İsmail BIYIKa, Mustafa ALBAYRAKb, Fatih KESKİNc, Ayşe Nur MUTd aKütahya Health Sciences University Faculty of Medicine, Department of Gynecology and Obstetrics, Kütahya, TURKEY bPrivate Reyap Hospital, Clinic of Gynecology and Obstetrics, Tekirdağ, TURKEY cSultan 1. Murat State Hospital, Clinic of Gynecology and Obstetrics, Edirne, TURKEY dAnkara University Faculty of Medicine, Department of Epidemiology, Ankara, TURKEY
ABSTRACT Objective: The aim of this study is to compare the duration of surgery and anesthesia, complication rates and the amount of anesthetic drugs used and the cost in laparoscopic tubal ligation cases with and without the use of manipulator. This retrospective case control study included the women who underwent elective interval laparoscopic tubal ligation. Material and Methods: The time between intubation and the onset of surgery, duration of surgery (main operation time) and intubation-extubation (total operation time-duration of anesthesia) were recorded in the operating room. Results: Demographic datas were similar between the patients with and without manipulators (p> 0.05). In the non-manipulator group, intubation to beginning of surgery time, main operation time, total anesthesia time were found to be shorter (p <0.001, p <0.001, p <0.001, respectively). Postoperative hospital stay, the amount of parenteral anesthetic drug used, the need for postoperative parenteral analgesics, the number of laparoscopic ports used and the complication rates were similar between the two groups (p> 0.05). Sevoflurane use was found to be less in the non-manipulator group (p <0.001). Conclusions: In laparoscopic tubal ligation operation where no uterine manipulator is used, anesthesia and total surgery times are approximately 8 minutes shorter. The use of uterine manipulator increases the duration of surgery and the amount of sevoflurane used. Laparoscopic tubal ligation without uterine manipulator may be considered in cases where severe adhesions are not anticipated and no additional intervention is planned. Besides, avoidance of manipulator use may have the advantage of time and cost savings.
Pollack A. ACOG practice bulletin. Clinical management guidelines for obstetrician-gynecologists. Number 46. Obstet Gynecol. 2003;102(3):647-58. [Crossref][PubMed]
Centers for Disease Control and Prevention (CDC). National Survey of Family Growth. Available at http://www.cdc.gov/nchs/nsfg.htm. Accessed: October 12, 2011.
Jamieson DJ, Hillis SD, Duerr A, Marchbanks PA, Costello C, Peterson HB. Complications of interval laparoscopic tubal sterilization: findings from the United States Collaborative Review of Sterilization. Obstet Gynecol. 2000;96(6):997-1002. [Crossref]
van den Haak L, Alleblas C, Nieboer TE, Rhemrev JP, Jansen FW. Efficacy and safety of uterine manipulators in laparoscopic surgery: a review. Arch Gynecol Obstet. 2015;292(5):1003-11. [Crossref][PubMed]
Akdemir A, Cirpan T. Iatrogenic uterine perforation and bowel penetration using a Hohlmanipulator: a case report. Int J Surg Case Rep. 2014;5(5):271-3. [Crossref][PubMed][PMC]
Mehta PV. Laparoscopic sterilizations (16,803) without vaginal manipulation. Int J Gynaecol Obstet. 1982;20(4):323-5. [Crossref]
Banerjee AK, Emembolu JO. Plastic suction curette as uterine manipulator at combined laparoscopic sterilization: a prospective study of 531 cases. Eur J Contracept Reprod Health Care. 2006;11(4):310-3. [Crossref][PubMed]
Khandwala SD. Development of a simplified laparoscopic sterilization technique. J Reprod Med. 1984;29(8):586-8.
Carney PI, Yao J, Lin J, Law A. Comparison of healthcare costs among commercially ınsured women in the united states who underwent hysteroscopic sterilization versus laparoscopic bilateral tubal ligation sterilization. J Womens Health (Larchmt). 2017;26(5):483-90. [Crossref][PubMed]
Prasad P, Agochiya J, Hecht RM. Uterine manipulation during laparoscopic sterilization- can we do without it? Austin J Womens Health. 2014;1(1):1-3.
Yildirim A, Goksu H, Toprak GC, Kılıc R, Yasar MA. [The safety and quality of low flow anaesthesia with isoflurane, sevoflurane and desflurane]. Fırat Med J. 2006;11(3):170-4.
Westhoff C, Davis A. Tubal sterilization: focus on the U.S. experience. Fertil Steril. 2000;73(5):913-22. [Crossref]
MacKay AP, Kieke BA Jr, Koonin LM, Beattie K. Tubal sterilization in the United States, 1994-1996. Fam Plann Perspect. 2001;33(4): 161-5. [Crossref][PubMed]
Stevanovic PD, Petrova G, Miljkovic B, Scepanovic R, Perunovic R, Stojanovic D, et al. Low fresh gas flow balanced anesthesia versus target controlled intravenous infusion anesthesia in laparoscopic cholecystectomy: a cost-minimization analysis. Clin Ther. 2008;30(9):1714-25. [Crossref][PubMed]
Childers CP, Maggard-Gibbons M. Understanding costs of care in the operating room. JAMA Surg. 2018;18(4):e176233. [Crossref][PubMed][PMC]
Shippert RD. A study of time-dependent operating room fees and how to save $100 000 by using time-saving products. The American Journal of Cosmetic Surgery. 2005;22:25-34. [Crossref]
Macario A. What does one minute of operating room time cost? J Clin Anesth. 2010;22(4): 233-6. [Crossref][PubMed]