Total Laparoscopic Hysterectomy Under Regional Anesthesia

Moawad, Nash S.; Flores, Estefania Santamaria; Le-Wendling, Linda; Sumner, Martina T.; Enneking, F. Kayser

doi:10.1097/aog.0000000000002618

Cited by 16 publications

(20 citation statements)

References 7 publications

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“…Surgical gynecological procedures, under RA, are currently limited to diagnostic laparoscopy adnexectomy, ablation of endometriotic foci, and adhesiolysis [ 11 , 12 ]. Only one case report on total laparoscopic hysterectomy is reported in the literature [ 13 ]. Recently, a review by Della Corte et al has shown no significant advantages to using SA over GA for laparoscopic treatment of gynecological diseases [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic gynecological surgery under minimally invasive anesthesia: a prospective cohort study

et al. 2022

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The purpose of this study is to assess the feasibility and the perioperative outcomes of laparoscopic gynecological surgery in regional anesthesia (RA) from the point of view of the surgeon, anesthesiologist and patient. This is a prospective cohort study comprising sixty-six women planned to undergo gynecologic laparoscopy surgery for benign pathology at tertiary care gynecolgical center of the University Federico II of Naples. Women were assigned, according to their preference, to either RA (Group A) or general anesthesia (GA) (Group B). Surgical, anesthesiologic and postoperative recovery data were recorded. Postoperative pain was considered as the primary outcome. Secondary outcomes included mobilization, length of hospital stay, global surgeons and patient satisfaction, intraoperative pain assessment in Group A. Immediate postoperative pain was significantly lower in Group A 0 vs 2 (p < 0.001), with no significant differences at 24 h. The secondary outcome demonstrated early patient’s mobilization (p < 0.001) as well as early discharge (p < 0.001) and greater patient’s satisfaction for the Group A. In these patients, a maximum pain score of 3 points out of 5 was recorded through the entire surgery. RA showed to decrease the impact of surgical stress and to guarantee a quicker recovery without compromising surgical results. Although several surgical approaches can be employed to treat different conditions, RA technique could be a viable option for well-selected patients affected by gynecological diseases.

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Section: Introductionmentioning

confidence: 99%

Laparoscopic gynecological surgery under minimally invasive anesthesia: a prospective cohort study

et al. 2022

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“…On the other hand, there are risks of hypotension due to sympathetic blockade, hyperesthesia, pain, and also increased surgical time due to the limitation of intra-abdominal pressure. 1 The awake laparoscopy has been used in minor surgeries, such as diagnostic procedures in case of penetrating abdominal wounds, gynecological surgeries including endometriosis ablation, salpingo-oophorectomy, hysterectomy or sleeve gastrectomies 2 , 4 …”

Section: Discussionmentioning

confidence: 99%

Awake Da Vinci robotic partial nephrectomy: First case report ever in a situation of need

Oderda

Calleris

Allasia

et al. 2022

Urology Case Reports

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We report a unique case of a robotic partial nephrectomy performed under continuous spinal anesthesia (CSA). A 63-year-old woman, active smoker with mild obesity and previous right pneumonectomy, was diagnosed with a growing 5.5-cm renal right cystic tumor. Being at high risk for general anesthesia, a loco-regional approach was indicated. Therefore, after multidisciplinary discussion, a robotic-assisted partial nephrectomy under CSA was considered mandatory. After T4-T5 sensory and motor block, retroperitoneoscopic robot-assisted surgery was successfully performed. Postoperative period was uneventful, with optimal pain control. This unique case demonstrates the feasibility of robotic surgery under CSA, for imperative indications.

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“…Even though previous research has shown that laparoscopy can lead to aerosolization of blood borne viruses, there is no evidence to indicate that this effect is seen with COVID-19 [ 40 , 41 , 91 ], if few precautions are taken in MIS procedures. For MIS procedures, use of devices to filter released CO 2 for aerosolized particles should be considered.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopy in Gynecologic and Abdominal Surgery in Regional (Spinal, Peridural) Anesthesia, the Utility of the Technique during COVID-19 Pandemic

et al. 2021

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Background: laparoscopic surgery is mainly performed in general anesthesia. Symptomatic patients infected with COVID-19 needing surgery are however at higher risk for COVID-19 complications in general anesthesia than in regional anesthesia. Even so, Covid transfection is a hazard to medical personnel during the intubation procedure and treatment drugs may be in shortage during a pandemic. Recovery and hospital stay are also shorter after laparoscopy. Laparoscopy performed in regional anesthesia may have several advantages in limiting Covid. Methods: international literature on the risk of COVID-19 complications development was searched. 3 topics concerning laparoscopic surgery were reviewed: (1) Achievements in laparoscopy; (2) Advantages of regional anesthesia compared to general anesthesia; (3) Feasibility to perform laparoscopy in regional anesthesia in COVID-19 pandemic. The authors reviewed abstracts and full-text articles concerning laparoscopic surgery, gynecology, anesthesia and COVID-19. Studies published in PubMed, Embase, Cochrane Library and found in Google Scholar before 1st FEB, 2021 were retrieved and analyzed. Results: a total of 83 studies were found, all of them written in English. 17 studies could be found in gynecology and in general surgery about laparoscopy with regional anesthesia. In Covid time only one study compared laparoscopic surgery in general anesthesia to laparotomy and another study laparotomy in general anesthesia to regional anesthesia. Laparoscopy showed no disadvantage compared to laparotomy in Covid pandemic and in another study laparotomy in general anesthesia was associated with higher mortality and more pulmonary complications. Trendelenburg position can be a threat if used by inexperienced personnel and can induce unintended anesthesia of breathing organs. On the other hand Trendelenburg position has advantages for cardiovascular and pulmonary functions. Pneumoperitoneum of low CO2 pressure is well tolerated by patients. Conclusions: elective surgery should be postponed in symptomatic Covid patients. In inevitable emergency surgery intubation anesthesia in COVID-19 pandemic is as far as possible to be avoided. In COVID-19 pandemic, regional anesthesia is the preferred choice. The optimum may be the combination of laparoscopic surgery with regional anesthesia. Reducing the pneumoperitoneum is a good compromise for the comfort of patients and surgeons. A special case is gynecology, which needs to be performed in Trendelenburg position to free pelvic organs.

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Total Laparoscopic Hysterectomy Under Regional Anesthesia

Abstract: With a committed patient, adequate planning, and knowledge of the potential intraoperative complications, regional anesthesia is an option for select women undergoing laparoscopic hysterectomy.

Cited by 16 publications

References 7 publications

Laparoscopic gynecological surgery under minimally invasive anesthesia: a prospective cohort study

Laparoscopic gynecological surgery under minimally invasive anesthesia: a prospective cohort study

Awake Da Vinci robotic partial nephrectomy: First case report ever in a situation of need

Laparoscopy in Gynecologic and Abdominal Surgery in Regional (Spinal, Peridural) Anesthesia, the Utility of the Technique during COVID-19 Pandemic

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