4K Versus 3D Laparoscopic Colporraphy by Surgeons in Training: a Prospective Randomized Trial
Study Details
Study Description
Brief Summary
This prospective randomized trial aims to assess if the operative time of vaginal cuff suture performed by trainees could be reduced using 3D laparoscopy instead of 4K laparoscopy.
Condition or Disease | Intervention/Treatment | Phase |
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Detailed Description
All patients with benign uterine pathology at preoperative examinations (pelvic ultrasound and / or magnetic resonance and / or CT) and with indication for total laparoscopic hysterectomy with consequently need for laparoscopic suture of the vaginal cuff, will be enrolled in the study.
- I TIME/OUT OF PROTOCOL TIME (performed by expert surgeons) While under general anesthesia, the patient is positioned in the dorsal lithotomic position with both legs supported in stirrups with a Trendelenburg tilt and arms along the body. A four disposable or reusable, sterile trocar transperitoneal approach is used. A 10 mm port is inserted at the umbilicus for the telescope. Once pneumoperitoneum (12 mmHg) is achieved, intra-abdominal visualization will be obtained with a 0° 4K high-definition telescope (VISERA UHD 4K 10 mm, Olympus Winter & IBE GMBH, Hamburg - Germany) or with 0° 3D laparoscopy high-definition (Olympus Winter & IBE GMBH, Hamburg - Germany).
Two additional 5 mm ports are placed under direct visualization, in the right lower abdomen medial to the right obliterated umbilical artery and in the left lower abdomen lateral to the inferior epigastric vessels. One more 5-mm trocar is inserted in the right mid abdomen at the level of the umbilicus. The instruments used include bipolar grasper, monopolar scissors, monopolar hook, various graspers and a suction irrigation system. Clermont Ferrand uterine manipulator (Model K.Storz Endoskope,Tuttlingen, Germany) is optionally used to move the uterus.
Total hysterectomy is then performed according to standard technique.
- II TIME/PROTOCOL TIME (performed by surgeon in training) The vaginal vault is closed with a 0 Vycril suture laparoscopically (continuous suture). In order to avoid excess operating time, 15 min was allocated for completion of cuff closure by surgeons-in-training, after which time the attending surgeon took over this task.
Operative time, estimated blood loss, incidence of intra or post-operative complications, postoperative pain, days of hospitalization and costs will be recordered
Study Design
Arms and Interventions
Arm | Intervention/Treatment |
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3D laparoscopy arm Patients submitted to vaginal cuff closure after total laparoscopic hysterectomy using a 3D laparoscopic camera |
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4k laparoscopy arm Patients submitted to vaginal cuff closure after total laparoscopic hysterectomy using a 4k laparoscopic camera |
Outcome Measures
Primary Outcome Measures
- operative time [intra-operative]
To compare the time taken to close the vaginal cuff, which was defined as time, starting from the initial grasp of the suture to cutting the suture, with 3D Laparoscopy vs 4K laparoscopy
Secondary Outcome Measures
- Intra-operative complications [intra-operative]
Evaluate the incidence of intraoperative complications in the two laparoscopic system (intraoperative blood loss, need for intraoperative transfusions, bladder lesions, ureteral lesions, vascular lesions, intestinal lesions)
Other Outcome Measures
- post-operative complications [up to 3 months]
- Evaluate the incidence of postoperative complications (dehiscence of the vaginal cuff, fever, urinary tract infections, surgical wound infections)
Eligibility Criteria
Criteria
Inclusion Criteria:
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Patients suffering from benign gynecological pathology (uterine fibromatosis, abnormal blood loss, complex hyperplasia with atypia, uterine prolapse) with indication for total uterine hysterectomy and consequently need for laparoscopic suture of the vaginal cuff
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American Society of Anesthesiologists (ASA) class < 3
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Patient's informed consent
Exclusion Criteria:
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Suspected neoplastic pathology
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Patients not eligible for surgery
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Actual pregnancies or pelvic inflammatory disease
Contacts and Locations
Locations
Site | City | State | Country | Postal Code | |
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1 | Fondazione Policlinico Universitario A. Gemelli, IRCCS | Rome | RM | Italy | 00168 |
Sponsors and Collaborators
- Catholic University of the Sacred Heart
Investigators
None specified.Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- DIPUSVSP-27-07-2088