title: Laparoscopic Salpingo-oophorectomy in Conscious Sedation.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Departments of Obstetrics and Gynecology.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Rosati
authors.affiliation: Departments of Obstetrics and Gynecology.
authors.forename: Silvia
authors.initials: S
authors.lastname: Bramante
authors.affiliation: Departments of Obstetrics and Gynecology.
authors.forename: Fiorella
authors.initials: F
authors.lastname: Conti
authors.affiliation: Anesthesia and Intensive Care, Santo Spirito Hospital, Pescara, Italy.
authors.forename: Maria
authors.initials: M
authors.lastname: Rizzi
authors.affiliation: Anesthesia and Intensive Care, Santo Spirito Hospital, Pescara, Italy.
authors.forename: Antonella
authors.initials: A
authors.lastname: Frattari
authors.affiliation: Anesthesia and Intensive Care, Santo Spirito Hospital, Pescara, Italy.
authors.forename: Tullio
authors.initials: T
authors.lastname: Spina
mesh_terms: D000328:Adult; D000368:Aged; D016292:Procedural Sedation / Q000379:methods*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000601:surgery*; D010052:Ovariectomy / Q000379:methods*; D017060:Patient Satisfaction
keywords: Operative laparoscopy in conscious sedation; Ovarian cysts; Salpingo-oophorectomy