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Aim: The aim of this study was to evaluate immediate pain control in patients who underwent laparoscopic myomectomy (LM) by intraoperative injection of ropivacaine into both uterosacral ligaments. Methods: The study was a prospective, double‐blind, randomized study. We analyzed 46 cases of LM performed between July 2015 and November 2016 by a single surgeon. We randomized the enrolled patients into either a ropivacaine or a saline injection group. Before the surgeon closed the abdominal wall, each 7.5% ropivacaine (5 mL) or saline (5 mL) was administered into both uterosacral ligaments through laparoscopic injection needle. We compared the pain intensity scores 2, 6, 12, and 24 h after injection between the two groups. Results: The pain intensity scores were not significantly different. However, the ropivacaine group requested less of the analgesic than the placebo‐injected group requested (P = 0.035). No patient in the ropivacaine group reported any side effects. Conclusion: Intraoperative ropivacaine injection into both uterosacral ligaments during LM can reduce the dosage of opioid analgesics. [ABSTRACT FROM AUTHOR]

Abstract: Aims: To evaluate the surgical outcomes of both approach methods (laparoscopy vs laparotomy) and to suggest the proper surgical approach according to type of uterine adenomyosis (focal vs diffuse). Methods: We retrospectively analyzed 224 cases of uterine adenomyomectomy, 116 laparotomic and 108 laparoscopic, performed between July 2011 and June 2016 by a single surgeon (Y. S. K.). In all 224 cases, the surgeon had used transient occlusion of the uterine artery (TOUA). Surgical outcomes included weight of specimen, operating time, estimated blood loss and intraoperative injury to other organs. Postoperative clinical outcomes included symptom improvement (dysmenorrhea, menorrhagia and others) and recurrence. Results: All patients in the laparoscopic group had been diagnosed with focal uterine adenomyosis, and most in the laparotomic group (85.3%) had been diagnosed with diffuse type. The largest lesion diameters were 6.48 cm in the laparotomic group and 4.34 cm in the laparotomic group. Operation time and estimated blood loss were 116.12 min and 222.67 mL in the laparotomic group and 75.09 min, respectively, and 155.33 mL in the laparoscopic group. There was no case of laparotomic conversion in patients with laparoscopic adenomyomectomy. Conclusion: Conservative surgery is effective to reduce the symptoms of adenomyosis regardless of approach method. For near‐complete excision of adenomyosis, the diffuse type is recommended to be treated with laparotomic adenomyomectomy, and focal lesions less than 5 cm can be treated with laparoscopic conservative surgery. [ABSTRACT FROM AUTHOR]

Background: To introduce the safe and effective surgical technique of laparoscopic adenomyomectomy with transient occlusion of uterine arteries (TOUA) in patients with symptomatic uterine adenomyoma. Subjects and Methods: In a prospective case study, we examined all cases of laparoscopic adenomyomectomy with TOUA performed by a single surgeon at Ulsan University Hospital, Ulsan, Korea, between May 2011 and September 2012. Surgical outcomes included operative time, intraoperative injury of blood vessels, nerves, and pelvic organs, as well as intraoperative blood loss. We assessed the degree of improvement in dysmenorrhea and menorrhagia and the recurrence of adenomyomic lesions by ultrasonography at the 6-month follow-up after laparoscopic adenomyomectomy with TOUA. Results: Thirty-four women who were refractory to medical treatment or who wanted surgical treatment for preserving their uterus underwent laparoscopic adenomyomectomy with TOUA using an endoscopic vascular clip. The mean age was 43.79±4.94 years. The mean diameter of the adenomyomas was 5.29±1.82 cm. The mean TOUA time, operation time, and hospital stay were 7.33±4.12 minutes, 84.09±31.48 minutes, and 3.82±1.24 days, respectively. The mean estimated blood loss was 148.18±93.99 mL, and no injury to the uterine arteries or pelvic nerves occurred. No cases of conversion to a laparotomy or major complications occurred. At the 6-month follow-up, complete remission of dysmenorrhea and menorrhagia occurred in 72.2% and 87.5% of patients, respectively. Conclusions: Laparoscopic adenomyomectomy with TOUA could be a safe and effective surgical method for women with symptomatic uterine adenomyoma who want to preserve their fertility. [ABSTRACT FROM AUTHOR]

Background: To determine whether performing transient occlusion of uterine arteries (TOUA) immediately before laparoscopic myomectomy can reduce intraoperative complications. Subjects and Methods: In a retrospective case-control study, laparoscopic myomectomy with and without TOUA was examined. Data were analyzed from 89 laparoscopic myomectomies performed by a single surgeon (Y.-S. Kwon) at Ulsan University Hospital (Ulsan, Korea) between March 2011 and December 2011. Surgical outcomes included preoperative myoma size, number of myoma, operative time, and operative blood loss. Results: Forty-nine women underwent laparoscopic myomectomy with TOUA with endoscopic vascular clipping, whereas 40 control patients underwent laparoscopic myomectomy alone. The TOUA group had no case of nerve or vascular injury during the operation time. The mean time of occlusion of both the uterine arteries was 15 minutes. The TOUA group had less mean blood loss during the operation than the group with laparoscopic myomectomy alone (111.9 versus 203.4 mL; P<.001). There were no significant differences in size and number of uterine myomas and intraoperative complications between the two groups. Moreover, there was not even a single case of conversion of laparoscopy to laparotomy in either group. Conclusions: TOUA performed immediately before laparoscopic myomectomy facilitated minimally invasive surgery with lower blood loss and no differences in other intraoperative complications. [ABSTRACT FROM AUTHOR]

Background: This article reports our early experience with the use of lidocaine patches for pain control in the immediate postoperative period after laparoscopic gynecologic surgery. Subjects and Methods: A prospective, double-blind, placebo-controlled clinical trial was conducted on 40 patients undergoing a gynecologic laparoscopy who were randomized to receive either topical patches of 700 mg of lidocaine ( n=20) or placebo patches ( n=20). The patch was divided evenly into four smaller patches, which were applied at the four port sites and changed every 12 hours for 36 hours after surgery. Postoperative pain was evaluated using the visual analog scale (VAS) score and the Prince Henry and 5-point verbal rating pain scale (VRS), and the analgesic requirement was also evaluated at 1, 6, 12, 24, and 36 hours after surgery. Results: The VAS score for wound pain was lower in the lidocaine patch group at 1 and 6 hours after surgery than the control group ( P=.005 and <.0005, respectively). The VAS scores for postoperative pain were lower in the lidocaine patch group at rest 1 hour after surgery ( P=.045). The 5-point VRS score for postoperative pain was lower in the lidocaine patch group at 6 and 12 hours after surgery ( P=.015 and .035, respectively) than in the control group. Conclusions: Topical lidocaine patches at the laparoscopic port sites reduced postoperative pain, particularly postoperative wound pain after gynecological laparoscopic procedures. [ABSTRACT FROM AUTHOR]

Background: Single-port-access hand-assisted laparoscopic surgery (SPA-HALS) is a method intended to provide surgical outcomes with advantages similar to those of SPA-pure laparoscopic surgery (SPA-PLS) for patients with benign large adnexal tumors and to reduce the spillage of tumor contents. This study aimed to assess the feasibility and methodology of SPA-HALS for benign large adnexal tumors and to compare the surgical outcomes of SPA-HALS and SPA-PLS performed by a single surgeon (H.-J. R.). Methods: Between March 2009 and February 2011, 139 patients underwent SPA adnexal surgery. The SPA-PLS procedure was performed for 96 candidates for conventional laparoscopic adnexal surgery, whereas SPA-HALS was performed for 43 patients with large adnexal tumors. The patient demographics and surgical outcomes of these two groups were compared. Results: The median adnexal tumor size was larger in the patients who underwent SPA-HALS than in those who underwent SPA-PLS (10.9 vs. 6.3 cm; p < 0.001). Spillage occurred for four patients in the SPA-HALS group (10.3%) compared with 33 patients in the SPA-PLS group (31.3%) ( p = 0.005). The relative risk of spillage was 4.43 times higher in the SPA-PLS than in the SPA-HALS group (95% confidence interval [CI], 1.45-13.53). Adnexa-conserving surgery was significantly more frequent in the SPA-HALS group than in the SPA-PLS group (76.7% vs. 43.8%; p < 0.001). Additional procedures were less frequent in the SPA-HALS group (16.3% vs. 33.3%, p = 0.043). The median estimated blood loss was significantly lower in the SPA-HALS group (50 vs. 105 ml; p = 0.001). The two groups did not differ significantly in median operation time (75 vs. 70 min), complication rate (0% vs. 3.1%), or postoperative hospital stay (2 vs. 2 days). Conclusion: The findings showed that SPA-HALS extracorporeal adnexal surgery allows for thorough evaluation of peritoneal structure and complete surgery of benign large adnexal tumors while retaining the advantages of SPA adnexal surgery. Furthermore, this technique may reduce the intraperitoneal spillage rate for benign large adnexal tumors. [ABSTRACT FROM AUTHOR]