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Yoshida K, Kondo E, Ishida M, Ichikawa Y, Watashige N, Okumura A, Matsumoto T, Okamoto K, Maki S, Kubo-Kaneda M, Nii M, Ikeda T. Visceral Adipose Tissue Percentage Compared to Body Mass Index as Better Indicator of Surgical Outcomes in Women With Obesity and Endometrial Cancer. J Minim Invasive Gynecol 2024; 31:445-452. [PMID: 38417674 DOI: 10.1016/j.jmig.2024.02.009] [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: 09/27/2023] [Revised: 02/03/2024] [Accepted: 02/23/2024] [Indexed: 03/01/2024]
Abstract
STUDY OBJECTIVE To assess the impact visceral adipose tissue percentage (VAT%) on surgical outcomes during minimally invasive surgery in obese women with endometrial cancer. DESIGN Retrospective observational cohort study. SETTING Mie University Hospital, Japan. PATIENTS Of the 73 women (body mass index [BMI] >30 kg/m2) with obesity and primary endometrial cancer, 52 underwent robotic surgery, while 21 underwent laparoscopic surgery between April 2014 and December 2022. INTERVENTIONS We investigated the correlation between surgical outcomes (operative time and blood loss) and obesity (BMI and visceral adipose tissue percentage [VAT%]). MEASUREMENTS AND MAIN RESULTS Abdominal fat-related parameters were measured at the level of the umbilicus using preoperative computed tomography. A weak negative correlation was found between BMI and VAT% (CC = -0.313, p = .001). Multivariate analysis showed that VAT% had a stronger correlation to total and practical operative time than BMI (β = 0.338 vs 0.267, β = 0.311 vs 0.209, respectively) and was an independent predictor of blood loss. VAT% was an independent predictive marker prolonged for operative time and increased blood loss during lymphadenectomy. CONCLUSION VAT% could be an indicator of surgical outcomes for patients with obesity and endometrial cancer.
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Affiliation(s)
- Kenta Yoshida
- Department of Obstetrics and Gynecology, Mie University Hospital, Mie, Japan
| | - Eiji Kondo
- Department of Obstetrics and Gynecology, Mie University Hospital, Mie, Japan.
| | - Masaki Ishida
- Department of Radiology, Mie University Hospital, Mie, Japan
| | | | - Naoki Watashige
- Department of Obstetrics and Gynecology, Mie University Hospital, Mie, Japan
| | - Asumi Okumura
- Department of Obstetrics and Gynecology, Mie University Hospital, Mie, Japan
| | - Tsuyoshi Matsumoto
- Department of Obstetrics and Gynecology, Mie University Hospital, Mie, Japan
| | - Kota Okamoto
- Department of Obstetrics and Gynecology, Mie University Hospital, Mie, Japan
| | - Shintaro Maki
- Department of Obstetrics and Gynecology, Mie University Hospital, Mie, Japan
| | - Michiko Kubo-Kaneda
- Department of Obstetrics and Gynecology, Mie University Hospital, Mie, Japan
| | - Masafumi Nii
- Department of Obstetrics and Gynecology, Mie University Hospital, Mie, Japan
| | - Tomoaki Ikeda
- Department of Obstetrics and Gynecology, Mie University Hospital, Mie, Japan
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Gheza F, Pinkard L, Grand A, Aguiluz-Cornejo G, Mangano A, Ladanyi A. Development of an affordable, immersive model for robotic vaginal cuff closure: a randomized trial. J Robot Surg 2023; 17:109-116. [PMID: 35353300 DOI: 10.1007/s11701-022-01404-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 03/16/2022] [Indexed: 11/24/2022]
Abstract
Safe and secure closure of the vaginal cuff is a critical component of a robotic assisted hysterectomy procedure. Our aim in this study is to develop and validate a novel vaginal cuff closure model (VC) created from porcine heart that allows trainees to obtain competency in a low-risk environment. Ten expert and 20 novice robotic surgeons performed a cuff closure exercise on the VC model and on the dV-Trainer®, a virtual reality simulator (VR). Performances were timed, videotaped, and scored using the modified Global Evaluative Assessment of Robotic Skills (mGEARS) score. Expert robotic surgeons completed the task faster on both the VR (531 vs. 814 s, p = 0.03) and the VC platforms (311 vs. 631 s, p < 0.001) and achieved higher mGEAR scores (32.25 vs. 22.07, p < 0.0001). Knot quality and suturing accuracy were better in the VC than in the VR environment in both groups. In a post-completion survey, both expert and novice surgeons expressed strong preference towards the VC model. In this study, the novel VC model proved to be a reliable simulation tool with high face, content, and construct validity. Due to its simplicity and low cost, this high-yield simulation exercise can easily be incorporated into robotic training curricula of obstetrics and gynecology residents.
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Affiliation(s)
- Federico Gheza
- Department of Surgery, University of Illinois Chicago, 840 S Wood Street Suite 435E, Chicago, IL, 60612, USA.
| | - Lauren Pinkard
- Department of Obstetrics and Gynecology, University of Illinois Chicago, Chicago, IL, USA
| | - Arielle Grand
- Department of Obstetrics and Gynecology, University of Illinois Chicago, Chicago, IL, USA
| | - Gabriela Aguiluz-Cornejo
- Department of Surgery, University of Illinois Chicago, 840 S Wood Street Suite 435E, Chicago, IL, 60612, USA
| | - Alberto Mangano
- Department of Surgery, University of Illinois Chicago, 840 S Wood Street Suite 435E, Chicago, IL, 60612, USA
| | - Andras Ladanyi
- Department of Obstetrics and Gynecology, University of Illinois Chicago, Chicago, IL, USA
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Gitas G, Alkatout I, Proppe L, Hanker L, Allahqoli L, Grimbizis G, Rody A, Werner N, Sommer S, Baum S. Long-term satisfaction of patients after laparoscopic and robotic-assisted hysterectomy. Arch Gynecol Obstet 2021; 305:1481-1490. [PMID: 34954814 PMCID: PMC9166875 DOI: 10.1007/s00404-021-06360-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 12/06/2021] [Indexed: 11/26/2022]
Abstract
Introduction Da-Vinci-Xi is the most recent device used in gynecologic robotic surgery. The aim of the present study was to compare the long-term satisfaction of patients who had undergone conventional laparoscopic hysterectomy or robotic assisted laparoscopic hysterectomy using the Da-Vinci-Xi surgical system. Methods All hysterectomies performed at the University Hospital of Luebeck from 2018 to 2019 were reviewed. Postoperative outcomes were compared between women who had undergone total hysterectomy with da Vinci Xi (n = 42) or conventional laparoscopy (n = 97). Postoperative outcomes included pain, elimination of complaints after surgery, bladder function, sexual function, satisfaction with the cosmetic outcome, positive experiences after robotic surgery, and satisfaction with the surgeon’s preoperative explanation. Obese patients were evaluated separately in a subgroup analysis. Results Both groups had similar baseline characteristics and complication rates. Preoperative complaints subsided after surgery in a little more than 90% of patients. No significant differences were noted between groups in this regard (p = 0.262), or with reference to postoperative pain after one week (p = 0.866) and one month (p = 0.580), stress incontinence (p = 0.343), sexual function (p = 0.766) and the cosmetic outcome of the abdominal incisions (p = 0.273). The majority of patients who had undergone robotic surgery (96.8%) would be willing to undergo the procedure again if necessary. The subgroup analysis of obese patients revealed no significant differences. Conclusion The Da-Vinci-Xi device did not improve the long-term surgical satisfaction of normal-weight or obese patients who underwent hysterectomy compared with patients who underwent conventional laparoscopy performed by experienced laparoscopic surgeons.
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Affiliation(s)
- Georgios Gitas
- Department of Obstetrics and Gynecology, University Hospital of Schleswig Holstein, Campus Luebeck, Ratzeburger Allee 160, Haus A, 23538, Luebeck, Germany.
| | - I Alkatout
- Department of Obstetrics and Gynecology, University Hospital of Schleswig Holstein, Campus Kiel, Kiel, Germany
| | - L Proppe
- Department of Obstetrics and Gynecology, University Hospital of Schleswig Holstein, Campus Luebeck, Ratzeburger Allee 160, Haus A, 23538, Luebeck, Germany
| | - L Hanker
- Department of Obstetrics and Gynecology, University Hospital of Schleswig Holstein, Campus Luebeck, Ratzeburger Allee 160, Haus A, 23538, Luebeck, Germany
| | - L Allahqoli
- School of Public Health, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - G Grimbizis
- First Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - A Rody
- Department of Obstetrics and Gynecology, University Hospital of Schleswig Holstein, Campus Luebeck, Ratzeburger Allee 160, Haus A, 23538, Luebeck, Germany
| | - N Werner
- Department of Obstetrics and Gynecology, University Hospital of Schleswig Holstein, Campus Luebeck, Ratzeburger Allee 160, Haus A, 23538, Luebeck, Germany
| | - S Sommer
- Department of Obstetrics and Gynecology, University Hospital of Schleswig Holstein, Campus Luebeck, Ratzeburger Allee 160, Haus A, 23538, Luebeck, Germany
| | - S Baum
- Department of Obstetrics and Gynecology, University Hospital of Schleswig Holstein, Campus Luebeck, Ratzeburger Allee 160, Haus A, 23538, Luebeck, Germany
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Carbonnel M, Moawad GN, Tarazi MM, Revaux A, Kennel T, Favre-Inhofer A, Ayoubi JM. Robotic Hysterectomy for Benign Indications: What Have We Learned from a Decade? JSLS 2021; 25:JSLS.2020.00091. [PMID: 33879990 PMCID: PMC8035818 DOI: 10.4293/jsls.2020.00091] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background and Objectives Robotic surgery data need a setback on many years of practice with high-volume surgeons to evaluate its real value. Our main objective was to study the impact of a decade of robotic surgery on minimally-invasive hysterectomies for benign indications. Our secondary objectives were to evaluate our results for high-volume surgeons and complex cases. Methods In this retrospective cohort study, we reviewed medical records at Foch Hospital, from 2010 to 2019, to evaluate the outcomes of robotic hysterectomies for benign disease. We compared the trends of benign hysterectomies done by laparoscopy and laparotomy during this period. We analyzed the proficiency group (≥ 75 cases per surgeon) and complex cases including obese patients and large uteri (>250 g). Results 495 hysterectomies were performed by robotic, 275 by laparotomy, and 130 by laparoscopy. The laparotomy approach decreased from 62% to 29%, whereas the robotic approach increased from 26% to 61%. The operating room (OR) time decreased in the proficiency group (157.3 ± 43.32 versus 178.6 ± 48.05, P = 0.005); whereas the uterine weight was higher (194.6 ± 158.6 versus 161.3 ± 139.4, P = 0.04). Lower EBL and shorter OR time were seen with uteri ≤ 250 g subgroup (64.24 ± 110.2 ml versus 116.63 ± 146.98 ml, P = 0.0004) (169.62 ± 47.50 min versus 192.44 ± 45.82 min, P = 0.0001). The estimated blood loss (EBL) was less in the BMI ≤ 30 subgroup (68.83 ± 119.24 ml versus 124.53 ± 186.14 ml, P = 0.0005). Conclusion A shift was observed between the laparotomy and robotic approaches. High-volume surgeons were more efficient and showed a decrease in OR time after 75 cases despite an increase in uterine weight.
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Affiliation(s)
- Marie Carbonnel
- Department of Obstetrics and, Gynecology, Foch Hospital, Suresnes, Faculty of Medicine, Paris Ouest (UVSQ), France
| | - Gaby N Moawad
- Department of Obstetrics & Gynecology, George Washington University School of Medicine and Health Sciences, 2150 Pennsylvania Ave. NW, Ste 6A429, 20037 Washington, DC, USA
| | - Mia Maria Tarazi
- Department of Obstetrics and, Gynecology, Foch Hospital, Suresnes, Faculty of Medicine, Paris Ouest (UVSQ), France
| | - Aurelie Revaux
- Department of Obstetrics and, Gynecology, Foch Hospital, Suresnes, Faculty of Medicine, Paris Ouest (UVSQ), France
| | - Titouan Kennel
- Department of Clinic Research, Foch Hospital, Suresnes, France
| | - Angéline Favre-Inhofer
- Department of Obstetrics and, Gynecology, Foch Hospital, Suresnes, Faculty of Medicine, Paris Ouest (UVSQ), France
| | - Jean Marc Ayoubi
- Department of Obstetrics and, Gynecology, Foch Hospital, Suresnes, Faculty of Medicine, Paris Ouest (UVSQ), France
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Matanes E, Eisenberg N, Amajoud Z, Gupta V, Yasmeen A, Ismail S, Racovitan F, Raban O, Lau S, Salvador S, Gotlieb WH, Kogan L. Sentinel Lymph Node Sampling as an Alternative to Lymphadenectomy in Patients With Endometrial Cancer and Obesity. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2021; 43:1136-1144.e1. [PMID: 33984524 DOI: 10.1016/j.jogc.2021.04.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 04/19/2021] [Accepted: 04/20/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Although its use in endometrial cancer staging is relatively new, sentinel lymph node (SLN) sampling has been shown to be highly accurate and is associated with few complications. However, some studies report lower rates of detection with SLN sampling among patients with obesity. The aim of the current study is to evaluate the feasibility of SLN sampling in endometrial cancer for patients with obesity, and to determine whether omitting lymph node dissection (LND) in surgical staging using SLN sampling impacts oncologic outcomes. METHODS we conducted a retrospective study of patients with obesity (BMI ≥35 kg/m2), diagnosed with endometrial carcinoma between 2007 and 2017, that compared surgical and oncologic outcomes of 2 cohorts: patients who underwent LND and patients who underwent SLN without lymphadenectomy. The primary outcome was operative time. Secondary outcomes included intraoperative bleeding; lymph node assessment information; intraoperative and postoperative adverse events; and oncologic outcomes including progression-free survival (PFS), overall survival (OS), and disease-specific survival (DSS). PFS was defined as the time from surgery to the recurrence or death from any cause. OS was defined as time from diagnosis to death or the last date the patient was known to be alive, and DSS was defined as the time from the surgery to death from the disease. RESULTS Out of 223 patients with a median BMI of 40.6 kg/m2, 140 underwent LND and 83 underwent SLN alone. The median operative time for patients in the SLN group was shorter than that of patients in the LND group (190.5 [range 108-393] vs. 238 [131-440] min; P < 0.001), and the SLN group had lower median estimated blood loss than the LND group (30 [range 0-300] vs. 40 [range 0-800] mL; P = 0.03). At the 24-month follow-up cut-off, 98% of patients were alive and 95.5% were disease free, with no significant differences in OS, DSS, and PFS between the 2 groups (P = 0.7, P = 0.8, and P = 0.4, respectively). CONCLUSIONS In patients with obesity, omitting LND from surgical staging with SLN sampling was associated with shorter operative times and less bleeding and did not affect survival at 2 years.
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Affiliation(s)
- Emad Matanes
- Division of Gynecologic Oncology, Jewish General Hospital, McGill University, Montreal, Québec; Segal Cancer Center, Lady Davis Institute of Medical Research, McGill University, Montreal, Québec
| | - Neta Eisenberg
- Department of Obstetrics and Gynecology, Yitzhak Shamir Medical Center, Tel-Aviv University, Tel-Aviv, Israel
| | - Zainab Amajoud
- Division of Gynecologic Oncology, Jewish General Hospital, McGill University, Montreal, Québec
| | - Vishaal Gupta
- Division of Gynecologic Oncology, Jewish General Hospital, McGill University, Montreal, Québec
| | - Amber Yasmeen
- Division of Gynecologic Oncology, Jewish General Hospital, McGill University, Montreal, Québec; Segal Cancer Center, Lady Davis Institute of Medical Research, McGill University, Montreal, Québec
| | - Sara Ismail
- Division of Gynecologic Oncology, Jewish General Hospital, McGill University, Montreal, Québec
| | - Florentin Racovitan
- Division of Gynecologic Oncology, Jewish General Hospital, McGill University, Montreal, Québec
| | - Oded Raban
- Division of Gynecologic Oncology, Jewish General Hospital, McGill University, Montreal, Québec; Segal Cancer Center, Lady Davis Institute of Medical Research, McGill University, Montreal, Québec
| | - Susie Lau
- Division of Gynecologic Oncology, Jewish General Hospital, McGill University, Montreal, Québec; Segal Cancer Center, Lady Davis Institute of Medical Research, McGill University, Montreal, Québec
| | - Shannon Salvador
- Division of Gynecologic Oncology, Jewish General Hospital, McGill University, Montreal, Québec; Segal Cancer Center, Lady Davis Institute of Medical Research, McGill University, Montreal, Québec
| | - Walter H Gotlieb
- Division of Gynecologic Oncology, Jewish General Hospital, McGill University, Montreal, Québec; Segal Cancer Center, Lady Davis Institute of Medical Research, McGill University, Montreal, Québec.
| | - Liron Kogan
- Division of Gynecologic Oncology, Jewish General Hospital, McGill University, Montreal, Québec; Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, affiliated with the Hebrew
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Gitas G, Alkatout I, Proppe L, Werner N, Rody A, Hanker L, Pados G, Freytag D, Sommer S, Baum S. Surgical outcomes of conventional laparoscopic and robotic-assisted hysterectomy. Int J Med Robot 2021; 17:e2225. [PMID: 33440062 DOI: 10.1002/rcs.2225] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 01/06/2021] [Accepted: 01/08/2021] [Indexed: 11/08/2022]
Abstract
INTRODUCTION The aim of the present study was to compare surgical outcomes of total laparoscopic hysterectomy with those of the robotic approach using the da Vinci Xi system. METHODS Patients who underwent hysterectomy with da Vinci Xi for early endometrial cancer or benign indications from 2018 to 2019 were selected. The control group consisted of patients who underwent conventional laparoscopy. RESULTS A total of 300 patients were included in the study. The mean duration of surgery differed significantly (p = 0.025) between those who underwent laparoscopy (125.01 ± 76.168) and robotic-assisted surgery (142.96 ± 82.657 min). Blood loss, median hospital stay, intraoperative and postoperative complications were similar in both groups. No statistical difference was observed in the subgroups with a body mass index of more than 30 kg/m2 or more than 40 kg/m2 concerning the duration of surgery or the surgical outcome. CONCLUSION The da Vinci Xi did not improve surgical outcomes in patients who underwent hysterectomy by trained laparoscopists and takes more time than conventional laparoscopy when performed in patients of normal weight.
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Affiliation(s)
- Georgios Gitas
- Department of Obstetrics and Gynecology, University Hospital of Schleswig Holstein, Campus Luebeck, Luebeck, Germany
| | - Ibrahim Alkatout
- Department of Obstetrics and Gynecology, University Hospital of Schleswig Holstein, Campus Kiel, Kiel, Germany
| | - Louisa Proppe
- Department of Obstetrics and Gynecology, University Hospital of Schleswig Holstein, Campus Luebeck, Luebeck, Germany
| | - Nele Werner
- Department of Obstetrics and Gynecology, University Hospital of Schleswig Holstein, Campus Luebeck, Luebeck, Germany
| | - Achim Rody
- Department of Obstetrics and Gynecology, University Hospital of Schleswig Holstein, Campus Luebeck, Luebeck, Germany
| | - Lars Hanker
- Department of Obstetrics and Gynecology, University Hospital of Schleswig Holstein, Campus Luebeck, Luebeck, Germany
| | - George Pados
- First Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Damaris Freytag
- Department of Obstetrics and Gynecology, University Hospital of Schleswig Holstein, Campus Kiel, Kiel, Germany
| | - Soteris Sommer
- Department of Obstetrics and Gynecology, University Hospital of Schleswig Holstein, Campus Luebeck, Luebeck, Germany
| | - Sascha Baum
- Department of Obstetrics and Gynecology, University Hospital of Schleswig Holstein, Campus Luebeck, Luebeck, Germany
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Corrado G, Mereu L, Bogliolo S, Cela V, Gardella B, Sperduti I, Certelli C, Pellegrini A, Posar G, Zampa A, Tateo S, Gadducci A, Spinillo A, Vizza E. Comparison between single-site and multiport robot-assisted hysterectomy in obese patients with endometrial cancer: An Italian multi-institutional study. Int J Med Robot 2020; 16:e2066. [PMID: 31850677 DOI: 10.1002/rcs.2066] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 10/29/2019] [Accepted: 12/06/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND The aim of this study is to compare robotic single-site hysterectomy (RSSH) and robotic multiport hysterectomy (RMPH) for endometrial cancer (EC) in obese patients in terms of surgical outcomes. METHODS This retrospective study compares RSSH with RMPH in obese patients with EC and FIGO stages I to II divided in three classes according to their body mass index (BMI): class A (30-34.9 kg/m2 ), class B (35-39.9 kg/m2 ), and class C (>40 kg/m2 ). RESULTS We included 225 patients (RSSH: 76; RMPH: 149). The operative time and estimated blood loss (EBL) were lower in the A class of the RSSH group. The EBL and the conversion rate increased when the BMI increased in the RSSH group. The hospital stay was higher in the A class of the RMPH group. CONCLUSIONS The advantages of RSSH in terms of reduced invasiveness remain true only in the first BMI class, whereas they are lost when the BMI increased.
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Affiliation(s)
- Giacomo Corrado
- Department of Woman, Child Health and Public Health, Gynecologic Oncology Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Liliana Mereu
- Obstetrics and Gynecological Department, Santa Chiara Hospital, Trento, Italy
| | - Stefano Bogliolo
- Department of Gynecologic Oncology, Division of Gynecology, European Institute of Oncology, Milan, Italy
| | - Vito Cela
- Department of Obstetrics and Gynaecology, University of Pisa, Pisa, Italy
| | - Barbara Gardella
- Department of Obstetrics and Gynaecology, IRCCS-Fondazione Policlinico San Matteo and University of Pavia, Pavia, Italy
| | - Isabella Sperduti
- Scientific Direction, "Regina Elena" National Cancer Institute, IRCCS, Rome, Italy
| | - Camilla Certelli
- Department of Experimental Clinical Oncology, Gynecologic Oncology Unit, "Regina Elena" National Cancer Institute, IRCCS, Rome, Italy
| | - Alice Pellegrini
- Obstetrics and Gynecological Department, Santa Chiara Hospital, Trento, Italy
| | - Giulia Posar
- Department of Obstetrics and Gynaecology, University of Pisa, Pisa, Italy
| | - Ashanti Zampa
- Department of Experimental Clinical Oncology, Gynecologic Oncology Unit, "Regina Elena" National Cancer Institute, IRCCS, Rome, Italy
| | - Saverio Tateo
- Obstetrics and Gynecological Department, Santa Chiara Hospital, Trento, Italy
| | - Angiolo Gadducci
- Department of Obstetrics and Gynaecology, University of Pisa, Pisa, Italy
| | - Arsenio Spinillo
- Department of Obstetrics and Gynaecology, IRCCS-Fondazione Policlinico San Matteo and University of Pavia, Pavia, Italy
| | - Enrico Vizza
- Department of Experimental Clinical Oncology, Gynecologic Oncology Unit, "Regina Elena" National Cancer Institute, IRCCS, Rome, Italy
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Yong PJ, Thurston J, Singh SS, Allaire C. Guideline No. 386-Gynaecologic Surgery for Patients with Obesity. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 41:1356-1370.e7. [DOI: 10.1016/j.jogc.2018.12.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Yong PJ, Thurston J, Singh SS, Allaire C. Directive clinique No 386 - Chirurgie gynécologique chez les patientes obèses. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 41:1371-1388.e7. [PMID: 31443851 DOI: 10.1016/j.jogc.2019.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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10
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Chinder PS, Hindiskere S, Doddarangappa S, Sk R, Mascarenhas A, Pal U. Robotic Surgery Assisted Staged En-Bloc Sacrectomy for Sacral Chordoma: A Case Report. JBJS Case Connect 2019; 9:e0240. [PMID: 31140987 DOI: 10.2106/jbjs.cc.18.00240] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
CASE Two male patients aged 37 years and 39 years, diagnosed with sacral chordoma, underwent robotic-assisted preparatory adhesiolysis from the anterior aspect of the tumor, followed by posterior en-bloc partial sacrectomy. The average total operative time was 360 minutes (anterior docking + anterior console + posterior excision), and mean blood loss was 930 mL. Both patients were mobilized early, had no postoperative complications, and were free of local recurrence at 18 month of follow-up. CONCLUSIONS Robotic-assisted surgery is a novel, valid, safe, and minimally invasive technique which drastically reduces the associated surgical complications of single-staged posterior sacrectomy, resulting in excellent functional and oncological outcome.
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Affiliation(s)
- Pramod S Chinder
- Department of Musculoskeletal Oncology, HCG Hospital, Bangalore, India
| | - Suraj Hindiskere
- Department of Musculoskeletal Oncology, HCG Hospital, Bangalore, India
| | | | - Raghunath Sk
- Department of Uro Oncology. HCG Hospital, Bangalore, India
| | | | - Utkarsh Pal
- Department of Musculoskeletal Oncology, HCG Hospital, Bangalore, India
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Corrado G, Vizza E, Cela V, Mereu L, Bogliolo S, Legge F, Ciccarone F, Mancini E, Gallotta V, Baiocco E, Monterossi G, Perri MT, Zampa A, Pasciuto T, Scambia G. Laparoscopic versus robotic hysterectomy in obese and extremely obese patients with endometrial cancer: A multi-institutional analysis. Eur J Surg Oncol 2018; 44:1935-1941. [DOI: 10.1016/j.ejso.2018.08.021] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 08/14/2018] [Accepted: 08/28/2018] [Indexed: 11/26/2022] Open
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Gueli Alletti S, Rossitto C, Cianci S, Perrone E, Pizzacalla S, Monterossi G, Vizzielli G, Gidaro S, Scambia G. The Senhance™ surgical robotic system ("Senhance") for total hysterectomy in obese patients: a pilot study. J Robot Surg 2017. [PMID: 28624984 DOI: 10.1007/s11701-017-0718-9] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This pilot study was aimed to value the feasibility and safety of Senhance Robotic Platform for hysterectomy in obese patients. Ten obese patients (30 < BMI < 40) underwent elective Senhance total extrafascial hysterectomy with bilateral salpingo-oophorectomy at the Division of Gynecologic Oncology of "Policlinico A. Gemelli" Foundation, Rome, Italy. Perioperative and postoperative outcomes data were recorded. The median age was 60 years (range 51-75) and the median BMI was 33.3 kg/m2 (range 30.4-38.3). The median uterine weight was 112.5 g (range 77-225). Indication to total hysterectomy was early-stage (FIGO Stage IA) endometrial cancer in 100% of patients. The median operative time (OT) was 110 min (70-200). The median docking time was 10.5 min (5-25). The median estimated blood loss was 100 mL (50-200). No conversions to laparotomy were recorded. No intra- and 30-day postoperative complications were registered. The median ileus was 17 h (12-36) and the median time to discharge was 2 days (1-4). The median VAS scores registered at 2, 4, 12, and 24 h were, respectively, 2 (1-3), 2 (1-3), 4 (1-8), and 3 (1-5). Our study results suggest that Senhance platform could be safe for hysterectomy even in obese patients. More clinical data are needed to determine whether this approach would offer any additional benefits in a new middle line between standard laparoscopy and robotics.
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Affiliation(s)
- Salvatore Gueli Alletti
- Department of Obstetrics and Gynecologic, "Policlinico Gemelli" Foundation, Catholic University of the Sacred Heart, L.go A. Gemelli, 1, 00168, Rome, Italy.
| | - C Rossitto
- Department of Obstetrics and Gynecologic, "Policlinico Gemelli" Foundation, Catholic University of the Sacred Heart, L.go A. Gemelli, 1, 00168, Rome, Italy
| | - S Cianci
- Department of Obstetrics and Gynecologic, "Policlinico Gemelli" Foundation, Catholic University of the Sacred Heart, L.go A. Gemelli, 1, 00168, Rome, Italy
| | - E Perrone
- Department of Obstetrics and Gynecologic, "Policlinico Gemelli" Foundation, Catholic University of the Sacred Heart, L.go A. Gemelli, 1, 00168, Rome, Italy
| | - S Pizzacalla
- Department of Obstetrics and Gynecologic, "Policlinico Gemelli" Foundation, Catholic University of the Sacred Heart, L.go A. Gemelli, 1, 00168, Rome, Italy
| | - G Monterossi
- Department of Obstetrics and Gynecologic, "Policlinico Gemelli" Foundation, Catholic University of the Sacred Heart, L.go A. Gemelli, 1, 00168, Rome, Italy
| | - G Vizzielli
- Department of Obstetrics and Gynecologic, "Policlinico Gemelli" Foundation, Catholic University of the Sacred Heart, L.go A. Gemelli, 1, 00168, Rome, Italy
| | - S Gidaro
- Biomedical and Experimental Sciences Department, "G. D'Annunzio" University, Chieti, Italy
| | - G Scambia
- Department of Obstetrics and Gynecologic, "Policlinico Gemelli" Foundation, Catholic University of the Sacred Heart, L.go A. Gemelli, 1, 00168, Rome, Italy
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Machado KK, Fader AN. Approaches to Morbidly Obese Women with Gynecologic Cancer. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2016. [DOI: 10.1007/s13669-016-0181-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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14
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Robotic assisted hysterectomy in obese patients: a systematic review. Arch Gynecol Obstet 2016; 293:1169-83. [DOI: 10.1007/s00404-016-4028-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 01/19/2016] [Indexed: 10/22/2022]
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15
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Robotic Hysterectomy in Severely Obese Patients With Endometrial Cancer: A Multicenter Study. J Minim Invasive Gynecol 2016; 23:94-100. [DOI: 10.1016/j.jmig.2015.08.887] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 08/25/2015] [Accepted: 08/27/2015] [Indexed: 11/19/2022]
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16
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Blikkendaal MD, Schepers EM, van Zwet EW, Twijnstra ARH, Jansen FW. Hysterectomy in very obese and morbidly obese patients: a systematic review with cumulative analysis of comparative studies. Arch Gynecol Obstet 2015; 292:723-38. [PMID: 25773357 PMCID: PMC4560773 DOI: 10.1007/s00404-015-3680-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 02/25/2015] [Indexed: 12/12/2022]
Abstract
PURPOSE Some studies suggest that also regarding the patient with a body mass index (BMI) ≥35 kg/m(2) the minimally invasive approach to hysterectomy is superior. However, current practice and research on the preference of gynaecologists still show that the rate of abdominal hysterectomy (AH) increases as the BMI increases. A systematic review with cumulative analysis of comparative studies was performed to evaluate the outcomes of AH, laparoscopic hysterectomy (LH) and vaginal hysterectomy (VH) in very obese and morbidly obese patients (BMI ≥35 kg/m(2)). METHODS PubMed and EMBASE were searched for records on AH, LH and VH for benign indications or (early stage) malignancy through October 2014. Included studies were graded on level of evidence. Studies with a comparative design were pooled in a cumulative analysis. RESULTS Two randomized controlled trials, seven prospective studies and 14 retrospective studies were included (2232 patients; 1058 AHs, 959 LHs, and 215 VHs). The cumulative analysis identified that, compared to LH, AH was associated with more wound dehiscence [risk ratio (RR) 2.58, 95 % confidence interval (CI) 1.71-3.90; P = 0.000], more wound infection (RR 4.36, 95 % CI 2.79-6.80; P = 0.000), and longer hospital admission (mean difference 2.9 days, 95 % CI 1.96-3.74; P = 0.000). The pooled conversion rate was 10.6 %. Compared to AH, VH was associated with similar advantages as LH. CONCLUSIONS Compared to AH, both LH and VH are associated with fewer postoperative complications and shorter length of hospital stay. Therefore, the feasibility of LH and VH should be considered prior the abdominal approach to hysterectomy in very obese and morbidly obese patients.
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Affiliation(s)
- Mathijs D. Blikkendaal
- Department of Gynaecology, Leiden University Medical Centre, PO Box 9600, 2300 RC Leiden, The Netherlands
| | - Evelyn M. Schepers
- Department of Gynaecology, Bronovo Hospital, PO Box 96900, 2509 JH The Hague, The Netherlands
| | - Erik W. van Zwet
- Department of Medical Statistics, Leiden University Medical Centre, PO Box 9600, 2300 RC Leiden, The Netherlands
| | - Andries R. H. Twijnstra
- Department of Gynaecology, Leiden University Medical Centre, PO Box 9600, 2300 RC Leiden, The Netherlands
| | - Frank Willem Jansen
- Department of Gynaecology, Leiden University Medical Centre, PO Box 9600, 2300 RC Leiden, The Netherlands
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17
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Chan JK, Gardner AB, Taylor K, Thompson CA, Blansit K, Yu X, Kapp DS. Robotic versus laparoscopic versus open surgery in morbidly obese endometrial cancer patients - a comparative analysis of total charges and complication rates. Gynecol Oncol 2015; 139:300-5. [PMID: 26363212 DOI: 10.1016/j.ygyno.2015.09.006] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 08/31/2015] [Accepted: 09/06/2015] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To compare the complications and charges of robotic vs. laparoscopic vs. open surgeries in morbidly obese patients treated for endometrial cancer. METHODS Data were obtained from the Nationwide Inpatient Sample from 2011. Chi-squared, Wilcoxon rank sum two-sample tests, and multivariate analyses were used for statistical analyses. RESULTS Of 1087 morbidly obese (BMI ≥40kg/m(2)) endometrial cancer patients (median age: 59years, range: 22 to 89), 567 (52%) had open surgery (OS), 98 (9%) laparoscopic (LS), and 422 (39%) robotic surgery (RS). 23% of OS, 13% of LS, and 8% of RS patients experienced an intraoperative or postoperative complication including: blood transfusions, mechanical ventilation, urinary tract injury, gastrointestinal injury, wound debridement, infection, venous thromboembolism, and lymphedema (p<0.0001). RS and LS patients were less likely to receive blood transfusions compared to OS (5% and 6% vs. 14%, respectively; p<0.0001). The median lengths of hospitalization for OS, LS, and RS patients were 4, 1, and 1days, respectively (p<0.0001). Median total charges associated with OS, LS, and RS were $39,281, $40,997, and $45,030 (p=0.037), respectively. CONCLUSIONS In morbidly obese endometrial cancer patients, minimally invasive robotic or laparoscopic surgeries were associated with fewer complications and less days of hospitalization relative to open surgery. Compared to laparoscopic approach, robotic surgeries had comparable rates of complications but higher charges.
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Affiliation(s)
- John K Chan
- Division of Gynecologic Oncology, California Pacific Palo Alto Medical Foundation, San Francisco, CA, United States.
| | - Austin B Gardner
- Palo Alto Medical Foundation Research Institute, Palo Alto, CA, United States
| | - Katie Taylor
- Division of Gynecologic Oncology, California Pacific Palo Alto Medical Foundation, San Francisco, CA, United States
| | - Caroline A Thompson
- Palo Alto Medical Foundation Research Institute, Palo Alto, CA, United States; Department of Epidemiology and Biostatistics, College of Public Health, San Diego State University, San Diego, CA, United States
| | - Kevin Blansit
- Palo Alto Medical Foundation Research Institute, Palo Alto, CA, United States
| | - Xinhua Yu
- Department of Epidemiology and Biostatistics, University of Memphis, Memphis, TN, United States
| | - Daniel S Kapp
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, United States
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18
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Stephan JM, Goodheart MJ, McDonald M, Hansen J, Reyes HD, Button A, Bender D. Robotic surgery in supermorbidly obese patients with endometrial cancer. Am J Obstet Gynecol 2015; 213:49.e1-49.e8. [PMID: 25644437 DOI: 10.1016/j.ajog.2015.01.052] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2014] [Revised: 11/27/2014] [Accepted: 01/29/2015] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Morbid obesity is a known risk factor for the development of endometrial cancer. Several studies have demonstrated the overall feasibility of robotic-assisted surgical staging for endometrial cancer as well as the benefits of robotics compared with laparotomy. However, there have been few reports that have evaluated robotic surgery for endometrial cancer in the supermorbidly obese population (body mass index [BMI], ≥50 kg/m(2)). We sought to evaluate safety, feasibility, and outcomes for supermorbidly obese patients who undergo robotic surgery for endometrial cancer, compared with patients with lower body mass indices. STUDY DESIGN We performed a retrospective chart review of 168 patients with suspected early-stage endometrial adenocarcinoma who underwent robotic surgery for the management of their disease. Analysis of variance and univariate logistic regression were used to compare patient characteristics and surgical variables across all body weights. Cox proportional hazard regression was used to determine the impact of body weight on recurrence-free and overall survival. RESULTS The mean BMI of our cohort was 40.9 kg/m(2). Median follow up was 31 months. Fifty-six patients, 30% of which had grade 2 or 3 tumors, were supermorbidly obese with a BMI of ≥50 kg/m(2) (mean, 56.3 kg/m(2)). A comparison between the supermorbidly obese and lower-weight patients demonstrated no differences in terms of length of hospital stay, blood loss, complication rates, numbers of pelvic and paraaortic lymph nodes retrieved, or recurrence and survival. There was a correlation between BMI and conversion to an open procedure, in which the odds of conversion increased with increasing BMI (P = .02). CONCLUSION Offering robotic surgery to supermorbidly obese patients with endometrial cancer is a safe and feasible surgical management option. When compared with patients with a lower BMI, the supermorbidly obese patient had a similar outcome, length of hospital stay, blood loss, complications, and numbers of lymph nodes retrieved.
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