopic hysterectomy according to their body mass index. Method. A retrospective study was performed for patients undergoing total laparoscopic hysterectomy at a tertiary care center for a period of 4 years. Patients were divided into two groups: obese (BMI > 30 Kg/m2) and nonobese (BMI < 30 Kg/m2). Duration of surgery, intraoperative blood loss, successful laparoscopic completion, and intraoperative complications were compared in two groups. Result. A total of 253 patients underwent total laparoscopic hysterectomy from January 2010 to December 2013. Out of them, 105 women (41.5%) had a BMI of more than 30 kg/m2. Overall, the mean blood loss was 85.79 ± 54.17 mL; the operative time was 54.17 ± 19.83 min. The surgery was completed laparoscopically in 244 (96.4%) women while laparotomy was done in 4 cases and vaginal suturing and closure of vault were done in 5 cases. Risk of vaginal assistance was higher in obese patients whereas out of the 4 conversions to laparotomy 3 had BMI < 30 kg/m2. The operative time was increased as the BMI of patient increased. Conclusions. Total laparoscopic hysterectomy is a safe and effective procedure for obese patients and can be performed with an efficacy similar to that in nonobese patients.

scholarly journals Introduction of gasless laparoscopic surgery as a minimally invasive procedure for endometrial cancer and its usefulness from the viewpoint of the learning curve

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Hiroe Ito ◽  
Tetsuya Moritake ◽  
Fumitoshi Terauchi ◽  
Keiichi Isaka
Keyword(s):  
Endometrial Cancer ◽  
Laparoscopic Surgery ◽  
Blood Loss ◽  
Learning Curve ◽  
Hospital Stay ◽  
Open Surgery ◽  
Operative Time ◽  
Perioperative Complications ◽  
Survival Rates ◽  
Significant Difference

Abstract Background We investigated the usefulness of gasless laparoscopic surgery (GLS) using a subcutaneous abdominal wall lifting method for endometrial cancer. Methods We studied 105 patients with early endometrial cancer who underwent GLS (55) or open surgery (50). A uterine manipulator was used in all GLS cases. We compared operative time, blood loss, number of lymph nodes removed, hospital stay, perioperative complications, cases converted to laparotomy, and recurrence and survival rates. We also studied the learning curve and proficiency of GLS. Results The GLS group had significantly longer operative time (265 vs. 191 min), reduced blood loss (184 vs. 425 mL), shorter hospital stay (9.9 vs. 17.6 days), and fewer postoperative complications (1.8 vs. 12.0%) than the open group. No case was converted to laparotomy. Disease-free and overall survival rates at 4 years postoperatively (GLS vs. open groups) were 98.0 versus 97.8 and 100 versus 95.7%, respectively, and there was no significant difference between the groups. Regarding the learning curve for GLS, two different phases were observed in approximately 10 cases. Operator 2, who was not accustomed to laparoscopic surgery, showed a significant reduction in operative time in the later phase 2. Conclusions GLS for endometrial cancer results in less bleeding, shorter hospital stay, and fewer complications than open surgery. Recurrence and survival rates were not significantly different from those of open surgery. This technique may be introduced in a short time for operators who are skilled at open surgery but not used to laparoscopic surgery.

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