Single-Incision Hysterectomy Outcomes With and Without Robotic Assistance

Designing a core data set for benign hysterectomy registration system and its implementation in a referral teaching hospital in Northwest Iran

BACKGROUND AND AIMS

Although minimally invasive hysterectomy offers advantages, abdominal hysterectomy remains the predominant surgical method. Creating a standardized dataset and establishing a hysterectomy registry system present opportunities for early interventions in reducing volume and selecting benign hysterectomy methods. This research aims to develop a dataset for designing benign hysterectomy registration system.

METHODS

Between April and September 2020, a qualitative study was carried out to create a data set for enrolling patients who were candidate for hysterectomy. At this stage, the research team conducted an information needs assessment, relevant data element identification, registry software development, and field testing; Subsequently, a web-based application was designed. In June 2023the registry software was evaluated using data extracted from medical records of patients admitted at Al-Zahra Hospital in Tabriz, Iran.

RESULTS

During two months, 40 patients with benign hysterectomy were successfully registered. The final dataset for the hysterectomy patient registry comprise 11 main groups, 27 subclasses, and a total of 91 Data elements. Mandatory data and essential reports were defined. Furthermore, a web-based registry system designed and evaluated based on data set and various scenarios.

CONCLUSION

Creating a hysterectomy registration system is the initial stride toward identifying and registering hysterectomy candidate patients. this system capture information about the procedure techniques, and associated complications. In Iran, this registry can serve as a valuable resource for assessing the quality of care delivered and the distribution of clinical measures.

Evaluation of the learning curve and safety outcomes in robotic assisted vaginal natural orifice transluminal endoscopic hysterectomy: A case series of 84 patients

BACKGROUND

To explore the learning curve and safety outcomes of robotic assisted transvaginal natural orifice transluminal endoscopic surgery (R-vNOTES) for hysterectomy in benign gynaecological diseases.

METHODS

A retrospective chart review of all patients undergoing R-vNOTES hysterectomy for benign gynaecological disease from 2019 to 2021.

SETTING

An academic tertiary care university hospital in Houston, TX, USA.

RESULTS

84 patients were identified that met the study requirements. The mean hysterectomy time was 77.27 ± 2.89 min. The median additional operation time was 63 (8-206) min. There were two conversions to robotic assisted single incision laparoscopy. Thirteen (15.48%) patients had an associated complication. Analysis of the learning curve suggests plateauing of hysterectomy time at approximately 10 cases and time for robot docking and port placement after 10-20 cases.

CONCLUSION

R-vNOTES is a safe and effective route for hysterectomy. For a surgeon with experience in laparoscopic single site surgery and abdominal robotic surgery, they need to perform 10 cases of R-vNOTES hysterectomy and 10-20 cases in port placement and robotic docking to achieve proficiency.

Therapeutic effect of transumbilical single-port laparoscopic surgery versus triple-port laparoscopic surgery for ovarian cyst

OBJECTIVE

To compare the therapeutic effect of transumbilical single-port laparoscopic surgery (TSPLS) and three-port laparoscopic surgery (TPLS) on ovarian cyst.

METHODS

Clinical data of 60 patients with ovarian cyst admitted to our hospital were respectively analyzed. The patients were divided into a TPLS group (n=30) and a TSPLS group (n=30) according to surgical methods. Clinical indicators, visual analogue scale (VAS), self-rating anxiety scale (SAS), self-rating depression scale (SDS) and satisfaction regarding aesthetic appearance of the incision were compared between the two groups.

RESULTS

The operation time, time to anal exhaust and hospital stay in the TSPLS group were shorter than those in the TPLS group, and lower postoperative VAS, SAS and SDS scores and higher quality-of-life score were seen in the TSPLS group (all P<0.05). The incidence of postoperative complications in the TSPLS group was lower than that in the TPLS group (P<0.05). The overall satisfaction in the TSPLS group was significantly higher than that in the TPLS group (93.33% vs. 66.67%; χ²=51.526, P=0.001).

CONCLUSION

Compared with TPLS, TSPLS has better therapeutic effect on ovarian cyst. TSPLS can improve the clinical indications of patients with higher safety.