|
1
|
Kapurubandara S, Baekelandt J, Laws P, King J. Adoption of vaginally assisted natural orifice transluminal endoscopic surgery for hysterectomy: A single tertiary experience. Aust N Z J Obstet Gynaecol 2024. [PMID: 39007484 DOI: 10.1111/ajo.13862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 06/23/2024] [Indexed: 07/16/2024]
Abstract
BACKGROUND Vaginal hysterectomy (VH) rate is declining despite being considered as the optimal minimally invasive option for hysterectomy with reduced operative time and length of stay compared with laparoscopic hysterectomy (LH). Vaginal assisted natural orifice transluminal endoscopic surgery hysterectomy (VANH) combines the advantages of both vaginal and endoscopic approach to surgery. AIMS To report feasibility and early experience of a single surgeon adopting VANH at a tertiary Australian hospital. MATERIALS AND METHODS Prospective review of the first 20 VANH cases with complete data set collected retrospectively including patient demographics, indication for surgery and perioperative outcomes. RESULTS The median age of the first 20 participants was 51.5 years (47-57 years of age) and the median body mass index was 33.5 kg/m2 (27.8-38.3 kg/m2). The predominant indication was complex hyperplasia with atypia (12/20, 60%). The median parity was two (1-3) where four patients were nulliparous. The median blood loss was 125 mL (100-200 mL) with an operative time of 149 min (138-198 min) and median weight of the specimen of 181.5 g (66.5-219 g). The mean length of stay was 1.4 days (1-2 days). Five cases had conversion to laparoscopy and the majority (80%) occurred within the first ten cases. CONCLUSIONS VANH is feasible but there is a learning curve to achieve competence in this technique, which requires adequate training in the early stages of adoption with careful case selection. Until further robust data is available to determine the clinical benefit and safety profile of VANH, patients should be carefully counselled and the decision on mode of hysterectomy be individualised.
Collapse
Affiliation(s)
- Supuni Kapurubandara
- University of Sydney, Sydney, New South Wales, Australia
- Department of Obstetrics and Gynaecology, Westmead Hospital, Sydney, New South Wales, Australia
- Sydney West Area Pelvic Surgical Unit (SWAPS), Sydney, New South Wales, Australia
| | - Jan Baekelandt
- The Department of Gynecological Oncology and Minimally Invasive Surgery, Imelda Hospital, Bonheiden, Belgium
- Department of Development and Regeneration, Faculty of Medicine, Group Biomedical Sciences, KU Leuven-University of Leuven, Leuven, Belgium
| | - Patrick Laws
- Department of Obstetrics and Gynaecology, Westmead Hospital, Sydney, New South Wales, Australia
| | - Jenny King
- University of Sydney, Sydney, New South Wales, Australia
- Pelvic Floor Unit, Westmead Hospital, Sydney, New South Wales, Australia
| |
Collapse
|
|
2
|
Frassanito L, Di Bidino R, Vassalli F, Michnacs K, Giuri PP, Zanfini BA, Catarci S, Filetici N, Sonnino C, Cicchetti A, Arcuri G, Draisci G. Personalized Predictive Hemodynamic Management for Gynecologic Oncologic Surgery: Feasibility of Cost-Benefit Derivatives of Digital Medical Devices. J Pers Med 2023; 14:58. [PMID: 38248759 PMCID: PMC10820080 DOI: 10.3390/jpm14010058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 12/22/2023] [Accepted: 12/29/2023] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND Intraoperative hypotension is associated with increased perioperative complications, hospital length of stay (LOS) and healthcare expenditure in gynecologic surgery. We tested the hypothesis that the adoption of a machine learning-based warning algorithm (hypotension prediction index-HPI) might yield an economic advantage, with a reduction in adverse outcomes that outweighs the costs for its implementation as a medical device. METHODS A retrospective-matched cohort cost-benefit Italian study in gynecologic surgery was conducted. Sixty-six female patients treated with standard goal-directed therapy (GDT) were matched in a 2:1 ratio with thirty-three patients treated with HPI based on ASA status, diagnosis, procedure, surgical duration and age. RESULTS The most relevant contributor to medical costs was operating room occupation (46%), followed by hospital stay (30%) and medical devices (15%). Patients in the HPI group had EURO 300 greater outlay for medical devices without major differences in total costs (GDT 5425 (3505, 8127), HPI 5227 (4201, 7023) p = 0.697). A pre-specified subgroup analysis of 50% of patients undergoing laparotomic surgery showed similar medical device costs and total costs, with a non-significant saving of EUR 1000 in the HPI group (GDT 8005 (5961, 9679), HPI 7023 (5227, 11,438), p = 0.945). The hospital LOS and intensive care unit stay were similar in the cohorts and subgroups. CONCLUSIONS Implementation of HPI is associated with a scenario of cost neutrality, with possible economic advantage in high-risk settings.
Collapse
Affiliation(s)
- Luciano Frassanito
- Department of Emergency, Anesthesiologic and Intensive Care Sciences, IRCCS Fondazione Policlinico A. Gemelli, Largo A. Gemelli 8, 00168 Rome, Italy; (P.P.G.); (B.A.Z.); (S.C.); (N.F.); (C.S.); (G.D.)
| | - Rossella Di Bidino
- Department of Health Technology, IRCCS Fondazione Policlinico A. Gemelli, 00168 Rome, Italy; (R.D.B.); (G.A.)
| | - Francesco Vassalli
- Department of Critical Care and Perinatal Medicine, IRCCS Istituto G. Gaslini, 16147 Genoa, Italy;
| | | | - Pietro Paolo Giuri
- Department of Emergency, Anesthesiologic and Intensive Care Sciences, IRCCS Fondazione Policlinico A. Gemelli, Largo A. Gemelli 8, 00168 Rome, Italy; (P.P.G.); (B.A.Z.); (S.C.); (N.F.); (C.S.); (G.D.)
| | - Bruno Antonio Zanfini
- Department of Emergency, Anesthesiologic and Intensive Care Sciences, IRCCS Fondazione Policlinico A. Gemelli, Largo A. Gemelli 8, 00168 Rome, Italy; (P.P.G.); (B.A.Z.); (S.C.); (N.F.); (C.S.); (G.D.)
| | - Stefano Catarci
- Department of Emergency, Anesthesiologic and Intensive Care Sciences, IRCCS Fondazione Policlinico A. Gemelli, Largo A. Gemelli 8, 00168 Rome, Italy; (P.P.G.); (B.A.Z.); (S.C.); (N.F.); (C.S.); (G.D.)
| | - Nicoletta Filetici
- Department of Emergency, Anesthesiologic and Intensive Care Sciences, IRCCS Fondazione Policlinico A. Gemelli, Largo A. Gemelli 8, 00168 Rome, Italy; (P.P.G.); (B.A.Z.); (S.C.); (N.F.); (C.S.); (G.D.)
| | - Chiara Sonnino
- Department of Emergency, Anesthesiologic and Intensive Care Sciences, IRCCS Fondazione Policlinico A. Gemelli, Largo A. Gemelli 8, 00168 Rome, Italy; (P.P.G.); (B.A.Z.); (S.C.); (N.F.); (C.S.); (G.D.)
| | - Americo Cicchetti
- Department of Management Studies, Faculty of Economics, Catholic University of Sacred Heart, 00168 Rome, Italy;
| | - Giovanni Arcuri
- Department of Health Technology, IRCCS Fondazione Policlinico A. Gemelli, 00168 Rome, Italy; (R.D.B.); (G.A.)
| | - Gaetano Draisci
- Department of Emergency, Anesthesiologic and Intensive Care Sciences, IRCCS Fondazione Policlinico A. Gemelli, Largo A. Gemelli 8, 00168 Rome, Italy; (P.P.G.); (B.A.Z.); (S.C.); (N.F.); (C.S.); (G.D.)
| |
Collapse
|