Advanced Gynecologic Laparoscopy in a Fast-Track Ambulatory Surgery Center

Nezhat, Camran; Main, Jillian; Paka, Chandhana; Soliemannjad, Rose; Ma, Parsa

doi:10.4293/jsls.2014.00291

Cited by 21 publications

(17 citation statements)

References 23 publications

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“…The two surgeons who performed all surgeries in this study are both experienced, high‐volume surgical specialists who are especially proficient in the reported minimally invasive techniques. But while past studies have emphasized the importance of proper patient selection to ensure safe outcomes at an ASC, our data show similar patient characteristics across the two settings, including comorbidities and BMI.…”

Section: Discussionsupporting

confidence: 53%

“…8 Although past research has established the safety of same-day discharge after minimally invasive myomectomy, 9 there is limited data on performing this procedure at a freestanding ASC. 10,11 The high risk of intraoperative hemorrhage during myomectomy is one of the main concerns of performing this procedure at an ASC, where blood transfusion capabilities and subspecialty support are not typically present.…”

Section: Introductionmentioning

confidence: 99%

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Laparoscopic‐assisted myomectomy: Surgery center versus outpatient hospital

Danilyants¹,

Mamik

MacKoul³

et al. 2020

J of Obstet and Gynaecol

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Aim To compare the safety protocols and operative outcomes of women undergoing laparoscopic‐assisted myomectomy (LAM) by the same surgeons at a freestanding ambulatory surgery center (ASC) versus a hospital outpatient setting. Methods Retrospective chart review of all women ≥18 years old with symptomatic leiomyoma, who underwent LAM with uterine artery occlusion or ligation for blood loss control, at a freestanding ASC between 2013 and 2017, and an outpatient hospital setting between 2011 and 2013, both serving the metropolitan Washington, DC area. The procedures were performed by two minimally invasive gynecologic surgical specialists from a single practice. The safety protocols of each setting were reviewed to identify similarities and differences. Results A total of 816 LAM cases were analyzed (ASC = 588, hospital = 228). The rate of complications was comparable across settings, as was the average myoma weight (ASC = 396.2 g; hospital = 461.5 g; P = 0.064). Operative time was significantly shorter at the ASC: 68 min (95% CI 66–70) versus 80 min at hospital (95% CI 76–84), P < 0.0001. Ambulatory surgery center and hospital protocols differed in limits of preoperative hemoglobin (minimum 9.0 g/dL, 7.5 g/dL respectively), lower nurse/patient ratio in PACU, and were similar in intraoperative surgical safety standards. Conclusion Laparoscopic‐assisted myomectomy can be performed safely and effectively by skilled surgeons at a freestanding ASC, even in patients with morbid obesity or large leiomyoma.

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Section: Discussionsupporting

confidence: 53%

Section: Introductionmentioning

confidence: 99%

Laparoscopic‐assisted myomectomy: Surgery center versus outpatient hospital

Danilyants¹,

Mamik

MacKoul³

et al. 2020

J of Obstet and Gynaecol

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“…A decrease in CRP on the third POD predicts an uncomplicated course with a high probability. With an increasing focus on 'fast track surgery' [40], this could help to shorten the hospital stay for these patients.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Value of Serial Measurement of C-Reactive Protein in the Detection of a Surgical Complication after Laparoscopic Bowel Resection for Endometriosis

Riiskjær¹,

Forman²,

Kesmodel

et al. 2016

Gynecol Obstet Invest

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Aims: The study aimed to assess the diagnostic value of serial monitoring of biochemical inflammatory markers (C-reactive protein (CRP) and white blood cell (WBC) count) in the postoperative diagnosis of anastomotic leakage or ureteral injury after bowel resection for deep infiltrating endometriosis. Methods: This is a review of prospectively collected data from 217 patients who underwent laparoscopic bowel resection for endometriosis from January 2009 to April 2015. Patients with an anastomotic leakage or ureteral injury were identified and classified. Results: The frequency of anastomotic leakage requiring reoperation was 8.3%. The frequency of ureteral injury was 4.6%. Median time to diagnosis was 6 days for anastomotic leakage and 8 days for ureteral injury. The daily mean values of serum CRP were significantly higher in patients with a surgical complication starting at the second postoperative day (POD 2, p = 0.004). WBC was significantly higher (p < 0.05) on POD 2 and 3 in patients with a surgical complication. A decrease in CRP from POD 1 to 3 predicted an uncomplicated course in 92.1% of the cases. Conclusion: A decrease in CRP from POD 1 to 3 was an indicator of uncomplicated subsequent postoperative course. The test is recommended when early discharge after rectal resection for deep infiltrating endometriosis is considered.

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“…Partial cystectomy is a bladder-preserving operation for the treatment of BE that can be performed via laparotomy [107,108,[111][112][113][114] or laparoscopy [102][103][104][105][106][107][108][109][111][112][113][114][115][116][117][118][119][120][121][122][123][124] without or with robotic assistance (Table 5) [125][126][127][128][129][130]. This procedure consists of partial bladder resection for detrusor endometriosis with or without preventive cystoscopic catheterization of the ureters.…”

Section: Segmental Bladder Resectionmentioning

confidence: 99%