Outcomes of Total Laparoscopic Hysterectomy Using a 5-mm Versus 10-mm Laparoscope: A Randomized Control Trial.

Autor:	Acton JN; Department of Endoscopy, King Edward Memorial Hospital, Perth, Western Australia, Australia. Electronic address: jadeacton@gmail.com., Salfinger SG; Department of Gynaecologic Oncology, St. John of God Hospital Subiaco, University of Western Australia, Perth, Western Australia, Australia., Tan J; Department of Gynaecologic Oncology, St. John of God Hospital Subiaco, University of Western Australia, Perth, Western Australia, Australia., Cohen PA; Department of Gynaecologic Oncology, St. John of God Hospital Subiaco, University of Western Australia, Perth, Western Australia, Australia.
Jazyk:	angličtina
Zdroj:	Journal of minimally invasive gynecology [J Minim Invasive Gynecol] 2016 Jan; Vol. 23 (1), pp. 101-6. Date of Electronic Publication: 2015 Sep 11.
DOI:	10.1016/j.jmig.2015.09.001
Abstrakt:	Study Objective: To determine if the use of a 5-mm umbilical incision and laparoscope would result in a higher likelihood of earlier discharge from hospital after total laparoscopic hysterectomy (TLH) compared with a 10-mm umbilical incision and laparoscope. Secondary objectives of the study were to determine if the use of a 5-mm laparoscope would lead to a reduction in postoperative pain scores and a shorter operating time without an increase in complication rates. Design: Prospective, randomized, double-blinded, clinical trial (Canadian Task Force classification I). Setting: A tertiary care setting. Patients: Seventy-eight patients scheduled for TLH were prospectively recruited. Interventions: Women undergoing TLH were assigned to either a 5-mm umbilical port and laparoscope (5LH) or a 10-mm umbilical port and laparoscope (10LH). All patients underwent a standardized operative technique and anesthetic protocol. Patients and research assistants responsible for postoperative pain assessment were blinded to group. Analysis was by intention-to-treat. Measurements and Main Results: The primary outcome measure was length of hospital stay. Secondary outcome measures were operating time, pain scores on postoperative days 1 and 7, and complication rates. There was no difference in length of hospital stay between the 2 arms. Compared with the 10LH group, the 5LH group had shorter operative times (32.6 vs 40 minutes; p = .01) and less postoperative pain on day 1 (2.5 vs 3.3; p = .03 for "pain with movement") and on day 7 (.92 vs 1.8; p = .002). Complication rates were similar between the 2 groups. Conclusion: TLH with a 5-mm laparoscope resulted in shorter operative times and less pain on postoperative days 1 and 7, compared with a 10-mm laparoscope, with similar length of stay and complications. (Crown Copyright © 2016. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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