Tek Portlu Laparoskopik ve Vajinal Histerektomilerde İnflamatuar Belirteçlerin Retrospektif Değerlendirilmesi
Öz
Amaç: Bu çalışmada iki doğal orifis histerektomide - tek portlu laparoskopik histerektomi (SLH) ve vajinal histerektomi (VH) - inflamatuar belirteç değişikliklerini saptamak amaçlanmıştır.
Gereç ve Yöntem: 2018-2019 arasında yapılan SLH ve VH yapılmış hastalardan elde edilen veriler retrospektif olarak incelendi. Ameliyat öncesi ve sonrası hematokrit (HCT), hemoglobin (HB), beyaz kan hücresi (WBC), trombosit (PLR) ve nötrofil-lenfosit (NLR) oranları ve değerleri ile hastaların demografik özellikleri karşılaştırıldı. Bu çalışma aynı zamanda ‘Clinical Trials’ a kaydedilmiştir; kayıt numarası: NCT04221308.
Bulgular: Postoperatif dönemde WBC, NLR ve PLR istatistiksel olarak artmış, HB ve HCT tüm gruplarda azalmıştır. Bununla birlikte, inflamatuar belirteçlerdeki değişiklikler her iki grupta da benzerdi. HB ve HCT'deki değişiklikler SLH grubunda daha azdı. Ayrıca SLH grubunda hem ameliyat süresi hem de hastanede kalış süresi daha yüksek olarak saptanmıştır.
Sonuç: Her iki ‘doğal orifice’ tekniği de düşük morbidite ve iyi kozmetik sonuçlar sağlamıştır. Enflamatuar belirteçlerle ilgili sonuçlar her iki prosedürün de kabul edilebilir olduğunu göstermektedir. SLH uygulamadaki cerrahi deneyim arttıkça operasyon ve hastanede kalış süreleri azalabilir.
Anahtar Kelimeler
lenfosit aktivasyonu doğal orifis endoskopik cerrahi nötrofil aktivasyonu trombosit aktivasyonu vajinal histerektomi
Kaynakça
- 1. Garry R. Health economics of hysterectomy. Best Pract Res Clin Obstet Gynaecol 2005; 19: 451-5. 2. Yoon BS, Seong SJ, Kim IH, Song T, Kim ML, Kim MK. Operative outcomes of single-port-access laparoscopy-assisted vaginal hysterectomy compared with single-port-access total laparoscopic hysterectomy. Taiwan J Obstet Gynecol 2014;53(4):486-9. 3. AAGL Advancing Minimally Invasive Gynecology Worldwide. AAGL position statement: route of hysterectomy to treat benign uterine disease. J Minim Invasive Gynecol 2011; 18:1–3. 4. American Congress of Obstetricians and Gynecologists. Choosing the route of hysterectomy for benign disease. ACOG Committee opinion no. 444. Obstet Gynecol 2009; 114:1156–8. 5. Nieboer TE, Hendriks JC, Bongers MY, Vierhout ME, Kluivers KB. Quality of life after laparoscopic and abdominal hysterectomy: a randomized controlled trial. Obstet Gynecol 2012; 119:85–91. 6. Demirayak G, Özdemir İA, Comba C, Çetin BA, Mathyk BA, Yıldız M, et al. Comparison of laparoendoscopic single-site (LESS) surgery and conventional multiport laparoscopic (CMPL) surgery for hysterectomy: long-term outcomes of abdominal incisional scar. J Obstet Gynaecol 2019; 26:1-5. 7. Cruickshank AM, Fraser WD, Burns HJ, Van Damme J, Shenkin A. Response of serum interleukin-6 in patients undergoing elective surgery of varying severity. Clin Sci (Lond) 1990;79 (2):161-5. 8. Allendorf JD, Bessler M, Whelan RL, Trokel M, Laird DA, Terry MB, et al. Postoperative immune function varies inversely with the degree of surgical trauma in a murine model. Surg Endosc 1997;11(5):427-30. 9. Lennard TW, Shenton BK, Borzotta A, Donnelly PK, White M, Gerrie LM, et al. The influence of surgical operations on components of the human immune system. Br J Surg 1985;72(10):771-6. 10. Iwase M, Kondo G, Watanabe H, Takaoka S, Uchida M, Ohashi M, et al. Regulation of Fas-mediated apoptosis in neutrophils after surgery-induced acute inflammation. J Surg Res 2006;134 (1): 114-23. 11. Ogawa K, Hirai M, Katsube T, Murayama M, Hamaguchi K, Shimakawa T, et al. Suppression of cellular immunity by surgical stress. Surgery 2000; 127: 329-36. 12. Collet D, Vitale GC, Reynolds M, Klar E, Cheadle WG. Peritoneal host defenses are less impaired by laparoscopy than by open operation. Surg Endosc 1995;9(10):1059-64. 13. Sietses C, Wiezer MJ, Eijsbouts QA, van Leeuwen PA, Beelen RH, Meijer S, et al. The influence of laparoscopic surgery on postoperative polymorphonuclear leukocyte function. Surg Endosc 2000;14(9):812-6. 14. Malik E, Buchweitz O, Müller-Steinhardt M, Kressin P, Meyhöfer-Malik A, Diedrich K. Prospective evaluation of the systemic immune response following abdominal, vaginal, and laparoscopically assisted vaginal hysterectomy. Surg Endosc 2001;15(5):463-6. 15. Wheeless CR. A rapid, inexpensive and effective method of surgical sterilization by laparoscopy. J Reprod Med 1969;3: 65–9. 16. Choi YS, Shin KS, Choi J, Park JN, Oh YS, Rhee TE. Single-port access laparoscopy-assisted vaginal hysterectomy: our initial experiences with 100 cases. Minim Invasive Surg. 2012; 2012:543627 doi: 10.1155/2012/543627. Epub 2012 Sep 4. 17. Gilabert-Estelles J, Castello JM, Gilabert-Aguilar J. Transumbilical single-incision laparoscopic hysterectomy for large uterus: feasibility of the technique. Gynecol Surg 2010; 7(2):143-48. 18. Lee YY, Kim TJ, Kim CJ, Kang H, Choi CH, Lee JW, et al. Single-port Access laparoscopic-assisted vaginal hysterectomy: a novel method with a wound retractor and a glove. J Minim Invasive Gynecol 2009; 16(4): 450-53. 19. Terzi H, Biler A, Turkay U, Kale A. A comparison of novel laparoscopic suturing techniques in single-port surgery. Minim Invasive Ther Allied Technol 2019;28(6):338-43. 20. Goolab BD. Vaginal hysterectomy and relative merits over abdominal and laparoscopically assisted hysterectomy. Best Pract Res Clin Obstet Gynaecol 2013; 27:393–413. 21. Dedden SJ, Geomini PMAJ, Huirne JAF, Bongers MY. Vaginal and Laparoscopic hysterectomy as an outpatient procedure: A systematic review. Eur J Obstet Gynecol Reprod Biol 2017;216: 212-23. 22. Fornara P, Doehn C, Seyfarth M, Jocham D. Why is urological laparoscopy minimally invasive? Eur Urol 2000;37(3):241-50. 23. Sietses C, Wiezer MJ, Eijsbouts QA, Beelen RH, van Leeuwen PA, von Blomberg BM, et al. A prospective randomized study of the systemic immune response after laparoscopic and conventional Nissen fundoplication. Surgery 1999;126(1):5-9. 24. Slade MS, Simmons RL, Yunis E, Greenberg LJ. Immunodepression after major surgery in normal patients. Surgery 1975;78(3):363-72. 25. Gupta A, Watson DI. Effect of laparoscopy on immune function. Br J Surg 2001;88(10):1296-306. 26. Grace PA, Quereshi A, Coleman J, Keane R, McEntee G, Broe P, et al. Reduced postoperative hospitalization after laparoscopic cholecystectomy. Br J Surg 1991;78(2):160-2. 27. Faist E, Kupper TS, Baker CC, Chaudry IH, Dwyer J, Baue AE. Depression of cellular immunity after major injury. Its association with posttraumatic complications and its reversal with immunomodulation. Arch Surg 1986 ;121(9):1000-5. 28. Sandberg EM, la Chapelle CF, van den Tweel MM, Schoones JW, Jansen FW. Laparoendoscopic single-site surgery versus conventional laparoscopy for hysterectomy: a systematic review and meta-analysis. Arch Gynecol Obstet 2017;295(5):1089-3. 29. Ramirez PT. Single-port laparoscopic surgery: is a single incision the next frontier in minimally invasive gynecologic surgery? Gynecol Oncol 2009; 114:143–4. 30. Fader AN, Escobar PF. Laparo endoscopic single-site surgery (LESS) in gynecologic oncology: technique and initial report. Gynecol Oncol 2009; 114: 157–61.
Evaluation of Inflammatory Markers in Single-Port Laparoscopic and Vaginal Hysterectomies: A Retrospective Study in Kocaeli, Northwest Turkey
Öz
Objective: The authors in this study aimed to detect inflammatory marker changes in two natural orifice hysterectomies: single-port laparoscopic hysterectomy (SLH) and vaginal hysterectomy (VH).
Materials and Methods: Between 2018 and 2019, data obtained from patients in the SLH and VH groups were reviewed retrospectively. The preoperative and postoperative hematocrit (HCT), hemoglobin (HB), white blood cell (WBC), platelet (PLR), and neutrophil-lymphocyte (NLR) ratios and values were compared as well as the demographic characteristics of the patients. This study was also registered in Registry of Clinical Trials; registration number: NCT04221308.
Results: In the postoperative period, WBC, NLR, and PLR were statistically increased, and HB and HCT were decreased in all groups. However, the changes in inflammatory markers were similar in both groups. The changes in HB and HCT were less in the SLH group. Moreover, both the duration of the operation and the hospital stay were higher in the SLH group.
Conclusions: Both natural orifice techniques provided low morbidity and good cosmetic results. The results regarding inflammatory markers indicate that both procedures are acceptable. As surgical experience in performing SLH increases, operation and hospital stay durations may decrease.
Anahtar Kelimeler
lymphocyte activation natural orifice endoscopic surgery neutrophil activation platelet activation vaginal hysterectomy
Kaynakça
- 1. Garry R. Health economics of hysterectomy. Best Pract Res Clin Obstet Gynaecol 2005; 19: 451-5. 2. Yoon BS, Seong SJ, Kim IH, Song T, Kim ML, Kim MK. Operative outcomes of single-port-access laparoscopy-assisted vaginal hysterectomy compared with single-port-access total laparoscopic hysterectomy. Taiwan J Obstet Gynecol 2014;53(4):486-9. 3. AAGL Advancing Minimally Invasive Gynecology Worldwide. AAGL position statement: route of hysterectomy to treat benign uterine disease. J Minim Invasive Gynecol 2011; 18:1–3. 4. American Congress of Obstetricians and Gynecologists. Choosing the route of hysterectomy for benign disease. ACOG Committee opinion no. 444. Obstet Gynecol 2009; 114:1156–8. 5. Nieboer TE, Hendriks JC, Bongers MY, Vierhout ME, Kluivers KB. Quality of life after laparoscopic and abdominal hysterectomy: a randomized controlled trial. Obstet Gynecol 2012; 119:85–91. 6. Demirayak G, Özdemir İA, Comba C, Çetin BA, Mathyk BA, Yıldız M, et al. Comparison of laparoendoscopic single-site (LESS) surgery and conventional multiport laparoscopic (CMPL) surgery for hysterectomy: long-term outcomes of abdominal incisional scar. J Obstet Gynaecol 2019; 26:1-5. 7. Cruickshank AM, Fraser WD, Burns HJ, Van Damme J, Shenkin A. Response of serum interleukin-6 in patients undergoing elective surgery of varying severity. Clin Sci (Lond) 1990;79 (2):161-5. 8. Allendorf JD, Bessler M, Whelan RL, Trokel M, Laird DA, Terry MB, et al. Postoperative immune function varies inversely with the degree of surgical trauma in a murine model. Surg Endosc 1997;11(5):427-30. 9. Lennard TW, Shenton BK, Borzotta A, Donnelly PK, White M, Gerrie LM, et al. The influence of surgical operations on components of the human immune system. Br J Surg 1985;72(10):771-6. 10. Iwase M, Kondo G, Watanabe H, Takaoka S, Uchida M, Ohashi M, et al. Regulation of Fas-mediated apoptosis in neutrophils after surgery-induced acute inflammation. J Surg Res 2006;134 (1): 114-23. 11. Ogawa K, Hirai M, Katsube T, Murayama M, Hamaguchi K, Shimakawa T, et al. Suppression of cellular immunity by surgical stress. Surgery 2000; 127: 329-36. 12. Collet D, Vitale GC, Reynolds M, Klar E, Cheadle WG. Peritoneal host defenses are less impaired by laparoscopy than by open operation. Surg Endosc 1995;9(10):1059-64. 13. Sietses C, Wiezer MJ, Eijsbouts QA, van Leeuwen PA, Beelen RH, Meijer S, et al. The influence of laparoscopic surgery on postoperative polymorphonuclear leukocyte function. Surg Endosc 2000;14(9):812-6. 14. Malik E, Buchweitz O, Müller-Steinhardt M, Kressin P, Meyhöfer-Malik A, Diedrich K. Prospective evaluation of the systemic immune response following abdominal, vaginal, and laparoscopically assisted vaginal hysterectomy. Surg Endosc 2001;15(5):463-6. 15. Wheeless CR. A rapid, inexpensive and effective method of surgical sterilization by laparoscopy. J Reprod Med 1969;3: 65–9. 16. Choi YS, Shin KS, Choi J, Park JN, Oh YS, Rhee TE. Single-port access laparoscopy-assisted vaginal hysterectomy: our initial experiences with 100 cases. Minim Invasive Surg. 2012; 2012:543627 doi: 10.1155/2012/543627. Epub 2012 Sep 4. 17. Gilabert-Estelles J, Castello JM, Gilabert-Aguilar J. Transumbilical single-incision laparoscopic hysterectomy for large uterus: feasibility of the technique. Gynecol Surg 2010; 7(2):143-48. 18. Lee YY, Kim TJ, Kim CJ, Kang H, Choi CH, Lee JW, et al. Single-port Access laparoscopic-assisted vaginal hysterectomy: a novel method with a wound retractor and a glove. J Minim Invasive Gynecol 2009; 16(4): 450-53. 19. Terzi H, Biler A, Turkay U, Kale A. A comparison of novel laparoscopic suturing techniques in single-port surgery. Minim Invasive Ther Allied Technol 2019;28(6):338-43. 20. Goolab BD. Vaginal hysterectomy and relative merits over abdominal and laparoscopically assisted hysterectomy. Best Pract Res Clin Obstet Gynaecol 2013; 27:393–413. 21. Dedden SJ, Geomini PMAJ, Huirne JAF, Bongers MY. Vaginal and Laparoscopic hysterectomy as an outpatient procedure: A systematic review. Eur J Obstet Gynecol Reprod Biol 2017;216: 212-23. 22. Fornara P, Doehn C, Seyfarth M, Jocham D. Why is urological laparoscopy minimally invasive? Eur Urol 2000;37(3):241-50. 23. Sietses C, Wiezer MJ, Eijsbouts QA, Beelen RH, van Leeuwen PA, von Blomberg BM, et al. A prospective randomized study of the systemic immune response after laparoscopic and conventional Nissen fundoplication. Surgery 1999;126(1):5-9. 24. Slade MS, Simmons RL, Yunis E, Greenberg LJ. Immunodepression after major surgery in normal patients. Surgery 1975;78(3):363-72. 25. Gupta A, Watson DI. Effect of laparoscopy on immune function. Br J Surg 2001;88(10):1296-306. 26. Grace PA, Quereshi A, Coleman J, Keane R, McEntee G, Broe P, et al. Reduced postoperative hospitalization after laparoscopic cholecystectomy. Br J Surg 1991;78(2):160-2. 27. Faist E, Kupper TS, Baker CC, Chaudry IH, Dwyer J, Baue AE. Depression of cellular immunity after major injury. Its association with posttraumatic complications and its reversal with immunomodulation. Arch Surg 1986 ;121(9):1000-5. 28. Sandberg EM, la Chapelle CF, van den Tweel MM, Schoones JW, Jansen FW. Laparoendoscopic single-site surgery versus conventional laparoscopy for hysterectomy: a systematic review and meta-analysis. Arch Gynecol Obstet 2017;295(5):1089-3. 29. Ramirez PT. Single-port laparoscopic surgery: is a single incision the next frontier in minimally invasive gynecologic surgery? Gynecol Oncol 2009; 114:143–4. 30. Fader AN, Escobar PF. Laparo endoscopic single-site surgery (LESS) in gynecologic oncology: technique and initial report. Gynecol Oncol 2009; 114: 157–61.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Orjinal Araştırma |
| Yazarlar | |
| Yayımlanma Tarihi | 30 Eylül 2020 |
| Yayımlandığı Sayı | Yıl 2020 |