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Pickett CM, Seeratan DD, Mol BWJ, Nieboer TE, Johnson N, Bonestroo T, Aarts JW. Surgical approach to hysterectomy for benign gynaecological disease. Cochrane Database Syst Rev 2023; 8:CD003677. [PMID: 37642285 PMCID: PMC10464658 DOI: 10.1002/14651858.cd003677.pub6] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
BACKGROUND Currently, there are five major approaches to hysterectomy for benign gynaecological disease: abdominal hysterectomy (AH), vaginal hysterectomy (VH), laparoscopic hysterectomy (LH), robotic-assisted hysterectomy (RH) and vaginal natural orifice hysterectomy (V-NOTES). Within the LH category we further differentiate the laparoscopic-assisted vaginal hysterectomy (LAVH) from the total laparoscopic hysterectomy (TLH) and single-port laparoscopic hysterectomy (SP-LH). OBJECTIVES To assess the effectiveness and safety of different surgical approaches to hysterectomy for women with benign gynaecological conditions. SEARCH METHODS We searched the following databases (from their inception to December 2022): the Cochrane Gynaecology and Fertility Specialised Register of Controlled Trials, CENTRAL, MEDLINE, Embase, CINAHL and PsycINFO. We also searched the trial registries and relevant reference lists, and communicated with experts in the field for any additional trials. SELECTION CRITERIA We included randomised controlled trials (RCTs) in which clinical outcomes were compared between one surgical approach to hysterectomy and another. DATA COLLECTION AND ANALYSIS At least two review authors independently selected trials, assessed risk of bias and performed data extraction. Our primary outcomes were return to normal activities, satisfaction and quality of life, intraoperative visceral injury and major long-term complications (i.e. fistula, pelvic-abdominal pain, urinary dysfunction, bowel dysfunction, pelvic floor condition and sexual dysfunction). MAIN RESULTS We included 63 studies with 6811 women. The evidence for most comparisons was of low or moderate certainty. The main limitations were poor reporting and imprecision. Vaginal hysterectomy (VH) versus abdominal hysterectomy (AH) (12 RCTs, 1046 women) Return to normal activities was probably faster in the VH group (mean difference (MD) -10.91 days, 95% confidence interval (CI) -17.95 to -3.87; 4 RCTs, 274 women; I2 = 67%; moderate-certainty evidence). This suggests that if the return to normal activities after AH is assumed to be 42 days, then after VH it would be between 24 and 38 days. We are uncertain whether there is a difference between the groups for the other primary outcomes. Laparoscopic hysterectomy (LH) versus AH (28 RCTs, 3431 women) Return to normal activities may be sooner in the LH group (MD -13.01 days, 95% CI -16.47 to -9.56; 7 RCTs, 618 women; I2 = 68%, low-certainty evidence), but there may be more urinary tract injuries in the LH group (odds ratio (OR) 2.16, 95% CI 1.19 to 3.93; 18 RCTs, 2594 women; I2 = 0%; moderate-certainty evidence). This suggests that if the return to normal activities after abdominal hysterectomy is assumed to be 37 days, then after laparoscopic hysterectomy it would be between 22 and 25 days. It also suggests that if the rate of ureter injury during abdominal hysterectomy is assumed to be 0.2%, then during laparoscopic hysterectomy it would be between 0.2% and 2%. We are uncertain whether there is a difference between the groups for the other primary outcomes. LH versus VH (22 RCTs, 2135 women) We are uncertain whether there is a difference between the groups for any of our primary outcomes. Both short- and long-term complications were rare in both groups. Robotic-assisted hysterectomy (RH) versus LH (three RCTs, 296 women) None of the studies reported satisfaction rates or quality of life. We are uncertain whether there is a difference between the groups for our other primary outcomes. Single-port laparoscopic hysterectomy (SP-LH) versus LH (seven RCTs, 621 women) None of the studies reported satisfaction rates, quality of life or major long-term complications. We are uncertain whether there is a difference between the groups for rates of intraoperative visceral injury. Total laparoscopic hysterectomy (TLH) versus laparoscopic-assisted vaginal hysterectomy (LAVH) (three RCTs, 233 women) None of the studies reported satisfaction rates or quality of life. We are uncertain whether there is a difference between the groups for rates of intraoperative visceral injury or major long-term complications. Transvaginal natural orifice transluminal endoscopic surgery (V-NOTES) versus LH (two RCTs, 96 women) We are uncertain whether there is a difference between the groups for rates of bladder injury. Our other primary outcomes were not reported. Overall, adverse events were rare in the included studies. AUTHORS' CONCLUSIONS Among women undergoing hysterectomy for benign disease, VH appears to be superior to AH. When technically feasible, VH should be performed in preference to AH because it is associated with faster return to normal activities, fewer wound/abdominal wall infections and shorter hospital stay. Where VH is not possible, LH has advantages over AH including faster return to normal activities, shorter hospital stay, and decreased risk of wound/abdominal wall infection, febrile episodes or unspecified infection, and transfusion. These advantages must be balanced against the increased risk of ureteric injury and longer operative time. When compared to LH, VH was associated with no difference in time to return to normal activities but shorter operative time and shorter hospital stay. RH and V-NOTES require further evaluation since there is a lack of evidence of any patient benefit over conventional LH. Overall, the evidence in this review has to be interpreted with caution as adverse event rates were low, resulting in low power for these comparisons. The surgical approach to hysterectomy should be discussed with the patient and decided in the light of the relative benefits and hazards. Surgical expertise is difficult to quantify and poorly reported in the available studies and this may influence outcomes in ways that cannot be accounted for in this review. In conclusion, when VH is not feasible, LH has multiple advantages over AH, but at the cost of more ureteric injuries. Evidence is limited for RH and V-NOTES.
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Affiliation(s)
- Charlotte M Pickett
- Department of Obstetrics and Gynecology, University of California San Diego, La Jolla, California, USA
| | - Dachel D Seeratan
- Department of Obstetrics and Gynaecology, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Ben Willem J Mol
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia
| | | | - Neil Johnson
- Obstetrics & Gynaecology, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Tijmen Bonestroo
- Department of Obstetrics and Gynecology, Rijnstate Hospital, Arnhem, Netherlands
| | - Johanna Wm Aarts
- Obstetrics and Gynaecology, Amsterdam University Medical Centers, Amsterdam, Netherlands
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Tsafrir Z, Janosek-Albright K, Aoun J, Diaz-Insua M, Abd-El-Barr AER, Schiff L, Talukdar S, Menon M, Munkarah A, Theoharis E, Eisenstein D. The impact of a wireless audio system on communication in robotic-assisted laparoscopic surgery: A prospective controlled trial. PLoS One 2020; 15:e0220214. [PMID: 31923185 PMCID: PMC6953850 DOI: 10.1371/journal.pone.0220214] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Accepted: 11/25/2019] [Indexed: 11/23/2022] Open
Abstract
Background Robotic surgery presents a challenge to effective teamwork and communication in the operating theatre (OR). Our objective was to evaluate the effect of using a wireless audio headset device on communication, efficiency and patient outcome in robotic surgery. Methods and findings A prospective controlled trial of team members participating in gynecologic and urologic robotic procedures between January and March 2015. In the first phase, all surgeries were performed without headsets (control), followed by the intervention phase where all team members used the wireless headsets. Noise levels were measured during both phases. After each case, all team members evaluated the quality of communication, performance, teamwork and mental load using a validated 14-point questionnaire graded on a 1–10 scale. Higher overall scores indicated better communication and efficiency. Clinical and surgical data of all patients in the study were retrieved, analyzed and correlated with the survey results. The study included 137 procedures, yielding 843 questionnaires with an overall response rate of 89% (843/943). Self-reported communication quality was better in cases where headsets were used (113.0 ± 1.6 vs. 101.4 ± 1.6; p < .001). Use of headsets reduced the percentage of time with a noise level above 70 dB at the console (8.2% ± 0.6 vs. 5.3% ± 0.6, p < .001), but had no significant effect on length of surgery nor postoperative complications. Conclusions The use of wireless headset devices improved quality of communication between team members and reduced the peak noise level in the robotic OR.
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Affiliation(s)
- Ziv Tsafrir
- Minimally Invasive Gynecologic Surgery, Women’s Health Services, Henry Ford Hospital, Detroit, Michigan
- Department of Obstetrics and Gynecology, Kaplan medical Center, Rehovot, Affiliated to the Faculty of Medicine, the Hebrew University, Jerusalem, Israel
- * E-mail: ,
| | | | - Joelle Aoun
- Minimally Invasive Gynecologic Surgery, Women’s Health Services, Henry Ford Hospital, Detroit, Michigan
| | | | | | - Lauren Schiff
- Minimally Invasive Gynecologic Surgery, Women’s Health Services, Henry Ford Hospital, Detroit, Michigan
| | - Shobhana Talukdar
- Minimally Invasive Gynecologic Surgery, Women’s Health Services, Henry Ford Hospital, Detroit, Michigan
| | - Mani Menon
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan
| | - Adnan Munkarah
- Minimally Invasive Gynecologic Surgery, Women’s Health Services, Henry Ford Hospital, Detroit, Michigan
| | - Evan Theoharis
- Minimally Invasive Gynecologic Surgery, Women’s Health Services, Henry Ford Hospital, Detroit, Michigan
| | - David Eisenstein
- Minimally Invasive Gynecologic Surgery, Women’s Health Services, Henry Ford Hospital, Detroit, Michigan
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Margueritte F, Sallée C, Legros M, Lacorre A, Piver P, Aubard Y, Tardieu A, Gauthier T. Description of an initiation program to robotic in vivo gynecological surgery for junior surgeons. J Gynecol Obstet Hum Reprod 2019; 49:101627. [PMID: 31499279 DOI: 10.1016/j.jogoh.2019.101627] [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: 04/21/2019] [Revised: 08/21/2019] [Accepted: 09/05/2019] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Most gynecological residents or junior surgeons do not practice nor experience robotic surgery due to lack of access during residency or poor knowledge about this growing surgical technology. This study evaluated the feasibility and safety of a 3-half-day experiencing and training session for robot-assisted gynecological surgery designed for residents and fellows. MATERIEL AND METHODS This is a prospective, single-center observational study about a training course aimed at residents or fellows at the university teaching hospital of Limoges (France). It spreads over three consecutive half-days: one dedicated to simulation exercises involving the Da Vinci Skills Simulator© and the other two, to practice in two robot-assisted procedures with dual-console equipment supervised by a senior surgeon (as it is usually performed in a university teaching hospital). Complications during surgery, patient's medical records as well as the participants' performances during in vivo suturing acts were gathered. Feedback on the session was obtained with a questionnaire at the end of the course. RESULTS Twelve sessions involving 24 patients operated on by 34 trainees from 16 different teaching university hospitals across the country took place. No conversion to laparotomy nor any major peri- or post-operative complication was reported. Time for stitching decreased significantly (p=.016) between the first and the second in vivo surgery. Use of the dual console was found helpful and most attendees (96.8%) would recommend this training session. CONCLUSION We showed this training course with both simulation and in vivo surgery was feasible, safe and was a well-liked initiation program for robotic surgery.
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Affiliation(s)
- François Margueritte
- Department of Obstetrics and Gynecology, University Teaching hospital of Limoges, Mother and Child Hospital, 8 avenue Dominique Larrey, 87 000, Limoges, France.
| | - Camille Sallée
- Department of Obstetrics and Gynecology, University Teaching hospital of Limoges, Mother and Child Hospital, 8 avenue Dominique Larrey, 87 000, Limoges, France
| | - Maxime Legros
- Department of Obstetrics and Gynecology, University Teaching hospital of Limoges, Mother and Child Hospital, 8 avenue Dominique Larrey, 87 000, Limoges, France
| | - Aymeline Lacorre
- Department of Obstetrics and Gynecology, University Teaching hospital of Limoges, Mother and Child Hospital, 8 avenue Dominique Larrey, 87 000, Limoges, France
| | - Pascal Piver
- Department of Obstetrics and Gynecology, University Teaching hospital of Limoges, Mother and Child Hospital, 8 avenue Dominique Larrey, 87 000, Limoges, France
| | - Yves Aubard
- Department of Obstetrics and Gynecology, University Teaching hospital of Limoges, Mother and Child Hospital, 8 avenue Dominique Larrey, 87 000, Limoges, France
| | - Antoine Tardieu
- Department of Obstetrics and Gynecology, University Teaching hospital of Limoges, Mother and Child Hospital, 8 avenue Dominique Larrey, 87 000, Limoges, France
| | - Tristan Gauthier
- Department of Obstetrics and Gynecology, University Teaching hospital of Limoges, Mother and Child Hospital, 8 avenue Dominique Larrey, 87 000, Limoges, France
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Tsafrir Z, Janosek-albright K, Aoun J, Diaz-insua M, Abd-el-barr A, Schiff L, Talukdar S, Menon M, Munkarah A, Theoharis E, Eisenstein D. The Impact of a Wireless Audio System on Communication in Robotic-Assisted Laparoscopic Surgery: A Prospective Controlled Trial.. [DOI: 10.1101/701078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
AbstractBackgroundRobotic surgery presents a challenge to effective teamwork and communication in the operating theatre (OR). Our objective was to evaluate the effect of using a wireless audio headset device on communication, efficiency and patient outcome in robotic surgery.Methods and findingsA prospective controlled trial of team members participating in gynecologic and urologic robotic procedures between January and March 2015. In the first phase, all surgeries were performed without headsets (control), followed by the intervention phase where all team members used the wireless headsets. Noise levels were measured during both phases. After each case, all team members evaluated the quality of communication, performance, teamwork and mental load using a validated 14-point questionnaire graded on a 1-10 scale. Higher overall scores indicated better communication and efficiency. Clinical and surgical data of all patients in the study were retrieved, analyzed and correlated with the survey results.The study included 137 procedures, yielding 843 questionnaires with an overall response rate of 89% (843/943). Self-reported communication quality was better in cases where headsets were used (113.0 ± 1.6 vs. 101.4 ± 1.6; p < .001). Use of headsets reduced the percentage of time with a noise level above 70 dB at the console (8.2% ± 0.6 vs. 5.3% ± 0.6, p < .001), but had no significant effect on length of surgery nor postoperative complications.ConclusionsThe use of wireless headset devices improved quality of communication between team members and reduced the peak noise level in the robotic OR.
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Cantillo E, Emerson JB, Mathews C. Less Is More: Minimally Invasive and Quality Surgical Management of Gynecologic Cancer. Obstet Gynecol Clin North Am 2019; 46:55-66. [PMID: 30683266 DOI: 10.1016/j.ogc.2018.09.004] [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: 01/14/2023]
Abstract
Surgery is a cornerstone of gynecologic oncology. Minimally invasive techniques have been adopted rapidly, in lieu of open approaches, in cervical and endometrial cancer staging. In addition, nodal assessment has undergone significant changes with the introduction of SLN biopsies. The movement toward less is more has also been seen with perioperative and postoperative care and the advent of ERAS protocols, which attempt to maintain normal physiology with the goal of improving functional recovery. It is imperative that new technology be critically evaluated to ensure that oncologic outcomes are not compromised.
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Affiliation(s)
- Evelyn Cantillo
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Vermont College of Medicine, 111 Colchester Avenue, Smith 408, Burlington, VT 05404, USA.
| | - Jenna B Emerson
- Program in Women' Oncology, Women and Infants Hospital, 101 Dudley Street, Providence, RI 02905, USA
| | - Cara Mathews
- Program in Women' Oncology, Women and Infants Hospital, 101 Dudley Street, Providence, RI 02905, USA
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Pavlov VN, Plechev VV, Safiullin RI, Ishmetov VS, Kashaev MS, Ignatenko PV, Arhipov AN, Rabtsun AA, Safin RF, Pushkareva AE, Blagodarov SI. PRELIMINARY EXPERIENCE OF THE AORTO-FEMORAL SHUNTING USING THE DA VINCI SURGICAL SYSTEM. CREATIVE SURGERY AND ONCOLOGY 2018. [DOI: 10.24060/2076-3093-2018-8-1-7-13] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Introduction. Robot surgery is one of the most high-demand and dynamic developing realms of medicine. It is widely used in urology, proctology, thoracic, cardiovascular surgery and gynecology. In February 2018 a robot surgery centre opened in Volga Federal District of the Russian Federation based on the clinic of the Bashkir State Medical University (city of Ufa).Materials and methods. The present paper demonstrates the first successful robot-assisted vascular operations within a master-class called "Aorto-Femoral Shunting with the use of robot-assisted surgical system Da Vinci".Results. Exemplified with three operations: two linear aorto-femoral shunting and lumbar sympathectomy demonstrate technical peculiarities and advantages of robot-assisted vascular surgery. The findings show positive short-term results of the performed surgical interference that combine minimal injury and blood loss which help to reduce hospital stay in an intensive therapy department and intestinal distention duration. These clinical effects enabled to provide early activization of patients and possibility to adequately correct nutritional status with enteral feeding. The above-mentioned advantages eventually resulted in reduction of post-operation stay of patients in in-patient department and of cost of treatment.Conclusion. Robot-assisted surgical system Da Vinci being the most cutting-edge in the realm of endoscopic surgery, enables to carry out operational interference with minimal blood loss and injury of tissues which helps to reduce postoperation and recovery periods.
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7
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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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Schiff L, Tsafrir Z, Aoun J, Taylor A, Theoharis E, Eisenstein D. Quality of Communication in Robotic Surgery and Surgical Outcomes. JSLS 2017; 20:JSLS.2016.00026. [PMID: 27493469 PMCID: PMC4949353 DOI: 10.4293/jsls.2016.00026] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background and Objectives: Robotic surgery has introduced unique challenges to surgical workflow. The association between quality of communication in robotic-assisted laparoscopic surgery and surgical outcomes was evaluated. Methods: After each gynecologic robotic surgery, the team members involved in the surgery completed a survey regarding the quality of communication. A composite quality-of-communication score was developed using principal component analysis. A higher composite quality-of-communication score signified poor communication. Objective parameters, such as operative time and estimated blood loss (EBL), were gathered from the patient's medical record and correlated with the composite quality-of-communication scores. Results: Forty robotic cases from March through May 2013 were included. Thirty-two participants including surgeons, circulating nurses, and surgical technicians participated in the study. A higher composite quality-of-communication score was associated with greater EBL (P = .010) and longer operative time (P = .045), after adjustment for body mass index, prior major abdominal surgery, and uterine weight. Specifically, for every 1-SD increase in the perceived lack of communication, there was an additional 51 mL EBL and a 31-min increase in operative time. The most common reasons reported for poor communication in the operating room were noise level (28/36, 78%) and console-to-bedside communication problems (23/36, 64%). Conclusion: Our study demonstrates a significant association between poor intraoperative team communication and worse surgical outcomes in robotic gynecologic surgery. Employing strategies to decrease extraneous room noise, improve console-to-bedside communication and team training may have a positive impact on communication and related surgical outcomes.
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Affiliation(s)
- Lauren Schiff
- Division of Advanced Laparoscopy and Pelvic Pain, Department of Obstetrics and Gynecology. University of North Carolina, Chapel Hill, North Carolina, USA
| | - Ziv Tsafrir
- Division of Minimally Invasive Gynecology, Women's Health Services, Henry Ford Hospital, West Bloomfield, Michigan, USA
| | - Joelle Aoun
- Division of Minimally Invasive Gynecology, Women's Health Services, Henry Ford Hospital, West Bloomfield, Michigan, USA
| | - Andrew Taylor
- Division of Biostatistics, Public Health Sciences, Henry Ford Health System, Detroit, Michigan, USA
| | - Evan Theoharis
- Division of Minimally Invasive Gynecology, Women's Health Services, Henry Ford Hospital, West Bloomfield, Michigan, USA
| | - David Eisenstein
- Division of Minimally Invasive Gynecology, Women's Health Services, Henry Ford Hospital, West Bloomfield, Michigan, USA
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Learning Curve Analysis of Different Stages of Robotic-Assisted Laparoscopic Hysterectomy. BIOMED RESEARCH INTERNATIONAL 2017; 2017:1827913. [PMID: 28373977 PMCID: PMC5360940 DOI: 10.1155/2017/1827913] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Revised: 01/28/2017] [Accepted: 02/20/2017] [Indexed: 11/17/2022]
Abstract
Objective. To analyze the learning curves of the different stages of robotic-assisted laparoscopic hysterectomy. Design. Retrospective analysis. Design Classification. Canadian Task Force classification II-2. Setting. Kaohsiung Medical University Hospital, Kaohsiung, Taiwan. Patient Intervention. Women receiving robotic-assisted total and subtotal laparoscopic hysterectomies for benign conditions from May 1, 2013, to August 31, 2015. Measurements and Main Results. The mean age, body mass index (BMI), and uterine weight were 46.44 ± 5.31 years, 23.97 ± 4.75 kg/m2, and 435.48 ± 250.62 g, respectively. The most rapid learning curve was obtained for the main surgery console stage; eight experiences were required to achieve duration stability, and the time spent in this stage did not violate the control rules. The docking stage required 14 experiences to achieve duration stability, and the suture stage was the most difficult to master, requiring 26 experiences. BMI did not considerably affect the duration of the three stages. The uterine weight and the presence of adhesion did not substantially affect the main surgery console time. Conclusion. Different stages of robotic-assisted laparoscopic hysterectomy have different learning curves. The main surgery console stage has the most rapid learning curve, whereas the suture stage has the slowest learning curve.
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A risk model and cost analysis of post-operative incisional hernia following 2,145 open hysterectomies-Defining indications and opportunities for risk reduction. Am J Surg 2016; 213:1083-1090. [PMID: 27769544 DOI: 10.1016/j.amjsurg.2016.09.047] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 09/16/2016] [Accepted: 09/29/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND Incisional hernia (IH) is a complication following open abdominal hysterectomy. This study addresses the incidence and health care cost of IH repair after open hysterectomy, and identify perioperative risk factors to create predictive risk models. METHODS We conduct a retrospective review of patients who underwent open hysterectomy between 2005 and 2013 at the University of Pennsylvania. The primary outcome was post-hysterectomy IH. Univariate/multivariate cox proportional hazard analyses identified perioperative risk factors. We performed cox hazard regression modeling with bootstrapped validation, risk stratification, and assessment of model performance. RESULTS 2145 patients underwent open hysterectomy during the study period. 76 patients developed IH, and all underwent repair. 31.3% underwent reoperation, generating higher costs ($71,559 vs. $23,313, p < 0.001). 8 risk factors were included in the model, the strongest being presence of a vertical incision (HR = 3.73 [2.01-6.92]). Extreme-risk patients experienced the highest incidence of IH (22%) vs. low-risk patients (0.8%) [C-statistic = 0.82]. CONCLUSIONS We identify perioperative risk factors for IH and provide a risk prediction instrument to accurately stratify patients in effort to offer risk reductive techniques. SUMMARY Open hysterectomies account for a magnitude of surgical procedures worldwide. This study presents an internally validated risk model of IH in patients undergoing open hysterectomy after a review of 2145 cases. With an increasing emphasis on prevention in healthcare, we create a risk model to improve outcomes after open hysterectomies in effort to identify high-risk patients, facilitate preoperative risk counseling, and implement evidence-based strategies to improve outcomes.
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Rossitto C, Gueli Alletti S, Romano F, Fiore A, Coretti S, Oradei M, Ruggeri M, Cicchetti A, Marchetti M, Fanfani F, Scambia G. Use of robot-specific resources and operating room times: the case of Telelap Alf-X robotic hysterectomy. Int J Med Robot 2016; 12:613-619. [DOI: 10.1002/rcs.1724] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Revised: 11/21/2015] [Accepted: 11/26/2015] [Indexed: 11/06/2022]
Affiliation(s)
- Cristiano Rossitto
- Division of Gynaecological Oncology; Catholic University of the Sacred Heart; Rome Italy
| | | | - Federica Romano
- ALTEMS, Postgraduate School in Health Economics and Management; Catholic University of the Sacred Heart; Rome Italy
| | - Alessandra Fiore
- ALTEMS, Postgraduate School in Health Economics and Management; Catholic University of the Sacred Heart; Rome Italy
| | - Silvia Coretti
- ALTEMS, Postgraduate School in Health Economics and Management; Catholic University of the Sacred Heart; Rome Italy
| | - Marco Oradei
- Health Technology Assessment Unit; 'A.Gemelli' Hospital; Rome Italy
| | - Matteo Ruggeri
- ALTEMS, Postgraduate School in Health Economics and Management; Catholic University of the Sacred Heart; Rome Italy
- Institute of Economic Policy; Catholic University of the Sacred Heart; Milan Italy
| | - Americo Cicchetti
- ALTEMS, Postgraduate School in Health Economics and Management; Catholic University of the Sacred Heart; Rome Italy
- Health Technology Assessment Unit; 'A.Gemelli' Hospital; Rome Italy
| | - Marco Marchetti
- Health Technology Assessment Unit; 'A.Gemelli' Hospital; Rome Italy
| | - Francesco Fanfani
- Division of Gynaecological Oncology; Catholic University of the Sacred Heart; Rome Italy
| | - Giovanni Scambia
- Division of Gynaecological Oncology; Catholic University of the Sacred Heart; Rome Italy
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Fanfani F, Restaino S, Gueli Alletti S, Fagotti A, Monterossi G, Rossitto C, Costantini B, Scambia G. TELELAP ALF-X Robotic-assisted Laparoscopic Hysterectomy: Feasibility and Perioperative Outcomes. J Minim Invasive Gynecol 2015; 22:1011-7. [DOI: 10.1016/j.jmig.2015.05.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 04/26/2015] [Accepted: 05/06/2015] [Indexed: 10/23/2022]
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13
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Aarts JWM, Nieboer TE, Johnson N, Tavender E, Garry R, Mol BWJ, Kluivers KB. Surgical approach to hysterectomy for benign gynaecological disease. Cochrane Database Syst Rev 2015; 2015:CD003677. [PMID: 26264829 PMCID: PMC6984437 DOI: 10.1002/14651858.cd003677.pub5] [Citation(s) in RCA: 261] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The four approaches to hysterectomy for benign disease are abdominal hysterectomy (AH), vaginal hysterectomy (VH), laparoscopic hysterectomy (LH) and robotic-assisted hysterectomy (RH). OBJECTIVES To assess the effectiveness and safety of different surgical approaches to hysterectomy for women with benign gynaecological conditions. SEARCH METHODS We searched the following databases (from inception to 14 August 2014) using the Ovid platform: Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE; EMBASE; Cumulative Index to Nursing and Allied Health Literature (CINAHL) and PsycINFO. We also searched relevant citation lists. We used both indexed and free-text terms. SELECTION CRITERIA We included randomised controlled trials (RCTs) in which clinical outcomes were compared between one surgical approach to hysterectomy and another. DATA COLLECTION AND ANALYSIS At least two review authors independently selected trials, assessed risk of bias and performed data extraction. Our primary outcomes were return to normal activities, satisfaction, quality of life, intraoperative visceral injury and major long-term complications (i.e. fistula, pelvi-abdominal pain, urinary dysfunction, bowel dysfunction, pelvic floor condition and sexual dysfunction). MAIN RESULTS We included 47 studies with 5102 women. The evidence for most comparisons was of low or moderate quality. The main limitations were poor reporting and imprecision. Vaginal hysterectomy (VH) versus abdominal hysterectomy (AH) (nine RCTs, 762 women)Return to normal activities was shorter in the VH group (mean difference (MD) -9.5 days, 95% confidence interval (CI) -12.6 to -6.4, three RCTs, 176 women, I(2) = 75%, moderate quality evidence). There was no evidence of a difference between the groups for the other primary outcomes. Laparoscopic hysterectomy (LH) versus AH (25 RCTs, 2983 women)Return to normal activities was shorter in the LH group (MD -13.6 days, 95% CI -15.4 to -11.8; six RCTs, 520 women, I(2) = 71%, low quality evidence), but there were more urinary tract injuries in the LH group (odds ratio (OR) 2.4, 95% CI 1.2 to 4.8, 13 RCTs, 2140 women, I(2) = 0%, low quality evidence). There was no evidence of a difference between the groups for the other primary outcomes. LH versus VH (16 RCTs, 1440 women)There was no evidence of a difference between the groups for any primary outcomes. Robotic-assisted hysterectomy (RH) versus LH (two RCTs, 152 women)There was no evidence of a difference between the groups for any primary outcomes. Neither of the studies reported satisfaction rates or quality of life.Overall, the number of adverse events was low in the included studies. AUTHORS' CONCLUSIONS Among women undergoing hysterectomy for benign disease, VH appears to be superior to LH and AH, as it is associated with faster return to normal activities. When technically feasible, VH should be performed in preference to AH because of more rapid recovery and fewer febrile episodes postoperatively. Where VH is not possible, LH has some advantages over AH (including more rapid recovery and fewer febrile episodes and wound or abdominal wall infections), but these are offset by a longer operating time. No advantages of LH over VH could be found; LH had a longer operation time, and total laparoscopic hysterectomy (TLH) had more urinary tract injuries. Of the three subcategories of LH, there are more RCT data for laparoscopic-assisted vaginal hysterectomy and LH than for TLH. Single-port laparoscopic hysterectomy and RH should either be abandoned or further evaluated since there is a lack of evidence of any benefit over conventional LH. Overall, the evidence in this review has to be interpreted with caution as adverse event rates were low, resulting in low power for these comparisons. The surgical approach to hysterectomy should be discussed and decided in the light of the relative benefits and hazards. These benefits and hazards seem to be dependent on surgical expertise and this may influence the decision. In conclusion, when VH is not feasible, LH may avoid the need for AH, but LH is associated with more urinary tract injuries. There is no evidence that RH is of benefit in this population. Preferably, the surgical approach to hysterectomy should be decided by the woman in discussion with her surgeon.
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Affiliation(s)
- Johanna WM Aarts
- Radboud University Nijmegen Medical CenterDepartment of Obstetrics and GynaecologyGeert Grooteplein 10NijmegenNetherlands6500HB
| | - Theodoor E Nieboer
- Radboud University Nijmegen Medical CenterDepartment of Obstetrics and GynaecologyGeert Grooteplein 10NijmegenNetherlands6500HB
| | - Neil Johnson
- University of AdelaideRobinson Research InstituteNorwich Centre Ground Floor, 55 King William RoadNorth AdelaideAdelaideSouth AustraliaAustralia5006
| | - Emma Tavender
- Monash UniversityAustralian Satellite of the Cochrane EPOC Group, Department of SurgeryLevel 6, 99 Commercial RoadMelbourneVictoriaAustraliaVIC 3004
| | - Ray Garry
- University of Teeside and South Cleveland Hospital, MiddlesbroughGynaecological Surgery94 WestgateGuisboroughYorkshireUKTS14 6AP
| | - Ben Willem J Mol
- The University of AdelaideThe Robinson Institute, School of Paediatrics and Reproductive HealthLevel 3, Medical School South BuildingFrome RoadAdelaideSouth AustraliaAustraliaSA 5005
| | - Kirsten B Kluivers
- Radboud University Nijmegen Medical CenterDepartment of Obstetrics and GynaecologyGeert Grooteplein 10NijmegenNetherlands6500HB
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Rudmik L, An W, Livingstone D, Matthews W, Seikaly H, Scrimger R, Marshall D. Making a case for high-volume robotic surgery centers: A cost-effectiveness analysis of transoral robotic surgery. J Surg Oncol 2015; 112:155-63. [DOI: 10.1002/jso.23974] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 06/23/2015] [Indexed: 12/30/2022]
Affiliation(s)
- Luke Rudmik
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery; University of Calgary; Calgary Alberta Canada
| | - Wenyi An
- Department of Community Health Sciences; University of Calgary; Calgary Alberta Canada
| | - Devon Livingstone
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery; University of Calgary; Calgary Alberta Canada
| | - Wayne Matthews
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery; University of Calgary; Calgary Alberta Canada
| | - Hadi Seikaly
- D ivision of Otolaryngology-Head and Neck Surgery; Department of Surgery; University of Alberta; Edmonton Alberta Canada
| | - Rufus Scrimger
- Division of Radiation Oncology; Department of Oncology; University of Alberta; Edmonton Alberta Canada
| | - Deborah Marshall
- Canada Research Chair; Health Services and Systems Research; Department of Community Health Sciences; University of Calgary; Calgary Alberta Canada
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15
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Chong GO, Lee YH, Hong DG, Cho YL, Lee YS. Robotic hysterectomy or myomectomy without power morcellation: A single-port assisted three-incision technique with manual morcellation. Int J Med Robot 2015; 12:483-9. [DOI: 10.1002/rcs.1668] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 04/06/2015] [Accepted: 04/12/2015] [Indexed: 12/26/2022]
Affiliation(s)
- Gun Oh Chong
- Department of Obstetrics and Gynaecology, School of Medicine; Kyungpook National University Medical Centre; Daegu South Korea
| | - Yoon Hee Lee
- Department of Obstetrics and Gynaecology, School of Medicine; Kyungpook National University Medical Centre; Daegu South Korea
| | - Dae Gy Hong
- Department of Obstetrics and Gynaecology, School of Medicine; Kyungpook National University Medical Centre; Daegu South Korea
| | - Young Lae Cho
- Department of Obstetrics and Gynaecology, School of Medicine; Kyungpook National University Medical Centre; Daegu South Korea
| | - Yoon Soon Lee
- Department of Obstetrics and Gynaecology, School of Medicine; Kyungpook National University Medical Centre; Daegu South Korea
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16
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Abstract
Technology has transformed surgery more within the last 30 years than the previous 2000 years of human history combined. These innovations have changed not only how the surgeon practices but have also altered the very essence of what it is to be a surgeon in the modern era. Beyond the industrial revolution, today's information revolution allows patients access to an abundance of easily accessible, unfiltered information which they can use to evaluate their surgical treatment, and truly participate in their personal care. We are entering yet another revolution specifically affecting surgeons, where the traditional surgical tools of our craft are becoming "smart." Intelligence in surgical tools and connectivity based on sensory data, processing, and analysis are enabling and enhancing a surgeon's capacity and capability. Given the tempo of change, within one generation the traditional role and identity of a surgeon will be fully transformed. In this article, the impact of the information revolution, technological advances combined with smart connectivity on the changing role of surgery will be considered.
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Affiliation(s)
- Sharifa Himidan
- Pediatric General and Thoracic Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario
| | - Peter Kim
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children׳s National Health System, Washington District of Columbia; The Joseph E. Robert Jr Center for Surgical Care, Children׳s National Health System, 111 Michigan Ave NW, Washington District of Columbia 20010; George Washington University, Washington District of Columbia.
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