Single Incision Laparoscopic Surgery for Gynecology: Experience of Ankara Training and Research Hospital Yetkin Karasu, Mustafa Burak Akselim, Duygu Doğdu, Yusuf Ergün Ankara Training and Research Hospital 2017-05-17 Hi, my name is Dr. Duygu Doğdu. I am going to present our experience about SILS for gynecologic operations in Ankara Training and Research Hospital. First of all we want to thank to the organization committee for this opportunity. It is an honor to be here and have this chance to share our data with you.

SILS for gynecology 2014- Single center 112 patients Benign adnexal masses Ectopic Pregnancies Surgical sterilization From 2014 until now we have performed 112 SILS. These operations included benign adnexal masses, surgical sterilization operations and ectopic pregnancies.

SILS for benign adnexal masses 32 patients Single center 2014- Prospective study Pathological diagnosis   Functional cyst 15 Endometrioma 3 Dermoid cyst 6 Mucinous cystadenoma 4 Parasitic myoma Hydrosalpinx 2 Cystadenofibroma Surgeries Performed   Cystectomy 21 Salpingectomy 2 Oopherectomy 4 Salpingooopherectomy Cystectomy-Ovarian Detorsion 1 Estimated Blood Loss (ml) (mean) (±SD) 28.1±24.4 Hematocrit Change (%) (mean) (±SD) 2.9±2.2 Conversion to Laparotomy Intraoperative Complication Postoperative Complication Operation Time (min.) (mean) (±SD) 65.9±19.7 Length of Hospital-Stay (days) (mean) (±SD) 1.79±0.8 Bu hastaların ameliyat sonrasın patoljik tanılarına göre dağılımları tabloda özetlenmiştir. En sık sebep fonksiyonel kistlerdi. The number of patients with benign adnexal mass surgery was 32. The distribution of these patients according to their pathologic diagnosis after surgery is summarized in the table. The most common cause was functional cysts. There was no difference between either group regarding preoperative diagnosis, intraoperative surgical procedure performed, and postoperative pathological diagnosis. Karasu, Yetkin, et al. "Comparison of single-incision and conventional laparoscopic surgery for benign adnexal masses." Minimally Invasive Therapy & Allied Technologies (2017): 1-6.

SILS for benign adnexal masses   CLS (n=39) SILS (n=32) P Age (years) (mean) (±SD) 29.9±7.96 31.1±8.35 0.628 Gravidity (median) (min-max) 2 (0-5) 2 (1-5) 0.309 Parity (median) (min-max) 2 (0-2) 0.57 BMI (kg/m2) (mean) (±SD) 23.4±2.83 24.8±3.69 0.218 Previous abdominal surgery) Laparotomy 4 12 0.014 Laparoscopy 2 Adnexal mass size (cm) (mean) (±SD) 7.48±1.89 7.92±1.41 0.162 2 grubun bazı klinik özelliklerinin karşılaştırılması tablodaki gibidir.Preoperatif tanı, intraoperatif cerrahi girişim ve postoperatif patolojik tanı açısından iki grup arasında fark yoktu. Buna ek olarak, toplam operasyon süresi, intraoperatif kanama miktarı ve ameliyat öncesi ve sonrası hematokrit (HCT) değişimi bakımından gruplar farklılık göstermedi. Bununla birlikte, hastanede kalış süresi CLS grubunda daha uzun (p <0.02) cls 1,9 gün sıls 1.4 gün CLS: CONVENTIONAL LAPAROSCOPY There was no difference between either group regarding preoperative diagnosis, intraoperative surgical procedure performed, and postoperative pathological diagnosis. In addition, neither group exhibited a difference in terms of total operation time, amount of intraoperative bleeding, and preoperative-postoperative hematocrit (HCT) change. However, length of hospital stay was longer for the CLS group (p<0.02) Karasu, Yetkin, et al. "Comparison of single-incision and conventional laparoscopic surgery for benign adnexal masses." Minimally Invasive Therapy & Allied Technologies (2017): 1-6.

SILS for benign adnexal masses Postoperative pain scores (mean) (±SD) CLS (n=39) SILS (n=32) P Recovery room 7.94±1.24 6.71±1.46 0.001 6th hour 4.29±1.20 3.07±1.39 <0.001 12th hour 2.89±1.30 1.86±1.21 0.003 24th hour 1.60±0.95 1.28±1.24 0.195 Additional analgesic dose (ampules) 1.37±0.49 1.18±0.39 0.095 Tüm hastalarda postoperatif ağrı değerlendirilmesi görsel ağrı skorlaması ile yapıldı. Postoperatif 0, 6 ve 12. saatteki ağrı skorları, SILS grubunda CLS grubuna göre daha düşüktü. Postoperatif 24. saat ağrı skorları her iki grupta da benzerdi. ilave analjezik ihtiyacı her iki grupta benzerdi. The postoperative 0, 6th, and 12th hour VAS scores were lower in SILS group versus the CLS group. Postoperative 24th hour pain scores were similar in both groups. The groups did not feature any variation regarding additional analgesic requirement.

Burada kliniğimizde SILS ile gerçekleştirilen bir dermoid kist olgusunu görmekteyiz. Bu videnonun tamamını oynatmak zorunda değiliz zaman yetmeyebilir. Video başladıktan biraz oynatıp yarısına gidebilirsin.

SILS for surgical sterilization 48 patients Single center 2014- Method: Parsial salpingectomy SILS'li 48 hastada tubal ligasyon uyguladık. Kullanılan yöntem kısmi salpenjektomidir. We performed tubal ligation in 48 patients with SILS. The method used was partial salpengectomy.

SILS for surgical sterilization   CLS (n=62) SILS P (n=48) Age (years) (mean) (±SD) 34.7 (±3,26) 36.1 (±3,45) 0.055 Gravidity (median) (min-max) 4 (1-6) 4 (2-11) 0.031 Parity (median) (min-max) 3 (1-6) 3 (2-8) 0.722 Abortion (median) (min-max) 0 (0-4) 1 (0-4) 0.005 BMI (kg/m2) (mean) (±SD) 24.9 (±3,80) 25.1 (±2,82) 0.267 Mode of previous deliveries Vaginal 45 (72.6%) 33 (68.8%) 0.661 § Caesarean section 17 (27.4%) 15 (31.3%) Gruplar yaş, vücut kitle indeksi (VKİ) ve doğum sayısı bakımından benzerdi. Daha önceki doğumların türü açısından gruplar da benzerdi. The groups were similar in terms of age, body mass index (BMI), and number of deliveries. The groups were also similar in terms of the type of previous deliveries.

SILS for surgical sterilization   CLS (n=62) SILS (n=48) P Mean Laparoscopic Entry Time (min.) (±SD) 6,96 (±2,89) 4.85 (±1,45) <0.001 Mean Operation Time (min.) (±SD) 39.1 (±12,04) 37.2 (±8,43) 0.190 Mean Hematocrit Change (%)(±SD) 2.35 (±2,02) 2.43 (±2,44) 0.491 Mean Length of Hospital-Stay (days) (±SD) 1.56 (±0,49) 1.45 (±0,50) 0.271 Conversion to Laparotomy % NA SILS grubunda laparoskopik giriş süresi daha kısaydı. Toplam ameliyat süresi, hemotokrit değişimi yatış süresi gibi diğer operatif bulgular iki grupta benzerdi. Konvansiyonel laparoskopi grubundaki bir hastada sağ aksesuar portunu takarken inferior epigastrik arter hasar gördü. Liman çıkarıldı ve kanama transabdominal dikiş ile kontrol edildi. Laparoscopic entry time was shorter in the SILS group. Other operative findings were similar in two groups. One patient in the conventional laparoscopy group had injury of the inferior epigastric artery while inserting the right accessory port. The port was removed, and the bleeding was controlled with a transabdominal suture.

SILS for surgical sterilization Postoperative pain scores (mean) (±SD) CLS (n=62) SILS P (n=48) Initial (recovery room) 7,12 (±1,26) 6,79 (± 1,35) 0.506 6th hour 3,71 (± 0,80) 4,04 (± 1,20) 0.119 12th hour 2,65 (± 0.95) 2,46 (± 0,85) 0.279 24th hour 1,77 (± 1,02) 1,58 (± 0,82) 0.373 Additional analgesic dose (ampule) 1,81 (± 0,82) 1,02 (± 0,40) 0.739 Cerrahi sterilizasyon olgularında tüm ağrı skorlamaları benzerdi. The groups had similar VAS scores immediately after patients’ transport to a recovery room (initial assessment), and at the 6th, 12th and 24th hours .

SILS for ectopic pregnancy   SILS n=32 Age (years) (mean) (±SD) 32,4 (±5,68) Gravidity (median) (min-max) 3 (2-5) Parity (median) (min-max) 2 (0-3) BMI (kg/m2) (mean) (±SD) 26,5 (±3,57) Previous Surgery LPT 5 (15,6%) LS 3 (9,4%) 32 ektopik gebelik olgusunun tedavisinde SILS yapıldı. Bu slaytta bu hastaların demografik özelliklerinden bazıları özetlendi. Hastaların tümünde tercih edilen yöntem salpenjektomiydi. SILS was performed in 32 patients with ectopic pregnancy. In this slide we summarized the basic demographic characteristics of ectopic pregnancy patients. Bu videoda da batına port yerleştirilip kanların biraz aspire edildiğini gösterdikten sonra ortasına ilerletebilirsin . Sonra ektopik gebelik görüldükten sonra yine biraz ilerletip son kısmını göster.

SILS for ectopic pregnancy   SILS (n=32) Mean Operation Time (min.) (±SD) 52,8 (±21,18) Mean Hematocrit Change (%)(±SD) 3,4 (±2,14) Mean Length of Hospital-Stay (days) (±SD) 1,6 (±0,49) Postoperative pain scores (mean) (±SD) SILS (n=32) Initial (recovery room) 7,9 (± 1,39) 6th hour 4,34 (± 1,14) 12th hour 3,04 (± 1,17) 24th hour 1,47 (± 1,36) Ortalama cerrahi süresi 52 dakika idi. Ağrı skorları tablodaki gibidir. Hiçbirinde SILS laparotomiye veya konvansiyonel laparoskopiye çevirilmedi. The mean duration of surgery was 52 minutes. None of them had been converted to SILS laparotomy or conventional laparoscopy.

Conclusion SILS is effective and safe method for the treatment of benign adnexal masses and ectopic pregnancies. SILS may also be preferred in cases of surgical sterilization. SILS benign adneksiyel kitlelerin, dış gebeliklerin tedavisinde etkili ve güvenli bir yöntemdir. Cerrahi sterilizasyon olgularında da SILS tercih edilebilir.

Thank you for your attention