Comparative Evaluation of 2-Port Laparoscopic Ovariectomy Using LigaSure versus Standard 3-Port Laparoscopic Ovariectomy with a Bipolar Electrode in Mares
Keywords:
Laparoscopic, Ligasure, minimally invasive, mare, ovariectomy, granulosa cell tumorAbstract
Ensuring fast and efficient hemostasis is crucial for achieving optimal outcomes in laparoscopic ovariectomy surgery. This study compared the clinical outcomes of standing laparoscopic ovariectomy for medium-sized granulosa cell tumors (≤15 cm in size) using a 2-port LigaSure versus a 3-port bipolar electrode, focusing on operating time, mean blood loss, intraoperative and postoperative complications, and the duration of the prospective hospital stay. Twelve mares were divided into two groups: six underwent standing laparoscopic ovariectomy with LigaSure through a 2-port approach, while the remaining six underwent the standard 3-port procedure with the bipolar electrode. Our findings demonstrated that 2-port laparoscopic ovariectomy using LigaSure was not only technically feasible and safe but also offered several advantages, including shorter operating times, simplified procedures, decreased postoperative analgesic requirements, and improved cosmetic appearance of surgical wounds. Moreover, this technique proved to be a reliable method for achieving hemostasis of the mesovarium while also being technically straightforward, time-saving, and cost-effective. Overall, our study suggests that 2-port laparoscopic ovariectomy with LigaSure is a promising alternative to the standard 3-port approach. This approach not only benefits patients by potentially reducing postoperative discomfort and enhancing recovery but also provides advantages for surgeons in terms of efficiency and resource utilization.
References
Knowles EJ, Tremaine WH, Pearson GR, Mair TS. A database survey of equine tumours in the United Kingdom. Equine Veterinary Journal 2015;48:280–4. https://doi.org/10.1111/evj.12421.
Renaudin CD, Kelleman AA, Keel K, McCracken JL, Ball BA, Ferris RA, et al. Equine granulosa cell tumours among other ovarian conditions: Diagnostic challenges. Equine Veterinary Journal 2021;53:60–70. https://doi.org/10.1111/evj.13279.
Ball BA, Almeida J, Conley AJ. Determination of serum anti-Müllerian hormone concentrations for the diagnosis of granulosa-cell tumours in mares. Equine Veterinary Journal 2013;45:199–203. https://doi.org/10.1111/j.2042-3306.2012.00594.x.
Sherlock CE, Lott‐Ellis K, Bergren A, Withers JM, Fews D, Mair TS. Granulosa cell tumours in the mare: A review of 52 cases. Equine Veterinary Education 2015;28:75–82. https://doi.org/10.1111/eve.12449.
Tommasa SD, Roth SP, Triebe T, Brehm W, Lohmann KL, Stöckle SD. Successful intra-abdominal resection of a 24 kg ovarian granulosa cell tumor in a Warmblood mare. Open Veterinary Journal 2023;13:1212–8. https://doi.org/10.5455/OVJ.2023.v13.i9.17.
Murphy J, Hendrickson DA, Hendrix S. Right flank laparoscopic ovariectomy of a regressing granulosa thecal cell tumor of a pregnant mare: A case review. Journal of Equine Veterinary Science 2005;25:309–11. https://doi.org/10.1016/j.jevs.2005.06.009.
Castillo JM, Tse MPY, Dockweiler JC, Cheong SH, de Amorim MD. Bilateral granulosa cell tumor in a cycling mare. The Canadian Veterinary Journal 2019;60:480–4.
McKinnon AO, Barker KJ. Granulosa theca cell tumours. Equine Veterinary Education 2010;22:121–4. https://doi.org/10.2746/095777309X480533.
Maurice KT. Diagnosis and surgical removal of a granulosa-theca cell tumor in a mare. The Canadian Veterinary Journal 2005;46:644.
Kobluk CN, Ames TR, Geor RJ. The Horse: Diseases & Clinical Management. Philadelphia: W.B. Saunders; 1995.
De Bont MP, Wilderjans H, Simon O. Standing laparoscopic ovariectomy technique with intraabdominal dissection for removal of large pathologic ovaries in mares. Veterinary Surgery 2010;39:737–41. https://doi.org/10.1111/j.1532-950x.2010.00695.x.
Kelmer G, Raz T, Berlin D, Steinman A, Tatz AJ. Standing open-flank approach for removal of enlarged pathologic ovaries in mares. The Veterinary Record 2013;172:687. https://doi.org/10.1136/vr.101380.
Caron JP. Equine laparoscopy: gonadectomy. Compendium 2013;35:E4.
Kirshtein B, Haas EM. Single port laparoscopic surgery: concept and controversies of new technique. Minimally Invasive Surgery 2012;2012:456541. https://doi.org/10.1155/2012/456541.
Kim S-J, Choi B-J, Lee SC. Overview of single-port laparoscopic surgery for colorectal cancers: past, present, and the future. World Journal of Gastroenterology 2014;20:997–1004. https://doi.org/10.3748/wjg.v20.i4.997.
Mori T. Concept of reduced port laparoscopic surgery. In: Mori T, Dapri G, editors. Reduced Port Laparoscopic Surgery, Tokyo: Springer Japan; 2014, p. 11–21. https://doi.org/10.1007/978-4-431-54601-6_2.
Lacitignola L, Guadalupi M, Massari F. Single incision laparoscopic surgery (SILS) in small animals: a systematic review and meta-analysis of current veterinary literature. Veterinary Sciences 2021;8:144. https://doi.org/10.3390/vetsci8080144.
Collivignarelli F, Bianchi A, Paolini A, Vignoli M, Crisi PE, Falerno I, et al. Two-port laparoscopic adrenalectomy in dogs. Animals (Basel) 2022;12:2917. https://doi.org/10.3390/ani12212917.
Kunisaki C, Makino H, Yamaguchi N, Izumisawa Y, Miyamato H, Sato K, et al. Surgical advantages of reduced-port laparoscopic gastrectomy in gastric cancer. Surgical Endoscopy 2016;30:5520–8. https://doi.org/10.1007/s00464-016-4916-8.
Wang L, Deng Y, Yan S, Ma X, Wang C, Miao W, et al. Comparison of clinical safety and feasibility between reduced-port laparoscopic radical gastrectomy and conventional laparoscopic radical gastrectomy: A retrospective study. Frontiers in Surgery 2022;9.
Petrizzi L, Guerri G, Straticò P, Cuomo A, Vullo C, De Amicis I, et al. Laparoscopic ovariectomy in standing mule mares. Journal of Equine Veterinary Science 2020;84:102857. https://doi.org/10.1016/j.jevs.2019.102857.
Elnasharty M, Moustafa M. How to deal with challenges in laparoscopic hysterectomy. The Obstetrician & Gynaecologist 2020;22:313–7. https://doi.org/10.1111/tog.12693.
Yusoff AR, Lomanto D. Hemostasis in laparoscopic surgery. In: Lomanto D, Chen WT-L, Fuentes MB, editors. Mastering Endo-Laparoscopic and Thoracoscopic Surgery: ELSA Manual, Singapore: Springer Nature; 2023, p. 39–44. https://doi.org/10.1007/978-981-19-3755-2_7.
Redmann JG, Lavin TE, French MS, Broussard TD, Lapointe-Gagner M. Improving hemostasis in sleeve gastrectomy with alternative stapler. JSLS: Journal of the Society of Laparoendoscopic Surgeons 2020;24:e2020.00073. https://doi.org/10.4293/JSLS.2020.00073.
Zhang H, Xu H, Fei K, Guo D, Duan Y. The safety and efficiency of a 1470 nm laser in obtaining tract hemostasis in tubeless percutaneous nephrolithotomy: a retrospective cross-sectional study. BMC Urology 2022;22:94. https://doi.org/10.1186/s12894-022-01046-z.
Nam KW, Lee SB, Kim IY, Kim KG, Park SJ. A new hemostatic clip for endoscopic surgery that can maintain blood flow after clipping. World J Gastroenterol 2014;20:1325–31. https://doi.org/10.3748/wjg.v20.i5.1325.
Ibrahim ZM, Ghoneim HM, Kishk EA, Abbas AM, Greash MA, Atwa KA. Bipolar electrocoagulation versus intracorporeal hemostatic suturing for laparoscopic ovarian cystectomy: prospective cohort study on effects. Journal of Gynecologic Surgery 2020;36:103–8. https://doi.org/10.1089/gyn.2019.0027.
Klingler CH, Remzi M, Marberger M, Janetschek G, Patel HRH. Haemostasis in laparoscopy. European Urology 2006;50:948–57. https://doi.org/10.1016/j.eururo.2006.01.058.
Philipose KJ, Sinha B. Laparoscopic surgery. Medical Journal, Armed Forces India 1994;50:137–43. https://doi.org/10.1016/S0377-1237(17)31019-5.
Msezane LP, Katz MH, Gofrit ON, Shalhav AL, Zorn KC. Hemostatic agents and instruments in laparoscopic renal surgery. Journal of Endourology 2008;22:403–8. https://doi.org/10.1089/end.2007.9844.
Huang H-Y, Liu Y-C, Li Y-C, Kuo H-H, Wang C-J. Comparison of three different hemostatic devices in laparoscopic myomectomy. Journal of the Chinese Medical Association 2018;81:178–82. https://doi.org/10.1016/j.jcma.2017.04.012.
Grieco M, Apa D, Spoletini D, Grattarola E, Carlini M. Major vessel sealing in laparoscopic surgery for colorectal cancer: a single-center experience with 759 patients. World Journal of Surgical Oncology 2018;16:101. https://doi.org/10.1186/s12957-018-1402-x.
Velotti N, Manigrasso M, Di Lauro K, Vitiello A, Berardi G, Manzolillo D, et al. Comparison between LigasureTM and harmonic® in laparoscopic sleeve gastrectomy: a single-center experience on 422 patients. Journal of Obesity 2019;2019:3402137. https://doi.org/10.1155/2019/3402137.
Bracamonte JL, Thomas KL. Laparoscopic cryptorchidectomy with a vessel-sealing device in dorsal recumbent horses: 43 cases. Veterinary Surgery 2017;46:559–65. https://doi.org/10.1111/vsu.12624
Hubert JD, Burba DJ, Moore RM. Evaluation of a vessel-sealing device for laparoscopic granulosa cell tumor removal in standing mares. Veterinary Surgery 2006;35:324–9. https://doi.org/10.1111/j.1532-950X.2006.00151.x.
Teng W, Liu J, Liu W, Jiang J, Chen M, Zang W. Short-term outcomes of reduced-port laparoscopic surgery versus conventional laparoscopic surgery for total gastrectomy: a single-institute experience. BMC Surgery 2023;23:75. https://doi.org/10.1186/s12893-023-01972-1.
Sasaki A, Nitta H, Otsuka K, Obuchi T, Baba S, Koeda K, et al. Pros and cons. In: Mori T, Dapri G, editors. Reduced Port Laparoscopic Surgery, Tokyo: Springer Japan; 2014, p. 27–34. https://doi.org/10.1007/978-4-431-54601-6_4.
Barreto da Rocha P, Driessen B, McDonnell SM, Hopster K, Zarucco L, Gozalo-Marcilla M, et al. A critical evaluation for validation of composite and unidimensional postoperative pain scales in horses. PLoS One 2021;16:e0255618. https://doi.org/10.1371/journal.pone.0255618.
Bancroft JD, Gamble M, editors. Theory and Practice of Histological Techniques. Sixth Edition. London: Churchill Livingstone; 2008. https://doi.org/10.1016/B978-0-443-10279-0.50002-6.
Röcken M, Mosel G, Seyrek‐Intas K, Seyrek‐Intas D, Litzke F, Verver J, et al. Unilateral and bilateral laparoscopic ovariectomy in 157 mares: a retrospective multicenter study. Veterinary Surgery 2011;40:1009–14. https://doi.org/10.1111/j.1532-950x.2011.00884.x.
Karande VC. LigasureTM 5-mm blunt tip laparoscopic instrument. Journal of Obstetrics and Gynaecology of India 2015;65:350–2. https://doi.org/10.1007/s13224-015-0745-2.
Newman RM, Traverso LW. Principles of laparoscopic hemostasis. In: Scott-Conner CEH, editor. The SAGES Manual: Fundamentals of Laparoscopy, Thoracoscopy, and GI Endoscopy, New York, NY: Springer; 2006, p. 49–59. https://doi.org/10.1007/0-387-30485-1_6.
Novitsky YW, Kercher KW, Czerniach DR, Kaban GK, Khera S, Gallagher-Dorval KA, et al. Advantages of mini-laparoscopic vs conventional laparoscopic cholecystectomy: results of a prospective randomized trial. Archives of Surgery 2005;140:1178–83. https://doi.org/10.1001/archsurg.140.12.1178.
Toro A, Mannino M, Cappello G, Di Stefano A, Di Carlo I. Comparison of two entry methods for laparoscopic port entry: technical point of view. Diagnostic and Therapeutic Endoscopy 2012;2012:305428. https://doi.org/10.1155/2012/305428.
Justo-Janeiro JM, Vincent GT, Vázquez de Lara F, de la Rosa Paredes R, Orozco EP, Vázquez de Lara LG. One, two, or three ports in laparoscopic cholecystectomy? International Surgery 2014;99:739–44. https://doi.org/10.9738/INTSURG-D-13-00234.1.
Granados J-R, Usón-Casaus J, Martínez J-M, Sánchez-Margallo F, Pérez-Merino E. Canine laparoscopic ovariectomy using two 3- and 5-mm portal sites: A prospective randomized clinical trial. The Canadian Veterinary Journal 2017;58:565–70.
Vázquez FJ, Vitoria A, Gómez-Arrue J, Fuente S, Barrachina L, de Blas I, et al. Complications in laparoscopic access in standing horses using cannula and trocar units developed for human medicine. Veterinary Sciences 2023;10:61. https://doi.org/10.3390/vetsci10010061.
Alkatout I, Schollmeyer T, Hawaldar NA, Sharma N, Mettler L. Principles and safety measures of electrosurgery in laparoscopy. JSLS 2012;16:130–9. https://doi.org/10.4293/108680812X13291597716348
Hand R, Rakestraw P, Taylor T. Evaluation of a vessel-sealing device for use in laparoscopic ovariectomy in mares. Veterinary Surgery 2002;31:240–4. https://doi.org/10.1053/jvet.2002.33482.
Proença LM. Two-portal access laparoscopic ovariectomy using Ligasure Atlas in exotic companion mammals. Veterinary Clinics of North America: Exotic Animal Practice 2015;18:587–96. https://doi.org/10.1016/j.cvex.2015.04.010.
Shariati E, Bakhtiari J, Khalaj A, Niasari-Naslaji A. Comparison between two portal laparoscopy and open surgery for ovariectomy in dogs. Vet Res Forum 2014;5:219–23.
Borle FR, Mehra B, Ranjan Singh A. Comparison of cosmetic outcome between single-incision laparoscopic cholecystectomy and conventional laparoscopic cholecystectomy in rural Indian population: a randomized clinical trial. The Indian Journal of Surgery 2015;77:877–80. https://doi.org/10.1007/s12262-014-1044-3.
Tapia-Araya AE, Díaz-Güemes Martin-Portugués I, Bermejo LF, Sánchez-Margallo FM. Laparoscopic ovariectomy in dogs: comparison between laparoendoscopic single-site and three-portal access. Journal of Veterinary Science 2015;16:525–30. https://doi.org/10.4142/jvs.2015.16.4.525.
Sohail AH, Silverstein J, Hakmi H, Pacheco TBS, Hadi YB, Gangwani MK, et al. Single-incision laparoscopic cholecystectomy using the marionette transumbilical approach is safe and efficient with careful patient selection: a comparative analysis with conventional multiport laparoscopic cholecystectomy. Surgery Journal (New York, NY) 2023;9:e13–7. https://doi.org/10.1055/s-0042-1759772.
Newcomb WL, Hope WW, Schmelzer TM, Heath JJ, Norton HJ, Lincourt AE, et al. Comparison of blood vessel sealing among new electrosurgical and ultrasonic devices. Surgical Endoscopy 2008;23:90–6. https://doi.org/10.1007/s00464-008-9932-x.
Timm RW, Asher RM, Tellio KR, Welling AL, Clymer JW, Amaral JF. Sealing vessels up to 7 mm in diameter solely with ultrasonic technology. Medical Devices (Auckland, NZ) 2014;7:263–71. https://doi.org/10.2147/MDER.s66848.
Toishi M, Yoshida K, Agatsuma H, Sakaizawa T, Eguchi T, Saito G, et al. Usefulness of vessel-sealing devices for ≤7 mm diameter vessels: a randomized controlled trial for human thoracoscopic lobectomy in primary lung cancer. Interactive CardioVascular and Thoracic Surgery 2014;19:448–55. https://doi.org/10.1093/icvts/ivu176.
Gauthier O, Holopherne‐Doran D, Gendarme T, Chebroux A, Thorin C, Tainturier D, et al. Assessment of postoperative pain in cats after ovariectomy by laparoscopy, median celiotomy, or flank laparotomy. Veterinary Surgery 2014;44:23–30. https://doi.org/10.1111/j.1532-950x.2014.12150.x.
Hernández-Avalos I, Valverde A, Ibancovichi-Camarillo JA, Sánchez-Aparicio P, Recillas-Morales S, Osorio-Avalos J, et al. Clinical evaluation of postoperative analgesia, cardiorespiratory parameters and changes in liver and renal function tests of paracetamol compared to meloxicam and carprofen in dogs undergoing ovariohysterectomy. PLoS One 2020;15:e0223697. https://doi.org/10.1371/journal.pone.0223697.
Hiremath SCS, Ahmed Z. Comparison of two entry methods and their cosmetic outcomes in creating pneumoperitoneum: a prospective observational study. Surgery Journal (New York, NY) 2022;8:e239–44. https://doi.org/10.1055/s-0042-1756182.
Downloads
Published
Issue
Section
License
Copyright (c) 2024 Mohamed W. El-Sherif, Ahmed Fotouh, Ahmed N. El-Khamary
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors retain the copyright of their manuscripts, and all Open Access articles are distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided that the original work is properly cited.
