Single-incision total laparoscopic hysterectomy
Department of Gynaecological Endoscopy, BEAMS Hospital, 674, 16 Cross Road, Behind Khar Gymkhana, Khar Pali, Mumbai 400052, India.Journal of Minimal Access Surgery (Impact Factor: 0.81). 01/2011; 7(1):78-82. DOI: 10.4103/0972-9941.72389
Single-incision laparoscopic surgery is an alternative to conventional multiport laparoscopy. Single-access laparoscopy using a transumbilical port affords maximum cosmetic benefits because the surgical incision is hidden in the umbilicus. The advantages of single-access laparoscopic surgery may include less bleeding, infection, and hernia formation and better cosmetic outcome and less pain. The disadvantages and limitations include longer surgery time, difficulty in learning the technique, and the need for specialized instruments. Ongoing refinement of the surgical technique and instrumentation is likely to expand its role in gynecologic surgery in the future. We perform single-incision total laparoscopic hysterectomy using three ports in the single transumbilical incision.
- [Show abstract] [Hide abstract]
ABSTRACT: This paper presents findings on hysterectomy prevalence from a 2010 cross-sectional household survey of 2,214 rural and 1,641 urban, insured and uninsured women in low-income households in Ahmedabad city and district in Gujarat, India. The study investigated why hysterectomy was a leading reason for use of health insurance by women insured by SEWA, a women's organisation that operates a community-based health insurance scheme. Of insured women, 9.8% of rural women and 5.3% of urban women had had a hysterectomy, compared to 7.2% and 4.0%, respectively, of uninsured women. Approximately one-third of all hysterectomies were in women younger than 35 years of age. Rural women used the private sector more often for hysterectomy, while urban use was almost evenly split between the public and private sectors. SEWA's community health workers suggested that such young women underwent hysterectomies due to difficulties with menstruation and a range of gynaecological morbidities. The extent of these and of unnecessary hysterectomy, as well as providers' attitudes, require further investigation. We recommend the provision of information on hysterectomy as part of community health education for women, and better provision of basic gynaecological care as areas for advocacy and action by SEWA and the public health community in India.Reproductive health matters 05/2011; 19(37):42-51. DOI:10.1016/S0968-8080(11)37553-2 · 1.43 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: Total abdominal colectomy is the procedure of choice for debilitated patients with acute, medical refractory ulcerative colitis in our practice. A laparoscopic approach has been previously shown to be safe and effective, and has become our preferred strategy. This study illustrates the laparoscopic evolution towards a truly minimally invasive approach comparing three phases of a single colorectal surgeon experience. In May 2010 single incision laparoscopy was introduced in our practice and has become our preferred approach. Ten consecutive ulcerative colitis patients were case matched and compared with 10 previous laparoscopic-assisted (Feb 2003-Jan 2007) and 10 hand-assisted (Feb 2006-Apr 2010) total abdominal colectomies. Patient, disease and surgery-related factors were analyzed and short-term outcomes were compared. Given the study design, there were no differences in demographics, smoking history, disease duration and severity, nutritional and inflammatory parameters, and indication for surgery between groups. Single incision patients were more likely to have received immunosuppressive therapy within 30 days of the surgery (p = 0.016). In the single incision group we noticed significantly shorter duration of surgery (p < 0.001) and faster resumption of solid diet (p = 0.019) compared to the other groups. Other short-term outcomes did not differ between groups. Single incision laparoscopy offers a safe alternative to other laparoscopic approaches. Despite the higher technical complexity, the duration of surgery is shorter with faster resumption of oral intake. Studies with larger sample size and longer follow-up will be required to confirm the benefits of this approach.Journal of Gastrointestinal Surgery 09/2011; 15(11):1909-16. DOI:10.1007/s11605-011-1666-8 · 2.80 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: A three-stage restorative proctocolectomy with ileal pouch-anal anastomosis is the treatment of choice for the particularly debilitated patient with medically refractory ulcerative colitis (UC). Laparoscopic surgery has been shown to offer several advantages over the open approach in this setting. Single-incision laparoscopic surgery is an emerging minimally invasive strategy representing a truly scarless procedure for the first surgical step, namely, the total abdominal colectomy (TAC). Nine consecutive patients with medically refractory UC underwent a single-incision laparoscopic TAC between May and October 2010. All patients were on aggressive medical therapy with corticosteroids or immunosuppressors and were selected for this approach on the basis of their body habitus and the absence of relevant comorbidities. The whole operation was performed through a single access to the abdominal cavity, placed at the ostomy site marked preoperatively. Mean operating time was 142 ± 23 min, with an estimate blood loss of 108 ± 125 ml. No intraoperative complications or conversions to conventional laparoscopy or open surgery occurred. In all cases the postoperative course was uneventful. The return of bowel function was observed on postoperative day 1.7 ± 0.7, and patients could tolerate a solid diet on postoperative day 3 ± 0.5. The mean postoperative length of stay was 5.2 ± 1.3 days. In our experience, a single-incision laparoscopic approach to total abdominal colectomy for refractory ulcerative colitis has been shown to be safe and feasible. Initial results suggest that this technique can lead to improvements in short-term outcomes in selected patients.Surgical Endoscopy 09/2011; 26(3):862-8. DOI:10.1007/s00464-011-1925-5 · 3.26 Impact Factor
Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. The impact factor represents a rough estimation of the journal's impact factor and does not reflect the actual current impact factor. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.