Gasless Laparoscopy versus Conventional Laparoscopy in Uterine Myomectomy: A Single-Centre Randomized Trial

Abstract

In a single-centre, randomized trial, gasless laparoscopic myomectomy was compared with conventional laparoscopic myomectomy. The study examined feasibility, safety, reliability and post-operative outcomes. Estimated blood loss, duration of surgery, early post-operative outcomes and length of hospital stay were recorded. Compared with conventional laparoscopic myomectomy, gasless laparoscopy resulted in significantly lower intra-operative blood loss (median 100 ml vs 80 ml, respectively) and duration of surgery (median 94 min vs 71 min, respectively). Post-operative abdominal drainage volume was significantly lower after gasless laparoscopy than after conventional laparoscopy (median 100 ml vs 240 ml). There was no significant difference between duration of post-operative fever, post-operative time to flatus or length of hospital stay. Both forms of laparoscopy are suitable for uterine myomectomy, and comparison of these methods showed that gasless laparoscopy had potential advantages over conventional laparoscopy.

The effects and costs of laparoscopic versus abdominal myomectomy in patients with uterine fibroids: a systematic review and meta-analysis

“…Thirty nine studies were reviewed for eligibility by scrutinizing full-text articles. Eventually, 12 eligible RCTs [13][14][15][16][17][18][19][20][21][22][23][24] were included in this meta-analysis. The PRISMA flowchart is showed in Fig.…”

“…The sample sizes ranged from 40 to 384 patients. Six studies [13,14,16,[18][19][20] were conducted in Italy and the remaining six RCTs [15,17,[21][22][23][24] were conducted in China. The mean age of included patients varied from 28 to 50 years old, and the follow-up period differed from 1 to more than 12 months.…”

“…Seven studies [13,14,16,19,[21][22][23] reported the duration of postoperative ileus, the pooled data from the eight RCTs revealed that LM could significantly shorten the duration of postoperative ileus compared with AM (OR = − 10.91, 95% CI -18.72--3.11, P = 0.006, I 2 = 99%; Fig. 4b).…”

Clinical effectiveness of gasless laparoscopic surgery for abdominal conditions: systematic review and meta-analysis

“…A further breakdown of this analysis shows that, in 1990s, with the peak interest in gasless technique, studies reported higher conversion rates for adnexal procedures with smaller sample sizes [ 32 , 33 ]. A myomectomy study by Wang and colleagues in 2011, with a larger sample size, did not report any conversions in either group [ 34 ]. One explanation given by Cravello and colleagues was the location of adnexal organs in obese patients resulting in limited views of the pelvis when using the gasless technique [ 32 ].…”

Hybrid approach of retractor-based and conventional laparoscopy enabling minimally invasive hysterectomy in a morbidly obese patient: Case report and review of the literature

“…According to current data, there are no significant differences between conventional and gasless laparoscopy regarding blood loss and hospital stay (5,7). Some authors even reported less intraoperative blood loss and less postoperative drainage volume (17). First data suggest that immune response is less in gasless laparoscopy-assisted surgery when compared with traditional laparoscopy, and the difference may have effects on the post operative recovery (18).There is an economic benefit as hospital charges are lower in gasless laparoscopy (5).…”