A simple gasless single-port laparoscopy suitable for use in middle- and low-income countries or primary hospitals
Abstract
Objectives: The purpose of the present study is to explore the effectiveness of a modified suspension method combined with gasless single-port laparoscopy (MS-GSPL) for the treatment of benign ovarian tumors. The aim of this approach is to provide a convenient, economical, and minimally invasive method that is suitable for widespread use, even in middle- and low-income countries or primary hospitals.
Material and methods: Retrospective analysis of patients who underwent laparoscopic unilateral ovarian cystectomy due to benign ovarian tumors from January 2019 to December 2019.Thirty-six cases were treated with MS-GSPL, and 36 cases were treated with single-port laparoscopy (SPL). The patients’ medical records, perioperative surgical outcomes, postoperative pain scores and complications were reviewed and compared.
Results: There are no significant differences in age, body mass index, previous pelvic surgery, tumor diameter, and tumor pathologic outcomes between MS-GSPL group and SPL group. The median operation times were 50 (Q1~Q3, 44~62.25) min in the MS-GSPL group and 60.5 (Q1~Q3, 57.25~78) min in the SPL group with a significant difference. The median estimated blood loss was 40 (Q1~Q3, 30~50) mL in the MS-GSPL group and 50(Q1~Q3, 30~60) mL in the SPL group with no significant difference. Compared with SPL group, patients in MS-GSPL group had earlier postoperative exhaust times, shorter hospital stays and lower costs, and all these differences were statistically significant (p < 0.05). There was a strong positive correlation between operation time and BMI in the MS-GSPL groups.
Conclusions: The patients receiving MS-GSPL treatment have quick postoperative recoveries. MS-GSPL is a novel, safe and economical surgical method that is suitable for extensive clinical development in middle- and low-income countries or primary hospitals.
Keywords: gasless laparoscopyovarian tumorsingle-port laparoscopysuspension methodbody mass index
References
- Boruta DM. Laparoendoscopic single-site surgery in gynecologic oncology: An update. Gynecol Oncol. 2016; 141(3): 616–623.
- Kosumi T, Kubota A, Usui N, et al. Laparoscopic Ovarian Cystectomy Using a Single Umbilical Puncture Method. Surgical Laparoscopy, Endoscopy & Percutaneous Techniques. 2001; 11(1): 63–65.
- Xiao J, Fu K, Duan K, et al. Pregnancy-preserving Laparoendoscopic Single-site Surgery for Gynecologic Disease: A Case Series. J Minim Invasive Gynecol. 2020; 27(7): 1588–1597.
- Chen S, Qi X, Chen L, et al. Laparoendoscopic Single-site Surgery for Comprehensive Staging of Early Ovarian Cancer. J Minim Invasive Gynecol. 2019; 26(5): 806.
- Demirayak G. A different technique in gasless laparoendoscopic single-site hysterectomy. J Obstet Gynaecol. 2017; 37(5): 622–626.
- Wang Y, Yao Y, Dou Y, et al. Chopstick technique used in laparoendoscopic single site radical hysterectomy for early stage cervical cancer. Sci Rep. 2021; 11(1): 6882.
- Ma J, Yang J, Cheng S, et al. The Learning Curve of Laparoendoscopic Single-Site Surgery in Benign Gynecological Diseases. J Invest Surg. 2022; 35(2): 363–370.
- Caglià P, Tracia A, Buffone A, et al. Physiopathology and clinical considerations of laparoscopic surgery in the elderly. Int J Surg. 2016; 33 Suppl 1: S97–S9S102.
- Li SH, Deng J, Huang FT, et al. Impact of gasless laparoscopy on circulation, respiration, stress response, and other complications in gynecological geriatrics. Int J Clin Exp Med. 2014; 7(9): 2877–2882.
- Nagai H, Inaba T, Kamiya S, et al. A New Method of Laparoscopic Cholecystectomy. Surgical Laparoscopy, Endoscopy & Percutaneous Techniques. 1991; 1(2): 126.
- Ülker K, Hüseyinoğlu Ü, Kılıç N. Management of benign ovarian cysts by a novel, gasless, single-incision laparoscopic technique: keyless abdominal rope-lifting surgery (KARS). Surg Endosc. 2013; 27(1): 189–198.
- Takeda A, Imoto S, Nakamura H. Gasless laparoendoscopic single-site surgery for management of adnexal masses during pregnancy. Eur J Obstet Gynecol Reprod Biol. 2014; 180: 28–34.
- Wang X, Li Y. Comparison of perioperative outcomes of single-port laparoscopy, three-port laparoscopy and conventional laparotomy in removing giant ovarian cysts larger than 15 cm. BMC Surg. 2021; 21(1): 205.
- WHO Expert Consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet. 2004; 363(9403): 157–163.
- David-Montefiore E, Rouzier R, Chapron C, et al. Collegiale d'Obstétrique et Gynécologie de Paris-Ile de France. Surgical routes and complications of hysterectomy for benign disorders: a prospective observational study in French university hospitals. Hum Reprod. 2007; 22(1): 260–265.
- Mishra A, Bains L, Jesudin G, et al. Evaluation of Gasless Laparoscopy as a Tool for Minimal Access Surgery in Low-to Middle-Income Countries: A Phase II Noninferiority Randomized Controlled Study. J Am Coll Surg. 2020; 231(5): 511–519.
- Pellegrino A, Damiani GR, Tartagni M, et al. Isobaric laparoscopy using LaparoTenser system in surgical gynecologic oncology. J Minim Invasive Gynecol. 2013; 20(5): 686–690.
- Takeda A, Imoto S, Mori M, et al. Management of large adnexal tumors by isobaric laparoendoscopic single-site surgery with a wound retractor. Eur J Obstet Gynecol Reprod Biol. 2013; 166(2): 185–189.
- Takeda A, Hayashi S, Imoto S, et al. Gasless single-port laparoscopic-assisted vaginal hysterectomy for large uteri weighing 500g or more. Eur J Obstet Gynecol Reprod Biol. 2016; 203: 239–244.
- Demirayak G. A different technique in gasless laparoendoscopic single-site hysterectomy. J Obstet Gynaecol. 2017; 37(5): 622–626.
- Palomba S, Zupi E, Falbo A, et al. New tool (Laparotenser) for gasless laparoscopic myomectomy: a multicenter-controlled study. Fertil Steril. 2010; 94(3): 1090–1096.
- Casati A, Valentini G, Ferrari S, et al. Cardiorespiratory changes during gynaecological laparoscopy by abdominal wall elevation: comparison with carbon dioxide pneumoperitoneum. Br J Anaesth. 1997; 78(1): 51–54.
- Koivusalo AM, Kellokumpu I, Lindgren L. Gasless laparoscopic cholecystectomy: comparison of postoperative recovery with conventional technique. Br J Anaesth. 1996; 77(5): 576–580.
- Son JS, Oh JY, Ko S. Effects of hypercapnia on postoperative nausea and vomiting after laparoscopic surgery: a double-blind randomized controlled study. Surg Endosc. 2017; 31(11): 4576–4582.
- Kim MiK, Hwang JHa, Kim JH, et al. Gasless Total Laparoscopic Hysterectomy with New Abdominal-Wall Retraction System. JSLS. 2020; 24(1).
- Kaloo P, Armstrong S, Kaloo C, et al. Interventions to reduce shoulder pain following gynaecological laparoscopic procedures. Cochrane Database Syst Rev. 2019; 1(1): CD011101.
- Sao CH, Chan-Tiopianco M, Chung KC, et al. Pain after laparoscopic surgery: Focus on shoulder-tip pain after gynecological laparoscopic surgery. J Chin Med Assoc. 2019; 82(11): 819–826.
- Hwang JHa, Kim SR, Kim JH, et al. Gasless single-port access laparoscopy using a J-shaped retractor in patients undergoing adnexal surgery. Surg Endosc. 2021; 35(6): 2457–2464.
