Application of TSPV 4-step teaching in skill training of gynecologic laparoscopic surgery / 中华医学教育探索杂志

Objective:To explore the application and teaching effect of TSPV (short for theoretical teaching, simulated surgical skills training, practical surgery training, and video-based review) 4-step teaching in skill training of gynecologic laparoscopic surgery.Methods:A total of 30 trainees who participated in gynecologic laparoscopic surgery training were randomly divided into two groups, with 15 in each group. The experimental group received TSPV 4-step teaching, while the control group adopted traditional teaching and completed training and assessment in stages. The general data, training assessment results, teaching feedback and satisfaction survey of the two groups were compared and analyzed. SPSS 20.0 was used for t-test and Chi-square test. Results:There was no statistical difference in age, gender distribution, education background, clinical working experiences and other general data between the two groups. There was no significant difference in the theoretical examination scores between the two groups [(85.3±4.6) vs. (83.4±4.3), P=0.252]. The scores of simulated operation assessment [(91.7±5.2) vs. [(72.4±5.9), P<0.001] and clinical practice assessment [(88.5±4.8) vs. (82.7±6.7), P=0.011] in the experimental group were better that those in the control group. In addition, the experimental group had a better overall evaluation of teaching satisfaction. Conclusion:TSPV 4-step teaching is a more optimized and popular gynecologic laparoscopic training mode, which is recommended to further promote the validation in teaching.

Combination of a pulmonary recruitment maneuver and intraperitoneal bupivacaine for the reduction of postoperative shoulder pain in gynecologic laparoscopy: a randomized, controlled trial

OBJECTIVE: To compare the efficacy of a pulmonary recruitment maneuver using lower airway pressure (30 cm H2O) and intraperitoneal bupivacaine, alone or in combination, for reducing shoulder pain after gynecologic laparoscopy.METHODS: A prospective controlled study was performed in a teaching hospital with patients who underwent elective gynecologic laparoscopic surgery. Two hundred eighty-seven patients were randomized into 1 of 4 groups: group A, placebo; group B, intraperitoneal instillation of bupivacaine; group C, CO2 removal by a pulmonary recruitment maneuver; group D, combination of intraperitoneal bupivacaine and pulmonary recruitment maneuver. The interventions were performed at the end of surgery. Shoulder pain was recorded on a visual analog scale (VAS) at 1, 6, 12, and 24 hours postoperatively.RESULTS: The overall incidence of shoulder pain was 49.8% and the incidence tended to gradually decrease from group A to group D (59.0% in group A, 54.8% in group B, 44.4% in group C, and 41.5% in group D; P=0.026). In addition, the VAS scores gradually decreased from group A to D, although a statistically significant difference was only found at 6 hours postoperatively (P=0.03). There were no complications related to the interventions.CONCLUSION: The combination of a pulmonary recruitment maneuver with intraperitoneal bupivacaine significantly reduced shoulder pain after gynecologic laparoscopy.TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01039441

Intraocular Pressure Changes during Gynecologic Laparoscopy in Patients Anesthetized with Propofol versus Desflurane

BACKGROUND: Gynecologic laparoscopic surgery requires head-down position, so intraocular pressure can increase. It was reported that desflurane maintained low IOP values during anesthesia. The aim of this study was to investigate IOP changes after pneumoperitoneum with positional change from the supine position to head down under either desflurane or propofol anesthesia. METHODS: Forty two patients scheduled for gynecologic laparoscopy were enrolled. They were randomly allocated into propofol and desflurane group. In the propofol group, anesthesia was induced and maintained with propofol. In the desflurane group, anesthesia was induced with thiopental sodium and maintained with desflurane. Ventilation was adjusted to maintain normocarbia and MBP, HR, peak inspiratory pressure, ETCO2, IOP of both eyes were measured at the following time points: awake supine position for baseline, after anesthetic induction, at 5 min, 10 min and 20 min after peumoperitoneum. At each time point, IOP of each eye was measured three times with the handheld tonometer (Tono-pen(R)XL) and mean value was recorded. RESULTS: Different pattern of IOP change was shown between two groups. IOP decreased after induction and increased significantly after peumoperitoneum with head-down position in both group. In the desflurane group, however, IOP after pneumoperitoneum increased so highly and exceeded the preoperative IOP values (P < 0.001). In contrast, IOP of the propofol group kept similar to baseline value. A correlation was found between MAP and IOP values in the desflurane group. CONCLUSIONS: In gynecologic laparoscopy, propofol may be a better choice rather than desflurane for the control of IOP during pneumoperitoneum.

Complications of gynecologic laparoscopy / 대한산부인과학회지

OBJECTIVE: to describe our experience and examine the frequency of gynecologic laparoscopy complication performed in a secondary care hospital. METHODS: We retrospectively studied 262 patients were treated by gynecologic laparoscopy (mean age 43 yrs). Period of study were from March 2003 through March 2005 in one teaching hospital. Data were analyzed using SPSS for windows software. Frequency and descriptive statistics were calculated. RESULTS: The overall number of complication in 262 laparoscopies was 16 (6.1%). 5 ureter injuries, 3 stump disruption, 2 troca site hematoma, 1 bladder injury, 1 small bowel injury, 1 post operative bowel obstruction, 1 leg neuropathy, 1 leg weakness, 1 massive bleeding. The complication rates were analysed by type of surgery. We evaluated correlation with variable factors. Our complication rates were higher to those reported in the literature and were significantly different by type of surgery. Complications were related to variable factors of blood transfusion and anesthetic time. CONCLUSION: The complication rate occurred at higher rates in our institution. All patients complications developed were treated and none sustained long-term morbidity. However, operative laparoscopy should be performed carefully. Early recognition of injuries, preferably intraoperatively, with immediate appropriate treatment is crucial. It is also important to be alert to early manifestations of complications in the postoperative observation period.

The carbon dioxide insufflation volume required to attain adequate pneumoperitoneum in gynecologic laparoscopy patients

Objectives: The objectives of this study were to determine the carbon dioxide insufflation volume needed to attain pneumoperitoneum in patients who underwent gynecologic laparoscopic surgery and to determine if body mass index (BMI) and parity affected the carbon dioxide insufflation volume. Methodology: The insufflation volume of carbon dioxide was noted after a present pressure of 16 mm Hg was attained in the carbon dioxide insufflator for patients who underwent laparoscopy. Patients were grouped according to BMI and parity. The mean, standard deviation and range was computed for the carbon dioxide insufflation volume. One-way analysis of variance was used to determine the significance of BMI and parity in relation to carbon dioxide insufflation volume. Results: The mean carbon dioxide insufflation volume needed to for pneumoperitoneum was 3.15 liters. When grouped according to BMI and parity, there were significant differences in carbon dioxide insufflation volume.

Anesthetic Management during Laparoscopic Cystectomy in a Third Trimester Pregnancy: A case report / 대한마취과학회지

Pregnancy, especially in the third trimester, has been considered a contraindication of laparoscopic procedure because the effect of CO2 pneumoperitoneum on the fetus and uterine blood flow was unclear. However, the benefits of laparoscopic surgery such as less stress response and shorter hospital stay are postulated. Laparoscopic surgery may be beneficial in pregnant patients compared to open laparotomy, and the safety of laparoscopic operations in pregnant women is under investigation. The careful anesthetic management and close monitoring of patient and fetus will be helpful in making laparoscopic surgery safer in pregnant patients. We report the anesthetic management for laparoscopic surgery in a third trimester pregnant patient with torsion of an ovarian cyst. We monitored the intestinal mucosal CO2 using Tonocap, because we considered it could represent the uterine perfusion and intestinal CO2 status. Although the arterial and intestinal mucosal CO2 tension increased gradually during the operation, hypercapnia was not remarkable. The respiratory and monitored parameters were stable during the laparoscopic procedure. The patient has maintained uneventful pregnancy and delivered a healthy baby at 41 weeks of gestation.