Interdisciplinary Laparoscopic News From the European Society for Gynaecological Endoscopy
by Anja Hirschelmann and Rudy Leon De Wilde
Professor and Head of Department of Obstetrics, Gynecology and Gynecological Oncology, PIUS Clinic, Oldenburg, Germany (Rudy Leon De Wilde)
As obesity is increasing, it is important to investigate its impact on complications in laparoscopic surgery. In basic and advanced laparoscopic gynecologic procedures, no significant differences between normal-weight, pre-obese and obese women were found in terms of laparotomy conversion rate, intraoperative and postoperative complications. Therefore, obese women do not seem to be at a higher risk of complications during laparoscopic surgery [1–3].
The next major step forward in imaging technologies in the operating room could be cinematographic 3D.
Although different specialties perform laparoscopic surgery, there is an enormous variety in training, policy, quality assurance and instrument safety. A multidisciplinary evidence based guideline was presented in order to enhance patient care and safety in minimally invasive surgery (MIS). The guideline was developed by gynecologists, general surgeons, an anesthetist and a urologist authorized by their scientific association. Important topics were: laparoscopic entry techniques, specific trocar use, electrosurgical techniques, prevention of trocar site herniation, patient positioning, anesthesiology, perioperative care, training, patient information, multidisciplinary user consultation, complication registration and introduction of new techniques and technology. The assessment of knowledge, techniques, skills and other aspects required for safe MIS procedures should be performed multidisciplinarily to transcend the boundaries of the individual disciplines .
The establishment of laparoscopic skill laboratories is important and should be promoted. However, grading of training facilities for minimally invasive surgery and surgical skills curricula is necessary. Exploding numbers of skills laboratories are being set, in absence of concrete guideline how to do this. A consensus list consisting of a set of quality criteria was developed using the knowledge of 23 well recognized experts. The consensus list can be used when setting up a skills laboratory, but also for verifying the quality of an existing laboratory .
To further reduce postoperative pain after laparoscopic procedures, two different perioperative strategies were investigated. 300 patients undergoing laparoscopic hysterectomy were randomized into 3 groups. Group A (n=100) received no special treatment, Group B (n=100) received peri-incisional injections with 0.4% lidocaine (10ml) after closure of laparoscopic incisions, and Group C (n=100) received lidocaine injection and reduction of residual intraperitoneal gas volume by maintenance of the umbilical trocar for five additional minutes after removal of the other trocars. Pain scores and analgetic requirements were measured. Group B and C had significantly lower pain scores at 1 hour postoperatively. Although the pain scores were also decreased after 2 and 4 hours postoperatively, this was not statistically significant. Analgetic requirements at 1, 2 and 4 hours postoperatively were significantly lower in Group B and C compared to group A. Therefore, peri-incicional infiltration of lidocaine and reduction of residual intraperitoneal gas volume could be effective strategies to reduce early postoperative pain .
1. Nellore V, Flanagan V, Hawthorn R, Bjornsson S, Pringle S, Hardwick C, Ghim Poh P (2011) Laparoscopic assisted vaginal hysterectomy: impact of body mass index on outcomes. Gynecol Surg 8(Suppl 1):S39
2. Syed Hashim S, Lotfallah H (2011) Feasibility of advanced laparoscopic gynaecologic surgery in obese women. Gynecol Surg 8(Suppl 1):S118
3. Goncalves A, Marques C, Antunes I, Simoes M, Ribeiro F, Pereira AP (2011) Laparoscopy and body mass index: do the obese have a higer risk? Gynecol Surg 8(Suppl 1):S194
4. Kent A, Smith R, Rockall T, Jourdan I (2011) Laparoscopic hysterectomy using cinematographic 3D. Gynecol Surg 8(Suppl 1):S90
5. Kent A, Smith R, Rockall T, Jourdan I (2011) The benefits of cinematographic 3D in laparoscopic suturing. Gynecol Surg 8(Suppl 1):S92
6. La Chapelle C, Jansen FW (2011) Multidisciplinary guideline development in MIS: a challenge for all? Gynecol Surg 8(Suppl 1):S66
7. Hiemstra E, Schreuder H, Stiggelbout A, Jansen FW (2011) Grading surgical skills curricula and training facilities for minimally invasive surgery. Gynecol Surg 8(Suppl 1):S63
8. Radosa J, Baum S, Radosa M, Guzmann D, Solomayer E (2011) Effects of perioperative strategies to reduce postoperative pain in patients undergoing laparoscopic hysterectomy. Gynecol Surg 8(Suppl 1):S133