Efficacy and safety of robotic-assisted surgery in challenging hysterectomies - a single institutional experience

OBJECTIVE

An increasing number of robotic hysterectomies are being performed and the most common indication is fibroids. Fibroid uterus is common indication for hysterectomy for enlarged uteri. The role of robotic approach for complex pathologies as enlarged uterus is still debatable. The study aimed to analyze the feasibility of robotic hysterectomy in patients with enlarged uteri and the impact of uterine weight on surgical outcomes and on operative time length.

PATIENTS AND METHODS

One hundred and thirty-eight patients who underwent robotic hysterectomy for benign indications at the 2nd Division of Obstetrics and Gynecology, Azienda Ospedaliero-Universitaria Pisana, University of Pisa were consecutively enrolled.

RESULTS

Data of patients undergoing robotic surgery for benign indications were collected. Patients were stratified in two groups based on their uterine weight, to analyze the effective impact of uterine weight and dimension on surgical performance, operative time and postoperative outcomes. Conversion rate was 0%. Median uterine weight was 615 g (range 400-1900 g). Median total operating time was 131 minutes (range 70-255 minutes). Increase in uterine weight significantly increased operative times (p=0.003) and morcellation time (p=0.001). On the other hand, operative time was just partially influenced by route for removal of the uterus (p=0.085) but significantly affected by uterine weight (p=0.008), previous surgeries (p=0.003) and BMI of the patient (p=0.005).

CONCLUSIONS

Robotic hysterectomy is feasible and safe for challenging cases as large uteri. This technique could enable patients with outsized uteri, not suitable for vaginal hysterectomy, to undergo minimally invasive surgery with excellent results. Larger studies to investigate and compare robotic with other surgical approaches for difficult hysterectomies are needed to confirm these data.

Panic attacks with and without agoraphobia: a comparison

22 patients with panic disorder (PD) were compared with 42 cases suffering from agoraphobia with panic attacks for a number of variables. The two groups did not differ for age, sex ratio, age of onset, social class, severity of nonsituational anxiety and personality profiles. On the other hand agoraphobics showed lower education and worse social adaptation. A higher prevalence of traumatic life events was also observed for agoraphobics compared with subjects suffering from PD.

Viqualine in resistant depression: a double-blind, placebo-controlled trial

Viqualine dihydrochloride is a new molecule, which possesses strong serotonin reuptake inhibition properties and, at the same time, diazepam-like actions, such as [3H]-diazepam-binding inhibition and antipunishment effect. The drug was administered double-blindly to 10 patients suffering from major depression resistant to previous treatments with tricyclics. The comparison group (10 patients) received placebo. Lorazepam (10 mg/day) was also given to both groups. Viqualine proved to be significantly superior to placebo in the 4th week of treatment on all the three rating scales which were used. Tolerability of viqualine was good both objectively and on subjective grounds.

Assessment of depression: a comparison of rating scales

Six depression rating scales (RS) (Beck Depression Inventory, BDI; Zung Self-Rating Scale, SDS; Visual Analogue Scale, VAS; Hamilton Depression Rating Scale, HRSD; Wechsler Depression Rating Scale; Bunney and Hamburg Rating Scale, BHRS) were administered to the same 100 depressed patients and compared as regards ease of use, reliability, distribution, and validity. Separate factor analyses carried out on the items of the single scales showed considerably different factorial structures, thus revealing that different concepts of depression are at the basis of the various scales. These differences suggest that comparison of results derived by the use of different scales must be regarded with caution.

[Body illness and changes in verbal communication. Study of the alexithymic phenomenon in somatic disease]

The Schalling--Sifneos Personality Scale was administered to several groups of subjects (patient suffering from chronic hepatitis or from ulcerative colitis, patients undergoing chronic periodic haemodialysis, encephalopathic patient and healthy subjects) in order to assess the presence of alexithymia in healthy subjects, in patients suffering from chronic organic pathologies and in psychosomatic patients. The results obtained permit one to distinguish the psychosomatic patients from other groups of subjects: compared to healthy subjects, patients suffering from ulcerous rectocolitis obtained higher average scores, while compared to patients suffering from other organic pathologies their scores showed a wider scatter. A distinction is therefore proposed between primary alexithymia, of a distinctive cognitive-affective kind which predisposes towards psychosomatic pathology, and secondary alexithymia which is associated with stressful situations, such as illness, and which is essentially defensive in origin.

[Schizoaffective psychoses: review of nosographic concepts and longitudinal clinical study]

A through review of the literature relating to the schizoaffective psychoses was undertaken; the considerable variety of criteria used for diagnosis accounts for the diversity of the results obtained by various researchers. In order to identify a homogeneous group of schizoaffective patients, four parameters, on which the literature is in agreement were formulated. These have enabled us to isolate 27 schizoaffective subjects and to compare them with two control groups: 25 cases of schizophrenia and 26 cases of maniac-depressive psychosis. On the basis of the symptomatological and social variables considered (age of onset, cultural level, social adaptation, family history, early and recent events, response to short-term pharmacological treatment, symptomatology during the observation period), we believe that we are able to distinguish schizoaffective subjects from both schizophrenic and dysthymic subjects.

[Chronic dialysis and forcing of the ability to fantasize. Evaluation of the alexithymic phenomenon in a group of dialyzed patients]

In order to evaluate personality modifications toward greater concreteness and a consequent reduction of fantasizing in subjects undergoing chronic haemodialytic treatment, the Shalling Sifneos Personality Scale (S.S.P.S.) was administered to a group of patients undergoing dialysis and to two control groups: one consisting of patients with chronic hepatitis and the other of healthy subjects. The S.S.P.S. measures the alexithymic traits of the personality. Subjects undergoing dialysis scored significantly higher than chronic hepatitis patients and healthy subjects; the latter group had the lowest scores. The alexithymic score, moreover, appears to be directly correlated with the duration of dialysis. It is suggested that the prominence of the alexithymic phenomenon may be related to defense mechanisms against recurrent anguish about dying and to the tendency to assume certain characteristics of the particular therapeutic regimen, such as concreteness and rationality, so as to be able to tolerate the aggressive aspects of the treatment.