SummaryWe conducted a randomised controlled trial to compare the efficacy of forced-air warming (Bair Hugger TM , Augustine Medical model 500 ⁄ OR, Prairie, MN) with that of an electric heating pad (Operatherm 202, KanMed, Sweden) for maintenance of intra-operative body temperature in 60 patients undergoing total knee replacement under combined spinal-epidural anaesthesia. Intra-operative tympanic and rectal temperatures and verbal analogue score for thermal comfort were recorded. There were no differences in any measurements between the two groups, with mean (SD) final rectal temperatures of 36.8 (0.4)°C with forced-air warming and 36.9 (0.4)°C with the electric pad. The heating pad is as effective as forced-air warming for maintenance of intra-operative body temperature.

Background and Objectives:Mechanical bowel preparation (MBP) has been used prior to total laparoscopic hysterectomy (TLH), but evidence for its use is lacking. Our study seeks to assess whether or not completion of preoperative MBP prior to TLH improves visualization of the surgical field, bowel handling, or overall ease of the operation.Methods:Women aged 18–65 years undergoing TLH for benign indications at a level 1 trauma center were randomized to a bowel preparation (BP; n = 39) or non–bowel preparation (NP; n = 39) regimen. After each operation, the surgeon completed a survey about intraoperative visualization of the surgical field, bowel handling, and the overall ease of the operation. The surgeon was also asked whether or not he thought the patient had completed MBP. The patient completed a survey about pre- and postoperative gastrointestinal discomfort. The surgeon was blinded to whether MBP was completed before the operation.Results:There was no difference in intraoperative visualization, bowel handling, or overall ease of the operation between the BP and NP groups. Comfort levels before and after surgery were not significantly different between the two groups. The surgeon was able to correctly predict whether the patient performed MBP in 59% of cases.Conclusion:The routine use of MBP before TLH does not improve intraoperative visualization, bowel handling, or overall ease of performing the procedure. It also has no significant effect on patient comfort levels. MBP is not indicated before TLH for benign indications.

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Introduction: Hysterectomy is one of the most common gynecologic procedures performed. Minimally invasive laparoscopic techniques are preferred; however, laparotomy is still commonly performed for large uteri.Case Description: We performed hand-assisted total laparoscopic hysterectomy of a 5200-g uterus.Discussion: Hand-assisted laparoscopy is an alternative approach to laparotomy for large uteri and has similar benefits to traditional laparoscopic surgery. To our knowledge, the uterus in our patient is the largest uterus reported to have been removed laparoscopically.