Cosmetic outcome of skin adhesives versus transcutaneous sutures in laparoscopic port-site wounds: a prospective randomized controlled trial.

BACKGROUND: In an elective laparoscopic surgery, the cosmetic outcome becomes increasingly important. We conducted a study to evaluate the cosmetic outcome 3 months after a laparoscopic procedure and compared skin adhesive (SA) versus transcutaneous suture (TS). METHODS: A randomized, controlled, prospective study was conducted at a single study centre in Hamburg, Germany. Seventy-seven patients undergoing laparoscopic surgery with two lower abdominal port sites met the study requirements. It was decided randomly which port site would be closed with SA. The opposite site was closed with TS. Wounds were assessed after 7-12 days and after 3 months. Cosmetic outcome was measured by a visual analogue scale (VAS) completed by the patient, by the Hollander wound evaluation scale (HWES) and by the judgement of blinded investigators. RESULTS: Seventy-seven subjects were randomized. Complete data from the 3-month follow-up visit were available from 56 patients (72.7 %). The VAS scale ranged from 0 to 100 mm with "0" representing the best possible cosmetic outcome. Median satisfaction was 2 mm in the TS group and 3 mm in the SA group. The mean was high in both groups 4.6 (s = 13.1) versus 3.8 mm (s = 4.6). The outcome was neither clinically nor statistically significant. Cosmetic outcome was assessed by an investigator, and the HWES showed no difference. In regard to complications, no difference was found between SA and TS, either. CONCLUSIONS: In conclusion this study demonstrated that closure of laparoscopic port-site wounds leads to equivalent outcomes whether SAs or TSs are used. Complications are rare in both methods. Thus, SAs seem to be a valid alternative to sutures in laparoscopic surgery. Registration site: www.clinicaltrials.gov . REGISTRATION NUMBER: NCT02179723.

Congenital partial atresia of the Fallopian tube.

Partial tubal atresia is a rare anomaly of unknown pathogenesis. It can occur unilaterally or bilaterally, mainly including the proximal isthmic portion or the proximal ampullary segment ('mid-portion'), and is especially associated with uterine anomalies. Any more extensive pelvic surgery, including preoperative diagnosis of associated urological anomalies, must be well planned in such patients. Salpingostomy and fimbrial approximation is a realistic option in patients with congenital ampullary atresia who wish to have a child. A MEDLINE search was performed and 18 patients found with partial atresia of different tubal portions. This report describes a further patient and reviews the available literature.

NovaSure impedance-controlled system for endometrial ablation.

STUDY OBJECTIVE: To assess the efficacy and safety of the NovaSure endometrial ablation system in women with severe dysfunctional uterine bleeding (DUB). STUDY DESIGN: Prospective, single-arm, controlled, observational pilot study (Canadian Task Force classification II-1). SETTING: Free-standing center for gynecologic endoscopy. PATIENTS: One hundred seven premenopausal women whose menorrhagia was unresponsive to medical therapy, who had completed childbearing, and who had undistorted uterine cavities. INTERVENTION: Endometrial ablation with the NovaSure system. MEASUREMENTS AND MAIN RESULTS: Diaries were used to qualify patients for the study, as well as for posttreatment evaluation of menstrual blood loss and bleeding pattern (amenorrhea, spotting, hypomenorrhea, eumenorrhea, menorrhagia). No drug or mechanical endometrial pretreatment was administered. Position of the uterus was not a factor in patient selection. No intraoperative or postoperative complications occurred. Treatment time averaged 94 seconds. Of 107 women, 106 completed 6 months of follow-up and 105 had 12 months. Amenorrhea was 46% and 58%, respectively. CONCLUSION: The NovaSure System is safe and is effective in treating women with DUB. Endometrial pretreatment is not necessary, and presence of blood in the uterine cavity during treatment is not a limiting factor.