Laparoscopic, minilaparoscopic, single-port and percutaneous hysterectomy: Comparison of perioperative outcomes of minimally invasive approaches in gynecologic surgery

Objectives During the last decade endoscopic surgical procedures have been constantly evolving. The latest innovation in ultra-minimally invasive surgery (MIS) is the percutaneous technology (Percuvance\ue2\u84\ua2 Percutaneous Surgical System (PSS), Teleflex Inc., USA). We compared surgical outcome of hysterectomy, in a retrospective cohort study using the most recent MIS techniques as single-site (LESS) surgery, 3\uc2\ua0mm laparoscopy (MiniLPS) and percutaneous system (PSS) with standard laparoscopy (LPS). Study design This is a matched retrospective cohort study. Endometrial Hyperplasia/Early stage endometrial cancer or benign pathology were the indication for surgery. Data of laparoscopic hysterectomies performed between May 2013 and April 2016 using PSS, LPS, MiniLPS, and LESS were collected and compared. Results The characteristics of each group were similar. The median Operative time (OT) was significantly longer in LESS compared to all other groups (120\uc2\ua0min [range 55\ue2\u80\u93165] in LESS, 91\uc2\ua0min [range 60\ue2\u80\u93180] in MiniLPS, 70\uc2\ua0min [range 55\ue2\u80\u93230] in LPS and 65 [range 40\ue2\u80\u93180] in PSS; p\uc2\ua0=\uc2\ua00.0001). No significant differences among the 4 groups were observed in terms of estimated blood loss, conversion to laparoscopy or laparotomy, and intra e post-operative complications. Statistically significant differences were recorded in median VAS 24\uc2\ua0h (2 [range 0\ue2\u80\u933] in PSS, 2 [range 0\ue2\u80\u933] in MiniLPS, 3 [range 2\ue2\u80\u935] in LESS and 2 [range 1\ue2\u80\u935] in LPS; p\uc2\ua0=\uc2\ua00.0001). The average time of discharge was (1\uc2\ua0day [range 1\ue2\u80\u933] in PSS, 1\uc2\ua0day [range 1\ue2\u80\u932] in MiniLPS, 1\uc2\ua0days [range 1\ue2\u80\u932] in LESS and 1\uc2\ua0day [range 1\ue2\u80\u933] in LPS; p\uc2\ua0=\uc2\ua00.99). Conclusions Data show that the effort to minimize the impact of surgical invasiveness can be feasible and could improve the advantages, not only in terms of aesthetic outcomes, even if the differences among the endoscopic approaches have not a relevant clinical impact. The technology innovations like PSS maintain the same triangulation between instruments as standard LPS with an evident decrease of the invasiveness thanks to reduced instruments size, even if the lack of suitability of bipolar energy, that require a multifunction instrument, remain a limit of these instruments

The Senhance™ surgical robotic system (“Senhance”) for total hysterectomy in obese patients: a pilot study

This pilot study was aimed to value the feasibility and safety of Senhance Robotic Platform for hysterectomy in obese patients. Ten obese patients (30 < BMI < 40) underwent elective Senhance total extrafascial hysterectomy with bilateral salpingo-oophorectomy at the Division of Gynecologic Oncology of “Policlinico A. Gemelli” Foundation, Rome, Italy. Perioperative and postoperative outcomes data were recorded. The median age was 60 years (range 51–75) and the median BMI was 33.3 kg/m2 (range 30.4–38.3). The median uterine weight was 112.5 g (range 77–225). Indication to total hysterectomy was early-stage (FIGO Stage IA) endometrial cancer in 100% of patients. The median operative time (OT) was 110 min (70–200). The median docking time was 10.5 min (5–25). The median estimated blood loss was 100 mL (50–200). No conversions to laparotomy were recorded. No intra- and 30-day postoperative complications were registered. The median ileus was 17 h (12–36) and the median time to discharge was 2 days (1–4). The median VAS scores registered at 2, 4, 12, and 24 h were, respectively, 2 (1–3), 2 (1–3), 4 (1–8), and 3 (1–5). Our study results suggest that Senhance platform could be safe for hysterectomy even in obese patients. More clinical data are needed to determine whether this approach would offer any additional benefits in a new middle line between standard laparoscopy and robotics

The Senhance \uae assisted laparoscopy in urogynaecology: case report of sacral colpopexy with subtotal hysterectomy with bilateral salpingo-oophorectomy for pelvic organ prolapse *: * Video Article, to see the video use this link: https://qrco.de/bbdi3G

The aim of this case report was to evaluate the feasibility, efficacy, and safety of nerve-sparing laparoscopic sacrocolpopexy (SCP) performed with a minimally invasive approach by using 2.9-mm Senhance \uae surgical robotic system (Senhance \uae , TRANSENTERIX Inc., USA). A 60-year-old Caucasian woman with symptomatic pelvic organ prolapse-Q (POP-Q) Aa: 2, Ba: 3, C: +4, Bp:2, Ap: 2, TVL:10 underwent subtotal hysterectomy with bilateral salpingo-oophorectomy, with nerve-sparing SCP performed using the Senhance surgical robotic system.. The urogynaecological assessment on the day of discharge and at the 3 month follow-up showed surgical anatomic success (<2 POP-Q stage). The patient was fully satisfied with the cosmetic result. This is the first case of SCP performed with this innovative system. SCP using "Senhance \uae" is a feasible and effective approach with good results in terms of operative time, cosmesis, postoperative pain and length of hospitalisation

Laparoscopic sacrocolpopexy plus ventral rectopexy for multicompartment pelvic organ prolapse

Background: Pelvic organ prolapse (POP) is a dynamic disorder that affects the entire pelvic diaphragm. POP may often involve multiple organs. Abdominal sacrocolpopexy is considered the gold standard to treat female anterior and apical prolapse. Abdominal ventral mesh rectopexy has gained increasing acceptance as an effective treatment for rectal prolapse. The aim of the present study was to assess the safety, feasibility and 1-year outcomes of laparoscopic sacrocolpopexy plus ventral rectopexy as a combined treatment of multicompartment POP. Methods: All female patients at our institution with anterior and apical prolapse with symptoms of obstructed defecation were examined by an urogynecologist and a colorectal surgeon, and were judged suitable for the study. Patients with Pelvic Organ Prolapse Quantification (POP-Q) system stage III and IV and concomitant rectal prolapse were treated by laparoscopic sacrocolpopexy plus ventral rectopexy. After surgery, 1- and 12-month follow-up was performed and the data were retrospectively analyzed. Patients' symptoms were evaluated using the Female Sexual Distress Scale (FSDS), Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire (PISQ-12), and Wexner-Agachan constipation score. Results: A total of 98 patients underwent surgery. No intraoperative or postoperative morbidity occurred. At the time of follow-up, all women expressed great satisfaction with the surgical treatment: all the patients had at most POP-Q Stage 1 and 78.8% had a Patient Global Impression of Improvement (PGI-I) score < 3. Significant improvement of symptoms related to POP and to obstructed defecation syndrome, as shown by the FSDS, PISQ-12, and Wexner-Agachan constipation score, was observed in all patients at follow-up CONCLUSIONS: Laparoscopic sacrocolpopexy with ventral rectopexy is a feasible and safe procedure for the combined surgical management of anterior, apical, and posterior prolapse, and provides excellent objective and subjective outcomes