• Disparities in health
• Hysterectomy
• Minimally invasive surgery
• Robotic-assisted hysterectomy
• Surgical complications
• Surgical trends

• Humans
• Female
• Michigan/epidemiology
• Retrospective Studies
• Robotic Surgical Procedures/methods
• Hysterectomy/methods
• Laparoscopy/methods
• Hospitals
• Hysterectomy, Vaginal

Following a 2014 safety warning (that laparoscopic power morcellation may increase tumor dissemination if patients have occult uterine cancer), hysterectomy practice shifted from laparoscopic to abdominal approach. This avoided morcellating occult cancer, but increased perioperative complications. To inform the national impact of this practice change, we examined the cost-effectiveness of hysterectomy practice in the postwarning period, in comparison to counterfactual hysterectomy practice had there been no morcellation warning.

We constructed a decision tree model to simulate relevant outcomes over the lifetime of patients in the national population undergoing hysterectomy for presumed benign indications. The model accounted for both hysterectomy- and occult cancer-related outcomes. Probability-, cost-, and utility weight-related input parameters were derived from analysis of the State Inpatient Databases, State Ambulatory Surgery and Services Databases, data from the New York Statewide Planning and Research Cooperative System and New York State Cancer Registry, and published literature.

With an estimated national sample of 353,567 adult women, base case analysis showed that changes in hysterectomy practice after the morcellation warning led to a net gain of 867.15 quality-adjusted life years (QALYs), but an increase of $19.54 million in costs (incremental cost-effectiveness ratio = $22,537/QALY). In probabilistic sensitivity analysis, the practice changes were cost-effective in 54.0% of the simulations when evaluated at a threshold of $50,000/QALY, which increased to 70.9% when evaluated at a threshold of $200,000/QALY.

Hysterectomy practice changes induced by the morcellation warning are expected to be cost-effective, but uncertainty in parameter values may affect the cost-effectiveness results.

• High volume surgeon
• Laparoscopy
• Minimally invasive gynecology
• Robotic-assisted hysterectomy
• Surgical Complications

• Senhance
• benign hysterectomy
• da Vinci
• laparoscopy
• robotics

• advantages
• criteria
• da Vinci robot
• endometriosis
• quality of life
• treatment

• cervical cancer
• surgical oncology

• Clinical Protocols
• Disease-Free Survival
• Female
• Humans
• Hysterectomy/adverse effects
• Hysterectomy/methods
• Laparoscopy/adverse effects
• Laparoscopy/methods
• Lymph Node Excision/adverse effects
• Lymph Node Excision/methods
• Neoplasm Staging
• Prospective Studies
• Robotic Surgical Procedures/adverse effects
• Robotic Surgical Procedures/methods
• Treatment Outcome
• Uterine Cervical Neoplasms/pathology
• Uterine Cervical Neoplasms/surgery

• hysterectomy
• infectious complication
• laparoscopy
• minimally invasive technique
• robotic

• Female
• Humans
• Hysterectomy/adverse effects
• Hysterectomy/methods
• Hysterectomy/statistics & numerical data
• Laparoscopy/adverse effects
• Laparoscopy/methods
• Laparoscopy/statistics & numerical data
• Robotic Surgical Procedures/adverse effects
• Robotic Surgical Procedures/methods
• Robotic Surgical Procedures/statistics & numerical data
• Surgical Wound Infection/epidemiology
• Surgical Wound Infection/etiology
• Treatment Outcome

• Robotic assisted hysterectomy
• Type and screen test
• Value proposition

• Hysterectomy
• Laparoscopy
• Minimally invasive approach
• Robotic
• Surgical route

To evaluate the feasibility, safety and peri- and postoperative outcomes of robotic single-site supracervical hysterectomy (RSSSH) for benign gynecologic disease.

We report 3 patients who received RSSSH for adenomyosis of the uterus from November 2015 to April 2016. We evaluated the feasibility, safety and outcomes among these patients.

The mean surgical time was 244 min and the estimated blood loss was 216 mL, with no blood transfusion necessitated. The docking time was shortened gradually from 30 to 10 min. We spent 148 min on console operation. Manual morcellation time was also short, ranging from 5 to 10 min. The mean hospital stay was 5 d. Lower VAS pain score was also noted. There is no complication during or after surgery.

RSSSH is feasible and safe, incurs less postoperative pain and gives good cosmetic appearance. The technique of in-bag, manual morcellation can avoid tumor dissemination.

• Robotic surgery
• Single-site
• Supracervical hysterectomy
• Single port
• Subtotal hysterectomy

Hysterectomy is the most frequent surgery done with robotic assistance in the world and has been widely studied since its emergence. The surgical outcomes of the robotic hysterectomy are similar to those obtained with other minimally invasive hysterectomy techniques (laparoscopic and vaginal) and appear as a promising surgical technique in gynecology surgery. The aim of this study was to observe the learning curve of robot-assisted hysterectomy in a French surgical center, and was to evaluate the impact of the surgical mentoring.

We retrospectively collected the data from the files of the robot-assisted hysterectomies with the Da Vinci^® Surgical System performed between March 2010 and June 2014 at the Foch hospital in Suresnes (France). We first studied the operative time according to the number of cases, independently of the surgeon to determine two periods: the initial learning phase (Phase 1) and the control of surgical skills phase (Phase 2). The phase was defined by mastering the basic surgical tasks. Secondarily, we compared these two periods for operative time, blood losses, body mass index (BMI), days of hospitalizations, and uterine weight. We, finally, studied the difference of the learning curve between an experimented surgeon (S1) who practiced first the robot-assisted hysterectomies and a less experimented surgeon (S2) who first assisted S1 and then operated on his own patients.

A total of 154 robot-assisted hysterectomies were analyzed. Twenty procedures were necessary to access to the control of surgical skills phase. There was a significant decrease of the operative time between the learning phase (156.8 min) compared to the control of surgical skills phase (125.8 min, p = 0.003). No difference between these two periods for blood losses, BMI, days of hospitalizations and uterine weight was demonstrated. The learning curve of S1 showed 20 procedures to master the robot-assisted hysterectomies with a significant decrease of the operative time, while the learning curve of S2 showed no improvement in operative time with respect to case number.

Twenty robot-assisted hysterectomies are necessary to achieve control of surgical skills. The companionship to learn robotic surgery seems also promising, by improving the learning phase for this surgical technique.

• educational program
• laparoscopy
• learning curve
• robotic-assisted hysterectomy

• Case-mix
• Complication
• Conversion
• Laparoscopic hysterectomy
• Predictors
• Quality assessment
• Surgical outcome

To study the role of robotics in various gynaecological cases, benign and malignant.

A total number of 80 cases have been analyzed. Operative time, estimated blood loss, hospital stay, complications, conversion rates have been retrospectively studied in all cases. Nodal yield, vaginal margin and paracervical clearance have been studied in all malignant cases. This investigation was conducted at a single minimal access surgery institute.

Of total 80 cases, 29 were benign and 51 were malignant cases. In benign cases, total robotic hysterectomies were 24, 2 cases of tubotuboplasty, 1 case of endometriotic cyst excision, 1 case of metroplasty and 1 case of rectovaginal fistula. In 51 cases, 37 of radical hysterectomy, 9 exenterations and 6 were parametrectomy. In benign cases, mean operative time was 80 min, estimated blood loss was 20 ml, mean hospital stay was for 1 day, no major complications and no conversions. In malignant cases, mean operative time was 122 min, estimated blood loss was 50-100ml, 2 cases of ureteric fistulas and no conversions, nodal yield was 30, vaginal margin was 2.5-3.8 cm and para cervical clearance was 3-3.5 cm.

Ours is the largest series of robotic surgery in gynecological procedures in India. Benign and malignant cases were addressed robotically showing the feasibility.

• Hysterectomy
• Robot
• gynecological
• laparoscopy

• Laparoscopic hysterectomy
• Minimally invasive surgery
• Narcotics
• Pain
• Robotic
• da Vinci

Objectives. A prospective study was carried out to compare vaginal hysterectomy (VH) and robotically assisted hysterectomy (RH) for benign gynecological disease. Materials and Methods. All patients who underwent hysterectomy from March 2010 to March 2012 for a benign disease were included. Patients' demographics per and post surgery results were collected from medical files. A questionnaire was also conducted 2 months after surgery. Results. Sixty patients were included in the RH group and thirty four in the VH one. Operative time was significantly longer in the RH group (132.1 ± 5.7 versus 75.3 ± 6.7 min; P < 0.0001). Blood loss and length of hospital stay were significantly reduced: 47 ± 7 versus 125 ± 20 ml; P < 0.01, and 2.4 ± 0.1 versus 3.3 ± 0.2 days; P < 0.0001, respectively. Less pain was reported at D1 and D2 by RH patients, and levels of analgesia were lower compared to those observed in the VH group. No differences were found regarding the rate of conversion to laparotomy, intra- or postoperative complications. Conclusion. Robotically assisted hysterectomy appears to reduce blood loss, postoperative pain, and length of hospital stay, but it is associated with longer operative time and higher cost. Specific indications for RH remain to be defined.

• Uterine fibroids
• drug therapy
• hysterectomy
• multi-target drugs
• pathogenesis

• Benign total vaginal hysterectomy
• Minimally invasive surgery
• Robotic assistance
• da Vinci

The introduction of da Vinci Robotic Surgery to the field of Gynecology has resulted in large changes in surgical management. The robotic platform allows less experienced laparoscopic surgeons to perform more complex procedures. In general gynecology and reproductive gynecology, the robot is being increasingly used for procedures such as hysterectomies, myomectomies, adnexal surgery, and tubal anastomosis. Among urogynecology the robot is being utilized for sacrocolopexies. In the field of gynecologic oncology, the robot is being increasingly used for hysterectomies and lymphadenectomies in oncologic diseases. Despite the rapid and widespread adoption of robotic surgery in gynecology, there are no randomized trials comparing its efficacy and safety to other traditional surgical approaches. Our aim is to update previously published reviews with a focus on only comparative observational studies. We determined that, with the right amount of training and skill, along with appropriate patient selection, robotic surgery can be highly advantageous. Patients will likely have less blood loss, less post-operative pain, faster recoveries, and fewer complications compared to open surgery and potentially even laparoscopy. However, until larger, well-designed observational studies or randomized control trials are completed which report long-term outcomes, we cannot definitively state the superiority of robotic surgery over other surgical methods.

• Celecoxib
• Early discharge
• NSAIDs
• Outpatient
• Robotic-assisted laparoscopic hysterectomy
• Ropivacaine