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Risk factors for uterine rupture after laparoscopic myomectomy

Case reports for uterine rupture subsequent to laparoscopic myomectomy were reviewed to determine whether common causal factors could be identified. Published cases were identified via electronic searches of PubMed, Google Scholar, and hand searches of references, and unpublished cases were obtained via E-mail queries to the AAGL membership and AAGL Listserve participants. Nineteen cases of uterine rupture after laparoscopic myomectomy were identified. The removed myomas ranged in size from 1 through 11 cm (mean, 4.5 cm). Only 3 cases involved multilayered closure of uterine defects. Electrosurgery was used for hemostasis in all but 2 cases. No plausible contributing factor could be found in one case [corrected]. It seems reasonable for surgeons to adhere to techniques developed for abdominal myomectomy including limited use of electrosurgery and multilayered closure of the myometrium. Nevertheless, individual wound healing characteristics may predispose to uterine rupture.

Abdominal access in gynaecological laparoscopy: a comparison between direct optical and blind closed access by Verres needle

OBJECTIVEnComplications associated with initial abdominal entry are a prime concern for laparoscopic surgeons. In order to minimize first access-related complications in laparoscopy, several techniques and technologies have been introduced in the past years. This investigation compares two laparoscopic access techniques.nnnSTUDY DESIGNn194 women underwent laparoscopic surgery for simple ovarian cysts: 93 were assigned to direct optical access (DOA) abdominal entry (group I), and 101 women to classical closed method by Verres needle, pneumoperitoneum and trocar entry (group II). The following parameters were compared: time required for entry into abdomen, occurrence of vascular and/or bowel injury, blood loss. The results were analyzed using SAS software. p-value<0.05 was considered as significant.nnnRESULTSnNo statistically significant differences were observed in the occurrence of blood loss and minor vascular injury between the two techniques, as well as minor bowel injuries; time for of abdominal entry, instead, were significantly reduced in the DOA group.nnnCONCLUSIONSnThe results of the preliminary comparison between the DOA and the Verres methods, commonly used by gynecologists, suggests that the visual entry system confers a statistical advantage over closed entry technique with Verres needle, in terms of time saving and due to the minor vascular and bowel injuries, thus enabling a safe and expeditious, visually-guided, entry for surgeons.

Small Bowel Obstruction Associated With Use of a Gelatin-Thrombin Matrix Sealant (FloSeal) after Laparoscopic Gynecologic Surgery

We report 2 cases of laparoscopic gynecologic procedures, complicated by small bowel obstruction possibly related to use of a hemostatic agent. The cause was most likely from excess material not incorporated in the hemostatic clot at the site of application. Gentle irrigation and removal of excess material from the site of application is recommended by the manufacturer of FloSeal and may reduce the risk of postoperative adhesion formation and small bowel obstruction.

Initial laparoscopic access in postmenopausal women: a preliminary prospective study

Objective: Estrogen loss at menopause has a profound influence on skin, with postmenopausal atrophy and loss of tone and elasticity. Because more than 50% of major laparoscopic complications occur during initial entry under the abdominal skin, the efficacy and the safety of two laparoscopic access techniques were compared in postmenopausal women. Methods: One hundred eighty-six postmenopausal women underwent laparoscopic surgery for simple ovarian cysts: 89 were assigned to direct optical access (DOA), abdominal entry (group I), and 97 to the classic closed Veress needle approach, pneumoperitoneum, and trocar entry (group II). The following parameters were compared: time needed for entry into the abdomen, occurrence of vascular and/or bowel injury, and blood loss. Results were analyzed using SAS software, considering P value less than 0.05 as significant. Results: No statistically significant differences were observed in the occurrence of major vascular and/or bowel injury between the two techniques (P > 0.05), whereas time for abdominal entry was significantly reduced in the DOA group, as well as the occurrence of minor vascular injuries (P < 0.05). Conclusions: Results of this preliminary comparison on the DOA and the Veress methods, commonly used by gynecologists, suggest that the visual entry system offers a statistical advantage over the closed Veress needle approach, in terms of time saving and limiting minor vascular injuries, thus enabling a safe and fast visually guided entry in postmenopausal women.

Abdominal access in gynaecologic laparoscopy: a comparison between direct optical and open access.

BACKGROUNDnMore than 50% of major laparoscopic complications occur during the initial entry into the abdomen. We investigated the efficacy and the safety of two laparoscopic access techniques: the direct optical access (DOA) versus the classical open entry, as described by Hasson.nnnMATERIALS AND METHODSnTwo hundred and two premenopausal women, homogeneous in age, parity, and body mass index undergoing laparoscopic surgery for simple ovarian cysts, were prospectively, randomly assigned to either open or DOA abdominal entry for laparoscopic surgery. The following parameters were compared: duration of access for entry into the abdomen, occurrence of vascular and/or bowel injury, and blood loss. The results were analyzed by using SAS software (SAS Institute, Inc., Cary, NC), considering a P-value of <0.05 as significant.nnnRESULTSnNo statistically significant differences were observed in the occurrence of major vascular and/or bowel injury between the two techniques. However, time for establishment of abdominal entry was significantly reduced in the DOA group, as was the blood loss (P < 0.05).nnnCONCLUSIONSnThe results of this preliminary comparison on the DOA and the Hasson methods, commonly used by general surgeons and less frequently by gynecologists, suggest that the visual entry system confers a little statistical advantage over the traditional Hasson entry, in terms of safety, minimal time saving, and in reducing blood loss, allowing a safe, fast, visually guided entry.