Kovit Khampitak

Comparison of Laparoscopically Assisted Vaginal Hysterectomy and Abdominal Hysterectomy: A Randomized Controlled Trial

OBJECTIVE To compare intraoperative hemorrhage and other operative parameters after laparoscopically assisted vaginal hysterectomy (LAVH) versus total abdominal hysterectomy (TAH) for benign gynecologic conditions. DESIGN A prospective, randomized, controlled trial. MATERIALS AND METHODS Between April 2010 and March 2011, 50 Thai patients with strong indications for hysterectomy--with uterine sizes ≤16 weeks of gravid uterus and with no contraindications for open or laparoscopic surgeries--were randomly assigned for LAVH or TAH. MAIN OUTCOME MEASURES Intraoperative blood loss, operating time, postoperative analgesic requirements, perioperative complications, and duration of hospitalization. RESULTS Intraoperative blood loss was significantly less in the LAVH group (median 120 mL [range 50-300]) than in the TAH group (median 250 mL [105-800]) (median difference 130 mL, p <.001, 95% confidence interval [CI] 55-200). The LAVH group required significantly less postoperative morphine sulfate administration (median 3 mg [range 0-12]) than the TAH group (15 mg [6-24]) (median difference 9 mg, p <.001, 95% CI 9-12). The hospital stay for the LAVH group (median 3 days; range 2-7) was significantly shorter than that of the TAH group (median 4 days; range 4-5) (median difference 2 days, p <.001, 95% CI 1-2). The operating time was comparable between the 2 groups (median 100 minutes; range 50-240) for the LAVH and 115 minutes (range 60-200) for the TAH group (median difference 5 minutes, p =.592, 95% CI -15-25). There were no conversions from a LAVH to a laparotomy. CONCLUSIONS The LAVH has advantages over the TAH in that in the former there is less intraoperative blood loss, less postoperative morphine requirement, and a shorter duration of postoperative hospital stays.

The effect of peritoneal gas drain on postoperative pain in benign gynecologic laparoscopic surgery: a double-blinded randomized controlled trial controlled trial

Objectives To compare the effect of peritoneal gas drain on postoperative pain in benign gynecologic laparoscopic surgery and the amount of postoperative analgesic dosage. Methods The trial included 45 females who had undergone operations during the period December 2014 to October 2015. The patients were block randomized based on operating time (<2 and ≥2 hours). The intervention group (n=23) was treated with postoperative intraperitoneal gas drain and the control group (n=22) was not. The mean difference in scores for shoulder, epigastric, suprapubic, and overall pain at 6, 24, 48 hours postoperatively were statistically evaluated using mixed-effect restricted maximum likelihood regression. The differences in the analgesic drug usage between the groups were also analyzed using a Student’s t-test. The data were divided and analyzed to two subgroups based on operating time (<2 hours, n=20; and

Incidence of and risk factors for febrile morbidity after laparoscopic-assisted vaginal hysterectomy

2 hours, n=25). Results The intervention had significantly lower overall pain than the control group, with a mean difference and 95% confidence interval at 6, 24, and 48 hours of 2.59 (1.49–3.69), 2.23 (1.13–3.34), and 1.48 (0.3–2.58), respectively. Correspondingly, analgesic drug dosage was significantly lower in the intervention group (3.52±1.47 mg vs 5.72±2.43 mg, P<0.001). The three largest mean differences in patients with operating times of ≥2 hours were in overall pain, suprapubic pain at 6 hours, and shoulder pain at 24 hours at 3.27 (1.14–5.39), 3.20 (1.11–5.26), and 3.13 (1.00–5.24), respectively. These were greater than the three largest mean differences in the group with operating times of <2 hours, which were 2.81 (1.31–4.29), 2.63 (0.51–4.73), and 2.02 (0.68–3.36). The greatest analgesic drug requirement was in the control group with a longer operative time. Conclusion The use of intraperitoneal gas drain was shown to reduce overall postoperative pain in benign gynecologic laparoscopic surgery. The effects were higher in patients who had experienced longer operating times.

A New Concept for a “Vaginal Hysterectomy” Robot

Background The purpose of this study was to assess the incidence of and risk factors for postoperative febrile morbidity after laparoscopic-assisted vaginal hysterectomy (LAVH). Methods This retrospective study was carried out using the medical records of women with benign gynecologic conditions who underwent LAVH between June 2007 and May 2012 at Srinagarind Hospital in Thailand. Data were collected to assess baseline patient characteristics, occurrence of body temperature ≥38°C on two occasions at least 6 hours apart in the 24 hours following the surgical procedure, and possible risk factors related to postoperative febrile morbidity. Results In total, 199 women underwent LAVH during the study period. They had a mean age of 46±6 years, a mean body mass index of 24.0±3.2 kg/m2, a mean surgical duration of 134±52 minutes, median estimated blood loss of 200 mL, a mean total hospital stay of 5±2 days, and a mean postoperative hospital stay of 3±2 days. Postoperative febrile morbidity was documented in 31 cases (15.6%). The cause of postoperative fever was unknown in most cases, with only two cases having an identifiable cause. The risk of postoperative febrile morbidity was highest in women treated with more than two antibacterial agents and with a regimen of more than 3 days. Conclusion This study shows a moderately high rate of febrile morbidity after LAVH, for which the main risk factors were use of multiple drugs and doses for antibiotic prophylaxis.

Optimal port placement could improve the ergonomic design of laparoscope manipulating robot

The design concept of a novel vaginal hysterectomy robot which is composed of three compound robots is discussed. The results of in vitro mechanical evaluation of the first two prototypes are reported and ideas for future development discussed.

The Levels of Lycopene, α-Tocopherol and a Marker of Oxidative Stress in Healthy Northeast Thai Elderly

Laparoscope manipulating robot is useful for maintaining a stable view during a laparoscopic operation. However, a large apparatus can interfere with surgical space, set-up time and repositioning. Furthermore, it consumes a lot of initial and maintenance cost. Ten consecutive robotic assisted laparoscopic pelvic surgeries were performed in order to study the maximum and optimal motion-angle in difference port placements. The maximum horizontal angle(X) for right pelvic view (Mx Rt X) was 30 degree and the maximum horizontal angle(X) for left pelvic view (Mx Lt X) was -25 degree. The median of maximum vertical angle (Y) for upward motion (Mx Up Y) was 44 degree (range 32-55 degree) and the median of maximum vertical angle (Y) for downward motion (Mx Dn Y) was 24 degree. The median optimal angle in operation of right uterine horn was 14 degree (range 3-30 degree) in horizontal plane (Opt Rt X) and 28 degree (range 24-43 degree) in vertical plane (Opt Rt Y). The median optimal angle in operation of left uterine horn was -10 degree (range -4--25 degree) in horizontal plane (Opt Lt X) and 29 degree (range 24-51 degree) in vertical plane (Opt Lt Y). The median optimal depth (Z) of endoscope position in right uterine horn operation (Opt In Rt Z) was 9.5 cm (range 7.5-12.5 cm) and left(Opt In Lt Z) was 9.5 cm (range 6-12.5 cm). L, U, +1U ports were selected by an experience gynecologic laparoscopist as the suitable port mimicked to human pelvic surgery. Then we concluded that the endoscope camera needed to move from -30 degree to +30 degree in the left to right direction (X) and from 0 degree to +60 degree in the up/down (Y) direction and, 15 cm for in/out motion (Z) in order to reach the maximum angle for full pelvic operation. From this results, we hope to design an ergonomic robot with less interferes with the surgeon.