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Aim: The aim of the study was to assess the incidence of postoperative adhesion by baseball running suture using barbed suture (BS) in laparoscopic myomectomy in comparison with sutures using an absorbable thread.Methods: Two hundred fifteen patients who underwent second-look laparoscopy (SLL) 6 months after laparoscopic myomectomy at our hospital between 2010 and 2014 were retrospectively reviewed. The incidence, numbers, types, and extent of adhesions were evaluated according to the more comprehensive adhesion scoring method. Propensity score matching (PS) (1:1) between the groups was performed by using the diameter of the largest myoma, the number of enucleated myomas, and the type of adhesion barrier.Results: Running baseball sutures and running sutures were applied to 28 and 187 patients with unidirectional BS and absorbable thread, respectively, to close the incised serosal wounds enucleating largest myomas during laparoscopic myomectomy. After PS matching for the patients, surgical findings and the incidence of postoperative wound adhesions were compared between the groups, including 22 patients each. The surgical findings were similar between the groups, except for the total surgical duration and blood loss (medians), which were significantly shorter and lower in the BS group than in the absorbable thread group (70 vs. 100 min; p = 0.01, 50 vs. 100 mL; p = 0.02). Regarding findings of SLL, no significant differences in the incidence of postoperative wound adhesions were found between the groups (BS, 4/22 [18.2%] versus absorbable thread, 8/22 [36.4%]; p = 0.31).Conclusion: Our data indicated that the incidence of postoperative adhesion following the use of BS for wound closure in laparoscopic myomectomy was similar to that following the use of conventional suture. [ABSTRACT FROM AUTHOR]

Aim: Since 2014, Japan Society of Gynecologic and Obstetric Endoscopy and minimally invasive therapy (JSGOE) conducted a nationwide survey on gynecologic endoscopic surgery. We aimed to evaluate the current status and complications associated with endoscopic surgery by Japan gynecologic and obstetric endoscopy‐database registry system (JOE‐D). Methods: Electrical medical records concerning the endoscopic surgery were generated from the daily use of reporting system. The subjects were all patients who underwent gynecologic endoscopic surgery. In addition to assessment of actual numbers, diagnosis, and operative methods, adverse events were registered. Results: Total 203 970 patients performed laparoscopic, hysteroscopic and falloposcopic surgery for 3 years, 2014–2016. The numbers of endoscopic surgeries conducted in 2016 were increased more than 67 000, 13 000 or 450 cases, respectively. Incidence rates of complications involving these three types of surgeries in each year were approximately 3.1%. Incidences of intraoperative complications were relatively high in malignant diseases, laparoscopic‐assisted vaginal hysterectomy (LAVH) and myomectomy (LAM). In total laparoscopic hysterectomy/laparoscopic hysterectomy (TLH/LH) performed from 2014 to 2016, ureteral injury as intra and postoperative complication occurred in 0.35%. In the past 3 years, the rates of vascular injury, urinary tract, and bowel injury as intraoperative complications caused by laparoscopic surgery were approximately 0.1%. In the hysteroscopic surgery, the rates of total intra‐ and postoperative complications were 0.78%. Conclusion: We exhibited the current status by the nationwide survey of gynecologic endoscopic surgery all over Japan. Severe intra or postoperative complications were identified over the 3 years at a rate of 0.04%. [ABSTRACT FROM AUTHOR]

Objective. To determine whether uterine repair at laparoscopic myomectomy influences postoperative adhesions. Design. Retrospective study. Setting. University-affiliated hospital. Population. A total of 108 patients who underwent second-look laparoscopy after laparoscopic myomectomy without concomitant pelvic surgery between January 2006 and May 2010. Methods. Absorbable cellulose adhesion barriers were used for uterine repair at initial surgery in all women. The presence of adhesions was evaluated by second-look laparoscopy. Main outcome measures. The influence of background factors (diameter of largest myoma, number of myomas, incision sites and number of suture layers) and the uterine status immediately after uterine repair at laparoscopic myomectomy (number, length and location of wounds, as well as wound appearance classified as virtually normal, swollen or protruding) on adhesion formation were analysed in 108 women with 296 uterine wounds. Data were analysed by logistic regression analysis. Results. Forty-one (38.0%) women had adhesions to their uterus at follow up. We identified 48 (16.2%) adhesions among 296 wounds in all women. A protruding wound was significantly associated with postoperative wound adhesion (odds ratio, 2.53; p=0.02). The number of enucleated subserosal myomas (odds ratio, 3.29; p<0.001) and the diameter of the largest myoma (odds ratio, 1.05; p<0.001) were significantly associated with wound protrusion, which was a critical factor influencing adhesion. Conclusions. Postoperative wound adhesion formation seems to depend on uterine status immediately after laparoscopic myomectomy. [ABSTRACT FROM AUTHOR]

In order to reduce the risk of visceral injury for patients with upper abdominal adhesions, we devised an alternative to the umbilical approach. Five patients who had undergone a previous upper abdominal laparotomy and were scheduled for gynecologic laparoscopic surgeries at our hospital were evaluated. A micro-trocar was inserted via the posterior vaginal fornix and the periumbilicus was observed using a micro-laparoscope inserted in the micro-trocar. A trocar for conventional laparoscopy was inserted into the umbilicus under micro-laparoscopic observation in the cul-de-sac to avoid visceral organ adherent to the periumbilicus. Four cases had adhesions of the transverse colon, small bowel or omentum to the upper abdomen due to previous surgery; however, we were able to accomplish laparoscopic surgery without injury to adhesive organs in all patients. The micro-laparoscopic primary approach via the posterior vaginal fornix is a safe primary approach for patients who have undergone a previous upper abdominal laparotomy. [ABSTRACT FROM AUTHOR]

Objective: To examine the factors influencing the development of adhesions after laparoscopic myomectomy (LM) and the efficacy of adhesion-preventing agents.Design: Prospective nonrandomized study.Setting: University-affiliated hospital.Patient(s): Three hundred seventy-two patients who underwent LM alone by the same surgeon between 2000 and 2005 were included for the analysis in this study.Intervention(s): Video tape recording was performed during the second-look laparoscopy (SLL) to evaluate the postoperative uterine wound adhesions and adhesions around the uterine adnexa. Statistical workup was conducted using logistic regression analysis.Main Outcome Measure(s): Evaluation of adhesions at the uterine wound and of de novo adhesions of the uterine adnexa by SLL.Result(s): The SLL revealed uterine surgical wound adhesions in 141 patients (37.9%) and de novo adhesions of the uterine adnexa in 33 patients (8.9%). The results of analysis to determine the factors influencing the development of postoperative adhesions revealed that the diameter of the largest myoma, number of myomas, and type of adhesion-preventing agent used (except for fibrin sheath, which had no effect) influenced the incidence of postoperative adhesions at the surgical wound, but only the diameter of the largest myoma influenced the incidence of de novo adhesions of the uterine adnexa.Conclusion(s): Development of surgical wound adhesions after LM can be prevented by the use of an appropriate adhesion-preventing agent. [ABSTRACT FROM AUTHOR]

Myomectomy is associated with the development of adhesions, and even when the patient is operated on laparoscopically, postoperative adhesions can often occur. Seprafilm is an effective and highly safe barrier to postoperative adhesions. However, it is vulnerable to tears and difficult to handle. We developed a device to introduce Seprafilm into the abdominal cavity during the laparoscopic procedure. Seprafilm is divided into 6 pieces and the pieces are rolled and inserted into the purpose-built introducer to be guided into the abdominal cavity. The inner syringe is pushed in and Seprafilm is applied onto the uterine wound with two grasping forceps. Of 117 patients in our study, we were able to use Seprafilm on 114 patients (97.4%). In total, 221 pieces of Seprafilm were used, and 87 pieces were damaged during the operation. Of these 87 pieces, 58 were damaged when inserted into the introducer, though this kind of loss tended to decrease with training, and 29 pieces were damaged during application to the wound. Seprafilm can be used safely and efficiently during laparoscopic surgery. [ABSTRACT FROM AUTHOR]

Objective To investigate the incidence of port-site adhesions following use of radially expanding trocars (RETs) at laparoscopic myomectomy by observation via second-look laparoscopy (SLL). Methods In a retrospective study, data from patients who underwent SLL after laparoscopic myomectomy between January 2007 and June 2012 at Juntendo University Hospital, Tokyo, were assessed for the incidence of port-site adhesions forming below RET incisional scars when fascial and peritoneal defects had not been closed. Results During the study period, 554 patients underwent SLL, and 2176 incisional scars were examined. Adhesions were detected in 15 patients (2.8%); thus, the incidence of port-site adhesions under scars was 0.7% (15/2176). Among these 15 patients, the wounds with adhesions were located as follows: 6 (1.1%) under the umbilical scar, 5 (0.9%) under the right lower abdominal scar, 2 (0.4%) under the left upper abdominal scar, and 2 (0.4%) under the left lower abdominal scar. According to multiple regression analysis, the duration of laparoscopic myomectomy was positively associated with port-site adhesions (odds ratio, 1.79; 95% confidence interval, 1.09–2.94; P = 0.02). Conclusion The present data suggest that the incidence of port-site hernias and adhesions under RET incisional scars is low despite the non-closure of fascial and peritoneal defects. [ABSTRACT FROM AUTHOR]