Learning Curve Analysis of Intracorporeal Cuff Suturing During Robotic Single-Site Total Hysterectomy

WOS: 000351481200012PubMed ID: 24952342Study Objective: To analyze the learning curve of intracorporeal cuff suturing during robotic single-site total hysterectomy. Design: Retrospective study (Canadian Task Force classification Setting: University hospital. Patients: Twenty-four patients with benign indications for hysterectomy. Interventions: Twenty-four patients who underwent robotic single-site total hysterectomy to treat benign indications were included in the study. Surgical procedures were performed by a single surgeon with extensive experience in laparoscopy, using the single-site platform of the da Vinci Surgical System. All vaginal cuffs were closed intracorporeally using semi-rigid single-site instruments. Measurements and Main Results: An exponential learning curve technique was used to analyze the learning curve. The overall mean (SD) vaginal cuff closure time was 23.2 (7) minutes. Learning curve analysis revealed a decrease in vaginal closure time after 14 procedures. Conclusions: An experienced robotic surgeon requires approximately 14 procedures to achieve proficiency in intracorporeal cuff suturing during robotic single-site total hysterectomy. Novel instruments that create perfect triangulation are needed to overcome the current challenges of suturing and to shorten operative time. (C) 2015 AAGL. All rights reserved

The Impact of Carbon Dioxide Pneumoperitoneum on Ovarian Ischemia-Reperfusion Injury during Laparoscopic Surgery: A Preliminary Study

WOS: 000432461700025PubMed ID: 29107119Study Objective: To investigate whether carbon dioxide pneumoperitoneum causes ischemia-reperfusion injury to the ovaries during laparoscopic surgery. Design: A prospective controlled clinical study (Canadian Task Force classification II-1). Setting: A tertiary academic center. Patients: Premenopausal women who underwent hysterectomy with bilateral salpingo-oophorectomy (HSO) via open abdominal and laparoscopic approaches between 2014 and 2015. Interventions: In both surgical approaches, unilateral oophorectomy was performed immediately after abdominal entry, and the remaining contralateral ovary was excised at the end of the hysterectomy in order to compare the effect of these surgical procedures on ovarian tissue. Additionally, plasma samples were collected at the following time points: (1) before abdominal entry, (2) at the end of hysterectomy, and (3) before contralateral oophorectomy. Plasma samples were assessed for biochemical oxidative stress markers malondialdehyde (MDA) and 8-hydroxy-2'-deoxyguanosine (8-OHdG). Ovarian tissue samples were assessed for MDA and further evaluated for ischemia-reperfusion injury using a histologic scoring method. Measurements and Main Results: Twenty premenopausal women undergoing HSO via open abdominal surgery (n = 10) and laparoscopy (n = 10) were included. Baseline characteristics (age, body mass index, parity, and gravida) and operative data (operative time, estimated blood loss, and intraoperative complication) were similar between groups. Perioperative plasma MDA levels, histologic scores, and tissue oxidative stress markers did not show a significant difference in either group or between groups. However, plasma 8-OHdG levels were significantly different when the second sample in the abdominal HSO group was compared with the first sample in the abdominal HSO group and the third sample in the laparoscopic HSO group (p =.012 and .001, respectively). Conclusion: Carbon dioxide pneumoperitoneum does not cause ischemia-reperfusion injury in the human ovaries at clinically safe levels of intra-abdominal pressure. (C) 2017 AAGL. All rights reserved.Ege University Scientific Research ProjectsEge University [2013-TIP 044]Supported by Ege University Scientific Research Projects (2013-TIP 044)

Which Should Be the Preferred Technique During Laparoscopic Ovarian Cystectomy: Hemostatic Sutures or Bipolar Electrocoagulation? A Randomized Controlled Prospective Study of Long-Term Ovarian Reserve

WOS: 000399044500008PubMed ID: 27436368The aim of the present study was to determine the long-term effects of different laparoscopic hemostatic techniques on ovarian reserve after ovarian cystectomy. Ninety patients with unilateral ovarian cysts were recruited and randomly distributed into 2 groups. Laparoscopic stripping cystectomy was performed in all patients. Afterward, cystectomy hemostasis was achieved via hemostatic suture or bipolar electrocoagulation. Serum levels of anti-Mullerian hormone (AMH) were determined preoperatively and postoperatively at 1, 3, and 12 months, and patients were evaluated for residual ovarian volume, antral follicle count, and pregnancy. The statistical difference was determined between the 2 groups in terms of AMH levels at 3 months (hemostatic suture group = 3.17 +/- 3.40 vs bipolar electrocoagulation group = 2.38 +/- 2.57, P = .006) and 12 months (hemostatic suture group = 3.71 +/- 3.09 vs bipolar electrocoagulation group = 2.78 +/- 2.85, P = .005). In addition, in the hemostatic suture group, there was no statistically significant difference between preoperative and postoperative AMH levels (P = .165) and between the postoperative antral follicle count (P = .779) and the residual ovarian volume (P = .248), whereas in the bipolar electrocoagulation group, postoperative AMH levels were lower than preoperative levels (P = .028) and postoperative residual ovarian volumes at 3 and 12 months were lower than those at 1 month (P = .001). Nonetheless, pregnancy rates were not significantly different (P = .546). Bipolar electrocoagulation is more destructive compared with hemostatic suture. However, the ovarian reserve does not decrease further during the follow-up period.Ege University Faculty of Medicine-Research Funds Project, Izmir, Turkey [2012-TIP-094]The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was funded by the Ege University Faculty of Medicine-Research Funds Project [grant number 2012-TIP-094, Izmir, Turkey]. Additionally, no commercial support was obtained for this study