子宮内膜症に対する細径腹腔鏡下手術

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Introduction: In an attempt to reduce pain and improve cosmetic outcome in laparoscopic surgery, there has been a recent drive to reduce port sizes (mini-laparoscopic surgery: MLS) or port number (single-site laparoscopic surgery). We evaluated the safety and efficacy of MLS in the patients with endometriosis and compared its outcome with that of the conventional laparoscopic surgery (CLS). Methods: MLS was conducted with one 5-mm port for a 5-mm laparoscope as well as one 5-mm port and two 2.3-mm ports for the MiniLap Grasper. Conventional laparoscopic surgery (CLS) employs one 12-mm port for a 10-mm laparoscope and three 5-mm ports. A total of 24 patients with endometriomas underwent MLS (13) or CLS (11). We compared patient characteristics, operative findings, complications, postoperative pain medicine requirements, and serum CRP levels. Results: The total r-ASRM (Revised American Society for Reproductive Medicine classification of endometriosis) scores for patients with endometriomas were not significantly different between the MLS (56.5) and the CLS (52.9) groups. Two of 13 patients were converted from MLS to CLS because of severe tubal adhesions. However, no major postoperative complications were encountered. Median operating times were similar between MLS (123 minutes) and CLS (107 minutes). The mean frequency of analgesic administration and serum CRP levels were significantly lower following MLS than following CLS (Mean frequency 1.5±0.53 for MLS and 2.7±0.6, CRP 0.66±0.28 for MLS and 1.00±0.53 for CLS). Cosmetic outcomes were superior with MLS, compared to CLS. Conclusions: Compared to conventional laparoscopic surgery, the use of mini-laparoscopic techniques resulted in decreased incisional pain in the early postoperative period while improving cosmetic appearance.

子宮内膜症に対する細径腹腔鏡下手術

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