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Baracy MG, Kerl A, Hagglund K, Fennell B, Corey L, Aslam MF. Trends in surgical approach to hysterectomy and perioperative outcomes in Michigan hospitals from 2010 through 2020. J Robot Surg 2023; 17:2211-2220. [PMID: 37280406 DOI: 10.1007/s11701-023-01631-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 05/21/2023] [Indexed: 06/08/2023]
Abstract
The objective of this study was to determine the trends in surgical approach to hysterectomy over the last decade and compare perioperative outcomes and complications. This retrospective cohort study used clinical registry data from the Michigan Hospitals that participated in Michigan Surgical Quality Collaborative (MSQC) from January 1st, 2010 through December 30th, 2020. A multigroup time series analysis was performed to determine how surgical approach to hysterectomy [open/TAH, laparoscopic (TLH/LAVH), and robotic-assisted (RA)] has changed over the last decade. Abnormal uterine bleeding, uterine fibroids, chronic pelvic pain, pelvic organ prolapse, endometriosis, pelvic mass, and endometrial cancer were the most common indications for hysterectomy. The open approach to hysterectomy declined from 32.6 to 16.9%, a 1.9-fold decrease, with an average decline of 1.6% per year (95% CI - 2.3 to - 0.9%). Laparoscopic-assisted hysterectomies decreased from 27.2 to 23.8%, a 1.5-fold decrease, with an average decrease of 0.1% per year (95% CI - 0.7 to 0.6%). Finally, the robotic-assisted approach increased from 38.3 to 49.3%, a 1.25-fold increase, with an average of 1.1% per year (95% CI 0.5 to 1.7%). For malignant cases, open procedures decreased from 71.4 to 26.6%, a 2.7-fold decrease, while RA-hysterectomy increased from 19.0 to 58.7%, a 3.1-fold increase. After controlling for the confounding variables age, race, and gynecologic malignancy, RA hysterectomy was found to have the lowest rate of complications when compared to the vaginal, laparoscopic and open approaches. Finally, after controlling for uterine weight, black patients were twice as likely to undergo an open hysterectomy compared to white patients.
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Affiliation(s)
- Michael G Baracy
- Department of Obstetrics and Gynecology, Ascension St. John Hospital, 22101 Moross Rd, Detroit, MI, 48236, USA.
| | - Alexis Kerl
- Department of Family Medicine, Ascension St. John Hospital, Detroit, MI, 48236, USA
| | - Karen Hagglund
- Department of Biomedical Investigations and Research, Ascension St. John Hospital, Detroit, MI, 48236, USA
| | - Brian Fennell
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, 48202, USA
| | - Logan Corey
- Department of Gynecologic Oncology, Wayne State University, Detroit, MI, 48202, USA
| | - Muhammad Faisal Aslam
- Department of Female Pelvic Medicine and Reconstructive Surgery, Ascension St. John Hospital, Detroit, MI, 48236, USA
- College of Osteopathic Medicine, Michigan State University, East Lansing, MI, 48824, USA
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2
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Xu X, Desai VB, Schwartz PE, Gross CP, Lin H, Schymura MJ, Wright JD. Safety Warning about Laparoscopic Power Morcellation in Hysterectomy: A Cost-Effectiveness Analysis of National Impact. WOMEN'S HEALTH REPORTS 2022; 3:369-384. [PMID: 35415718 PMCID: PMC8994439 DOI: 10.1089/whr.2021.0101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 02/22/2022] [Indexed: 11/09/2022]
Abstract
Background: 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. Materials and Methods: 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. Results: 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. Conclusion: 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.
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Affiliation(s)
- Xiao Xu
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut, USA
- Yale Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven, Connecticut, USA
| | - Vrunda B. Desai
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut, USA
- CooperSurgical, Inc., Trumbull, Connecticut, USA
| | - Peter E. Schwartz
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut, USA
| | - Cary P. Gross
- Yale Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Haiqun Lin
- Division of Nursing Science, Rutgers University School of Nursing, Newark, New Jersey, USA
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Newark, New Jersey, USA
| | - Maria J. Schymura
- New York State Cancer Registry, New York State Department of Health, Albany, New York, USA
| | - Jason D. Wright
- Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, New York, USA
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Minimally invasive hysterectomy for benign indications-surgical volume matters: a retrospective cohort study comparing complications of robotic-assisted and conventional laparoscopic hysterectomies. J Robot Surg 2022; 16:1199-1207. [PMID: 34981444 DOI: 10.1007/s11701-021-01340-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 11/21/2021] [Indexed: 10/19/2022]
Abstract
The objective of this study was to evaluate the incidence of perioperative complications in robotic-assisted hysterectomies performed by high-volume robotic surgeons compared to conventional laparoscopic hysterectomies performed by all gynecologic surgeons. This retrospective cohort study was performed at a single-center community based hospital and medical center. A total of 332 patients who underwent hysterectomy for benign indications were included in this study. Half of these patients (n = 166) underwent conventional laparoscopic hysterectomy and the other half underwent a robotic-assisted laparoscopic hysterectomy. The main outcome measures included composite complication rate, estimated blood loss (EBL), and hospital length of stay (LOS). Median (IQR) EBL was significantly lower for robotic hysterectomy [22.5 (30) mL] compared to laparoscopic hysterectomy [100 (150) mL, p < 0.0001]. LOS was significantly shorter for robotic hysterectomy (1.0 ± 0.2 day) compared to laparoscopic hysterectomy (1.2 ± 0.7 days, p = 0.04). Despite averaging 3.0 (IQR 1.0) concomitant procedures compared to 0 (IQR 1.0) for the conventional laparoscopic hysterectomies, the incidence of any type of complication was lower in the robotic hysterectomy group (2 vs. 6%, p = 0.05). Finally, in a logistic regression model controlling for multiple confounders, robotic-assisted hysterectomy was less likely to result in a perioperative complication compared to traditional laparoscopic hysterectomy [odds ratio (95% CI) = 0.2 (0.1, 0.90), p = 0.04]. In conclusion, robotic-assisted hysterectomy may reduce complications compared with conventional laparoscopic hysterectomy when performed by high volume surgeons, especially in the setting of other concomitant gynecologic surgeries.
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Coussons H, Feldstein J, McCarus S. Senhance surgical system in benign hysterectomy: A real-world comparative assessment of case times and instrument costs versus da Vinci robotics and laparoscopic-assisted vaginal hysterectomy procedures. Int J Med Robot 2021; 17:e2261. [PMID: 33860631 DOI: 10.1002/rcs.2261] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 04/05/2021] [Accepted: 04/06/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Comparison of retrospective, learning curve benign hysterectomy cost and case time data from Senhance total laparoscopic hysterectomy (TLH) cases with similar da Vinci robot cases and laparoscopic-assisted vaginal hysterectomy (LAVH) cases. METHODS Instrument costs, console time, and case time analysis from six surgeons at four U.S. and European hospitals compared with retrospective, sequential da Vinci TLH and standard laparoscopic LAVH cases extracted from the CAVAlytics database. RESULTS Senhance Gyn surgeons in their learning curve when compared to da Vinci learning curve Gyn surgeons achieved lower median instrument costs ($559 vs. $1393, respectively, p < 0.001) with comparable console times (91.5 vs. 96 min, p = 0.898); Senhance and LAVH case costs were comparable ($559 vs. $498, p = 0.336). CONCLUSION In benign hysterectomy, the Senhance system may present a lower-cost approach with equivalent case times compared with similar da Vinci robotic cases.
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Affiliation(s)
| | - Josh Feldstein
- CAVA Robotics International, Amherst, Massachusetts, USA
| | - Steve McCarus
- AdventHealth Winter Park Hospital, Winter Park, Florida, USA
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Gkegkes ID, Iavazzo C, Iatrakis G, Iavazzo PE, Pechlivani F, Antoniou E, Bakalianou K. Robotic Management of Endometriosis: Discussion of Use, Criteria and Advantages: a Review of the Literature. ACTA MEDICA (HRADEC KRÁLOVÉ) 2020; 62:147-149. [PMID: 32036846 DOI: 10.14712/18059694.2020.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Endometriosis is a very common benign condition affecting fertility and quality of life. Different methods, either definitive or fertility sparing are used for its management by using open, laparoscopic, and robotic techniques. This is a literature review presenting the role and the advantages of robotic surgery in endometriosis. Such a management is effective, safe, and feasible in hands of well-trained multidisciplinary teams even for severe cases of endometriosis.
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Affiliation(s)
- Ioannis D Gkegkes
- Department of Surgery, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK.
| | - Christos Iavazzo
- Department of Gynaecological Oncology, The Christie Hospital, Manchester, UK
| | - George Iatrakis
- Department of Obstetrics and Gynaecology, Technological Educational Institution of Athens, Athens, Greece
| | | | - Fani Pechlivani
- Department of Obstetrics and Gynaecology, Technological Educational Institution of Athens, Athens, Greece
| | - Evangelia Antoniou
- Department of Obstetrics and Gynaecology, Technological Educational Institution of Athens, Athens, Greece
| | - Konstadia Bakalianou
- Department of Obstetrics and Gynecology, General Hospital "Agia Olga", Athens, Greece
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Falconer H, Palsdottir K, Stalberg K, Dahm-Kähler P, Ottander U, Lundin ES, Wijk L, Kimmig R, Jensen PT, Zahl Eriksson AG, Mäenpää J, Persson J, Salehi S. Robot-assisted approach to cervical cancer (RACC): an international multi-center, open-label randomized controlled trial. Int J Gynecol Cancer 2019; 29:1072-1076. [PMID: 31203203 DOI: 10.1136/ijgc-2019-000558] [Citation(s) in RCA: 98] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2019] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Radical hysterectomy with pelvic lymphadenectomy represents the standard treatment for early-stage cervical cancer. Results from a recent randomized controlled trial demonstrate that minimally invasive surgery is inferior to laparotomy with regards to disease-free and overall survival. PRIMARY OBJECTIVE To investigate the oncologic safety of robot-assisted surgery for early-stage cervical cancer as compared with standard laparotomy. STUDY HYPOTHESIS Robot-assisted laparoscopic radical hysterectomy is non-inferior to laparotomy in regards to recurrence-free survival with the advantage of fewer post-operative complications and superior patient-reported outcomes. TRIAL DESIGN Prospective, multi-institutional, international, open-label randomized clinical trial. Consecutive women with early-stage cervical cancer will be assessed for eligibility and subsequently randomized 1:1 to either robot-assisted laparoscopic surgery or laparotomy. Institutional review board approval will be required from all participating institutions. The trial is coordinated from Karolinska University Hospital, Sweden. MAJOR INCLUSION/EXCLUSION CRITERIA Women over 18 with cervical cancer FIGO (2018) stages IB1, IB2, and IIA1 squamous, adenocarcinoma, or adenosquamous will be included. Women are not eligible if they have evidence of metastatic disease, serious co-morbidity, or a secondary invasive neoplasm in the past 5 years. PRIMARY ENDPOINT Recurrence-free survival at 5 years between women who underwent robot-assisted laparoscopic surgery versus laparotomy for early-stage cervical cancer. SAMPLE SIZE The clinical non-inferiority margin in this study is defined as a 5-year recurrence-free survival not worsened by >7.5%. With an expected recurrence-free survival of 85%, the study needs to observe 127 events with a one-sided level of significance (α) of 5% and a power (1-β) of 80%. With 5 years of recruitment and 3 years of follow-up, the necessary number of events will be reached if the study can recruit a total of 768 patients. ESTIMATED DATES FOR COMPLETING ACCRUAL AND PRESENTING RESULTS Trial launch is estimated to be May 2019 and the trial is estimated to close in May 2027 with presentation of data shortly thereafter. TRIAL REGISTRATION The trial is registered at ClinicalTrials.gov (NCT03719547).
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Affiliation(s)
- Henrik Falconer
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Kolbrun Palsdottir
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Karin Stalberg
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | | | - Ulrika Ottander
- Department of Clinical Sciences, Umeå Universitet Medicinska fakulteten, Umea, Sweden
| | - Evelyn Serreyn Lundin
- Obstetrics and Gynecology, Linkopings universitet, Linkoping, Sweden
- Linkopings Universitet Institutionen for klinisk och experimentell medicin, Linkoping, Sweden
| | - Lena Wijk
- Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Rainer Kimmig
- Gynecology and Obstetrics, University Hospital of Duisburg-Essen, Essen, Germany
| | | | | | - Johanna Mäenpää
- Faculty of Medicine and Medical Technology, Tampere University, Tampere, Pirkanmaa, Finland
| | - Jan Persson
- Department of Obstetrics and Gynecology, Lund University Hosptial, Lund, Sweden
| | - Sahar Salehi
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
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7
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Marra AR, Puig-Asensio M, Edmond MB, Schweizer ML, Bender D. Infectious complications of laparoscopic and robotic hysterectomy: a systematic literature review and meta-analysis. Int J Gynecol Cancer 2019; 29:518-530. [PMID: 30833440 DOI: 10.1136/ijgc-2018-000098] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 12/07/2018] [Accepted: 12/11/2018] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE We performed a systematic review of the literature and meta-analysis of the infectious complications of hysterectomy, comparing robotic-assisted hysterectomy to conventional laparoscopic-assisted hysterectomy. METHODS We searched PubMed, CINAHL, CDSR, and EMBASE through July 2018 for studies evaluating robotic-assisted hysterectomy, laparoscopic-assisted hysterectomy, and infectious complications. We employed random-effect models to obtain pooled OR estimates. Heterogeneity was evaluated with I2 estimation and the Cochran Q statistic. Pooled ORs were calculated separately based on the reason for hysterectomy (eg, benign uterine diseases, endometrial cancer, and cervical cancer). RESULTS Fifty studies were included in the final review for the meta-analysis with 176 016 patients undergoing hysterectomy. There was no statistically significant difference in the number of infectious complication events between robotic-assisted hysterectomy and laparoscopic-assisted hysterectomy (pooled OR 0.97; 95 % CI 0.74 to 1.28). When we performed a stratified analysis, similar results were found with no statistically significant difference in infectious complications comparing robotic-assisted hysterectomy to laparoscopic-assisted hysterectomy among patients with benign uterine disease (pooled OR 1.10; 95 % CI 0.70 to 1.73), endometrial cancer (pooled OR 0.97; 95 % CI 0.55 to 1.73), or cervical cancer (pooled OR 1.09; 95 % CI 0.60 to 1.97). CONCLUSION In our meta-analysis the rate of infectious complications associated with robotic-assisted hysterectomy was no different than that associated with conventional laparoscopic-assisted hysterectomy.
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Affiliation(s)
- Alexandre R Marra
- Office of Clinical Quality, Safety and Performance Improvement University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
- Division of General Internal Medicine, Department of Internal Medicine, Carver College of Medicine, Iowa City, Iowa, USA
- Division of Medical Practice, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Mireia Puig-Asensio
- Office of Clinical Quality, Safety and Performance Improvement University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
- Division of General Internal Medicine, Department of Internal Medicine, Carver College of Medicine, Iowa City, Iowa, USA
| | - Michael B Edmond
- Office of Clinical Quality, Safety and Performance Improvement University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
- Division of General Internal Medicine, Department of Internal Medicine, Carver College of Medicine, Iowa City, Iowa, USA
- Division of Infectious Diseases, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Marin L Schweizer
- Division of General Internal Medicine, Department of Internal Medicine, Carver College of Medicine, Iowa City, Iowa, USA
- The Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, Iowa, USA
| | - David Bender
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
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8
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Rayborn MK, Turner JL, Park SG. Cost effectiveness of preoperative screening for healthy patients undergoing robotic hysterectomy. J Perioper Pract 2018; 27:129-134. [PMID: 29239201 DOI: 10.1177/175045891702700603] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 07/06/2016] [Indexed: 11/15/2022]
Abstract
The objective of this study was to determine whether routine preoperative type and screen blood testing is cost effective and medically warranted for benign diagnosis in healthy patients undergoing robotic hysterectomy. The study was designed as a cross sectional retrospective descriptive study. Four hundred and twenty two medical records of American Society of Anesthesiologists (ASA) Classifications I and II patients undergoing robotically-assisted laparoscopic hysterectomy between 1 June 2011 and 31 May 2014 at a 211 bed regional medical center were analysed. The results from this study paralleled the findings of other published research. Preoperative type and screen testing was performed on 249 (59%) of the patients in the study. Ten patients (2.4% of the group) converted to open laparotomy. Mean estimated blood loss was 59.59ml. No perioperative transfusions were required. The results indicate that preoperative type and screen testing is not warranted for patients meeting the inclusion criteria.
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Affiliation(s)
- Michong K Rayborn
- College of Nursing, University of Southern Mississippi at Hattiesburg, Mississippi, USA
| | - John L Turner
- Pinebelt Anesthesia Associates PLLC, Hattiesburg, Mississippi, USA
| | - Sun G Park
- Creative Project Solutions LLC, Heidelberg, Mississippi, USA
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A Swedish population-based evaluation of benign hysterectomy, comparing minimally invasive and abdominal surgery. Eur J Obstet Gynecol Reprod Biol 2018; 222:113-118. [PMID: 29408741 DOI: 10.1016/j.ejogrb.2018.01.019] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Revised: 01/10/2018] [Accepted: 01/16/2018] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The aim was to evaluate surgical routes for benign hysterectomy in a Swedish population, including abdominal and minimally invasive surgery. STUDY DESIGN Prospectively collected data from the Swedish National GynOp Registry 2009-2015: 13 806 hysterectomy cases were included: abdominal (AH, n = 7485), vaginal (VH, n = 3767), conventional laparoscopic (LH, n = 1539) and robotically-assisted (RAH, n = 1015). RESULTS The VH group had the shortest operation time at 75 min, AH 97 min and RAH 104 min. LH was longest at 127 min (p < 0.005). The mean estimated blood loss was higher in the AH group (250 ml) compared to all minimally invasive surgery (MIS, 65-172 ml); p < 0.005). Conversion rates were 10% for LH, 4.8% for VH and 1.6% for RAH (p < 0.005). Hospitalization and patient-reported time to normal activities of daily living (ADL) were longer for AH compared to MIS (p < 0.005). Time to return to work was eight days longer in the AH group (35 days) compared with the MIS groups (p < 0.005). Complications were fewest in the VH group at 5.4% compared with AH 7.6% and RAH 8.7% (both p < 0.001), but did not significantly differ from the LH group at 6.6%. Overall patient satisfaction was reported to be 86-94% one year after surgery. CONCLUSION Women operated on for benign hysterectomy with minimally invasive methods in Sweden 2009-2015 had reduced length of hospitalization, as well as time to resuming normal ADL and return to work, compared to AH. Postoperative outcome measures were improved by minimally invasive methods and MIS should preferably be used.
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Ding DC, Hong MK, Chu TY, Chang YH, Liu HW. Robotic single-site supracervical hysterectomy with manual morcellation: Preliminary experience. World J Clin Cases 2017; 5:172-177. [PMID: 28560234 PMCID: PMC5434316 DOI: 10.12998/wjcc.v5.i5.172] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 12/08/2016] [Accepted: 03/02/2017] [Indexed: 02/05/2023] Open
Abstract
AIM To evaluate the feasibility, safety and peri- and postoperative outcomes of robotic single-site supracervical hysterectomy (RSSSH) for benign gynecologic disease.
METHODS 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.
RESULTS 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.
CONCLUSION 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.
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Favre A, Huberlant S, Carbonnel M, Goetgheluck J, Revaux A, Ayoubi JM. Pedagogic Approach in the Surgical Learning: The First Period of "Assistant Surgeon" May Improve the Learning Curve for Laparoscopic Robotic-Assisted Hysterectomy. Front Surg 2016; 3:58. [PMID: 27853733 PMCID: PMC5089967 DOI: 10.3389/fsurg.2016.00058] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 10/10/2016] [Indexed: 12/18/2022] Open
Abstract
Background 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. Methods 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. Results 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. Conclusion 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.
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Affiliation(s)
- Angeline Favre
- Obstetrics and Gynecology Department, Foch Hospital , Suresnes , France
| | | | - Marie Carbonnel
- Obstetrics and Gynecology Department, Foch Hospital , Suresnes , France
| | - Julie Goetgheluck
- Obstetrics and Gynecology Department, Foch Hospital , Suresnes , France
| | - Aurelie Revaux
- Obstetrics and Gynecology Department, Foch Hospital , Suresnes , France
| | - Jean Marc Ayoubi
- Obstetrics and Gynecology Department, Foch Hospital , Suresnes , France
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Gauthier T, Huet S, Marcelli M, Lamblin G, Chêne G. Hystérectomie pour pathologie bénigne : choix de la voie d’abord, technique de suture vaginale et morcellement : recommandations. ACTA ACUST UNITED AC 2015; 44:1168-82. [DOI: 10.1016/j.jgyn.2015.09.032] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Accepted: 09/18/2015] [Indexed: 11/16/2022]
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Driessen SRC, Sandberg EM, la Chapelle CF, Twijnstra ARH, Rhemrev JPT, Jansen FW. Case-Mix Variables and Predictors for Outcomes of Laparoscopic Hysterectomy: A Systematic Review. J Minim Invasive Gynecol 2015; 23:317-30. [PMID: 26611613 DOI: 10.1016/j.jmig.2015.11.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 11/10/2015] [Accepted: 11/12/2015] [Indexed: 12/14/2022]
Abstract
The assessment of surgical quality is complex, and an adequate case-mix correction is missing in currently applied quality indicators. The purpose of this study is to give an overview of all studies mentioning statistically significant associations between patient characteristics and surgical outcomes for laparoscopic hysterectomy (LH). Additionally, we identified a set of potential case-mix characteristics for LH. This systematic review was conducted according to the Meta-Analysis of Observational Studies in Epidemiology guidelines. We searched PubMed and EMBASE from January 1, 2000 to August 1, 2015. All articles describing statistically significant associations between patient characteristics and adverse outcomes of LH for benign indications were included. Primary outcomes were blood loss, operative time, conversion, and complications. The methodologic quality of the included studies was assessed using the Newcastle-Ottawa Quality Assessment Scale. The included articles were summed per predictor and surgical outcome. Three sets of case-mix characteristics were determined, stratified by different levels of evidence. Eighty-five of 1549 identified studies were considered eligible. Uterine weight and body mass index (BMI) were the most mentioned predictors (described, respectively, 83 and 45 times) in high quality studies. For longer operative time and higher blood loss, uterine weight ≥ 250 to 300 g and ≥500 g and BMI ≥ 30 kg/m(2) dominated as predictors. Previous operations, adhesions, and higher age were also considered as predictors for longer operative time. For complications and conversions, the patient characteristics varied widely, and uterine weight, BMI, previous operations, adhesions, and age predominated. Studies of high methodologic quality indicated uterine weight and BMI as relevant case-mix characteristics for all surgical outcomes. For future development of quality indicators of LH and to compare surgical outcomes adequately, a case-mix correction is suggested for at least uterine weight and BMI. A potential case-mix correction for adhesions and previous operations can be considered. For both surgeons and patients it is valuable to be aware of potential factors predicting adverse outcomes and to anticipate this. Finally, to benchmark clinical outcomes at an international level, it is of the utmost importance to introduce uniform outcome definitions.
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Affiliation(s)
- Sara R C Driessen
- Department of Gynecology, Leiden University Medical Center, Leiden, The Netherlands
| | - Evelien M Sandberg
- Department of Gynecology, Leiden University Medical Center, Leiden, The Netherlands
| | - Claire F la Chapelle
- Department of Gynecology, Leiden University Medical Center, Leiden, The Netherlands
| | - Andries R H Twijnstra
- Department of Obstetrics and Gynecology, Bronovo Hospital, The Hague, The Netherlands
| | - Johann P T Rhemrev
- Department of Obstetrics and Gynecology, Bronovo Hospital, The Hague, The Netherlands
| | - Frank Willem Jansen
- Department of Gynecology, Leiden University Medical Center, Leiden, The Netherlands; Department BioMechanical Engineering, Delft University of Technology, Delft, The Netherlands.
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Hanafi M. Comparative Study of Vaginal, Abdominal, and Robotic Laparoscopic Hysterectomy: Clinical Outcome and Cost. J Gynecol Surg 2015. [DOI: 10.1089/gyn.2015.0010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Magdi Hanafi
- Department of Gynecology, Emory Saint Joseph's Hospital, Atlanta, GA
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15
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Yaribakht S, Guillemin F, Harter V, Malartic C, Marchal F. Nouvelle approche de la courbe d’apprentissage en chirurgie oncogynécologique robot-assistée. ACTA ACUST UNITED AC 2015; 43:348-55. [DOI: 10.1016/j.gyobfe.2015.02.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 02/17/2015] [Indexed: 11/26/2022]
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16
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Luciano AA, Luciano DE, Gabbert J, Seshadri-Kreaden U. The impact of robotics on the mode of benign hysterectomy and clinical outcomes. Int J Med Robot 2015; 12:114-24. [DOI: 10.1002/rcs.1648] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2015] [Indexed: 11/11/2022]
Affiliation(s)
- Anthony A. Luciano
- Center for Fertility and Women's Health; Obstetrics and Gynecology, Hospital of Central Connecticut; New Britain CT USA
| | - Danielle E. Luciano
- Center for Fertility and Women's Health; Obstetrics and Gynecology, Hospital of Central Connecticut; New Britain CT USA
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Puntambekar SP, Kathya N, Mallireddy C, Puntambekar SS, Agarwal G, Joshi S, Kenawadekar R, Lawande A. Indian experience of robotics in gynecology. J Minim Access Surg 2014; 10:80-3. [PMID: 24761082 PMCID: PMC3996738 DOI: 10.4103/0972-9941.129957] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Accepted: 10/16/2013] [Indexed: 11/06/2022] Open
Abstract
AIMS: To study the role of robotics in various gynaecological cases, benign and malignant. MATERIALS AND METHODS: 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. RESULTS: 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. CONCLUSIONS: Ours is the largest series of robotic surgery in gynecological procedures in India. Benign and malignant cases were addressed robotically showing the feasibility.
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Affiliation(s)
- Shailesh P Puntambekar
- Department of Minimal access surgery, Galaxy Care Laparoscopy Institute, Pune, Maharashtra, India
| | - Nallapothula Kathya
- Department of Minimal access surgery, Galaxy Care Laparoscopy Institute, Pune, Maharashtra, India
| | - Chaitanya Mallireddy
- Department of Minimal access surgery, Galaxy Care Laparoscopy Institute, Pune, Maharashtra, India
| | - Seema S Puntambekar
- Department of Minimal access surgery, Galaxy Care Laparoscopy Institute, Pune, Maharashtra, India
| | - Geetanjali Agarwal
- Department of Minimal access surgery, Galaxy Care Laparoscopy Institute, Pune, Maharashtra, India
| | - Saurabh Joshi
- Department of Minimal access surgery, Galaxy Care Laparoscopy Institute, Pune, Maharashtra, India
| | - Rahul Kenawadekar
- Department of Minimal access surgery, Galaxy Care Laparoscopy Institute, Pune, Maharashtra, India
| | - Akhil Lawande
- Department of Minimal access surgery, Galaxy Care Laparoscopy Institute, Pune, Maharashtra, India
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18
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Betcher RE, Chaney JP, Lacy PR, Otey SK, Wood DJ. Analysis of postoperative pain in robotic versus traditional laparoscopic hysterectomy. J Robot Surg 2014; 8:35-41. [PMID: 27637237 DOI: 10.1007/s11701-013-0418-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Accepted: 06/05/2013] [Indexed: 11/28/2022]
Abstract
The aim of this study was to assess postoperative pain and narcotic use in the first 23 h following robotic versus traditional laparoscopic hysterectomy for benign pathology. The study design was that of a retrospective case-control study of robotic (first 100 consecutive) versus traditional (last 100 consecutive) total laparoscopic hysterectomy cases at an obstetrics and gynecology multi-institutional community practice. Patient characteristics were equivalent in both groups (age, p = 0.364; body mass index, p = 0.326; uterine weight, p = 0.565), except for a higher number of Caucasians in the traditional laparoscopic group (p = 0.017). Compared to patients who underwent robotic laparoscopic hysterectomy, those who underwent the traditional procedure had higher visual analog scale pain scores (3.1 ± 1.5 vs. 4.6 ± 2.4, respectively; p < 0.001) and used more narcotics (27.5 vs. 35.4 mg hydrocodone, respectively; p < 0.05). Factors that could potentially increase pain (more procedures, more ports, total incision size, and longer operative time) were significantly higher in the robotic group, but only surgical approach, amount of narcotic, and age correlated with pain levels when evaluated with regression analysis. Complication rates were equivalent between groups. In conclusion, patients who underwent robotic assisted laparoscopic hysterectomy had statistically decreased postoperative pain scores and narcotic use than those who underwent the traditional laparoscopic approach, even when the robotic cases involved more procedures and ports and were associated with longer operative time.
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Affiliation(s)
- Raymond E Betcher
- Physicians and Surgeons Clinic, Obstetrics and Gynecology, Baptist Memorial Hospital-Golden Triangle, 225 Baptist Blvd., Columbus, MS, 39705, USA.
- Physicians and Surgeons Clinic, Obstetrics and Gynecology, Gilmore Memorial Regional Medical Center, 900 Earl Frye Blvd, Amory, MS, 38821, USA.
| | - James P Chaney
- Physicians and Surgeons Clinic, Obstetrics and Gynecology, Baptist Memorial Hospital-Golden Triangle, 225 Baptist Blvd., Columbus, MS, 39705, USA
- Physicians and Surgeons Clinic, Obstetrics and Gynecology, Gilmore Memorial Regional Medical Center, 900 Earl Frye Blvd, Amory, MS, 38821, USA
| | - Pamela R Lacy
- Physicians and Surgeons Clinic, Obstetrics and Gynecology, Baptist Memorial Hospital-Golden Triangle, 225 Baptist Blvd., Columbus, MS, 39705, USA
- Physicians and Surgeons Clinic, Obstetrics and Gynecology, Gilmore Memorial Regional Medical Center, 900 Earl Frye Blvd, Amory, MS, 38821, USA
| | - Stephen K Otey
- Physicians and Surgeons Clinic, Obstetrics and Gynecology, Baptist Memorial Hospital-Golden Triangle, 225 Baptist Blvd., Columbus, MS, 39705, USA
- Physicians and Surgeons Clinic, Obstetrics and Gynecology, Gilmore Memorial Regional Medical Center, 900 Earl Frye Blvd, Amory, MS, 38821, USA
| | - Duke J Wood
- Physicians and Surgeons Clinic, Obstetrics and Gynecology, Baptist Memorial Hospital-Golden Triangle, 225 Baptist Blvd., Columbus, MS, 39705, USA
- Physicians and Surgeons Clinic, Obstetrics and Gynecology, Gilmore Memorial Regional Medical Center, 900 Earl Frye Blvd, Amory, MS, 38821, USA
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Carugno J, Gyang A, Hoover F, Taylor K, Lamvu G. Physician Risk Estimation of Operative Time: A Comparison of Risk Factors for Prolonged Operative Time in Robotic and Conventional Laparoscopic Hysterectomy. J Gynecol Surg 2014. [DOI: 10.1089/gyn.2013.0037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jose Carugno
- Division of Advanced & Minimally Invasive Gynecology, Department of Graduate Medical Education, Florida Hospital, Orlando, FL
| | - Anthony Gyang
- Division of Advanced & Minimally Invasive Gynecology, Department of Graduate Medical Education, Florida Hospital, Orlando, FL
| | - Frederick Hoover
- Division of Advanced & Minimally Invasive Gynecology, Department of Graduate Medical Education, Florida Hospital, Orlando, FL
| | - Kelly Taylor
- Division of Advanced & Minimally Invasive Gynecology, Department of Graduate Medical Education, Florida Hospital, Orlando, FL
| | - Georgine Lamvu
- Division of Advanced & Minimally Invasive Gynecology, Department of Graduate Medical Education, Florida Hospital, Orlando, FL
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20
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Robotically Assisted Hysterectomy versus Vaginal Hysterectomy for Benign Disease: A Prospective Study. Minim Invasive Surg 2013; 2013:429105. [PMID: 23936645 PMCID: PMC3723086 DOI: 10.1155/2013/429105] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2013] [Accepted: 06/03/2013] [Indexed: 11/18/2022] Open
Abstract
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.
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Perez M, Perrenot C, Tran N, Hossu G, Felblinger J, Hubert J. Prior experience in micro-surgery may improve the surgeon's performance in robotic surgical training. Int J Med Robot 2013; 9:351-8. [DOI: 10.1002/rcs.1499] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2013] [Indexed: 11/08/2022]
Affiliation(s)
- Manuela Perez
- IADI Laboratory, INSERM- U947; Lorraine University, Allée du Morvan; 54500 Vandoeuvre-les-Nancy France
- Department of Emergency and General Surgery, Central Hospital; University Hospital of Nancy; Avenue du Marechal de Lattre de Tassigny 54000 Nancy France
| | - Cyril Perrenot
- IADI Laboratory, INSERM- U947; Lorraine University, Allée du Morvan; 54500 Vandoeuvre-les-Nancy France
- School of Surgery, Faculty of Medicine-UHP; Lorraine University; Avenue de la Forêt de Haye 54511 Vandoeuvre-les-Nancy France
| | - Nguyen Tran
- School of Surgery, Faculty of Medicine-UHP; Lorraine University; Avenue de la Forêt de Haye 54511 Vandoeuvre-les-Nancy France
| | - Gabriela Hossu
- CIC-IT Nancy,INSERM-CIT801- Lorraine University; Avenue de la Forêt de Haye 54511 Vandoeuvre-les-Nancy France
| | - Jacques Felblinger
- IADI Laboratory, INSERM- U947; Lorraine University, Allée du Morvan; 54500 Vandoeuvre-les-Nancy France
| | - Jacques Hubert
- IADI Laboratory, INSERM- U947; Lorraine University, Allée du Morvan; 54500 Vandoeuvre-les-Nancy France
- School of Surgery, Faculty of Medicine-UHP; Lorraine University; Avenue de la Forêt de Haye 54511 Vandoeuvre-les-Nancy France
- Department of Urology, Brabois Hospital; University Hospital of Nancy; Allée du Morvan 54511 Vandoeuvre-les-Nancy France
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22
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Salama SS, Kılıç GS. Uterine fibroids and current clinical challenges. J Turk Ger Gynecol Assoc 2013; 14:40-5. [PMID: 24592069 PMCID: PMC3881727 DOI: 10.5152/jtgga.2013.09] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Accepted: 02/25/2013] [Indexed: 11/22/2022] Open
Abstract
Uterine fibroids (UF) are the most common gynecological tumors in premenopausal women. Hysterectomy remains the major and definitive therapeutic option. Minimally invasive surgical techniques for performing hysterectomy have many advantages over laparotomy. Current drug therapies for UF remain unsatisfactory. Unquestionably, continued investigation of novel agents is necessary. The currently used drugs for UF treatment which exclusively modulate a single target, typically either the estrogen or progesterone signaling pathways, are limited in their therapeutic effects. By contrast, multi-target drugs which simultaneously modulate multiple critical hubs in the network of the signaling pathways underlying UF pathogenesis should achieve robust and durable therapeutic effects.
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Affiliation(s)
- Salama S. Salama
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Baylor College of Medicine, Houston, Texas, USA
| | - Gökhan S. Kılıç
- Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas, USA
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23
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Jacome EG, Hebert AE, Christian F. Comparative analysis of vaginal versus robotic-assisted hysterectomy for benign indications. J Robot Surg 2013; 7:39-46. [PMID: 27000891 DOI: 10.1007/s11701-012-0339-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2011] [Accepted: 02/01/2012] [Indexed: 11/29/2022]
Abstract
We aimed to compare perioperative outcomes of robotic-assisted hysterectomy versus vaginal hysterectomy in patients with benign gynecologic conditions, using a retrospective chart review of 240 consecutive benign hysterectomies from May 2008 to April of 2010 performed by a single surgical team at the Eisenhower Medical Center. The analysis included an equal number of cases in each group: 120 robotic-assisted total laparoscopic hysterectomies and 120 total vaginal hysterectomies. Consecutive cases met the inclusion criteria of benign disease. There were no statistically significant differences related to age, body mass index, history of prior abdominal surgery, or uterine weight. Operative times in the robotic group were significantly longer by an average of 59 min (p < 0.001). Patients with robotic-assisted hysterectomy had clinically equivalent estimated blood loss (55.5 ml vs. 84.7 ml, p < 0.001) and the intraoperative complication rates were 1.7% vaginal versus 0% robotic (p = 0.156). There was one conversion in the vaginal group due to pelvic adhesions and no conversions in the robotic group. Length of hospital stay was 1 day for both groups. The perioperative complication rates were equivalent between groups (6.7 vs. 11.7%, p = 0.180), but there were more major complications in the vaginal group (0 vs. 3.3%, p = 0.044). We conclude that, in a comparable group of patients, robotic-assisted hysterectomy takes longer to complete but results in fewer major complications.
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Affiliation(s)
- Enrique G Jacome
- Department of Gynecology, Eisenhower Medical Center, 72780 Country Club Dr. Suite A103, Rancho Mirage, CA, 92270, USA.
| | | | - Frank Christian
- Department of Gynecology, Eisenhower Medical Center, 72780 Country Club Dr. Suite A103, Rancho Mirage, CA, 92270, USA
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O'Neill M, Moran PS, Teljeur C, O'Sullivan OE, O'Reilly BA, Hewitt M, Flattery M, Ryan M. Robot-assisted hysterectomy compared to open and laparoscopic approaches: systematic review and meta-analysis. Arch Gynecol Obstet 2013; 287:907-18. [PMID: 23291924 DOI: 10.1007/s00404-012-2681-z] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Accepted: 12/06/2012] [Indexed: 02/06/2023]
Abstract
PURPOSE To review the safety and effectiveness of robot-assisted hysterectomy compared to traditional open and conventional laparoscopic surgery, differentiating radical, simple total with node staging, and simple total hysterectomy. METHODS Medline, Embase, the Cochrane library, and the Journal of Robotic Surgery were searched for controlled trials and observational studies with historic or concurrent controls. Data were pooled using random effects meta-analysis. RESULTS Compared to open surgery, robot-assisted radical hysterectomy is associated with reduced hospital stay and blood transfusions. For simple total hysterectomy with node staging, robot-assisted surgery is associated with reduced hospital stay, complications, and blood transfusions compared to open surgery. Compared to conventional laparoscopic surgery, robot-assisted simple total hysterectomy with node staging is associated with complications and conversions. CONCLUSIONS Compared to open surgery, robot-assisted hysterectomy offers benefits for reduced length of hospital stay and blood transfusions. The best evidence of improved outcomes is for simple total hysterectomy with node staging. Study quality was poor.
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Affiliation(s)
- Michelle O'Neill
- Health Technology Assessment, Health Information and Quality Authority, George's Court, George's Lane, Dublin 7, Ireland.
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25
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Robotic compared with conventional laparoscopic hysterectomy: a randomized controlled trial. Obstet Gynecol 2012; 120:604-11. [PMID: 22914470 DOI: 10.1097/aog.0b013e318265b61a] [Citation(s) in RCA: 143] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To compare surgical outcome and quality of life of robot-assisted laparoscopic hysterectomy with conventional laparoscopic hysterectomy. METHODS For this controlled clinical trial, patients with benign indications for hysterectomy were randomized to receive either a robotic (robotic group) or conventional laparoscopic hysterectomy (conventional group). The primary end point was total operating time; secondary end points were perioperative outcome, blood loss, and the change in quality of life. RESULTS Ninety-five patients out of 100 randomized patients completed the study. Patient age, body mass index, and uterus weight showed no significant differences between both groups. All results are given as mean (± standard deviation; median). Total operating time for the robotic group was significantly higher with 106 (± 29; 103) compared with 75 (± 21; 74) (conventional group) minutes. Blood loss, complications, analgesics use, and return to activity for both groups were comparable. The change in preoperative to postoperative quality-of-life index (quality of life measured on a linear scale from 0 to 100) was significantly higher in the robotic group, with 13 (± 10; 13) compared with 5 (± 14; 5) (conventional group). CONCLUSION Robot-assisted laparoscopic hysterectomy and conventional laparoscopy compare well in most surgical aspects, but the robotic procedure is associated with longer operating times. Postoperative quality-of-life index was better; however, long-term, there was no difference. However, subjective postoperative parameters such as analgesic use and return to activity showed no significant difference between both groups.
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Robot-assisted hysterectomy vs total laparoscopic hysterectomy: a comparison of short-term surgical outcomes. Int J Med Robot 2012; 8:453-7. [DOI: 10.1002/rcs.1463] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2012] [Indexed: 11/07/2022]
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Robot-assisted surgery:—impact on gynaecological and pelvic floor reconstructive surgery. Int Urogynecol J 2012; 23:1163-73. [DOI: 10.1007/s00192-012-1790-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2012] [Accepted: 04/11/2012] [Indexed: 10/28/2022]
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Robotic versus laparoscopic hysterectomy: a review of recent comparative studies. Curr Opin Obstet Gynecol 2011; 23:283-8. [PMID: 21666467 DOI: 10.1097/gco.0b013e328348a26e] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To illustrate the current stand on robotic versus conventional laparoscopic hysterectomy regarding operating times, clinical outcome and costs. RECENT FINDINGS Only six studies were reviewed, as there are only few recent studies comparing robotic with laparoscopic hysterectomy and most are retrospective. Apart from one multicentre study with over 36 000 patients, 350 institutions and numerous surgeons, most studies were performed with few cases by one or two surgeons at one or two hospitals. Operating times for robotic hysterectomies generally were longer, ranging from 89.9 to 267 min. Surgery time for conventional laparoscopic hysterectomies was between 83 and 206 min. In all studies, clinical outcomes such as blood loss, complications or hospital stay of both the robotic and the conventional laparoscopic procedure were similar. Only two studies compared costs and both came up with very similar findings. Cost for a robot-assisted hysterectomy is approximately 2600 USD higher than that for conventional laparoscopic hysterectomy not including investment and amortization. SUMMARY Robotic and conventional laparoscopic hysterectomy are essentially equivalent regarding surgical and clinical outcome. Operating times are slightly higher and costs are significantly higher for the robotic procedure.
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Robotic surgery in gynecology: an updated systematic review. Obstet Gynecol Int 2011; 2011:852061. [PMID: 22190948 PMCID: PMC3236390 DOI: 10.1155/2011/852061] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2011] [Accepted: 08/25/2011] [Indexed: 12/04/2022] Open
Abstract
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.
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Scandola M, Grespan L, Vicentini M, Fiorini P. Robot-Assisted Laparoscopic Hysterectomy vs Traditional Laparoscopic Hysterectomy: Five Metaanalyses. J Minim Invasive Gynecol 2011; 18:705-15. [DOI: 10.1016/j.jmig.2011.08.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2011] [Revised: 08/04/2011] [Accepted: 08/12/2011] [Indexed: 10/16/2022]
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GEPPERT BARBARA, LÖNNERFORS CELINE, PERSSON JAN. Robot-assisted laparoscopic hysterectomy in obese and morbidly obese women: surgical technique and comparison with open surgery. Acta Obstet Gynecol Scand 2011; 90:1210-7. [DOI: 10.1111/j.1600-0412.2011.01253.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Shultz TM. Preemptive multimodal analgesia facilitates same-day discharge following robot-assisted hysterectomy. J Robot Surg 2011; 6:115-23. [PMID: 27628274 DOI: 10.1007/s11701-011-0276-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2010] [Accepted: 05/09/2011] [Indexed: 12/14/2022]
Abstract
We aimed to determine whether early hospital discharge following minimally invasive surgery can be achieved through the use of preemptive multimodal analgesia without compromising patient safety or comfort. Data were retrospectively collected for 150 patients who underwent robotic-assisted laparoscopic hysterectomy for benign indications from 9 December 2009 to 6 October 2010 at Cox Health Systems (Springfield, MO, USA). One surgeon performed 100 consecutive cases with all patients receiving preemptive multimodal treatment with celecoxib and ropivacaine. These cases were compared with 50 patients treated with an opioid-based postoperative analgesia regimen by one of four other surgeons at the same center. Patient characteristics, perioperative outcomes, opioid requirement, and time to discharge were compared between groups. The patients in the multimodal group had significantly reduced opioid requirements intraoperatively (25.0 mg vs. 29.9 mg, P = 0.0077), postoperatively on the day of surgery (10.9 mg vs. 17.9 mg, P = 0.0030), and on the first postoperative day (3.1 mg vs. 15.3 mg, P = 0.0001). There were no differences in procedure time, transfusions, or readmission rates between groups. Time in the Post-Anesthesia Care Unit (PACU) was decreased in the multimodal group (72.0 min vs. 88.4 min, P < 0.0001), as was time to discharge from the hospital (8.5 h vs. 30.2 h, P < 0.0001). Age and body mass index were both significantly lower in the multimodal group; however, regression analyses demonstrated that analgesia regimen was the only parameter that predicted opioid requirement and time to discharge. Preemptive multimodal analgesia reduced the total dose of rescue opioids, facilitating same-day discharge without compromising patient comfort or safety.
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Affiliation(s)
- Thomas M Shultz
- Primrose OB/GYN, Cox Health Systems, 1000 E. Primrose #270, Springfield, MO, 65807, USA.
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PARK H, YOON BS, SEONG SJ, KIM JY, SHIM JY, PARK CT. Can misoprostol reduce blood loss in laparoscopy-assisted vaginal hysterectomy? Aust N Z J Obstet Gynaecol 2011; 51:248-51. [DOI: 10.1111/j.1479-828x.2011.01304.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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