A prospective randomised control trial to compare the perioperative outcomes and ergonomic challenges between triangular versus midline port placement in total extra-peritoneal repair of uncomplicated unilateral inguinal hernia
| Autor: | Ajay Kumar Pal, Suresh Kumar, Akshay Anand, Sapna Singh, Abhinav Arun Sonkar, Manish K. Agrawal, Harvinder Singh Pahwa, Awanish Kumar |
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| Rok vydání: | 2019 |
| Předmět: |
Adult
medicine.medical_specialty Shoulders Hernia Inguinal Wrist Perioperative Care 03 medical and health sciences 0302 clinical medicine Port (medical) Quality of life Medicine Humans Prospective Studies Laparoscopy Herniorrhaphy medicine.diagnostic_test business.industry Human factors and ergonomics Perioperative Middle Aged Surgery medicine.anatomical_structure 030220 oncology & carcinogenesis Quality of Life 030211 gastroenterology & hepatology Ergonomics Peritoneum business Abdominal surgery |
| Zdroj: | Surgical endoscopy. 35(3) |
| ISSN: | 1432-2218 |
| Popis: | Routine TEP technique requires three skin incisions for placement of three trocars in the midline. Otherwise, this can be done by three-port triangular technique or two-hand technique. This study reports a randomised trial of perioperative outcomes and ergonomics characteristics of this procedure using two different techniques of port insertion. N = 28 patients were randomised into two groups for triangular three-port (TTEP) versus midline three-port TEP (MTEP) hernioplasty after informed written consent in Department of Surgery, King George’s Medical University UP between September 2016 and September 2017 after institutional ethical approval. Patient-related outcomes in terms of quality of life (QOL) and ergonomic evaluation of the technique were compared in double-blinded fashion. Postoperative pain score at 24 h post surgery (5.1 ± 0.6; 95% CI 4.9–5.3 vs. 4.8 ± 0.4; 95% CI 4.6–4.9) differed, while hospital stay, time to return to routine work, tolerance to oral feeds and intraoperative complications occurrence (OR 2.1; 95% CI 0.2–24.3) were comparable in both groups. Time to return to office work (5.5 ± 0.5; 95% CI 5.4–5.7 vs. 4.0 ± 0.8; 95% CI 3.7–4.3) and immediate postoperative sensation of mesh and pain score were significantly higher in MTEP compared to TTEP. Ergonomic parameters including visualization of landmark score, spreading of mesh score and total surgeon satisfaction score (TTEP 8.4 ± 0.7; 95% CI 8.1–8.6 vs. MTEP 7.0 ± 0.8; 95% CI 6.7–7.3), mental effort quotient (SMEQ score: TTEP 50.6 ± 12.7; 95% CI 45.9–55.3 vs. MTEP 70.8 ± 12.6: 95% CI 66.1–75.4) and physical effort quotient (LEDQ scores in wrist, hand, arm and shoulders) were also superior in triangular technique of port placement. Triangular three-port TEP hernioplasty is ergonomically feasible and enables a surgeon to perform surgery safely using basic principles of laparoscopy. |
| Databáze: | OpenAIRE |
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