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Arslan S, Vehviläinen-Julkunen K, Parviainen A. How does robotic surgery affect gynecology patient care? J Robot Surg 2024; 18:256. [PMID: 38896293 PMCID: PMC11186900 DOI: 10.1007/s11701-024-01955-1] [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: 03/17/2024] [Accepted: 04/14/2024] [Indexed: 06/21/2024]
Abstract
The aim of this review is to map the current research on the needs of gynecological patients treated with robotic surgery. Systematic Rapid Review. Pubmed, Web of Science, Google Scholar. Search was limited from the years 2017-2021. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement was followed. Rapid review is a synthesis of information produced in a shorter time than systematic reviews, which allows clinical nurses to access evidence in the decision-making process. The methodological steps implemented were the following: (1) needs assessment and topic selection, (2) study development, (3) literature search, (4) screening and study selection, (5) data extraction, (6) risk-of-bias assessment and (7) knowledge synthesis. The search yielded 815 articles, 746 were excluded after screening the title and abstract, and 69 full-text syntheses were performed. Only 10 articles were included in the final analysis. This research evaluated the effects of robotic surgery on the patient under seven themes; operative time, length of stay, complications, estimated blood loss, pain, survivor, and conversion. Five studies were on endometrial cancer, one study on gynecologic cancer, two studies on hysterectomy, one study on patient safety, and one study on cervical cancer. The results show that robotic surgery can change the needs of patients by solving ongoing problems in gynecological patients. This requires a better understanding of robotic surgery procedures while facilitating nursing care over patient care.
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Affiliation(s)
- Sibel Arslan
- Department of Surgical Diseases Nursing Science, Faculty of Health Sciences, Kilis 7 Aralık Universty, Kilis, Türkiye
| | - Katri Vehviläinen-Julkunen
- Department of Nursing Science, Faculty of Health Sciences, Kuopio University Hospital, University of Eastern Finland, Kuopio, Finland.
| | - Anndra Parviainen
- Department of Nursing Science, Faculty of Health Sciences, School of Medicine, Institute of Public Health and Clinical Nutrition, Universty Eastern of Finland, Kuopio, Finland
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Wessel KJ, Varnava C, Wiebringhaus P, Hiort M, Hirsch T, Kückelhaus M. [Robot-assisted Microsurgery for Autologous Breast Reconstruction - Robotic Breast Reconstruction]. HANDCHIR MIKROCHIR P 2024; 56:114-121. [PMID: 38670084 DOI: 10.1055/a-2241-5737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND With the introduction of novel surgical robots and surgical microscopes for the special needs of open microsurgery, the concept of robotic-assisted microsurgery is gaining popularity. While initial preclinical studies indicate a steep learning curve, favourable ergonomics and improved precision, albeit with an increased operating time, data on the clinical application of the new systems is still limited. This study describes our first clinical experience with robotic-assisted autologous breast reconstruction and outlines the opportunities and limitations of the approach. PATIENTS AND METHODS Our retrospective data analysis included a total of 28 patients who underwent unilateral robotic-assisted autologous breast reconstruction between July 2022 and August 2023. We applied a combined approach using the Symani Surgical System together with the RoboticScope. Descriptive evaluation of patient characteristics, surgical data and complications was performed. RESULTS Average patient age was 54.3±11.1 years and average BMI was 26.5±3.5 kg/m2. Twenty-six patients received a DIEP flap and 2 patients received a PAP flap, the flaps being connected to the internal mammary artery in 22 cases, to a perforator of the internal mammary artery in 5 cases, and to a branch of the thoracodorsal artery in one case. The average incision-suture time was 267±89 min, with an average ischaemia time of 86±20 min and duration of the arterial anastomosis of 29±12 min. In two cases, immediate intraoperative anastomosis revision was performed, but no flap loss occurred. CONCLUSION The results of this study demonstrate the safe feasibility of robot-assisted autologous breast reconstruction using a combination of Symani and RoboticScope. In the future, special attention should be paid to minimally invasive techniques of flap harvest and connecting vessel preparation.
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Affiliation(s)
- Kai J Wessel
- Klinik für Plastische Chirurgie, Universitätsklinikum Münster, Münster, Germany
- Abteilung für Plastische, Rekonstruktive und Ästhetische Chirurgie, Handchirurgie, Fachklinik Hornheide eV, Münster, Germany
- Abteilung für Plastische und Rekonstruktive Chirurgie, Institut für Muskuloskelettale Medizin, Universität Münster, Münster, Germany
| | - Charalampos Varnava
- Klinik für Plastische Chirurgie, Universitätsklinikum Münster, Münster, Germany
- Abteilung für Plastische, Rekonstruktive und Ästhetische Chirurgie, Handchirurgie, Fachklinik Hornheide eV, Münster, Germany
- Abteilung für Plastische und Rekonstruktive Chirurgie, Institut für Muskuloskelettale Medizin, Universität Münster, Münster, Germany
| | - Philipp Wiebringhaus
- Klinik für Plastische Chirurgie, Universitätsklinikum Münster, Münster, Germany
- Abteilung für Plastische, Rekonstruktive und Ästhetische Chirurgie, Handchirurgie, Fachklinik Hornheide eV, Münster, Germany
- Abteilung für Plastische und Rekonstruktive Chirurgie, Institut für Muskuloskelettale Medizin, Universität Münster, Münster, Germany
| | - Mirkka Hiort
- Klinik für Plastische Chirurgie, Universitätsklinikum Münster, Münster, Germany
- Abteilung für Plastische, Rekonstruktive und Ästhetische Chirurgie, Handchirurgie, Fachklinik Hornheide eV, Münster, Germany
- Abteilung für Plastische und Rekonstruktive Chirurgie, Institut für Muskuloskelettale Medizin, Universität Münster, Münster, Germany
| | - Tobias Hirsch
- Klinik für Plastische Chirurgie, Universitätsklinikum Münster, Münster, Germany
- Abteilung für Plastische, Rekonstruktive und Ästhetische Chirurgie, Handchirurgie, Fachklinik Hornheide eV, Münster, Germany
- Abteilung für Plastische und Rekonstruktive Chirurgie, Institut für Muskuloskelettale Medizin, Universität Münster, Münster, Germany
| | - Maximilian Kückelhaus
- Klinik für Plastische Chirurgie, Universitätsklinikum Münster, Münster, Germany
- Abteilung für Plastische, Rekonstruktive und Ästhetische Chirurgie, Handchirurgie, Fachklinik Hornheide eV, Münster, Germany
- Abteilung für Plastische und Rekonstruktive Chirurgie, Institut für Muskuloskelettale Medizin, Universität Münster, Münster, Germany
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Lenfant L, Canlorbe G, Belghiti J, Kreaden US, Hebert AE, Nikpayam M, Uzan C, Azaïs H. Robotic-assisted benign hysterectomy compared with laparoscopic, vaginal, and open surgery: a systematic review and meta-analysis. J Robot Surg 2023; 17:2647-2662. [PMID: 37856058 PMCID: PMC10678826 DOI: 10.1007/s11701-023-01724-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 09/17/2023] [Indexed: 10/20/2023]
Abstract
The potential benefits and limitations of benign hysterectomy surgical approaches are still debated. We aimed at evaluating any differences with a systematic review and meta-analysis. PubMed, MEDLINE, and EMBASE databases were last searched on 6/2/2021 to identify English randomized controlled trials (RCTs), prospective cohort and retrospective independent database studies published between Jan 1, 2010 and Dec 31, 2020 reporting perioperative outcomes following robotic hysterectomy versus laparoscopic, open, or vaginal approach (PROSPERO #CRD42022352718). Twenty-four articles were included that reported on 110,306 robotic, 262,715 laparoscopic, 189,237 vaginal, and 554,407 open patients. The robotic approach was associated with a shorter hospital stay (p < 0.00001), less blood loss (p = 0.009), and fewer complications (OR: 0.42 [0.27, 0.66], p = 0.0001) when compared to the open approach. The main benefit compared to the laparoscopic and vaginal approaches was a shorter hospital (R/L WMD: - 0.144 [- 0.21, - 0.08], p < 0.0001; R/V WMD: - 0.39 [- 0.70, - 0.08], p = 0.01). Other benefits seen were sensitive to the inclusion of database studies. Study type differences in outcomes, a lack of RCTs for robotic vs. open comparisons, learning curve issues, and limited robotic vs. vaginal publications are limitations. While the robotic approach was mainly comparable to the laparoscopic approach, this meta-analysis confirms the classic benefits of minimally invasive surgery when comparing robotic hysterectomy to open surgery. We also reported the advantages of robotic surgery over vaginal surgery in a patient population with a higher incidence of large uterus and prior surgery.
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Affiliation(s)
- Louis Lenfant
- Department of Urology, Academic Hospital Pitié-Salpêtrière, APHP, Sorbonne Université, 75013, Paris, France
- Department of Surgery and Oncological Gynecology, Pitié-Salpétrière University Hospital, Assistance Publique des Hôpitaux de Paris, Sorbonne University, Paris, France
| | - Geoffroy Canlorbe
- Department of Surgery and Oncological Gynecology, Pitié-Salpétrière University Hospital, Assistance Publique des Hôpitaux de Paris, Sorbonne University, Paris, France
| | - Jérémie Belghiti
- Department of Surgery and Oncological Gynecology, Pitié-Salpétrière University Hospital, Assistance Publique des Hôpitaux de Paris, Sorbonne University, Paris, France
| | - Usha Seshadri Kreaden
- Biostatistics & Global Evidence Management, Intuitive Surgical Inc, Sunnyvale, CA, USA
| | - April E Hebert
- Biostatistics & Global Evidence Management, Intuitive Surgical Inc, Sunnyvale, CA, USA
| | - Marianne Nikpayam
- Department of Surgery and Oncological Gynecology, Pitié-Salpétrière University Hospital, Assistance Publique des Hôpitaux de Paris, Sorbonne University, Paris, France
| | - Catherine Uzan
- Department of Surgery and Oncological Gynecology, Pitié-Salpétrière University Hospital, Assistance Publique des Hôpitaux de Paris, Sorbonne University, Paris, France
| | - Henri Azaïs
- Department of Surgery and Oncological Gynecology, Pitié-Salpétrière University Hospital, Assistance Publique des Hôpitaux de Paris, Sorbonne University, Paris, France.
- Gynecologic and Breast Oncologic Surgery Department, Georges Pompidou European Hospital, APHP, Centre, Université de Paris Cité, Paris, France.
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Daykan Y, Farinha R, Schraffordt SE, Mottrie A, O'Reilly BA. A cost-effective model for training in Robot-Assisted Sacrocolpopexy. Int Urogynecol J 2023; 34:3059-3062. [PMID: 37453031 DOI: 10.1007/s00192-023-05604-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 06/25/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND The number of robotically assisted sacrocolpopexy procedures are increasing; therefore, experienced clinicians are needed. Simulation-based cadaver models are challenging in aspects of cost and availability. Therefore, we need to look at alternative and more cost-effective models. OBJECTIVE The objective of this video was to design a new surgical model for the training of robotic-assisted sacrocolpopexy, which is affordable and accessible. METHODS We used a whole chicken model to simulate the female pelvic floor. We used Medtronic's Hugo™ RAS system as the robotic console in that procedure. A vaginal cuff was prepared from the proventriculus (stomach), and a Y shaped mesh was secured to the ischium to simulate the sacrocolpopexy procedure. CONCLUSION This model is easily constructed and in our view is cost-effective. We have demonstrated a new valuable education tool that can serve as a practical simulation model to teach the sacrocolpopexy procedure and to improve trainees' skills. A larger cohort study size is essential to demonstrate the learning curve among young trainees using this simulation model.
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Affiliation(s)
- Yair Daykan
- Department of Urogynaecology, Cork University Maternity Hospital, Cork, Ireland.
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Rui Farinha
- Department of Urology, OLV, Aalst, Belgium
- ORSI Academy, Melle, Belgium
| | | | - Alexander Mottrie
- Department of Urology, OLV, Aalst, Belgium
- ORSI Academy, Melle, Belgium
| | - Barry A O'Reilly
- Department of Urogynaecology, Cork University Maternity Hospital, Cork, Ireland
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Daykan Y, Rotem R, O'Reilly BA. Robot-assisted laparoscopic pelvic floor surgery: Review. Best Pract Res Clin Obstet Gynaecol 2023; 91:102418. [PMID: 37776580 DOI: 10.1016/j.bpobgyn.2023.102418] [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: 12/19/2022] [Revised: 07/22/2023] [Accepted: 08/26/2023] [Indexed: 10/02/2023]
Abstract
Minimally invasive surgical techniques have become more common in pelvic floor reconstructive urogynaecological surgery, specifically, robotic-assisted pelvic floor surgery. Female pelvic floor anatomy is complex, and some repairs require highly experienced surgical skills that can be gained more easily using robotic-assisted surgery. A common application of the robotic platform in urogynaecological surgeries includes sacrocolpopexy, which has become the gold standard approach in the last decade for the correction of apical prolapse. Additional procedures include sacrohysteropexy, sacrocervicopexy, fistula repair, and complex procedures involving the bladder and other pelvic organs. Despite its increasing use and clear benefit in our field, data in the literature and, in particular, randomised controlled trials are sparse. This review provides an update, incorporating recently published literature and our personal experience in that field.
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Affiliation(s)
- Yair Daykan
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Reut Rotem
- Department of Urogynaecology, Cork University Maternity Hospital, Cork, Ireland; Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, Affiliated with the Hebrew University School of Medicine, Jerusalem, Israel
| | - Barry A O'Reilly
- Department of Urogynaecology, Cork University Maternity Hospital, Cork, Ireland
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[Trends in upper urinary tract reconstruction surgery over a decade based on a multi-center database]. BEIJING DA XUE XUE BAO. YI XUE BAN = JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2022; 54. [PMID: 35950394 PMCID: PMC9385503 DOI: 10.19723/j.issn.1671-167x.2022.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To study the trend of surgical type, surgical procedure and etiological distribution of upper urinary tract repair in recent 10 years. METHODS The preoperative and perioperative variables and follow-up data of upper urinary tract reconstruction surgery in RECUTTER (Reconstruction of Urinary Tract: Technology, Epidemiology and Result) database from 2010 to 2021 were searched, collected and analyzed. The surgical type, surgical procedure, duration of hospitalization, time of operation, incidence of short-term complications, and proportion of the patients undergoing reoperations were compared between the two groups of 2010-2017 period and 2018-2021 period. RESULTS A total of 1 072 patients were included in the RECUTTER database. Congenital factors and iatrogenic injuries were the main causes of upper urinary tract repair. Among them, 129 (12.0%) patients had open operation, 403 (37.6%) patients had laparoscopic surgery, 322 (30.0%) patients had robot-assisted laparoscopic surgery and 218 (20.3%) patients had endourological procedure. In the last decade, the total number of surgeries showed a noticeable increasing annual trend and the proportion of robot-assisted laparoscopic surgery in 2018-2021 was significantly higher than that in 2010-2017 (P < 0.001). The 1 072 patients included 124 (11.6%) cases of ileal ureter replacements, 440 (41.1%) cases of pyeloplasty, 229 (21.4%) cases of balloon dilation, 109 (10.2%) cases of ureteral reimplantation, 49 (4.6%) cases of boari flap-Psoas hitch surgery, 60 (5.6%) cases of uretero-ureteral anastomosis, 61 (5.7%) cases of lingual mucosal onlay graft ureteroplasty or appendiceal onlay flap ureteroplasty. Pyeloplasty and balloon dilatation had been the main types of surgery, while the proportion of lingual mucosal onlay graft ureteroplasty plus appendiceal onlay flap ureteroplasty had increased significantly in recent years (P < 0.05). In addition, the time of operation was significantly increased (P < 0.05) after 2018, which was considered to be related to the sharp increase in the proportion of robot-assisted laparoscopic surgery. We found that minimally invasive surgery (endourological procedure and robot-assisted laparoscopic surgery) as an independent risk factor (P=0.050, OR=0.472) could reduce the incidence of short-term post-operative complications. CONCLUSION We have justified the value of the RECUTTER database, created by the Institute of Urology, Peking University in data support for clinical research work, and provided valuable experience for the construction of other multi-center databases at home and abroad. In recent 10 years, we have observed that, in upper urinary tract reconstruction surgery, the surgery type tends to be minimally invasive and the surgery procedure tends to be complicated, suggesting the superiority of robot-assisted laparoscopic surgery.
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Jiang Y, Yang F, Ma J, Zhang N, Zhang C, Li G, Li Z. Surgical and oncological outcomes of distal gastrectomy compared to total gastrectomy for middle‑third gastric cancer: A systematic review and meta‑analysis. Oncol Lett 2022; 24:291. [PMID: 35949603 PMCID: PMC9353235 DOI: 10.3892/ol.2022.13411] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 06/08/2022] [Indexed: 11/23/2022] Open
Abstract
Distal gastrectomy (DG) and total gastrectomy (TG) are the most common types of radical surgery for patients with middle-third gastric cancer (MTGC). However, the indications and benefits of the two procedures still remain controversial. The present meta-analysis aimed to compare the surgical and oncological outcomes of DG and TG in the treatment of MTGC. A rigorous literature review was performed in the databases of PubMed, Embase, Web of Science, China National Knowledge Infrastructure and Chinese BioMedical Literature to retrieve studies published up to February 2022. The Newcastle-Ottawa Scale was used to assess the quality of included studies and a meta-analysis was performed using RevMan 5.3 software. A total of 12 retrospective studies performing comparisons of DG and TG were included in the present meta-analysis. For patients who underwent DG, a lower rate of overall post-operative complications, anastomosis leakage and intro-abdominal infection was determined. No significant difference was observed between DG and TG in the 5-year overall survival when the proximal resection margin ranged from 3 to 5 cm. Although DG was associated with a higher 5-year overall survival rate when compared to TG, there was no significant difference in the stratified analyses by TNM stage. In conclusion, the prognosis of MTGC did not depend on the extent of gastrectomy. With lower complications and acceptable oncological outcomes, DG was a safe and feasible surgical procedure for MTGC when a negative proximal margin was confirmed.
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Affiliation(s)
- Yuxing Jiang
- Department of Intensive Care Unit, The 305 Hospital of PLA, Beijing 100017, P.R. China
| | - Fan Yang
- Department of General Medicine, Southwest Hospital, Third Military Medical University, Chongqing 400038, P.R. China
| | - Jingfu Ma
- Department of Intensive Care Unit, The 305 Hospital of PLA, Beijing 100017, P.R. China
| | - Ning Zhang
- Department of Intensive Care Unit, The 305 Hospital of PLA, Beijing 100017, P.R. China
| | - Chao Zhang
- Department of General Medicine, Southwest Hospital, Third Military Medical University, Chongqing 400038, P.R. China
| | - Gaoming Li
- Center for Disease Control and Prevention of Central Theater Command, Beijing 100049, P.R. China
| | - Zhengyan Li
- Department of General Surgery, Center for Minimally Invasive Gastrointestinal Surgery, Southwest Hospital, Third Military Medical University, Chongqing 400038, P.R. China
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Youssef Y, Afaneh H, Borahay MA. Strategies for Cost Optimization in Minimally Invasive Gynecologic Surgery. JSLS 2022; 26:JSLS.2022.00015. [PMID: 36071991 PMCID: PMC9385110 DOI: 10.4293/jsls.2022.00015] [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: Cost and quality are important, complex, and intertwined surgical outcomes. Evidence suggests that major cost drivers include operating room time, length of stay, re-admission, surgical complications, and quality of pre-operative and operative care in general. Our practices shape both costs and quality of gynecologic surgery. Various factors are explored in this review article to present and identify ways to implement cost-effective change that also improve quality of patient care. Database: We searched MEDLINE and PubMed databases for relevant articles. Discussion: Clinical preferences and decisions, surgeon experience, trainee education, and defensive medicine can influence cost. In addition, an incongruent physician-administration relationship may impact decisions across the healthcare system. The accelerating adoption of minimally invasive surgery, particularly the robotic approach, presents both an opportunity and a challenge. An example of practices that improve outcomes, patient satisfaction, and cut cost is pre-operative optimization, enhanced recovery after surgery, and the growing adoption of outpatient hysterectomy. The identification of cost-drivers and finding strategies to improve them would simultaneously improve quality and patient outcomes while reducing costs in minimally invasive gynecologic surgery.
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Affiliation(s)
- Youssef Youssef
- Department of Obstetrics and Gynecology, Hurley Medical Center/Michigan State University College of Human Medicine, Flint, MI
| | - Huda Afaneh
- Women's Health Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Mostafa A Borahay
- Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, MD
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Minimally invasive hysterectomy for benign indications-surgical volume matters: a retrospective cohort study comparing complications of robotic-assisted and conventional laparoscopic hysterectomies. J Robot Surg 2022; 16:1199-1207. [PMID: 34981444 DOI: 10.1007/s11701-021-01340-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 11/21/2021] [Indexed: 10/19/2022]
Abstract
The objective of this study was to evaluate the incidence of perioperative complications in robotic-assisted hysterectomies performed by high-volume robotic surgeons compared to conventional laparoscopic hysterectomies performed by all gynecologic surgeons. This retrospective cohort study was performed at a single-center community based hospital and medical center. A total of 332 patients who underwent hysterectomy for benign indications were included in this study. Half of these patients (n = 166) underwent conventional laparoscopic hysterectomy and the other half underwent a robotic-assisted laparoscopic hysterectomy. The main outcome measures included composite complication rate, estimated blood loss (EBL), and hospital length of stay (LOS). Median (IQR) EBL was significantly lower for robotic hysterectomy [22.5 (30) mL] compared to laparoscopic hysterectomy [100 (150) mL, p < 0.0001]. LOS was significantly shorter for robotic hysterectomy (1.0 ± 0.2 day) compared to laparoscopic hysterectomy (1.2 ± 0.7 days, p = 0.04). Despite averaging 3.0 (IQR 1.0) concomitant procedures compared to 0 (IQR 1.0) for the conventional laparoscopic hysterectomies, the incidence of any type of complication was lower in the robotic hysterectomy group (2 vs. 6%, p = 0.05). Finally, in a logistic regression model controlling for multiple confounders, robotic-assisted hysterectomy was less likely to result in a perioperative complication compared to traditional laparoscopic hysterectomy [odds ratio (95% CI) = 0.2 (0.1, 0.90), p = 0.04]. In conclusion, robotic-assisted hysterectomy may reduce complications compared with conventional laparoscopic hysterectomy when performed by high volume surgeons, especially in the setting of other concomitant gynecologic surgeries.
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Marchand G, Taher Masoud A, Ware K, Govindan M, King A, Ruther S, Brazil G, Calteux N, Coriell C, Ulibarri H, Parise J, Arroyo A, Filippelli C, Loli H, Sainz K. Systematic review and meta-analysis of all randomized controlled trials comparing gynecologic laparoscopic procedures with and without robotic assistance. Eur J Obstet Gynecol Reprod Biol 2021; 265:30-38. [PMID: 34418694 DOI: 10.1016/j.ejogrb.2021.07.038] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 07/15/2021] [Accepted: 07/21/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Following the publication of several high quality randomized controlled trials regarding the comparison of similar laparoscopic gynecologic procedures being performed with or without robotic assistance, we aimed to perform a systematic review to identify any differences in patient safety and expected incidence of complications in these procedures. DATA SOURCES Articles on ClinicalTrials.Gov, Embase, MEDLINE, PubMed, Scopus, and Web of Science databases were retrieved and screened for eligibility up to April 1st 2021. METHODS OF STUDY SELECTION In addition to meeting our screening algorithm, we included studies that met all the following: randomized control trials (RCT), enrolling patients for indicated laparoscopic gynecologic procedures, and comparing Robotic Surgery (RS) with Laparoscopic Surgery (LS) in terms of safety or complications. TABULATION, INTEGRATION, AND RESULTS Data was pooled as mean difference (MD) or risk ratio (RR) with a 95% confidence interval (CI). Ultimately, six studies were included in this meta-analysis. Pooled data revealed that RS and LS have similar risk for intraoperative complications (RR = 0.87; 95% CI [0.23, 3.36], P = 0.84), postoperative complications (RR = 1.07; 95% CI [0.57, 2.01], P = 0.83), significant intraoperative hemorrhage (RR = 1.40; 95% CI [0.59, 3.34], P = 0.44), postoperative hemorrhage (RR = 0.43; 95% CI [0.15, 1.22], P = 0.11), vaginal cuff dehiscence (RR = 1.13; 95% CI [0.24, 5.41], P = 0.88), postoperative wound infection, urinary tract infection, and urinary bladder or ureteral injury. RS had "surgeon declared" lower estimated blood loss (MD = 85.27; 95% CI [46.45, 124.09], P < 0.00001) and shorter postoperative hospital stay (MD = 1.20; 95% CI [0.38, 2.01], P = 0.004). CONCLUSION There was a statistically significant decrease in hospital stay and "surgeon declared" blood loss seen in the RS group. There was no statistically significant increase in risk of developing other postoperative complications between the LS and R groups.
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Affiliation(s)
- Greg Marchand
- Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA.
| | - Ahmed Taher Masoud
- Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA; Fayoum University Faculty of Medicine, Fayoum, Egypt
| | - Kelly Ware
- Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA; International University of Health Sciences, Basseterre, Saint Kitts and Nevis
| | - Malini Govindan
- Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
| | - Alexa King
- Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
| | - Stacy Ruther
- Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
| | - Giovanna Brazil
- Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
| | - Nicolas Calteux
- Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
| | | | - Hollie Ulibarri
- Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
| | - Julia Parise
- Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
| | - Amanda Arroyo
- Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
| | - Candace Filippelli
- Midwestern University College of Osteopathic Medicine, Glendale, AZ, USA
| | - Helen Loli
- Midwestern University College of Osteopathic Medicine, Glendale, AZ, USA
| | - Katelyn Sainz
- Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
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Bahadur A, Kumawat M, Chawla L, Kapur D, Bahurupi Y, Mundhra R. Robotic-Assisted Hysterectomy for Benign Indications of Uteri Less Than Fourteen Weeks Size Versus More Than Fourteen Weeks Size: A Comparative Study. Cureus 2021; 13:e15263. [PMID: 34189001 PMCID: PMC8233156 DOI: 10.7759/cureus.15263] [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: 11/17/2022] Open
Abstract
Objectives This study was conducted to evaluate the feasibility of robotic hysterectomy for benign indications in patients with small size (<14 weeks) versus large size (>14 weeks) uterus. Methods This prospective study was conducted in a single centre from August 2018 to January 2020 in the Department of Obstetrics and Gynecology at All India Institute of Medical Sciences, Rishikesh (Uttarakhand). Surgical outcomes of 216 patients who underwent a robotic hysterectomy in our institution for benign indications were analysed. Women opting for definitive surgical management by minimally invasive technique were divided into two groups according to the size of the uterus less than 14 weeks (group 1) versus more than equal to 14 weeks (group 2). Data collected in both groups included intra-operative and post-operative parameters, length of hospital stay and morbidity if any. Results The demographic profile was comparable in both groups. The mean estimated blood loss was 180.78 ±68.0 ml (range, 10-340 ml) in group 1 and 253.49 ±57ml (range, 60-360 ml) in group 2 (p-value < 0.0001). However, the fall in haemoglobin level after 24 hours of surgery was not statistically significantly different between the two groups. The total duration of surgery in group 1 was 97.86 ± 12.0 minutes (range, 78-132 minutes) and in group 2 was 116.60 ± 15.4 minutes (range, 97-156 minutes), the difference being statically significant (p-value < 0.0001, 95% CI 103±2.1). Console time in group 1 was 43.84 ±6.0 minutes (range, 34-57 minutes) and in group 2 53.22 ±5.5 minutes (range, 44-66 minutes), the difference being statistically significant (p-value < 0.0001, 95% CI 46.57±0.97). There was no difference observed in terms of intra-operative and post-operative complications between the two groups. Conclusion The total duration of surgery and estimated blood loss were directly proportional to the size of the uterus. However, complication rate, hospital stay and requirement of post-op analgesia were comparable in both groups. Robotic surgery in a larger uterus is a feasible option in terms of better surgical outcomes and postoperative course. Thus, robotic hysterectomy in women with a large uterus is a suitable approach in the narrow region of the pelvis.
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Affiliation(s)
- Anupama Bahadur
- Obstetrics and Gynecology, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
| | - Mamta Kumawat
- Obstetrics and Gynecology, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
| | - Latika Chawla
- Obstetrics and Gynecology, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
| | - Dhriti Kapur
- Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, Delhi, IND
| | - Yogesh Bahurupi
- Community and Family Medicine, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
| | - Rajlaxmi Mundhra
- Obstetrics and Gynecology, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
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Role of paracervical block in reducing postoperative pain after laparoscopic hysterectomy: A systematic reivew and meta-analysis of randomized controlled trials. J Gynecol Obstet Hum Reprod 2021; 50:102156. [PMID: 33984542 DOI: 10.1016/j.jogoh.2021.102156] [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: 03/11/2021] [Accepted: 04/24/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVE We aimed to perform a systematic review and meta-analysis in order to evaluate the effect of paracervical anesthetic block among women undergoing laparoscopic hysterectomy. METHODS A systematic search was done in Cochrane Library, PubMed, ISI web of science, and Scopus during January 2021. We selected randomized clinical trials (RCTs) compared paracervical anesthetic block versus normal saline (control group) among women undergoing laparoscopic hysterectomy. We pooled the continuous data as mean difference (MD) and dichotomous data as risk ratio (RR) with the corresponding 95% confidence intervals using Revman software. Our primary outcome was pain scores evaluated by visual analog scale (VAS) at 30 min and 1 hour. Our secondary outcomes were postoperative additional opioids requirement and length of hospital stay. RESULTS Three RCTs met our inclusion criteria with a total number of 233 patients. We found that paracervical anesthetic block was linked to a significant reduction in VAS pain score at 30 min and 1 hour post-hysterectomy (MD= -2.13, 95% CI [-3.09, -1.16], p>0.001 & MD= -1.87, 95% CI [-3.22, -0.52], p = 0.006). There was a significant decrease in additional opioids requirement postoperatively among paracervical anesthetic block group in comparison with control group (p = 0.002). No significant difference was found between both groups regarding the length of hospital stay. CONCLUSION Paracervical anesthetic block is effective in reducing postoperative pain after laparoscopic hysterectomy with decrease in opioids administration postoperatively.
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Richards L, Healey M, Cheng C, Reddington C, Robson-Hamond C, Dior U. Risk Factors and Outcomes of Conversion to Open Surgery in Benign Gynecologic Laparoscopies: A Case-Control Study. J Minim Invasive Gynecol 2021; 28:1786-1794. [PMID: 33892186 DOI: 10.1016/j.jmig.2021.03.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 03/26/2021] [Accepted: 03/30/2021] [Indexed: 11/19/2022]
Abstract
STUDY OBJECTIVE To describe cases of conversion from gynecologic laparoscopy to open surgery and to assess risk factors for conversion and conversion outcomes. DESIGN A retrospective case-control study. SETTING Tertiary referral hospital in Melbourne, Australia. PATIENTS Eighty-five cases of conversion from laparoscopy to laparotomy and 170 controls matched by age, surgical date, and gynecologic unit from 2006 to 2017. INTERVENTIONS Demographic, clinical, and surgical data were collected and compared between the study groups. Logistic regression was performed to identify preoperative and intraoperative risk factors for conversion. MEASUREMENTS AND MAIN RESULTS Rate of conversion during the study period was 0.7%. The most common indication for conversion was unexpected surgical complexity (67% of cases), which included severe adhesive disease, specimen size, severe pathology, and inadequate views. Factors that were significantly associated with risk of conversion in multivariate analysis were previous pelvic inflammatory disease (adjusted odds ratio [aOR] 5.16; 95% confidence interval [CI], 1.35-19.71; p = .02), previous open surgery (aOR 3.62; 95% CI, 1.52-8.58; p <.01), history of endometriosis (aOR 2.96; 95% CI, 1.17-7.50; p = .02), and elevated body mass index (aOR 1.07; 95% CI, 1.01-1.13; p = .02). As compared with current surgery for endometriosis, odds of conversion were higher in surgeries for emergency indications (aOR 5.40; 95% CI, 1.53-18.98; p <.01), uterine pathologies (aOR 3.34; 95% CI, 1.10-10.12; p = .03), and adnexal pathologies (aOR 2.76; 95% CI, 1.19-6.40; p = .02). With the inclusion of intraoperative factors, surgical adhesions were also found to be associated with conversion (aOR 3.19; 95% CI, 1.30-7.85; p = .01). Most skilled laparoscopic surgeon level as defined by the Australasian Gynaecological Endoscopy and Surgery Society was not associated with conversion risk. Conversion to laparotomy was associated with a higher rate of intraoperative and postoperative complications and prolonged length of stay. CONCLUSION Conversion to laparotomy is a rare but very important clinical outcome measure of laparoscopic surgery. Understanding the factors contributing to conversion and perioperative outcomes may help clinicians to identify and counsel patients before surgery and to reduce surgical morbidity.
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Affiliation(s)
- Lucy Richards
- Gynaecology 2 Unit (Endometriosis and Pelvic Pain), Royal Women's Hospital, Melbourne (all authors).
| | - Martin Healey
- Gynaecology 2 Unit (Endometriosis and Pelvic Pain), Royal Women's Hospital, Melbourne (all authors); Department of Obstetrics and Gynecology, University of Melbourne, Parkville (Drs. Healey and Cheng), Victoria, Australia
| | - Claudia Cheng
- Gynaecology 2 Unit (Endometriosis and Pelvic Pain), Royal Women's Hospital, Melbourne (all authors); Department of Obstetrics and Gynecology, University of Melbourne, Parkville (Drs. Healey and Cheng), Victoria, Australia
| | - Charlotte Reddington
- Gynaecology 2 Unit (Endometriosis and Pelvic Pain), Royal Women's Hospital, Melbourne (all authors)
| | - Caitlin Robson-Hamond
- Gynaecology 2 Unit (Endometriosis and Pelvic Pain), Royal Women's Hospital, Melbourne (all authors)
| | - Uri Dior
- Gynaecology 2 Unit (Endometriosis and Pelvic Pain), Royal Women's Hospital, Melbourne (all authors); Hadassah-Hebrew University Medical Center, Jerusalem, Israel (Dr. Dior)
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Dior UP, Kathurusinghe S, Cheng C, Reddington C, Daley AJ, Ang C, Healey M. Effect of Surgical Skin Antisepsis on Surgical Site Infections in Patients Undergoing Gynecological Laparoscopic Surgery: A Double-Blind Randomized Clinical Trial. JAMA Surg 2021; 155:807-815. [PMID: 32639545 DOI: 10.1001/jamasurg.2020.1953] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Importance Gynecological laparoscopies are one of the most common surgical procedures worldwide. Limited evidence exists on rates of surgical site infections in patients undergoing gynecological laparoscopies and strategies to prevent these infections. Objective To compare rates of port-site infections, organ or space infections, and any type of surgical site infections among patients who underwent gynecological laparoscopies and received 1 of 3 types of skin preparation solutions. Design, Setting, and Participants A double-blind randomized clinical trial was conducted between February 28, 2017, and November 26, 2018, at a tertiary university-affiliated referral center. A total of 661 patients 18 years or older who underwent an elective operative laparoscopy for treatment of nonmalignant gynecological disorders were randomly assigned in a 1:1:1 ratio to have their skin cleaned before surgery with alcohol-based chlorhexidine, alcohol-based povidone-iodine, or water-based povidone-iodine. Statistical analysis was performed from February 28, 2017, to November 26, 2018. Analyses were performed on a modified intention-to-treat basis. Interventions A total of 221 patients were randomized to have their skin prepared preoperatively with water-based povidone-iodine, 220 were randomized to alcohol-based povidone-iodine, and 220 were randomized to alcohol-based chlorhexidine. The patients were blinded to the solution used to clean their skin. Patients were followed up 1 and 4 weeks after surgery by a physician who was blinded to the skin preparation solution used at surgery. Evidence of infection according to Centers for Disease Control and Prevention criteria were documented. Main Outcomes and Measures The primary outcome of this study was port-site infection 30 days after surgery. Secondary outcomes were organ or space infections and any type of surgical site infections; the study also aimed to prospectively describe rates of surgical site infections in gynecological laparoscopies. Results Of the 661 patients, 640 (96.8%; mean [SD] age, 36.2 [10.6] years) were examined after surgery by a physician at the study site and were included in the modified intention-to-treat analysis. The overall rate of port-site infection was 10.2% (65 of 640), rate of organ or space infection was 6.6% (42 of 640), and rate of any surgical site infection was 16.3% (104 of 640). The odds ratio for port-site infection for alcohol-based chlorhexidine vs water-based povidone-iodine was 1.13 (95% CI, 0.61-2.08), for alcohol-based chlorhexidine vs alcohol-based povidone-iodine was 1.34 (95% CI, 0.71-2.52), and for water-based povidone-iodine vs alcohol-based povidone-iodine was 1.19 (95% 0.62-2.27). Conclusions and Relevance Surgical site infections were more common than expected among patients who underwent gynecological laparoscopies. No skin preparation solution provided an advantage compared with the other solutions in reducing infection rates. Trial Registration http://anzctr.org.au Identifier: ACTRN12617000475347.
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Affiliation(s)
- Uri P Dior
- Gynaecology Division, The Royal Women's Hospital, Parkville, Victoria, Australia.,Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | | | - Claudia Cheng
- Gynaecology Division, The Royal Women's Hospital, Parkville, Victoria, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia
| | - Charlotte Reddington
- Gynaecology Division, The Royal Women's Hospital, Parkville, Victoria, Australia
| | - Andrew J Daley
- Department of Microbiology and Infectious Disease, The Royal Women's Hospital, Parkville, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Catarina Ang
- Gynaecology Division, The Royal Women's Hospital, Parkville, Victoria, Australia
| | - Martin Healey
- Gynaecology Division, The Royal Women's Hospital, Parkville, Victoria, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia
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Abstract
minimally invasive surgery (MIS) is the standard approach to performance of several gynecologic procedures, including hysterectomy, gynecologic cancer staging procedures, myomectomy, pelvic organ prolapse repair, and select adnexal procedures. Robotic-assisted surgery, a computer-based MIS approach, has been adopted widely in the United States and several other countries. Robotics may offer technological and ergonomic benefits that overcome limitations associated with conventional laparoscopy; however, it is not clear that reported claims of superiority translate into improved gynecologic patient outcomes compared with other MIS approaches. This review critically appraises the evolving role, benefits, limitations, and controversies of robotic-assisted surgery utilization in benign and oncologic gynecology settings.
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17
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Elessawy M, Schneekloth S, Günther V, Maass N, Mettler L, Alkatout I. Postoperative Telephone-Based Questionnaire on Quality of Life after Robotic-Assisted Laparoscopic Hysterectomy versus Conventional Total Laparoscopic Hysterectomy. J Clin Med 2020; 9:jcm9092849. [PMID: 32887523 PMCID: PMC7565397 DOI: 10.3390/jcm9092849] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 08/28/2020] [Accepted: 08/29/2020] [Indexed: 12/14/2022] Open
Abstract
Aim: The objective of the study was to evaluate the benefits of robotic-surgery for hysterectomy compared to conventional laparoscopy for benign indications. A specially prepared telephone-based questionnaire was used postoperatively. Method: All women (n = 155) undergoing total laparoscopic hysterectomy for benign indications either by the robotic-assisted procedure (RALH) or conventional laparoscopy (CL) between 1 January 2013 and 31 December 2017 at the Department of the Gynecology, University Hospitals, Campus Kiel, Germany, were eligible for analysis. Intra-operative and postoperative parameters affecting the patients’ quality of life were assessed by a telephone-based questionnaire. The latter addressed postoperative pain, limitations of basic hygiene, daily activity, active pursuit of hobbies, sexual intercourse, and days of sick leave. All patients received the questionnaire by post at least three weeks prior to being contacted on the phone. Results: 78% of the contacted patients responded to the questionnaire; 96% (n = 115) of the patients said they would recommend the operation to other patients. Both groups needed 42 days to resume their regular hobbies. In whole 90.8% (n = 108) were total satisfied with the cosmetic result of the abdominal incision; the numbers in the respective groups were 80% (80% n = 36) in RALH and 97.3% (n = 72) in CL. The difference was significant on the Chi-square test (p = 0.002). 5% (n = 7) were dissatisfied with the scar (13.3%; n = 6) in the RALH group, and 1.4% (n = 1) in CL. In all 1.7 % of patients were dissatisfied with the position of the incisions; the respective numbers were 4.4 % (n = 2) in the RALH group and no patient in the CL group. 33% of patients experienced no limitations in regard of sexual intercourse after the operation. The median number of days taken to resume sexual intercourse after the operation was 56 days in the CL group, and 49 days in the RALH group. Nearly 30% (n = 25) were hesitant to resume intercourse. The median operating time was 145 min in the RALH group, which was significantly longer than the 117 min taken in the CL group (p < 0.001). Conclusions: The RALH procedure was associated with some minor advantages for the patients according to the results, however it does not have major significant advantages, especially in regard of early restoration of sexual function, while the CL shows shorter operating times and similar limitation. Postoperative counseling of patients should be aligned to their fears and expectations in regard of sexual function.
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Affiliation(s)
- Mohamed Elessawy
- Department of Gynecology and Obstetrics, University Hospitals Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany; (V.G.); (N.M.); (L.M.); (I.A.)
- Correspondence:
| | - Sarah Schneekloth
- Department of Gynecology and Obstetrics, University Hospitals Schleswig-Holstein, Campus Luebeck, 23562 Luebeck, Germany;
| | - Veronika Günther
- Department of Gynecology and Obstetrics, University Hospitals Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany; (V.G.); (N.M.); (L.M.); (I.A.)
| | - Nicolai Maass
- Department of Gynecology and Obstetrics, University Hospitals Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany; (V.G.); (N.M.); (L.M.); (I.A.)
| | - Liselotte Mettler
- Department of Gynecology and Obstetrics, University Hospitals Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany; (V.G.); (N.M.); (L.M.); (I.A.)
| | - Ibrahim Alkatout
- Department of Gynecology and Obstetrics, University Hospitals Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany; (V.G.); (N.M.); (L.M.); (I.A.)
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18
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Panico G, Campagna G, Vacca L, Caramazza D, Pizzacalla S, Rumolo V, Scambia G, Ercoli A. The Senhance ® assisted laparoscopy in urogynaecology: case report of sacral colpopexy with subtotal hysterectomy with bilateral salpingo-oophorectomy for pelvic organ prolapse *: * Video Article, to see the video use this link: https://qrco.de/bbdi3G. Facts Views Vis Obgyn 2020; 12:245-248. [PMID: 33123699 PMCID: PMC7580262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The aim of this case report was to evaluate the feasibility, efficacy, and safety of nerve-sparing laparoscopic sacrocolpopexy (SCP) performed with a minimally invasive approach by using 2.9-mm Senhance ® surgical robotic system (Senhance ® , TRANSENTERIX Inc., USA). A 60-year-old Caucasian woman with symptomatic pelvic organ prolapse-Q (POP-Q) Aa: 2, Ba: 3, C: +4, Bp:2, Ap: 2, TVL:10 underwent subtotal hysterectomy with bilateral salpingo-oophorectomy, with nerve-sparing SCP performed using the Senhance surgical robotic system.. The urogynaecological assessment on the day of discharge and at the 3 month follow-up showed surgical anatomic success (<2 POP-Q stage). The patient was fully satisfied with the cosmetic result. This is the first case of SCP performed with this innovative system. SCP using "Senhance ®" is a feasible and effective approach with good results in terms of operative time, cosmesis, postoperative pain and length of hospitalisation.
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Affiliation(s)
- G Panico
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Uroginecologia e Chirurgia Ricostruttiva del Pavimento Pelvico, Dipartimento di Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Roma, Italia,00168
| | - G Campagna
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Uroginecologia e Chirurgia Ricostruttiva del Pavimento Pelvico, Dipartimento di Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Roma, Italia,00168
| | - L Vacca
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Uroginecologia e Chirurgia Ricostruttiva del Pavimento Pelvico, Dipartimento di Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Roma, Italia,00168
| | - D Caramazza
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Uroginecologia e Chirurgia Ricostruttiva del Pavimento Pelvico, Dipartimento di Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Roma, Italia,00168
| | - S Pizzacalla
- Università Cattolica del Sacro Cuore, Istituto di Ginecologia ed Ostetricia, Roma, Italia, 00168; 4 PID Ginecologia Oncologica e Chirurgia Ginecologica Miniinvasiva, Università degli studi di Messina, Policlinico G.Martino, Messina, Italia ,98124
| | - V Rumolo
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Ginecologia Oncologica, Dipartimento di Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Roma, Italia, 00168
| | - G Scambia
- Università Cattolica del Sacro Cuore, Istituto di Ginecologia ed Ostetricia, Roma, Italia, 00168; 4 PID Ginecologia Oncologica e Chirurgia Ginecologica Miniinvasiva, Università degli studi di Messina, Policlinico G.Martino, Messina, Italia ,98124,Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Ginecologia Oncologica, Dipartimento di Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Roma, Italia, 00168
| | - A Ercoli
- Department of Gynaecology and Obstetrics, University of East Piedmont “A. Avogadro”, Novara, Italy
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Gray KE, Ma EW, Callegari LS, Magnusson SL, Tartaglione EV, Christy AY, Katon JG. Understanding Variation in Availability and Provision of Minimally Invasive Hysterectomy: A Qualitative Study of Department of Veterans Affairs Gynecologists. Womens Health Issues 2020; 30:200-206. [DOI: 10.1016/j.whi.2020.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 02/11/2020] [Accepted: 02/21/2020] [Indexed: 12/30/2022]
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20
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Ajao MO, Larsen CR, Manoucheri E, Goggins ER, Rask MT, Cox MKB, Mushinski A, Gu X, Cohen SL, Rudnicki M, Einarsson JI. Two-dimensional (2D) versus three-dimensional (3D) laparoscopy for vaginal cuff closure by surgeons-in-training: a randomized controlled trial. Surg Endosc 2020; 34:1237-1243. [PMID: 31172324 DOI: 10.1007/s00464-019-06886-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 05/31/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND Objective evidence is lacking as to the benefit of the addition of 3D vision to conventional laparoscopy in Gynecologic surgery. This study aims to compare 3-D visual system to traditional 2-D laparoscopic visualization for the laparoscopic closure of the vaginal cuff during total laparoscopic hysterectomy by surgeons-in-training [defined as senior OBGYN resident or Minimally Invasive Gynecologic Surgery (MIGS) fellow]. METHODS 51 patients undergoing total laparoscopic hysterectomy at two tertiary care academic hospitals were randomized to two-dimensional or three-dimensional vision system with cuff closure performed by surgeons-in-training. The primary outcome was the time taken for vaginal cuff closure. Secondary outcomes included peri-operative outcomes and assessment of surgeon's perception of ease of cuff closure. RESULTS 27 (52.9%) cases were allocated to cuff closure with the 2D system and 24 (47.1%) cases to closure with the 3D vision system. Patient baseline characteristics were similar between the vision systems. Mean vaginal cuff closure time was not significantly different between 2D and 3D vision (10.1 min for 2D versus 12 min for 3D, p = 0.31). An additional 24 s was added to cuff closure time with each 1 kg/m2 increase in BMI, after controlling for potential confounders (p = 0.003). There was no difference in the surgeon rating of ease of cuff closure between 2D and 3D. Peri-operative outcomes are similar among the two groups. CONCLUSION We did not demonstrate any benefits of 3D vision system over conventional 2D for the task of laparoscopic vaginal cuff suturing performed by surgeons-in-training. RCT Registration Number NCT02192606 https://clinicaltrials.gov/ct2/show/NCT02192606 (July 17, 2014).
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Affiliation(s)
- Mobolaji O Ajao
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA.
| | - Christian R Larsen
- The Robotic & Minimal Invasive Surgical Research Unit, Department of Gynecology, Copenhagen University Hospital, Herlev, Denmark
| | - Elmira Manoucheri
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA
| | - Emily R Goggins
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA
| | - Maja T Rask
- Department of Obstetrics and Gynecology, Odense University Hospital, Odense, Denmark
| | - Mary K B Cox
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA
| | - Avery Mushinski
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA
| | - Xiangmei Gu
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA
| | - Sarah L Cohen
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA
| | - Martin Rudnicki
- Department of Obstetrics and Gynecology, Odense University Hospital, Odense, Denmark
| | - Jon I Einarsson
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA
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Feldstein J, Coussons H. Achieving robotic program best practice performance and cost versus laparoscopy: Two case studies define a framework for optimization. Int J Med Robot 2020; 16:e2098. [PMID: 32096901 DOI: 10.1002/rcs.2098] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 01/14/2020] [Accepted: 02/13/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND Robotic surgery is seen by many hospital administrators and surgeons as slower and more expensive than laparoscopic surgery despite the implementation of commonly held robotic best practices. Multiple factors, including surgeon learning curves and program governance, are often overlooked, precluding optimal robotic program performance. METHODS An assessment of several leading robotic surgery publications is presented followed by real-world case studies from two US hospitals: an existing robotic program in a mid-sized, regional hospital system and a small, rural hospital that launched a new program. RESULTS Improvements in robotic surgery costs/program efficiency were seen at the hospital system vs baseline at 18 months post-implementation; and high-performance robotic efficiency and cost benchmarks were matched or surpassed at the rural hospital at 1 year post-launch. DISCUSSION When best practices are utilized in robotic programs, surgical case times, costs, and efficiency performance metrics equaling or exceeding laparoscopy can be achieved.
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Affiliation(s)
- Josh Feldstein
- CAVA Robotics International, LLC, Northampton, Massachusetts, USA
| | - Herbert Coussons
- CAVA Robotics International, LLC, Northampton, Massachusetts, USA
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Marra AR, Puig-Asensio M, Edmond MB, Schweizer ML, Bender D. Infectious complications of laparoscopic and robotic hysterectomy: a systematic literature review and meta-analysis. Int J Gynecol Cancer 2020; 29:518-530. [PMID: 30833440 DOI: 10.1136/ijgc-2018-000098] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 12/07/2018] [Accepted: 12/11/2018] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE We performed a systematic review of the literature and meta-analysis of the infectious complications of hysterectomy, comparing robotic-assisted hysterectomy to conventional laparoscopic-assisted hysterectomy. METHODS We searched PubMed, CINAHL, CDSR, and EMBASE through July 2018 for studies evaluating robotic-assisted hysterectomy, laparoscopic-assisted hysterectomy, and infectious complications. We employed random-effect models to obtain pooled OR estimates. Heterogeneity was evaluated with I2 estimation and the Cochran Q statistic. Pooled ORs were calculated separately based on the reason for hysterectomy (eg, benign uterine diseases, endometrial cancer, and cervical cancer). RESULTS Fifty studies were included in the final review for the meta-analysis with 176 016 patients undergoing hysterectomy. There was no statistically significant difference in the number of infectious complication events between robotic-assisted hysterectomy and laparoscopic-assisted hysterectomy (pooled OR 0.97; 95 % CI 0.74 to 1.28). When we performed a stratified analysis, similar results were found with no statistically significant difference in infectious complications comparing robotic-assisted hysterectomy to laparoscopic-assisted hysterectomy among patients with benign uterine disease (pooled OR 1.10; 95 % CI 0.70 to 1.73), endometrial cancer (pooled OR 0.97; 95 % CI 0.55 to 1.73), or cervical cancer (pooled OR 1.09; 95 % CI 0.60 to 1.97). CONCLUSION In our meta-analysis the rate of infectious complications associated with robotic-assisted hysterectomy was no different than that associated with conventional laparoscopic-assisted hysterectomy.
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Affiliation(s)
- Alexandre R Marra
- Office of Clinical Quality, Safety and Performance Improvement University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
- Division of General Internal Medicine, Department of Internal Medicine, Carver College of Medicine, Iowa City, Iowa, USA
- Division of Medical Practice, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Mireia Puig-Asensio
- Office of Clinical Quality, Safety and Performance Improvement University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
- Division of General Internal Medicine, Department of Internal Medicine, Carver College of Medicine, Iowa City, Iowa, USA
| | - Michael B Edmond
- Office of Clinical Quality, Safety and Performance Improvement University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
- Division of General Internal Medicine, Department of Internal Medicine, Carver College of Medicine, Iowa City, Iowa, USA
- Division of Infectious Diseases, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Marin L Schweizer
- Division of General Internal Medicine, Department of Internal Medicine, Carver College of Medicine, Iowa City, Iowa, USA
- The Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, Iowa, USA
| | - David Bender
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
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Herrinton LJ, Raine-Bennett T, Liu L, Alexeeff SE, Ramos W, Suh-Burgmann B. Outcomes of Robotic Hysterectomy for Treatment of Benign Conditions: Influence of Patient Complexity. Perm J 2019; 24:19.035. [PMID: 31905335 DOI: 10.7812/tpp/19.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Robotic hysterectomy may offer advantages for complex cases over the conventional laparoscopic approach. OBJECTIVE To assess the association of surgical approach (robotic vs conventional) with blood loss, risks of readmission, reoperation, complications, and average operative time. METHODS In a retrospective cohort study, we used the electronic medical records of Kaiser Permanente Northern California, 2011 to 2015, to estimate outcomes of robotic and conventional laparoscopic hysterectomy among women with complex or noncomplex benign disease. Mixed-effects regression models accounted for patient characteristics and surgeon volume. RESULTS The study included 560 robotic and 6785 conventional laparoscopic cases. Overall, 1836 patients (25%) met criteria for being complex. The average operative time was 152 minutes for robotic hysterectomy and 157 minutes for conventional laparoscopic hysterectomy (p < 0.0001). Complex surgical cases averaged 190 minutes and noncomplex cases averaged 144 minutes. The difference in operative time for high-volume surgeons treating complex patients with robotic hysterectomy vs conventional hysterectomy was 21 minutes faster (p < 0.05). After adjustment, the risk of blood loss at least 51 mL was lower for robotic surgery than for conventional surgery for complex and noncomplex patients. Other than risk of urinary tract complications, we observed no differences in the risks of complications or risk of reoperation between robotic and conventional laparoscopy for complex and noncomplex patients. CONCLUSION For women with complex disease, the robotic approach, when used by a higher-volume surgeon, may be associated with shorter operative time and slightly less blood loss, but not with lower risk of complications.
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Affiliation(s)
| | | | | | | | - Wilfredo Ramos
- Department of Obstetrics and Gynecology, Sacramento Medical Center, CA
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Schuttringer E, Beleche T. The impact of recent power morcellator risk information on inpatient surgery and patient outcomes. J Comp Eff Res 2019; 9:53-65. [PMID: 31840551 DOI: 10.2217/cer-2019-0093] [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: 11/21/2022] Open
Abstract
Aim: We examine the impact of the new risk information about a surgical device on surgery and patient outcomes for hysterectomy in the inpatient setting. Methods: We utilize a difference-in-differences approach to assess the impact of new risk information on patient outcomes in the inpatient setting between 2009 and 2014. The inpatient data come from a nationally representative sample of hospitalizations in the USA. We use the likelihood of laparoscopic surgery, measures of resource use and surgical complications as outcome variables. Results: We estimate a three-percentage point decrease in the likelihood of receiving laparoscopic hysterectomy, a one-percentage point increase in the likelihood of experiencing a surgical complication and no impact on resource use, relative to pre-existing means. Conclusion: Our findings show that there was movement away from laparoscopic surgery in the months following the dissemination of new risk information. These changes had limited effect on patient outcomes.
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Affiliation(s)
- Ehren Schuttringer
- Food & Drug Administration Office of the Commissioner, 10903 New Hampshire Ave, Silver Spring, Maryland, MD 20993, USA
| | - Trinidad Beleche
- Food & Drug Administration Office of the Commissioner, 10903 New Hampshire Ave, Silver Spring, Maryland, MD 20993, USA
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25
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Xiong Z, Rindos NB, Lee T. Increasing the Rate of Laparoscopic Hysterectomy Safely for Benign Gynecologic Disease. J Gynecol Surg 2019. [DOI: 10.1089/gyn.2019.0032] [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)
- Zhoufang Xiong
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Noah B. Rindos
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Magee–Women's Hospital of the University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Ted Lee
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Magee–Women's Hospital of the University of Pittsburgh Medical Center, Pittsburgh, PA
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26
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Akazawa M, Lee SL, Liu WM. Impact of uterine weight on robotic hysterectomy: Analysis of 500 cases in a single institute. Int J Med Robot 2019; 15:e2026. [PMID: 31310418 DOI: 10.1002/rcs.2026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 06/26/2019] [Accepted: 07/08/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUNDS Robotic surgeries have been used frequently for benign diseases in gynecology. However, the advantage of robotic surgery for huge uterus is unclear. METHODS We analyzed surgical outcomes of 527 patients who underwent robotic hysterectomies for benign diseases, separating uterine sizes into five groups by every 250 g. RESULTS Median operative time in the five groups was 123 minutes (<250 g), 130 minutes (250-500 g), 144 minutes (500-750 g), 180 minutes (750-1000 g), and 170 minutes (>1000 g). Median estimated blood loss was 50, 100, 100, 200, and 400 mL in the five groups, respectively. The incidence of intraoperative complications did not correlate with uterine weight. CONCLUSIONS Operative time, estimated blood loss, and the incidence of conversion to laparotomy increased with uterine size during robotic hysterectomies, especially evident in a uterus >750 g.
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Affiliation(s)
- Munetoshi Akazawa
- Department of Obstetrics and Gynecology, Taipei Medical University Hospital, Taipei, Taiwan
| | - Sheng-Lun Lee
- Department of Obstetrics and Gynecology, Taipei Medical University Hospital, Taipei, Taiwan
| | - Wei-Min Liu
- Department of Obstetrics and Gynecology, Taipei Medical University Hospital, Taipei, Taiwan
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27
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Martínez-Maestre MA, Melero-Cortés LM, Coronado PJ, González-Cejudo C, García-Agua N, García-Ruíz AJ, Jódar-Sánchez F. Long term COST-minimization analysis of robot-assisted hysterectomy versus conventional laparoscopic hysterectomy. HEALTH ECONOMICS REVIEW 2019; 9:18. [PMID: 31214891 PMCID: PMC6734326 DOI: 10.1186/s13561-019-0236-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 06/06/2019] [Indexed: 05/07/2023]
Abstract
BACKGROUND The aim of this study is to carry out the economic evaluation, in term of a cost-minimization analysis that considers healthcare costs and indirect costs, of robot-assisted hysterectomy (RAH) compared with conventional laparoscopic hysterectomy (CLH) in female adults scheduled for total laparoscopic hysterectomy for benign conditions. METHODS Cost-minimization analysis based on an analytic observational study of prospective cohorts with a five-year time horizon. Eligible participants were all female adults scheduled for total laparoscopic hysterectomy for benign conditions at tertiary hospital. The economic evaluation was conducted from a Spanish National Health Service and societal perspective, including healthcare costs and indirect costs. The costs are expressed in Euros from the year 2015. RESULTS One hundred sixty nine patients were analyzed, 68 in the RAH group and 101 in the CLH group. Average cost for the RAH group was €8982.42 compared to €8015.14 for the CLH group (incremental cost €967.27; p = 0.054). Healthcare cost is the most important component of total cost and represents 86.4% for the RAH group and 82.3% for the CLH group. The difference of €1169 (p = 0.01) in the average healthcare cost is mainly due to the cost of purchasing and maintaining the equipment (difference of €1206.39 in favor of RAH; p < 0.005). With regard to indirect costs, for patients in the RAH group the costs associated with loss of productivity were lower (difference of €203.42; p = 0.17), while the cost of trips to the hospital was higher (difference of €1.98; p = 0.66) in respect to CLH. CONCLUSIONS Our findings reveal similar effectiveness between RAH and CLH, although CLH is the more efficient option from the point of view of an economic analysis based on cost-minimization.
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Affiliation(s)
| | | | - Pluvio J. Coronado
- Women’s Health Institute, San Carlos Clinic Hospital, IdISSC, Madrid, Spain
| | | | - Nuria García-Agua
- Health Economics & Rational Use of Drugs, Faculty of Medicine, University of Málaga, Málaga, Spain
- Pharmacoeconomics: Clinical and Economic Evaluation of Pharmaceutical Drugs and Palliative Care, Institute of Biomedical Research in Malaga (IBIMA), Málaga, Spain
| | - Antonio J. García-Ruíz
- Health Economics & Rational Use of Drugs, Faculty of Medicine, University of Málaga, Málaga, Spain
- Pharmacoeconomics: Clinical and Economic Evaluation of Pharmaceutical Drugs and Palliative Care, Institute of Biomedical Research in Malaga (IBIMA), Málaga, Spain
| | - Francisco Jódar-Sánchez
- Biomedical Informatics, Biomedical Engineering and Health Economy, Institute of Biomedicine of Seville, IBiS/Virgen del Rocío University Hospital / CSIC / University of Seville, Seville, Spain
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28
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Kaaki B, Lewis E, Takallapally S, Cleveland B. Direct cost of hysterectomy: comparison of robotic versus other routes. J Robot Surg 2019; 14:305-310. [PMID: 31165995 DOI: 10.1007/s11701-019-00982-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 06/03/2019] [Indexed: 11/24/2022]
Abstract
The aim of this study was to investigate the direct cost of robotic hysterectomy in comparison with abdominal, vaginal, and laparoscopic routes past the initial learning curve. We examined a consecutive case series of 348 patients undergoing abdominal (AH), vaginal (VH), laparoscopic (LH), or robotic hysterectomy (RH) for benign conditions between January 2015 and March 2017. The primary outcome was the direct cost of hysterectomy, while the secondary outcome was length of stay. Multiple linear regression was used to examine the cost and length of stay across the four hysterectomy groups after controlling for potential confounding variables. 19 (5.5%) patients underwent AH, 53 (15.2%) LH, and 59 (16.9%) VH, while 217 (62.4%) RH. VH group was the oldest at age 52.1 years (p < 0.01), whereas AH group had the highest BMI at 35.9 kg/m2 (p = 0.03). While colporrhaphy was most frequently performed in VH (81%), mid-urethral sling was most common in RH (30%) (p < 0.01). The average direct cost was $3865 for RH, $4063 for AH, $2791 for VH, and $3818 for LH. Upon multivariate analysis, RH and VH were $650.47 (p < 0.01) and $883.07 (p < 0.01) cheaper, respectively, compared to AH. The average length of stay was the shortest for RH at 10.7 h, followed by LH at 15.5 h, vaginal at 20 h, and abdominal at 51.5 h (p < 0.01). VH has the lowest direct cost, while AH has the highest. Both VH and RH have a significantly lower cost than that of AH. RH has the shortest hospital stay, whereas AH has the longest.
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Affiliation(s)
- Bilal Kaaki
- Des Moines University, Des Moines, IA, USA. .,Department of Obstetrics and Gynecology, UnityPoint Health, 1825 Logan Ave., Waterloo, IA, 50703, USA.
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29
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Wu CZ, Klebanoff JS, Tyan P, Moawad GN. Review of strategies and factors to maximize cost-effectiveness of robotic hysterectomies and myomectomies in benign gynecological disease. J Robot Surg 2019; 13:635-642. [PMID: 30919259 DOI: 10.1007/s11701-019-00948-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 03/19/2019] [Indexed: 12/15/2022]
Abstract
Common benign gynecologic procedures include hysterectomies and myomectomies, with hysterectomy being the most common gynecologic procedure in the United States [1]. While historically performed via laparotomy, the field of gynecologic surgery was revolutionized with the advent of laparoscopic techniques, with the most recent advancement being the introduction of robotic-assisted surgery in 2005. Robotic surgery has all the benefits of laparoscopic surgery such as decreased blood loss, quicker return to activities, and shorter length of hospital stay. Additional robotic-specific advantages include but are not limited to improved ergonomics, 3D visualization, and intuitive surgical movements. Despite these advantages, one of the most commonly cited drawbacks of robotic surgery is the associated cost. While the initial cost to purchase the robotic console and its associated maintenance costs are relatively high, robotic surgery can be cost-effective when utilized correctly.This article reviews application strategies and factors that can offset traditional costs and maximize the benefits of robotic surgery.
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Affiliation(s)
- Catherine Z Wu
- Department of Obstetrics and Gynecology, Division of Minimally Invasive Gynecology, The George Washington University Hospital, 2150 Pennsylvania Ave NW, Washington, DC, 20037, USA
| | - Jordan S Klebanoff
- Department of Obstetrics and Gynecology, Division of Minimally Invasive Gynecology, The George Washington University Hospital, 2150 Pennsylvania Ave NW, Washington, DC, 20037, USA
| | - Paul Tyan
- Department of Obstetrics and Gynecology, Division of Minimally Invasive Gynecology, The University of North Carolina, Chapel Hill, NC, USA
| | - Gaby N Moawad
- Department of Obstetrics and Gynecology, Division of Minimally Invasive Gynecology, The George Washington University Hospital, 2150 Pennsylvania Ave NW, Washington, DC, 20037, USA.
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30
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Barr Grzesh RL, Treszezamsky AD, Fenske SS, Rascoff LG, Moshier EL, Ascher-Walsh C. Use of Paracervical Block Before Laparoscopic Supracervical Hysterectomy. JSLS 2018; 22:JSLS.2018.00023. [PMID: 30356343 PMCID: PMC6174006 DOI: 10.4293/jsls.2018.00023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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 Objective: Some patients who undergo laparoscopic hysterectomy request overnight admission for pain management, thus increasing costs for a surgery that is safe for same-day discharge. We wanted to evaluate whether a paracervical block of bupivacaine with epinephrine before laparoscopic supracervical hysterectomy would decrease overnight admission rates, postoperative pain, and pain medication requirement Methods: This was a randomized, double-blind, placebo-controlled, parallel-group trial (Canadian Task Force classification I) at an academic medical center. Patients undergoing laparoscopic supracervical hysterectomy were randomized to a 20-mL paracervical injection of either 0.25% bupivacaine with epinephrine or 20 mL normal saline before skin incision. All providers, except the circulating nurse, were blinded. The primary outcome was overnight hospital admission rate. Secondary outcomes included postoperative pain medication use and pain scores. Analysis included t test, χ2, Wilcoxon, and ANOVA. Results: One hundred thirty-two patients were enrolled—68 in the treatment group and 64 in the placebo group. Demographics were similar between groups. The unplanned overnight admission rate was 34% for the treatment group and 27% for the placebo group (P = .25). After discharge, the treatment group used on average 8.5 tablets of narcotics, whereas the placebo group used 11.7 tablets (P = .07). The treatment group took 13.1 tablets of nonnarcotic analgesics compared to 11.2 in the placebo group (P = .57). Both groups reported similar pain scores. Conclusion: Paracervical block with bupivacaine and epinephrine before laparoscopic supracervical hysterectomy did not decrease overnight admission rate or affect postoperative pain. Postoperative opiate use was minimally decreased.
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Affiliation(s)
- Rachel L Barr Grzesh
- Department of Obstetrics, Gynecology and Reproductive Science, Division of Gynecology
| | | | - Suzanne S Fenske
- Department of Obstetrics, Gynecology and Reproductive Science, Division of Gynecology
| | - Lauren G Rascoff
- Department of Obstetrics, Gynecology and Reproductive Science, Division of Gynecology
| | - Erin L Moshier
- Division of Biostatistics, Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Charles Ascher-Walsh
- Department of Obstetrics, Gynecology and Reproductive Science, Division of Gynecology
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Yin X, Zhu L, Tan W, Zhu X, Liu S, Xu W. Time Intervals Between Prior Cervical Conization and Posterior Hysterectomy Influence Postoperative Infection in Patients with Cervical Intraepithelial Neoplasia or Cancer. Med Sci Monit 2018; 24:9063-9072. [PMID: 30547901 PMCID: PMC6302663 DOI: 10.12659/msm.911892] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background This study was conducted to observe the influence of different time intervals between prior cervical conization and posterior hysterectomy on postoperative infection in female patients with cervical intraepithelial neoplasia or cancer. Material/Methods Medical records of 170 patients who underwent hysterectomy following cervical conization between November 2010 and September 2016 at the Zhenjiang 4th Hospital were reviewed. According to the interval between hysterectomy and cervical conization, patients were classified into 1–2-week, 4–5-week, and 6-week groups. The outcomes of 46 patients who underwent conization with iodoform gauze inside the vagina were observed. Results The total postoperative infection rate after hysterectomy was 25.3% (43/170). The expression levels of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and high mobility group box 1 (HMGB1) in the cervical secretions and tissues were found to gradually increase, peaking at 2 weeks after conization, then significantly decreasing 3–6 weeks onwards. Compared with the 1–2-week group, the 4–5-week and 6-week groups exhibited significantly lower infection rates (2/42, 4.8%, 4–5-week group; 0%, 0/33, 6-week group; vs. 41/95, 43.2%, 1–2-week group; p<0.001). In the 1–2-week group in particular, the postoperative infection rate after laparoscopic hysterectomy was significantly higher than the rate after abdominal hysterectomy (21/35, 60% vs. 20/60, 33%, p=0.0177). In addition, the vaginal and cervical wound infection rates after conization in patients treated with iodoform were significantly lower than the rates in those without iodoform treatment (p<0.05). Conclusions Hysterectomy should be performed at least 4 weeks after conization. Treatment with iodoform would be beneficial.
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Affiliation(s)
- Xinming Yin
- Department of Gynecology, Maternal and Child Care Service Center, Zhenjiang 4th Hospital, Zhenjiang, Jiangsu, China (mainland)
| | - Li Zhu
- Department of Gynecology, Maternal and Child Care Service Center, Zhenjiang 4th Hospital, Zhenjiang, Jiangsu, China (mainland)
| | - Weiwei Tan
- Department of Gynecology, Maternal and Child Care Service Center, Zhenjiang 4th Hospital, Zhenjiang, Jiangsu, China (mainland)
| | - Xiaolan Zhu
- Department of Gynecology, Maternal and Child Care Service Center, Zhenjiang 4th Hospital, Zhenjiang, Jiangsu, China (mainland)
| | - Songping Liu
- Department of Gynecology, Maternal and Child Care Service Center, Zhenjiang 4th Hospital, Zhenjiang, Jiangsu, China (mainland)
| | - Wenlin Xu
- Department of Gynecology, Maternal and Child Care Service Center, Zhenjiang 4th Hospital, Zhenjiang, Jiangsu, China (mainland)
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Trends in Route of Hysterectomy after the Implementation of a Comprehensive Robotic Training Program. Minim Invasive Surg 2018; 2018:7362489. [PMID: 30310699 PMCID: PMC6166379 DOI: 10.1155/2018/7362489] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 08/06/2018] [Accepted: 08/27/2018] [Indexed: 12/13/2022] Open
Abstract
Objective To evaluate trends in surgical approach for hysterectomy following the introduction and implementation of a comprehensive robotic surgery program. Methods A retrospective review of all hysterectomies done at two institutions, a community hospital and a suburban, tertiary-care teaching hospital, in the same health system over a five-year period, January 2010 through December 2014. A robotic surgery training program was implemented during the first year of the study and trends in route of hysterectomy were evaluated in the subsequent years. Results A total of 5175 patients undergoing hysterectomy, for both benign and malignant indications, were included in the study. There was a significant decrease in the percent of cases performed through an abdominal approach at both the community and teaching hospitals (19.3% decline at each institution). There was an inversely related significant increase in the percent of robotic procedures at both the community and teaching hospitals (44.5% and 17%, respectively). A decrease in number of cases performed vaginally over this period was only noted in the community hospital site (25.2% decrease), and there was a slightly higher rate of vaginal hysterectomies at the teaching hospital over this study period (21.9% in 2010, 24.1% in 2014). Conclusion The decrease in number of abdominal and laparoscopic hysterectomies and increase in number of robotic hysterectomies that was seen are consistent with national trends. The initiation of a robotic training program did not prevent the proliferation of use of the robot but did aim to ensure proficiency on the robot prior to gaining privileges for patient use. This type of comprehensive training and monitoring program could be applied to future technologic advances to ensure a standard level of surgical proficiency. Trends in route of hysterectomy are clearly multifactorial and involve patient, provider, and location-specific factors that are likely to continue to change.
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Korsholm M, Sørensen J, Mogensen O, Wu C, Karlsen K, Jensen PT. A systematic review about costing methodology in robotic surgery: evidence for low quality in most of the studies. HEALTH ECONOMICS REVIEW 2018; 8:21. [PMID: 30194567 PMCID: PMC6128948 DOI: 10.1186/s13561-018-0207-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 09/03/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES The main objective of this review was to evaluate the methodological design in studies reporting resource use and costs related to robotic surgery in gynecology. METHODS Systematic searches were performed in the databases PubMed, Embase, Scopus, and The Centre for Reviews and Dissemination database for relevant studies before May 2016. The quality of the methodological design was assessed with items regarding methodology from the Consolidated Health Economic Evaluation Reporting Standards (CHEERS). The systematic review was reported according to the PRISMA guidelines. RESULTS Thirty-two relevant studies were included. None of the reviewed studied fully complied with the CHEERS methodological checklist. Background and objectives, Target population and subgroups and Setting and location were covered in sufficient details in all studies whereas the Study perspective, Justification of the time horizon, Discount rate, and Estimating resources and costs were covered in less than 50%. Most of the studies (29/32) used the health care sector perspective whereas the societal perspective was applied in three studies. The time horizon was stated in 18/32 of the studies. CONCLUSIONS The methodological quality of studies evaluating costs of robotic surgery was low. The longest follow-up was 4 months and in general, the use of detailed cost data were lacking in most of the investigations. Key determinants, such as purchasing, maintenance costs of the robotic platform, and the use of surgical equipment, were rarely reported. If health care cost analyses lack transparency regarding cost drivers included it may not provide a true foundation for decision-making.
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Affiliation(s)
- Malene Korsholm
- Department of Gynecology and Obstetrics, Faculty of Health Sciences, Odense University Hospital, Clinical Institute, University of Southern Denmark, Odense, Denmark
- Danish Centre for Health Economics (DaCHE), Department of Public Health, University of Southern Denmark, Odense, Denmark
- Clinical Institute, University of Southern Denmark, Odense, Denmark
- Center of Evidence-Based Medicine Odense (CEBMO), Odense University Hospital, Clinical Institute, University of Southern Denmark, Odense, Denmark
- Research Unit of Gynecology and Obstetrics, University of Southern Denmark, Odense University Hospital, Kløvervænget 10, 10th Floor, 5000 Odense, Denmark
| | - Jan Sørensen
- Danish Centre for Health Economics (DaCHE), Department of Public Health, University of Southern Denmark, Odense, Denmark
- Healthcare Outcomes Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Ole Mogensen
- Department of Pelvic Cancer, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden
- Clinical Institute, University of Southern Denmark, Odense, Denmark
| | - Chunsen Wu
- Department of Gynecology and Obstetrics, Faculty of Health Sciences, Odense University Hospital, Clinical Institute, University of Southern Denmark, Odense, Denmark
- Clinical Institute, University of Southern Denmark, Odense, Denmark
| | - Kamilla Karlsen
- Department of Gynecology and Obstetrics, Faculty of Health Sciences, Odense University Hospital, Clinical Institute, University of Southern Denmark, Odense, Denmark
- Clinical Institute, University of Southern Denmark, Odense, Denmark
| | - Pernille T. Jensen
- Department of Gynecology and Obstetrics, Faculty of Health Sciences, Odense University Hospital, Clinical Institute, University of Southern Denmark, Odense, Denmark
- Clinical Institute, University of Southern Denmark, Odense, Denmark
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Waldman I, Wagner S, Kulaylat AS, Deimling TA. Physical Well-Being and Route of Benign Hysterectomy. Womens Health Issues 2018; 28:456-461. [PMID: 30177340 DOI: 10.1016/j.whi.2018.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 03/07/2018] [Accepted: 03/13/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES We sought to determine if there is an association between preoperative risk factors as defined by the American Society of Anesthesiologists (ASA) physical status score and the route of hysterectomy for benign indications. METHODS In this retrospective cohort study, the American College of Surgeons National Surgical Quality Improvement Project database was used to determine the route of hysterectomy, using Current Procedural Terminology codes, and associated ASA class. The analysis included abdominal, vaginal, total laparoscopic, and laparoscopic assisted vaginal routes of hysterectomy. Routes of hysterectomy were also grouped as either abdominal or minimally invasive for analysis. Multinomial logistic regression was used to model route of hysterectomy as a function of patient covariates, including ASA class, age, race and ethnicity, and body mass index. RESULTS The analysis included 117,919 patients from the National Surgical Quality Improvement Project database. Patients with ASA classification of III or IV to V had significantly decreased odds of undergoing a minimally invasive approach for hysterectomy (odds ratio [OR], 0.81 [95% confidence interval (CI)], 0.77-0.85; and OR, 0.42 [95% CI, 0.37-0.48], respectively). Secondary outcome analysis revealed that a body mass index of more than 30 kg/m2 was associated with significantly lower odds of undergoing a minimally invasive hysterectomy (OR, 0.87; 95% CI, 0.85-0.89). With respect to race/ethnicity, all non-White groups had decreased odds of undergoing a hysterectomy via a minimally invasive approach. Age 75 years or older was correlated with an increased likelihood of minimally invasive hysterectomy (OR, 1.18; 95% CI, 1.10-1.26). CONCLUSIONS Patients with increased preoperative risk as defined by a high ASA classification are less likely to undergo a hysterectomy using a minimally invasive route for benign indications.
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Affiliation(s)
- Ian Waldman
- Department of Obstetrics and Gynecology, Division of Minimally Invasive GYN Surgery, Milton S Hershey Medical Center, Penn State University, Hershey, Pennsylvania
| | - Stephen Wagner
- Department of Obstetrics and Gynecology, Division of Minimally Invasive GYN Surgery, Milton S Hershey Medical Center, Penn State University, Hershey, Pennsylvania
| | - Audrey S Kulaylat
- Department of Surgery, Milton S Hershey Medical Center, Penn State University, Hershey, Pennsylvania
| | - Timothy A Deimling
- Department of Obstetrics and Gynecology, Division of Minimally Invasive GYN Surgery, Milton S Hershey Medical Center, Penn State University, Hershey, Pennsylvania.
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Schuessler Z, Schuessler H, Strohaber J. Robotic-assisted hysterectomy in a community hospital after seven years of experience. LAPAROSCOPIC, ENDOSCOPIC AND ROBOTIC SURGERY 2018. [DOI: 10.1016/j.lers.2018.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Robotic surgery: is it right for India? J Robot Surg 2018; 12:725-726. [PMID: 29869199 DOI: 10.1007/s11701-018-0830-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 05/31/2018] [Indexed: 10/14/2022]
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Ackerman SJ, Daniel S, Baik R, Liu E, Mehendale S, Tackett S, Hellan M. Comparison of complication and conversion rates between robotic-assisted and laparoscopic rectal resection for rectal cancer: which patients and providers could benefit most from robotic-assisted surgery? J Med Econ 2018; 21:254-261. [PMID: 29065737 DOI: 10.1080/13696998.2017.1396994] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
AIMS To compare (1) complication and (2) conversion rates to open surgery (OS) from laparoscopic surgery (LS) and robotic-assisted surgery (RA) for rectal cancer patients who underwent rectal resection. (3) To identify patient, physician, and hospital predictors of conversion. MATERIALS AND METHODS A US-based database study was conducted utilizing the 2012-2014 Premier Healthcare Data, including rectal cancer patients ≥18 with rectal resection. ICD-9-CM diagnosis and procedural codes were utilized to identify surgical approaches, conversions to OS, and surgical complications. Propensity score matching on patient, surgeon, and hospital level characteristics was used to create comparable groups of RA\LS patients (n = 533 per group). Predictors of conversion from LS and RA to OS were identified with stepwise logistic regression in the unmatched sample. RESULTS Post-match results suggested comparable perioperative complication rates (RA 29% vs LS 29%; p = .7784); whereas conversion rates to OS were 12% for RA vs 29% for LS (p < .0001). Colorectal surgeons (RA 9% vs LS 23%), general surgeons (RA 13% vs LS 35%), and smaller bed-size hospitals (RA 14% vs LS 33%) have reduced conversion rates for RA vs LS (p < .0001). Statistically significant predictors of conversion included LS, non-colorectal surgeon, and smaller bed-size hospitals. LIMITATIONS Retrospective observational study limitations apply. Analysis of the hospital administrative database was subject to the data captured in the database and the accuracy of coding. Propensity score matching limitations apply. RA and LS groups were balanced with respect to measured patient, surgeon, and hospital characteristics. CONCLUSIONS Compared to LS, RA offers a higher probability of completing a successful minimally invasive surgery for rectal cancer patients undergoing rectal resection without exacerbating complications. Male, obese, or moderately-to-severely ill patients had higher conversion rates. While colorectal surgeons had lower conversion rates from RA than LS, the reduction was magnified for general surgeons and smaller bed-size hospitals.
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Affiliation(s)
| | | | - Rebecca Baik
- b Covance Market Access Services , Gaithersburg , MD , USA
| | - Emelline Liu
- c Health Economics and Outcomes Research, Intuitive Surgical , Sunnyvale , CA , USA
| | | | - Scott Tackett
- c Health Economics and Outcomes Research, Intuitive Surgical , Sunnyvale , CA , USA
| | - Minia Hellan
- e Surgical Oncology, Wright State University , Centerville , OH , USA
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A Swedish population-based evaluation of benign hysterectomy, comparing minimally invasive and abdominal surgery. Eur J Obstet Gynecol Reprod Biol 2018; 222:113-118. [PMID: 29408741 DOI: 10.1016/j.ejogrb.2018.01.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Revised: 01/10/2018] [Accepted: 01/16/2018] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The aim was to evaluate surgical routes for benign hysterectomy in a Swedish population, including abdominal and minimally invasive surgery. STUDY DESIGN Prospectively collected data from the Swedish National GynOp Registry 2009-2015: 13 806 hysterectomy cases were included: abdominal (AH, n = 7485), vaginal (VH, n = 3767), conventional laparoscopic (LH, n = 1539) and robotically-assisted (RAH, n = 1015). RESULTS The VH group had the shortest operation time at 75 min, AH 97 min and RAH 104 min. LH was longest at 127 min (p < 0.005). The mean estimated blood loss was higher in the AH group (250 ml) compared to all minimally invasive surgery (MIS, 65-172 ml); p < 0.005). Conversion rates were 10% for LH, 4.8% for VH and 1.6% for RAH (p < 0.005). Hospitalization and patient-reported time to normal activities of daily living (ADL) were longer for AH compared to MIS (p < 0.005). Time to return to work was eight days longer in the AH group (35 days) compared with the MIS groups (p < 0.005). Complications were fewest in the VH group at 5.4% compared with AH 7.6% and RAH 8.7% (both p < 0.001), but did not significantly differ from the LH group at 6.6%. Overall patient satisfaction was reported to be 86-94% one year after surgery. CONCLUSION Women operated on for benign hysterectomy with minimally invasive methods in Sweden 2009-2015 had reduced length of hospitalization, as well as time to resuming normal ADL and return to work, compared to AH. Postoperative outcome measures were improved by minimally invasive methods and MIS should preferably be used.
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Gali B, Bakkum-Gamez JN, Plevak DJ, Schroeder D, Wilson TO, Jankowski CJ. Perioperative Outcomes of Robotic-Assisted Hysterectomy Compared With Open Hysterectomy. Anesth Analg 2018; 126:127-133. [PMID: 28430689 DOI: 10.1213/ane.0000000000001935] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Increasing numbers of robotic hysterectomies (RH) are being performed. To provide ventilation (with pneumoperitoneum and steep Trendelenburg position) for these procedures, utilization of lung protective strategies with limiting airway pressures and tidal volumes is difficult. Little is known about the effects of intraoperative mechanical ventilation and high peak airway pressures on perioperative complications. We performed a retrospective review to determine whether patients undergoing RH had increased pulmonary complications compared to total abdominal hysterectomy (TAH). METHODS We performed a single center retrospective review comparing the intraoperative, anesthetic, and immediate and 30-day postoperative course of patients undergoing RH to TAH, including intraoperative ventilatory parameters and respiratory complications. Patients undergoing TAH (201) from 2004 to 2006 were compared to RH (251) from 2009 to 2012. It was our hypothesis that patients undergoing RH would have increased incidence of postoperative pulmonary complications. A secondary hypothesis was that morbid obesity predicts pulmonary complications in patients undergoing RH. Complications were compared between groups using Fisher's exact test. To account for potential confounders, the primary analysis was performed for a subgroup of patients matched on the propensity for RH. RESULTS A total of 351 RH and 201 TAH procedures are included. Higher inspiratory pressures were required in ventilation of the RH group (median [25th, 75th] 31 [26, 36] cm H2O) than the TAH group (23 [19, 27] cm H2O) (P < .001) at 30 minutes after incision. Peak inspiratory pressures at 30 minutes after incision for RH increased according to increasing body mass index group (P < .001). There were 163 RH and 163 TAH procedures included in the propensity matched analysis. From this analysis, there were no significant differences in cardiopulmonary complications between RH and TAH (0.6% vs 1.2%; odds ratio = 2.0, 95% confidence interval = 0.2-2.4; P = 1.00). Surgical site infection was significantly lower in the RH compared to TAH group (0.6% vs 8.6%; P < .001). Hospital length of stay was longer for those who underwent TAH versus RH (median [25th, 75th] 2 [2, 3] vs 1 [0, 2] days; P < .001). CONCLUSIONS There was no significant difference in perioperative complications in obese and morbidly obese women compared to nonobese undergoing RH. Patients undergoing RH had shorter hospital stays, fewer infectious complications, and no increase in overall complications compared to TAH. Higher ventilatory airway pressures (RH versus TAH and obese versus nonobese) did not result in an increase in cardiopulmonary or overall complications. We believe that peritoneal insufflation attenuates the effect of high airway pressures by raising intrapleural pressure and reducing the gradient across terminal bronchioles and alveoli. Thus, we propose that lung protective strategies for patients undergoing RH account for the markedly elevated intraperitoneal and intrapleural pressures, whereas transpulmonary airway pressures remain static. This reduced transpulmonary gradient attenuates the strain on lung tissue that would otherwise be imposed by ventilation at high pressures.
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Affiliation(s)
| | | | | | - Darrell Schroeder
- Division of Biomedical Statistics & Informatics, Mayo Clinic, Rochester, Minnesota
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Comparison of Perioperative Complications by Route of Hysterectomy Performed for Benign Conditions. Female Pelvic Med Reconstr Surg 2017; 22:364-8. [PMID: 27403755 DOI: 10.1097/spv.0000000000000292] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to compare perioperative complications by route of hysterectomy before and after the introduction of robotic surgery. METHODS This is an ancillary analysis of a multicenter, retrospective cohort study with historical controls through the Fellows' Pelvic Research Network. Hysterectomies performed for benign conditions were collected prior to introduction of the robot (prerobot) and the year after introduction of the robot (postrobot) at each institution. To obtain a representative annual case distribution for each institution, a maximum of 20 cases per month were selected using stratified random sampling. Patient demographics and intraoperative and postoperative complication data were collected. RESULTS One thousand four hundred forty cases were included in this study, 732 in the prerobot and 708 in the postrobot period. Intraoperative complications in the prerobot group were highest in the abdominal group (7.4%) followed by vaginal (3.9%) and laparoscopic (3.7%) groups. Postoperative complications were higher in the vaginal (8.3%) and abdominal (7.4%) groups compared with laparoscopic (1.8%) groups (P = 0.03), because of a higher proportion of infections. In the postrobot period, intraoperative complications were lower in the vaginal (2.8%), robotic (3%), and laparoscopic (4.6%) groups compared with abdominal (10.8%) (P = 0.04). Postoperative complications were lowest in the vaginal (5.1%), laparoscopic (3.6%), and robotic (3%) approaches compared with the abdominal (13.9%) approach (P = 0.003). CONCLUSIONS Vaginal hysterectomy has comparable rates of perioperative complications when compared with robotic and laparoscopic approaches and should be considered as a primary surgical approach in the growing armamentarium of minimally invasive approaches for hysterectomy for benign conditions.
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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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Rajadurai VA, Tan J, Salfinger SG, Cohen PA. Outcomes in women undergoing robotic-assisted laparoscopic hysterectomy compared to conventional laparoscopic hysterectomy at a tertiary hospital in Western Australia. Aust N Z J Obstet Gynaecol 2017; 58:443-448. [PMID: 29168558 DOI: 10.1111/ajo.12749] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 10/16/2017] [Indexed: 12/28/2022]
Abstract
BACKGROUND Robotic-assisted laparoscopic hysterectomy (RALH) is associated with improved outcomes compared to open surgery in patients with endometrial cancer but data are conflicting when comparing RALH to conventional total laparoscopic hysterectomy (TLH). In October 2014, a RALH program was established in Perth, Western Australia. AIM To compare outcomes in patients undergoing RALH with a matched cohort undergoing TLH. MATERIALS AND METHODS A retrospective matched cohort study compared outcomes in 45 patients who underwent RALH with 45 controls who were patients treated with TLH. RESULTS Mean operating time was longer in the RALH group compared to controls (75.42 min vs 53.18 min, mean difference 22.24 min, P < 0.001, 95% Cl, 11.07-33.42). No differences were observed in mean pain scores (RALH 1.47 vs TLH 1.84 P = 0.31), mean parenteral and oral opioid use (RALH 14.3 mg and 42.4 mg vs TLH 17.5 mg and 52.57 mg, P = 0.42 and 0.42, respectively), and mean length of stay (RALH 1.51 vs TLH 1.67 days, P = 0.49). Two patients in the RALH group and one patient in the TLH group sustained iatrogenic bladder injuries (P = 0.62). CONCLUSION The establishment of the RALH program at our institution appeared to be associated with equivalent morbidity, post-operative pain, opioid use and length of stay compared to conventional laparoscopy. A surgical learning curve for RALH was observed. Well-designed prospective studies are needed to further evaluate short- and long-term patient function, morbidity, quality of life and oncologic outcomes.
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Affiliation(s)
- Vinita A Rajadurai
- Bendat Family Comprehensive Cancer Centre, St John of God Subiaco Hospital, Subiaco, Perth, Australia
| | - Jason Tan
- Bendat Family Comprehensive Cancer Centre, St John of God Subiaco Hospital, Subiaco, Perth, Australia.,Division of Women's and Infants' Health, School of Medicine, University of Western Australia, Crawley, Western Australia, Australia.,School of Medicine, University of Notre Dame, Fremantle, Western Australia, Australia.,WOMEN Centre, West Leederville, Western Australia, Australia
| | - Stuart G Salfinger
- Bendat Family Comprehensive Cancer Centre, St John of God Subiaco Hospital, Subiaco, Perth, Australia.,Division of Women's and Infants' Health, School of Medicine, University of Western Australia, Crawley, Western Australia, Australia.,School of Medicine, University of Notre Dame, Fremantle, Western Australia, Australia
| | - Paul A Cohen
- Bendat Family Comprehensive Cancer Centre, St John of God Subiaco Hospital, Subiaco, Perth, Australia.,Division of Women's and Infants' Health, School of Medicine, University of Western Australia, Crawley, Western Australia, Australia.,WOMEN Centre, West Leederville, Western Australia, Australia.,Institute for Health Research, University of Notre Dame Australia, Fremantle, Western Australia, Australia
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Arm reduced robotic-assisted laparoscopic hysterectomy with transvaginal cuff closure. Wideochir Inne Tech Maloinwazyjne 2017; 12:271-276. [PMID: 29062448 PMCID: PMC5649497 DOI: 10.5114/wiitm.2017.68772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 04/26/2017] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The use of robotics for benign etiology in gynecology has not proven to be more beneficial when compared to traditional laparoscopy. The major concern regarding robotic hysterectomy stems from its high cost. AIM To evaluate the clinical utility and effectiveness of one-arm reduced robotic-assisted laparoscopic hysterectomy as a cost-effective surgical option for total robotic hysterectomy. MATERIAL AND METHODS A sample population of 54 women who underwent robotic-assisted laparoscopic surgery for benign gynecologic indications was evaluated, and two groups were identified: (1) the two-armed robotic-assisted laparoscopic surgery group (n = 38 patients), and (2) the three-armed robotic-assisted laparoscopic surgery group (n = 16 patients). RESULTS An increased cost was observed when three-armed robotic surgery was employed for benign gynecologic surgery (p < 0.001). The cost reduction observed in the study group was primarily derived from one robotic arm reduction and vaginal closure of the cuff. This cost reduction was achieved without an increase in complication rates or undesirable postoperative outcomes. An estimated profit between $399.5 and $421.5 was made for each patient depending on the suture material chosen for cuff closure. Two-armed surgery resulted in an 18.6% reduction in procedure-specific costs for robotic hysterectomy. CONCLUSIONS Two-armed robotic-assisted laparoscopic hysterectomy appears to be a cost-effective solution for robotic gynecologic surgery. This surgical solution can be performed as effectively as classical three-armed robotic hysterectomies for benign indications without the risk of increased surgical-related morbidities. This approach has the potential to be a widely preferred surgical approach in medical communities where cost reduction is one of the primary determinants of surgery type.
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Katon JG, Gray K, Callegari L, Gardella C, Gibson C, Ma E, Lynch KE, Zephyrin L. Trends in hysterectomy rates among women veterans in the US Department of Veterans Affairs. Am J Obstet Gynecol 2017; 217:428.e1-428.e11. [PMID: 28578175 DOI: 10.1016/j.ajog.2017.05.057] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Revised: 05/09/2017] [Accepted: 05/23/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Prior studies demonstrate a higher prevalence of hysterectomy among veterans compared with nonveterans. While studies identify overall decreasing hysterectomy rates in the United States, none report rates of hysterectomy among women veterans. Given the increasing numbers of women veterans using Veterans Affairs health care, there is an ongoing need to ensure high-quality gynecology care. Therefore, it is important to examine current hysterectomy trends, including proportion of minimally invasive surgeries, among veterans using Veterans Affairs health care. OBJECTIVE Our objective was to describe hysterectomy trends and utilization of minimally invasive hysterectomy in the Veterans Affairs healthcare system. STUDY DESIGN This longitudinal study used Veterans Affairs clinical and administrative data from fiscal year 2008 to 2014 to identify hysterectomies provided or paid for by Veterans Affairs. Crude and age-adjusted hysterectomy rates were calculated by indication (benign or malignant), mode (abdominal, laparoscopic, vaginal, robotic assisted, unspecified), and source of care (provided vs paid for by Veterans Affairs). Mode and indication for hysterectomy were classified using International Classification of Diseases, ninth revision, codes. The distribution of hysterectomy mode in each year was calculated by indication and source of care. RESULTS Between fiscal year 2008 and fiscal year 2014, the total hysterectomy rate decreased from 4.0 per 1000 to 2.6 per 1000 unique women veteran Veterans Affairs users. Age-adjusted rates of abdominal hysterectomy for benign indications decreased over the study period from 1.54 per 1000 (95% confidence interval, 1.40-1.69) to 0.77 per 1000 (95% confidence interval, 0.69-0.85) for procedures provided by Veterans Affairs and 0.77 per 1,000 (95% confidence interval, 0.69-0.85) to 0.29 per 1,000 (95% confidence interval, 0.23-0.34) for those paid for by Veterans Affairs. Among hysterectomies for benign indications provided by (n = 5296) or paid for (n = 2610) by Veterans Affairs, the percentage of hysterectomies performed abdominally decreased from 67.2% to 46.8% and from 68.9% to 57.6%, respectively. CONCLUSION These findings suggest that gynecology care provided within Veterans Affairs has kept pace with national trends in reducing hysterectomy rates and increasing utilization of minimally invasive surgical techniques.
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Affiliation(s)
- Jodie G Katon
- Health Services Research and Development Center of Innovation for Veteran-Centered and Value Driven Care, US Department of Veterans Affairs, Veterans Affairs Puget Sound Healthcare System, Seattle, WA; Department of Health Services, University of Washington School of Public Health, Seattle, WA.
| | - Kristen Gray
- Health Services Research and Development Center of Innovation for Veteran-Centered and Value Driven Care, US Department of Veterans Affairs, Veterans Affairs Puget Sound Healthcare System, Seattle, WA; Department of Health Services, University of Washington School of Public Health, Seattle, WA
| | - Lisa Callegari
- Health Services Research and Development Center of Innovation for Veteran-Centered and Value Driven Care, US Department of Veterans Affairs, Veterans Affairs Puget Sound Healthcare System, Seattle, WA; Department of Health Services, University of Washington School of Public Health, Seattle, WA; Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, WA
| | - Carolyn Gardella
- Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, WA; Veterans Affairs Puget Sound Healthcare System Medical Center, Seattle, WA
| | - Carolyn Gibson
- San Francisco Veterans Affairs Health Care System, San Francisco, CA; Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Erica Ma
- Health Services Research and Development Center of Innovation for Veteran-Centered and Value Driven Care, US Department of Veterans Affairs, Veterans Affairs Puget Sound Healthcare System, Seattle, WA
| | - Kristine E Lynch
- Department of Veterans Affairs, Salt Lake City Health Care System, Salt Lake City, UT; Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT
| | - Laurie Zephyrin
- Women's Health Services, Veterans Affairs Office of Patient Care Services, Washington, DC; Department of Obstetrics and Gynecology, New York University Langone School of Medicine, New York, NY
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Nicklin J. The future of robotic-assisted laparoscopic gynaecologic surgery in Australia - A time and a place for everything. Aust N Z J Obstet Gynaecol 2017; 57:493-498. [PMID: 28857135 DOI: 10.1111/ajo.12688] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 07/19/2017] [Indexed: 12/14/2022]
Abstract
There has been a significant increase in minimally invasive surgery in gynaecology over the last 15 years, with approximately only one-third of hysterectomies for benign disease now performed via laparotomy. While robotic surgery offers considerable technical advantages over conventional laparoscopy and is associated with only a modest learning curve, the improvement in clinical outcomes is marginal and there are several disadvantages. There are increased set-up and operating times, the need to accommodate and maintain large sophisticated equipment, and the requirement for additional training. The preeminent issue regarding the place of robotic gynaecological surgery is cost. How this is addressed and contained will ultimately determine uptake in Australia. From the published literature to date, robotic surgery compared with conventional laparoscopic surgery is associated with marginal improvements in clinical outcomes for benign hysterectomy and endometrial cancer surgery, but little improvement for other benign gynaecological surgery or for cervical cancer surgery. Robotic surgery probably does improve clinical outcomes in obese and morbidly obese patients and is associated with improved ergonomics for the surgeon. It is likely that there will be continued substantial improvements in robotic surgical platforms into the foreseeable future and that robotic surgery will play an increasingly important role in gynaecological surgery in Australia.
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Affiliation(s)
- James Nicklin
- Queensland Centre for Gynaecological Cancer, Brisbane, Queensland, Australia
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Health resource utilization and costs during the first 90 days following robot-assisted hysterectomy. Int Urogynecol J 2017; 29:865-872. [DOI: 10.1007/s00192-017-3432-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 07/13/2017] [Indexed: 10/19/2022]
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Preoperative Vaginal Metronidazole Decreases the Risk of Pelvic Infections After Radical Robotic Hysterectomy. Int J Gynecol Cancer 2017; 27:1783-1787. [PMID: 28763367 DOI: 10.1097/igc.0000000000001083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES Risk factors and infection rates of radical robotic procedures have yet to be described in gynecology. A practice improvement strategy using a solitary dose of vaginal metronidazole the night before surgery was initiated to determine if it decreased the risk of pelvic infection. METHODS A retrospective chart review of robotic radical hysterectomies for gynecologic malignancy at our institution from April 2010 through April 2016 was performed. Demographic data, operative data, and data on use of metronidazole before surgery were collected. χ Statistical analysis, Student t test, and multivariate analysis were performed to analyze the data. RESULTS Ninety-four patients met the inclusion criteria, and 46 patients received vaginal metronidazole. Demographic and clinical factors were similar between the 2 groups. The pelvic infection rate was significantly higher in nonusers at 13% (6/46) compared with users at 0% (0/42) (P ≤ 0.05). The genitourinary infection rate was also significantly higher in nonusers at 20% as compared with users at 2.2% (P = 0.02). Operative risk factors found to be associated with pelvic infection included hospital length of stay, blood loss, and metronidazole use. Multivariate regression analysis determined that only vaginal metronidazole had a clinically significant reduction of pelvic and genitourinary infection. DISCUSSION A single dose of preoperative vaginal metronidazole reduces the risk of pelvic and genitourinary infection after robotic radical hysterectomy.
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Laursen KR, Hyldgård VB, Jensen PT, Søgaard R. Health care cost consequences of using robot technology for hysterectomy: a register-based study of consecutive patients during 2006-2013. J Robot Surg 2017; 12:283-294. [PMID: 28695441 DOI: 10.1007/s11701-017-0725-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 07/04/2017] [Indexed: 10/19/2022]
Abstract
The objective of this study is to examine the costs attributable to robotic-assisted laparoscopic hysterectomy from a broad healthcare sector perspective in a register-based longitudinal study. The population in this study were 7670 consecutive women undergoing hysterectomy between January 2006 and August 2013 in public hospitals in Denmark. The interventions in the study were total and radical hysterectomy performed robotic-assisted laparoscopic hysterectomy (RALH), total laparoscopic hysterectomy (TLH), or open abdominal hysterectomy (OAH). Service use in the healthcare sector was evaluated 1 year before to 1 year after the surgery. Tariffs of the activity-based remuneration system and the diagnosis-related grouping case-mix system were used for valuation of primary and secondary care, respectively. Costs attributable to RALH were estimated using a difference-in-difference analytical approach and adjusted using multivariate linear regression. The main outcome measure was costs attributable to OAH, TLH, and RALH. For benign conditions RALH generated cost savings of € 2460 (95% CI 845; 4075) per patient compared to OAH and non-significant cost savings of € 1045 (95% CI -200; 2291) when compared with TLH. In cancer patients RALH generated cost savings of 3445 (95% CI 415; 6474) per patient when compared to OAH and increased costs of € 3345 (95% CI 2348; 4342) when compared to TLH. In cancer patients undergoing radical hysterectomy, RALH generated non-significant extra costs compared to OAH. Cost consequences were primarily due to differences in the use of inpatient service. There is a cost argument for using robot technology in patients with benign disease. In patients with malignant disease, the cost argument is dependent on comparator.
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Affiliation(s)
| | - Vibe Bolvig Hyldgård
- Department of Public Health, Aarhus University, Bartholins Allé 2, 8000, Aarhus, Denmark. .,Health Economics, DEFACTUM, Central Denmark Region, Olof Palmes Allé 15, 8200, Aarhus N, Denmark.
| | - Pernille Tine Jensen
- Department of Gynecology and Obstetrics, Odense University Hospital, Søndre Blvd. 29, 5000, Odense C, Denmark
| | - Rikke Søgaard
- Department of Public Health, Aarhus University, Bartholins Allé 2, 8000, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200, Aarhus N, Denmark
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Attitudes and Beliefs Regarding the Utility of Robotically Assisted Gynecologic Surgery Among Practicing Gynecologists. J Healthc Qual 2017; 39:211-218. [DOI: 10.1097/jhq.0000000000000017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Shee K, Ghali FM, Hyams ES. Practice Makes Perfect: Correlations Between Prior Experience in High-level Athletics and Robotic Surgical Performance Do Not Persist After Task Repetition. JOURNAL OF SURGICAL EDUCATION 2017; 74:630-637. [PMID: 28087244 DOI: 10.1016/j.jsurg.2016.12.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 11/07/2016] [Accepted: 12/21/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Robotic surgical skill development is central to training in urology as well as in other surgical disciplines. Here, we describe a pilot study assessing the relationships between robotic surgery simulator performance and 3 categories of activities, namely, videogames, musical instruments, and athletics. DESIGN A questionnaire was administered to preclinical medical students for general demographic information and prior experiences in surgery, videogames, musical instruments, and athletics. For follow-up performance studies, we used the Matchboard Level 1 and 2 modules on the da Vinci Skills Simulator, and recorded overall score, time to complete, economy of motion, workspace range, instrument collisions, instruments out of view, and drops. Task 1 was run once, whereas task 2 was run 3 times. SETTING All performance studies on the da Vinci Surgical Skills Simulator took place in the Simulation Center at Dartmouth-Hitchcock Medical Center. PARTICIPANTS All participants were medical students at the Geisel School of Medicine. After excluding students with prior hands-on experience in surgery, a total of 30 students completed the study. RESULTS We found a significant correlation between athletic skill level and performance for both task 1 (p = 0.0002) and task 2 (p = 0.0009). No significant correlations were found for videogame or musical instrument skill level. Students with experience in certain athletics (e.g., volleyball, tennis, and baseball) tended to perform better than students with experience in other athletics (e.g., track and field). For task 2, which was run 3 times, this association did not persist after the third repetition due to significant improvements in students with low-level athletic skill (levels 0-2). CONCLUSIONS Our study suggests that prior experience in high-level athletics, but not videogames or musical instruments, significantly influences surgical proficiency in robot-naive students. Furthermore, our study suggests that practice through task repetition can overcome initial differences that may be related to a background in athletics. These novel relationships may have broader implications for the future recruitment and training of robotic surgeons and may warrant further investigation.
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Affiliation(s)
- Kevin Shee
- Geisel School of Medicine, Hanover, New Hampshire.
| | - Fady M Ghali
- Geisel School of Medicine, Hanover, New Hampshire
| | - Elias S Hyams
- Department of Urology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
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