Chen Kuo-Hu, Chen Li-Ru, Seow Kok-Min
Department of Obstetrics and Gynecology, Taipei Tzu-Chi Hospital, The Buddhist Tzu-Chi Medical Foundation, Taipei, Taiwan, and School of Medicine, Tzu-Chi University, Hualien, Taiwan.
Mackay Memorial Hospital, Taipei, Taiwan, and Department of Mechanical Engineering, National Chiao-Tung University, Hsinchu, Taiwan.
J Minim Invasive Gynecol. 2015 Jul-Aug;22(5):767-75. doi: 10.1016/j.jmig.2015.02.018. Epub 2015 Mar 7.
To describe a method of ovarian suspension with adjustable sutures (OSAS) for facilitating laparoendoscopic single-site gynecologic surgery (LESS) and to investigate the effect of OSAS on LESS.
Prospective cohort study (Canadian Task Force classification: II-2).
University teaching hospital.
One hundred seventy-eight patients with benign 5- to 15-cm cystic ovarian tumors who underwent LESS with OSAS (suspension group, n = 90) and without OSAS (control group, n = 88).
For patients who underwent OSAS (suspension group), 1 end of double-head straight needles with a polypropylene suture was inserted into the pelvic cavity through the abdominal skin to penetrate the cyst or ovarian parenchyma and puncture outside the abdominal skin. After cutting off the needles, both sides of the remaining suture were held together by a clamp, without knotting, so that the manipulator could "lift," "loosen," or "fix" the stitches to adjust the tension.
The average time to create OSAS was 2.9 min. For the suspension and control groups, the average blood loss was 81.4 and 131.8 mL (p < .001), and the operative time was 42.0 and 61.3 min (p < .001), respectively. There were no significant differences in the incidence of complications (5.6% vs 9.1%; p = .365), but there were significant differences in conversions to standard non-single-site laparoscopy (5.6% vs 15.9%; p = .025) and laparotomy (1.1% vs 6.8%; p = .040). Logistic regression analysis revealed that the ratios of conversion to standard non-single-site laparoscopy (odds ratio [OR], 0.126; 95% confidence interval [CI], 0.311-0.508) and laparotomy (OR, 0.032; 95% CI, 0.002-0.479) were much lower in the suspension group; the risk of complications was comparable (OR, 0.346; 95% CI, 0.085-1.403).
OSAS is an easy, safe, and feasible method that offers advantages during LESS. Although routine use of OSAS is not necessary, OSAS can be considered during LESS to facilitate the surgery.
描述一种采用可调节缝线的卵巢悬吊术（OSAS）以促进腹腔镜单孔妇科手术（LESS）的方法，并研究OSAS对LESS的影响。
前瞻性队列研究（加拿大工作组分类：II-2）。
大学教学医院。
178例患有5至15厘米良性卵巢囊性肿瘤的患者，其中90例接受了采用OSAS的LESS手术（悬吊组），88例未接受OSAS手术（对照组）。
对于接受OSAS手术的患者（悬吊组），将带有聚丙烯缝线的双头直针的一端通过腹部皮肤插入盆腔，穿透囊肿或卵巢实质后从腹部皮肤穿出。切断针头后，用夹子将剩余缝线的两端夹在一起，不打结，以便术者能够“提起”、“松开”或“固定”缝线以调节张力。
创建OSAS的平均时间为2.9分钟。悬吊组和对照组的平均失血量分别为81.4毫升和131.8毫升（p<0.001），手术时间分别为42.0分钟和61.3分钟（p<0.001）。并发症发生率无显著差异（5.6%对9.1%；p=0.365），但转为标准非单孔腹腔镜手术的比例有显著差异（5.6%对15.9%；p=0.025），转为开腹手术的比例也有显著差异（1.1%对6.8%；p=0.040）。逻辑回归分析显示，悬吊组转为标准非单孔腹腔镜手术的比例（比值比[OR]，0.126；95%置信区间[CI]，0.311-0.508）和转为开腹手术的比例（OR，0.032；95%CI，0.002-0.479）要低得多；并发症风险相当（OR，0.346；95%CI，0.085-1.403）。
OSAS是一种简便、安全且可行的方法，在LESS手术中具有优势。虽然不必常规使用OSAS，但在LESS手术中可考虑采用OSAS以利于手术操作。
