Inflammatory Markers in Natural Orifice Hysterectomies

Inflammation Clinical Trial

Official title:

Evaluation of Inflammatory Markers in Single Port Laparoscopic and Vaginal Hysterectomies: A Retrospective Study in Kocaeli, Northwest Turkey

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT04221308
• Other study ID #: 23068423
• Status: Completed
• Start date: January 1, 2018
• Est. completion date: December 15, 2019

Study information

• Verified date: January 2020
• Source: Derince Training and Research Hospital
• Contact: n/a
• Is FDA regulated: No
• Study type: Observational

Clinical Trial Summary

The authors aimed to detect inflammatory marker changes in two natural orifice hysterectomies: single-port laparoscopic hysterectomy (SLH) and vaginal hysterectomy (VH).

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.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 134
• Est. completion date: December 15, 2019
• Est. primary completion date: November 30, 2019
• Accepts healthy volunteers: No
• Gender: Female
• Age group: 45 Years to 60 Years

Eligibility

Inclusion Criteria:

• hysterectomy requirement with any conditions in gynecologic diseases

Exclusion Criteria:

• patients with a chronic disease (e.g., hypertension, diabetes mellitus, and rheumatologic, nephrological, and hematological diseases)

• the presence of active infection

• using of corticosteroid, acetylsalicylic acid, or anticoagulant

• cystocele or rectocele repair with mesh

Related Conditions & MeSH terms

• Genital Diseases, Female
• Gynecologic Disease
• Inflammation

Intervention

Device:
• Single port laparoscopic systems
The first assistant handles the scope from the patient's right side. The second assistant, who is positioned between the legs of the patient, inserts a uterine manipulator (Rumi System; Cooper Surgical, CT). At the beginning of the surgery, a 1.5 to 2.5 cm vertical incision is made within the umbilicus using the open Hasson approach. After the bottom retractor ring of the wound retractor component of the Octo-Port is inverted (DalimSurgNet, Seoul, Korea), it is inserted through the incision deep in the peritoneum. Carbon dioxide is insufflated through the gas valve of the Octo-Port to maintain intra-abdominal pressure at 10 to 12 mm Hg. Through the 10 mm channels of the Octo-Port, a 10 mm, 30° rigid laparoscope is introduced. Rigid laparoscopic instruments are introduced through the 5 mm channels of the Octo-Port. The utero-ovarian ligament or infundibulopelvic ligament, uterine vessels, and uterine ligaments are transected by using the 5 mm LigaSure vessel sealer device

Locations

Country	Name	City	State
Turkey	Derince Training and Research Hospital	Kocaeli

Sponsors (1)

Lead Sponsor	Collaborator
Derince Training and Research Hospital

Country where clinical trial is conducted

Turkey, 

References & Publications (33)

AAGL Advancing Minimally Invasive Gynecology Worldwide. AAGL position statement: route of hysterectomy to treat benign uterine disease. J Minim Invasive Gynecol. 2011 Jan-Feb;18(1):1-3. doi: 10.1016/j.jmig.2010.10.001. Epub 2010 Nov 6. — View Citation

ACOG Committee Opinion No. 444: choosing the route of hysterectomy for benign disease. Obstet Gynecol. 2009 Nov;114(5):1156-8. doi: 10.1097/AOG.0b013e3181c33c72. — View Citation

Allendorf JD, Bessler M, Whelan RL, Trokel M, Laird DA, Terry MB, Treat MR. Postoperative immune function varies inversely with the degree of surgical trauma in a murine model. Surg Endosc. 1997 May;11(5):427-30. — View Citation

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. — View Citation

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 Oct;9(10):1059-64. — View Citation

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 Aug;79(2):161-5. — View Citation

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 Sep;216:212-223. doi: 10.1016/j.ejogrb.2017.07.015. Epub 2017 Jul 22. Review. — View Citation

Fader AN, Escobar PF. Laparoendoscopic single-site surgery (LESS) in gynecologic oncology: technique and initial report. Gynecol Oncol. 2009 Aug;114(2):157-61. doi: 10.1016/j.ygyno.2009.05.020. Epub 2009 May 28. — View Citation

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 Sep;121(9):1000-5. — View Citation

Fornara P, Doehn C, Seyfarth M, Jocham D. Why is urological laparoscopy minimally invasive? Eur Urol. 2000 Mar;37(3):241-50. — View Citation

Garry R. Health economics of hysterectomy. Best Pract Res Clin Obstet Gynaecol. 2005 Jun;19(3):451-65. Epub 2005 Mar 2. Review. — View Citation

Goolab BD. Vaginal hysterectomy and relative merits over abdominal and laparoscopically assisted hysterectomy. Best Pract Res Clin Obstet Gynaecol. 2013 Jun;27(3):393-413. doi: 10.1016/j.bpobgyn.2013.01.003. Epub 2013 Apr 18. — View Citation

Grace PA, Quereshi A, Coleman J, Keane R, McEntee G, Broe P, Osborne H, Bouchier-Hayes D. Reduced postoperative hospitalization after laparoscopic cholecystectomy. Br J Surg. 1991 Feb;78(2):160-2. — View Citation

Gupta A, Watson DI. Effect of laparoscopy on immune function. Br J Surg. 2001 Oct;88(10):1296-306. Review. — View Citation

Gynecol Surg. 2010; 7(2):143-148

Gynecol Surg. 2013; 10:117-122

Iwase M, Kondo G, Watanabe H, Takaoka S, Uchida M, Ohashi M, Nagumo M. Regulation of Fas-mediated apoptosis in neutrophils after surgery-induced acute inflammation. J Surg Res. 2006 Jul;134(1):114-23. Epub 2005 Dec 27. — View Citation

J Obstet Gynaecol. 2019; 26:1-5.

Lee YY, Kim TJ, Kim CJ, Kang H, Choi CH, Lee JW, Kim BG, Lee JH, Bae DS. Single-port access laparoscopic-assisted vaginal hysterectomy: a novel method with a wound retractor and a glove. J Minim Invasive Gynecol. 2009 Jul-Aug;16(4):450-3. doi: 10.1016/j.jmig.2009.03.022. Epub 2009 May 31. — View Citation

Lennard TW, Shenton BK, Borzotta A, Donnelly PK, White M, Gerrie LM, Proud G, Taylor RM. The influence of surgical operations on components of the human immune system. Br J Surg. 1985 Oct;72(10):771-6. — View Citation

Liliana M, Alessandro P, Giada C, Luca M. Single-port access laparoscopic hysterectomy: a new dimension of minimally invasive surgery. J Gynecol Endosc Surg. 2011 Jan;2(1):11-7. doi: 10.4103/0974-1216.85273. — View Citation

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 May;15(5):463-6. Epub 2001 Mar 13. — View Citation

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 Jan;119(1):85-91. doi: 10.1097/AOG.0b013e31823d3b00. — View Citation

Nieboer TE, Johnson N, Lethaby A, Tavender E, Curr E, Garry R, van Voorst S, Mol BW, Kluivers KB. Surgical approach to hysterectomy for benign gynaecological disease. Cochrane Database Syst Rev. 2009 Jul 8;(3):CD003677. doi: 10.1002/14651858.CD003677.pub4. Review. Update in: Cochrane Database Syst Rev. 2015;8:CD003677. — View Citation

Ogawa K, Hirai M, Katsube T, Murayama M, Hamaguchi K, Shimakawa T, Naritake Y, Hosokawa T, Kajiwara T. Suppression of cellular immunity by surgical stress. Surgery. 2000 Mar;127(3):329-36. Erratum in: Surgery 2000 Jun;127(6):613. — View Citation

Ramirez PT. Single-port laparoscopic surgery: is a single incision the next frontier in minimally invasive gynecologic surgery? Gynecol Oncol. 2009 Aug;114(2):143-4. doi: 10.1016/j.ygyno.2009.06.007. — View Citation

Romanelli JR, Earle DB. Single-port laparoscopic surgery: an overview. Surg Endosc. 2009 Jul;23(7):1419-27. doi: 10.1007/s00464-009-0463-x. Epub 2009 Apr 4. Review. — View Citation

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 May;295(5):1089-1103. doi: 10.1007/s00404-017-4323-y. Epub 2017 Mar 29. Review. — View Citation

Sietses C, Wiezer MJ, Eijsbouts QA, Beelen RH, van Leeuwen PA, von Blomberg BM, Meijer S, Cuesta MA. A prospective randomized study of the systemic immune response after laparoscopic and conventional Nissen fundoplication. Surgery. 1999 Jul;126(1):5-9. — View Citation

Sietses C, Wiezer MJ, Eijsbouts QA, van Leeuwen PA, Beelen RH, Meijer S, Cuesta MA. The influence of laparoscopic surgery on postoperative polymorphonuclear leukocyte function. Surg Endosc. 2000 Sep;14(9):812-6. — View Citation

Slade MS, Simmons RL, Yunis E, Greenberg LJ. Immunodepression after major surgery in normal patients. Surgery. 1975 Sep;78(3):363-72. — View Citation

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 Dec;28(6):338-343. doi: 10.1080/13645706.2019.1567554. Epub 2019 Feb 22. — View Citation

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 Dec;53(4):486-9. doi: 10.1016/j.tjog.2013.07.003. — View Citation

* Note: There are 33 references in all — Click here to view all references

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Changes in hematocrit levels	Hematocrit (%) levels in the first 24 hours after single port laparoscopic or vaginal hysterectomies were compared.	1 day
Primary	Changes in hemoglobin levels	Hemoglobin levels in the first 24 hours after single port laparoscopic or vaginal hysterectomies were compared.	1 day
Primary	Changes in white blood cell levels	white blood cell (x103/mm3), in the first 24 hours after single port laparoscopic or vaginal hysterectomies were compared.	1 day
Primary	Changes in neutrophil-lymphocyte and platelet-lymphocyte ratio	neutrophil-lymphocyte and platelet-lymphocyte ratio in the first 24 hours after single port laparoscopic or vaginal hysterectomies were compared.	1 day