Hand-Assisted Approach to Laparoscopic Myomectomy and Hysterectomy

Tusheva, Olga A.; Cohen, Sarah L.; Einarsson, Jon I.

doi:10.1016/j.jmig.2012.12.001

Cited by 18 publications

(5 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The surgical approach was chosen by individual surgeons according to surgeon and patient preference. LM was performed using a multiport approach; hand-assisted laparoscopic procedures (n = 3) were categorized into this group [15]. RM was performed with a da Vinci Robot (Intuitive Surgical, Sunnyvale, CA) and in some cases used a hybrid approach whereby myoma enucleation was performed with conventional laparoscopy and uterine closure was performed with robotic assistance.…”

Section: Methodsmentioning

confidence: 99%

Perioperative Outcomes of Myomectomy for Extreme Myoma Burden: Comparison of Surgical Approaches

Jansen

Clark

Dmello

et al. 2019

Journal of Minimally Invasive Gynecology

Self Cite

View full text Add to dashboard Cite

To describe the perioperative outcomes of various modes of myomectomy (abdominal [AM], laparoscopic [LM], or robotic [RM]) in cases of extreme myoma burden. Design: Retrospective cohort study (Canadian Task Force classification II-2). Setting: A tertiary academic center in Boston, Massachusetts. Patients: All women who underwent an AM, LM, or RM for extreme myoma burden, defined as representing the upper quartile for specimen weight (≥434.6 g) or myoma count (≥7 myomas), between 2009 and 2016. Interventions: Baseline demographics and perioperative outcomes were collected from review of medical records, including estimated blood loss, operative time, length of stay, and complications. Univariate linear and logistic regression analyses were conducted. Measurements and Main Results: During the study period 659 women underwent myomectomy for extreme myoma burden; 47.2% of cases were AM, 28.1% LM, and 24.7% RM. Overall myoma burden differed across the 3 routes and was greatest in the AM group (mean weight: 696.2 § 784.5 g for AM vs 586.6 § 426.1 g for LM and 586.6 § 426.1 g for RM; mean number: 16.8 § 15.0 for AM vs 7.2 § 7.0 for LM and 6.7 § 4.7 for RM; p <.001 for both). The 3 routes differed in operative time and length of stay, with RM having the longest operative time (mean, 239.7 minutes; p <.001) and AM the longest length of stay (mean, 2.2 § .9 days; p <.001). Other perioperative outcomes were similar across the surgical approaches. Increasing myoma burden was associated with an increased risk of perioperative complications for all surgical approaches, with a threshold of 13 myomas associated with an almost 2-fold higher risk of perioperative complications (odds ratio, 1.77; 95% confidence interval, 1.17−2.70; p = .009). Cumulative incidence of perioperative complications with increasing specimen weight was greater in the RM cases as compared with AM (p = .002) or LM (p = .020), whereas the cumulative incidence of perioperative complications with increasing myoma count was lowest with AM compared with LM (p <.001) or RM (p <.001). Conclusion: Myomectomy for extreme myomas is feasible using an abdominal, laparoscopic, or robotic approach. Increased myoma burden is associated with an increased risk of perioperative complications. A threshold of 13 myomas was associated with an almost 2-fold higher risk of perioperative complications for all modes. Perioperative complication outcomes were more favorable in AM or LM over RM with increased myoma weight and AM over LM or RM with increased myoma number.

show abstract

Section: Methodsmentioning

confidence: 99%

Perioperative Outcomes of Myomectomy for Extreme Myoma Burden: Comparison of Surgical Approaches

Jansen

Clark

Dmello

et al. 2019

Journal of Minimally Invasive Gynecology

Self Cite

View full text Add to dashboard Cite

show abstract

“…Although we observed variation in the assessments of potential effects on clinical scenarios (Figure 4), several previous studies noted the added value of the intra-abdominal hand, which provided a tactile sense in the procedure. [26][27][28][29] Haptic feedback availability in future laparoscopic instruments will likely increase the number of patients who receive a minimally invasive surgical approach. Consequently, it is expected that the length of hospital stay and postprocedure pain will decrease and the overall quality of life will improve.…”

Section: Discussionmentioning

confidence: 99%

Performance of a Haptic Feedback Grasper in Laparoscopic Surgery: A Randomized Pilot Comparison With Conventional Graspers in a Porcine Model

Alleblas

Vleugels²,

Stommel

et al. 2019

Surg Innov

View full text Add to dashboard Cite

Background. Compared with open surgery, minimally invasive surgery is limited by reduced sensation of tissue properties. A laparoscopic grasper with integrated haptic feedback technology that improves the ability to sense tissue properties might provide a solution. The force reflecting operation instrument (FROI) is a new laparoscopic grasper, designed to provide information about the interaction forces between the instrument and tissue through resistance in the handle. This pilot study aimed to assess the functionality of the FROI compared with a conventional grasper in an in vivo setting. Methods. In this randomized trial, we used a standard laparoscopic surgical setup to perform laparoscopic surgery in pigs. In all, 11 surgeons performed colorectal, gynecological, or urological procedures, once with the FROI and once with a conventional grasper. Participants were asked to complete the NASA Task Load Index Rating Scale and rate 5 specific features for both graspers. To capture opinions on the overall functionality of the FROI, participants were asked to answer 8 open questions. Results. The surgeons reported that the use of the FROI significantly improved tissue consistency perception, arterial pulse detection, and force control compared with the conventional grasper. No significant differences were found in surgeons’ muscular strain or operative time. The most emphasized topics in the open questions were improved soft-tissue handling and importance for complex procedures. Conclusion. Through this first in vivo analysis of the functionality of the FROI, a multispecialty group of laparoscopic surgeons confirmed the added value of haptic feedback technology in a live surgical setting.

show abstract

“…It has been suggested that tissue removal via minilaparotomy has similar preoperative outcomes when compared with laparoscopy, with or without manual morcellation. [45][46][47][48] A containment bag may also be used to minimize intra-abdominal tissue spread. For large specimens, bivalving, coring, or ''paper-roll'' technique have all been described as methods to remove a large specimen through a 3 to 5 cm incision.…”

Section: Alternatives To Open Morcellationmentioning

confidence: 99%

Laparoscopic Hysterectomy for Uterine Fibroids

Hinchcliff

Cohen²

2016

Clinical Obstetrics &Amp; Gynecology

Self Cite

View full text Add to dashboard Cite

As more complex cases and larger uterine specimens are able to be managed with minimally invasive surgery, the limitations of tissue retrieval with these methods are of increasing concern. Risks of morcellator-related injury, tissue dissemination, or fragmentation must be weighed against increased morbidity of abdominal approach to hysterectomy. In an effort to mitigate the risks of tissue morcellation, containment system use must be considered when fragmenting a specimen, either with power morcellation or a manual technique via the vagina or minilaparotomy.

show abstract

Hand-Assisted Approach to Laparoscopic Myomectomy and Hysterectomy

Cited by 18 publications

References 9 publications

Perioperative Outcomes of Myomectomy for Extreme Myoma Burden: Comparison of Surgical Approaches

Perioperative Outcomes of Myomectomy for Extreme Myoma Burden: Comparison of Surgical Approaches

Performance of a Haptic Feedback Grasper in Laparoscopic Surgery: A Randomized Pilot Comparison With Conventional Graspers in a Porcine Model

Laparoscopic Hysterectomy for Uterine Fibroids

Contact Info

Product

Resources

About