Journal of minimally invasive gynecology
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J Minim Invasive Gynecol · Feb 2019
Case ReportsVascular Entrapment of Both the Sciatic and Pudendal Nerves Causing Persistent Sciatica and Pudendal Neuralgia.
To demonstrate the laparoscopic approach to malformed branches of the vessels entrapping the nerves of the sacral plexus. ⋯ A less well-known cause of chronic pelvic pain is compression of the sacral plexus by dilated or malformed branches of the internal iliac vessels. Laparoscopic management of vascular entrapment of the sacral plexus has been described by Possover et al [1,2] and Lemos et al [3]. This procedure appears to be feasible and effective, but requires significant experience and familiarity with laparoscopy techniques and pelvic nerve anatomy.
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J Minim Invasive Gynecol · Feb 2019
A Systematic Review of Perioperative Opioid Management for Minimally Invasive Hysterectomy.
Excessive opioid use and misuse is a pervasive and growing societal problem, and decreasing the surgical contribution to this epidemic represents an opportunity to improve outcomes. Here we describe patterns of opioid prescription, consumption, and persistent use among women undergoing minimally invasive hysterectomy (MIH) for benign indications. We performed a systematic review of English full-text articles addressing opioids and gynecologic surgery using MEDLINE and Cochrane Central Register of Controlled Trials according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. ⋯ In a population at risk for persistent opioid use, prescription often exceeds patients' needs. Guidelines for opioid prescribing in the setting of multimodal anesthetic regimens may allow us to lessen our contribution to the opioid epidemic. Further research on patients with chronic pain, patients with chronic opioid use, and the role of patient education is needed.
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J Minim Invasive Gynecol · Feb 2019
Enhanced Recovery after Minimally Invasive Gynecologic Procedures with Bowel Surgery: A Systematic Review.
Enhanced recovery after surgery (ERAS) is an evidence-based approach to perioperative care of the surgical patient. A mounting body of literature in gynecologic surgery has demonstrated that ERAS improves postoperative outcomes, shortens hospital length of stay, and reduces cost without increasing complications or readmissions. Most of the existing literature has concentrated on open surgery, questioning if patients undergoing minimally invasive surgery also derive benefit. ⋯ These studies included patients undergoing MIGS for benign and/or malignant indications and showed that ERAS pathways decreased length of stay and/or increased the proportion of same-day discharge surgeries, improved patient satisfaction, and reduced hospital costs while maintaining low postoperative complication and readmission rates. Although limited, data from a single study suggest that ERAS in MIGS with bowel surgery leads to shortened hospital stay, stable postoperative morbidity, and less readmissions. Although the variation between the published protocols underscores the need for standardization, existing literature supports the adoption of ERAS as safe and effective when planning MIGS.
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Preemptive analgesia is an intervention provided before initiating painful stimuli that may reduce or prevent subsequent pain. This systematic review examines the evidence supporting the practice of preemptive analgesia in minimally invasive gynecologic surgery (MIGS). We searched PubMed, Cochrane Register for Controlled Trials, and Embase from inception through February 26, 2018. ⋯ Preemptive anticonvulsants, ketamine, and dexmedetomidine have a positive effect on postoperative pain and opioid use but are limited by side effects. Preemptive dexamethasone, acetaminophen, and nonsteroidal anti-inflammatory drugs have a modest effect on postoperative pain control. Despite these findings, additional quality work is needed to find more definitive methods of preemptive pain control for MIGS.
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J Minim Invasive Gynecol · Feb 2019
Enhanced Recovery after Surgery in Gynecology: A Review of the Literature.
Enhanced recovery after surgery (ERAS), or "fast-track" protocol, aims to minimize the physiologic stress of surgery and optimize the rehabilitation of patients. However, there is limited data in obstetrics and gynecology. ⋯ We recommend preoperative counseling to the patient, no bowel preparation, an opioid-sparing multimodal approach to pain management, goal-directed fluid management, minimally invasive surgery when possible, and early mobilization and feeding. This is a multidisciplinary team effort and requires active patient participation in the process.