Kilpiö Olga, Härkki Päivi S M, Mentula Maarit J, Jokela Ritva M, Pakarinen Päivi I
Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Eur J Obstet Gynecol Reprod Biol. 2017 Nov;218:49-54. doi: 10.1016/j.ejogrb.2017.08.040. Epub 2017 Sep 4.
In laparoscopic adnexal surgery the conventional method of removing a mass from the abdominal cavity in Finland is through a 10-mm-wide lateral abdominal port. The larger the lateral trocar, the greater the risk of pain, complications and delayed recovery. Here, we assumed that adnexal mass removal through a 10-mm umbilical port together with 5-mm side trocars would decrease the postoperative need of analgesics when compared with removal through a 10-mm lateral abdominal port.
Women scheduled for laparoscopic surgery of a benign adnexal mass were invited to participate. The participants were randomized into two groups: removal via the transumbilical (TU) (n=21) or lateral transabdominal (TA) (n=21) route. General anesthesia and use of local anesthetics were standardized. The amount of postoperative opioid (oxycodone) and visual analog scale (VAS) scores for pain were the primary outcome measures. Secondary outcome measures were nausea/vomiting (VAS evaluation), time to discharge, peri- and postoperative complications, surgeons' opinions of the alternative methods and patients' satisfaction, evaluated via a questionnaire sent six months postoperatively.
There were no significant differences in the use of opioids or median pain-VAS scores between the groups during the first 24h postoperatively. However, in the TU group the amount of women with very low pain-VAS scores (0-1) during the whole 12-h follow-up time was significantly greater than in the TA group (4 vs. 0 women p=0.04). The amounts of nausea and vomiting, and median times to discharge were similar in both groups. There were no major complications.
Both transumbilical and transabdominal routes of abdominal mass removal during laparoscopy were feasible and safe. However, the transumbilical route resulted in more women with very low pain-VAS scores.
在芬兰，腹腔镜附件手术中从腹腔移除肿物的传统方法是通过一个10毫米宽的侧腹端口。侧腹套管针越大，疼痛、并发症和恢复延迟的风险就越大。在此，我们假设与通过10毫米侧腹端口移除相比，通过10毫米脐部端口和5毫米侧方套管针移除附件肿物会减少术后镇痛药物的需求。
邀请计划进行腹腔镜良性附件肿物手术的女性参与。参与者被随机分为两组：经脐部（TU）组（n = 21）和经侧腹（TA）组（n = 21）。全身麻醉和局部麻醉剂的使用标准化。术后阿片类药物（羟考酮）的用量和疼痛视觉模拟评分（VAS）是主要结局指标。次要结局指标包括恶心/呕吐（VAS评估）、出院时间、围手术期和术后并发症、外科医生对替代方法的意见以及患者满意度，通过术后六个月发送的问卷进行评估。
术后24小时内两组在阿片类药物使用或疼痛VAS评分中位数方面无显著差异。然而，在整个12小时随访期间，TU组疼痛VAS评分非常低（0 - 1）的女性数量显著多于TA组（4名对0名女性，p = 0.04）。两组的恶心和呕吐量以及出院时间中位数相似。无重大并发症。
腹腔镜手术中经脐部和经侧腹途径移除腹部肿物均可行且安全。然而，经脐部途径导致更多女性疼痛VAS评分非常低。
