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Zhang C, Liu D, Zhang Q, Li Q, He L, Lin Y, Ge H. A case control study of vNOTES hysterectomy with the da Vinci surgical system and conventional vNOTES hysterectomy. Medicine (Baltimore) 2024; 103:e37323. [PMID: 38457540 PMCID: PMC10919455 DOI: 10.1097/md.0000000000037323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 01/29/2024] [Accepted: 01/30/2024] [Indexed: 03/10/2024] Open
Abstract
The aim of the case control study was to compare surgical outcomes of transvaginal natural orifice transluminal endoscopic surgery (vNOTES) hysterectomy with the da Vinci surgical system (dVSS) and conventional vNOTES. A case control study was performed on 25 cases in our hospital. Patients (n = 8) who underwent vNOTES hysterectomy with dVSS were selected to compare with the control group (n = 17) consisted of patients who underwent conventional vNOTES. Patients in the 2 groups underwent different operations respectively, and no case was transferred to transabdominal laparoscopy. In the conventional vNOTES group, 1 patient happened intraoperative hemorrhage of about 1000 mL, and was treated with blood transfusion, and the other one of vNOTES hysterectomy with dVSS had poor incision healing within 1 month after surgery. The other patients had no intraoperative and postoperative complications. The difference of pain scores on the first day (P = .006) and the third day (P = .045) after the 2 surgical methods differed significantly. No statistical differences were observed in operation time, median hospital stay, blood loss, decreased hemoglobin 3 days after surgery, and postoperative white blood cell count. vNOTES hysterectomy with dVSS is safe and feasible, and can achieve the same effect as the conventional vNOTES hysterectomy. And this method may alleviate the pain of patients.
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Affiliation(s)
- Chengling Zhang
- Department of Gynecology, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Dandan Liu
- Department of Gynecology, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Qiang Zhang
- Department of Gynecology, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Qiaoqiao Li
- Department of Gynecology, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Li He
- Department of Gynecology, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Yonghong Lin
- Department of Gynecology, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Huisheng Ge
- Department of Gynecology, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
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Zadabedini Masouleh T, Etchegary H, Hodgkinson K, Wilson BJ, Dawson L. Beyond Sterilization: A Comprehensive Review on the Safety and Efficacy of Opportunistic Salpingectomy as a Preventative Strategy for Ovarian Cancer. Curr Oncol 2023; 30:10152-10165. [PMID: 38132373 PMCID: PMC10742942 DOI: 10.3390/curroncol30120739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 11/19/2023] [Accepted: 11/27/2023] [Indexed: 12/23/2023] Open
Abstract
Ovarian cancer (OC) is Canada's third most common gynecological cancer, with an estimated 3000 new cases and 1950 deaths projected in 2022. No effective screening has been found to identify OC, especially the most common subtype, high-grade serous carcinoma (HGSC), at an earlier, curable stage. In patients with hereditary predispositions such as BRCA mutations, the rates of HGSC are significantly elevated, leading to the use of risk-reducing salpingo-oophorectomy as the key preventative intervention. Although surgery has been shown to prevent HGSC in high-risk women, the associated premature menopause has adverse long-term sequelae and mortality due to non-cancer causes. The fact that 75% of HGSCs are sporadic means that most women diagnosed with HGSC will not have had the option to avail of either screening or prevention. Recent research suggests that the fimbrial distal fallopian tube is the most likely origin of HGSC. This has led to the development of a prevention plan for the general population: opportunistic salpingectomy, the removal of both fallopian tubes. This article aims to compile and review the studies evaluating the effect of opportunistic salpingectomy on surgical-related complications, ovarian reserve, cost, and OC incidence when performed along with hysterectomy or instead of tubal ligation in the general population.
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Affiliation(s)
- Tahereh Zadabedini Masouleh
- Clinical Epidemiology Program, Faculty of Medicine, Memorial University of Newfoundland, St. John’s, NL A1B 3V6, Canada;
| | - Holly Etchegary
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University, St. John’s, NL A1B 3V6, Canada
| | - Kathleen Hodgkinson
- Division of Community Health and Humanities, Memorial University of Newfoundland, St. John’s, NL A1B 3V6, Canada
- Division of Biomedical Sciences, Memorial University of Newfoundland, St. John’s, NL A1B 3V6, Canada
| | - Brenda J. Wilson
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University, St. John’s, NL A1B 3V6, Canada
| | - Lesa Dawson
- Discipline of Obstetrics and Gynecology, Faculty of Medicine, Memorial University, St. John’s, NL A1B 3V6, Canada
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Xu P, Zhao Z, Tian Y, Li Y, Liu Y, Ji M. A retrospective analysis of robot-assisted total hysterectomy by transvaginal natural orifice transluminal endoscopic surgery. Heliyon 2023; 9:e19207. [PMID: 37662750 PMCID: PMC10474405 DOI: 10.1016/j.heliyon.2023.e19207] [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: 06/03/2023] [Revised: 08/10/2023] [Accepted: 08/16/2023] [Indexed: 09/05/2023] Open
Abstract
Objective The present study aimed to explore the feasibility and safety of robot-assisted total hysterectomy by transvaginal natural orifice transluminal endoscopic surgery (vNOTES). Methods In this study, the clinical data of 37 patients who underwent da Vinci robot-assisted total hysterectomy by vNOTES between September 1, 2019 and March 31, 2022 at the Department of Gynecology, the First Affiliated Hospital of Zhengzhou University, China were retrospectively analyzed. Clinical characteristics, operative postoperative complications, surgical outcomes, and postoperative pain scores were collected and analyzed. Results The average age of the patients included in the study was 47.43 ± 4.44 years. The body mass index (BMI) was calculated using the formula BMI = body weight (kg)/height2 (m2). The average BMI was 23.16 ± 2.72 kg/m2. Among the 37 patients, 30 patients underwent total hysterectomy and bilateral salpingectomy, of which 11 patients underwent ovarian cystectomy simultaneously. Among these 11 patients, three had bilateral ovarian cysts and eight had unilateral ovarian cysts, with the largest cyst diameter measuring 8 cm. The remaining seven patients underwent total hysterectomy and bilateral salpingo-oophorectomy. The average operative time was 86.19 ± 17.83 min, and the estimated intraoperative blood loss was 24.46 ± 15.40 mL, with no intraoperative complications reported. The time to the first postoperative exhaust was 18.51 ± 6.63 h, and the average postoperative length of hospital stay was 3.81 ± 1.05 days. The postoperative visual analog scale (VAS) pain scores were 5.30 ± 0.91 at 24 h after surgery, 3.30 ± 0.70 at 36 h after surgery, and 1.14 ± 0.92 at 48 h after surgery. Only one patient experienced a fever exceeding 38.5 °C, which resolved after receiving antibiotic treatment. Conclusion The use of the da Vinci robot-assisted total hysterectomy by vNOTES demonstrated safety and offers several advantages. These include reduced surgical trauma, an aesthetic incision, decreased pain, and shorter duration of postoperative exhaust time and hospital stay. These benefits contribute to accelerated postoperative rehabilitation.
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Affiliation(s)
- Penglin Xu
- Department of Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450052, PR China
| | - Zhao Zhao
- Department of Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450052, PR China
| | - Yanpeng Tian
- Department of Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450052, PR China
| | - Yue Li
- Department of Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450052, PR China
| | - Yafen Liu
- Department of Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450052, PR China
| | - Mei Ji
- Department of Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450052, PR China
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Riemma G, Pasanisi F, Reino A, Solazzo MC, Ronsini C. Robotic Single-Site Hysterectomy in Gynecologic Benign Pathology: A Systematic Review of the Literature. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59020411. [PMID: 36837612 PMCID: PMC9966893 DOI: 10.3390/medicina59020411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 02/08/2023] [Accepted: 02/17/2023] [Indexed: 02/22/2023]
Abstract
Background and objectives: Total hysterectomy is one of the most common gynecologic surgical procedures and it is mainly performed for benign pathologies. The introduction of robotic single-site surgery (RSS) as an acceptable alternative to laparoendoscopic surgery combines the advantages of robotics with the aesthetic result of a single incision. This study aims to review the existing literature on a single-site robotic hysterectomy in patients with benign pathologies and verify its safety and feasibility. Materials and Methods: Following the recommendations in the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement, FP and AR systematically screened the PubMed, Embase, and Scopus databases. No temporal or geographical limitation was discriminatory. Studies containing data about feasibility and safety were included. Results: From 219, only eight studies met the inclusion criteria, and a total of 212 patients were included with a mean patient age of 45.42 years old (range 28-49.5 years old) and a mean BMI of 25.74 kg/m2 (range 22-28.5 kg/m2). The mean presurgical time, including port placement and docking time, was 15.56 (range 3-30) minutes. Mean console time was reported in six studies and is 83.21 min (range 25-180 min). The mean operative time is 136.6 min (range 60-294 min) and the mean blood loss is 43.68 mL (range 15-300 mL). Only two patients in the total analyzed had intraoperative complications and no conversion to LPT occurred. The median hospital stay was 1.71 days (range 0.96-3.5 days). The postoperative complication rate was estimated at 1.4% (vaginal bleeding). Conclusions: Our review supports the safety and feasibility of robotic single-site hysterectomy for benign gynecological diseases.
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Giannini A, D’Oria O, Bogani G, Di Donato V, Vizza E, Chiantera V, Laganà AS, Muzii L, Salerno MG, Caserta D, Gerli S, Favilli A. Hysterectomy: Let's Step Up the Ladder of Evidence to Look Over the Horizon. J Clin Med 2022; 11:jcm11236940. [PMID: 36498515 PMCID: PMC9737634 DOI: 10.3390/jcm11236940] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 11/22/2022] [Indexed: 11/27/2022] Open
Abstract
Hysterectomy is one of the most common non-obstetric gynecological surgical procedures carried out in Western countries [...].
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Affiliation(s)
- Andrea Giannini
- Department of Medical and Surgical Sciences and Translational Medicine, PhD Course in “Translational Medicine and Oncology”, Sapienza University, 00185 Rome, Italy
- Department of Maternal and Child Health and Urological Sciences, Policlinico Umberto I, Sapienza University of Rome, 00185 Rome, Italy
- Correspondence:
| | - Ottavia D’Oria
- Department of Medical and Surgical Sciences and Translational Medicine, PhD Course in “Translational Medicine and Oncology”, Sapienza University, 00185 Rome, Italy
- Obstetrics and Gynecological Unit, Department of Woman’s and Child’s Health, San Camillo-Forlanini Hospital, 00152 Rome, Italy
| | - Giorgio Bogani
- Department of Maternal and Child Health and Urological Sciences, Policlinico Umberto I, Sapienza University of Rome, 00185 Rome, Italy
| | - Violante Di Donato
- Department of Maternal and Child Health and Urological Sciences, Policlinico Umberto I, Sapienza University of Rome, 00185 Rome, Italy
| | - Enrico Vizza
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, IRCSS-Regina Elena National Cancer Unit Institute, 00144 Rome, Italy
| | - Vito Chiantera
- Unit of Gynecologic Oncology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), ARNAS “Civico-Di Cristina-Benfratelli”, University of Palermo, 90133 Palermo, Italy
| | - Antonio Simone Laganà
- Unit of Gynecologic Oncology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), ARNAS “Civico-Di Cristina-Benfratelli”, University of Palermo, 90133 Palermo, Italy
| | - Ludovico Muzii
- Department of Maternal and Child Health and Urological Sciences, Policlinico Umberto I, Sapienza University of Rome, 00185 Rome, Italy
| | - Maria Giovanna Salerno
- Obstetrics and Gynecological Unit, Department of Woman’s and Child’s Health, San Camillo-Forlanini Hospital, 00152 Rome, Italy
| | - Donatella Caserta
- Department of Medical and Surgical Sciences and Translational Medicine, Gynecology Division, Sant’Andrea University Hospital, Sapienza University of Rome, Via di Grottarossa 1035, 00189 Rome, Italy
| | - Sandro Gerli
- Section of Obstetrics and Gynecology, Department of Medicine and Surgery, University of Perugia, 06123 Perugia, Italy
| | - Alessandro Favilli
- Section of Obstetrics and Gynecology, Department of Medicine and Surgery, University of Perugia, 06123 Perugia, Italy
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Li L, Chen Q, Zhang N, Yao X, Wang C. Use of antidepressants following hysterectomy with or without oophorectomy: A national sample in the US. Maturitas 2022; 167:32-38. [DOI: 10.1016/j.maturitas.2022.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 09/11/2022] [Accepted: 09/25/2022] [Indexed: 10/14/2022]
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Hong CX, Kamdar NS, Morgan DM. Predictors of same-day discharge following benign minimally invasive hysterectomy. Am J Obstet Gynecol 2022; 227:320.e1-320.e9. [PMID: 35580633 DOI: 10.1016/j.ajog.2022.05.026] [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: 01/03/2022] [Revised: 05/06/2022] [Accepted: 05/10/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Same-day discharge following minimally invasive hysterectomy has been shown to be safe and feasible in select populations, but many nonclinical factors influencing same-day discharge remain unexplored. OBJECTIVE To develop prediction models for same-day discharge following minimally invasive hysterectomy using both clinical and nonclinical attributes and to compare model concordance of individual attribute groups. STUDY DESIGN We performed a retrospective study of patients who underwent elective minimally invasive hysterectomy for benign gynecologic indications at 69 hospitals in a statewide quality improvement collaborative between 2012 and 2019. Potential predictors of same-day discharge were determined a priori and placed into 1 of 7 attribute groupings: intraoperative, surgeon, hospital, surgical timing, patient clinical, patient socioeconomic, and patient geographic attributes. To account for clustering of same-day discharge practices among surgeons and within hospitals, hierarchical multivariable logistic regression models were fitted using predictors from each attribute group individually and all predictors in a composite model. Receiver operator characteristic curves were generated for each model. The Hanley-McNeil test was used for comparisons, 95% confidence intervals for the areas under the receiver operator characteristic curve were calculated, and a P value of <.05 was considered significant. RESULTS Of the 23,513 patients in our study, 5062 (21.5%) had same-day discharge. The composite model had an area under the receiver operator characteristic curve of 0.770 (95% confidence interval, 0.763-0.777). Among models using factors from individual attribute groups, the model using intraoperative attributes had the highest concordance for same-day discharge (area under the receiver operator characteristic curve, 0.720; 95% confidence interval, 0.712-0.727). The models using surgeon and hospital attributes were the second and third most concordant, respectively (area under the receiver operator characteristic curve, 0.678; 95% confidence interval, 0.670-0.685; area under the receiver operator characteristic curve, 0.655; 95% confidence interval, 0.656-0.664). Models using surgical timing and patient clinical, socioeconomic, and geographic attributes had poor predictive ability (all areas under the receiver operator characteristic curve <0.6). CONCLUSION Clinical and nonclinical attributes contributed to a composite prediction model with good discrimination in predicting same-day discharge following minimally invasive hysterectomy. Factors related to intraoperative, hospital, and surgeon attributes produced models with the strongest predictive ability. Focusing on these attributes may aid efforts to improve utilization of same-day discharge following minimally invasive hysterectomy.
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Yang J, Fan X, Gao J, Li D, Xu Y, Chen G. Cost effectiveness analysis of total laparoscopic hysterectomy versus total abdominal hysterectomy for uterine fibroids in Western China: a societal perspective. BMC Health Serv Res 2022; 22:252. [PMID: 35209891 PMCID: PMC8867663 DOI: 10.1186/s12913-022-07644-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 02/15/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND As a common female pelvic tumor, uterine fibroids remain the leading cause for hysterectomy in China. Hysterectomy provides a good surgical treatment of uterine fibroids, and it guarantees the removal of all uterine fibroids without lower risk of recurrence. This study compares the cost effectiveness of total laparoscopic hysterectomy (TLH) versus total abdominal hysterectomy (TAH) for women with uterine fibroids from a societal perspective. METHODS An economic analysis was conducted in 392 patients (TLH n = 75; TAH n = 317), including all relevant costs over a 12-month time horizon. Primary outcome was major surgical complications; secondary outcomes were postoperative discomfort symptoms and time of return to normal activities. Clinical, outcomes and costs data were collected from medical records, telephone survey and financial information system. Generalized linear models were used to assess costs and outcomes differences between the two groups. Incremental cost effectiveness ratio (ICER) was used to estimate the cost effectiveness. RESULTS Mean direct costs were $2,925.71 for TLH, $2,436.24 for TAH, respectively. Mean indirect costs were $1,133.22 for TLH, $1,394.85 for TAH, respectively. Incremental societal costs were $256.86 (95%CI: 249.03-264.69). Mean differences in outcome were: 4.53% (95%CI: 4.35-4.71) for major surgical complications; 6.75% (95%CI: 6.45-7.05) for postoperative discomfort symptoms; 1.27 (95%CI: 1.23-1.30) weeks for time to return to normal activities. ICER of TLH was $5,669.16 (95%CI: 5,384.76-5,955.56) per complication averted, $3,801.54 (95%CI: 3,634.81-3,968.28) per postoperative discomfort symptoms averted and $202.96 (95%CI: 194.97-210.95) per week saved to return to normal activities. CONCLUSIONS TLH is cost effective compared with TAH in preventing additional complications based on our estimated conservative threshold in China. The findings provide useful information for researchers to conduct further cost effectiveness analysis based on prospective study which can provide stronger and more evidence, in China. In addition, the data may be useful for Chinese health care policy-makers and medical insurance payers to make related health care decisions.
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Affiliation(s)
- Jinjuan Yang
- School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, 710061, People's Republic of China
| | - Xiaojing Fan
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, 710049, People's Republic of China.
| | - Jianmin Gao
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, 710049, People's Republic of China.
| | - Dan Li
- School of Public Management, Northwest University School, Xi'an, 710127, People's Republic of China
| | - Yongjian Xu
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, 710049, People's Republic of China
| | - Gang Chen
- Monash Business School, Monash University, Clayton, VIC, 3145, Australia
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Taniguchi F. Strategies and Outcomes of Total Laparoscopic Hysterectomy for Large Uterine Cervical Fibroids. JSLS 2021; 25:JSLS.2021.00031. [PMID: 34866891 PMCID: PMC8603400 DOI: 10.4293/jsls.2021.00031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background and Objectives: To present the methods and outcomes of total laparoscopic hysterectomy with debulking surgery for large cervical fibroids. Methods: This is a single-center study. Twenty-one women who underwent total laparoscopic hysterectomy between October 1, 2012 and November 30, 2020 for large cervical fibroids (diameter ≥10 cm) based on a diagnosis by magnetic resonance imagining were enrolled. Conventional total laparoscopic hysterectomy for large cervical fibroids was initially attempted. If this could not be completed, debulking surgery, such as enucleation of large cervical fibroids or cervical amputation, was performed during total laparoscopic hysterectomy. Results: Total laparoscopic hysterectomy could be completed in all 21 patients with large cervical fibroids without blood transfusion. Conventional total laparoscopic hysterectomy was performed in four patients (19%), and 17 patients (81%) required debulking surgery at the time of total laparoscopic hysterectomy. The median diameter of the major axis of the cervical fibroid, uterine weight, intraoperative blood loss, and operative time were 12 cm, 750 g, 100 mL, and 191 min, respectively. Conclusion: Total laparoscopic hysterectomy for large cervical fibroids, although minimally invasive, requires a high level of laparoscopic skill. However, our data suggests that total laparoscopic hysterectomy for large cervical fibroids can be feasible, with an acceptable level of blood loss, by performing debulking surgeries such as enucleation of large cervical fibroids or cervical amputation.
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Affiliation(s)
- Fumiaki Taniguchi
- Department of Obstetrics and Gynecology, Takanohara Central Hospital, Nara City, Japan
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Antoun L, Smith P, Afifi Y, Cullis K, Clark TJ. Short stay laparoscopic hysterectomy: An evaluation of feasibility and patient satisfaction. Facts Views Vis Obgyn 2021; 13:377-385. [PMID: 35026099 PMCID: PMC9148708 DOI: 10.52054/fvvo.13.4.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background Short-stay total laparoscopic hysterectomy (TLH) could lead to reduced hospital costs and decrease complications associated with hospitalisation such as hospital acquired-infection and venous thromboembolism. Objective To evaluate the feasibility, safety and patient satisfaction of a novel short ‘less than 23-hour’ stay TLH protocol. Material and Methods Prospective cohort study, at Birmingham Women’s Hospital, United Kingdom including eligible women undergoing TLH for benign indications or early stage cervical/endometrial cancer. Main outcome measures Feasibility of discharge within 23-hours following TLH. Surgical complications and readmission rates were collected within 30-days of hysterectomy and patient’s satisfaction was assessed at 6-weeks. Results Of the 128 eligible women, 104/128 women (81%) were discharged within 23-hours of admission, of which 62/104 or 60% (48.4% of the whole cohort) were discharged on the same day. Adenomyosis/fibroids, and previous caesarean sections were associated with a greater likelihood of stay beyond 23-hours (P<0.05). The overall complications rate was 13/128 (10%) with two grade-3 Clavien-Dindo intraoperative complications; one serosal bowel injury oversewn and one ureteric injury requiring reimplantation. The readmissions rate was 5/128 (4%). 94% of patients were ‘happy’ or ‘very happy’ with the pathway, although satisfaction was higher in short-stay patients (RR 1.2; 95% CI 0.95–1.94). Conclusion Hospital discharge within 23-hours of TLH appears to be safe, feasible and acceptable to patients where a standardised, multidisciplinary care protocol is used. What is new? Our study is the first prospective case series in the UK reporting the safety and acceptability for performing laparoscopic hysterectomy as a 23-hour day case procedure.
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Nakayama J, Hayashi E, Shahin M, DeLozier S, El-Nashar SA. An Evaluation of Gynecologic Procedure Billing by Medicare. J Gynecol Surg 2021. [DOI: 10.1089/gyn.2020.0218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- John Nakayama
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Emi Hayashi
- Department of Medicine, Mount Sinai Hospital, New York, New York, USA
| | - Mark Shahin
- Abington Jefferson Hospital, Hanjani Institute for Gynecologic Oncology, Asplundh Cancer Pavilion, Sidney Kimmel Cancer Center of Thomas Jefferson University, Willow Grove, Pennsylvania, USA
| | - Sarah DeLozier
- Clinical Research Center, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Sherif A. El-Nashar
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
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Gynecologic Surgery Proportion and Utilization Trends in the NSQIP Database from 2010 Through 2015 with Correlation to Technology and Policy. J Gynecol Surg 2021. [DOI: 10.1089/gyn.2020.0180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Lungu DA, Foresi E, Belardi P, Nuti S, Giannini A, Simoncini T. The Impact of New Surgical Techniques on Geographical Unwarranted Variation: The Case of Benign Hysterectomy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18136722. [PMID: 34206452 PMCID: PMC8297008 DOI: 10.3390/ijerph18136722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 06/18/2021] [Accepted: 06/19/2021] [Indexed: 11/16/2022]
Abstract
Since the 1980s, the international literature has reported variations for healthcare services, especially for elective ones. Variations are positive if they reflect patient preferences, while if they do not, they are unwarranted, and thus avoidable. Benign hysterectomy is among the most frequent elective surgical procedures in developed countries, and, in recent years, it has been increasingly delivered through minimally invasive surgical techniques, namely laparoscopic or robotic. The question therefore arises over what the impact of these new surgical techniques on avoidable variation is. In this study we analyze the extent of unwarranted geographical variation of treatment rates and of the adoption of minimally invasive procedures for benign hysterectomy in an Italian regional healthcare system. We assess the impact of the surgical approach on the provision of benign hysterectomy, in terms of efficiency (by measuring the average length of stay) and efficacy (by measuring the post-operative complications). Geographical variation was observed among regional health districts for treatment rates and waiting times. At a provider level, we found differences for the minimally invasive approach. We found a positive and significant association between rates and the percentage of minimally invasive procedures. Providers that frequently adopt minimally invasive procedures have shorter average length of stay, and when they also perform open hysterectomies, fewer complications.
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Affiliation(s)
- Daniel Adrian Lungu
- Management and Healthcare Laboratory, Institute of Management and Department EMbeDS, Scuola Superiore Sant’Anna, 56127 Pisa, Italy; (E.F.); (P.B.); (S.N.)
- Correspondence:
| | - Elisa Foresi
- Management and Healthcare Laboratory, Institute of Management and Department EMbeDS, Scuola Superiore Sant’Anna, 56127 Pisa, Italy; (E.F.); (P.B.); (S.N.)
| | - Paolo Belardi
- Management and Healthcare Laboratory, Institute of Management and Department EMbeDS, Scuola Superiore Sant’Anna, 56127 Pisa, Italy; (E.F.); (P.B.); (S.N.)
| | - Sabina Nuti
- Management and Healthcare Laboratory, Institute of Management and Department EMbeDS, Scuola Superiore Sant’Anna, 56127 Pisa, Italy; (E.F.); (P.B.); (S.N.)
| | - Andrea Giannini
- Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy; (A.G.); (T.S.)
| | - Tommaso Simoncini
- Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy; (A.G.); (T.S.)
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14
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Lycke KD, Kahlert J, Damgaard R, Mogensen O, Hammer A. Trends in Hysterectomy Incidence Rates During 2000-2015 in Denmark: Shifting from Abdominal to Minimally Invasive Surgical Procedures. Clin Epidemiol 2021; 13:407-416. [PMID: 34103999 PMCID: PMC8180274 DOI: 10.2147/clep.s300394] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 04/17/2021] [Indexed: 12/16/2022] Open
Abstract
Background Hysterectomy (removal of the uterus) is a common surgical procedure in gynecology. Although minimally invasive surgical procedures have been introduced, hysterectomy is still associated with risk of short- and long-term complications. Given that hysterectomized women are no longer at risk of either hysterectomy or being diagnosed with endometrial or cervical cancer, it is important to describe trends in hysterectomy rates. Objective To describe trends in hysterectomy incidence rates overall and stratified by age, indication, and procedure. Methods Nationwide population-based cohort study using Danish national registries, 2000–2015, was conducted. We calculated the overall hysterectomy-corrected and age-standardized incidence rates of hysterectomy among women ≥20 years old. Incidence rates were stratified by age group, indication, and surgical procedure. We performed trend analyses using Joinpoint regression, thereby estimating the average annual percentage change (AAPC). Results A total of 98,484 women had a hysterectomy during the study period, corresponding to an overall age-standardized, hysterectomy-corrected hysterectomy incidence rate (SIR) of 351.1 per 100,000 person-years (95% CI 348.9;353.3). SIR of hysterectomy declined over time (AAPC −1.4; 95% CI −1.9;-1.0), which was driven by a decline in rates of benign hysterectomy (AAPC −2.1; 95% CI −2.7;-1.6). Irrespective of indication, rates of abdominal hysterectomy declined substantially during the study period and were surpassed by rates of minimally invasive procedures (ie, laparoscopy and robot-assisted laparoscopy) in 2013. Conclusion Hysterectomy-corrected incidence rates of benign hysterectomy declined over time. Irrespective of indication, we observed a shift in surgical procedure over time, from abdominal hysterectomy to minimally invasive surgical procedures.
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Affiliation(s)
- Kathrine Dyhr Lycke
- Department of Obstetrics and Gynecology, NIDO
- Denmark, Gødstrup Hospital, Herning, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Johnny Kahlert
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Rikke Damgaard
- Department of Obstetrics and Gynecology, NIDO
- Denmark, Gødstrup Hospital, Herning, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Ole Mogensen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Anne Hammer
- Department of Obstetrics and Gynecology, NIDO
- Denmark, Gødstrup Hospital, Herning, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
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15
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Duangpirom W, Pattanaprateep O, Vallibhakara O, Hongsakorn W, Sophonsritsuk A. Cost-Utility Analysis of Total Abdominal Versus Total Laparoscopic Hysterectomy in a Thai University Hospital. J Gynecol Surg 2021. [DOI: 10.1089/gyn.2020.0108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Warat Duangpirom
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Ramathidodi Hospital, Mahidol University, Bangkok, Thailand
| | - Oraluck Pattanaprateep
- Section for Clinical Epidemiology and Biostatistics, and Faculty of Medicine, Ramathidodi Hospital, Mahidol University, Bangkok, Thailand
| | - Orawin Vallibhakara
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Ramathidodi Hospital, Mahidol University, Bangkok, Thailand
- Reproductive Endocrinology and Infertility Unit, Faculty of Medicine, Ramathidodi Hospital, Mahidol University, Bangkok, Thailand
| | - Woradej Hongsakorn
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Ramathidodi Hospital, Mahidol University, Bangkok, Thailand
- Reproductive Endocrinology and Infertility Unit, Faculty of Medicine, Ramathidodi Hospital, Mahidol University, Bangkok, Thailand
| | - Areepan Sophonsritsuk
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Ramathidodi Hospital, Mahidol University, Bangkok, Thailand
- Reproductive Endocrinology and Infertility Unit, Faculty of Medicine, Ramathidodi Hospital, Mahidol University, Bangkok, Thailand
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16
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vNOTES Hysterectomy with Sentinel Lymph Node Mapping for Endometrial Cancer: Description of Technique and Perioperative Outcomes. J Minim Invasive Gynecol 2021; 28:1254-1261. [PMID: 33516958 DOI: 10.1016/j.jmig.2021.01.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 01/08/2021] [Accepted: 01/24/2021] [Indexed: 11/21/2022]
Abstract
STUDY OBJECTIVE To explore the technique and clinical value of transvaginal natural orifice transluminal endoscopic surgery (vNOTES) in hysterectomy and sentinel lymph node (SLN) mapping for endometrial cancer by comparing its perioperative outcomes with those of laparoscopic staging. DESIGN Retrospective cohort study. SETTING Department of gynecology at a tertiary medical center. PATIENTS All women diagnosed with endometrial cancer who underwent minimally invasive surgery at our center between August 2017 and May 2020. INTERVENTIONS Both vNOTES and laparoscopic approaches were used for hysterectomy and SLN mapping. The success of SLN detection as well as perioperative outcomes were subsequently analyzed. MEASUREMENTS AND MAIN RESULTS This study included 74 patients; 23 patients underwent vNOTES surgery, whereas 51 underwent standard laparoscopic surgery. The total successful SLN detection was 95.7% in the vNOTES group and 92.2% in the laparoscopy group (p >.05), whereas the bilateral success rates were 87.0% and 90.2%, respectively. No difference in SLN detection was observed between the 2 groups in terms of the side-specific mapping efficacy quotient (91.3% vs 91.2%, p = .47). The number of harvested SLNs, operative time, estimated blood loss, and intraoperative complications in the 2 groups were similar. One (4.3%) postoperative complication occurred in the vNOTES group vs 4 (7.9%) in the laparoscopy group (p = .029), and the median postoperative hospital stay was 3 days vs 4 days (p = .003). CONCLUSION This study suggests that the vNOTES procedure is feasible, with a potentially decreased postoperative hospital stay, faster recovery, and better cosmetic results. However, prospective research is needed to validate its broader clinical application.
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17
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Winner BA, Ross WT, Dukes J, Biest SW. Impact of a High-Volume Gynecologic Surgeon Preceptor on Benign Laparoscopic Hysterectomy. J Gynecol Surg 2020. [DOI: 10.1089/gyn.2019.0091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Brooke A. Winner
- Department of Obstetrics and Gynecology, University of Washington, Seattle, Washington, USA
| | - Whitney Trotter Ross
- Department of Obstetrics and Gynecology, Penn State Health, Hershey, Pennsylvania, USA
| | - Jonathan Dukes
- Department of Advanced Analytics, Ascension Health, St. Louis, Missouri, USA
| | - Scott W. Biest
- Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, Missouri, USA
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18
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Society of gynecologic oncology future of physician payment reform task force: Lessons learned in developing and implementing surgical alternative payment models. Gynecol Oncol 2020; 156:701-709. [PMID: 31916980 DOI: 10.1016/j.ygyno.2019.12.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 12/23/2019] [Indexed: 11/24/2022]
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19
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Mui J, Gottenbos L, Liu C, Hejazi S, Mohtashami F. Increasing the Technicity Index to 92% in a Community Hospital: A 5-Year Retrospective Review. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 41:1709-1716. [PMID: 30948338 DOI: 10.1016/j.jogc.2019.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 02/04/2019] [Accepted: 02/06/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE This study describes the observed trends in hysterectomy routes at Langley Memorial Hospital (LMH) in Langley, British Columbia, over 5 consecutive years. Associations between patient characteristics and surgical approach were explored, and approach-based surgical outcomes were evaluated using the institutional technicity index (TI), defined as the ratio of hysterectomies performed by minimally invasive surgery to all hysterectomies. METHODS A retrospective descriptive study involving 706 women who underwent hysterectomy at LMH between January 1, 2012 and December 31, 2016 by six full-time surgeons was performed. From the patient characteristics and surgical outcomes associated with the route of hysterectomy, the annual institutional and overall rates of hysterectomy by type were calculated according to the Canadian Task Force Classification II-2. RESULTS The TI increased from 67% to 92% from 2012 to 2016. Specifically, the proportion of hysterectomies completed by a total laparoscopic approach increased from 37% to 78%, whereas hysterectomies performed by the abdominal or laparoscopic-assisted vaginal approach decreased from 32% to 8% and from 17% to 1%, respectively. Vaginal hysterectomy rates remained constant across the study period. Minimally invasive surgery was associated with significantly reduced surgical blood loss and decreased length of hospital stay, with no difference in surgical time compared with an open approach. CONCLUSIONS As far as the study investigators are aware, the TI at LMH is among the highest reported to date in Canada. Potential contributing factors include well-trained and experienced gynaecologic surgeons, readily available peer-to-peer mentorship, certified gynaecologic assistance, dedicated surgical staff, and consistency in the operating room set-up. Hence, achieving a high TI in a community setting is feasible without increasing the risk of surgical complications or length of surgery.
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Affiliation(s)
- Justin Mui
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of British Columbia, Vancouver, BC
| | - Lila Gottenbos
- Department of Obstetrics and Gynecology, Langley Memorial Hospital, Fraser Health Authority, Langley, BC
| | - Christine Liu
- Faculty of Medicine, University of British Columbia, Vancouver, BC
| | - Samar Hejazi
- Department of Evaluation and Research Services, Fraser Health Authority, Surrey, BC
| | - Fariba Mohtashami
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of British Columbia, Vancouver, BC; Department of Obstetrics and Gynecology, Langley Memorial Hospital, Fraser Health Authority, Langley, BC.
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20
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Thurston J, Murji A, Scattolon S, Wolfman W, Kives S, Sanders A, Leyland N. No 377- Indications gynécologiques bénignes de l'hystérectomie. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 41:558-574. [DOI: 10.1016/j.jogc.2019.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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21
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Moawad G, Tyan P, Marfori C, Abi Khalil E, Park D. Effect of postoperative partial bladder filling after minimally invasive hysterectomy on postanesthesia care unit discharge and cost: a single-blinded, randomized controlled trial. Am J Obstet Gynecol 2019; 220:367.e1-367.e7. [PMID: 30639089 DOI: 10.1016/j.ajog.2018.12.034] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 12/19/2018] [Accepted: 12/20/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Hysterectomy is one of the most common surgical procedures performed each year with substantial related health care costs. This trial studied the effect of postoperative bladder backfilling to submicturition level in the operating room and its effect on early postoperative patient care and related cost. OBJECTIVE The objective of the study was to compare the effect of bladder backfilling on early postoperative patient care and related cost. STUDY DESIGN This was a randomized, single-blinded, controlled trial conducted between April 2016 and February 2017 at a single urban university hospital providing tertiary care for minimally invasive gynecologic surgery. Ninety-one patients undergoing straight-stick laparoscopic and robot-assisted hysterectomy by minimally invasive gynecologic surgeons for benign indications were recruited. The bladder was partially backfilled with 150 mL of normal saline postoperatively in the intervention group and drained in the control group, as per standard of care. Main outcomes studied were time needed to void, time spent in the postanesthesia care unit, and postanesthesia care unit cost after minimally invasive hysterectomy. Our secondary outcomes were postoperative complications. RESULTS Forty-six patients (50.5%) were randomized to the intervention group, and 45 patients (49.5%) to the control group. Baseline comparative analysis of demographics and preoperative patient-specific variables, surgical history, intraoperative characteristics, and administered medications found the 2 groups to be largely homogenous. After regression analyses for adjustment, we found a significant reduction in the time needed to void, time spent in the postanesthesia care unit, and postanesthesia care unit-associated cost in the intervention group. Patients voided 64.9 minutes earlier than the control group (P = .015) ans spent 64 fewer minutes in the postanesthesia care unit (P = .006), resulting in $401.5 (USD) saving per patient (P = .006). None of the patients encountered any postoperative complications. CONCLUSION Based on the findings of this randomized clinical trial, postoperative bladder backfilling to submicturition level shortens the time needed for patients to void in the postanesthesia care unit, resulting in shorter postanesthesia care unit stay and resultant cost savings. Conservatively projecting our findings on minimally invasive hysterectomy procedure is estimated to result in $69 million to $139 million (USD) per year in savings. Initiating similar investigations in other ambulatory surgical fields will likely result in a more substantial impact.
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Affiliation(s)
- Gaby Moawad
- Department of Obstetrics and Gynecology, Division of Minimally Invasive Gynecologic Surgery, George Washington University Hospital, Washington, DC.
| | - Paul Tyan
- Department of Obstetrics and Gynecology, Division of Minimally Invasive Gynecologic Surgery, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Cherie Marfori
- Department of Obstetrics and Gynecology, Division of Minimally Invasive Gynecologic Surgery, George Washington University Hospital, Washington, DC
| | - Elias Abi Khalil
- Department of Obstetrics and Gynecology, Division of Minimally Invasive Gynecologic Surgery, George Washington University Hospital, Washington, DC
| | - Daniel Park
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, George Washington University, Washington, DC
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22
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Thurston J, Murji A, Scattolon S, Wolfman W, Kives S, Sanders A, Leyland N. No. 377-Hysterectomy for Benign Gynaecologic Indications. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 41:543-557. [DOI: 10.1016/j.jogc.2018.12.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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23
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Tyan P, Robinson J, Dandapani M, Li J, Gu A, Moawad GN. Novel Approach for 2-Port Laparoscopic Hysterectomy. Surg Innov 2019; 26:442-448. [PMID: 30907239 DOI: 10.1177/1553350619827693] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Objectives. To describe a novel technique for a port-reducing laparoscopic hysterectomy. The 2-port laparoscopic hysterectomy (TPH) is performed through two 5-mm ports without the use of any multiport channels. We demonstrate outcomes via a large case series. We also describe and provide a video showing the TPH technique. Methods. Retrospective comparative study between the newly developed TPH and the conventional 4-port hysterectomy techniques. Variables of patients who underwent a TPH with fellowship-trained gynecologic surgeons at a single academic university hospital were collected through electronic medical records chart review. Results. Forty-five patients underwent a TPH. Mean age was 39.4, body mass index was 28.5 kg/m2, and uterine weight was 170.0 g. Our outcomes of interest were operative time (98.4 minutes, mean), estimated blood loss (65.6 mL, mean), conversion to 3-port (1/45), and intraoperative (0/45) and postoperative (5/45) complications. By comparing the TPH to the conventional 4-port laparoscopic hysterectomy within a similar setting, we provide insight into variables that prompt the minimally invasive gynecologic surgeon to perform a port-reducing procedure. Patients were more likely to be allocated for a TPH if they were younger (37.8 vs 44.7, P = .005), had a lower body mass index (29.0 vs 32.5, P = .07), smaller uterus (143.1 vs 672.3 g, P < .001), and were white (56.8% and 22.4%, P < .001). Conclusions. The TPH is a novel port-reducing hysterectomy that is safe in a subset of patients with small uteri and limited surgical history who require no other surgical interventions at the time of hysterectomy.
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Affiliation(s)
- Paul Tyan
- 1 University of North Carolina, Chapel Hill, NC, USA
| | - James Robinson
- 2 Georgetown University, Washington, DC, USA.,3 MedStar Washington Hospital Center, Washington, DC, USA
| | | | - Jessica Li
- 5 George Washington University, Washington, DC, USA
| | - Alex Gu
- 5 George Washington University, Washington, DC, USA
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24
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Predictors of Overnight Admission after Minimally Invasive Hysterectomy in the Expert Setting. J Minim Invasive Gynecol 2019; 26:122-128. [DOI: 10.1016/j.jmig.2018.04.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 04/19/2018] [Accepted: 04/20/2018] [Indexed: 11/22/2022]
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25
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Buttigieg SC, Gauci D, Bezzina F, Dey PK. Post-surgery length of stay using multi-criteria decision-making tool. J Health Organ Manag 2018; 32:514-531. [PMID: 29969350 DOI: 10.1108/jhom-08-2017-0196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose Length of stay (LOS) in hospital after surgery varies for each patient depending on surgeon's decision that considers criticality of the surgery, patient's conditions before and after surgery, expected time to recovery and experience of the surgeon involved. Decision on patients' LOS at hospital post-surgery affects overall healthcare performance as it affects both cost and quality of care. The purpose of this paper is to develop a model for deriving the most appropriate LOS after surgical interventions. Design/methodology/approach The study adopts an action research involving multiple stakeholders (surgeon, patients/patients' relatives, hospital management and other medics). First, a conceptual model is developed using literature and experts' opinion. Second, the model is applied in three surgical interventions in a public hospital in Malta to demonstrate the effectiveness of the model. Third, the policy alternatives developed are compared to a selection of current international standards for each surgical intervention. The proposed model analyses three LOS threshold policies for three procedures using efficiency and responsiveness criteria. The entire analysis is carried out using 325 randomly selected patient files along with structured interactions with more than 50 stakeholders (surgeon, patients/patients' relatives, hospital management and other medics). A multiple criteria decision-making method is deployed for model building and data analysis. The method involves combining the analytic hierarchy process (AHP) for verbal subjective judgements on prioritizing the four predictors of surgical LOS-medical, financial, social and risk, with pairwise comparisons of the sub-criteria under each criterion in line with the concerned interventions-the objective data of which are obtained from the patients' files. Findings The proposed model was successfully applied to decide on the best policy alternative for LOS for the three interventions. The best policy alternatives compared well to current international benchmarks. Research limitations/implications The proposed method needs to be tested for other interventions across various healthcare settings. Practical implications Multi-criteria decision-making tools enable resource optimization and overall improvement of patient care through the application of a scientific management technique that involves all relevant stakeholders while utilizing both subjective judgements as well as objective data. Originality/value Traditionally, the duration of post-surgery LOS is mainly based on the surgeons' clinical but also arbitrary decisions, with, as a result, having insufficiently explicable variations in LOS amongst peers for similar interventions. According to the authors' knowledge, this is the first attempt to derive post-surgery LOS using the AHP, a multiple criteria decision-making method.
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Affiliation(s)
- Sandra C Buttigieg
- Department of Health Services Management, Faculty of Health Sciences, University of Malta , Msida, Malta
- School of Social Policy, College of Social Sciences, University of Birmingham , Birmingham, UK
| | - Dorothy Gauci
- Department of Health Services Management, Faculty of Health Sciences, University of Malta , Msida, Malta
| | - Frank Bezzina
- Department of Management, Faculty of Economics, Management and Accountancy, University of Malta , Msida, Malta
| | - Prasanta K Dey
- Aston Business School, Aston University , Birmingham, UK
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Cassis C, Mukhopadhyay S, Sule MM, Kuruba N. Feasibility of early discharge following vaginal hysterectomy with a bipolar electrocoagulation device. Int J Gynaecol Obstet 2018; 142:182-186. [PMID: 29718559 DOI: 10.1002/ijgo.12515] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 03/02/2018] [Accepted: 04/27/2018] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To evaluate the safety and efficacy of vaginal hysterectomy for benign conditions (excluding prolapse) using the BiClamp (Erbe Elektromedizin, Tübingen, Germany) bipolar electrocoagulation system. METHODS The present study was a prospective audit of a consecutive case series of patients who underwent vaginal hysterectomy for benign conditions, performed using the BiClamp between March 1, 2015, and June 30, 2016, at Norfolk and Norwich University Hospital, Norwich, UK. Surgeries performed for benign conditions were eligible, excluding prolapse; severe endometriosis with pelvic adhesions was an exclusion criterion. Patient demographics and past history were recorded, along with intraoperative findings and adverse events. Follow-up data were obtained via telephone interviews 24 hours after surgery and a nurse-led postoperative clinic 8 weeks postoperatively. RESULTS The series included 75 patients; 32 (43%) were discharged on the same day as surgery and 70 (93%) within 23 hours. There were two patients who experienced vault hematomas and remained admitted for more than 24 hours. There was one intraoperative bladder injury that was repaired vaginally. No delayed adverse events occurred within 8 weeks. No patient required patient-controlled analgesia or an epidural injection for postoperative analgesia. CONCLUSION Patients experienced low postoperative pain following BiClamp treatment and 93% were was discharged within 23 hours.
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Affiliation(s)
| | | | - Medha M Sule
- Norfolk and Norwich University Hospital, Norwich, UK
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27
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Uccella S, Malzoni M, Cromi A, Seracchioli R, Ciravolo G, Fanfani F, Shakir F, Gueli Alletti S, Legge F, Berretta R, Corrado G, Casarella L, Donarini P, Zanello M, Perrone E, Gisone B, Vizza E, Scambia G, Ghezzi F. Laparoscopic vs transvaginal cuff closure after total laparoscopic hysterectomy: a randomized trial by the Italian Society of Gynecologic Endoscopy. Am J Obstet Gynecol 2018; 218:500.e1-500.e13. [PMID: 29410107 DOI: 10.1016/j.ajog.2018.01.029] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 01/10/2018] [Accepted: 01/23/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND Vaginal cuff dehiscence following hysterectomy is considered an infrequent but potentially devastating complication. Different possible techniques for cuff closure have been proposed to reduce this threatening adverse event. OBJECTIVE The aim of the present randomized study was to compare laparoscopic and transvaginal suture of the vaginal vault at the end of a total laparoscopic hysterectomy, in terms of incidence of vaginal dehiscence and vaginal cuff complications. Factors associated with vaginal dehiscence were also analyzed. This article presents the results of the interim analysis of the trial. STUDY DESIGN Patients undergoing total laparoscopic hysterectomy for benign indications were randomized at the time of colpotomy to receive vaginal closure through transvaginal vs laparoscopic approach using a 1:1 ratio. Allocation concealment was obtained using a password-protected randomization database. Monopolar energy for colpotomy was set at 60W. Vaginal closure was performed with a single-layer running braided and coated 0-polyglactin suture. In all cases an attempt was performed to include the posterior peritoneum in the suture. Laparoscopic knots were tied intracorporeally. All patients were scheduled for a postoperative follow-up visit 3 months after surgery, to detect possible vaginal cuff complications. Univariate and multivariable analyses were performed to identify independent predictors of vaginal cuff dehiscence after total laparoscopic hysterectomy. RESULTS After enrollment of 1408 patients, a prespecified interim analysis was conducted. Thirteen (0.9%) women did not undergo the postoperative assessment and were excluded. Baseline characteristics of the 1395 patients included (695 in the transvaginal group and 700 in the laparoscopic group) were similar between groups. Patients in the transvaginal group had a significantly higher incidence of vaginal dehiscence (2.7% vs 1%; odds ratio, 2.78; 95% confidence interval, 1.16-6.63; P = .01) and of any cuff complication (9.8% vs 4.7%; odds ratio, 2.19; 95% confidence interval, 1.43-3.37; P = .0003). Based on these findings, the data monitoring committee recommended that the trial be terminated early. After multivariable analysis, transvaginal closure of the vault was independently associated with a higher incidence of vaginal dehiscence and any vaginal complication; premenopausal status and smoking habit were independently associated with a higher risk of dehiscence. CONCLUSION Laparoscopic closure of the vaginal cuff at the end of total laparoscopic hysterectomy is associated with a significant reduction of vaginal dehiscence, any cuff complication, vaginal bleeding, vaginal cuff hematoma, postoperative infection, need for vaginal resuture, and reintervention.
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Affiliation(s)
- Stefano Uccella
- Department of Woman and Child Health, Fondazione "Policlinico Universitario A. Gemelli," Rome, Italy; Department of Obstetrics and Gynecology, University of Insubria, Del Ponte Hospital, Varese, Italy.
| | - Mario Malzoni
- Endoscopica Malzoni-Center for Advanced Endoscopic Gynecological Surgery, Avellino, Italy
| | - Antonella Cromi
- Department of Obstetrics and Gynecology, University of Insubria, Del Ponte Hospital, Varese, Italy
| | - Renato Seracchioli
- Minimally Invasive Gynecological Surgery Unit, Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - Giuseppe Ciravolo
- Department of Obstetrics and Gynecology, Spedali Civili di Brescia, Brescia, Italy
| | - Francesco Fanfani
- Department of Medicine and Aging Sciences, University "Gabriele d'Annunzio" of Chieti-Pescara, Chieti, Italy
| | - Fevzi Shakir
- Department of Obstetrics and Gynecology, Royal Free Hospital, London, United Kingdom
| | - Salvatore Gueli Alletti
- Department of Woman and Child Health, Fondazione "Policlinico Universitario A. Gemelli," Rome, Italy
| | - Francesco Legge
- Division of Gynecology, Department of Obstetrics and Gynecology, "F. Miulli" General Hospital, Acquaviva delle Fonti, Bari, Italy
| | - Roberto Berretta
- Department of Gynecology and Obstetrics, University of Parma, Parma, Italy
| | - Giacomo Corrado
- Department of Woman and Child Health, Fondazione "Policlinico Universitario A. Gemelli," Rome, Italy
| | - Lucia Casarella
- Endoscopica Malzoni-Center for Advanced Endoscopic Gynecological Surgery, Avellino, Italy
| | - Paolo Donarini
- Department of Obstetrics and Gynecology, Spedali Civili di Brescia, Brescia, Italy
| | - Margherita Zanello
- Minimally Invasive Gynecological Surgery Unit, Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - Emanuele Perrone
- Gynecologic Oncology Unit, Fondazione "Policlinico Universitario A. Gemelli," Catholic University, Rome, Italy
| | - Baldo Gisone
- Department of Obstetrics and Gynecology, University of Insubria, Del Ponte Hospital, Varese, Italy
| | - Enrico Vizza
- Department of Oncological Surgery, Gynecologic Oncologic Unit, "Regina Elena" National Cancer Institute, Rome, Italy
| | - Giovanni Scambia
- Gynecologic Oncology Unit, Fondazione "Policlinico Universitario A. Gemelli," Catholic University, Rome, Italy
| | - Fabio Ghezzi
- Department of Obstetrics and Gynecology, University of Insubria, Del Ponte Hospital, Varese, Italy
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Ko EM, Havrilesky LJ, Alvarez RD, Zivanovic O, Boyd LR, Jewell EL, Timmins PF, Gibb RS, Jhingran A, Cohn DE, Dowdy SC, Powell MA, Chalas E, Huang Y, Rathbun J, Wright JD. Society of Gynecologic Oncology Future of Physician Payment Reform Task Force report: The Endometrial Cancer Alternative Payment Model (ECAP). Gynecol Oncol 2018; 149:232-240. [DOI: 10.1016/j.ygyno.2018.02.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 02/14/2018] [Accepted: 02/17/2018] [Indexed: 01/07/2023]
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Augusto KL, Brilhante AVM, Modesto GCD, Saboia DM, Rocha CFC, Karbage SAL, de Magalhães TF, Bezerra LRPS. Costs and mortality rates of surgical approaches to hysterectomy in Brazil. Rev Saude Publica 2018; 52:25. [PMID: 29561962 PMCID: PMC6257415 DOI: 10.11606/s1518-8787.2018052000129] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Accepted: 04/24/2017] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To analyze the costs of hysterectomies performed in Brazil due to benign conditions, and to assess its hospital admittance and mortality rates. METHODS A retrospective cohort was carried out from January 2010 to December 2014, analyzing all hysterectomies (n = 428,346) registered on the DATASUS database between January 2010 and December 2014. Data were collected through a structured questionnaire and analyzed using the SPSS 20.0 for Windows. RESULTS Hospital admissions were 300,231 for total abdominal hysterectomies, 46,056 for vaginal hysterectomies, 29,959 for subtotal abdominal hysterectomies and 1,522 for laparoscopic hysterectomies. Mortality rates were 0.26%, 0.09%, 0.07% and 0.05% for subtotal, total abdominal, laparoscopic, and vaginal hysterectomies, respectively. Among the procedures studied, total abdominal hysterectomies had the most costs (R$217,802,574.77), followed by vaginal hysterectomies (R$24,173,490.00), subtotal abdominal hysterectomies (R$19.253.300,00) and laparoscopic hysterectomies (R$794,680.40). CONCLUSIONS Total abdominal hysterectomies had the highest overall costs mainly because it was the most commonly performed technique. Mortality rates were greatest in subtotal abdominal hysterectomies; this, however, may be due to bias related to missing data in our database.
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Affiliation(s)
- Kathiane Lustosa Augusto
- Universidade Federal do Ceará. Faculdade de Medicina. Maternidade Escola Assis Chateaubriand. Fortaleza, CE, Brasil
| | | | | | - Dayana Maia Saboia
- Universidade Federal do Ceará. Programa de Pós-Graduação em Enfermagem. Fortaleza, CE, Brasil
| | | | - Sara Arcanjo Lino Karbage
- Universidade Federal do Ceará. Faculdade de Medicina. Maternidade Escola Assis Chateaubriand. Fortaleza, CE, Brasil
| | - Thaís Fontes de Magalhães
- Universidade Federal do Ceará. Programa de Pós-Graduação em Ciências Clínico-Cirúrgicas. Fortaleza, CE, Brasil
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Preoperative Factors That Predict the Need to Morcellate in Total Laparoscopic Hysterectomy. J Minim Invasive Gynecol 2018; 25:158-162. [DOI: 10.1016/j.jmig.2017.09.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 08/22/2017] [Accepted: 09/17/2017] [Indexed: 12/28/2022]
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Moawad G, Liu E, Song C, Fu AZ. Movement to outpatient hysterectomy for benign indications in the United States, 2008-2014. PLoS One 2017; 12:e0188812. [PMID: 29190666 PMCID: PMC5708798 DOI: 10.1371/journal.pone.0188812] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 10/30/2017] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION The past decade has witnessed adoption of conservative gynecologic treatments, including minimally invasive surgery (MIS), alongside steady declines in inpatient hysterectomies. It remains unclear what factors have contributed to trends in outpatient benign hysterectomy (BH), as well as whether these trends exacerbate disparities. MATERIALS AND METHODS Retrospective cohort of 527,964 women ≥18 years old who underwent BH from 2008 to 2014. BH surgical approaches included: open/abdominal hysterectomy (AH), vaginal hysterectomy (VH), laparoscopic hysterectomy (LH), and robotic-assisted hysterectomy (RH). Quarterly frequencies were calculated by care setting and surgical approach. We used multilevel logistic regression (MLR) using the most recent year of data (2014) to examine the influence of patient-, physician-, and hospital-level preoperative factors and surgical approaches on outpatient migration. RESULTS From 2008-2014, surgical approaches for LH and RH increased, which coincided with decreases in VH and AH. Overall, a 44.2% shift was observed from inpatient to outpatient settings (P<0.0001). Among all outpatient visits MIS increased, particularly for RH (3.6% to 41.07%). We observed increases in the proportion of non-Hispanic Black and Medicaid patients who obtained MIS in 2014 vs. 2008 (P<0.001). Surgical approach (51.8%) and physician outpatient MIS experience (19.9%) had the greatest influence on predicting outpatient BH. Compared with LH, RH was associated with statistically significantly higher likelihood of outpatient BH overall (OR 1.23; 95% CI, 1.16-1.31), as well as in sub-analyses of more complex cases and hospitals that performed ≥1 RH (P<0.05). CONCLUSION From 2008-2014, rates of LH and RH significantly increased. A significant shift from inpatient to outpatient setting was observed. These findings suggest that RH may facilitate the shift to outpatient BH, particularly for patients with complexities. The adoption of MIS in outpatient settings may improve access to disadvantaged patient groups.
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Affiliation(s)
- Gaby Moawad
- George Washington University, Washington, DC, United States of America
| | - Emelline Liu
- Intuitive Surgical, Inc, Sunnyvale, California, United States of America
| | - Chao Song
- Intuitive Surgical, Inc, Sunnyvale, California, United States of America
| | - Alex Z. Fu
- Georgetown University Medical Center, Washington, DC, United States of America
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Gutman RE, Morgan D, Levy B, Kho RM, Walter AJ, Mansuria S. How Can We Increase the Percentage and Quality of Minimally Invasive Hysterectomy for Benign Disease Among Low/Intermediate-Volume Gynecologic Surgeons? A Perspective Piece From an Expert Panel Session at the 2017 Society of Gynecologic Surgeons Annual Meeting. J Minim Invasive Gynecol 2017; 24:1055-1059. [PMID: 28576694 DOI: 10.1016/j.jmig.2017.05.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Accepted: 05/23/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Robert E Gutman
- MedStar Washington Hospital Center, Georgetown University, Washington, DC.
| | | | - Barbara Levy
- American Congress of Obstetricians and Gynecologists, Washington, DC
| | | | | | - Suketu Mansuria
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Eriksson AGZ, Graul A, Yu MC, Halko A, Chi DS, Zivanovic O, Gardner GJ, Sonoda Y, Barakat RR, Abu-Rustum NR, Leitao MM. Minimal access surgery compared to laparotomy for secondary surgical cytoreduction in patients with recurrent ovarian carcinoma: Perioperative and oncologic outcomes. Gynecol Oncol 2017; 146:263-267. [PMID: 28527673 DOI: 10.1016/j.ygyno.2017.05.022] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 05/12/2017] [Accepted: 05/13/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To assess the perioperative outcomes of minimal access surgery (MAS) in secondary surgical cytoreduction (SSCR) for recurrent epithelial ovarian cancer (ROC); to compare oncologic outcomes with laparotomy (LAP). METHODS Using an institutional database, we identified all patients with ROC undergoing SSCR from 1/5/09-6/14/14. Selection for MAS or LAP was based on surgeon preference. To minimize selection bias, preoperative imaging was reviewed for all LAP cases. In this manner, we identified potential MAS candidates, who were used in the comparison. Intent-to-treat analyses were undertaken using statistical testing. RESULTS 170 cases were identified (131 LAP, 8 LSC, 31 RBT). 68/131 (52%) LAP cases were deemed potential candidates for MAS. Feasibility analyses included 68 LAP and 39 MAS cases. Six (15%) MAS cases were converted to LAP. Median age, BMI, operative time did not differ significantly between the groups. Complete gross resection was achieved in 37/39 (95%) MAS, 63/68 (93%) LAP (P=1.0). Median estimated blood loss was 50cm3 (range, 5-500) MAS, 150cm3 (range, 0-1500) LAP (P=0.001). Median length of stay was 1day (range, 0-23) MAS, 5days (range, 1-21) LAP (P<0.001). Complications occurred in 3/39 (8%) MAS, 15/68 (22%) LAP (P=0.06). The 2-year progression-free survival was 56.1% (SE 9%) MAS, 63.5% (SE 6%) LAP (P=1.0). The 2-year overall survival was 92.2% (SE 5.4%) MAS, 81.4% (SE 5.5%) LAP (P=0.7). CONCLUSIONS MAS for SSCR is feasible in properly selected cases. MAS is associated with favorable perioperative outcomes and similar oncologic outcomes, compared to LAP.
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Affiliation(s)
- Ane Gerda Z Eriksson
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ashley Graul
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Miao C Yu
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Anthony Halko
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Dennis S Chi
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Weill Cornell Medical College, New York, NY, USA
| | - Oliver Zivanovic
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Weill Cornell Medical College, New York, NY, USA
| | - Ginger J Gardner
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Weill Cornell Medical College, New York, NY, USA
| | - Yukio Sonoda
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Weill Cornell Medical College, New York, NY, USA
| | - Richard R Barakat
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Weill Cornell Medical College, New York, NY, USA
| | - Nadeem R Abu-Rustum
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Weill Cornell Medical College, New York, NY, USA
| | - Mario M Leitao
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Weill Cornell Medical College, New York, NY, USA.
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Nitschmann CC, Multinu F, Bakkum-Gamez JN, Langstraat CL, Occhino JA, Weaver AL, Cliby WA, Mariani A, Dowdy SC. Vaginal vs. robotic hysterectomy for patients with endometrial cancer: A comparison of outcomes and cost of care. Gynecol Oncol 2017; 145:555-561. [PMID: 28392125 DOI: 10.1016/j.ygyno.2017.03.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 03/03/2017] [Accepted: 03/05/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare outcomes and cost for patients with endometrial cancer undergoing vaginal hysterectomy (VH) or robotic hysterectomy (RH), with or without lymphadenectomy (LND). METHODS Patients undergoing planned VH (and laparoscopic LND) or RH (and robotic LND) between January 2007 and November 2012 were reviewed. Patients with stage IV disease, synchronous cancer, synchronous surgery, or treated with palliative intent were excluded. Patients were objectively triaged to LND per institutional protocol based on frozen section. Outcomes were compared between VH and RH groups matched 1:1 on propensity scores. RESULTS VH was planned in 153 patients; 60 (39%) had concurrent LND while 93 (61%) were low risk and did not require LND. RH was planned in 398 patients; 225 (56%) required concurrent LND and 173 (44%) did not. Among 50 PS-matched pairs without LND, there was no significant difference in complications, length of stay, readmission, or progression free survival. However, median operative time was 1.3h longer and median 30-day cost $3150 higher for RH compared to VH (both p<0.001). Among patients requiring LND, 42 PS-matched pairs were identified. Median operative time was not different when pelvic and para-aortic LND was performed, and 12min longer in the VH group for pelvic LND alone (p=0.03). Median 30-day cost was $921 higher for RH compared to VH when LND was required (p=0.08). CONCLUSION Utilization of vaginal hysterectomy for endometrial cancer results in similar surgical and oncologic outcomes and lower costs compared to RH and should be considered for appropriate patients with a low risk of requiring LND.
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Affiliation(s)
- C C Nitschmann
- Department of Obstetrics and Gynecology, Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, United States
| | - F Multinu
- Department of Obstetrics and Gynecology, Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, United States
| | - J N Bakkum-Gamez
- Department of Obstetrics and Gynecology, Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, United States
| | - C L Langstraat
- Department of Obstetrics and Gynecology, Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, United States
| | - J A Occhino
- Department of Obstetrics and Gynecology, Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, United States
| | - A L Weaver
- Department of Health Science Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, United States
| | - W A Cliby
- Department of Obstetrics and Gynecology, Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, United States
| | - A Mariani
- Department of Obstetrics and Gynecology, Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, United States
| | - S C Dowdy
- Department of Obstetrics and Gynecology, Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, United States.
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Abstract
Within the last 10 years there have been significant advances in minimal-access surgery. Although no emerging technology has demonstrated improved outcomes or fewer complications than standard laparoscopy, the introduction of the robotic surgical platform has significantly lowered abdominal hysterectomy rates. While operative time and cost were higher in robotic-assisted procedures when the technology was first introduced, newer studies demonstrate equivalent or improved robotic surgical efficiency with increased experience. Single-port hysterectomy has not improved postoperative pain or subjective cosmetic results. Emerging platforms with flexible, articulating instruments may increase the uptake of single-port procedures including natural orifice transluminal endoscopic cases.
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Heaton RL, Walid MS. An intention-to-treat study of total laparoscopic hysterectomy. Int J Gynaecol Obstet 2016; 111:57-61. [DOI: 10.1016/j.ijgo.2010.04.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2010] [Revised: 04/21/2010] [Accepted: 04/26/2010] [Indexed: 11/28/2022]
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Korsholm M, Mogensen O, Jeppesen MM, Lysdal VK, Traen K, Jensen PT. Systematic review of same-day discharge after minimally invasive hysterectomy. Int J Gynaecol Obstet 2016; 136:128-137. [DOI: 10.1002/ijgo.12023] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 08/05/2016] [Accepted: 10/21/2016] [Indexed: 01/23/2023]
Affiliation(s)
- Malene Korsholm
- Department of Gynecology and Obstetrics; Odense University Hospital; University of Southern Denmark; Odense Denmark
| | - Ole Mogensen
- Department of Gynecology and Obstetrics; Odense University Hospital; University of Southern Denmark; Odense Denmark
| | - Mette M. Jeppesen
- Department of Gynecology and Obstetrics; Odense University Hospital; University of Southern Denmark; Odense Denmark
| | - Vibeke K. Lysdal
- Department of Gynecology and Obstetrics; Odense University Hospital; University of Southern Denmark; Odense Denmark
| | - Koen Traen
- Department of Gynecology and Obstetrics; Odense University Hospital; University of Southern Denmark; Odense Denmark
| | - Pernille T. Jensen
- Department of Gynecology and Obstetrics; Odense University Hospital; University of Southern Denmark; Odense Denmark
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Feferkorn I, Schmidt M, Segev Y, Zilberlicht A, Auslender R, Abramov Y. Vaginal cuff closure technique and the risk for infected pelvic hematoma after vaginal hysterectomy. Eur J Obstet Gynecol Reprod Biol 2016; 206:194-197. [PMID: 27723550 DOI: 10.1016/j.ejogrb.2016.09.015] [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: 05/14/2016] [Revised: 09/12/2016] [Accepted: 09/13/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Infected pelvic hematoma is a relatively common complication of vaginal hysterectomy, manifesting with postoperative pain and fever which often necessitate surgical drainage. We aimed to assess the effect of the surgical technique for vaginal cuff closure on the incidence of this complication. STUDY DESIGN Until March 31, 2010, our surgical protocol for vaginal hysterectomy included complete vaginal cuff closure. After this date, all surgeries were performed using another technique, by which a patent tract was left at the vaginal cuff for drainage of blood, secretions and debris. We reviewed medical records of all women who underwent vaginal hysterectomy for pelvic organ prolapse in our institution between January 2006 and November 2015, including demographic, clinical and surgical data. We compared the incidence of postoperative infected pelvic hematomas before and after March 31, 2010. RESULTS We identified 325 women who underwent vaginal hysterectomy during the first time period (group I) and 243 women who underwent this procedure during the second time period (group II). While demographic and clinical data were not significantly different between the two groups, the incidence of infected pelvic hematomas necessitating hospitalization was significantly lower in group II (3.8% vs. 13.5%, p<0.0001). CONCLUSIONS A significant reduction in the incidence of infected pelvic hematoma following vaginal hysterectomy was noted using a surgical technique that allows for drainage of blood and debris through the vaginal cuff.
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Affiliation(s)
- Ido Feferkorn
- Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, Carmel Medical Center, Technion University, Rappaport Faculty of Medicine, Haifa, Israel.
| | - Meirav Schmidt
- Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, Carmel Medical Center, Technion University, Rappaport Faculty of Medicine, Haifa, Israel
| | - Yakir Segev
- Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, Carmel Medical Center, Technion University, Rappaport Faculty of Medicine, Haifa, Israel
| | - Ariel Zilberlicht
- Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, Carmel Medical Center, Technion University, Rappaport Faculty of Medicine, Haifa, Israel
| | - Ron Auslender
- Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, Carmel Medical Center, Technion University, Rappaport Faculty of Medicine, Haifa, Israel
| | - Yoram Abramov
- Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, Carmel Medical Center, Technion University, Rappaport Faculty of Medicine, Haifa, Israel
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Shepherd JP, Kantartzis KL, Ahn KH, Bonidie MJ, Lee T. Cost analysis when open surgeons perform minimally invasive hysterectomy. JSLS 2016; 18:JSLS.2014.00181. [PMID: 25489215 PMCID: PMC4254479 DOI: 10.4293/jsls.2014.00181] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background and Objective: The costs to perform a hysterectomy are widely variable. Our objective was to determine hysterectomy costs by route and whether traditionally open surgeons lower costs when performing laparoscopy versus robotics. Methods: Hysterectomy costs including subcategories were collected from 2011 to 2013. Costs were skewed, so 2 statistical transformations were performed. Costs were compared by surgeon classification (open, laparoscopic, or robotic) and surgery route. Results: A total of 4,871 hysterectomies were performed: 34.2% open, 50.7% laparoscopic, and 15.1% robotic. Laparoscopic hysterectomy had the lowest total costs (P < .001). By cost subcategory, laparoscopic hysterectomy was lower than robotic hysterectomy in 6 and higher in 1. When performing robotic hysterectomy, open and robotic surgeon costs were similar. With laparoscopic hysterectomy, open surgeons had higher costs than laparoscopic surgeons for 1 of 2 statistical transformations (P = .007). Open surgeons had lower costs performing laparoscopic hysterectomy than robotic hysterectomy with robotic maintenance and depreciation included (P < .001) but similar costs if these variables were excluded. Conclusion: Although laparoscopic hysterectomy had lowest costs overall, robotics may be no more costly than laparoscopic hysterectomy when performed by surgeons who predominantly perform open hysterectomy.
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Affiliation(s)
- Jonathan P Shepherd
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee-Womens Hospital, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Kelly L Kantartzis
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee-Womens Hospital, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Ki Hoon Ahn
- Korea University Medical Center, Seoul, South Korea
| | - Michael J Bonidie
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee-Womens Hospital, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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Bahri N, Tohidinik HR, Fathi Najafi T, Larki M, Amini T, Askari Sartavosi Z. Depression Following Hysterectomy and the Influencing Factors. IRANIAN RED CRESCENT MEDICAL JOURNAL 2016; 18:e30493. [PMID: 27066267 PMCID: PMC4819414 DOI: 10.5812/ircmj.30493] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Accepted: 07/07/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Hysterectomy is one of the most common gynecological surgeries performed worldwide. However, women undergoing this surgery often experience negative emotional reactions. OBJECTIVES This study was done with the aim of investigating the relationship between hysterectomy and postoperative depression, three months after the procedure. MATERIALS AND METHODS This longitudinal study was conducted in the province of Khorasan-Razavi in Iran, using multistage sampling. At first, three cities were selected from the province by cluster sampling; then, five hospitals were randomly selected from these cities. The participants included 53 women who were hysterectomy candidates in one of the five selected hospitals. The participants' demographics and hysterectomy procedure information were entered into two separate questionnaires, and the Beck depression inventory (BDI) was employed to measure their severity of depression before and three months after the surgery. The statistical package for the social sciences (SPSS) version 16 was used for the statistical analysis, and a P value of < 0.05 was considered to be statistically significant. RESULTS The means and standard deviations of the participants' depression scores before and three months after their hysterectomies were 13.01 ± 10.1 and 11.02 ± 10.3, respectively. Although the mean score of depression decreased three months after the hysterectomy, the difference was not statistically significant. However, a significant relationship was found between the satisfaction with the outcome of the hysterectomy and the postoperative depression score (P = 0.04). CONCLUSIONS In this study, undergoing a hysterectomy did not show a relationship with postoperative depression three months after the surgery. Moreover, the only factor related to depression following a hysterectomy was satisfaction with the surgery.
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Affiliation(s)
- Narjes Bahri
- Department of Midwifery, Nursing and Midwifery School, Gonabad University of Medical Sciences, Gonabad, IR Iran
| | - Hamid Reza Tohidinik
- Department of Public Health, School of Health, Gonabad University of Medical Sciences, Gonabad, IR Iran
| | - Tahereh Fathi Najafi
- Department of Midwifery, Mashhad Branch, Islamic Azad University, Mashhad, IR Iran
| | - Mona Larki
- Student Research Committee, Faculty of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, IR Iran
- Corresponding Author: Mona Larki, Student Research Committee, Faculty of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, IR Iran. Tel: +98-9163519526, Fax: +98-5157223814, E-mail:
| | - Thoraya Amini
- Student Research Committee, Nursing and Midwifery School, Gonabad University of medical Sciences, Gonabad, IR Iran
| | - Zahra Askari Sartavosi
- Student Research Committee, Nursing and Midwifery School, Gonabad University of medical Sciences, Gonabad, IR Iran
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Hur HC, King LP, Klebanoff MJ, Hur C, Ricciotti HA. Fibroid morcellation: a shared clinical decision tool for mode of hysterectomy. Eur J Obstet Gynecol Reprod Biol 2015; 195:122-127. [DOI: 10.1016/j.ejogrb.2015.09.044] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 09/25/2015] [Accepted: 09/28/2015] [Indexed: 12/21/2022]
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Holloran-Schwartz MB, Gavard JA, Martin JC, Blaskiewicz RJ, Yeung PP. Single-Use Energy Sources and Operating Room Time for Laparoscopic Hysterectomy: A Randomized Controlled Trial. J Minim Invasive Gynecol 2015; 23:72-7. [PMID: 26318400 DOI: 10.1016/j.jmig.2015.08.881] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 08/18/2015] [Accepted: 08/19/2015] [Indexed: 11/28/2022]
Abstract
STUDY OBJECTIVES To compare the intraoperative direct costs of a single-use energy device with reusable energy devices during laparoscopic hysterectomy. DESIGN A randomized controlled trial (Canadian Task Force Classification I). SETTING An academic hospital. PATIENTS Forty-six women who underwent laparoscopic hysterectomy from March 2013 to September 2013. INTERVENTIONS Each patient served as her own control. One side of the uterine attachments was desiccated and transected with the single-use device (Ligasure 5-mm Blunt Tip LF1537 with the Force Triad generator). The other side was desiccated and transected with reusable bipolar forceps (RoBi 5 mm), and transected with monopolar scissors using the same Covidien Force Triad generator. The instrument approach used was randomized to the attending physician who was always on the patient's left side. Resident physicians always operated on the patient's right side and used the converse instruments of the attending physician. MEASUREMENTS AND MAIN RESULTS Start time was recorded at the utero-ovarian pedicle and end time was recorded after transection of the uterine artery on the same side. Costs included the single-use device; amortized costs of the generator, reusable instruments, and cords; cleaning and packaging of reusable instruments; and disposal of the single-use device. Operating room time was $94.14/min. We estimated that our single use-device cost $630.14 and had a total time savings of 6.7 min per case, or 3.35 min per side, which could justify the expense of the device. The single-use energy device had significant median time savings (-4.7 min per side, p < .001) and total intraoperative direct cost savings ($254.16 per case). CONCLUSIONS A single-use energy device that both desiccates and cuts significantly reduced operating room time to justify its own cost, and it also reduced total intraoperative direct costs during laparoscopic hysterectomy in our institution. Operating room cost per minute varies between institutions and must be considered before generalizing our results.
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Affiliation(s)
- M Brigid Holloran-Schwartz
- Department of Obstetrics, Gynecology, and Women's Health, Saint Louis University School of Medicine, Saint Louis, Missouri.
| | - Jeffrey A Gavard
- Department of Obstetrics, Gynecology, and Women's Health, Saint Louis University School of Medicine, Saint Louis, Missouri
| | - Jared C Martin
- Department of Obstetrics, Gynecology, and Women's Health, Saint Louis University School of Medicine, Saint Louis, Missouri
| | - Robert J Blaskiewicz
- Department of Obstetrics, Gynecology, and Women's Health, Saint Louis University School of Medicine, Saint Louis, Missouri
| | - Patrick P Yeung
- Department of Obstetrics, Gynecology, and Women's Health, Saint Louis University School of Medicine, Saint Louis, Missouri
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Tan-Kim J, Hartzell KA, Reinsch CS, O’Day CH, Kennedy JS, Menefee SA, Harrison TA. Uterine sarcomas and parasitic myomas after laparoscopic hysterectomy with power morcellation. Am J Obstet Gynecol 2015; 212:594.e1-10. [PMID: 25499259 DOI: 10.1016/j.ajog.2014.12.002] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 10/16/2014] [Accepted: 12/02/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The purpose of this study was to describe the incidence and risk factors for uterine sarcomas and parasitic myomas at the time of power morcellation. STUDY DESIGN We performed a retrospective review of 3523 women who underwent laparoscopic hysterectomy from 2001-2012. Univariate analyses were used for the morcellation cases to identify potential risk factors. Multivariable logistic regression was performed. RESULTS Nine hundred forty-one patients underwent power morcellation at the time of hysterectomy; 10 of 941 patients (1.1%) were diagnosed subsequently with uterine sarcomas or parasitic myomas. The overall incidence of uterine sarcoma was 6 of 941 (0.6%), with a median age of 47 years (range, 41-52 years). There was no association among any of the factors analyzed and uterine sarcoma. Three of 6 patients had sarcoma diagnosed on initial pathologic evaluation of the morcellated specimen; 3 patients had delayed diagnosis of sarcoma with benign disease at the time of the initial procedure (median time to second evaluation, 6 years). For parasitic myomas (n=4), the median age was 35 years (range, 32-40 years), and the median time to second evaluation was 5 years. On multivariate analysis, age<40 years (odds ratio, 26; 95% confidence interval, 2.7015-261.9; P≤.01) was associated with higher risk of the development of parasitic myomas. CONCLUSION Uterine sarcoma was found in 0.6% of patients who underwent power morcellation but was not found to be associated significantly with any preoperative factors. All 6 cases were noted to have apparent fibroid tumors as an indication for their hysterectomy. Age<40 years was a risk factor for parasitic myomas after power morcellation. Patients should be counseled about these complications before power morcellation.
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Analysis of hysterectomies for patients with uterine leiomyomas in China in 2010. Int J Gynaecol Obstet 2014; 129:71-4. [DOI: 10.1016/j.ijgo.2014.10.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Revised: 10/22/2014] [Accepted: 12/16/2014] [Indexed: 11/20/2022]
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Paraiso MFR. Robotic-assisted laparoscopic surgery for hysterectomy and pelvic organ prolapse repair. Fertil Steril 2014; 102:933-8. [DOI: 10.1016/j.fertnstert.2014.08.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Revised: 08/05/2014] [Accepted: 08/07/2014] [Indexed: 11/30/2022]
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Bogani G, Serati M, Uccella S, Ghezzi F. In-bag morcellation for presumed myoma retrieval at laparoscopy. Cancer 2014; 120:4004-5. [PMID: 25102972 DOI: 10.1002/cncr.28959] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 07/10/2014] [Indexed: 11/07/2022]
Affiliation(s)
- Giorgio Bogani
- Department of Obstetrics and Gynecology; University of Insubria, Del Ponte Hospital; Varese Italy
| | - Maurizio Serati
- Department of Obstetrics and Gynecology; University of Insubria, Del Ponte Hospital; Varese Italy
| | - Stefano Uccella
- Department of Obstetrics and Gynecology; University of Insubria, Del Ponte Hospital; Varese Italy
| | - Fabio Ghezzi
- Department of Obstetrics and Gynecology; University of Insubria, Del Ponte Hospital; Varese Italy
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Roy S, Patkar A, Daskiran M, Levine R, Hinoul P, Nigam S. Clinical and Economic Burden of Surgical Site Infection in Hysterectomy. Surg Infect (Larchmt) 2014; 15:266-73. [DOI: 10.1089/sur.2012.163] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Sanjoy Roy
- Health Economics and Outcomes Research, Johnson & Johnson Global Surgery Group, Somerville, New Jersey
| | - Anuprita Patkar
- Health Economics and Outcomes Research, Johnson & Johnson Global Surgery Group, Somerville, New Jersey
| | - Mehmet Daskiran
- Healthcare Informatics, Medical Devices & Diagnostics, Johnson & Johnson, Inc., New Brunswick, New Jersey
| | - Ronald Levine
- Healthcare Informatics, Medical Devices & Diagnostics, Johnson & Johnson, Inc., New Brunswick, New Jersey
| | - Piet Hinoul
- Medical Affairs, Johnson & Johnson Global Surgery Group, Somerville, New Jersey
| | - Somesh Nigam
- Independence Blue Cross, Philadelphia, Pennsylvania
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Abstract
OBJECTIVE To compare the costs of vaginal and abdominal hysterectomy with robotically assisted hysterectomy. METHODS We identified all cases of robotically assisted hysterectomy, with or without bilateral salpingo-oophorectomy, treated at the Mayo Clinic (Rochester, Minnesota) from January 1, 2007, through December 31, 2009. Cases were propensity score-matched (one-to-one) to cases of vaginal and abdominal hysterectomy, selected randomly from January 1, 2004, through December 31, 2006 (before acquisition of the robotic surgical system). All billed costs were abstracted through the sixth postoperative week from the Olmsted County Healthcare Expenditure and Utilization Database and compared between cohorts with a generalized linear modeling framework. Predicted costs were estimated with the recycled predictions method. Costs of operative complications also were estimated. RESULTS The total number of abdominal hysterectomies collected for comparison was 234 and the total number of vaginal hysterectomies was 212. Predicted mean cost of robotically assisted hysterectomy was $2,253 more than that of vaginal hysterectomy ($13,619 compared with $11,366; P<.001), although costs of complications were not significantly different. The predicted mean costs of robotically assisted compared with abdominal hysterectomy were similar ($14,679 compared with $15,588; P=.35). The costs of complications were not significantly different. CONCLUSIONS Overall, vaginal hysterectomy was less costly than robotically assisted hysterectomy. Abdominal hysterectomy and robotically assisted hysterectomy had similar costs. LEVEL OF EVIDENCE II.
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Rizzuto I, Odejinmi F, Al-Samarrai M. Can Body Mass Index Influence the Outcome of a Laparoscopic Hysterectomy? J Gynecol Surg 2014. [DOI: 10.1089/gyn.2012.0146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ivana Rizzuto
- Norfolk and Norwich University Hospital, Norwich, United Kingdom
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