Digestive System Diseases

All Conditions

Neoplasms

Liver Diseases

Liver Neoplasms

Hemangioma

Gastrointestinal Diseases

Neoplasms, Vascular Tissue

Neoplasms by Histologic Type

Gastrointestinal Neoplasms

Digestive System Neoplasms

Hematinics

All Drugs and Chemicals

Liver Extracts

Forty patients with liver disease were selected and divided into intrahepatic Glission's group as described in the detailed description.Total laparoscopic hepatectomy with intrahepatic Glisson's approach were performed. Operation began with division of liver ligaments, liver mobilization, followed by intrahepatic access to the Glissonian pedicle (containing arterial, portal, and bile duct branches ). A endoscopic stapler devices was used for Glissonian pedicle cutting and suture. Liver parenchyma was divided by harmonic scalpel combined with vascular stapler. The specimen was extracted through suprapubic incision.

intrahepatic Glisson's approach

Forty patients with liver disease were selected and divided into classical laparoscopic hepatectomy group as described in the detailed description.Total laparoscopic anatomical hepatectomy with classical procedure were performed.The initial step is to dissect hepatic portal and expose the liver artery, portal Vein branch and the bile duct. Then endoscopic stapler devices were used to cut the canal mentioned above. Final step is to divide the liver parenchyma along the following ischemic delineation.

classical hepatectomy

Shuguo Zheng

Shuguo Zheng, Professor

shuguo Zheng, professer

The purpose of this research is to compare the classical procedure with intrahepatic Glisson's approach for laparoscopic anatomical hepatectomy. The validity, feasibility and limitations were assessed objectively through our clinical prospective study. The investigators expect laparoscopic anatomical hepatectomy with intrahepatic Glisson's approach is safe, effective and feasible.

Background: China is the high incidence area of liver disease, some of which need to be treated by surgical liver resection. The development of minimal invasive techniques opened up a new situation for hepatectomy. Intrahepatic Glisson's approach and the classical procedure are the two major operation procedures used in laparoscopic hepatectomy. The intrahepatic Glisson's approach has the advantages of less intraoperative bleeding and shorter operation time in our experience and as previous studies. The investigators expect further comparison of the safety and efficacy through this prospective controlled study by using two kinds of operation procedures.

Intervention: Classical procedure versus intrahepatic Glisson's approach: a prospective randomized study. Eighty patients with liver disease need undergo hepatectomy were selected and divided into intrahepatic Glisson's group and classical procedure group randomly, each group contains 40 cases. Total laparoscopic hepatectomy were performed, with the intrahepatic Glisson's approach or classical procedure respectively.

Results:

1. Clinical data include: operation time, intraoperative blood loss, volume of blood transfusion, complications and mortality, postoperative liver function,long-term curative effect were collected and analysed.
2. Statistical method: groups t-test univariate/multivariate analysis, logistic regression analysis, mixed linear regression, Cox survival analysis were used.

Classical Procedure Versus Intrahepatic Glisson's Approach

Laparoscopic Anatomical Hepatectomy With Intrahepatic Glisson's Approach Versus Laparoscopic Anatomical Hepatectomy With Classical Procedure

Operation time, intraoperative blood loss, volume of blood transfusion, complications and mortality, postoperative liver function were collected and analysed to evaluate the safety of the operation.

Liver function, quality of life and survival time were collected and analysed to evaluate the postoperative curative effect. The examination of ultrasound , CT and/or MR were perfomed in outpatient if necessary. The follow up interval time: every six months.

Shuguo Zheng, MD

Professor of Hepatobiliary Surgery Institute; Chief Physician; Administrator of laparoscopic department

Wounds and Injuries

Symptoms and General Pathology

Respiratory Tract (Lung and Bronchial) Diseases

Ear, Nose, and Throat Diseases

Behaviors and Mental Disorders

Pain

Pilonidal Sinus

Paranasal Sinus Diseases

Cysts

Nose Diseases

Respiratory Tract Diseases

Otorhinolaryngologic Diseases

Quality of Life

Central Nervous System Depressants

Pharmaceutical Solutions

Anti-Infective Agents

Blood Substitutes

Coagulants

Micronutrients

Anesthetics

Povidone-Iodine

Povidone

Hemostatics

Iodine

Cadexomer iodine

The open surgical method and a moist gauze (with saline) were applied to patients in group A

Open surgery and then PRP application were performed on patients in group B. After the cavity was filled with PRP, the wound was covered with a dry gauze.

PRP was applied to the patients in group C after curettage of the sinus cavity. And again the wound was covered with a dry gauze.

Each patient entered the operating room, and after the administration of general anaesthesia, the patient was placed in the prone position. Then, the buttocks were stretched to the lateral sides using adhesive bands to remove the disease area. The sacrococcygeal region was cleaned and disinfected with 10% povidone iodine. After covering the area around the region, the sinus tract was examined by using a thin-steel cane. The length and wealth of the cavity were noted. Then, the sinus tract was removed. The depth of the cavity was noted. Then, 50 cc of 0.9% saline solution (SS) was taken into a syringe and applied to the cavity until it filled the whole space, allowing the cavity volume to be measured accurately. The measurement was performed by subtracting the remaining saline-solution volume in the syringe from the whole syringe volume, which was 50 cc.

Open surgery

In the operating room, after the patient was placed in the prone position, the region was removed by stretching the buttocks with adhesive bands and cleaning the area with 10% povidone iodine. The largest pit was excised, and hairs in the cavity were removed with forceps. Then, the whole cavity was curetted meticulously and irrigated with SS. After haemostasis, the cavity volume was measured

Minimal invasive surgery

Platelet rich plasma (PRP) was administered by filling the whole space from the lateral side of the cavity. After the first implementation of PRP, the second one was applied at 48 hours. Until that time, the dressing was not uncovered. PRP was applied on the 3rd, 4th and 5th days postoperatively.

Platelet rich plasma administration

Can Y Boztug, MD

Cihangir Akyol, MD

Pilonidal sinus disease is a common health-care problem, and surgical excision is the standard treatment modality. Controversy still exists regarding the best surgical technique for treating pilonidal disease in terms of minimizing disease recurrence and patient discomfort. In this study, the investigators compared the impact of autologous platelet-rich plasma (PRP) with that of minimally invasive techniques on pain reduction, return to daily activities, quality of life, and duration of wound healing after open excision and secondary closure.

Pilonidal sinus disease is a health problem that has been attempted to be overcome by various treatment modalities since the first time it was described by Herbert Mayo in 1833. PS is usually diagnosed at 30 years of age, and the disease has a male predominance of 70-80%.

Common morbidities after the surgical treatment of PS are pain, loss of productive work hours and wound infections owing to long healing times. Therefore, the main goals of treatment are accelerating the healing time by decreasing pain and reducing the loss of productive work hours.

Local administration of platelet-rich plasma (PRP), which contains growth factors (Gfs), is a new method that has been reported to accelerate the healing process by 30-40% \[2\].

In this study, we aimed to investigate the effect of PRP on the pain score, wound-healing process and quality of life in the treatment process for PS disease.

METHOD

Trial Design The investigators designed the trial as a prospective, controlled-randomized study. The study was started after obtaining patient consent and approval from the Ethics Committee of Ankara University Medicine Faculty in Ankara (Ethics Committee no: 03-162-18).

Randomization The patients were divided into three groups randomly. A simple randomization diagram was used for randomization. The open surgical method and a moist dressing were applied to patients in group A. Open surgery and then PRP application were performed on patients in group B. PRP was applied to the patients in group C after curettage of the sinus cavity.

Medical and Demographic History After enrolling the patients, the investigators noted all demographic data, including gender, age, education, comorbid disease existence and drug use. Then, Short Form-36 (SF-36) and Nottingham Health Profile (NHP) quality-of-life score forms were given to the patients, who were asked to complete the questionnaires before the surgery.

All patients were asked to clean the sacrococcygeal region from hair using depilatory cream.

Surgical Procedure The investigators designed group A as the control group. In this group, each patient entered the operating room, and after the administration of general anaesthesia, the patient was placed in the prone position. Then, the buttocks were stretched to the lateral sides using adhesive bands to remove the disease area. The sacrococcygeal region was cleaned and disinfected with 10% povidone iodine. After covering the area around the region, the sinus tract was examined by using a thin-steel cane. The length and wealth of the cavity were noted. Then, the sinus tract was removed. The depth of the cavity was noted. Then, 50 cc of 0.9% saline solution (SS) was taken into a syringe and applied to the cavity until it filled the whole space, allowing the cavity volume to be measured accurately. The measurement was performed by subtracting the remaining saline-solution volume in the syringe from the whole syringe volume, which was 50 cc. After measurement of the cavity volume, the cavity was dressed with wet gauze, and the operation ended.

PRP Administration Group B was designed as local PRP administration after excision. Whole steps were applied the same as in the first group until the step of dressing the cavity. After measurement of the cavity volume with 0.9% SS, PRP was administered by filling the whole space from the lateral side of the cavity. After the first implementation of PRP, the second one was applied at 48 hours. Until that time, the dressing was not uncovered. PRP was applied on the 3rd, 4th and 5th days postoperatively.

Minimal Invasive Surgery Group C was designed to receive local PRP administration after minimally invasive surgery with local anaesthesia. In the operating room, after the patient was placed in the prone position, the region was removed by stretching the buttocks with adhesive bands and cleaning the area with 10% povidone iodine. The largest pit was excised, and hairs in the cavity were removed with forceps. Then, the whole cavity was curetted meticulously and irrigated with SS. After haemostasis, the cavity volume was measured, and PRP was applied to the cavity. After the first implementation, as in the second group, we applied PRP on the 2nd, 3rd, 4th and 5th days after surgery.

Preparation of PRP For clinical applications, GMP-compliant human platelet concentrates can be created by the PRP method. Erythrocyte concentrate and platelet-containing plasma are separated by the first centrifugation, and platelet-poor plasma (PPP) and platelet-rich plasma (PRP)/platelet concentrate are created by the second centrifugation of the platelet-containing plasma \[3\]. Platelets contain coagulation factors, growth factors (PDGF, TGFβ1, IGF1, HGF1, VEGF, FGF2) and interleukins (IL1, IL4, IL6, IL10, IL13) \[4\].

The investigators prepared the platelet concentrate by the PRP method in Hacettepe University Blood Center Laboratory considering all standardized processes for healthy blood donors. In accordance with the 'National Blood and Blood Components Preparation Use and Quality Assurance Guidelines', the requirements for PRP should include at least 40 mL in volume, at least 60x109/unit platelets \[5\], and a maximum of 0.2x109/unit leukocytes \[6\]. After approval, 450 cc of blood was drawn from the patient by phlebotomy on the morning of surgery. A two-stage centrifugation method was used in the process of separating complete blood into its components. In the first stage, plasma was separated with the erythrocyte suspension by using temperature-controlled Heraeus Cryofuge 6000i low-speed centrifugation (22°C, 2500 rpm, 7 minutes). After a 1-hour waiting period at the second stage, the PRP/platelet concentrate was separated from the PPP by using high-speed centrifugation (22°C, 3200 rpm, 15 minutes). The PRP/platelet concentrate obtained after the second centrifugation step was shaken in the agitator for 1 hour, divided into 5 equal parts with a sterile connection device (Figure) and then sent to the Ankara University General Surgery Department.

The investigators preserved the PRP at 25 degrees Celsius in agitators. Before each dressing, the investigators applied the PRP aliquots to the wound by taking them one by one into the injector.

Postoperative Care All patients were discharged on the first postoperative day. Patients in all groups were advised not to open the wound for 2 days. Additionally, the surgical area had to be kept clean after bathing and bowel movements. If the patients experienced pain, they were recommended to take the prescribed pain reliever no more than 2 times a day.

The patients were divided into three groups randomly. A simple randomization diagram was used for randomization.

The open surgical method and a moist dressing were applied to patients in group A.

Open surgery and then PRP application were performed on patients in group B. PRP was applied to the patients in group C after curettage of the sinus cavity.

49 patients were included in the analysis. In this study, we compared the impact of autologous platelet-rich plasma (PRP) with that of minimally invasive techniques on pain reduction, return to daily activities, quality of life, and duration of wound healing after open excision and secondary closure.

Application of Platelet-rich Plasma in Pilonidal Sinus Disease

Application of Platelet-rich Plasma for the Management of Pilonidal Sinus Disease: A Randomized Clinical Trial of Different Treatment Modalities

Wound healing rate was evaluated as recovery time per the cavity volume (day/cc). This showed the time required for each 1 cc volume of the cavity to be filled on a daily basis. After open or minimally invasive surgery, the volume of the cavity was measured with saline solution. The cavity was filled with saline and the volume of the cavity was determined by calculating how much fluid it took. The measurements were performed on postoperative days 0, 2, 3, 4 and 21. Therefore recovery time per the cavity volume was calculated according to the differences between the measurements.

We used a visual analogue scale (VAS) to evaluate the pain score. The VAS score can range from 0 to 10. The higher the score, the higher sensation of pain. The VAS was applied five times after surgery: at 24 hours, 48 hours, 96 hours, 120 hours and 3 weeks. Patients were routinely prescribed "dexketoprofen trometamol" and recommended to take it no more than 2 times a day. How many tablets the patients used after the operation was recorded.

Short Form-36 (SF-36) and Nottingham Health Profile (NHP) questionnaires were applied to evaluate the quality of life before the surgery and three weeks after.

The SF-36 consists of eight scaled scoresand each scale is directly transformed into a 0-100 scale on the assumption that each question carries equal weight. The lower the score the more disability.

The NHP consists of two parts. The highest score in any section is 100 The higher the score, the greater the number and severity of problems We assessed the general health, limitations or activities, physical health problems, emotional health problems, social activity, pain, energy and emotions of the patients with the SF-36 questionnaire. Additionally, we evaluated the pain, energy level, emotional reaction, sleep, social isolation, and physical abilities of patients with the NHP questionnaire.

Cihangir Akyol

Associate Proffessor

Musculoskeletal Diseases

Spinal Neoplasms

Bone Neoplasms

Bone Diseases

Spinal Diseases

Patients in the experimental arm (experimental group, i.e. microsurgery through trans-Quadrant channel pathway) will be operated using Quadrant channel system. All the tumor resection will be operated through the Quadrant channel with assistance of microsurgical techniques.

Patients in the active comparator arm (control group, i.e. conventional open surgery) will be operated using the conventional open surgery. All the tumor resection will be operated directly with conventional procedures. More posterior structures of spine will be removed.

Patients in the experimental group will be general anaesthetized and placed in the prone position. Intra-operational electrophysiological monitoring will be used. Kirschner wire will be used to identify the position of the Quadrant channel with X-ray. After disinfection and draping, an incision of 3cm long and 2-3cm lateral to midline on the tumor side will be made. Soft tissues will be separated. Graded dilators will be used to establish Quadrant channel. Kerrison clamps will be used to expose the very local posterior spinal structures. Vertebral plate will be windowed with power drill to expose dural mater, and tumors will be removed with microsurgical techniques. Hemostasis will be performed after resection. Dural mater will be closed by titanium clips, and close incision by layers.

Trans-Quadrant Channel Surgery

Patients in the control group will be general anaesthetized during operation and placed in the prone position. Intra-operational electrophysiological monitoring will be used. Surgeons will locate the lesion by X-ray. After disinfection and draping, the midline incision of 7-10 cm and centered by the lesion segment will be made. Soft tissues will be cut and separated to expose posterior structure of spine. The root of spinal process and half of the vertebral plate on tumor side of certain segments will be removed. The dural mater will be opened. Then surgeons will remove tumor with microsurgical techniques. Hemostasis will be precisely performed after resection, and dural mater will be closed by suturing. Incision will be closed by layers. Drainage would be placed if necessary.

Conventional Open Surgery

Gang Bao, MD

Gang Bao, M.D.

Intra-spinal canal tumors are the general term of primary tumors from spinal cord or various tissues in the spinal canal and adjacent to the spinal cord, while the metastatic tumors are those from other sites other than spinal canal. Intra-spinal canal tumor is one of the most common diseases in neurosurgery, and surgery is the most effective treatment. Conventional open surgery is required to remove the posterior structures of the spine, which would lead to fracture of the posterior tension band, soft tissue injury, spine instability, and even spine deformity. So it is very important to protect and rebuild the posterior tension band for the stability of the spine. The team of Dr. John P. Kostuik from the Department of Orthopedics and Neurosurgery, the Johns Hopkins University, firstly introduced minimally invasive surgery for cervical and lumbar degenerative disease. However it has not been applied to the treatment of intra-spinal canal tumors. To date, the microsurgery of intra-spinal tumor through the trans-Quadrant channel pathway has not been widely performed in clinical practice. The investigators performed the microsurgery of intra-spinal canal tumor through the trans-Quadrant pathway in some patients previously and succeeded in the surgical treatments. The investigators analyzed the clinical data retrospectively, including surgical incision length, the volume of bleeding during operation, post-operative drainage volume, post-operative out-of-bed time point, post-operative length of stay in hospital, and post-operative visual analog pain (VAP) score. The group of patients using microsurgical technique through trans-Quadrant channel pathway showed better outcome compared with the group of patients using conventional open surgery. This innovation of microsurgery showed fewer traumas and bleeding, more rapid recovery, better prognosis and more safety in practice. Since there are some limitations to the retrospective study, it is necessary to design a prospective randomized controlled trial of the treatment of intra-spinal canal tumors using microsurgical technique through trans-Quadrant channel pathway.

This study is the prospective randomized controlled clinical trial.

1. Patient Recruitment: Patients who meets the diagnostic criteria of intra-spinal canal tumor and has surgical indications from May 2016 to June 2018 in the department of neurosurgery of our hospital could be recruited.
2. Screening: Demographic characteristics, such as gender, age, history of diseases (including but not limited in diabetes, heart disease, smoking history, and operation history, etc.), related laboratory tests (blood routing test, liver and kidney functions, electrolytes, blood coagulation function, and ECG, etc.) before entering either group.
3. Grouping: Patients who meets the diagnostic criteria and does not meet the exclusion criteria would be assigned into the experimental group and control group randomly. The informed consent forms should be signed before grouping.
4. Surgery: Patients in the experimental group will receive operation using microsurgical techniques through trans-Quadrant channel pathway. Patients in the control group will receive conventional open surgery.
5. Post-operative Observation and Follow-up: Clinical data will be collected after surgery and during follow-up. The time points include the 1st day, 7th day, 30th day, 90th day, and 180th day after surgery.
6. Statistical Analysis: Statisticians are blinded to the clinical data and grouping. The software SPSS (V. 16.0) will be used in statistics.

Surgical Treatment of Intra-spinal Canal Tumors Via Trans-Quadrant Channel

The Prospcetive Randomized Controlled Trial of the Surgical Treatment of Intra-spinal Canal Tumors Using Microsurgical Technique Through Trans-Quadrant Channel Pathway

The duration of hospital stay from the day after operation to the day of discharge.

The cost of the surgery, including operation cost, blood cost, anesthetic cost, and material cost, etc.

The drainage volume of surgery site from postoperation to the 1st day morning after operation.

The VAS scores on the 7th and 30th days after operation.

Collect the pre-operational JOAS score and the JOAS score on the 1st day after operation.

Collect the pre-operational JOAS score and the JOAS score on the 7th day after operation.

Collect the pre-operational JOAS score and the JOAS score on the 30th day after operation.

Collect the pre-operational JOAS score and the JOAS score on the 90th day after operation.

Collect the pre-operational JOAS score and the JOAS score on the 180th day after operation.

First Affiliated Hospital Xi'an Jiaotong University

Urinary Tract, Sexual Organs, and Pregnancy Conditions

Rare Diseases

Carcinoma, Renal Cell

Kidney Neoplasms

Urologic Neoplasms

Urogenital Neoplasms

Urogenital Diseases

Female Urogenital Diseases

Pregnancy Complications

Female Urogenital Diseases and Pregnancy Complications

Kidney Diseases

Urologic Diseases

Male Urogenital Diseases

Renal Cell Carcinoma

da Vinci surgical robotic assisted partial nephrectomy

Application of the da Vinci surgical robot to assist the partial nephrectomy

Robotic-assisted partial nephrectomy

Open surgery to conduct the partial nephrectomy

Open partial nephrectomy

Marc O Grimm, MD, Prof

Arnulf Stenzl, MD, Prof

To demonstrate that Robotic-Assisted partial nephrectomy is superior to Open partial nephrectomy in reducing the number of 30 day post-operative complications (Clavien-Dindo Type I-V) for patients with intermediate to high complexity kidney tumors.

Partial nephrectomy is the surgical removal of a kidney tumor while unaffected tissue remains intact so that the kidney function is maintained as far as possible. The more radical procedure would be the complete removal of the kidney, which is not examined in this trial.

Surgery will be randomized either to an open technique involving a large incision or the robotic assisted technique with a few small incisions (keyhole surgery). With robotic assisted surgery the movements of the surgeon are translated into the movement of the instruments.

It is not clear which of the two procedures, open or robotic assisted, has less complications. It is expected that these are different due to the different level of invasiveness and the level of direct access to the organ. This study aims to show that robotic assisted surgery results in less complications than open surgery.

Open vs Robotic Assisted Partial Nephrectomy

Any complication that occurred within 30 days post surgery

Period in which the kidney has no blood supply

Conversion from robotic to open, partial to radical

Volume of blood loss during the surgical procedure

Assessment of pain level via the Brief Pain Inventory (BPI)

Development of neuropathic pain via the DN-4 Patient interview questions

Data will be gathered from routine examination, not a mandatory assessment

Any Clavien-Dindo I-V post-operative complication

Readmission that can be linked to the partial nephrectomy

Re-operation that can be linked to the partial nephrectomy

time from surgery to death from any cause

time from surgery to death due to kidney cancer

time from surgery to first documented recurrence of renal cell carcinoma as defined by the investigator

Time from surgery to the first documented local recurrence e.g. tumor in the operated kidney or in the immediate vicinity (e.g. perirenal fat) at the surgical site. Portside recurrence / incisional, surgical access site recurrence to the affected kidney would also be considered as a local recurrence.

Intuitive Surgical

Genital Neoplasms, Female

Genital Diseases, Female

Genital Diseases

Laparoscopic Assisted Vaginal Hysterectomy

Abhilasha Agarwal, MS

Minilaparotomy hysterectomy (MLH) relies on the simplicity of traditional open technique of abdominal hysterectomy, imparts cosmesis and faster recovery of laparoscopic hysterectomy yet avoids the long learning curve, cost of expensive setup and instrumentation associated with the minimally invasive approaches namely laparoscopy and robotics. In the present study, we tried to ascertain if the results obtained with MLH can be compared to LAVH in terms of its feasibility, intraoperative variables, and complications. The null hypothesis was that both MLH and LAVH are comparable techniques, so where cost and surgeon's experience are the confining issues, patients can be reassured that MLH gives comparable results.

Around 600,000 hysterectomies are performed every year in the United States, making hysterectomy the second most common surgery for women, first being cesarean section. Most of the hysterectomies are done for non cancerous conditions. And the most common indication for the same is symptomatic fibroid uterus.

In spite of being the most common gynaecological surgery the route of hysterectomy has always been an issue of debate since early 19th century. In the beginning it started as vaginal hysterectomy which soon was taken over by laparotomy route. With the advent of laparoscopy as the recent minimally invasive route the choices have further increased. Laparoscopic route has prompted the need for development of other forms of hysterectomy which are minimally invasive and are associated with less perioperative morbidity with better postoperative outcomes. Abdominal route includes both conventional and minilaparotomy; laparoscopic route includes both Laparoscopic Assisted Vaginal Hysterectomy (LAVH) as well as Total Laparoscopic Hysterectomy (TLH). Each method has its own advantages and disadvantages. The vaginal route is preferable because it is associated with less perioperative morbidity and faster recovery. Although laparoscopic route offers minimally invasive alternative to abdominal hysterectomy when vaginal route is contraindicated (In case of huge fibroid uterus or patients with pelvic pathology), it has its own drawbacks. The laparoscopic instruments are costly, there is a long learning curve involved in the training, and the operating time with this route is prolonged.

The EVALUATE study suggested that majority of surgeons(67%) preferred abdominal approach as the route of surgery, especially when dealing with pelvic pathology. Hence, minilaparotomy hysterectomy as an alternative minimally invasive surgery method was started. It relies on traditional open techniques and inexpensive instrumentation, making it significantly faster than laparoscopy and easy to perform. Hoffman et al found minilaparotomy hysterectomy procedure effective and safe in non-obese women in whom vaginal approach was contraindicated. Fanfani et al did a retrospective analysis on 252 patients who underwent minilaparotomy hysterectomy and found it to be a feasible route of surgery in benign gynaecological conditions with operative time similar or shorter as compared to vaginal, laparotomy and laparoscopy surgery. Few surgeons have modified the incision depending on the their experience which led to development of Pelosi method of Minilaparotomy Hysterectomy in 2003.

The final choice of the route and method depends on multiple factors which include indication of surgery, size of fibroid, equipments available in the surgical set up, surgeons' expertise, patient's financial background.

All patients followed the same standard pre-operative protocol. All surgeries were performed under general anesthesia with endotracheal intubation. Demographic details that included age, parity, body mass index (BMI), baseline investigations, diagnosis, and co-morbidities, were collated a day prior to the day of surgery. On admission, patients were informed in detail about the operation modalities and the associated complications. Patients along with their relatives were counselled about the advantages and disadvantages of both the surgical methods and the final decision was made on a joint consensus between the surgeon and the patient, following which an informed written consent was obtained.

The aim of the study was to compare the feasibility of two minimally invasive surgical procedures in low resource settings (such as India) - Laparoscopic assisted vaginal hysterectomy (LAVH) and Minilaparotomy hysterectomy (transverse suprapubic incision \<7cm).

Comparative Study of LAVH and Minilaparotomy Hysterectomy

Comparative Study of Laparoscopic Assisted Vaginal Hysterectomy and Minilap Hysterectomy for Benign Gynaecological Conditions

All IPD that underlie results in a publication maybe shared after sponsor approval. Present status - undecided.

Weight and height will be combined to report BMI in kg/m\^2

All surgeries were performed by two gynecologists with an almost equal level of surgical competence.

Total amount of blood loss was calculated during both the methods. It was calculated by adding up the mop count (one fully soaked mop \~ 50 ml of blood loss) and the amount of fluid in the suction pump minus the saline used for irrigation.

There are various methods to score pain. In our study, we used visual analogue scale for the scoring. The pain was scored every 6th hourly for the first 24hrs and thereafter 24th hourly till 72 hrs.

The Visual Analogue Scale (VAS) (Figure 14) is a scoring scale on which the patient rates his/her pain on a scale of 0 to 10, 0 representing no pain and 10 representing excruciating or intolerable pain. The scoring is subjective and gives the patient freedom to choose the intensity of the pain as per their perception.

Visceral injury such as bladder/ ureter / bowel injury

Secondary haemorrhage, Urinary Tract Infection, Urinary retention, Wound infection, Thrombo-embolic complications, Febrile morbidity

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization
Classical Procedure Versus Intrahepatic Glisson's Approach	NCT01567631	Liver Diseases Liver Neoplasms Hepatic Haemang...	intrahepatic Gl... classical hepat...	18 Years - 70 Years	Southwest Hospital, China
Application of Platelet-rich Plasma in Pilonidal Sinus Disease	NCT04697082	Pilonidal Sinus Pilonidal Disea... Wound Heal Quality of Life Pain	Open surgery Minimal invasiv... Platelet rich p...	18 Years -	Ankara University
Surgical Treatment of Intra-spinal Canal Tumors Via Trans-Quadrant Channel	NCT02777398	Spinal Neoplasm...	Trans-Quadrant ... Conventional Op...	20 Years - 60 Years	First Affiliated Hospital Xi'an Jiaotong University
Surgical Treatment of Intra-spinal Canal Tumors Via Trans-Quadrant Channel	NCT02777398	Spinal Neoplasm...	Trans-Quadrant ... Conventional Op...	20 Years - 60 Years	First Affiliated Hospital Xi'an Jiaotong University
Open vs Robotic Assisted Partial Nephrectomy	NCT03849820	Renal Cancer	Robotic-assiste... Open partial ne...	18 Years -	Intuitive Surgical
Comparative Study of LAVH and Minilaparotomy Hysterectomy	NCT03548831	Hysterectomy Minimal Invasiv... Benign Gynecolo...		-	Manipal University

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