Risk of leakage with a new tissue containment system for power morcellation during gynecologic laparoscopy: An in vitro study

Purpose To evaluate leakage and tissue dissemination associated with a new tissue containment system for tissue removal during laparoscopic myomectomy morcellation using rigid pipes that can be seamlessly connected to detachable trocars. Methods Pork specimens were stained with indigo carmine dye and morcellated under laparoscopic guidance in a plastic trainer box. Morcellation was performed using two different containment systems. First, a polyurethane bag, 12 mm sheath for introduction into the peritoneal cavity, and 11 mm optic sleeve (control group). Second, a new tissue containment system using rigid pipes and detachable trocars (experimental group). All bags were inflated to 14–20 mmHg pressure using a standard CO2 insufflator. Visual evidence of spilled tissue or dye and procedure times were recorded. Results Thirty trials were performed using a multi-port approach and the two tissue containment systems. The leakage rate was 0.03% for the experimental group and 26.6% for the control group (p < 0.005). Morcellation time was significantly shorter in the experimental group compared to that in the control group (p < 0.05). Mean bag introduction and removal times of the experimental group were shorter than those of the control group; however, the removal time differences were not statistically significant. Conclusion The current study quantified leakage during morcellation and the convenience provided by a new tissue containment system. Further studies and clinical trials are needed to corroborate the findings and to evaluate the use of the new tissue containment system for minimally invasive surgical treatment of tumors.

Effect of Adding Midazolam to Dual Prophylaxis for Preventing Postoperative Nausea and Vomiting

Multimodal prophylaxis for postoperative nausea and vomiting (PONV) has been recommended, even in low-risk patients. Midazolam is known to have antiemetic properties. We researched the effects of adding midazolam to the dual prophylaxis of ondansetron and dexamethasone on PONV after gynecologic laparoscopy. In this prospective, randomized, double-blinded trial, 144 patients undergoing gynecological laparoscopic surgery under sevoflurane anesthesia were randomized to receive either normal saline (control group, n = 72) or midazolam 0.05 mg/kg (midazolam group, n = 72) intravenously at pre-induction. All patients were administered dexamethasone 4 mg at induction and ondansetron 4 mg at the completion of the laparoscopy, intravenously. The primary outcome was the incidence of complete response, which implied the absence of PONV without rescue antiemetic requirement until 24 h post-surgery. The complete response during the 24 h following laparoscopy was similar between the two groups: 41 patients (59%) in the control group and 48 patients (72%) in the midazolam group (p = 0.11). The incidence of nausea, severe nausea, retching/vomiting, and administration of rescue antiemetic was comparable between the two groups. The addition of 0.05 mg/kg midazolam at pre-induction to the dual prophylaxis had no additive preventive effect on PONV after gynecologic laparoscopy.

Warm and humidified insufflation gas during gynecologic laparoscopic surgery reduces postoperative pain in predisposed patients—a randomized, controlled multi-arm trial

Background Postoperative pain remains a common problem in gynecologic laparoscopy, especially in head zone-related regions, triggered by intra-abdominal pressure during capnoperitoneum. Humidified and prewarmed insufflation gas may ameliorate pain and be beneficial. Methods This prospective randomized controlled parallel group multi-arm single-center study investigated the effects of temperature and humidity of insufflation gas on postoperative pain during gynecologic laparoscopy with a duration ≥ 60 min. Female participants (18—70 years) were blinded and randomly assigned—computer generated—to either insufflation with dry cold CO2 with forced air warming blanket (“AIR”), humidified warm gas without forced air warming blanket (“HUMI”), or humidified warm gas with forced air warming blanket (“HUMI +”). We hypothesized that using humidified warm gas resulted in lower pain scores and less analgesic consumption. The primary endpoint postoperative pain was assessed for different pain localizations every 12 h during 7 days after surgery. Secondary endpoints were demand for painkillers and epidural anesthetics, length of stay in recovery room, and hospital stay. (Registration: ClinicalTrials.gov NCT02781194—completed). Results 150 participants were randomized. Compared to group “AIR” (n = 48), there was significantly less pain in group “HUMI +” (n = 48) in the recovery room (− 1.068; 95% CI − 2.08 to − 0.061), as well as significantly less ibuprofen use at day two (− 0.5871 g ± 0.258; p-value = 0.0471). Other variables did not change significantly. Stratification for presence of endometriosis or non-previous abdominal surgery in patient history revealed significantly less pain in both groups “HUMI” (n = 50) and “HUMI +” versus group “AIR.” Related side effects were not noted. Conclusion In the overall population, the use of warm, humidified insufflation gas did not yield clinically relevant effects; however, in predisposed patients with endometriosis and who could otherwise expect high pain levels, warm and humidified gas may be beneficial.

The effects of pre-emptive intravenous ibuprofen on the thiol/disulfide homeostasis and C-reactive protein level as the markers of oxidative stress and inflammation during gynecologic laparoscopy: A randomized clinical trial

Aims: In this study, we aimed to investigate the anti-inflammatory and antioxidant effects of intravenous ibuprofen by using the C-reactive protein level and thiol/disulfide homeostasis as the oxidative stress marker. Materials and Methods: This study was conducted on 70 patients aged between 30and65 who were scheduled for elective laparoscopic hysterectomy. The patients were divided into two groups to receive either preemptive 800mg of intravenous ibuprofen plus 1000 mg of intravenous paracetamol (Group IP) or only 1000 mg of intravenous paracetamol as a control group (Group P).The blood samples for thiol/disulfide homeostasis were collected as follows; before induction of anesthesia (T0),before pneumoperitoneum (T1),following post-deflation and discontinuation of anesthesia (T2) and postoperative 24th hour (T3).Simultaneous blood samples for C-reactive protein were also collected. The pre and postoperative urea, creatinine, alanine aminotransferase (ALT), and aspartate aminotransferase (AST) levels were measured. Results: A total of 69 patients were included in the study. The patient’s characteristics and intraoperative variables were comparable between groups (p>0.05). The number of patients requiring rescue analgesia, the total amount of analgesic used, VAS scores, and postoperative side effects were significantly lower in Group IP (p<0.001).There decrease in native and total thiol levels at T1, T2, T3 measurement points was significant in Group IP (p<0.001). In both groups, the comparison to baseline values demonstrated no significant changes in terms of disulfide level (p>0.05).The simultaneous CRP levels indicated a significant increase at the postoperative 24.hour in both groups (p<0.001). The difference between groups was insignificant (p>0.05). There was a significant increase in urea and creatinine levels in patients of Group IP (p<0.05). Conclusion: The pre-emptive administration of ibuprofen provided an effective pain control after gynecologic laparoscopy. However, ibuprofen changed the thiol/disulfide homeostasis in favor of oxidation and had no beneficial effect in surgically induced oxidative stress.