Innovations in Minimally Invasive Gynecologic Surgery: Improving Outcomes and Recovery Gynecology

A paradigm change has occurred in minimally invasive gynecologic surgery (MIGS), which uses improved techniques and technology to improve patient care and recovery after surgery. This review paper provides a thorough analysis of current advancements in MIGS, emphasising its significant influence on surgical results and patient recovery. This research examines significant technical developments, procedural improvements, and their effects on how gynecologic surgery is evolving. The accuracy and effectiveness of MIGS have been redefined by technological advancements such as augmented reality, robotic-assisted surgery, sophisticated imaging modalities, and specialty equipment. By reducing invasiveness and revolutionising the surgical technique, these advancements provide improved visibility, surgical precision, and manoeuvrability. The paper goes into detail on how important these developments are for streamlining complex procedures and enhancing patient outcomes. The study also explores the development of improved recovery pathways in MIGS, highlighting early mobilisation, individualised care plans, multimodal pain management techniques, and psychological support. When these tactics are included into perioperative treatment, they greatly speed up patients' recuperation and enhance their general health. When comparing MIGS advancements to open operations, a critical examination shows that patients have less blood loss, shorter hospital stays, fewer complications, better pain management, and a speedier return to regular activities. Promising findings are also shown in long-term patient outcomes and safety profiles after MIGS treatments

Early recovery after surgery in elective obstetrics-gynaecology surgeries: prospective single-center pilot study

Background: Enhanced recovery after surgery (ERAS) programmes employed in elective colorectal, vascular, urologic and orthopaedic surgery has provided strong evidence for decreased hospital stay without increase in postoperative complications. The aim of the study was to explore role and benefits, if any, of ERAS/ERP (early recovery protocols) implemented in patients undergoing elective obstetrics-gynaecological surgeries.Methods: Prospective cohort of 48 consecutive patients undergoing elective obstetrics-gynaecological surgeries were included. ERP included early feeding, urinary catheter removal, mobilisation/physiotherapy, intravenous line removal and optimal oral analgesia. This was compared to control group of 50 patients undergoing similar operations prior to introduction of ERP, SPC group-standard perioperative care. Demographics and indications of surgeries were similar for both groups. The primary end-points were length of stay (LOS) and incidence of complications (Clavien-Dindo classification). Difference in means was tested using the t test assuming unequal variances. Statistical significance was defined as p<0.05.Results: Two groups, A (non-ERAS/SPC) and B (ERAS) were comparable with regards to demographics and indication of surgery. The mean time to solid diet, urinary catheter removal, mobilization, iv fluid removal and shift to oral analgesia was 2.57, 1.13 (p<0.00001), 1.99 ,1.03 (p<0.00268), 1.63, 1.2 (p<0.00001), 1.72, 1.14 (p<0.00001), 1.8, 1.37 (p<0.00001) days respectively. There were 31 and 21 complications in both groups, respectively (p<0.0097). Hospital stay was significantly shorter in the ERAS group, 2.87, 2.61 (p<0.0378).Conclusions: This pilot study shows that ERPs can be successfully implemented with significant shorter hospital stays without increase in postoperative complications in elective obstetrics-gynecology patients

INFLUENCE OF DIFFERENT TYPES OF ANESTHESIA FOR LAPAROSCOPIC HYSTERECTOMY ON THE DYNAMICS OF STRESS HORMONES

The aim of the study – to evaluate the influence of different variants of anesthesia, including low-opioid (LOA) and opioid-free anesthesia (OFA), on the dynamics of the stress response during laparoscopic hysterectomy. Materials and methods:&nbsp;102 patients were randomly allocated into 3 groups: 37 women assigned to receive a standard opioid-based anesthesia (OBA group), 33 women – LOA group and 32 patients OFA group. Results: The patients of OFA group after induction and intubation of the trachea showed a significant (p&lt;0.05) increase in cortisol level by 155.4 % and 160.9 % compared with the OBA group and LOA group. After completion of the hysterectomy, regardless of the variant of anesthesia, the level of cortisol exceeded the preoperative one (pOBA=0.116, pLOA=0.049, pOFA=0.043). Two hours after surgery with standard anesthesia (OBA group) there was a further increase in the concentration of cortisol in the blood, exceeding the initial values by 142.9 % (p=0.043). Patients in the LOA group and OFA group tended to decrease cortisolemia. The changes in adrenaline &amp; glucose levels were somewhat similar. Conclusion: Use of OFA is accompanied by an aggravation of the stress response at the stage of hysterectomy, which is manifested by an increase in the level of adrenaline and cortisol. The most adequate perioperative protection is inherent in low-opioid anesthesia, which is accompanied by a lower release of stress hormones during hysterectomy and in the postoperative period. Opioid-based anesthesia provides adequate intraoperative protection, but is accompanied by insufficient postoperative analgesia

A Pain Control Optimization Pathway to Reduce Acute Postoperative Pain and Opioid Consumption Postoperatively: An Approach to Battling the Opioid Epidemic

Practice Problem: Healthcare providers worldwide are working to battle the opioid epidemic and reduce opioid-related harm to patients. Utilizing evidence-based acute pain management methods to reduce opioid consumption is critical to combat the problem. PICOT: The PICOT question that guided this project was: In opioid-naïve adult patients undergoing general anesthesia for out-patient, minimally invasive abdominal wall hernia surgery, how does the implementation of an evidence-based, preventative Pain Control Optimization Pathway (POP) using a multimodal, opioid-sparing acute pain management technique and standardized procedure-specific opioid prescribing, compared to standard treatment, affect postoperative pain scores and opioid consumption, upon discharge from the recovery room and 72 hours postoperative? Evidence: Evidence supported utilizing a multimodal, opioid-sparing acute pain management technique, patient counseling, and opioid prescribing guidelines to improve outcomes among opioid-naïve patients undergoing abdominal surgeries. Intervention: In this pre- and post-intervention evaluation, N = 28 patients received the POP care process during the perioperative period. Outcome: Results showed the mean pain score at discharge from the recovery room decreased from 4.8 to 2.82 on the 10-point Numeric Rating Scale post-intervention (p\u3c 0.001). Also, provider compliance with prescribing a procedure-specific opioid prescription increased from 73% to 100%, thus reducing opioid exposure and access. Conclusion: This project provided evidence that utilization of the innovative POP care process provided optimal pain control and decreased opioid consumption, consequently reducing the risk of new persistent opioid use

A randomized double-blind study to evaluate asurgeon-based technique to reduce post-operative pain in minimal gynecological surgery

Background: The study aims to evaluate whether instillation of levo-bupivacaine intraperitoneally decreases post-operative pain after laparoscopic gynaecological surgeries, using VAS pain Scale. Methods: Randomized placebo controlled double blinded study conducted at tertiary care hospital in New Delhi. 90 ASA I &amp; II women scheduled to undergo elective laparoscopic gynaecological surgeries. 20 ml 0.5% levo-bupivacaine diluted with 40ml normal saline (total 60ml) intraperitoneally at the end of surgery before closure of ports along with port site infiltration of levo-bupivacaine (3-5 ml) in intervention group and 60 ml normal saline intraperitoneally in control group. Results: Mean pain scores were significantly lower (p&lt;0.01) in the intervention group when compared to the control group for initial 4 hours of the study after that mean pain score was lower in intervention group than control group but it was statistically not significant. The requirement of rescue analgesia was also significantly lesser in intervention group compared to control group. Conclusions: Levo-bupivacaine is an easy, cheap and non-invasive method which provides good analgesia in the immediate postoperative period after laparoscopic gynaecological surgery, without adverse effects, especially in the early postoperative period. This improves patients experience and should be made an integral part of all minimal gynaecological endoscopic surgery

Prospective randomized trial of iliohypogastric-ilioinguinal nerve block on post-operative morphine use after inpatient surgery of the female reproductive tract

<p>Abstract</p> <p>Objective</p> <p>To determine the impact of pre-operative and intra-operative ilioinguinal and iliohypogastric nerve block on post-operative analgesic utilization and length of stay (LOS).</p> <p>Methods</p> <p>We conducted a prospective randomized double-blind placebo controlled trial to assess effectiveness of ilioinguinal-iliohypogastric nerve block (IINB) on post-operative morphine consumption in female study patients (<it>n </it>= 60). Patients undergoing laparotomy via Pfannenstiel incision received injection of either 0.5% bupivacaine + 5 mcg/ml epinephrine for IINB (Group I, <it>n </it>= 28) or saline of equivalent volume given to the same site (Group II, <it>n </it>= 32). All injections were placed before the skin incision and after closure of rectus fascia via direct infiltration. Measured outcomes were post-operative morphine consumption (and associated side-effects), visual analogue pain scores, and hospital length of stay (LOS).</p> <p>Results</p> <p>No difference in morphine use was observed between the two groups (47.3 mg in Group I vs. 45.9 mg in Group II; <it>p </it>= 0.85). There was a trend toward lower pain scores after surgery in Group I, but this was not statistically significant. The mean time to initiate oral narcotics was also similar, 23.3 h in Group I and 22.8 h in Group II (<it>p </it>= 0.7). LOS was somewhat shorter in Group I compared to Group II, but this difference was not statistically significant (<it>p </it>= 0.8). Side-effects occurred with similar frequency in both study groups.</p> <p>Conclusion</p> <p>In this population of patients undergoing inpatient surgery of the female reproductive tract, utilization of post-operative narcotics was not significantly influenced by IINB. Pain scores and LOS were also apparently unaffected by IINB, indicating a need for additional properly controlled prospective studies to identify alternative methods to optimize post-surgical pain management and reduce LOS.</p

A systematic review and meta-regression analysis of prophylactic gabapentin for postoperative pain

We searched MEDLINE, Embase, CINAHL, AMED and CENTRAL databases until December 2014 and included 133 randomised controlled trials of peri-operative gabapentin vs placebo. Gabapentin reduced mean (95% CI) 24-h morphine-equivalent consumption by 8.44 (7.26–9.62) mg, p < 0.001, whereas more specific reductions in morphine equivalents were predicted (R2 = 90%, p < 0.001) by the meta-regression equation: 3.73 + (−0.378 × control morphine consumption (mg)) + (−0.0023 × gabapentin dose (mg)) + (−1.917 × anaesthetic type), where ‘anaesthetic type’ is ‘1’ for general anaesthesia and ‘0’ for spinal anaesthesia. The type of surgery was not independently associated with gabapentin effect. Gabapentin reduced postoperative pain scores on a 10-point scale at 1 h, 2 h, 6 h, 12 h and 24 h by a mean (95% CI) of: 1.68 (1.35–2.01); 1.21 (0.88–1.55); 1.28 (0.98–1.57); 1.12 (0.91–1.33); and 0.71 (0.56–0.87), respectively, p < 0.001 for all. The risk ratios (95% CI) for postoperative nausea, vomiting, pruritus and sedation with gabapentin were: 0.78 (0.69–0.87), 0.67 (0.59–0.76), 0.64 (0.51–0.80) and 1.18 (1.09–1.28), respectively, p < 0.001 for all. Gabapentin reduced pre-operative anxiety and increased patient satisfaction on a 10-point scale by a mean (95% CI) of 1.52 (0.78–2.26) points and 0.89 (0.22–1.57) points, p < 0.001 and p = 0.01, respectively. All the effects of gabapentin may have been overestimated by statistically significant small study effects

Transversus abdominis plane block after Caesarean section in an area with limited resources

Background: The primary objective of this study was to assess whether transversus abdominis plane (TAP) block is effective as part of multimodal pain management following Caesarean section in an area with limited resources. The study also looked at the advantage of this block in reducing the consumption of morphine and diclofenac postoperatively.Methods: After approval by the institutional ethics committee and informed consent of participants, 108 ASA I and II patients for Caesarean section under spinal anaesthesia were randomly allocated to either the TAP block group or the control. The TAP block group received a landmark-orientated, bilateral TAP block in the triangle of Petit. Postoperative pain treatment followed the same protocol for both groups. Visual analogue scale (VAS) pain scores were measured at 2, 4, 6, 8, 12, 18 and 24 h postoperatively. At the same time, consumption of diclofenac and morphine was measured and compared.Results: No adverse effects of the TAP block were detected. VAS pain scores were significantly lower in the TAP block group at rest, deep breathing, intentional coughing, and mobilisation in all cases (p &lt; 0. 05). Morphine and diclofenac consumption was significantly higher in the control group (p &lt; 0. 001).Conclusion: TAP block reduced the VAS pain scores significantly both at rest and during stressors. As a result, morphine and diclofenac consumption was significantly reduced in the TAP block group. Therefore, it is feasible to implement TAP block as part of a multimodal analgesia regimen after Caesarean section in a tertiary health care centre in a developing nation.Keywords: Caesarean section, pain management, regional anaesthesia, transversus abdominis plane block, visual analogue scal