The use of sealing hemostat patch (HEMOPATCH®) in laparotomic myomectomy: a prospective case–control study

Montera, Roberto; Ficarola, Fernando; Plotti, Francesco; Terranova, Corrado; Nardone, Carlo De Cicco; Guzzo, Federica; Angioli, Roberto; Luvero, Daniela

doi:10.1007/s00404-023-06957-2

Cited by 3 publications

(3 citation statements)

References 40 publications

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“…Finally, in our study, there was a significant reduction in LOS, which is one of the main goals of ERAS protocols, along with a reduction in postoperative stress and complication rates, in agreement with the literature [15][16][17][18][19]. This seems to be associated with better pain control by the LRA group compared to the N-LRA, which allows better recovery in the post-operative period.…”

Section: The Tap Block In Minor Gynecologic Surgerysupporting

confidence: 91%

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The Role of TAP/RS Block in Minor Gynecologic Laparoscopic Surgery: A Randomized Clinical Trial

Terranova,

Schiavoni,

Ficarola

et al. 2024

Gynecol Obstet Invest

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Objectives: The aim of the study is to compare, in patients undergoing minor gynecological laparoscopic procedures, the effects of Ultra Sound (US) guided Transversus Abdominis Plane (TAP) + Rectus Sheath (RS) block versus no TAP/RS-block in terms of post-surgical pain control using the Numeric pain Rating Scale (NRS) and the degree of patient satisfaction, according to the main goals of Early Recovery After Surgery (ERAS) programmes. The primary outcome is to value the postoperative abdominal pain using NRS in both groups. Secondary outcomes are to evaluate blood values, presence of postoperative nausea and vomiting (PONV), postoperative ileus, level of patient expected satisfaction, time of discharge, length of stay (LOS) and the amounts of additional analgesics required. Design: In this prospective randomized controlled trial patients were randomly assigned to Loco Regional Anesthesia (LRA) Group, who received TAP and RS block under US guidance, or No Loco Regional Anesthesia(N-LRA) Group. Enrolled patients were randomized 1:1 to either receive bilateral TAP/RS block with Ropivacaine or sham treatment (patches were applied on the abdominal wall of the patients under general anesthesia). Participants: All patients aged between 18 and 75 years, with ASA (American Society of Anesthesiologists) physical status 1 to 2, undergoing laparoscopic minor gynecological surgery, were enrolled. Setting: The study was conducted to the University of Campus Bio-Medico Hospital of Rome. Methods: Half an hour before surgery, all patients received Gabapentin 300 mg per os. Once the patient underwent general anesthesia, US-guided bilateral TAP/RS block was performed by the anesthesiology team, while the uterine manipulator was positioned by a gynecology resident (not involved in the study). In the operative room, all patients received the same standardized anesthetic regimen. Postoperative abdominal pain was assessed at rest, after palpation, during movement and after a cough by evaluating the patient at 6, 12, 18, 24, 36, 48, and 72 hours after surgery, using the NRS from 0 to 10 in both groups. The amount of drug used for analgesia in the first 48 hours after surgery was recorded. Moreover, hemoglobin, white blood cells, and c-reactive protein levels were recordered at 24, 48, and 72 hours. The presence of PONV and the postoperative ileus were recorded throughout convalescence. The expected level of patient satisfaction at discharge and finally the LOS were assessed. Limitations: The major weakness of this study is that 60 ml of 0.5% ropivacaine was administered to each patient, without considering weight differences, yet contemporary literature rarely suggests volume/dose titration in fascial blocks. Results: 104 women, undergoing gynecological minor laparoscopic surgery, were enrolled and assigned to LRA Group (53 pts) and N-LRA Group (51 pts). Postoperative pain was significantly reduced in patients who received TAP/RS block. A reduction in the intake of non-steroidal anti-inflammatory drugs after surgery was registered in LRA Group (p<0.01). Moreover, a significant reduction of LOS (45.97±9.87 vs 65.08±17.32 hours; p<0.01) and PONV was observed in the LRA Group, as well as a better level of patient satisfaction at discharge (9.43±0.94 vs 8.26±1.19; p<0.01), compared to the N-LRA Group. Conclusions: US guided TAP and RS block significantly reduces postoperative pain after minor gynecologic laparoscopic surgery and improves patients' post-operative recovery.

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Section: The Tap Block In Minor Gynecologic Surgerysupporting

confidence: 91%

“…the patient at 6,12,18,24,36,48, and 72 h after surgery, using the NRS from 0 to 10 in both groups. The amount of drug used for analgesia in the first 48 h after surgery was recorded.…”

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confidence: 99%

The Role of TAP/RS Block in Minor Gynecologic Laparoscopic Surgery: A Randomized Clinical Trial

Terranova,

Schiavoni,

Ficarola

et al. 2024

Gynecol Obstet Invest

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“…Despite the benefits offered by laparoscopy, maintaining hemostasis throughout the procedure can occasionally be challenging. Fortunately, several treatments are available for managing hemostasis during myomectomy, including uterotonics, vasopressin, antifibrinolytic drugs, gelatin-thrombin as a hemostatic sealant, peri-cervical mechanical tourniquet, or laser dissection ( 12 , 13 , 20 , 21 ).…”

Section: Discussionmentioning

confidence: 99%

Minimizing blood loss in laparoscopic myomectomy with temporary occlusion of the hypogastric artery

Balulescu,

Nistor,

Lungeanu

et al. 2023

Front. Med.

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IntroductionUterine leiomyomas are common benign pelvic tumors. Currently, laparoscopic myomectomy (LM) is the preferred treatment option for women in the fertile age group with symptomatic myomas. The authors hypothesize that combining LM with a bilateral temporary occlusion of the hypogastric artery (TOHA) using vascular clips minimizes uterine blood flow during surgery and can significantly reduce surgery-associated blood loss.Materials and methodsThis single-center, prospective randomized study was conducted at the Department of Obstetrics and Gynecology, Municipal Emergency Clinical Hospital Timisoara, Romania. Patients aged between 18 and 49 who preferred laparoscopic myomectomy and wished to preserve fertility were included, provided they had intramural uterine leiomyomas larger than 4 cm in diameter that deformed the uterine cavity. The study analyzed data from 60 laparoscopic myomectomies performed by a single surgeon between January 2018 and December 2020. Patients were randomly assigned to either: “LM + TOHA” group (29 patients), and “LM” group (31 patients). The study’s main objective was to evaluate the impact of TOHA on perioperative blood loss, expressed as mean differences in Hb (delta Hb).ResultsDelta Hb was statistically lower in the “LM + TOHA” group compared to “LM” group, with mean ± standard (min–max): 1.68 ± 0.67 (0.39–3.99) vs. 2.63 ± 1.06 (0.83–4.92) g/dL, respectively (p < 0.001). There was a statistically significant higher need for postoperative iron perfusion in the “LM” group, specifically 0 vs. 12 patients (p < 0.001), and lower postoperative anemia in “LM + TOHA” group (p < 0.001). Necessary artery clipping time was 10.62 ± 2.47 (7–15) minutes, with no significant impact on overall operative time: 110.2 ± 13.65 vs. 106.3 ± 16.48 (p = 0.21). There was no difference in the length of hospitalization or 12-month post-intervention fertility.DiscussionPerforming bilateral TOHA prior to laparoscopic myomectomy has proven to be a valuable technique in reducing surgery-associated blood loss, while minimizing complications during surgery, with no significant increase in the overall operative time.Clinical trial registrationISRCTN registry, (www.isrctn.com), identifier ISRCTN66897343.

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Efficacy and safety of robot-assisted laparoscopic myomectomy versus laparoscopic myomectomy: a systematic evaluation and meta-analysis

et al. 2023

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Objective Systematic evaluation of the efficacy and safety of robotic-assisted laparoscopic myomectomy (RALM) versus laparoscopic myomectomy (LM). Methods PubMed, Embase, The Cochrane Library, and Web of Science database were searched by computer to seek relevant literature in order to compare the efficacy and safety of RALM with that of LM from the establishment of the databases to January 2023, and Review Manager 5.4 software was utilized to perform a meta-analysis on the literature. Results A total of 15 retrospective clinical controlled studies were included. There exists a total of 45,702 patients, among 11,618 patients in the RALM group and the remaining 34,084 patients in the LM group. Meta-analysis results revealed that RALM was associated with lesser intraoperative bleeding (MD = − 32.03, 95%CI − 57.24 to − 6.83, P = 0.01), lower incidence of blood transfusions (OR = 0.86, 95%CI 0.77 to 0.97, P = 0.01), shorter postoperative hospital stay (MD = − 0.11, 95%CI − 0.21 to − 0.01, P = 0.03), fewer transitions to open stomach (OR = 0.82, 95%CI 0.73 to 0.92, P = 0.0006), and lower incidence of postoperative complications (OR = 0.58, 95%CI 0.40 to 0.86, P = 0.006) than LM, whereas LM is more advantageous in terms of operative time (MD = 38.61, 95%CI 19.36 to 57.86, P < 0.0001). There was no statistical difference between the two surgical methods in terms of maximum myoma diameter (MD = 0.26, 95%CI − 0.17 to 0.70, P = 0.24). Conclusion In the aspects of intraoperative bleeding, lower incidence of blood transfusions, postoperative hospital stay, transit open stomach rate, and postoperative complications, RALM has a unique advantage than that of LM, while LM has advantages over RALM in terms of operative time.

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The use of sealing hemostat patch (HEMOPATCH®) in laparotomic myomectomy: a prospective case–control study

Cited by 3 publications

References 40 publications

The Role of TAP/RS Block in Minor Gynecologic Laparoscopic Surgery: A Randomized Clinical Trial

The Role of TAP/RS Block in Minor Gynecologic Laparoscopic Surgery: A Randomized Clinical Trial

Minimizing blood loss in laparoscopic myomectomy with temporary occlusion of the hypogastric artery

Efficacy and safety of robot-assisted laparoscopic myomectomy versus laparoscopic myomectomy: a systematic evaluation and meta-analysis

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