An Incidental Fallopian Tube Focal Serous Tubal Intraepithelial Lesion (STIL) Discovered on a Postoperative Pathology Report Following Hysterectomy and Salpingectomy: A Case Report.

A focal serous tubal intraepithelial lesion (STIL) is a rare lesion found on fallopian tubes that are characterized by atypical epithelial cells exhibiting morphological abnormalities with the accumulation of mutant p53 proteins. The p53 gene is a tumor suppressor gene, and when mutated gives rise to mutant p53 proteins that promote cancer cell growth and survival. We present a case of a 47-year-old gravida 2, para 2002 (G2P2) female who presented to the outpatient clinic with bilateral lower quadrant abdominal pain and back pain of four years' duration. The patient's history included endometriosis with lysis of adhesions and gynecological laparoscopy, leiomyomata, infertility, ovarian cyst, dysmenorrhea, two full term births, and Essure implants used for contraception; her family history included maternal grandfather with breast cancer. Multiple fibroids and endometriosis were confirmed on pelvic ultrasound (US) and magnetic resonance imaging (MRI). Due to worsening pain, the patient chose to have an elective hysterectomy and Essure implant removal with bilateral salpingectomy. The postoperative pathology report revealed a right fallopian tube with a STIL. Multiple genetic mutations are known to contribute to the development of STILs including p53 and the breast cancer gene (BRCA). There are two BRCA genes, BRCA1 and BRCA2, that have many functions including producing proteins that repair damaged DNA. When mutated, this allows cells to divide and change rapidly, leading to certain types of cancer. Given the patient's family history of breast cancer, the patient was tested for BRCA1 and BRCA2 for which the results were negative. However, even without having a BRCA mutation that is known to increase the risk of ovarian, fallopian tube, and peritoneal cancers, STILs continue to pose an increased risk of high-grade serous ovarian carcinoma (HGSOC). This case demonstrates the reasoning behind prophylactic salpingectomies alongside hysterectomies and the significance of the postoperative pathology report from gynecological procedures.

The effects of CO2 pneumoperitoneum at different temperature and humidity on hemodynamic and respiratory parameters and postoperative pain in gynecological laparoscopic surgery: A prospective randomized controlled study.

BACKGROUND: It is recommended to heat and humidity CO2 in laparoscopic surgery to prevent postoperative pain and hypothermia but information about its effects on hemodynamic and respiratory parameters is limited. We aimed to investigate the effects of standard and heated-humidified CO2 on hemodynamic and respiratory parameters, body temperature and pain in healthy patients. METHODS: One hundred patients who underwent total laparoscopic hysterectomy for benign pathology were divided into two groups: Group CD (cold-dry) patients were administered standard CO2, while Group HH (heated-humidified) patients were administered 95% humidified insufflation at 37 °C. Hemodynamic and respiratory parameters, body temperature, pain score and blood count parameters were recorded. RESULTS: A total of 96 patients were included in the study, taken from the 100 patients. Group HH (n:47) had only higher systolic blood pressure at 75, mean blood pressure at 50 and 55 and a lower heart rate between 15 and 45 min (p:0.049, 0.037, 0.013 respectively). Pain score, morphine consumption, end-tidal CO2 and arterial blood gas values were not different between the groups, with only body temperature from 40 min and minimum value being significantly higher (at a difference of 0.86-1.04 °C) in Group HH. Postoperative leukocyte, neutrophil and NLR (neutrophil-leukocyte ratio) were found to be higher in this group (p < 0.05). CONCLUSION: It has been found that both standard and heated-humidified CO2do not constitute a problem in terms of hemodynamic and respiratory parameters in healthy patients. The heated-humidified CO2group had only a higher core body temperature and inflammatory response. TRIAL REGISTRATION: NCT04508387.

Low-frequency electrical stimulation promotes the recovery of gastrointestinal motility following gynecological laparoscopy (Review).

The rapid recovery of gastrointestinal transit is critical for clinical recovery following laparoscopic procedures, including gynecological laparoscopies (GLs). Rehabilitation interventions post-surgery may provide significant prevention against early post-operative gastrointestinal motility disorders and maid aid in the acceleration of post-operative recovery in patients undergoing GLs. Among others, low-frequency electrical stimulation (LFES) has been demonstrated to pronouncedly mitigate the symptoms caused by gastrointestinal motility disorders; thus, this has attracted increasing attention over the past decade. The present study aimed to present an overview of the efficacy and application of LFES in gastrointestinal motility recovery following GL procedures.

Complications in laparoscopic and robotic-assisted surgery: definitions, classifications, incidence and risk factors - an up-to-date review.

Almost all gynecological and general-surgical operations are - or can be - performed laparoscopically. In comparison to an abdominal approach, the minimally invasive access offers several advantages; however, laparoscopy (both conventional and robotic-assisted) can be associated with a number of approach-specific complications. Although the majority of them are related to the laparoscopic entry, adverse events may also occur due to the presence of pneumoperitoneum or the use of laparoscopic instruments. Unfortunately, a high proportion of complications (especially affecting the bowel and ureter) remain unrecognized during surgery. This narrative review provides comprehensive up-to-date information about definitions, classifications, risk factors and incidence of surgical complications in conventional and robotic-assisted laparoscopy, with a special focus on gynecology. The topic is discussed from various perspectives, e.g. in the context of stage of surgery, injured organs, involved instruments, and in relation to malpractice claims.

The effect of opioid-free anesthesia on the quality of recovery after gynecological laparoscopy: study protocol for a prospective randomized controlled trial.

BACKGROUND: Because of the indiscriminate use of opioids during the perioperative period, opioid-free anesthesia (OFA) has been increasingly required. Nevertheless, the studies on the detailed techniques and effects of OFA are not sufficient. The Quality of Recovery-40 (QoR-40) questionnaire is a validated assessment tool for measuring recovery from general anesthesia. However, no study has used the QoR-40 to determine if OFA leads to better recovery than standard general anesthesia. Therefore, we aim to perform this study to determine the effects of OFA using dexmedetomidine and lidocaine on the quality of recovery as well as the various postoperative outcomes. METHODS: The participants (n = 78) will be allocated to one of the two groups; the study group will receive bolus and infusion of dexmedetomidine and lidocaine, and the control group will receive remifentanil infusion during general anesthesia for gynecological laparoscopy. The other processes including anesthetic and postoperative care will be performed similarly in the two groups. Intraoperative hemodynamic, anesthetic, and nociceptive variables will be recorded. Postoperative outcomes such as QoR-40, pain severity, and opioid-related side effects will be assessed. Additionally, an ancillary cytokine study (inflammatory cytokine, stress hormone, and reactive oxygen species) will be performed during the study period. DISCUSSION: This will be the first study to determine the effect of OFA, using the combination of dexmedetomidine and lidocaine, on the quality of recovery after gynecological laparoscopy compared with standard general anesthesia using remifentanil. The findings from this study will provide scientific and clinical evidence on the efficacy of OFA. TRIAL REGISTRATION: ClinicalTrials.gov NCT04409964 . Registered on 28 May 2020.

Laparoscopia de urgencia en la adolescente. A propósito de tres casos / Emergency laparoscopy in the adolescent. A report of three cases

Introducción: Está demostrada la importancia de la cirugía de mínimo acceso en las urgencias pediátricas a cualquier edad, por lo que constituye el enfoque actual tanto diagnóstico como terapéutico. Objetivo: Resaltar la utilidad de la laparoscopia para la cirugía de urgencia en las adolescentes. Presentación de casos: Tres adolescentes femeninas entre 14 y 18 años de edad, intervenidas por abdomen agudo quirúrgico por vía laparoscópica, se encontraron los siguientes hallazgos: Paciente 1: hemoperitoneo por quiste de cuerpo lúteo de ovario izquierdo, tratamiento por cirugía de mínimo acceso. Paciente 2: apendicitis aguda no complicada y quiste simple de ovario izquierdo no complicado, tratado por cirugía de mínimo acceso y la apendicectomía asistida. Paciente 3: torsión de quiste paraovárico de la trompa de Falopio derecha, tratamiento convencional a través de una minilaparotomía. Conclusiones: La laparoscopia de urgencia en estas adolescentes le facilitó al cirujano pediátrico un diagnóstico certero, con hallazgos ginecológicos transoperatorio y tratamiento quirúrgico variado a través de una cirugía mínimamente invasiva con múltiples ventajas para las pacientes(AU)

Introduction: The importance of minimal access surgery in pediatric emergencies at any age has been demonstrated, being the current diagnostic and therapeutic approach. Objective: To highlight the utility of laparoscopy for emergency surgery in adolescents. Case presentation: Three female adolescents between 14 and 18 years of age underwent laparoscopic surgery for acute abdomen. The main findings were: Patient 1: Hemoperitoneum due to corpus luteum of the left ovary, treated by minimal access surgery. Patient 2: Acute uncomplicated appendicitis and simple uncomplicated left ovary cyst, treated by minimal access surgery and assisted appendectomy. Patient 3: Torsion of the paraovarian cyst of the right fallopian tube, treated by conventional minilaparotomy. Conclusions: Emergency laparoscopy in these adolescents provided the pediatric surgeon an accurate diagnosis with intraoperative gynecological findings and varied surgical treatment through minimally invasive surgery, with multiple advantages for patients(AU)

Comparison of head-down lithotomy position and Trendelenburg position on cardiac output in patients undergoing gynecological laparoscopic surgery / 复旦学报（医学版）

Objective To compare the changes in cardiac output (CO) and other hemodynamic parameters in patients undergoing gynecological laparoscopic surgery in head-down lithotomy position and Trendelenburg position. Methods Sixty patients were divided into head-down lithotomy group and Trendelenburg group. CO was recorded as baseline by a noninvasive cardiac output monitor NICOM? system after the placement of patients. These measurements were also acquired when the patients were placed in the 30° head-down tilt(T0)following pneumoperitoneum establishment.Stroke volume(SV), heart rate(HR)and CO were monitored at 1-minute intervals thereafter for a total of 10 minutes(T1-T10),and mean arterial pressure(MAP)and total peripheral resistance(TPR)were monitored every 5 minutes. Results The reduction of CO in head-down lithotomy group was greater than that in Trendelenburg group(T0:-31％±19％ vs.-9％±34％;T1:-32％±18％ vs.-16％±38％;T2:-33％± 19％vs.-16％±26％;T3:-32％±22％vs.-16％±28％;T4:-31％±18％vs.-12％±38％;T5:-30％± 17％vs.-14％±37％;T6:-31％±17％ vs.-14％±33％,all P<0.05)during the first 6 minutes. MAP at baseline in head-down lithotomy group was significantly higher than that in Trendelenburg group[(97±11) mmHg vs.(85±6)mmHg,P<0.05].MAP decreased in head-down lithotomy group at T0(-8％±16％) and increased in Trendelenburg group at T5 and T10(T5:9％±15％,T10:12％±18％). Conclusion CO reduction was greater in patients in head-down lithotomy position than that in Trendelenburg position group during the first 10 minutes after adjusting the position following pneumoperitoneum establishment.

Opioid-Free Total Intravenous Anesthesia Improves Postoperative Quality of Recovery after Ambulatory Gynecologic Laparoscopy.

BACKGROUND: Gynecological laparoscopic surgery is commonly performed on an ambulatory basis under general anesthesia. The postoperative quality of recovery (QOR) should be considered one of the principal endpoints after ambulatory surgery. Total intravenous anesthesia (TIVA) with opioids is known to improve postoperative QOR after ambulatory surgery. However, opioids can be associated with an increased incidence of postoperative complications, which can affect postoperative QOR. The primary aim of this study was to compare the patient recovery using the QOR-40 at 24 h postoperative in ambulatory gynecological laparoscopy between opioid-free (OF) TIVA and opioid-based TIVA. SETTINGS AND DESIGN: A prospective, randomized, controlled, comparative study was conducted at the day surgery center. PATIENTS AND METHODS: Eighty females were included in the study. They were randomized into two equal groups: OF TIVA group with dexmedetomidine and propofol or opioid-based TIVA (O) group with fentanyl and propofol. The primary outcome was QOR-40 at 24 h postoperative, and the secondary outcomes were postoperative numerical rating scale (NRS), time to first rescue analgesia, number of rescue tramadol analgesia, and the incidence of postoperative nausea and vomiting. RESULTS: A statistically significant difference in total QOR-40 score at 24 h postoperative was observed between the groups (median [range] QOR-40 of 182.0 [164.0-192.0] in the OF TIVA group and 170.0 [156.0-185.0] in the O group; P = 0.03). OF group had significantly lower time to first rescue analgesia, maximum NRS pain scores, number of rescue tramadol analgesia, and ondansetron use. CONCLUSIONS: OF TIVA significantly improves postoperative QOR in patients undergoing ambulatory gynecological laparoscopic surgery.

Effect of multimodal intervention on postoperative nausea and vomiting in patients undergoing gynecological laparoscopy.

OBJECTIVE: Postoperative nausea and vomiting (PONV) is a common complication in patients undergoing gynecological laparoscopic surgery, and achieving good results is difficult with a single antiemetic method. This study investigated whether multimodal intervention can reduce PONV in patients undergoing gynecological laparoscopic surgery. METHODS: A total of 153 patients who underwent gynecological laparoscopic surgery were randomized into the control group and multimodal group. Patients in the multimodal group received dexmedetomidine 1 µg/kg intravenously 15 minutes before induction of anesthesia. A bilateral transversus abdominis plane block was performed with 0.375% ropivacaine 30 mL after induction of anesthesia. Scores of postoperative nausea and vomiting, the visual analog scale, and the Bruggemann comfort scale (BCS) were assessed 24 hours postoperatively. RESULTS: Nausea and vomiting scores were significantly lower at 2, 6, and 24 hours in the multimodal group compared with the control group. BCS scores were significantly higher at 0 to 24 hours in the multimodal group compared with the control group. CONCLUSIONS: Multimodal intervention improves PONV and increases patients' comfort. The multimodal approach can also enhance recovery after gynecological laparoscopic surgery.

Influence of Gas Pain, Post-operative Resilience, and Body Temperature Discomfort in Laparoscopic Myomectomy Patients after Thermotherapy.

PURPOSE: The purpose of this study was to investigate the effects of thermotherapy on gas pain, post-operative resilience, and body temperature discomfort among patients who received laparoscopic myomectomies. METHODS: The experimental group consisted of 62 patients with thermotherapy and the control group consisted of 60 patients. Thermotherapy was applied individually to the experimental group four hours after surgery. The collected data was analyzed using descriptive statistics, t-tests, χ²-tests, and repeated measures of analysis of variance, using IBM SPSS Statistics version 18. RESULTS: The results showed no significant interaction effect between the group and time of measurement in gas-related pain in the experimental group. For gas-related pain, there was significant difference in right shoulder pain at 24 hours (t=-4.222, p=.000), 48 hours (t=-3.688, p=.000), 72 hours (t=-2.250, p=.028), and left at 24 hours (t=-3.727, p=.000), 48 hours (t=-4.150, p=.000), and 72 hours (t=-2.482, p=.016) and both shoulders at 24 hours (t=-2.722, p=.009) and 48 hours (t=-2.525, p=.014). There was no significant difference in epigastric pain, excluding both epigastric pain at 48 hours (t=2.908, p=.005), 72 hours (t=3.010, p=.004), but there was a significant difference in objective body temperature discomfort (t=2.895, p=.008). CONCLUSION: Thermotherapy relieved shoulder gas-related pain and objective body temperature discomfort. It needs to be developed and applied to improve post-operative discomfort in patients with laparoscopic hysterectomies.

Influence of Gas Pain, Post-operative Resilience, and Body Temperature Discomfort in Laparoscopic Myomectomy Patients after Thermotherapy / 여성건강간호학회지

PURPOSE: The purpose of this study was to investigate the effects of thermotherapy on gas pain, post-operative resilience, and body temperature discomfort among patients who received laparoscopic myomectomies. METHODS: The experimental group consisted of 62 patients with thermotherapy and the control group consisted of 60 patients. Thermotherapy was applied individually to the experimental group four hours after surgery. The collected data was analyzed using descriptive statistics, t-tests, χ²-tests, and repeated measures of analysis of variance, using IBM SPSS Statistics version 18. RESULTS: The results showed no significant interaction effect between the group and time of measurement in gas-related pain in the experimental group. For gas-related pain, there was significant difference in right shoulder pain at 24 hours (t=-4.222, p=.000), 48 hours (t=-3.688, p=.000), 72 hours (t=-2.250, p=.028), and left at 24 hours (t=-3.727, p=.000), 48 hours (t=-4.150, p=.000), and 72 hours (t=-2.482, p=.016) and both shoulders at 24 hours (t=-2.722, p=.009) and 48 hours (t=-2.525, p=.014). There was no significant difference in epigastric pain, excluding both epigastric pain at 48 hours (t=2.908, p=.005), 72 hours (t=3.010, p=.004), but there was a significant difference in objective body temperature discomfort (t=2.895, p=.008). CONCLUSION: Thermotherapy relieved shoulder gas-related pain and objective body temperature discomfort. It needs to be developed and applied to improve post-operative discomfort in patients with laparoscopic hysterectomies.

Effects of dexmedetomidine as an adjunct in transversus abdominis plane block during gynecological laparoscopy.

Ultrasound-guided transversus abdominis plane (TAP) block for abdominal surgery has been widely studied in clinical settings. However, dexmedetomidine as an adjunctive analgesic combined with TAP block has been rarely reported. The present study evaluated the efficacy of TAP block combined with dexmedetomidine adjunct for gynecological laparoscopy. In brief, 90 patients were randomly divided into three groups: Group I, which received post-operative intravenous analgesia only after general anesthesia; Group II, which received a TAP block with 20 ml 0.375% ropivacaine; and Group III, which received a TAP block with 20 ml of 0.375% ropivacaine and 1 µg/kg dexmedetomidine after induction. In all groups, propofol was used for general anesthesia. The dosage of propofol, duration of the operation, and the time of awakening, spontaneous breathing and extubation were recorded. In addition, the Steward and visual analogue scale (VAS) scores were determined at 2, 4, 8, 12 and 24 h post-surgery. The occurrence of nausea and vomiting and/or respiratory depression was also recorded. Compared with those in Group I, the dosage of propofol, as well as the time of awakening, spontaneous breathing and extubation were significantly decreased in Group III (P<0.01 and P<0.05, respectively). In addition, the VAS score at 2 and 4 h in Group II (both P<0.05) and 2, 4 (both P<0.01) and 8 h (P<0.05) in Group III after the surgery were significantly lower compared with those in Group I. Furthermore, in Groups II and III, a lower number of cases experienced nausea and vomiting (P<0.05). In conclusion, the ultrasound-guided TAP block combined with dexmedetomidine adjunct may improve recovery from anesthesia and reduce post-operative pain (trial registration no. ChiCTR-IPR-15007398).

[Analysis of the entrance and suture method of umbilical incision in gynecological laparoscopy].

Objective: To explore the entrance and suture method of umbilical incision in gynecological laparoscopy. Methods: A total of 204 cases of gynecologic laparoscopy in our hospital from 2013 to 2016 were reviewed respectively. All the cases used two kinds of approach of umbilical incision: intra-umbilical incision and peri-umbilical incision (longitudinal/transverse oblique/arc incision according to the bellybutton natural skin folds) and two methods of suture: the suture of "U" and the suture of the whole subcutaneous tissue. Two groups were randomly assigned based on the entrance and suture method with each group 102 cases. The peri-operative outcomes were compared, including intra-operative and postoperative bleeding, postoperative incision fat liquefaction and infection, incision pain, incision appearance satisfaction and incision healing satisfaction. Results: The difference was statistically significant in the intra-operative and postoperative bleeding between two groups of intra-umbilical incision and peri-umbilical incision (P<0.05). There was statistically significant difference in postoperative incision fat liquefaction, infection and incision pain between two groups of the suture of "U" and the suture of the whole subcutaneous tissue (P<0.05). The incision appearance satisfaction showed no difference (P>0.05), but the difference was statistically significant (P<0.05) in the incision healing satisfaction between two groups. Conclusion: The peri-umbilical incision (longitudinal/transverse oblique/arc incision according to the bellybutton natural skin folds) and suture of the whole subcutaneous tissue can be the feasible modified methods with high practicability and security, good cosmetic result. It should be promoted in gynecologic laparoscopy.

Efficacy of ultrasound-guided transversus abdominis plane (TAP) block for preventive analgesia in patients underwent gynecological laparoscopy / 中国内镜杂志

Objective To evaluate the efficacy of ultrasound-guided transversus abdominis plane (TAP) block for preventive analgesia in patients undergoing gynecological laparoscopy. Methods 60 ASA physical status I ~ II, aged 30 ~ 50 yr, weighting 50 ~ 65 kg patients scheduled for elective gynecological laparoscopy were randomly divided into 3 groups using a random number table (n = 20 each): control group (group I), preoperative TAP block group (group II) and postoperative TAP block group (group III). Ultrasound-guided bilateral TAP block was performed before induction of anesthesia or at the end of surgery in II and III groups, respectively. Patient-controlled intravenous analgesia (PCIA) with 1μg/ml sufentanil (background infusion 2 ml/h, bolus dose 2 ml, lockout interval 15 min) was used until 2 days after surgery and VAS score was maintained ≤ 3. When VAS score > 3, flurbiprofen axetil 50 mg was injected intravenously as rescue medication. The consumption of sufentanil per hour, requirement for rescue medication, and development of adverse reactions were recorded within 24 h after surgery. Sufentanil-sparing degree was calculated. Results Compared with group I, the consumption of sufentanil per hour, requirement for rescue medication and the incidence of nausea and vomiting were significantly lower within 24 h after surgery in II and III groups (P < 0.05). The consumption of sufentanil per hour, requirement for rescue medication and the incidence of nausea and vomiting were significantly lower in group II than in group III (P < 0.05). The consumption of sufentanil was decreased by 35.0% in group II as compared with group I, and decreased by 16.0% in group II as compared with group III. Conclusion Ultrasound-guided TAP block can provide good postoperative analgesia in patients undergoing gynecological laparoscopy, and effect of preoperative nerve block is better than that of postoperative nerve block.

The effect of pressure-controlled inverse ratio ventilation on lung protection in obese patients undergoing gynecological laparoscopic surgery.

SPECIFIC AIM: To examine the effects of pressure-controlled inverse ratio ventilation (PCIRV) and volume-control ventilation (VCV) on arterial oxygenation, pulmonary function, hemodynamics, levels of surfactant protein A (SP-A), and tumor necrosis factor-α (TNF-α) in obese patients undergoing gynecological laparoscopic surgery. METHODS: Sixty patients, body mass index (BMI) ≥30 kg/m2, scheduled for elective gynecological laparoscopic surgery were enrolled in the study. Patients were randomly allocated to receive either PCIRV with an inspiratory-expiratory (I:E) ratio of 1.5:1 (PCIRV group n = 30) or VCV with an I:E ratio of 1:2 (VCV group n = 30). Ventilation variables, viz. tidal volume (V T), dynamic respiratory-system compliance (C RS), driving pressure (ΔP = V T/C RS), arterial blood oxygen partial pressure/fraction of inspiration oxygen (PaO2/FiO2) and arterial blood carbon dioxide partial pressure (PaCO2), were measured. Hemodynamic variables, viz. mean arterial pressure (MAP), heart rate (HR), and serum levels of SP-A and TNF-α, were also measured. RESULTS: When compared to patients in the VCV group, patients in the PCIRV group had higher V T, dynamic CRS, and PaO2/FiO2, and lower ΔP and PaCO2 at 20 and 60 min after the start of pneumoperitoneum (p < 0.05). Patients in the PCIRV group had lower SP-A and TNF-α levels at 24 and 48 h after surgery than those in the VCV group (p < 0.05). CONCLUSION: In obese patients undergoing gynecological laparoscopic surgery, PCIRV can improve ventilation, promote gas exchange and oxygenation, and is associated with decreased levels of SP-A and TNF-α. These effects demonstrate improved lung protection provided by PCIRV in this patient population.

Predictors of postoperative hemoglobin drop after laparoscopic myomectomy.

INTRODUCTION: Laparoscopic myomectomy (LM) can be associated with significant bleeding. AIM: To identify factors influencing the postoperative hemoglobin (Hb) drop after LM. MATERIAL AND METHODS: This is a retrospective, single-center study. We evaluated data of 150 consecutive patients undergoing LM due to intramural myomas between 2010 and 2015. RESULTS: The median age of the patients was 37 (23-53) years. The mean diameter of the largest myoma was 5.7 ±2.3 (1.5-12) cm. The mean surgical time was 83 ±38 (35-299) min. The median number of sutures was 3 (1-11). The mean postoperative Hb drop was 1.6 ±1.2 (0-6) g/dl, and the mean estimated blood loss was 261 ±159 (50-1700) ml. In the univariate analysis, the postoperative Hb drop correlated with the duration of surgery (p < 0.001), diameter of the largest myoma (p < 0.001), cumulative myoma weight (p < 0.001), and number of sutures (p < 0.001), but not with patients' age or number of intramural myomas. In the multivariable analysis, the surgical time (ß = 0.395, p < 0.001), diameter of the largest myoma (ß = 0.292, p = 0.03) and preoperative Hb concentration (ß = 0.299, p < 0.001) predicted the postoperative Hb change. CONCLUSIONS: Surgical time and dominant myoma diameter are independent predictors of the postoperative Hb drop after LM.

Assessment of Port-Specific Pain After Gynecological Laparoscopy: A Prospective Cohort Clinical Trial.

OBJECTIVE: To determine the association between pain related to laparoscopic port sites and different incision sizes after gynecological laparoscopy. DESIGN: Prospective, cohort trial Canadian Task Force classification 2-II. SETTING: Zhejiang Provincial People's Hospital, China. PATIENTS: Two hundred patients who underwent three-port laparoscopic gynecological procedures for benign indications. INTERVENTIONS: In total, 200 patients underwent laparoscopic gynecological procedures. Each patient had three incisions, one in the left lower abdomen, measuring 5, 10, or 15 mm based on the type of surgery, another measuring 10 mm in the umbilical port, and the third one measuring 5 mm, in the right lower abdomen. Port-related pain was registered and measured by visual analogue score (VAS). MEASUREMENTS AND MAIN RESULTS: The VAS score showed statistically significant differences between 5-, 10-, and 15-mm port sites at each time point (24 and 72 hours) (P < .05); the score elevated as the size of the incision increased. Pain was significantly lower at the umbilical port sites at 24 hours than in the left lower abdominal port sites with incisions of the same (10 mm) size (P = .013) and also significantly lower in the right lower abdominal port sites than in the left lower abdominal port sites with incisions of the same (5 mm) size (P = .041). Specimen extraction port significantly affected the 24-hour pain intensity, while specimen extraction port, surgical time, and previous abdominal surgery affected the 72-hour pain intensity. CONCLUSIONS: The size of port sites is the most important factor related to port-specific pain.

Effects observation on the treatment and nursing of chills after gynecological laparoscopic surgery with Butorphano and Tramadol Hydrochloride / 中国生化药物杂志

Objective To explore the effect of treatment and nursing of Butorphanol and Tramadol Hydrochloride on chills after gynecological laparoscopic surgery. Methods Retrospective analysis of 60 chills patients after gynecological laparoscopic surgery treated the Second Hospital of Jiaxing City from January 2015 to January 2017 were taken, 60 patients were randomly divided into the control groups and the observation group, 30 cases in the control group were given Tramadol Hydrochloride; 30 patients in the observation group were given Butorphanol, the two groups of patients were given clinical nursing, patients chills grading after 5 min, 10 min, 30 min, Prince-Henry score, Ramsay sedation score and adverse reactions of two groups were comprehensively evaluated. Results There was no significant difference in the chills grading between the control group and the control group. Ramsay sedation score in the observation group significantly higher than the control group at 4 h, 8 h and 12 h after treatment with statistical significance (P<0.05) , in the observation group, there were 3 cases of adverse reactions occurred, accounting for 10.0%, which was significantly lower than that (36.7%) of the control group with statistical significance (P<0.05). Conclusion Butorphanol has a significant effect on chills after gynecological laparoscopic surgery, sedative effect of which is better than Tramadol Hydrochloride, with less adverse reactions.

Effects observation on the treatment and nursing of chills after gynecological laparoscopic surgery with Butorphano and Tramadol Hydrochloride / 中国生化药物杂志

Objective To explore the effect of treatment and nursing of Butorphanol and Tramadol Hydrochloride on chills after gynecological laparoscopic surgery. Methods Retrospective analysis of 60 chills patients after gynecological laparoscopic surgery treated the Second Hospital of Jiaxing City from January 2015 to January 2017 were taken, 60 patients were randomly divided into the control groups and the observation group, 30 cases in the control group were given Tramadol Hydrochloride; 30 patients in the observation group were given Butorphanol, the two groups of patients were given clinical nursing, patients chills grading after 5 min, 10 min, 30 min, Prince-Henry score, Ramsay sedation score and adverse reactions of two groups were comprehensively evaluated. Results There was no significant difference in the chills grading between the control group and the control group. Ramsay sedation score in the observation group significantly higher than the control group at 4 h, 8 h and 12 h after treatment with statistical significance (P<0.05) , in the observation group, there were 3 cases of adverse reactions occurred, accounting for 10.0%, which was significantly lower than that (36.7%) of the control group with statistical significance (P<0.05). Conclusion Butorphanol has a significant effect on chills after gynecological laparoscopic surgery, sedative effect of which is better than Tramadol Hydrochloride, with less adverse reactions.

Application of short peptide enteral nutrition in preoperative bowel preparation for patients with gynecological laparoscopy / 肠外与肠内营养

Objective:To explore the feasibility and efficacy of short peptide enteral nutrition in preoperative bowel preparation for patients with gynecological laparoscopy.Methods:A total of 100 patients with gynecological laparoscopy were randomized into the trial group (n =50) and the control group (n =50) by using the random number table method.Patients in the study group received short peptide enteral nutrition for three days before operation without mechanical bowel preparation.Patients in the control group received traditional liguid diet and mechanical bowel preparation.The satisfaction of bowel preparation,postoperative anal exhaust time,hospitalization time and nutritionrelated parameters were compared between the two groups.Results:Doctor's satisfaction of bowel preparation in the study group was significantly higher than the control group (90％ vs 64％) (P ＜ 0.01).Postoperative anal exhaust time and hospitalization time were shorter in the control group (both P ＜ 0.05).The levels of postoperative albumin and hemoglobin in study group were significantly higher than the control group (bothP ＜ 0.05).Conclusion:Short peptide EN in preoperative bowel preparation of gynecological laparoscopy reveals a better efficacy and safety,a better recovery in postoperative intestinal function and nutritional status,and a shorter postoperative hospitalization time.It is well worth clinical promotion.