Razor-type dermatomes enable quick and thin vaginal dissection with less bleeding in colpocleisis
| Autor: | Ryohei Hattori, Shoji Suzuki, Ryota Ando, Takashi Kato, Kumiko Kato, Hirotaka Matsui, Yuji Hayashi, Mami Adachi, Hiroki Hirabayashi, Hideji Kawanishi |
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| Rok vydání: | 2019 |
| Předmět: |
medicine.medical_specialty
Perineoplasty Urology Dissection (medical) Colpotomy Total colpocleisis Pelvic Organ Prolapse 03 medical and health sciences Gynecologic Surgical Procedures 0302 clinical medicine Pregnancy Colpocleisis 0502 economics and business Humans Medicine Aged Retrospective Studies 030219 obstetrics & reproductive medicine Dermatome business.industry Dissection 05 social sciences Obstetrics and Gynecology Perioperative Muscle layer medicine.disease Surgery medicine.anatomical_structure Vagina Metzenbaum scissors Female Original Article 050211 marketing business |
| Zdroj: | International Urogynecology Journal |
| ISSN: | 1433-3023 0937-3462 |
| DOI: | 10.1007/s00192-019-04162-x |
| Popis: | Introduction and hypothesis Although colpocleisis is a low-invasive surgical option to treat pelvic organ prolapse, it sometimes involves a long operative time with substantial bleeding. To streamline the vaginal dissection process in colpoclesis, we introduced the usage of dermatomes. Methods All patients were sexually inactive women with post-hysterectomy prolapse. Data of the dermatome group were retrospectively compared with those of the historical control group based on operative features, perioperative complications and pathology of dissected tissue. In the dermatome group, 34 women underwent total colpocleisis with vaginal dissection using dermatomes; 4 were done mainly with electric dermatomes, and 30 were done with razor-type dermatomes. In the control group, 20 women underwent total colpocleisis with vaginal dissection using Metzenbaum scissors. Results Using dermatomes in vaginal dissection was helpful to shorten total operative time (including perineoplasty) by one third from 76 to 51 min, to shorten the time of colpocleisis by half, from 62 to 32 min, and to reduce intraoperative bleeding by 76%, from 62 to 15 ml. In addition, none in the dermatome group and 2/20 patients in the control group had unintended peritoneal opening. Dissection with scissors removed not only the epithelium and submucosal layer but also the muscle layer. This was minimized with razor-type dermatomes and never occurred with electric dermatomes. Whereas electric dermatomes are difficult to get accustomed to and are expensive, razor-type dermatomes enable thinner dissection compared with scissors, are easy to handle and are inexpensive. Conclusions Razor-type dermatomes enable quick and thin vaginal dissection with less bleeding. Therefore, they can be recommended as a practical tool for colpocleisis, a prolapse operation mainly for frail elderly patients. |
| Databáze: | OpenAIRE |
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