Hatasaka H H, Sharp H T, Dowling D D, Teahon K, Peterson C M
Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City 84132, USA.
J Laparoendosc Adv Surg Tech A. 1997 Oct;7(5):295-9. doi: 10.1089/lap.1997.7.295.
This study was done to compare costs, operating and recovery times, safety, and patient acceptance between (a) minimally invasive laparoscopic tubal ligation under sedation and local anesthesia and (b) conventional laparoscopic operating-room-based tubal ligations under general anesthesia.
Fourteen women desiring sterilization were randomized between tubal ligation under sedation/local analgesia versus general anesthesia. Procedures were performed by supervised residents previously unfamiliar with the minimally invasive technique. Hospital charges were used as a surrogate for cost. Operating or procedure room times, surgical complications, and recovery times were recorded. Patient acceptance was assessed using satisfaction surveys administered in the recovery room and again 1 week postoperatively.
The cost of minimally invasive tubal ligation was significantly lower than for the conventional technique ($1,615+/-$134 vs $2,820+/-$110, p < 0.001). Surgical times were not different between the two procedures: 40.4+/-15 min for the conventional technique versus 32.9+/-10 min for minimally invasive surgery. However, the total in-room time required in the operating room significantly exceeded that for the procedure room technique (84+/-10 min vs 60+/-2 min, p < 0.05). Likewise, recovery time for the general anesthesia technique was longer (48+/-6 min vs 14+/-7 min, p < 0.03). No complications were encountered with either surgical method. Patient satisfaction for pain, fatigue, and days of missed work was similar between the two groups.
The use of minimally invasive surgery to perform tubal ligation is advantageous over conventional laparoscopic tubal ligation under general anesthesia with regard to cost and time utilization. The minimally invasive technique appears to be easy to learn, safe, and well tolerated.
本研究旨在比较以下两种情况的成本、手术及恢复时间、安全性和患者接受度：（a）在镇静和局部麻醉下进行的微创腹腔镜输卵管结扎术，以及（b）在全身麻醉下基于传统腹腔镜手术室的输卵管结扎术。
14名希望绝育的女性被随机分为接受镇静/局部镇痛下的输卵管结扎术或全身麻醉。手术由此前不熟悉微创技术的住院医师在监督下进行。医院收费被用作成本的替代指标。记录手术或操作室时间、手术并发症和恢复时间。使用在恢复室及术后1周进行的满意度调查评估患者接受度。
微创输卵管结扎术的成本显著低于传统技术（1615±134美元对2820±110美元，p<0.001）。两种手术的手术时间无差异：传统技术为40.4±15分钟，微创手术为32.9±10分钟。然而，手术室所需的总室内时间显著超过操作室技术（84±10分钟对60±2分钟，p<0.05）。同样，全身麻醉技术的恢复时间更长（48±6分钟对14±7分钟，p<0.03）。两种手术方法均未出现并发症。两组患者在疼痛、疲劳和误工天数方面的满意度相似。
在成本和时间利用方面，使用微创手术进行输卵管结扎术优于全身麻醉下的传统腹腔镜输卵管结扎术。微创技术似乎易于学习、安全且耐受性良好。
