How to train practising gynaecologists in total laparoscopic hysterectomy: protocol for the stepped-wedge IMAGINE trial

Obermair, Andreas; Armfield, Nigel R; Graves, Nicholas; Gebski, Val; Hanna, George B.; Coleman, Mark; Hughes, Anne E.; Janda, Monika

doi:10.1136/bmjopen-2018-027155

Cited by 13 publications

(9 citation statements)

References 37 publications

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“…Hysterectomy is the most common major gynecological procedure in women [1], but hysterectomy for enlarged uteri is considered a challenge for gynecologic surgeons, due to the limit of exposure to surgical spaces [2]. Minimally invasive approaches as total laparoscopic hysterectomy should be used wherever possible [1] as it is the standard of care in majority of women diagnosed with endometrial cancer [3] and is feasible for enlarged uteri [2]. Postoperative (PO) pain remains one of the most common challenges following inpatient and outpatient surgeries [4].…”

Section: Introductionmentioning

confidence: 99%

Opioid-Free Anesthesia for Laparoscopic Hysterectomy: Is it Appropriate?

Salem

2019

JAICM

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Opioids are frequently associated with adverse events such as dizziness, drowsiness [7], high incidence of PO nausea and vomiting, which varies from 20%-60% [8] or constipation which disturbs PO recovery and extends the duration of hospital stay [7].With increased awareness of both short-and longterm problems associated with liberal perioperative opioid administration, the need for routinely and clinically feasible alternatives is greater than ever [9]. Implementation of multimodal analgesic regimen achieved equivalent and effective pain control aiming to reduce the reliance on opioid-based medications [10]. The application of enhanced recovery pathways promoted opioid-free and multimodal analgesia [11] and allowedAbstract Objective: To evaluate intraoperative (IO) and postoperative (PO) outcome of women assigned to laparoscopic hysterectomy under opioidfree anesthesia (OFA) in comparison to opioid-based anesthesia (OBA).Patient and Methods: 72 women were randomly divided into OBA and OFA groups according to the provided IO analgesic regimen. OBA patients received Fentanyl (FEN) as loading and Remifentanyl (REM) infusion as maintenance analgesia. OFA patients received preoperative parecoxib sodium for preparation, dexmedetomidine (DEX) and lidocaine (LID) as loading and maintenance analgesia. Study Outcomes included the frequency of patients developed IO deviated mean arterial pressure (MAP) measures by >20% of baseline measures, duration of surgery and time till fulfilling criteria for PACU discharge, duration of PO analgesia, time till 1st ambulation, PO complications and hospital stay.Results: Demographic data and surgical characteristics were comparable in all groups. The D group showed delay in onset for first call for analgesia (900±60.9min) while M and K groups results were (600±33.4min) and (350±17.4min) respectively, all of the group's results were statistically significant than the control group result (260±14.3min).Results: MAP measures during and 30-min after abdominal insufflations were significantly higher in patients of OFA than patients of OBA. Among 216 MAP readings, increased MAP measures by >20% of baseline measure was recorded in 10 (4.6%) versus 3 (1.4%) readings in OFA and OBA groups, respectively with a non-significant difference (p=0.091) between both groups. Duration till 1st ambulation was significantly shorter with OFA compared to OBA, while duration till 1st request of rescue analgesia was significantly longer with OFA, while the frequency of patients requested more rescue analgesia was significantly higher with OBA than OFA. PONV was reported in 53 patients and 17 patients required anti-emetic therapy with significantly higher incidence with OBA compared to OFA group. Conclusion:The applied protocol for OFA provided satisfactory IO analgesia and control of surgery-induced pressor reflexes. Also, it allowed reduction of PO analgesic consumption with early ambulation and reduced PONV that were reflected as shorter PO hospital stay.

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Section: Introductionmentioning

confidence: 99%

Opioid-Free Anesthesia for Laparoscopic Hysterectomy: Is it Appropriate?

Salem

2019

JAICM

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“…Г істеректомія є однією з найпоширеніших гінекологічних операцій, причому перевагу останнім часом надають саме лапароскопічним методам її проведення [1]. Вона вважається стандартом оперативного лікування у більшості жінок з лейоміомою матки [2].…”

Section: вариабельность сердечного ритма при лапароскопической гистерэктомии в зависимости от вида анестезии сп зайченко ра ткаченкоunclassified

Heart rate variability in laparoscopic hysterectomy depending on different types of anesthesia

Зайченко

Ткаченко

2021

RHW

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The objective: was to evaluate the effectiveness of various anesthesia options for laparoscopic hysterectomy, including low-opioid (LOA) and opioid-free anesthesia (OFA) by studying the dynamics of heart rate variability (HRV) indicators.Materials and methods. 102 patients were randomly assigned to 3 groups: 37 patients who received standard opioid anesthesia (control group), 33 women who received the LOA group, and 32 patients who received OFA.Results. Laparoscopic hysterectomy is accompanied by tension of the autonomic nervous system, especially its sympathetic link, which is manifested by an increase in the index of vago-sympathetic interaction at the traumatic stage of the operation. These changes were most significant in patients who received standard and opioid-free anesthesia, which indirectly indicates insufficient stress protection of these types of intraoperative anesthesia.Conclusions. The use of low-opioid anesthesia is accompanied by a greater stabilization of HRV indices, which indicates its sufficient autonomic protection during laparoscopic hysterectomy than standard and opioid-free anesthesia.

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“…Despite the known advantages of laparoscopic hysterectomy when compared to abdominal hysterectomy [ 3 ] and the recommendation of the American College of Obstetricians and Gynaecologists Committee Opinion regarding minimally invasive techniques for hysterectomy [ 4 ], the implementation of this novel surgical procedure, especially TLH, when the hysterectomy is performed entirely laparoscopically, including suturing of the vaginal cuff, has been slow in Australia and New Zealand, with reports that almost 40% of hysterectomies in Australia are performed using an open surgical approach or an abdominal hysterectomy [ 5 ]. Concerns regarding surgical complications, the paucity of surgical audits [ 1 ] and lack of adequate training have motivated the development of new protocols to improve the training of young gynaecologists [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Implementation of Total Laparoscopic Hysterectomy As the Default Technique and Lessons Learnt

Roman¹

2021

Cureus

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IntroductionConcerns about surgical complications and the paucity of surgical audits have been named as reasons for the slow implementation of total laparoscopic hysterectomy (TLH) in New Zealand and Australia, despite a majority of gynaecologists who would like to offer this less-invasive approach to their patients. Material and methodsThis study aims to assess the implementation of TLH as the default method of hysterectomy at a private institution in the Waikato region of New Zealand, and to identify factors related to the perioperative complications and to the failure to accomplish the above procedure laparoscopically in an unselected population.We present 1,287 cases collected over fourteen years with an emphasis on demographics, outcomes, indications for surgery, laparoscopic completion of the surgical procedure and perioperative major complications. ResultsOne hundred and fifty patients (11.7%) were nulliparous and 378 patients (29.4%) had a history of the previous laparotomy. The mean theatre time and SD was 144.84 ± 20.48 min; the mean blood loss was 137.24 ± 69 mL; the mean hospital stay was 2.07 ± 0.31 days; the median uterine weight was 177 g and the biggest uterus removed laparoscopically weighed 1,510 g. Twelve cases were converted to laparotomy (0.93%). The uterine weight had a statistically significant association with the conversion rate.The main indications for surgery were menorrhagia and/or recurrent dysmenorrhoea in 662 patients (51.4%) and fibroid uterus in 228 patients (17.7%). Six patients (0.47%) required blood transfusions. There was a total of 74 perioperative complications (5.7%) and 16 major complications (1.24%). BMI and uterine weight had a statistically significant association with major complication rates. Seven patients (0.54%) were reoperated as a result of a complication. ConclusionThe implementation of TLH as default is achievable and is a safe surgical option. BMI and uterine weight are factors associated significantly with major complications or conversion to laparotomy.

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How to train practising gynaecologists in total laparoscopic hysterectomy: protocol for the stepped-wedge IMAGINE trial

Cited by 13 publications

References 37 publications

Opioid-Free Anesthesia for Laparoscopic Hysterectomy: Is it Appropriate?

Opioid-Free Anesthesia for Laparoscopic Hysterectomy: Is it Appropriate?

Heart rate variability in laparoscopic hysterectomy depending on different types of anesthesia

Implementation of Total Laparoscopic Hysterectomy As the Default Technique and Lessons Learnt

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