A STUDY OF THE EFFECT OF VASOPRESSIN IN REDUCING BLOOD LOSS IN GYNAECOLOGICAL SURGERIES

BACKGROUND: The use of vasopressin in major surgeries like hysterectomy and myomectomy can decrease the morbidity of the patient by controlling the intra-operative blood loss. MATERIAL AND METHODS: About 100 patients undergoing elective vaginal hysterectomy and myomectomy were selected for the study. They were divided into two groups, in case group vasopressin in diluted form was inltrated intraoperatively in the surgical eld and in control group no inltration was done. The two groups were compared in terms of intraoperative blood loss, mean post operative hemoglobin decrease, hospital stay and associated adverse outcome. Statistical analysis was performed using statistical package for social science (SPSS) for windows version 19.0 software Chicago, SPSS. RESULT CONCLUSION: Vasopressin is a drug which can play a key role in reducing post-operative morbidity in the patients undergoing major gynaecological operations (vaginal hysterectomy and myomectomy) by decreasing intraoperative blood loss. In the present study estimated intraoperative blood loss in vasopressin group was 145.27 ml which was signicantly low in comparison to no injection group in which was 266.45 ml (p value <0.05). This resulted in lesser fall in post-operative heamoglobin level and reduced blood transfusion requirement in vasopressin group. Parameters like duration of surgery, change in vitals during surgery and post-operative complications showed no signicant change in vasopressin group (P<0.0001).

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Safety and effectiveness evaluation of a two-handed technique combining harmonic scalpel and laparoscopic Peng’s multifunction operative dissector in laparoscopic hemihepatectomy

World Journal of Surgical Oncology ◽

10.1186/s12957-021-02311-5 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Jingwei Cai ◽

Guixing Jiang ◽

Yuelong Liang ◽

Yangyang Xie ◽

Junhao Zheng ◽

...

Keyword(s):

Blood Loss ◽

Operative Time ◽

Harmonic Scalpel ◽

Peak Level ◽

Bile Leakage ◽

Liver Parenchyma ◽

Control Group ◽

Case Group ◽

Intraoperative Blood Loss ◽

And Control

Abstract Objectives This study was designed to evaluate the safety and effectiveness of a two-hand technique combining harmonic scalpel (HS) and laparoscopic Peng’s multifunction operative dissector (LPMOD) in patients who underwent laparoscopic hemihepatectomy (LHH). Methods We designed and conducted a case-control study nested in a prospectively collected laparoscopic liver surgery database. Patients who underwent LHH for liver parenchyma transection using HS + LPMOD were defined as cases (n = 98) and LPMOD only as controls (n = 47) from January 2016 to May 2018. Propensity score matching (1:1) between the case and control groups was used in the analyses. Results The case group had significantly less intraoperative blood loss in milliliters (169.4 ± 133.5 vs. 221.5 ± 176.3, P = 0.03) and shorter operative time in minutes (210.5 ± 56.1 vs. 265.7 ± 67.1, P = 0.02) comparing to the control group. The conversion to laparotomy, postoperative hospital stay, resection margin, the mean peak level of postoperative liver function parameters, bile leakage rate, and others were comparable between the two groups. There was no perioperative mortality. Conclusions We demonstrated that the two-handed technique combing HS and LPMOD in LHH is safe and effective which is associated with shorter operative time and less intraoperative blood loss compared with LPMOD alone. The technique facilitates laparoscopic liver resection and is recommended for use.

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A clinico-surgical outcome of vaginal hysterectomy with or without hydro dissection: a Quasi experimental study

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20183774 ◽

2018 ◽

Vol 7 (9) ◽

pp. 3668

Author(s):

Kirti M. Hurakadli ◽

L. L. Pujari ◽

Prashant G.

Keyword(s):

Blood Loss ◽

Vaginal Hysterectomy ◽

Minimal Invasive Surgery ◽

Minimal Invasive ◽

Intraoperative Blood Loss ◽

Duration Of Surgery ◽

Quasi Experimental ◽

Abdominal Route ◽

The Mean ◽

Lower Morbidity

Background: Vaginal hysterectomy -the signature operation of gynecologic profession, is a hallmark of gynecological extirpative hysterectomy surgery and surgical excellance1. In the era of minimal invasive surgery, Nondescent vaginal hysterectomy has evolved over the years and is opted over abdominal route. It is because of lower morbidity, less postoperative pain, more rapid return to normal activities and lesser hospital stay associated with this route of surgery. Practice of hydrodissection with diluted adrenalin has been noticed by few surgeons.Methods: We did a retrospective analysis of 267 cases of vaginal hysterectomies in our hospital over a period of three years, regarding the benefit of hydro dissection in reducing the blood loss and time of surgery, so as to incorporate this technique on routine basis.Results: Of 267 cases, NDVH was done in 107 (40.1%) cases, and 160 (59.9%) patients underwent vaginal hysterectomy with PFR. Of 267 cases, 121 (45.3%) cases had hydro dissection. In 146 (54.7%) cases hydro dissection was not done. The mean blood loss was significantly reduced in cases with hydro dissection to a mean of 1.07 mops when compared to cases with no hydro dissection-mean of 1.71 mops. Duration of surgery was also significantly reduced to a mean of 39.9 minutes in cases with hydro dissection when compared to cases with no hydro dissection with a mean of 46.3 minutes. There was no significant change in duration of hospital stay.Conclusions: Hydro dissection with diluted adrenaline should be routinely practice by all vaginal surgeons to reduce the duration of surgery and intraoperative blood loss.

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Comparison of 3-port with standard 4-port laparoscopic cholecystectomy: A clinical trial

Journal of Surgery and Trauma ◽

10.32592/jsurgery.2020.8.2.101 ◽

2020 ◽

pp. 52-57

Keyword(s):

Clinical Trial ◽

Laparoscopic Cholecystectomy ◽

Gallstone Disease ◽

Control Group ◽

P Value ◽

Case Group ◽

Double Blind ◽

Laparoscopic Cholecystectomy Group ◽

Significant Difference ◽

Duration Of Surgery

Introduction: Since the laparoscopic cholecystectomy was introduced first in 1990, the 4-port laparoscopic cholecystectomy was the gold standard. The 4-port (lateral) is used to hold gallbladder fundus and observe Calot's triangle. It is discussed that the 4-port technique is not required in many patients. Therefore, this study aimed to make a comparison between 3-port and 4-port laparoscopic cholecystectomy methods in the treatment of gallstone disease. Methods: A double-blind clinical trial was performed on patients admitted to Imam Reza Hospital, Birjand, Iran. The patients with gallstone disease (n=60) were randomly assigned into the case (3-port) and control (4-port) groups using balanced block randomization and underwent 3- or 4-port laparoscopic cholecystectomy. Postoperative pain was measured by a visual analog scale four h after surgery. The amount of pain-killer, duration of surgery, as well as length of stay and scars were measured in this study. Data were analyzed statistically in SPSS software (version 18) through the Chi-square test and t-test. A p-value less than 0.05 was considered statistically significant. Results: The groups were compared in terms of demographic characteristics. There were 24 females (80%) and 6 males (20%) in the control group and 25 females (83.4%) and 5 males (16.7%) in the case group (P=0.739). Moreover, the mean ages of the control and case groups were 59.823±7.8 and 61.10±4.7, respectively, and there was no significant difference between the groups in this regard (P=0.348). Furthermore, length of operation (P=0.001) and analgesic consumption (P=0.001) in the 3-port laparoscopic cholecystectomy group were lower than those in the 4-port group; however, the hospital stay (P=0.896) was the same in both groups. Conclusions: The 3-port laparoscopic cholecystectomy is a safe, reliable, and cost-effective method in patients who underwent laparoscopic cholecystectomy.

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Comparative study of abdominal hysterectomy and vaginal hysterectomy in non-descent cases a prospective study

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20170952 ◽

2017 ◽

Vol 6 (4) ◽

pp. 1265 ◽

Cited By ~ 1

Author(s):

Kalpana Mehta ◽

Om Prakash ◽

Dharmendra Singh Fatehpuriya ◽

Leena Verma

Keyword(s):

Blood Loss ◽

Vaginal Hysterectomy ◽

Operative Time ◽

Abdominal Hysterectomy ◽

Operative Blood Loss ◽

Operative Morbidity ◽

Benign Pathology ◽

Duration Of Surgery ◽

Analgesia Requirement ◽

A Prospective Study

Background: In the present times, the emphasis on minimally invasive surgery has lead to a resurgence of interest and importance of VH for non-prolapsed indications i.e. non-decent vaginal hysterectomy (NDVH) as the scar less hysterectomy. It has several benefits over abdominal hysterectomy in terms of cosmetic advantages, lesser post-operative morbidity and faster recovery. The objectives of the study was to compare and assess various factors like operative duration of surgery, intra operative blood loss, intra operative and post-operative complications, post-operative analgesia requirement, post-operative ambulation and duration of post-operative hospital stay and to put forward best route of hysterectomy.Methods: Hundred cases fulfilling, the selection criteria were included in the study. Patients were randomly divided in two groups-NDVH (non-decent vaginal hysterectomy) and abdominal hysterectomy.Results: Operative time, intra operative blood loss and post-operative morbidity was less in NDVH groups.Conclusions: Non-decent vaginal hysterectomy is a better alternative to abdominal hysterectomy in cases with benign pathology of the uterus, uterine size <14 weeks, uterus with good mobility and adequate vaginal access.

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A comparative study of coblation assissted adenotonsillectomy and cold dissection adenotonsillectomy in children

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20164814 ◽

2016 ◽

Vol 3 (1) ◽

pp. 122 ◽

Cited By ~ 1

Author(s):

Nithya V. ◽

Angshuman Dutta ◽

Sabarigirish K.

Keyword(s):

Postoperative Pain ◽

Blood Loss ◽

Postoperative Period ◽

P Value ◽

Intraoperative Blood Loss ◽

Pain Scores ◽

Significant Difference ◽

Duration Of Surgery ◽

The Mean ◽

Cold Dissection

Background: The aim of the present study was to compare intraoperative blood loss, operative duration and postoperative pain between coblation-assisted adenotonsillectomy and cold dissection adenotonsillectomy in children.Methods: A prospective, randomized, single-blind trial of pediatric patients aged 7 to 13 years undergoing adenotonsillectomy was conducted. Patients were randomized to undergo either cold dissection or coblation-assisted adenotonsillectomy. Measured intraoperative parameters included surgical duration and intraoperative blood loss. Measured postoperative parameters included a daily pain rating using the visual analog scale on the postoperative evening, postoperative day 1 and day 7. Intraoperative and postoperative measures were statistically compared between the two groups. Results: Sixty children were randomized and included in the study. 30 patients underwent cold dissection adenotonsillectomy and 30 coblation-assisted adenotonsillectomy. Mean age was 8.7 years in the coblation group and 9.1 years in the cold dissection group. Intraoperative blood loss was lower for the coblation assisted adenotonsillectomy group versus the cold dissection adenotonsillectomy group which was proved statistically (mean bleeding was 16.67 in coblation group and 58.67 in cold dissection group and p value <0.0001).There was statistically no significant difference in the mean pain scores in the 2 groups in the postoperative evening and on postoperative day 1. The mean pain scores on postoperative day 7 were found to be 3.4 in the coblation group and 2.47 in the cold dissection group with a significant p value of 0.0087. The average duration of surgery in the coblation group was 55.6 minutes as against 34.1 minutes in the cold dissection group. The p- value was found to be less than 0.0001 which makes the difference statistically significant. Conclusions: This study found that the intraoperative blood loss was significantly less in Coblation adenotonsillectomy than in cold dissection adenotonsillectomy. The duration of surgery in Coblation assisted adenotonsillectomy is significantly greater than the duration of surgery in cold dissectionadenotonsillectomy. While the postoperative pain scores are similar with coblation and cold dissection adenotonsillectomy in the early postoperative period, it is significantly more with coblation in the late postoperative period.

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Study on safety of non-descent vaginal hysterectomy for enlarged uterine size for benign uterine pathologies

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20191223 ◽

2019 ◽

Vol 8 (4) ◽

pp. 1588

Author(s):

Neelam Manda ◽

Oby Nagar ◽

Lata Rajoria ◽

C. P. Dadhich

Keyword(s):

Blood Loss ◽

Vaginal Hysterectomy ◽

Demographic Data ◽

Pelvic Sepsis ◽

Control Group ◽

Complication Rates ◽

Index Group ◽

Estimated Blood Loss ◽

Duration Of Surgery ◽

The Mean

Background: Vaginal hysterectomy is less commonly performed for benign pathologies if the uterine size exceeds 12 weeks in the belief that complications could be higher in this group. The aim of this prospective study was to compare surgical outcomes and safety of vaginal hysterectomy in women with non-prolapsed uteri of >12 weeks size to those with uteri of<12 weeks removed vaginally for similar indications.Methods: In this prospective cohort study, 92 patients were included who underwent NDVH for benign uterine conditions between May 2016 to December 2018. The index group comprised 32 women who underwent vaginal hysterectomy for non-prolapse uterus with uterine enlargement (>12 weeks), while the control group consisted of 60 women with uteri <12 weeks. Demographic data, duration of surgery, blood loss, intraoperative and postoperative complications were compared.Results: Women in the two groups had statistically similar mean age, Body Mass Index and parity (44 vs 42.77 years, 20.8 vs 21.56 kg m3 and 3.26 vs 3.83, respectively; p > 0.05). The mean operative time was significantly longer in the index group (62.47min; vs 48.17 min; p <0.0001). Women with enlarged uteri had greater mean estimated blood loss (123.2 ml vs 75.9 ml; p < 0.0001) but the mean length of hospital stay was similar (5.531 days vs 5.177 days; p > 0.05). Intra- and post-operative complications such as blood transfusion and pelvic sepsis, post-operative febrile illness and systemic infections were comparable in both groups.Conclusions: Vaginal hysterectomy in larger non-prolapsed uteri takes longer to perform and is associated with more blood loss compared to uteri <12 weeks but is not associated with a significant increase in complication rates.

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Comparison of morbidity associated with non-descent vaginal hysterectomy and total abdominal hysterectomy

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20181355 ◽

2018 ◽

Vol 7 (4) ◽

pp. 1554

Author(s):

Ranjita Ghadei ◽

Gupteswar Mishra

Keyword(s):

Blood Loss ◽

Hospital Stay ◽

Vaginal Hysterectomy ◽

Total Abdominal Hysterectomy ◽

Abdominal Hysterectomy ◽

Intraoperative Blood Loss ◽

Duration Of Hospital Stay ◽

Duration Of Surgery ◽

Stay Time ◽

Normal Work

Background: In the present scenario of importance non-invasive surgery, there is increase in interest and requirement of vaginal hysterectomy for non-prolapsed uterus, i.e. non-descent vaginal hysterectomy (NDVH) due to its scarless surgery. it has much more advantages than that of abdominal hysterectomy in term of cosmesis, lesser duration of surgery, lesser intraoperative complication, lesser post-operative morbidity and early resumption to work. The aim of the present study is to asses and compare various factors like duration of surgery, intraoperative blood loss, intraoperative and postoperative complication postoperative morbidities, pain perception on 3rd post-operative day, post-operative ambulation, duration of hospital stay, time taken to resume normal work, follow up complains and afterall to decide the appropriate route of hysterectomy for benign conditions.Methods: Hundreds of patients were selected as per the criteria. They were divided into two groups NDVH (non-descent vaginal hysterectomy) and TAH (total abdominal hysterectomy) according to the inclusion criteria. Above mentioned factors are compared between the two groups.Results: Duration of surgery, intraoperative blood loss, intraoperative complications, post-operative morbidities and complications, duration of hospital stay, time required to resume normal work are less in NDVH group.Conclusions: Non-descent vaginal hysterectomy is a better alternative to abdominal hysterectomy for benign conditions.

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Comparative Characteristics of Hemostasis During Vaginal Hysterectomy

Kuban Scientific Medical Bulletin ◽

10.25207/1608-6228-2019-26-6-61-69 ◽

2019 ◽

Vol 26 (6) ◽

pp. 61-69

Author(s):

Andrei N. Plekhanov ◽

Vitalii F. Bezhenar ◽

Tat’yana A. Epifanova ◽

Fedor V. Bezhenar

Keyword(s):

Postoperative Pain ◽

Blood Loss ◽

Vaginal Hysterectomy ◽

Operating Time ◽

Cost Effective ◽

Control Group ◽

Uterine Disease ◽

Intraoperative Blood Loss ◽

Bipolar Coagulation ◽

Suture Ligation

Aim. To compare the results of surgical treatment using bipolar hemostasis and traditional ligation of ligaments and blood vessels in vaginal hysterectomy.Material and methods. Fifty patients with benign uterine disease underwent vaginal hysterectomy using electrosurgery (n = 29) or conventional suture ligation (n = 21 controls).Results. Postoperative pain (especially on the fi rst day) was decreased in the electrosurgery group (5.50 ± 1.43 VAS points) as compared to the control group (7.64 ± 0.58 points), p < 0.001. Intraoperative blood loss was signifi cantly lower in electrosurgery group (82.86 ± 22.58 ml) than in the control group (226.36 ± 129.12 ml), p < 0.001. Operating time was signifi cantly shorter in the main group than in the controls (65.36 ± 20.9 min vs. 86.59 ± 40.19 min, p < 0.05). On average, 2.75 ± 1.11 suture packages were used with bipolar coagulation, 6.00 ± 1.93 in the controls (p < 0.001). Hospital stay was similar for both groups. Adverse event rates did not differ signifi cantly.Conclusions. Bipolar coagulation with the TissueSeal Plus proved to be more effi cient or identical to traditional suture ligation. Intraoperative blood loss, postoperative pain and the duration of the operation were less, while the complications were identical for both groups. In addition, bipolar coagulation was easier to use and cost effective. These fi ndings prove the feasibility and effectiveness of the use of electrosurgical techniques to perform hysterectomy and its further study

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Effect of Diluted Vasopressin vs Saline on Intraoperative Blood Loss during Vaginal Hysterectomy- A Randomised Controlled Trial

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2021/49162.15064 ◽

2021 ◽

Author(s):

Vinika Nimodia ◽

Sandhya Jain ◽

Shalini Rajaram ◽

Asha Tyagi ◽

Bindiya Gupta

Keyword(s):

Randomised Controlled Trial ◽

Blood Transfusion ◽

Blood Loss ◽

Vaginal Hysterectomy ◽

Controlled Trial ◽

Saline Group ◽

P Value ◽

Intraoperative Blood Loss ◽

Group I ◽

Randomised Controlled

Introduction: Vasopressin has been used to control blood loss in gynaecological surgeries such as in myomectomy, abdominal hysterectomy etc. Only few studies have demonstrated its efficacy in Vaginal Hysterectomy (VH) in reducing intraoperative blood loss. VH is frequently performed gynaecological surgery in safe lower dose of vasopressin. There is no consensus on dose of infiltration. Aim: To compare submucosal vasopressin vs saline infiltration during VH and assess surgical parameters i.e., intraoperative blood loss, postinfiltration vitals, ease of dissection, use of electrocautery, need of blood transfusion and complications. Materials and Methods: This randomised controlled trial was done in department of Obstetrics and Gynaecology in collaboration with Department of Anaesthesia from November 2017 to April 2019. Low risk women aged <65 years with Pelvic Organ Prolapse Quantification-Stage (POP-Q stage) III/IV prolapse were recruited from Outpatient Department (OPD). They were randomised into two groups. Group I (n=35) patients received submucosal infiltration with diluted vasopressin (40mL vasopressin of 0.1U/mL, total 4U), prior to the incision. Group II (n=35) patients received 40cc of normal saline. Vitals were checked at one and five minutes postinfiltration. All the qualitative parameters were compared between the two groups by chi-square test and quantitative parameters by unpaired t-test. Inter and intragroup comparison was done by Repetitive Measure ANOVA followed by Tukey’s test. For the parameters, which did not follow the Gaussian distribution, were compared by non-parametric Mann-Whitney test between the two groups. A p-value <0.05 was considered as significant. All the data analysis was carried out in Statistical Package for the Social Sciences (SPSS) version 20.0. Results: The mean estimated blood loss from incision till creation of flaps was half in vasopressin group as compared to saline group (21.33 mL vs 49.67 mL, p-value=0.001). Vasopressin group had less use of electrocautery, whereas ease of dissection was more in saline group. There was no significant difference in duration of surgery till flap creation and need of blood transfusion. There was fall in pulse rate and Blood Pressure (BP) in both groups which did not require medical intervention and was likely due to neuraxial anaesthesia. Conclusion: Vasopressin appears to be safe and effective in VH at infiltration dose of four units in dilution. However further studies on larger sample size are recommended to gather more evidence in this regard.

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Safety and Effectiveness Evaluation of A Two-Handed Technique Combining Harmonic Scalpel and Laparoscopic Peng’s Multifunction Operative Dissector in Laparoscopic Hemihepatectomy

10.21203/rs.3.rs-189868/v1 ◽

2021 ◽

Author(s):

Jingwei Cai ◽

Guixing Jiang ◽

Yuelong Liang ◽

Yangyang Xie ◽

Junhao Zheng ◽

...

Keyword(s):

Blood Loss ◽

Operative Time ◽

Harmonic Scalpel ◽

Peak Level ◽

Bile Leakage ◽

Liver Parenchyma ◽

Control Group ◽

Case Group ◽

Intraoperative Blood Loss ◽

And Control

Abstract ObjectivesThis study was designed to evaluate the safety and effectiveness of a two-hand technique combining harmonic scalpel (HS) and laparoscopic Peng’s multifunction operative dissector (LPMOD) in patients who underwent laparoscopic hemihepatectomy (LHH).MethodsWe designed and conducted a case-control study nested in a prospectively collected laparoscopic liver surgery database. Patients who underwent LHH for liver parenchyma transection using HS + LPMOD were defined as cases (n = 98) and LPMOD only as controls (n = 47) from January, 2016 to May, 2018. Propensity score matching (1:1) between the case and control groups was used in the analyses. ResultsThe case group had significantly less intraoperative blood loss in mL (169.4 ± 133.5 vs. 221.5 ± 176.3, P = 0.03) and shorter operative time in minutes (210.5 ± 56.1 vs. 265.7 ± 67.1, P = 0.02) comparing to the control group. The conversion to laparotomy, postoperative hospital stay, resection margin, the mean peak level of postoperative liver function parameters, bile leakage rate and others were comparable between the two groups. There was no perioperative mortality. ConclusionsWe demonstrated that the two-handed technique combing HS and LPMOD in LHH is safe and effective which is associated with shorter operative time and less intraoperative blood loss compared with LPMOD alone. The technique facilitates laparoscopic liver resection and is recommended for use.

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