TOTAL ABDOMINAL LAPAROSCOPIC HYSTERECTOMY: 3-YEAR RESULTS
MediLuxLtd, Baku, AZERBAIJAN
Introduction. In case contraindications (ovarian cysts, internal endometriosis, pain syndrome of the small pelvis, simultaneous surgical diseases of the abdominal cavity) to vaginal hysterectomy (HE) open abdominal, including laparoscopic HE shall be preferred. In recent years LHE successfully replaced open abdominal HE for its significant advantages and favorable results.
Object: Investigation of the results of total laparoscopic extirpation of uterus.
Materials and methods. In 2005-2008 there was performed total abdominal LHE in 57 patients at the age of 47.8±1,3 (40-63) at the Female health center of the “Central clinical hospital” Ltd of the Special medical service under the President of the Republic of Azerbaijan. In 3 patients there was made conversion to open surgery because of intraoperative hypertension and hemorrhage. Indications for endo-operation include nodular myoma of uterus (in 37 patients), glandular hyperplasia of endometrium (45 patients), uterine prolapse (8 patients) and high-grade dysplasia of uterine cervix (5 patients).2 patients suffered from associated diabetes mellitus, 27 patients – from 2nd-3rd grade obesity. In 7 patients size of uterus was equal to the sizes of 6-7 week, in 23 patients – to 7-8, in 18 8-9, in 3 9-10, and in 3 10-11 week pregnant uterus. Laparoscopic surgery was performed by using Liga Sure cautery tool. After cauterization and cutting of uteral ligaments and vessels, it was mobilized up to the level of ostium externa, cut at that level and extracted from vagina. Ligaments were sutured intravaginally and the stump of the neck of uterus was closed. Total abdominal LHE was performed with the sized of the uterus up to 1 week-pregnant uterus. The morcellator was not used.
Results. In 47 patients total LHE was performed jointly with bilateral, in 3 patients with unilateral salpingo-ovariectomy, in 4 patients growthless LHE, and in 17 patients – simultaneous surgical operation (rear colporrhaphy – in 8 patients, plastic surgery on umbilical hernia – in 2, laparoscopic appendectomy- in 2, laparoscopic cholecystectomy – in 4 patients, lithotripsy – in 1 patient). Average term of the operation was 149.7,5±1,7 in average, and loss of blood was minimal (15.1-40.2 ml; 22,8±4,3 ml in average). After the operation average length of hospital stay was 3.14±1,1 days. After the operation in one patient developed suppuration of trocar wound, in one patient – long-term continuous enteroparesis. The complications were treated conservatively.
Conclusion. Total abdominal LHE may be widely applied in gynecological practice as minimally invasive method in diabetic and obese patients, as alternative of open surgery. Liga Sure cautery facilitates the performance of operation, reduced blood loss and duration of operation.
COMPARATIVE ANALYSIS OF THE RESULT OF HISTORECTOMY METHODS
T.BAYRAMOVA 1, H.BAGHIROVA
MediLuxLtd1, Azerbaijan Medical University, Baku, AZERBAIJAN
Introduction. Despite rapid recovery of patients and low occurrence of complications after vaginal hysterectomy (HE), 2/3 of such operations are carried out abdominally. According to the results of scientific investigations of the last decade, vaginal HE (VHE) is better than abdominal HE (AHE). Contraindication to VHE (adnexal mass, internal endometriosis, pain syndrome of small pelvis, simultaneous abdominal surgical diseases), creates necessity in the making abdominal, especially laparoscopic HE an operation of choice. Execution of VHE is usually impossible in patients that underwent abdominal surgical operation, in patients with narrow inguinal arch and narrow neck of uterus. Integration of new surgical technologies into gynecologic experience, training of specialized endosurgeons and gynecologists, the improvement of their practical experience causes the increase of LHE frequency due to AHE.
Materials and methods. The investigative work was carried out on 203 patients that underwent surgical treatment at Female health center of the “Central clinical hospital” Ltd of the Special medical service under the President of the Republic of Azerbaijan in 2005-2008. The patients underwent surgical operation – historectomy because of nodular myoma of uterus, bleedings which cannot be treated conservatively, benign and malignant tumors of uterus, prolapse of uterus and other diseases. In 54 patients (26%) laparoscopic, in 3 (1,5%) - vaginal, and in 146 (71,9%) patients - abdominal HE was carried out. The volume of HE was total (137 - 67,5%) and supracervical (9 - 4,4%).
Results. Surgical complications of LHE are rare(15.4%), and AHE complications are relatively frequently encountered (19.2%) complications. Blood loss during LHE was minimal (10.1-60.3 ml), and maximal - during AHE (123,4 – 308,5 ml, p<0.01). Blood loss during VHE constituted average 152.1-195.5 ml (p<0.01).
The term of hospital stay after LHE ranged between 3.14±1.1day, after VHE – between 4.2±1.1days, after AHE between 5.1±1.4 days. The value of p between vaginal and abdominal HE was >0.01. The value of p between laparoscopic and vaginal HE was <0.05. LHE operation was 1,5-2 times cheaper than VHE and AHE operations.
Surgical operations were classified into 2 groups: local and common. Both local and common complications occurred mainly after AHE (19.2%), and rarely after LHE (15.%) operations. Local complications after VHE constituted 11.7%, no common complication were observed.
Conclusion. Short-term of surgical operation, reduction of drugs expenses, esthetic view (especially for young women), reduction of hospital stay and medical and social rehabilitation terms, early restoration of labor activity are among significant advantages of laparoscopic HE method.
CHARACTERISTICS OF SUBEPITHELIAL LESIONS DETECTED ON ENDOSONOGRAPHY AND THE RELATIONSHIP BETWEEN SIZE OF LESION AND OTHER MORPHOLOGIC MALIGNITY CRITERIA
M. BEKTAS, O. KESKİN, S. AGAYEVA, H. ANİKTAR, A. TUZUN, H. CETİNKAYA,
B. OZTURK, P. KUBİLAY, G. PACACİ, H. BOZKAYA, R. İDİLMAN, A. R. BEYLER, K. BAHAR
Ankara University, Ankara, TURKEY
Introduction: On endosonographic examination, some characteristics of subepithelial lesions (eg. >3 cm in size, marginal irregularity, containing heterogenic areas for example echogenic focus or cysts in lesion, presence of lymph node) increase malignity potential.
Material-Methods: Between January 2010 and August 2011, subepithelial lesions has been identified in 78 patients on EUS Laboratory of Ankara University Medical School Gastroenterology Department. Data of these patients were studied. Median age was 57 (25-59); F/M:41/37. Lesions were classified according to long-axis diameter of the lesion (≥ 2 cm and <2 cm). Relationship between diameter of the lesion and other morphologic features (marginal irregularity, presence of heterogenic areas for example echogenic focus or cysts in lesion, presence of lymph node) have been investigated.
Results: Among 78 lesions, 41 lesions were found in the stomach; 20 in esophagus; 15 in duodenum and 2 in rectum. Mean diameter of the long axis of lesions and short axis of the lesions was 20.46 and 12.8 mm respectively. Endoscopy showed ulcers in 21 patients and erosions in 7 patients. Among 78 lesions; 46.2% of lesions was originated from muscularis propria; 35.9% muscularis mucosa; 15.4% submucosa; 1.3% serosa and 1.3% mucosa. 69.2% of the lesions was hypoechoic and 11.5% of them was iso-hypoechoic. Among EUS macroscopic malignite criteria, cystic areas in lesion, marginal irregularity, presence of lymph node and hyperechogenic streaking were detected in 11.5%, 9%,7.7% and 6.4% of patients respectively. Lesion long-axis size was ≥2 cm in 30 patients. Presence of lymph node, marginal irregularity and cystic areas in lesion were more frequent in patients with lesions ≥2cm than patients who have lesions <2 cm [(%20 vs %0.0,p=0.02); (%23.3 vs %0.0,p=0.001); (%26.7 vs %2.1, p=0.002) respectively. Ulcers detected more frequently in subepithelial lesions ≥2cm than in lesions <2cm but this is not statistically significant (%17.2 vs %4.3 p:0.07).
Conclusion: In this study, marginal irregularity, cystic areas and presence of lymph node was found in subepithelial lesions ≥2cm at statistically higher rates so biopsy should be taken from these lesions during EUS procedure.