Advanced Gynecologic Laparoscopy in a Fast-Track Ambulatory Surgery Center

Abstract

Background/Objectives:It has been shown that major gynecologic laparoscopy is safe in hospital ambulatory settings, but there is little data to suggest the same in freestanding ambulatory surgery centers. This study evaluates the safety and efficacy of advanced gynecologic laparoscopic surgery using a fast-track model in freestanding ambulatory surgery centers and discusses our institution protocols.Methods:Retrospective, multicenter review was conducted of major gynecologic surgeries from August 1st 2010 to September 30th 2011 in 3 surgical centers with one primary surgeon. All patients were treated for symptomatic uterine leiomyomas and/or endometriosis. Primary outcome measures were unplanned admissions and discharge within 23 hours.Results:One hundred and thirty-four patients underwent major laparoscopic gynecologic surgery with a total of 160 procedures: 77 stage IV endometriosis treatment including 7 disk excisions of endometriosis from the large bowel, 3 ureteroneocystostomies and 1 partial bladder resection, 38 myomectomies, and 34 hysterectomies including 12 modified radical hysterectomies. The overall unplanned admission rate was 4.5%. One hundred and thirty-one patients (97.7%) were discharged within 24 hours after surgery. Three patients (2.2%) were transferred to the hospital postoperatively: 1 patient for observation of postoperative anemia and 2 patients for postoperative fever. Three patients (2.2%) were admitted to the hospital after discharge: 1 patient for postoperative ileus, 1 patient for postoperative fever, and 1 patient with septic pelvic thrombophlebitis. These postoperative issues all resolved without complication, and all patients had an uneventful follow-up.Conclusions:With appropriate resources and an experienced surgeon, advanced laparoscopic surgery can be safely performed in a fast-track ambulatory surgery center with a high rate of discharge within 23 hours and low unplanned readmission rate.

Laparoscopic‐assisted myomectomy: Surgery center versus outpatient hospital

“…The two surgeons who performed all surgeries in this study are both experienced, high‐volume surgical specialists who are especially proficient in the reported minimally invasive techniques. But while past studies have emphasized the importance of proper patient selection to ensure safe outcomes at an ASC, our data show similar patient characteristics across the two settings, including comorbidities and BMI.…”

“…8 Although past research has established the safety of same-day discharge after minimally invasive myomectomy, 9 there is limited data on performing this procedure at a freestanding ASC. 10,11 The high risk of intraoperative hemorrhage during myomectomy is one of the main concerns of performing this procedure at an ASC, where blood transfusion capabilities and subspecialty support are not typically present.…”

Diagnostic Value of Serial Measurement of C-Reactive Protein in the Detection of a Surgical Complication after Laparoscopic Bowel Resection for Endometriosis

“…A decrease in CRP on the third POD predicts an uncomplicated course with a high probability. With an increasing focus on 'fast track surgery' [40], this could help to shorten the hospital stay for these patients.…”

Bladder Endometriosis: A Systematic Review of Pathogenesis, Diagnosis, Treatment, Impact on Fertility, and Risk of Malignant Transformation

“…Partial cystectomy is a bladder-preserving operation for the treatment of BE that can be performed via laparotomy [107,108,[111][112][113][114] or laparoscopy [102][103][104][105][106][107][108][109][111][112][113][114][115][116][117][118][119][120][121][122][123][124] without or with robotic assistance (Table 5) [125][126][127][128][129][130]. This procedure consists of partial bladder resection for detrusor endometriosis with or without preventive cystoscopic catheterization of the ureters.…”