Mini-laparoscopic Hysterectomy Can be Feasible and Safe in Most of the Cases for the Clinics Performing Laparoscopy as the Standard Route of Hysterectomy

Abstract

Objective: To evaluate the feasibility and safety of mini-laparoscopic hysterectomy (mLH). Design: Retrospective cohort study. Settings: Tertiary private hospital. Patients: 46 mLH were performed during the period between January 2016 and February 2018. Interventions: A total of 46 women underwent mLH. Median age was 48 years [range 38-71], and median body mass index was 23 [range 18-39]. 65,2% (n = 30) of patents had at least one abdominal surgery, including caesarean section, endometriosis surgery, and myomectomy. Fibroids, adnexal masses, endometrial cancer and breast cancer were the main indications. The first entry into the peritoneal cavity was established through umbilicus with a 5-mm disposable trocar using direct trocar insertion technique. This port was used to introduce a 5-mm 30 0 telescope. A second 5-mm trocar was placed in the right lower quadrant for vessel sealing energy devices. Other ancillary trocars were inserted 3-mm (Karl Storz Endoscope mini-laparoscopy set). mLH was combined with bilateral salpingo-oophorectomy in majority (84,7%). Pelvic and paraaortic lymphadenectomy were performed in 7 patients with endometrial cancer. Measurements/Results: The mean operative time was 136 minutes with a mean CO2 consumption of 251 ml. There were no intraoperative complications. No conversion to either conventional laparoscopy or open surgery occurred. One patient had a severe bradycardia, and another patient had fever that dissolved at the second postoperative day. Median visual analogue scale scores were 2 [range 0-7) at 24 hours and 1 [range 0-7) at 3 days postoperatively. The average length of stay was 2 days [range 0-5], and the average time to return to everyday activities was 7 days [range 4-12]. Conclusions: Mini-laparoscopy provides similar instrument triangulation and dexterity requiring minimal additional training, besides its advantages in cosmetic outcome, postoperative pain, and port site complications. Minilaparoscopy can be feasible and safe in most cases in clinics performing laparoscopy as the standard route of hysterectomy.

Mini-Laparoscopic Gynecological Surgery Using Smaller Ports Minimizes Incisional Pain and Postoperative Scar Size: A Paired Sample Analysis

“…In our study, the use of smaller ports provide nearly scarless healing; however, no significant difference was observed between 2.4-mm and 3-mm ports. In our study cohort and our previous unpublished data, 10,22 the duration of mini-LS was not longer than con-LS and complication rates were similar. There was no intraoperative conversion from mini-LS to con-LS or open surgery.…”

“…All procedures were performed by 2 experienced surgeons (CT and DV) with ample experience in mini-LS. 10-12 The study was approved by the Koç University Institutional Review Board (2019.210.IRB1.033). Patients with chronic pain (n = 4), endometriosis with pain symptoms (n = 14), potentially pain-modifying diseases such as diabetes mellitus with microvascular complications, or peripheral neuropathy (n = 1) and patients aged >70 years (n = 2) were excluded.…”