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Background: Our aim was to compare single incision and conventional laparoscopic surgeries performed for benign adnexal masses with regard to their intraoperative characteristics and postoperative pain levels., Material and Methods: The main outcome measures were laparoscopic entry time, total operation time, amount of bleeding, intraoperative complications, post-operative pain scores, additional analgesic requirements, and length of hospital stay., Results: A total of 71 women, 39 in the conventional laparoscopy group and 32 in the SILS group, participated in the study. Demographic findings did not differ between the two groups. Similarly, rates of intraoperative complications, rates of conversion to laparotomy, pre- and postoperative hematocrit levels were not significantly different between the groups. Laparoscopic entry time was shorter in the SILS group (10.4 ± 5.9 min. vs. 5.28 ± 1.7 min.). However, total operation time was similar in the two groups. The groups did not show significant differences regarding additional analgesic requirements, or postoperative pain scores after 24 h. However, pain scores in the recovery room and after six and 12 h were lower in the SILS group., Conclusion: SILS seems to be effective and safe for the treatment of benign adnexal masses. SILS appears to be advantageous regarding postoperative pain especially in the early period.

Background: Despite the well-known and easily recognizable signs of bladder injury during laparoscopy, some injuries remain unnoticed. Intra-operative diagnosis of a urinary bladder injury provides the opportunity to repair and prevent later complications involving the formation of fistula, infection, ascites and impairment of renal function. Small and unrecognized bladder injuries increase the chance of morbidity and permanent organ dysfunctions., Objectives: The aim of the study was to evaluate the CO2 flow dynamics of bladder injury occurring during laparoscopy and the effect of the content of the abdominal viscera during injury., Material and Methods: The study involved eight male New Zealand rabbits. Following urinary catheterization of the rabbits with an 8-gauge urinary catheter connected securely to a urinary drainage bag, pneumoperitoneum was created at a pressure level of 12 mm Hg. The experiment consisted of three phases. After the observational phase (Phase 1), the anterior wall of the urinary bladder was perforated with the tip of a 21 G needle (Phase 2) and methylene blue was administrated to evaluate the CO2 flow dynamics (Phase 3)., Results: The amount of CO2 consumption and accumulation in the urinary drainage bags differed significantly among the three phases of the experiment (p<0.05). There was no CO2 consumption or accumulation in the urinary drainage bags during Phase 1. The amount of CO2 consumption and accumulation in the urinary drainage bags during Phase 2 was significantly higher than during Phase 3., Conclusions: Urinary catheterization helps in the diagnosis of small or unnoticed urinary bladder injuries occurring during laparoscopy. CO2 flow and consumption is lower if the viscosity of the content overlying the injury site is higher.

Background and Objectives: Keyless abdominal rope-lifting surgery is a novel, gasless, single-incision laparoscopic surgical technique. In this study we aimed to compare the postoperative pain from keyless abdominal rope-lifting surgery with carbon dioxide laparoscopy performed for benign ovarian cysts., Methods: During a 20-month period, 77 women underwent surgery for a benign ovarian cyst. Keyless abdominal rope-lifting surgery and conventional carbon dioxide laparoscopy techniques were used for the operations in 32 women and 45 women, respectively. The 2 operative techniques were compared with regard to demographic characteristics; preoperative, intraoperative, and postoperative data including early postoperative pain scores; and frequency of shoulder pain and analgesic requirements., Results: Data regarding demographic characteristics, preoperative findings, cyst diameters and rupture rates, intra-abdominal adhesions, intraoperative blood loss, and postoperative hospital stay did not differ between groups (P > .05). However, the mean operative and abdominal access times were significantly longer in the keyless abdominal rope-lifting surgery group (P < .05). Visual analog scale pain scores at initially and at the second, fourth, and 24th hours of the postoperative period were significantly lower in the keyless abdominal rope-lifting surgery group (P < .05). Similarly, keyless abdominal rope-lifting surgery caused significantly less shoulder pain and additional analgesic use (P < .05)., Conclusion: Keyless abdominal rope-lifting surgery seems to cause less pain in the management of benign ovarian cysts in comparison with conventional carbon dioxide laparoscopy.

Background: To find the most efficacious method to minimize the side effects and maximize the advantages of laparoscopic surgery, this study aimed to define and document a gasless, single-incision abdominal access technique for the management of benign ovarian cysts., Methods: During a 1½ year period, 55 women underwent surgery for a benign ovarian cyst. Conventional carbon dioxide (CO(2)) laparoscopy was used for 33 of the women, and 22 of the women underwent a novel, gasless, single-incision laparoscopic surgery. An abdominal access pathway through a single intraabdominal incision was used to place transabdominal sutures that elevated the abdominal wall, and the operations were performed through the intra-umbilical entry without the use of trocars. Thus, the new technique was called keyless abdominal rope-lifting surgery (KARS). Two operative groups were compared to assess the feasibility of the new technique., Results: All the operations could be performed by KARS without conversion to CO(2) laparoscopy or laparotomy. However, for two patients in the conventional laparoscopy group, minilaparotomy had to be performed for tissue retrieval. Although the two techniques had many similar results, the total operative times and the abdominal access times in the KARS group were significantly longer than in the conventional laparoscopy group (p < 0.05). Simple oral analgesics were adequate for postoperative pain relief in both groups., Conclusions: The KARS technique is a gasless, single-incision laparoscopic procedure that can be performed safely and effectively in terms of cosmesis, postoperative pain, and fertility preservation for the management of benign adnexal pathologies.

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