Anton Langebrekke

Total Laparoscopic Hysterectomy with Single-Port Access without Vaginal Surgery

There has been increasing attention to decreasing incisional morbidity and improving cosmetic outcomes in laparoscopic surgery by using fewer and smaller ports. Hysterectomy through single-port access has been reported in which the cuff was closed transvaginally. We report total laparoscopic hysterectomy through a single-port without vaginal surgery. Using improved instruments and bidirectional self-retaining sutures, the laparoscopic technique is almost as easy to perform as with the traditional 4-port access. This case illustrates the advantages and limitations of single-access laparoscopy.

Parasitic leiomyomas after laparoscopic surgery with morcellation

Parasitic leiomyomas after laparoscopic surgery with morcellation are a rare entity, and only a few small series and single case reports have been published in recent years. This was first known as a spontaneously occuring condition, but in recent years it has been observed more frequently as an iatrogenic condition after morcellation, and may occur several years after primary surgery. We present three patients diagnosed in an eight year period, representing an incidence of 0.12% after morcellation procedures in our department. The mechanisms leading to parasitic leiomyomas are discussed, as well as how we should minimize the risk of development of this rare condition.

Abdominal hysterectomy should not be considered as a primary method for uterine removal: A prospective randomised study of 100 patients referred to hysterectomy

Objective. The present study is a prospective randomized comparison of laparoscopically assisted vaginal hysterectomy (LH) with total abdominal hysterectomy (TAH).

Comparison of Laparoscopy and Laparotomy in Patients with Endometrial Cancer

STUDY OBJECTIVE To evaluate results and feasibility of laparoscopic surgery in patients with stage I endometrial cancer. DESIGN Prospective, nonrandomized study (Canadian Task Force classification II-I). SETTING University tertiary referring center. PATIENTS Fifty-one women with stage I endometrial cancer followed for 1 year. INTERVENTION Laparoscopy (27 women) and open surgery (24). MEASUREMENTS AND MAIN RESULTS We recorded operating time, complications, and length of hospital stay. Operating time differed between groups, 87 versus 143 minutes for laparotomy and laparoscopy, respectively. Hospital stay was 6.2 days and 4.3 days, respectively. In the laparotomy group one patient experienced wound dehiscence and another had a vesicovaginal fistula requiring secondary repair. Complications in the laparoscopy group were one conversion to laparotomy because of bladder perforation and one case of septicemia that required laparotomy on the second postoperative day. Perioperative transfusions were administered to two women in the laparotomy group and none in the laparoscopy group. CONCLUSION Laparoscopy may play an important role in treatment of early endometrial cancer. The procedure is difficult, however, and should be reserved to dedicated laparoscopists. It has low morbidity and, contrary to earlier recommendations, may be performed in older women with comorbidity.

Effectiveness of Abdominal Cerclage Placed via Laparotomy or Laparoscopy: Systematic Review

Preterm delivery remains a primary cause of neonatal morbidity and mortality. One cause of preterm birth is cervical incompetence. In women with a shortened or absent cervix or in those in whom previous vaginal cerclage failed, abdominal cerclage may be recommended. We performed a systematic literature search of PubMed, EMBASE, and the Cochrane database. Thirty-one eligible studies were selected. Six studies (135 patients) reported on the laparoscopic approach, and 26 (1116 patients) on the abdominal approach. Delivery of a viable infant at 34 weeks of gestation or more varied from 78.5% (laparoscopic) to 84.8% (abdominal). Second-trimester fetal loss occurred in 8.1% (laparoscopic) vs 7.8% (abdominal), with no reported third-trimester losses (laparoscopic) vs 1.2% (abdominal). We conclude that abdominal cerclage is associated with excellent results as treatment of cervical incompetence, with high fetal survival rates and minimal complications during surgery and pregnancy. Further studies are needed to differentiate which method is superior.

Laparoscopic hysterectomy: Initial experience

Laparoscopic hysterectomy is now being performed in our department in cases where no malignancy is suspected. This study presents the first 10 cases. Indications for hysterectomy were myomas, meno‐ and metrorrhagia resistant to medical and hysteroscopic treatment, and patients with pain and suspicion of having adenomyosis. No complications have been encountered during the laparoscopic operations, but one patient had a second laparoscopy on the first postoperative day due to postoperative bleeding. Another patient had a postoperative infection leading to a compression of the ureter. This report demonstrates that laparoscopic hysterectomy is a valuable addition to the new procedures in ‘minimal invasive surgery’, but only after long and appropriate training.

A randomized trial comparing monopolar electrodes using glycine 1.5% with two different types of bipolar electrodes (TCRis, Versapoint) using saline, in hysteroscopic surgery

OBJECTIVE To compare three types of equipment during hysteroscopic resection. DESIGN A randomized study. SETTING Womens clinic at Ullevaal University Hospital, Oslo, Norway. PATIENT(S) Two hundred premenopausal women with menorrhagia caused by dysfunctional bleedings, fibroids, or polyps. INTERVENTION(S) Hysteroscopic resection was performed either with monopolar electrodes using glycine 1.5% as irrigant or with two different types of bipolar electrodes (TCRis; Olympus, Hamburg, Germany and Versapoint; Gynecare, Menlo Park, CA) using saline as irrigant. MAIN OUTCOME MEASURE(S) Change in serum sodium as a result of irrigant consumption, operating time, and amount of tissue removed. RESULT(S) A statistically significant reduction in mean serum sodium from 138.7 mmol/L to 133.8 mmol/L was seen in the monopolar group, compared with the case of the saline groups with no reduction. The amount of resected tissue in the monopolar and TCRis group was approximately 1.00 g/min, compared with 0.65 g/min in the Versapoint group. Loss of fluid during the procedure was significantly higher in the two bipolar groups. CONCLUSION(S) Bipolar electrodes appear to have a safer profile compared with monopolar electrodes because of the unchanged serum sodium. Irrigant consumption was significantly higher in the two bipolar groups, without any side effects during or after the procedure. Furthermore, the TCRis loop appears to be superior to the Versapoint loop, as regards operating time and amount of tissue removed.

Surgery of borderline tumors of the ovary: retrospective comparison of short-term outcome after laparoscopy or laparotomy

Background. Laparoscopic management of borderline ovarian tumors is controversial. Objective. To retrospectively compare outcome after surgery by laparoscopy or laparotomy for borderline tumors. Methods. Ovarian tumors from all women operated at Ullevål University Hospital during a five‐year period were re‐evaluated histologically. Patients with borderline FIGO (International Federation of Gynaecology and Obstetrics) stage I tumors were retrospectively compared regarding surgery outcome following laparoscopy or laparotomy. Results. Histological re‐evaluation revealed only 3 misclassifications in 608 patients. Borderline tumors represented 36% of epithelial ovarian malignancies. The 107 borderline stage I included 52 serous, 53 mucinous, and 2 endometrioid tumors. Thirty‐eight patients were operated on primarily by laparoscopy and 69 by laparotomy (including 14 women starting with laparoscopy). In the laparoscopy group, more women were premenopausal (63% versus 35%, p = 0.01) and median tumor diameter was smaller (8.6 versus 16.4 cm, p<0.001) as compared to the laparotomy group. When tumor diameter exceeded 10 cm, intraoperative tumor rupture was significantly more frequent during laparoscopy than during laparotomy (p = 0.01). Less postoperative complications were seen after laparoscopic operations (p = 0.034), but laparoscopic surgeries were less extensive, without hysterectomy, as compared to laparotomy. During the 14–78 months follow‐up time, no relapse occurred in either group. After fertility‐sparing surgery, there was no statistical significant difference regarding successful pregnancies between the two groups. Conclusions. Laparoscopic treatment of borderline ovarian tumors is feasible if tumor is of moderate size (diameter below 10 cm), gives fewer complications, and shorter hospital stay. Long‐term follow‐up of larger materials is needed to determine the ultimate recurrence risk as well as fertility rates.

The laparoscopic Burch procedure. A preliminary report.

Laparoscopic retropubic colposuspension (Burch procedure) is now being performed in our department as the treatment for genuine stress urinary incontinence. This study presents the first eight cases. Our experience with the laparoscopic approach seems promising. The operative technique has been developed, and the method provides better visualization of the space of Retzius, the patients experienced minimal blood loss and a shorter hospital stay than with the laparotomy approach. Although short follow‐up, all the patients except one were continent after three months. This preliminary report demonstrates that laparoscopic Burch procedure may be a valuable addition to the new procedures in ‘minimal invasive surgery’.

Fertility outcome after treatment of tubal pregnancy by laparoscopic laser surgery.

In 150 women with tubal pregnancy consecutively treated over a two year period by laparoscopic techniques, 74 were treated conservatively by linear salpingotomy with carbon dioxide laser laparoscopy and 76 cases non‐conservatively through the laparoscope by salpingectomy. Between 15 and 37 months later all patients were contacted by means of questionnaires to evaluate subsequent fertility outcome. Sixty‐six percent (38/58) of those women who desired pregnancy after conservative laparoscopic treatment achieved an intrauterine pregnancy. The corresponding rate for women who desired pregnancy after salpingectomy was 45% (18/40). The recurrent ectopic pregnancy rates in the two groups were 7% (4/58) and 10% (4/40), respectively. This study confirms that tubal pregnancy can be appropriately managed by laparoscopic laser surgery with the advantages of minimal invasive techniques.