Percutaneous-assisted vs mini-laparoscopic hysterectomy: comparison of ultra-minimally invasive approaches
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ORIGINAL ARTICLE
Percutaneous‑assisted vs mini‑laparoscopic hysterectomy: comparison of ultra‑minimally invasive approaches Stefano Cianci1,2 · Emanuele Perrone2 · Cristiano Rossitto2 · Francesco Fanfani2 · Alessandro Tropea3 · Antonio Biondi4 · Giovanni Scambia2 · Salvatore Gueli Alletti2 Received: 11 May 2020 / Accepted: 21 September 2020 © Italian Society of Surgery (SIC) 2020
Abstract To assess the feasibility and the safety of the ultra-minimally invasive (U-MIS) approaches in gynecology, we compared our experience in percutaneous assisted hysterectomy (PSS-H) with a series of 3 mm mini-laparoscopy hysterectomy (m-LPSH). 126 patients affected by benign and malignant gynecological conditions were considered eligible for minimally invasive hysterectomy: 80 patients received PSS approach and 46 m-LPS approach. For both groups, we evaluated intra and perioperative outcomes, post-operative pain and cosmetic outcomes. The baseline characteristics were comparable between the two study groups. As well, no differences were reported in the clinical indications for hysterectomy, principally fibroids/ adenomyosis, endometrial hyperplasia and early stage endometrial cancer. The median operative time was 88.5 (40–190) minutes for PSS-H group and 95.0 (42–231) minutes in m-LPS-H group (p = 0.131). No differences were detected in median estimated blood loss (p = 0.104) as well, in the uterine manipulator usage (p = 0.127) between the two different surgical approaches. Only 1 (2.2%) conversion to standard laparoscopy occurred in m-LPS-H group (p = 0.691). One intra-operative complication was recorded 1 (1.3%) in the PSS-H group (p = 0.367). The post-operative early complication was recorded in five cases of PSS-H group (p = 0.158), none for m-LPS-H procedures. The results in post-operative pain detection was statistically significant after 4 h in favor of m-LPS-H group (p = 0.001). After 30 days no differences in cosmetic satisfaction were detected between the two groups (p = 0.206). PSS-H and m-LPS-H are two valid U-MIS alternatives for benign gynecological conditions and low/intermediate risk endometrial cancer. Keywords Hysterectomy · Minilaparoscopy · Ultra-minimally invasive surgery · Percutaneous instruments · 3 mm instruments
Introduction * Stefano Cianci [email protected] 1
Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Largo Madonna Delle Grazie 1, 80138 Naples, Italy
2
Gynecologic Oncology Unit, Women Wealth Area, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
3
Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti E Terapie Ad Alta Specializzazione), University of Pittsburgh Medical Center, Palermo, Italy
4
Department of General Surgery and Medical‑Surgical Specialties, University of Catania, Catania, Italy
Laparoscopic
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