abstract
Journal of the Society of Laparoendoscopic Surgeons / Society of Laparoendoscopic Surgeons
INTRODUCTION:
Conscious sedation has traditionally been used for laparoscopic tubal ligation.
General anesthesia with endotracheal intubation may be associated with
side effects, such as nausea, vomiting, cough, and dizziness, whereas
sedation offers the advantage of having the patient awake and breathing
spontaneously. Until now, only diagnostic laparoscopy and minor surgical
procedures have been performed in patients under conscious sedation.
CASE DESCRIPTION:
Our
report describes 5 cases of laparoscopic salpingo-oophorectomy
successfully performed with the aid of conventional-diameter
multifunctional instruments in patients under local anesthesia. Totally
intravenous sedation was provided by the continuous infusion of propofol
and remifentanil, administered through a workstation that uses
pharmacokinetic-pharmacodynamic models to titrate each drug, as well as
monitoring tools for levels of conscious sedation and local anesthesia.
We have labelled our current procedure with the acronym OLICS (Operative
Laparoscopy in Conscious Sedation). Four of the patients had mono- or
bilateral ovarian cysts and 1 patient, with the
BRCA1 gene
mutation and a family history of ovarian cancer, had normal ovaries.
Insufflation time ranged from 19 to 25 minutes. All patients maintained
spontaneous breathing throughout the surgical procedure, and no episodes
of hypotension or bradycardia occurred. Optimal pain control was
obtained in all cases. During the hospital stay, the patients did not
need further analgesic drugs. All the women reported high or very high
satisfaction and were discharged within 18 hours of the procedure.
DISCUSSION AND CONCLUSION:
Salpingo-oophorectomy
in conscious sedation is safe and feasible and avoids the complications
of general anesthesia. It can be offered to well-motivated patients
without a history of pelvic surgery and low to normal body mass index.
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