Postoperative Outcomes after Single-port Laparoscopic Removal of Adnexal Masses in Patients Referred to Gynecologic Oncology at a Large Academic Center

被引:11
作者
Moulton, Laura J. [1 ]
Jernigan, Amelia M. [2 ]
Michener, Chad M. [3 ]
机构
[1] Cleveland Clin, Obstet Gynecol & Womens Hlth Inst, Desk A81,9500 Euclid Ave, Cleveland, OH 44195 USA
[2] Louisiana State Univ, Dept Obstet & Gynecol, Div Gynecol Oncol, Healthcare Network, New Orleans, LA USA
[3] Cleveland Clin, Div Gynecol Oncol, Obstet Gynecol & Womens Hlth Inst, Cleveland, OH 44195 USA
关键词
Adnexal masses; Gynecologic oncology; Minimally invasive surgery; Ovarian masses; Single-port laparoscopy; RANDOMIZED CONTROLLED-TRIALS; SITE SURGERY LESS; CENTER EXPERIENCE; CONVENTIONAL LAPAROSCOPY; INCISIONAL HERNIA; ACCESS; RISK; COMPLICATIONS; HYSTERECTOMY; METAANALYSIS;
D O I
10.1016/j.jmig.2017.06.023
中图分类号
R71 [妇产科学];
学科分类号
100211 ;
摘要
Study Objective: To report surgical and pathologic outcomes after single-port laparoscopy (SPL) for adnexal masses in patients referred to a gynecologic oncology practice at a single academic institution. Design: A retrospective analysis (Canadian Task Force Classification II.2). Setting: A single academic institution with multiple hospital centers. Patients: Women who underwent at least 1 single-port laparoscopic surgery for the treatment of an adnexal mass from 2009 to 2015 after referral to a gynecologic oncology practice. Intervention: Data were collected on the surgical procedure, patient demographic variables, 30-day surgical outcomes, and hernia development. Measurements and Main Results: Three hundred twenty-five surgeries were performed in 322 patients with a median follow-up of 42.7 months. The median age was 54.5 years, and the median body mass index was 28.1 kg/m(2). All patients underwent unilateral or bilateral salpingectomy or oophorectomy with or without hysterectomy (26.5%). The median operative time was 90.0 minutes. The median mass dimension was 6.4 cm with 17.9% (n = 60) greater than 10 cm. Masses were categorized as simple (11.4%) and complex (69.5%). Although the majority (87.4%) of masses were benign, 7.4% were malignant, and 5.2% were borderline. Benign masses were physiologic (16.6%), serous cystadenomas (19.1%), mucinous cystadenomas (6.8%), endometriomas (12.3%), myomas (12.3%), and mature teratomas (9.2%). In malignant cases (7.4%), serous carcinoma was the most frequent histology (58.3%). The rate of adverse outcomes within 30 days, including reoperation (0.0%), intraoperative injury (1.5%), venous thromboembolism (0.3%), and transfusion (0.6%), was low. The development of incisional cellulitis was 4.6%. The rate of incisional hernia was 4.0%, with a median occurrence of 18.3 months. Diabetes mellitus (p=.03) and obesity (p=.04) were significant predictors for a hernia, but mass complexity (p=.28), American Society of Anesthesiologists class (p=.83), and smoking (p=.82) were not. Conclusion: In patients undergoing SPL for the removal of adnexal masses in a gynecologic oncology practice, the rate of benign disease is high. SPL removal of adnexal masses is feasible and safe with favorable surgical outcomes, rare short-term adverse outcomes, and a low incisional hernia rate. (C) 2017 AAGL. All rights reserved.
引用
收藏
页码:1137 / 1145
页数:9
相关论文
共 34 条
[1]   Surgical approach to hysterectomy for benign gynaecological disease [J].
Aarts, Johanna W. M. ;
Nieboer, Theodoor E. ;
Johnson, Neil ;
Tavender, Emma ;
Garry, Ray ;
Mol, Ben Willem J. ;
Kluivers, Kirsten B. .
COCHRANE DATABASE OF SYSTEMATIC REVIEWS, 2015, (08)
[2]   Incidence of Port-Site Incisional Hernia After Single-Incision Laparoscopic Surgery [J].
Agaba, Emmanuel Atta ;
Rainville, Harvey ;
Ikedilo, Ojinika ;
Vemulapali, Pratibha .
JSLS-JOURNAL OF THE SOCIETY OF LAPAROENDOSCOPIC SURGEONS, 2014, 18 (02) :204-210
[3]   Single-port laparoscopic surgery for benign salpingo-ovarian pathology: a single-center experience from Saudi Arabia [J].
Al-Badawi, Ismail A. ;
AlOmar, Osama ;
Albadawi, Naryman ;
Abu-Zaid, Ahmed .
ANNALS OF SAUDI MEDICINE, 2016, 36 (01) :64-69
[4]  
[Anonymous], DIAGN THER ENDOSC
[5]   Single-incision laparoscopic surgery through the umbilicus is associated with a higher incidence of trocar-site hernia than conventional laparoscopy: a meta-analysis of randomized controlled trials [J].
Antoniou, S. A. ;
Morales-Conde, S. ;
Antoniou, G. A. ;
Granderath, F. A. ;
Berrevoet, F. ;
Muysoms, F. E. .
HERNIA, 2016, 20 (01) :1-10
[6]   Laparoendoscopic Single-Site Surgery for Benign Ovarian Cystectomies [J].
Bedaiwy, Mohamed A. ;
Sheyn, David ;
Eghdami, Lily ;
Abdelhafez, Faten F. ;
Volsky, Jessica G. ;
Nickles-Fader, Amanada ;
Escobar, Pedro F. .
GYNECOLOGIC AND OBSTETRIC INVESTIGATION, 2015, 79 (03) :179-183
[7]   Laparoendoscopic Single-Site Surgery for Management of Ovarian Endometriomas [J].
Bedaiwy, Mohamed A. ;
Farghaly, Tarek ;
Hurd, William ;
Liu, James ;
Mansour, Gihan ;
Fader, Amanda Nickles ;
Escobar, Pedro .
JSLS-JOURNAL OF THE SOCIETY OF LAPAROENDOSCOPIC SURGEONS, 2014, 18 (02) :191-196
[8]   Influencing factors for port-site hernias after single-incision laparoscopy [J].
Buckley, F. P., III ;
Vassaur, H. E. ;
Jupiter, D. C. ;
Crosby, J. H. ;
Wheeless, C. J. ;
Vassaur, J. L. .
HERNIA, 2016, 20 (05) :729-733
[9]   Single-Port (Octoport) Assisted Extracorporeal Ovarian Cystectomy for the Treatment of Large Ovarian Cysts: Compare to Conventional Laparoscopy and Laparotomy [J].
Chong, Gun Oh ;
Hong, Dae Gy ;
Lee, Yoon Soon .
JOURNAL OF MINIMALLY INVASIVE GYNECOLOGY, 2015, 22 (01) :45-49
[10]   Laparoscopic ovariectomy by single-port access for ovarian cryopreservation [J].
Courbiere, Blandine ;
Crochet, Patrice ;
Marcelli, Maxime ;
Saias-Magnan, Jacqueline ;
Grillo, Jean Marie ;
Agostini, Aubert .
ARCHIVES OF GYNECOLOGY AND OBSTETRICS, 2016, 293 (03) :591-594