Gasless laparoscopic hysterectomy: A comparative study with total abdominal hysterectomy

Tintara, Hatern; Choobun, Thanapan; Geater, Alan

doi:10.1046/j.1341-8076.2003.00074.x

Cited by 10 publications

(5 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A detailed summary of the risk of bias for RCTs using RoB-2 tool is listed in Table 3 Supplement. In the non-RCT group, there were 12 general surgery and 10 gynaecology studies, with a total of 1,385 patients (Table 2 Supplement) [14][15][16][65][66][67][68][69][70][71][72][73][74][75][76][77][78][79][80][81][82][83]. The overall result level assessment for each outcome varied between low to high risk of bias.…”

Section: Resultsmentioning

confidence: 99%

Clinical effectiveness of gasless laparoscopic surgery for abdominal conditions: systematic review and meta-analysis

et al. 2021

View full text Add to dashboard Cite

Background In high-income countries, laparoscopic surgery is the preferred approach for many abdominal conditions. Conventional laparoscopy is a complex intervention that is challenging to adopt and implement in low resource settings. This systematic review and meta-analysis evaluate the clinical effectiveness of gasless laparoscopy compared to conventional laparoscopy with CO2 pneumoperitoneum and open surgery for general surgery and gynaecological procedures. Methods A search of the MEDLINE, EMBASE, Global Health, AJOL databases and Cochrane Library was performed from inception to January 2021. All randomised (RCTs) and comparative cohort (non-RCTs) studies comparing gasless laparoscopy with open surgery or conventional laparoscopy were included. The primary outcomes were mortality, conversion rates and intraoperative complications. Secondary outcomes: operative times and length of stay. The inverse variance random-effects model was used to synthesise data. Results 63 studies were included: 41 RCTs and 22 non-RCTs (3,620 patients). No procedure-related deaths were reported in the studies. For gasless vs conventional laparoscopy there was no difference in intraoperative complications for general RR 1.04 [CI 0.45–2.40] or gynaecological surgery RR 0.66 [0.14–3.13]. In the gasless laparoscopy group, the conversion rates for gynaecological surgery were high RR 11.72 [CI 2.26–60.87] when compared to conventional laparoscopy. For gasless vs open surgery, the operative times were longer for gasless surgery in general surgery RCT group MD (mean difference) 10 [CI 0.64, 19.36], but significantly shorter in the gynaecology RCT group MD − 18.74 [CI − 29.23, − 8.26]. For gasless laparoscopy vs open surgery non-RCT, the length of stay was shorter for gasless laparoscopy in general surgery MD − 3.94 [CI − 5.93, − 1.95] and gynaecology MD − 1.75 [CI − 2.64, − 0.86]. Overall GRADE assessment for RCTs and Non-RCTs was very low. Conclusion Gasless laparoscopy has advantages for selective general and gynaecological procedures and may have a vital role to play in low resource settings.

show abstract

Section: Resultsmentioning

confidence: 99%

Clinical effectiveness of gasless laparoscopic surgery for abdominal conditions: systematic review and meta-analysis

et al. 2021

View full text Add to dashboard Cite

show abstract

“…A variety of devices were designed using intra-abdominal or subcutaneous retraction with a point, linear, planar, or spiral lifting methods. They were used for gynecologic, [11][12][13] upper gastrointestinal, 14,15 lower gastrointestinal, 4,16,17 and exploratory diagnostic procedures. 18 They proved the feasibility of GAL in terms of safety, cost-effectiveness, and anesthetic requirements.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Gasless Laparoscopy as a Tool for Minimal Access Surgery in Low-to Middle-Income Countries: A Phase II Noninferiority Randomized Controlled Study

Mishra

Bains

Jesudin³

et al. 2020

Journal of the American College of Surgeons

View full text Add to dashboard Cite

BACKGROUND: Minimal access surgery is not available to most people in rural areas of low-to middle-income countries. This leads to an increase in morbidity and economic loss to the poor and marginalized. Gasless laparoscopic (GAL) procedures are possible in rural areas because they can be performed under spinal anesthesia. In most cases, it does not require the logistics of providing gases for pneumoperitoneum and general anesthesia. The current study compares GAL with conventional laparoscopic (COL) operations for general surgical procedures. METHODS: A single-center, nonblinded randomized controlled trial was conducted to evaluate noninferiority of GAL vs COL at a teaching hospital in New Delhi, India. Patients were allocated into 3 groups and underwent minimal access surgery (cholecystectomies and appendectomies). The procedures were performed by 2 surgeons choosing randomly between GAL and COL. The data were collected by postgraduates and analyzed by a biostatistician. RESULTS: One hundred patients who met the inclusion criteria were allocated into 2 groups. No significant difference was observed in the mean operating time between the GAL group (52.9 minutes) and the COL group (55 minutes) (p ¼ 0.3). Intraoperative vital signs were better in the GAL group (p < 0.05). The postoperative pain score was slightly higher in the GAL group (p ¼ 0.01); however, it did not require additional analgesics. CONCLUSIONS: No significant differences were found between the 2 groups. GAL can be considered as noninferior compared with COL and has the potential to be adopted in low-resource settings.

show abstract

“…11 The pneumoperitoneum is avoided by mechanical elevation of the anterior abdominal wall using a planar lifting system, inflatable balloon or other means to allow an overview of the abdominal organs. Several methods such as gynaecological, [12][13][14] upper or lower gastrointestinal [15][16][17][18][19][20] and exploratory diagnostic procedures 21 have been performed through single or multiple incisions using a gasless technique.…”

Section: Introductionmentioning

confidence: 99%

Gasless laparoscopy versus conventional laparoscopy and laparotomy: A systematic review on the safety and efficiency

et al. 2023

View full text Add to dashboard Cite

BackgroundGasless laparoscopy (GL) emerged to overcome the clinical and financial challenges of pneumoperitoneum and is often seen as a viable option for use in resource‐limited settings as a means of saving costs and resources. This study aims to systematically review the evidence available on the safety and efficiency of GL compared with conventional laparoscopy (CL) and laparotomy.MethodsFollowing the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines, Medline, Embase, Web of Science and Cochrane databases were searched. Variables of interest were determined a priori and Covidence software was used to screen studies for inclusion without demographic preference. The quality of studies was assessed using the Cochrane Risk Assessment tool.ResultsOf the 1080 studies screened, a total of 43 studies were included. Laparoscopic cholecystectomy was by far the most studied intervention in randomised studies. In these, the mean setup time for gasless and CL was 13.14 (95% CI −0.16 to 26.44) and 12.8 (95% CI −10.86 to 36.47) minutes, respectively. The mean duration of surgery for gasless and CL was 89.39 (95% CI 77.44 to 101.34) and 72.59 (95% CI 63.44 to 81.74) minutes, respectively, and the mean length of stay was 4.25 (95% CI 2.02 to 6.48) and 4.04 (95% CI 1.72 to 6.36) days, respectively. Most reported complications were haemorrhage and infection with no assessable statistical difference.ConclusionsAlthough GL seems to be a feasible approach for many general surgery interventions, the observed outcomes based on safety and efficiency are not sufficient to recommend GL as an alternative to CL or laparotomy. Larger randomised trials with a low risk of bias are warranted.

show abstract

Gasless laparoscopic hysterectomy: A comparative study with total abdominal hysterectomy

Abstract: Gasless laparoscopic hysterectomy may be an alternative technique for hysterectomy which provides laparoscopic benefit with minimal increase in hospital charges.

Cited by 10 publications

References 11 publications

Clinical effectiveness of gasless laparoscopic surgery for abdominal conditions: systematic review and meta-analysis

Clinical effectiveness of gasless laparoscopic surgery for abdominal conditions: systematic review and meta-analysis

Evaluation of Gasless Laparoscopy as a Tool for Minimal Access Surgery in Low-to Middle-Income Countries: A Phase II Noninferiority Randomized Controlled Study

Gasless laparoscopy versus conventional laparoscopy and laparotomy: A systematic review on the safety and efficiency

Contact Info

Product

Resources

About