Department of Obstetrics and Gynecology, Tokyo Medical University Hospital, Tokyo, Japan.
Department of Obstetrics and Gynecology, Akaeda Clinic, Tokyo, Japan.
JSLS. 2023 Jan-Mar;27(1). doi: 10.4293/JSLS.2022.00083.
To evaluate the efficacy of gasless reduced-port laparoscopic surgery (GRP-LS) using a subcutaneous abdominal wall lifting method for gynecological diseases.
This study included gasless laparoscopic surgeries performed at our hospital between September 1, 1993 and December 31, 2016. The new GRP-LS technique was compared with the conventional gasless three-port laparoscopic surgery (G3P-LS), based on patient background, operative results in patients treated for laparoscopic myomectomy (LM), laparoscopic ovarian cystectomy (LC), and laparoscopic salpingectomy (LT). Surgeons of the two techniques were categorized by the number of surgeries they had performed, and the number of surgeons and surgeries for each technique were compared.
GRP-LS was used in 2,338 cases and G3P-LS in 2,473 cases. GRP-LS was used in 980 LM cases, 804 LC cases, 240 LT cases, and 314 cases for other conditions. The operative time required for GRP-LS was significantly less for LM, LC, LT, and the procedure also had less blood loss for LM and LC than G3P-LS. G3P-LS required a transition to open surgery in 0.69% of cases, whereas GRP-LS showed a very low rate of 0.09%. Sixty-seven of the 78 GRP-LS surgeons (85.9%) had performed fewer than 50 GRP-LSs, and these surgeons performed about half of all surgeries. Eighty-three of the 93 GRP-LS surgeons (89.2%) had performed fewer than 50 G3P-LSs, and these surgeons performed 38.9% of all surgeries.
GRP-LS is an effective surgery with few complications and less cosmetic damage and can be easily introduced to novice or inexperienced laparoscopic surgeons.
评估使用皮下腹壁提升法的无气经脐小切口腹腔镜手术（GRP-LS）治疗妇科疾病的疗效。
本研究纳入了我院 1993 年 9 月 1 日至 2016 年 12 月 31 日期间进行的无气腹腔镜手术。新的 GRP-LS 技术与传统的无气三孔腹腔镜手术（G3P-LS）进行比较，比较指标为腹腔镜子宫肌瘤剔除术（LM）、腹腔镜卵巢囊肿切除术（LC）和腹腔镜输卵管切除术（LT）患者的背景和手术结果。根据手术次数将两种技术的外科医生进行分类，并比较两种技术的外科医生数量和手术数量。
GRP-LS 用于 2338 例，G3P-LS 用于 2473 例。GRP-LS 用于 980 例 LM 手术、804 例 LC 手术、240 例 LT 手术和 314 例其他疾病手术。GRP-LS 用于 LM、LC、LT 的手术时间明显短于 G3P-LS，且用于 LM 和 LC 的出血量也少于 G3P-LS。G3P-LS 中转开腹手术的发生率为 0.69%，而 GRP-LS 则非常低，为 0.09%。67 名（85.9%）GRP-LS 外科医生的手术量少于 50 例，这些外科医生完成了近一半的手术。83 名（89.2%）GRP-LS 外科医生的手术量少于 50 例 G3P-LS，这些外科医生完成了 38.9%的手术。
GRP-LS 是一种有效且并发症少、美容损伤小的手术，易于向新手或经验不足的腹腔镜外科医生推广。
