Obstetrics and Gynecology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", 80128 Naples, Italy.
Gynecology and Obstetrics Unit, Department of Medicine, Surgery and Dentistry "Schola Medica Salernitana", University of Salerno, 84081 Baronissi, Italy.
Medicina (Kaunas). 2022 Apr 23;58(5):578. doi: 10.3390/medicina58050578.
: The type of instrumentation used during laparoscopic surgery might impact on the learning curve of resident surgeons. The aim of this study was to investigate differences in operator satisfaction and surgical outcomes between tissue sealers and classic bipolar instruments during gynecological laparoscopies performed by residents. : A prospective cohort study conducted at two tertiary university hospitals between March 2019 and March 2021, on consecutive procedures: salpingo-oophorectomies (Group 1) and salpingectomies (Group 2), subdivided according to the utilized device: radiofrequency tissue sealers (Groups A1 and A2) or bipolar forceps (Groups B1 and B2). : 80 procedures were included. Concerning salpingo-oophorectomies, better visibility (8.4 ± 0.8 vs. 7.3 ± 0.9; = 0.03), reduced difficulty (5.4 ± 1.2 vs. 7.0 ± 1.4; = 0.02), improved overall satisfaction (9.2 ± 0.4 vs. 7.6 ± 1.0; = 0.02) and reduced procedure time (7.8 ± 3.4 vs. 12.6 ± 3.1; = 0.01) were reported by residents using tissue sealers. Intraoperative blood loss (12.2 ± 4.7 mL vs. 33.2 ± 9.7 mL; = 0.01) and 24 h postoperative pain (4.5 ± 1.1 vs. 5.7 ± 1.8; = 0.03) were lower in group A1 than B1. For salpingectomies, a significant reduction in duration was found in A2 compared to B2 (7.2 ± 3.4 min vs. 13.8 ± 2.2 min; = 0.02). Tissue sealers enhanced visibility (8.1 ± 1.1 vs. 6.7 ± 1.4; = 0.01), difficulty (6.5 ± 1.1 vs. 7.5 ± 0.9; = 0.04) and improved satisfaction (9.3 ± 0.5 vs. 7.5 ± 0.6; = 0.01). Moreover, hemoglobin loss and postoperative pain were reduced in A2 relative to B2 [(8.1 ± 4.2 % vs. 4.5 ± 1.1%; = 0.02) and (5.1 ± 0.9 vs. 4.1 ± 0.8; = 0.03), respectively] : The use of sealing devices by residents was related to reduced difficulty as well improved visibility and overall satisfaction, with improved surgical outcomes.
使用腹腔镜手术的仪器类型可能会影响住院医师的学习曲线。本研究旨在调查在住院医师进行的妇科腹腔镜手术中，使用组织密封剂与传统双极器械的手术结果和术者满意度之间的差异。
这是一项前瞻性队列研究，于 2019 年 3 月至 2021 年 3 月在两家三级大学医院进行，连续进行了输卵管卵巢切除术（第 1 组）和输卵管切除术（第 2 组），根据使用的器械进行了细分：射频组织密封器（A 组 1 和 A 组 2）或双极镊子（B 组 1 和 B 组 2）。共纳入 80 例手术。对于输卵管卵巢切除术，使用组织密封器的住院医师报告了更好的可视性（8.4 ± 0.8 比 7.3 ± 0.9； = 0.03）、更低的难度（5.4 ± 1.2 比 7.0 ± 1.4； = 0.02）、更高的总体满意度（9.2 ± 0.4 比 7.6 ± 1.0； = 0.02）和更短的手术时间（7.8 ± 3.4 比 12.6 ± 3.1； = 0.01）。与 B 组 1 相比，A 组 1 的术中出血量（12.2 ± 4.7 mL 比 33.2 ± 9.7 mL； = 0.01）和 24 小时术后疼痛（4.5 ± 1.1 比 5.7 ± 1.8； = 0.03）更低。对于输卵管切除术，与 B 组 2 相比，A 组 2 的手术时间显著缩短（7.2 ± 3.4 min 比 13.8 ± 2.2 min； = 0.02）。组织密封器提高了可视性（8.1 ± 1.1 比 6.7 ± 1.4； = 0.01）、难度（6.5 ± 1.1 比 7.5 ± 0.9； = 0.04）和满意度（9.3 ± 0.5 比 7.5 ± 0.6； = 0.01）。此外，与 B 组 2 相比，A 组 2 的血红蛋白丢失和术后疼痛减少（（8.1 ± 4.2%比 4.5 ± 1.1%； = 0.02）和（5.1 ± 0.9 比 4.1 ± 0.8； = 0.03））。
综上所述，住院医师使用密封装置可降低难度，提高可视性和整体满意度，并改善手术结果。
