| Objective:Minimally invasive surgery is the development trend of future surgery.Streamline surgical procedures,reduce postoperative trauma,the advantages of minimally invasive technology in intraoperative operations,postoperative closed incisions,postoperative pain and postoperative care are becoming more and more significant.Currently,minimally invasive surgery has been widely used in the diagnosis and treatment of various clinical diseases.Smaller wounds and more concealed wounds meet the increasing needs of patient,but higher requirements are placed on minimally invasive surgery.Transumbilical laparoendoscopic single-site surgery(TU-LESS)is a new way of minimally invasive surgery.It has a smaller incision than conventional multi-hole laparoscopic surgery and has been used in various gynecological benign diseases and even malignant tumors.However,there are still controversies in domestic and foreign research on whether it can reduce pain,improve cosmetic satisfaction,and surgical safety.At present,the controlled studies done by various studies are classified according to the type of disease,and the research on the impact of different surgical methods for the same disease is relatively rare.This study compares different surgical methods with the same disease,aims to understand its application safety,technical advantages and difficulty of promotion.And this technique has not been fully popularized at present,it is great significance to study its learning curve.We also explore the development direction of minimally invasive treatment of benign gynecological diseases.Methods: The patients undergoing transumbilical laparoendoscopic single-site surgery from April 2017 to December 2019 in Wu Hu second people's hospital were selected as the transumbilical laparoendoscopic single-site group.Patients who underwent traditional laparoscopic surgery with the same disease and the same surgical method were selected as the traditional laparoscopic group.There were 388 cases in the two groups,including 64 cases of single port laparoscopic ovarian cyst removal,20 cases of single port laparoscopic ovarian cyst removal,35 cases of single port laparoscopic hysterectomy,and single port laparoscopic ectopic pregnancy fallopian tube There were45 cases of resection and 30 cases of single port laparoscopic myoma removal.The two groups of patients follow a 1:1 pairing design.The operation effect indicators of two groups,such as operation time,intraoperative blood loss,visual ananlogue scale(VAS)and cosmetic score(CS)for comparative analysis.Draw a smooth line scatter plot of the number of surgical cases,blood loss,and surgical time of the same surgeon in chronological order.Results: There was no statistically significant difference in the general clinical indicators of the samples included in the study.Transumbilical laparoendoscopic single-site ovarian cyst removal operation time(104.05±30.83min)and transumbilical single port laparoscopic total hysterectomy(154.11±43.71min)are significantly higher than conventional laparoscopic surgery,the difference is statistically significant with P<0.05.There was no statistically significant difference in the operation time in transumbilical laparoendoscopic single-site ovarian cystectomy,ectopic pregnancy salpingectomy,and hysterectomy.At the same time,there was no statistically significant difference in blood loss between all types of surgery and conventional laparoscopic surgery.The 24-hour pain VAS score(2.59±0.66)of the transumbilical laparoendoscopic single-site surgery group was significantly lower than that of the traditional multiport laparoscopic group(3.02±0.69),and the difference was statistically significant with P<0.05.There was no statistically significant difference in 72-hour.The cosmetic satisfaction score(4.59±0.54)of the transumbilical single site abdominal cavity group was significantly higher than that of the traditional multiport laparoscopic group(4.35±0.58)in the first month after surgery,the difference was statistically significant.On the learning curve,salpingectomy for ectopic pregnancy entered the plateau stage in 10 cases,and ovarian cyst stripping entered the plateau stage in about25 cases.Conclusion: The use of transumbilical laparoendoscopic single-site surgery for gynecological benign diseases is safe and feasible,its better analgesic and cosmetic effects fit the patient needs.The operation time of some surgical methods is longer than that of conventional laparoscopic surgery.The learning of transumbilical laparoendoscopic single-site surgery needs to be gradual.Resection surgery can be mastered in a short time,and the learning time for surgery that requires suture is longer.To learn the transumbilical laparoendoscopic single-site surgery technique.it is better to master the technical essentials through relatively simple resection surgery and then perform the suture operation,... |
PDF Full Text Request