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

Abstract

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.

Minimally invasive anesthesia for laparoscopic hysterectomy: a case series

“…This represents a convincing result, especially if it is considered that a recent review with meta-analysis has demonstrated no significant advantages to using SA over GA for laparoscopic treatment of benign gynecological diseases [ 32 ]. On the other hand, a prospective study published by the same Group has reported how RA could be a viable option for well-selected patients affected by benign gynecological diseases [ 33 ]. In addition, the use of regional anesthesia is gaining more and more importance also in the field of obstetrics [ 34 , 35 ].…”

Findings from the Use of Spinal Anesthesia in the Laparoscopic Treatment of Extrauterine Pregnancy: Could It Represent an Alternative to General Anesthesia?

“…Vital signs were monitored: SpO 2 , heart rate, and blood pressure every 5 min. As already reported by Giampaolino et al [5], in the sitting position, in group A, RA was performed at the T9-T10 or T10-T11 level. In the subarachnoid space after the vision of clear cerebrospinal fluid in the spinal needle 27 gauge, without letting out the cerebrospinal fluid, ropivacaine 0.375% 18 mg, sufentanil 7 μg, and clonidine 20 μg were injected.…”

“…Currently, a range of minimally invasive anesthesiological approaches are employed in obstetrics and gynecology: these include neuraxial analgesia, patient-controlled epidural analgesia for labor [2], transversus abdominis plane block, which is commonly applied during obstetrics surgery, such as cesarean section, or during hysterectomy and laparoscopic oncological surgery [3], as well as multimodal local anesthesia performed during the hysteroscopic procedures [4]. “Minimally invasive” procedures performed in laparoscopy can be combined with a “minimally invasive” technique to achieve anesthesia, such as in regional anesthesia (RA) [5]. This technique lowers the risk of adverse effects in the postoperative period including the need for rescue analgesics and antiemetics, the risk of nosocomial infections, late mobilization, and late bowel canalization [1, 6].…”

“…This technique lowers the risk of adverse effects in the postoperative period including the need for rescue analgesics and antiemetics, the risk of nosocomial infections, late mobilization, and late bowel canalization [1, 6]. Moreover, it may guarantee hospital admission and discharge on the same day or within 24 h, helping to achieve the goal of a “day surgery” surgical approach [5]. About the intraoperatory management, RA is an easier procedure, has a lower probability of failure, and reduces the need of sedatives or narcotics and intubation [1].…”

Myomectomy in infertile women: More harm than good?

“…Finally, and not to be underestimated, is the benefit of SLL in planning of future fertility treatment, for example favoring the referral for IVF/ICSI for women deemed unlikely to conceive based on post-surgical laparoscopic appearance of the pelvis. The advent of mini-laparoscopy and the use of regional anesthesia for laparoscopic surgery, with rapid recovery time following day surgery, can encourage (in selected cases) this procedure ( 63 ).…”