Sterility of Selected Operative Sites During Total Laparoscopic Hysterectomy

Shockley, Marie E.; Beran, Benjamin; Nutting, Heather; Arnolds, Katrin; Sprague, M.L.; Zimberg, Stephen

doi:10.1016/j.jmig.2017.06.004

Cited by 7 publications

(5 citation statements)

References 14 publications

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“…A prior prospective study evaluated the concentration of bacteria at different steps and locations in TLH 10 and found that the abdominal field had more contaminants than the vaginal fornices. Our findings add to this small body of literature that treating the vagina, perineum, and abdomen as a single, continuous operative field may be acceptable and warrants additional research.…”

Section: Discussionmentioning

confidence: 99%

Surgical Field Separation in Total Laparoscopic Hysterectomy

Meyer,

Niino,

Schneyer

et al. 2024

Obstetrics &Amp; Gynecology

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We aimed to study whether separating the vaginal and abdominal surgical fields during total laparoscopic hysterectomy (TLH) is associated with surgical site infection rates. This was a retrospective cohort study of all patients who underwent TLH and any concomitant procedures with two minimally invasive gynecologic surgery subspecialists between January 2016 and May 2023. Among 680 included patients, the rate of infection was 0.8% with surgical field separation and 1.3% without (3/377 vs 4/303; odds ratio 0.60, 95% CI, 0.13–2.70). There was no statistical difference between groups; however, the difference in infection rates between groups was extremely small, which led to inadequate power. Our findings suggest that rates of infection after TLH are low, with or without surgical field separation. Treating the vagina, perineum, and abdomen as a single, continuous operative field during TLH may be an acceptable practice.

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Section: Discussionmentioning

confidence: 99%

Surgical Field Separation in Total Laparoscopic Hysterectomy

Meyer,

Niino,

Schneyer

et al. 2024

Obstetrics &Amp; Gynecology

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“…During total laparoscopic hysterectomy, some procedures (e.g. uterine manipulation and specimen delivery via colpotomy) may increase the risk of surgical site infection [30]. Considering the potential for intraoperative involuntary defecation, vaginal contamination is sometimes inevitable because of the anatomical proximity to the anus.…”

Section: Discussionmentioning

confidence: 99%

Effect of non-mechanical bowel preparation on postoperative gastrointestinal recovery after surgery of gynaecological malignant tumours: A randomised controlled trial

Wang

Xu²,

Li³

et al. 2022

Preprint

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Objective:To investigate the efcacy and safety of Non-mechanical bowel preparation in patients undergoing surgery of gynaecological malignant tumour.Methods: Patients (n=105) were randomized to receive mechanical bowel preparation（MBP）or Non-mechanical bowel preparation (Non-MBP). The primary outcomes were postoperative gastrointestinal function. Secondary outcomes included Postoperative complaints and plasma of D-lactate and diamine oxidase(DAO). Visualisation of the surgical field, involuntary defecation during surgery, operation time, wound healing, surgical site infection, length of hospital stay, andtolerance of mechanical bowel preparation.Results: Participants in the Non-MBP group exhibited shorter times until first bowel movement (27.87 vs. 29.48 h), first passage of flatus (50.96 vs. 55.08 h), and first passage of stool (75.94 vs. 98.50 h);they also exhibited fewer postoperative gastrointestinal symptoms, including nausea (18.9% vs. 38.5%), vomiting (26.4% vs. 51.9%), abdominal pain (34.0% vs. 78.9%), and bloating (3.8% vs.26.9%). The plasma D-lactate and DAO were significantly increased (2.93 vs. 5.68 nmol/mL and 20.46 vs. 54.49 ng/mL) after bowel preparation in the MBP group; but no differences in the Non-MBP group after bowel preparation. Compared with the MBP group, surgical field visualisation was superior (92.45% vs. 78.85%), and the operation time was shorter (173.58 vs. 203.88 min) in the Non-MBP group. Patients undergoing MBP complained of bloating (82.35%), unpleasant taste (78.43%), sleep disturbance (70.59%), nausea (68.63%), abdominal pain (64.71%), vomiting(45.10%), polydipsia (33.33%), dizziness (25.49%), and headache (7.84%).Conclusions: Non-MBP is more conducive to the recovery of postoperative gastrointestinal function after surgery of gynaecological malignant tumour.Trial registration number: Chictr.org.cn.( ChiCTR2200059101).

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“…In an observational study, Shockley and colleagues investigated the type and quantity of bacteria found intraoperatively on the abdomen, vagina, surgical gloves, instrument tips, and uterus at distinct time points during total laparoscopic hysterectomy. 17 They showed that in 98.9% of cultures, the overall bacterial concentrations did not exceed the threshold for infection. There was no bacterial growth from vaginal cultures, and the only samples with some bacterial growth belonged to the surgeon's gloves after specimen extraction; about one-third of samples showed growth after specimen extraction, but only 1 sample had a bacterial load above the infectious threshold of 5,000 colony-forming units per mL.…”

Section: Reducing Overage By Judicious Selection Of Surgical Devices ...mentioning

confidence: 98%

“…The authors therefore suggested that if a surgeon changes gloves, doing so after specimen extraction and before turning attention back to the abdomen for vaginal cuff closure may be most effective in reducing bacterial load. 17 Surgical site infection contributes to medical cost and likely medical waste as well. For example, surgical site infection may require prolonged treatments, tests, and medical instruments.…”

Section: Reducing Overage By Judicious Selection Of Surgical Devices ...mentioning

confidence: 99%

ObGyn’s steady progress toward going green in the OR—but gaps persist

Namazi

2023

OBGM

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Sterility of Selected Operative Sites During Total Laparoscopic Hysterectomy

Cited by 7 publications

References 14 publications

Surgical Field Separation in Total Laparoscopic Hysterectomy

Surgical Field Separation in Total Laparoscopic Hysterectomy

Effect of non-mechanical bowel preparation on postoperative gastrointestinal recovery after surgery of gynaecological malignant tumours: A randomised controlled trial

ObGyn’s steady progress toward going green in the OR—but gaps persist

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