Résumé
Objective To evaluate the value of gasless laparoscopic myomectomy(GLM)using a subcutaneous abdominal wall lifting system for leiomyomas.Methods The surgical outcomes,including operation time,intraoperative blood loss,recovery time of gastrointestinal function,hospital stay,complications,and cost of GLM using a subcutaneous abdominal wall lifting system(GLM group)and laparoscopic myomectomy with pneumoperitoneum(LM group)were compared.Results No intra-or post-operative complications occurred in both of the groups.No significant difference was found in the operation time and blood loss between the GLM and LM groups [(99.2?35.4)min vs.(102.7?28.8)min,t=-0.411,P=0.682;(77.0?48.3)ml vs.(89.6?53.8)ml,t=-0.940,P=0.351].While the GLM group had significantly shorter recovery time of gastrointestinal function and hospital stay [(1.8?0.5)d vs.(2.1?0.3)d,Mann-Whitney U=304.000,P=0.013;and(8.7?2.9)d vs.(10.3?3.1)d,t=-2.031,P=0.047],and lower cost [(6372.8?784.7)yuan vs.(7984.6?1048.7)yuan,t=-6.657,P=0.000].Conclusions Since GLM does no results in longer operation time and more blood loss than LM with pneumoperitoneum,it is suitable for large leiomyoma.The patients have quicker recovery,shorter hospital stay,and lower hospital cost after GLM.
Résumé
Objective To discuss the safety and efficacy of gasless laparoscopy in gynecological surgery.Methods A total of 58 patients who received gasless laparoscopic surgery from October 2006 to December 2007 were enrolled in this study.Among the patients,31 underwent ovarian cystectomy,23 received myomectomy,3 laparoscopic-assisted transvaginal hysterectomy(LAVH),and 1 salpingectomy(because of ectopic pregnancy).One trocar was used in 13 cases(ovarian cystectomy in 11 and myomectomy in 2) with the assistance of hysteroscopic resectoscopy,two trocars were employed in 27 cases(ovarian cystectomy in 11 and myomectomy in 16),and three trocars in 18 cases(ovarian cystectomy in 9,myomectomy in 5,LAVH in 3,and salpingectomy in 1).The instruments employed in this study were purchased from Daoke Co.Results All of the 58 surgeries were successfully completed.In the patients received ovarian cystectomy,the mean intraoperative blood loss was(46.8?10.1) ml(ranged from 10 to 200 ml),and the mean operation time was(66.3?6.7) min(30-150).While in the patients underwent myomectomy,the mean intraoperative blood loss was(94.3?8.2) ml(10-400),and the mean operation time was(104.3?6.7) min(60-180).For the 3 cases of LAVH,intraoperative blood loss was 100,200,and 150 ml;and operation time was 255,240,and 135 min,respectively.The salpingectomy was finished within 30 min.None of the 58 patients developed complications during and after the operations.They were discharged from the hospital in(7.9?1.6) days,and were followed up for 3 to 6 months,during which no complications occurred.Conclusions Gasless laparoscopic surgery is safe,effective,and minimally invasive for gynecological diseases.The procedure can be used for eldly patients and those who cannot tolerate general anesthesia due to cardiovascular diseases.