Takeda Akihiro, Imoto Sanae, Nakamura Hiromi
Department of Obstetrics & Gynecology, Gifu Prefectural Tajimi Hospital, 5-161 Maebata-cho, Tajimi, Gifu 507-8522, Japan.
Department of Obstetrics & Gynecology, Gifu Prefectural Tajimi Hospital, 5-161 Maebata-cho, Tajimi, Gifu 507-8522, Japan.
Eur J Obstet Gynecol Reprod Biol. 2014 Sep;180:28-34. doi: 10.1016/j.ejogrb.2014.06.019. Epub 2014 Jun 30.
To evaluate the safety and feasibility of gasless transumbilical laparoendoscopic single-site (LESS) surgery with abdominal-wall lift method for the management of adnexal masses during pregnancy.
Retrospective study of 29 women each undergoing gasless LESS surgery and multiport laparoscopic surgery for the management of adnexal masses during pregnancy. The two groups were compared for their surgical and pregnancy outcome measures.
Conceptions occurred spontaneously in all women including 2 cases each of monochorionic-diamniotic twins in both groups. Three and 2 cases of bilateral adnexal masses were noted in the LESS surgery group and the multiport laparoscopic surgery group, respectively. Estimated gestational age at surgery was significantly older and tumor diameter was significantly larger in the LESS surgery group than in the multiport laparoscopic surgery group. However, significant differences between the two groups were not evident in other patient demographics. There were no significant differences in type of surgery between the two groups. In 28 masses that received LESS adnexal cystectomy, LESS-assisted extracorporeal cystectomy was achieved in 23 masses. Excised tissue weight in the LESS surgery group was significantly heavier than in the multiport laparoscopic surgery group. Significant differences were not observed in other operative parameters between the two groups. Significant differences in postoperative complications were not identified between the two groups. Benign pathologies were obtained in 61 masses from both groups, except for a case of clear cell carcinoma managed by LESS salpingo-oophorectomy. Significant differences in pathological diagnosis were not observed between the two groups. Delivery of 61 neonates occurred in 57 women except for the case of clear cell carcinoma in which termination of the pregnancy was chosen. In the LESS surgery group, threatened premature delivery requiring admission and preterm delivery was noted in 3 and 4 cases, respectively. However, significant differences in pregnancy outcomes were not identified between the two groups. The neonatal course was uneventful in all infants.
Gasless LESS surgery for adnexal masses during pregnancy is a safe and feasible alternative to multiport laparoscopic surgery, with the avoidance of potential negative effects of carbon dioxide gas insufflation on mother and fetus.
评估腹壁提拉法无气腹经脐单孔腹腔镜手术（LESS）治疗孕期附件包块的安全性和可行性。
对29例接受无气腹LESS手术和多端口腹腔镜手术治疗孕期附件包块的女性进行回顾性研究。比较两组的手术和妊娠结局指标。
所有女性均自然受孕，两组各有2例单绒毛膜双羊膜囊双胎。LESS手术组和多端口腹腔镜手术组分别有3例和2例双侧附件包块。LESS手术组手术时的估计孕周显著大于多端口腹腔镜手术组，肿瘤直径也显著更大。然而，两组在其他患者人口统计学特征方面无明显差异。两组手术方式无显著差异。在28例接受LESS附件囊肿切除术的包块中，23例实现了LESS辅助体外囊肿切除术。LESS手术组切除组织重量显著重于多端口腹腔镜手术组。两组在其他手术参数方面未观察到显著差异。两组术后并发症无显著差异。两组61个包块均为良性病变，除1例通过LESS输卵管卵巢切除术治疗的透明细胞癌。两组病理诊断无显著差异。57例女性分娩61例新生儿，除1例选择终止妊娠的透明细胞癌病例。LESS手术组分别有3例和4例出现先兆早产需住院及早产。然而，两组妊娠结局无显著差异。所有婴儿的新生儿病程均顺利。
孕期附件包块的无气腹LESS手术是多端口腹腔镜手术的一种安全可行的替代方法，可避免二氧化碳气腹对母亲和胎儿的潜在负面影响。
