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Smaller assistant ports mean less prolapse repair pain
LAS VEGAS – Patients experience less right-sided pain after laparoscopic sacrocolpopexy when surgeons use an 8-mm assistant port instead of a 12-mm port, results from a small trial show.
In the trial, conducted at Loyola University Medical Center in Maywood, Ill.,17 women were randomized to undergo the procedure with an 8-mm assistant port, and 18 with a 12-mm port, both on the right side of the abdomen.
Overall, pain severity was low at 2 weeks postop in both groups at just over 1 point on a 10-point visual analogue scale and not statistically different. However, patients who had a 12-mm assistant port were more likely to report right-sided pain, compared with those who had an 8-mm assistant port (60% vs.18%, P = 0.027).
“I saw a lot of these patients in the clinic at 2 weeks, and even though the overall pain score was low, they kept complaining about a dull, achy pain on the right side. They were using ibuprofen, and some of them had even restricted [their activities] because they were afraid they were going to pop a stitch,” said study lead Yufan B. Chen, MD, a urogynecology fellow at Loyola.
He said the research team thinks the difference in port-site pain “is clinically significant. . Since our study ended, we have stopped using the 12-mm port in most of our cases; we use the 8-mm port for the assistant,” he said at the meeting, sponsored by the American Association of Gynecologic Laparoscopists.
The tradeoff was that there were more needle struggles with the 8-mm port, 3.1/case vs. 0.6/case (P = .004). Surgeons found inserting and withdrawing the Gore-Tex needle through the smaller port more difficult. But there were no needle losses in either group and no differences in operative time – an average of about 95 minutes.
“The larger port size essentially benefits the surgeon more than the patient. This is kind of a common theme in minimally invasive surgery where less is actually more,” he said. Since the study, “we have identified why we have challenges with the needle transport; it’s usually because the needle gets bent, so we just unbend it a little bit with our needle drivers before we remove it,” Dr. Chen said.
Even so, “there may be a role in using the 12-mm port when you have assistants who are not [that] experienced,” he said.
Laparoscopic sacrocolpopexy is done through four ports at Loyola: a 12-mm umbilical port for the scope; two 5-mm ports on the left for the primary surgeon; and the right side port for the assistant, through which the Gore-Tex needle is passed.
In the study, there were no demographic or preop differences between the two groups of women. About 60% were white, with a mean age of 61 years. About 10% of the women had had prior abdominal surgery.
The study received no industry funding, and the investigators had no disclosures.
SOURCE: Chen YB et al. 2018 AAGL Global Congress, Abstract 197.
LAS VEGAS – Patients experience less right-sided pain after laparoscopic sacrocolpopexy when surgeons use an 8-mm assistant port instead of a 12-mm port, results from a small trial show.
In the trial, conducted at Loyola University Medical Center in Maywood, Ill.,17 women were randomized to undergo the procedure with an 8-mm assistant port, and 18 with a 12-mm port, both on the right side of the abdomen.
Overall, pain severity was low at 2 weeks postop in both groups at just over 1 point on a 10-point visual analogue scale and not statistically different. However, patients who had a 12-mm assistant port were more likely to report right-sided pain, compared with those who had an 8-mm assistant port (60% vs.18%, P = 0.027).
“I saw a lot of these patients in the clinic at 2 weeks, and even though the overall pain score was low, they kept complaining about a dull, achy pain on the right side. They were using ibuprofen, and some of them had even restricted [their activities] because they were afraid they were going to pop a stitch,” said study lead Yufan B. Chen, MD, a urogynecology fellow at Loyola.
He said the research team thinks the difference in port-site pain “is clinically significant. . Since our study ended, we have stopped using the 12-mm port in most of our cases; we use the 8-mm port for the assistant,” he said at the meeting, sponsored by the American Association of Gynecologic Laparoscopists.
The tradeoff was that there were more needle struggles with the 8-mm port, 3.1/case vs. 0.6/case (P = .004). Surgeons found inserting and withdrawing the Gore-Tex needle through the smaller port more difficult. But there were no needle losses in either group and no differences in operative time – an average of about 95 minutes.
“The larger port size essentially benefits the surgeon more than the patient. This is kind of a common theme in minimally invasive surgery where less is actually more,” he said. Since the study, “we have identified why we have challenges with the needle transport; it’s usually because the needle gets bent, so we just unbend it a little bit with our needle drivers before we remove it,” Dr. Chen said.
Even so, “there may be a role in using the 12-mm port when you have assistants who are not [that] experienced,” he said.
Laparoscopic sacrocolpopexy is done through four ports at Loyola: a 12-mm umbilical port for the scope; two 5-mm ports on the left for the primary surgeon; and the right side port for the assistant, through which the Gore-Tex needle is passed.
In the study, there were no demographic or preop differences between the two groups of women. About 60% were white, with a mean age of 61 years. About 10% of the women had had prior abdominal surgery.
The study received no industry funding, and the investigators had no disclosures.
SOURCE: Chen YB et al. 2018 AAGL Global Congress, Abstract 197.
LAS VEGAS – Patients experience less right-sided pain after laparoscopic sacrocolpopexy when surgeons use an 8-mm assistant port instead of a 12-mm port, results from a small trial show.
In the trial, conducted at Loyola University Medical Center in Maywood, Ill.,17 women were randomized to undergo the procedure with an 8-mm assistant port, and 18 with a 12-mm port, both on the right side of the abdomen.
Overall, pain severity was low at 2 weeks postop in both groups at just over 1 point on a 10-point visual analogue scale and not statistically different. However, patients who had a 12-mm assistant port were more likely to report right-sided pain, compared with those who had an 8-mm assistant port (60% vs.18%, P = 0.027).
“I saw a lot of these patients in the clinic at 2 weeks, and even though the overall pain score was low, they kept complaining about a dull, achy pain on the right side. They were using ibuprofen, and some of them had even restricted [their activities] because they were afraid they were going to pop a stitch,” said study lead Yufan B. Chen, MD, a urogynecology fellow at Loyola.
He said the research team thinks the difference in port-site pain “is clinically significant. . Since our study ended, we have stopped using the 12-mm port in most of our cases; we use the 8-mm port for the assistant,” he said at the meeting, sponsored by the American Association of Gynecologic Laparoscopists.
The tradeoff was that there were more needle struggles with the 8-mm port, 3.1/case vs. 0.6/case (P = .004). Surgeons found inserting and withdrawing the Gore-Tex needle through the smaller port more difficult. But there were no needle losses in either group and no differences in operative time – an average of about 95 minutes.
“The larger port size essentially benefits the surgeon more than the patient. This is kind of a common theme in minimally invasive surgery where less is actually more,” he said. Since the study, “we have identified why we have challenges with the needle transport; it’s usually because the needle gets bent, so we just unbend it a little bit with our needle drivers before we remove it,” Dr. Chen said.
Even so, “there may be a role in using the 12-mm port when you have assistants who are not [that] experienced,” he said.
Laparoscopic sacrocolpopexy is done through four ports at Loyola: a 12-mm umbilical port for the scope; two 5-mm ports on the left for the primary surgeon; and the right side port for the assistant, through which the Gore-Tex needle is passed.
In the study, there were no demographic or preop differences between the two groups of women. About 60% were white, with a mean age of 61 years. About 10% of the women had had prior abdominal surgery.
The study received no industry funding, and the investigators had no disclosures.
SOURCE: Chen YB et al. 2018 AAGL Global Congress, Abstract 197.
REPORTING FROM AAGL GLOBAL CONGRESS
Key clinical point: Patients experienced less pain at 2 weeks with a smaller port; there are also more needle struggles, but that can be easily fixed.
Major finding: Patients who had a 12-mm assistant port were more likely to report right-sided pain, compared with those who received an 8- mm assistant port (60% vs. 18%, P = 0.027).
Study details: Randomized trial with 35 women.
Disclosures: The study received no industry funding, and the investigators had no disclosures.
Source: Chen YB et al. 2018 AAGL Global Congress, Abstract 197.
Try to normalize albumin before laparoscopic hysterectomy
LAS VEGAS – Serum albumin is an everyday health marker commonly used for risk assessment in open abdominal procedures, but it’s often not checked before laparoscopic hysterectomies.
Low levels mean something is off, be it malnutrition, inflammation, chronic disease, or other problems. If it can be normalized before surgery, it should be; women probably will do better, according to investigators from the University of Kentucky, Lexington.
“In minimally invasive gynecologic procedures, we haven’t come to adopt this marker just quite yet. It could be included in the routine battery of tests” at minimal cost. “I think it’s something we should consider,” said ob.gyn. resident Suzanne Lababidi, MD.
The team was curious why serum albumin generally is not a part of routine testing for laparoscopic hysterectomy. The first step was to see if it made a difference, so they reviewed 43,289 cases in the National Surgical Quality Improvement Program database. The women were “par for the course;” 51 years old, on average; and had a mean body mass index of 31.9 kg/m2. More than one-third were hypertensive. Mean albumin was in the normal range at 4.1 g/dL, Dr. Lababidi said at the meeting, sponsored by the American Association of Gynecologic Laparoscopists.
Her team did not come up with a cut-point to delay surgery – that’s the goal of further research – but they noticed on linear regression that women with lower preop albumin had higher rates of surgical site infections and intraoperative transfusions, plus higher rates of postop pneumonia; renal failure; urinary tract infection; sepsis; and deep vein thrombosis, among other issues – and even after controlling for hypertension, diabetes, and other comorbidities. The findings met statistical significance.
It’s true that patients with low albumin might have gone into the operating room sicker, but no matter; Dr. Lababidi’s point was that preop serum albumin is something to pay attention to and correct whenever possible before laparoscopic hysterectomies.
Preop levels are something to consider for “counseling and optimizing patients to improve surgical outcomes,” she said.
The next step toward an albumin cut-point is to weed out confounders by further stratifying patients based on albumin levels, she said.
The work received no industry funding. Dr. Lababidi had no disclosures.
SOURCE: Lababidi S et al. 2018 AAGL Global Congress, Abstract 199.
LAS VEGAS – Serum albumin is an everyday health marker commonly used for risk assessment in open abdominal procedures, but it’s often not checked before laparoscopic hysterectomies.
Low levels mean something is off, be it malnutrition, inflammation, chronic disease, or other problems. If it can be normalized before surgery, it should be; women probably will do better, according to investigators from the University of Kentucky, Lexington.
“In minimally invasive gynecologic procedures, we haven’t come to adopt this marker just quite yet. It could be included in the routine battery of tests” at minimal cost. “I think it’s something we should consider,” said ob.gyn. resident Suzanne Lababidi, MD.
The team was curious why serum albumin generally is not a part of routine testing for laparoscopic hysterectomy. The first step was to see if it made a difference, so they reviewed 43,289 cases in the National Surgical Quality Improvement Program database. The women were “par for the course;” 51 years old, on average; and had a mean body mass index of 31.9 kg/m2. More than one-third were hypertensive. Mean albumin was in the normal range at 4.1 g/dL, Dr. Lababidi said at the meeting, sponsored by the American Association of Gynecologic Laparoscopists.
Her team did not come up with a cut-point to delay surgery – that’s the goal of further research – but they noticed on linear regression that women with lower preop albumin had higher rates of surgical site infections and intraoperative transfusions, plus higher rates of postop pneumonia; renal failure; urinary tract infection; sepsis; and deep vein thrombosis, among other issues – and even after controlling for hypertension, diabetes, and other comorbidities. The findings met statistical significance.
It’s true that patients with low albumin might have gone into the operating room sicker, but no matter; Dr. Lababidi’s point was that preop serum albumin is something to pay attention to and correct whenever possible before laparoscopic hysterectomies.
Preop levels are something to consider for “counseling and optimizing patients to improve surgical outcomes,” she said.
The next step toward an albumin cut-point is to weed out confounders by further stratifying patients based on albumin levels, she said.
The work received no industry funding. Dr. Lababidi had no disclosures.
SOURCE: Lababidi S et al. 2018 AAGL Global Congress, Abstract 199.
LAS VEGAS – Serum albumin is an everyday health marker commonly used for risk assessment in open abdominal procedures, but it’s often not checked before laparoscopic hysterectomies.
Low levels mean something is off, be it malnutrition, inflammation, chronic disease, or other problems. If it can be normalized before surgery, it should be; women probably will do better, according to investigators from the University of Kentucky, Lexington.
“In minimally invasive gynecologic procedures, we haven’t come to adopt this marker just quite yet. It could be included in the routine battery of tests” at minimal cost. “I think it’s something we should consider,” said ob.gyn. resident Suzanne Lababidi, MD.
The team was curious why serum albumin generally is not a part of routine testing for laparoscopic hysterectomy. The first step was to see if it made a difference, so they reviewed 43,289 cases in the National Surgical Quality Improvement Program database. The women were “par for the course;” 51 years old, on average; and had a mean body mass index of 31.9 kg/m2. More than one-third were hypertensive. Mean albumin was in the normal range at 4.1 g/dL, Dr. Lababidi said at the meeting, sponsored by the American Association of Gynecologic Laparoscopists.
Her team did not come up with a cut-point to delay surgery – that’s the goal of further research – but they noticed on linear regression that women with lower preop albumin had higher rates of surgical site infections and intraoperative transfusions, plus higher rates of postop pneumonia; renal failure; urinary tract infection; sepsis; and deep vein thrombosis, among other issues – and even after controlling for hypertension, diabetes, and other comorbidities. The findings met statistical significance.
It’s true that patients with low albumin might have gone into the operating room sicker, but no matter; Dr. Lababidi’s point was that preop serum albumin is something to pay attention to and correct whenever possible before laparoscopic hysterectomies.
Preop levels are something to consider for “counseling and optimizing patients to improve surgical outcomes,” she said.
The next step toward an albumin cut-point is to weed out confounders by further stratifying patients based on albumin levels, she said.
The work received no industry funding. Dr. Lababidi had no disclosures.
SOURCE: Lababidi S et al. 2018 AAGL Global Congress, Abstract 199.
REPORTING FROM THE AAGL GLOBAL CONGRESS
Antibiotics backed as standard of care for myomectomies
LAS VEGAS – The surgical site infection rate was 2.9% among women who received perioperative antibiotics for fibroid surgery, but 7.8% among those who did not, in a review of 1,433 cases at Massachusetts General Hospital and Brigham and Women’s Hospital, Boston.
That is despite the fact that antibiotic cases were longer – 155 minutes vs. 89 minutes – and had more blood loss, 200 ml vs. 117 ml. Antibiotic cases also had larger specimen weights – 346 g vs. 176 g – and were more likely to have the uterine cavity entered, 30.2% vs. 14.4%.
“Surgical site infections were more common in the no-antibiotics group despite these being less complex cases.” There was “nearly a fivefold increased odds of surgical site infection or any infectious complication when no antibiotics were given,” after controlling for infection risk factors, including smoking and diabetes, said investigator Nisse V. Clark, MD, a minimally invasive gynecologic surgeon affiliated with Massachusetts General Hospital.
There are no perioperative antibiotic guidelines for myomectomies; maybe there should be. Almost 94% of the women in the review did receive antibiotics at the Harvard-affiliated hospitals, but the nationwide average has been pegged at about two-thirds, she said at the meeting, sponsored by the American Association of Gynecologic Laparoscopists.
The antibiotic cases usually received a cephalosporin before surgery, and were about evenly about evenly split between abdominal, robotic, and laparoscopic approaches.
About one-third of the 90 women (6.3%) who did not get antibiotics had hysteroscopic procedures in which antibiotics usually are not given because the peritoneal cavity is not breeched. Most of the rest, however, were laparoscopic cases. It’s unknown why they weren’t given antibiotics. In her own practice, Dr. Clark said preop antibiotics are the rule for laparoscopic myomectomies.
The surgical site infection difference was driven largely by higher incidences of pelvic abscesses and other organ space infections in the no-antibiotic group.
The only significant demographic difference between the two groups was that women who received antibiotics were slightly younger (mean 38 versus 39.7 years).
In addition to diabetes and smoking, the team adjusted for age, surgery route, body mass index, uterine entry, intraoperative complications, and myoma weight in their multivariate analysis. Still, women in the no-antibiotic group were 4.59 times more likely to have a surgical site infection, 4.76 more likely to have any infectious complication, and almost 8 times more likely to have a major infectious complication. All of the findings were statistically significant.
The study had no industry funding, and Dr. Clark had no disclosures.
LAS VEGAS – The surgical site infection rate was 2.9% among women who received perioperative antibiotics for fibroid surgery, but 7.8% among those who did not, in a review of 1,433 cases at Massachusetts General Hospital and Brigham and Women’s Hospital, Boston.
That is despite the fact that antibiotic cases were longer – 155 minutes vs. 89 minutes – and had more blood loss, 200 ml vs. 117 ml. Antibiotic cases also had larger specimen weights – 346 g vs. 176 g – and were more likely to have the uterine cavity entered, 30.2% vs. 14.4%.
“Surgical site infections were more common in the no-antibiotics group despite these being less complex cases.” There was “nearly a fivefold increased odds of surgical site infection or any infectious complication when no antibiotics were given,” after controlling for infection risk factors, including smoking and diabetes, said investigator Nisse V. Clark, MD, a minimally invasive gynecologic surgeon affiliated with Massachusetts General Hospital.
There are no perioperative antibiotic guidelines for myomectomies; maybe there should be. Almost 94% of the women in the review did receive antibiotics at the Harvard-affiliated hospitals, but the nationwide average has been pegged at about two-thirds, she said at the meeting, sponsored by the American Association of Gynecologic Laparoscopists.
The antibiotic cases usually received a cephalosporin before surgery, and were about evenly about evenly split between abdominal, robotic, and laparoscopic approaches.
About one-third of the 90 women (6.3%) who did not get antibiotics had hysteroscopic procedures in which antibiotics usually are not given because the peritoneal cavity is not breeched. Most of the rest, however, were laparoscopic cases. It’s unknown why they weren’t given antibiotics. In her own practice, Dr. Clark said preop antibiotics are the rule for laparoscopic myomectomies.
The surgical site infection difference was driven largely by higher incidences of pelvic abscesses and other organ space infections in the no-antibiotic group.
The only significant demographic difference between the two groups was that women who received antibiotics were slightly younger (mean 38 versus 39.7 years).
In addition to diabetes and smoking, the team adjusted for age, surgery route, body mass index, uterine entry, intraoperative complications, and myoma weight in their multivariate analysis. Still, women in the no-antibiotic group were 4.59 times more likely to have a surgical site infection, 4.76 more likely to have any infectious complication, and almost 8 times more likely to have a major infectious complication. All of the findings were statistically significant.
The study had no industry funding, and Dr. Clark had no disclosures.
LAS VEGAS – The surgical site infection rate was 2.9% among women who received perioperative antibiotics for fibroid surgery, but 7.8% among those who did not, in a review of 1,433 cases at Massachusetts General Hospital and Brigham and Women’s Hospital, Boston.
That is despite the fact that antibiotic cases were longer – 155 minutes vs. 89 minutes – and had more blood loss, 200 ml vs. 117 ml. Antibiotic cases also had larger specimen weights – 346 g vs. 176 g – and were more likely to have the uterine cavity entered, 30.2% vs. 14.4%.
“Surgical site infections were more common in the no-antibiotics group despite these being less complex cases.” There was “nearly a fivefold increased odds of surgical site infection or any infectious complication when no antibiotics were given,” after controlling for infection risk factors, including smoking and diabetes, said investigator Nisse V. Clark, MD, a minimally invasive gynecologic surgeon affiliated with Massachusetts General Hospital.
There are no perioperative antibiotic guidelines for myomectomies; maybe there should be. Almost 94% of the women in the review did receive antibiotics at the Harvard-affiliated hospitals, but the nationwide average has been pegged at about two-thirds, she said at the meeting, sponsored by the American Association of Gynecologic Laparoscopists.
The antibiotic cases usually received a cephalosporin before surgery, and were about evenly about evenly split between abdominal, robotic, and laparoscopic approaches.
About one-third of the 90 women (6.3%) who did not get antibiotics had hysteroscopic procedures in which antibiotics usually are not given because the peritoneal cavity is not breeched. Most of the rest, however, were laparoscopic cases. It’s unknown why they weren’t given antibiotics. In her own practice, Dr. Clark said preop antibiotics are the rule for laparoscopic myomectomies.
The surgical site infection difference was driven largely by higher incidences of pelvic abscesses and other organ space infections in the no-antibiotic group.
The only significant demographic difference between the two groups was that women who received antibiotics were slightly younger (mean 38 versus 39.7 years).
In addition to diabetes and smoking, the team adjusted for age, surgery route, body mass index, uterine entry, intraoperative complications, and myoma weight in their multivariate analysis. Still, women in the no-antibiotic group were 4.59 times more likely to have a surgical site infection, 4.76 more likely to have any infectious complication, and almost 8 times more likely to have a major infectious complication. All of the findings were statistically significant.
The study had no industry funding, and Dr. Clark had no disclosures.
REPORTING FROM THE AAGL GLOBAL CONGRESS
Key clinical point: A Boston study suggests that even low-risk cases benefit from antibiotics.
Major finding: The surgical site infection rate was 2.9% among women who received perioperative antibiotics for fibroid surgery, but 7.8% among those who did not.
Study details: Review of 1,433 myomectomies at two academic medical centers.
Disclosures: The study had no industry funding, and Dr. Clark had no disclosures.
Single-port robotic sacrocolpopexy has same learning curve as multiport
LAS VEGAS – according to Israeli investigators.
Multiport sacrocolpopexy is common, but the single-port approach hasn’t really caught on yet. That’s likely to change, however, with ongoing development of the da Vinci robotic platform, said lead investigator Emad Matanes, MD, of the Rambam Medical Center, Haifa, Israel.
The medical center recently has been switching over to the single-port approach, and Dr. Matanes and his colleagues wanted to share their experience with surgeons considering doing the same.
They compared their first 52 multiport cases during Dec. 2011-Dec. 2012 to their first 52 single-port cases during Aug. 2015-Aug. 2017.
It took about 15 cases with either approach for operative times to stabilize, dropping from an average of 222 minutes to 161 minutes after the first 15 single-port cases, and from 224 to 198 minutes after the first 15 multiport cases (J Minim Invasive Gynecol. 2018 Nov-Dec;25[7]:S47-S8).
With both, “we reached our steady state after the first 15. Both approaches are feasible, and for both, surgery times improve after 15 cases,” Dr. Matanes said at the American Association of Gynecologic Laparoscopists Global Congress.
Overall, the single-port approach proved about 20 minutes quicker, due to shorter docking and anesthesia times.
There wasn’t a single prolapse recurrence in either group, even after the first few cases. There was slightly less postoperative pain with single-port surgery (visual analogue scale sore 1.5 vs. 2 points), and slightly less estimated blood loss (38 mL vs. 54 mL), but neither difference was statistically significant.
There were no statistically significant differences between women in the two groups. Their average age was 58 years, mean body mass index was 28 kg/m2, and most women had a preoperative Pelvic Organ Prolapse Quantification score of 3.
There was no outside funding, and Dr. Matanes didn’t disclose any relevant financial disclosures.
LAS VEGAS – according to Israeli investigators.
Multiport sacrocolpopexy is common, but the single-port approach hasn’t really caught on yet. That’s likely to change, however, with ongoing development of the da Vinci robotic platform, said lead investigator Emad Matanes, MD, of the Rambam Medical Center, Haifa, Israel.
The medical center recently has been switching over to the single-port approach, and Dr. Matanes and his colleagues wanted to share their experience with surgeons considering doing the same.
They compared their first 52 multiport cases during Dec. 2011-Dec. 2012 to their first 52 single-port cases during Aug. 2015-Aug. 2017.
It took about 15 cases with either approach for operative times to stabilize, dropping from an average of 222 minutes to 161 minutes after the first 15 single-port cases, and from 224 to 198 minutes after the first 15 multiport cases (J Minim Invasive Gynecol. 2018 Nov-Dec;25[7]:S47-S8).
With both, “we reached our steady state after the first 15. Both approaches are feasible, and for both, surgery times improve after 15 cases,” Dr. Matanes said at the American Association of Gynecologic Laparoscopists Global Congress.
Overall, the single-port approach proved about 20 minutes quicker, due to shorter docking and anesthesia times.
There wasn’t a single prolapse recurrence in either group, even after the first few cases. There was slightly less postoperative pain with single-port surgery (visual analogue scale sore 1.5 vs. 2 points), and slightly less estimated blood loss (38 mL vs. 54 mL), but neither difference was statistically significant.
There were no statistically significant differences between women in the two groups. Their average age was 58 years, mean body mass index was 28 kg/m2, and most women had a preoperative Pelvic Organ Prolapse Quantification score of 3.
There was no outside funding, and Dr. Matanes didn’t disclose any relevant financial disclosures.
LAS VEGAS – according to Israeli investigators.
Multiport sacrocolpopexy is common, but the single-port approach hasn’t really caught on yet. That’s likely to change, however, with ongoing development of the da Vinci robotic platform, said lead investigator Emad Matanes, MD, of the Rambam Medical Center, Haifa, Israel.
The medical center recently has been switching over to the single-port approach, and Dr. Matanes and his colleagues wanted to share their experience with surgeons considering doing the same.
They compared their first 52 multiport cases during Dec. 2011-Dec. 2012 to their first 52 single-port cases during Aug. 2015-Aug. 2017.
It took about 15 cases with either approach for operative times to stabilize, dropping from an average of 222 minutes to 161 minutes after the first 15 single-port cases, and from 224 to 198 minutes after the first 15 multiport cases (J Minim Invasive Gynecol. 2018 Nov-Dec;25[7]:S47-S8).
With both, “we reached our steady state after the first 15. Both approaches are feasible, and for both, surgery times improve after 15 cases,” Dr. Matanes said at the American Association of Gynecologic Laparoscopists Global Congress.
Overall, the single-port approach proved about 20 minutes quicker, due to shorter docking and anesthesia times.
There wasn’t a single prolapse recurrence in either group, even after the first few cases. There was slightly less postoperative pain with single-port surgery (visual analogue scale sore 1.5 vs. 2 points), and slightly less estimated blood loss (38 mL vs. 54 mL), but neither difference was statistically significant.
There were no statistically significant differences between women in the two groups. Their average age was 58 years, mean body mass index was 28 kg/m2, and most women had a preoperative Pelvic Organ Prolapse Quantification score of 3.
There was no outside funding, and Dr. Matanes didn’t disclose any relevant financial disclosures.
REPORTING FROM THE AAGL GLOBAL CONGRESS