Human Reproduction, Vol 12, 2654-2657, Copyright © 1997 by Oxford University Press
JL Ordonez, J Dominguez, V Evrard and PR Koninckx
In order to evaluate the effect of training upon postoperative adhesions,
standard bipolar and mechanical, nonopposing injuries were performed in the
uterine horns and side walls of 52 mature female rabbits using a
conventional three-puncture laparoscopy, by an endoscopic surgeon with
limited experience. An additional injury, either bipolar or mechanical or
both, was performed in the retro- uterine space. With experience, the
duration of surgery decreased progressively from 12 +/- 2 to 8 +/- 1 min in
the first and last 10 animals respectively. The amount of perioperative
bleeding was not affected by experience. With experience the postoperative
adhesions decreased in extent (P = 0.0001), tenacity (P = 0.004), type (P =
0.002) and inflammation (P = 0.003) and for total score (P = 0.0002). These
changes were correlated with the briefer duration of surgery but not with
the amount of perioperative bleeding. The strong correlations of adhesion
scores in the pouch of Douglas, and around both uterine horns confirmed the
importance of the inter-animal variability in making adhesions. By logistic
regression, the adhesions in the pouch of Douglas were explained
simultaneously by the adhesions on the uterine horns (P = 0.0004, thus
correcting for inter-animal variability) by the amount of bleeding (P =
0.01) and the duration of surgery (P = 0.05). No major differences were
found in adhesions following a mechanical or a bipolar injury or following
such a lesion in the pouch of Douglas or at the uterine horns. In
conclusion, experience, expressed by the duration of surgery and to a
lesser extent perioperative bleeding, is a major co-factor in postoperative
adhesions, suggesting that duration of surgery should be strictly
standardized in endoscopic adhesion studies. The important inter-animal
variability can be circumvented by using a standard control lesion, making
each animal its own control.
ARTICLES
The effect of training and duration of surgery on adhesion formation in the rabbit model
Centre for Surgical Technologies, K.U. Leuven, University Hospital Gasthuisberg, Belgium.
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