Laparoscopic Salpingo-oophorectomy in Conscious Sedation

Abstract

Introduction:Conscious sedation has traditionally been used for laparoscopic tubal ligation. General anesthesia with endotracheal intubation may be associated with side effects, such as nausea, vomiting, cough, and dizziness, whereas sedation offers the advantage of having the patient awake and breathing spontaneously. Until now, only diagnostic laparoscopy and minor surgical procedures have been performed in patients under conscious sedation.Case Description:Our report describes 5 cases of laparoscopic salpingo-oophorectomy successfully performed with the aid of conventional-diameter multifunctional instruments in patients under local anesthesia. Totally intravenous sedation was provided by the continuous infusion of propofol and remifentanil, administered through a workstation that uses pharmacokinetic–pharmacodynamic models to titrate each drug, as well as monitoring tools for levels of conscious sedation and local anesthesia. We have labelled our current procedure with the acronym OLICS (Operative Laparoscopy in Conscious Sedation). Four of the patients had mono- or bilateral ovarian cysts and 1 patient, with the BRCA1 gene mutation and a family history of ovarian cancer, had normal ovaries. Insufflation time ranged from 19 to 25 minutes. All patients maintained spontaneous breathing throughout the surgical procedure, and no episodes of hypotension or bradycardia occurred. Optimal pain control was obtained in all cases. During the hospital stay, the patients did not need further analgesic drugs. All the women reported high or very high satisfaction and were discharged within 18 hours of the procedure.Discussion and Conclusion:Salpingo-oophorectomy in conscious sedation is safe and feasible and avoids the complications of general anesthesia. It can be offered to well-motivated patients without a history of pelvic surgery and low to normal body mass index.

Comparison of novel two‐port and conventional multiport laparoscopic surgery approaches for benign adnexal masses: The Bagli method

“…Rosatti et al published a case series including only five patients in the age range of 40s to 60s who underwent salpingo-oophorectomy by using three ports (10-mm trocar at umbilicus and two 5-mm trocar at left and right lower abdominal quadrant), and they changed the 10-mm optic with 5-mm optics for removing specimens from umbilicus. 27 In our study, we had no difficulty in performing our procedures as a result of not using an aid instrument to put specimens into the endobags. The general approach of inserting the mass into the bag is carried out in order to extend one of the 5-mm incisions to 10 mm, as well as to use at least one assisted laparoscopy instrument from another 5-mm port, under inspection with 10-mm optic in the umbilicus, even in developed and developing countries such as Finland and Turkey.…”

Operative Gynecological Laparoscopy Under Conscious Sedation

“…Patients could speak with the surgeon and the anesthetist whenever needed such as during pain mapping performed to identify the trigger points of chronic pelvic pain. 26 In the present study, we report a larger patient cohort obtained using the same procedure on patients with different surgical indications. In the current study, a higher level of sedation was required for port insertions and PNP induction.…”

“…2,3,4,8,46 -48 Conscious sedation offers the advantage of the patient being mostly awake or quickly arousable, and breathing spontaneously ( Table 4); furthermore, fast-track recovery may decrease hospitalization costs. 3,49 Our group recently published a case series of 5 patients undergoing bilateral salpingo-oophorectomy under conscious sedation [26]. In that report, we labelled the sedation procedure with the acronym OLICS (Operative Laparoscopy In Conscious Sedation), as all 5 patients included were able to follow their surgical procedures on the monitor.…”

“…With the same purpose, the multifunctional devices were helpful instruments, allowing for simultaneous cutting and sealing. 26 Low pressure of PNP (8 mm Hg) and gentle Trendelenburg position (15 degrees) were other key issues for maintenance of spontaneous breathing and minimizing heart complications and patient discomfort. Low pressure PNP may help decrease post-operative abdominal pain, shoulder pain, and PONV.…”

“…25 Rosati et al recently published a case series with 5 patients undergoing bilateral salpingo-oophorectomy under conscious sedation. 26 In that report, we labeled the sedation procedure Operative Laparoscopy in Conscious Sedation (OLICS). This retrospective observational study is focused on the feasibility and safety profile in a larger cohort of selected patients undergoing operative laparoscopy under conscious sedation with administration of local anesthesia.…”