“Robot-assisted laparoscopic management of a case with juvenile cystic adenomyoma.”
Akar, M. E., K. H. Leezer, et al. (2010).
Fertility and Sterility 94(3).
“[A role of robotic-assisted surgery to preserve female fertility? Comments about the first paratubal cystectomy performed with the "Da Vinci S" robotic system in a young girl.].”
Delotte, J., J. Breaud, et al. (2010).
Gynecologie, Obstetrique et Fertilite.
In the field of adnexal surgeries in children, robotic surgery seems to make easier the realization of minimal invasive surgery. It could lead to a decrease of post-surgical adherences and therefore preserve the fertility of young patients. We report the first paratubal cystectomy performed using robotic assistance on a child in order to preserve her future fertility and discuss advantages and disadvantages of this technology.
“A comprehensive method to train residents in robotic hysterectomy techniques.”
Finan, M. A., S. Silver, et al. (2010).
Journal of Robotic Surgery 4(3): 183-190.
Training residents to perform robotic surgery poses several challenges. We describe a comprehensive method, beginning with a dry lab, and progressing through bedside assisting, then segmental involvement, to full participation, for residents to train and obtain credentials in robotic hysterectomy. From August 1, 2006 through July 31, 2009 a training method was developed at the University of South Alabama on the Gynecologic Oncology service. A dry lab which closely simulates specific tasks performed in a robotic hysterectomy was accompanied by resident observation of robotic surgery, and followed with progressive involvement in the robotic console. This culminated in their completion of dozens of complete robotic hysterectomies. Sixteen residents completed the dry lab and 228 robotic cases were performed, 190 of which were hysterectomy; 161/190 (84.7%) included resident participation, 103/190 (54.2%) included resident participation in the console, and in 65/190 (34.2%) residents completed the hysterectomy procedure. The mean time for resident robotic hysterectomy was 45.08 min (range = 13-92 min), and the mean time to tie a single figure-of-eight suture in the vaginal cuff was 4.41 min (range = 2.25-9.25). Complications were similar for resident and attending surgeon cases. Using a dry lab as well as graded introduction to robotic surgery which begins with observation, progresses through bedside assisting, and culminates in complete hysterectomy by residents, we have demonstrated a method to train and credential Ob/Gyn residents in robotic hysterectomy © 2010 Springer-Verlag London Ltd.
“Leukocytosis after robotic hysterectomy: commonly observed but clinically insignificant.”
Goel, M., K. F. McGonigle, et al. (2010).
Journal of Robotic Surgery: 1-5.
Laboratory studies are commonly performed after surgery, but with little evidence of clinical utility. We evaluated our experience with measuring a complete blood count (CBC) to determine peripheral blood leukocyte count (WBC) postoperatively following consecutive robotic hysterectomies. From January 2008 through November 2009, two surgeons (KM, HM) performed 204 robotic hysterectomies. Patient age, weight, height, indication for surgery, surgical procedure, operative time, estimated blood loss, hospital length of stay, postoperative fever, and complications were prospectively recorded and correlated with WBC measured on the day after surgery. The postoperative WBC was elevated (>11,000/μl) in 59/204 (29%) patients. Eight (4%) patients had marked leukocytosis (WBC >15,000/μl; maximum 16,600/μl). There was no correlation between postoperative leukocytosis and operative time, BMI, performance of lymphadenectomy, or length of hospitalization. The only factor significantly associated with elevated postoperative WBC was elevated preoperative WBC (P < .001). Also, there was no correlation between postoperative leukocytosis with fever or infectious complications. The mean T<sub>max</sub> was 37.1<sup>o</sup>C and T<sub>max</sub> over 38<sup>o</sup>C was seen in nine patients. Of the five women who developed infectious complications, only one (diagnosed with pneumonia) had a minimally elevated postoperative WBC (11,600/μl); the other four (pneumonia and pelvic abscess, two each) had normal postoperative WBC. Routine measurement of WBC after robotic hysterectomy is not useful. In about 25% of cases there will be a slight leukocytosis, and rarely (about 4%) will the WBC exceed 15,000/μl. In no case was measurement of postoperative WBC clinically relevant. © 2010 Springer-Verlag London Ltd.
“Reply of the Authors: Robot-assisted laparoscopic management of a case with juvenile cystic adenomyoma.”
Kumakiri, J., M. Kitade, et al. (2010).
Fertility and Sterility 94(3).
“An update on surgery for pelvic organ prolapse.”
McIntyre, M., C. Goudelocke, et al. (2010).
Current Opinion in Urology.
PURPOSE OF REVIEW: The surgical management of pelvic organ prolapse continues to evolve. Recent advancements in techniques and materials have increased the available treatments for pelvic organ prolapse. A current understanding of the benefits and limitations offered by recently introduced materials and techniques is essential to their proper application. RECENT FINDINGS: Current surgical therapies for prolapse now include augmentation with synthetic mesh, which may also be utilized as part of a ‘kit’. In addition, both laparoscopic and robot-assisted techniques have been developed to address apical vaginal prolapse. Both the use of synthetic mesh and laparoscopic and robotic techniques should continue to be subjected to appropriate scrutiny to assess their long-term success and complications. SUMMARY: While the introduction of novel approaches to pelvic organ prolapse provide further options when considering appropriate therapy, the application of these materials and techniques should be examined with scientific rigor and should demonstrate both a significant benefit and low morbidity prior to widespread adoption. With continued research, we hopefully will be able to identify the ideal approaches and repairs to achieve optimal patient outcomes.
“Rate of vaginal cuff separation following laparoscopic or robotic hysterectomy.”
Nick, A. M., J. Lange, et al. (2010).
Gynecologic Oncology.
OBJECTIVE: Vaginal cuff separation is a rare but serious complication following hysterectomy. The goal of our study was to determine the rate of vaginal cuff separation and associated risk factors in patients undergoing laparoscopic or robotic hysterectomy. METHODS: We retrospectively identified patients who underwent a minimally invasive simple or radical hysterectomy at one institution between January 2000 and 2009. Fisher’s exact test, Wilcoxon rank sum test and multiple logistic regression were used to determine associations between variables and increased risk of separation. RESULTS: A total of 417 patients underwent laparoscopic (n=285) or robotic (n=132) hysterectomy during the study period. Three hundred and sixty-two underwent simple hysterectomy (249 laparoscopic, 113 robotic) and 57 underwent radical hysterectomy (36 laparoscopic, 19 robotic). Seven (1.7%) patients developed a cuff complication and all had a diagnosis of malignancy. Three (1.1%) patients in the laparoscopy group suffered a vaginal cuff evisceration (n=2) or separation (n=1). Four patients in the robotic group (3.0%) had a vaginal evisceration (n=1) or separation (n=3). There was no difference based on surgical approach (p=0.22). Vaginal cuff complications were 9.46-fold higher among patients who had a radical hysterectomy (p<0.01). Median time to presentation of vaginal cuff complication was 128days (range, 58-175) in the laparoscopy group and 37days (range, 32-44) in the robotic group. CONCLUSIONS: The overall risk of vaginal cuff complication was 1.7%. There appears to be no difference in cuff complication rates based on surgical approach. Radical hysterectomy, however, was associated with a 9-fold increase in vaginal cuff complications.
“Comparing Robot-Assisted with Conventional Laparoscopic Hysterectomy: Impact on Cost and Clinical Outcomes.”
Pasic, R. P., J. A. Rizzo, et al. (2010).
Journal of Minimally Invasive Gynecology.
OBJECTIVE: To compare clinical and economic outcomes (hospital costs) in women undergoing laparoscopic hysterectomy performed with and without robotic assistance in inpatient and outpatient settings. METHODS: Using the Premier hospital database, we identified women >18 years of age with a record of minimally invasive hysterectomy performed in 2007 to 2008. Univariable and multivariable analyses examined the association between robot-assisted hysterectomy and adverse events, hospital costs, surgery time, and length of stay. RESULTS: Of 36 188 patient records analyzed from 358 hospitals, 95% (n = 34 527) of laparoscopic hysterectomies were performed without robotic assistance. Inpatient and outpatient settings did not differ substantively in frequency of adverse events. For cardiac, neurologic, wound, and vascular complications, frequencies were <1% for robot and non-robot procedures. In inpatient and outpatient settings alike, use of robotic assistance was consistently associated with statistically significant, higher per-patient average hospital costs. Inpatient procedures with and without robotic assistance cost $9640 (95% confidence interval [CI] = $9621, $9659) versus $6973 (95% CI = $6959, $6987), respectively. Outpatient procedures with and without robotic assistance cost $7920 (95% CI = $7898, $7942) versus $5949 (95% CI = $5932, $5966), respectively. Inpatient surgery times were significantly longer for robot-assisted procedures, 3.22 hours (95% CI = 3.21, 3.23) compared with non-robot procedures at 2.82 hours (95% CI = 2.81, 2.83). Similarly, outpatient surgery times with robot averaged 2.99 hours (95% CI = 2.98, 3.00) versus 2.46 hours (2.45, 2.47) for non-robot procedures. CONCLUSION: Our findings reveal little clinical differences in perioperative and postoperative events. This, coupled with the increased per-case hospital cost of the robot, suggests that further investigation is warranted when considering this technology for routine laparoscopic hysterectomies.
“Surgical outcomes for robotic-assisted laparoscopic myomectomy compared to abdominal myomectomy.”
Sangha, R., D. I. Eisenstein, et al. (2010).
Journal of Robotic Surgery: 1-5.
A retrospective cohort of 100 robotic-assisted laparoscopic myomectomy (RM) patients and 48 laparotomic myomectomy (LM) patients at Henry Ford Hospital in Detroit, MI, USA was examined to compare surgical outcomes of RM with LM. Details of age, race, body mass index (BMI), procedure duration, estimated blood loss (EBL), length of stay (LOS), diameter of the largest leiomyoma and number of leiomyomata removed were collected. Procedure duration was significantly longer among RM patients (median: 194 min vs. 127.5 min; Wilcoxon rank sum (WRS) P < 0.001). EBL and LOS were both significantly greater among LM patients (EBL medians 200 vs. 100 ml, WRS P < 0.001; LOS medians 3 vs. 1, WRS P < 0.01). Among the RM patients, 39.4% had a LOS of at least 2 days compared to 89.4% among LM patients. Leiomyomata characteristics did not affect the observed associations. RM could enable widespread use of a minimally invasive approach for leiomyoma treatment. © 2010 Springer-Verlag London Ltd.
Study Objective: To estimate the trends in various types of hysterectomy (abdominal, vaginal, laparoscopic, and subtotal) and their distribution according to patient age, surgeon age, and hospital accreditation in Taiwan. Design: Retrospective cohort study (Canadian Task Force classification II-2). Setting: Population-based National Health Insurance (NHI) database. Patients: Women with NHI in Taiwan undergoing various types of hysterectomy to treat noncancerous lesions. Interventions: Data for this study were obtained from the Inpatient Expenditures by Admissions files of the NHI research database, released by the NHI program in Taiwan for 1996-2005. Measurements and Main Results: A total of 234. 939 women who underwent various types of hysterectomy were identified for analysis. The number of hysterectomies performed annually remained stationary during the 10-year study. Total abdominal hysterectomies decreased significantly (77.33% in 1996 vs 45.68% in 2005), laparoscopic hysterectomies increased significantly (5.20% vs 40.40%), vaginal hysterectomies decreased (14.70% vs 8.86%), and subtotal abdominal hysterectomies increased (2.76% vs 5.06%). Laparoscopic hysterectomy was more commonly performed in middle-aged women; vaginal hysterectomy was more common in older women; and subtotal abdominal hysterectomy was more common in younger women. Laparoscopic hysterectomy was performed more commonly in regional hospitals (33.11%), followed by medical centers (30.17%) and local hospitals (17.78%). Laparoscopic hysterectomy was performed more commonly in not-for-profit hospitals (30.25%), followed by private hospitals (29.32%) and government-owned hospitals (25.91%). Conclusion: There has been considerable change in the types of surgery used for hysterectomy in Taiwan over the past 10 years. As a minimally invasive approach, laparoscopic hysterectomy represents a profound change for both patients and surgeons. © 2010 AAGL.
“Robotic-assisted laparoscopic anterior pelvic exenteration in patients with advanced ovarian cancer: Farghaly’s technique.”
Farghaly, S. A. (2010).
European Journal of Gynaecological Oncology 31(4): 361-363.
The safety and efficacy of the robotic-assisted laparoscopic approach to anterior pelvic exenteration is evaluated in patients with advanced ovarian cancer undergoing anterior pelvic exenteration for involvement of the urinary bladder during primary cytoreduction surgery. All patients undergo preoperative lab work, imaging studies and bowel preparation prior to surgery. The Davinci surgical system is used to perform urinary cystectomy, total hysterectomy, bilateral salpingo-oophorectomy, bilateral pelvic adenectomy (including obturator, hypogastic, external iliac, and common iliac lymph nodes). In addition, debulking to less than 1 cm is performed. The anterior pelvic exenteration procedure involves wide perivesical dissection. Then the robot is locked, and ileal conduit is performed via a 6 cm lower midline incision. Operative time can be maintained in 4.6 hours with a mean blood loss of 215 ml and hospital stay of five days. Farghaly’s technique of robotic-assisted laparoscopic anterior pelvic exenteration in patients with advanced ovarian cancer is safe, feasible, and cost-effective with acceptable operative, pathological and short- and long-term clinical outcomes. It retains the advantage of minimally invasive surgery.
“Gynecologic oncologists’ opinion.”
Martino, M. A. and M. Pirigyi (2010).
Seminars in Oncology 37(4): 315-317.
“Rate of vaginal cuff separation following laparoscopic or robotic hysterectomy.”
Nick, A. M., J. Lange, et al. (2010).
Gynecologic Oncology.
OBJECTIVE: Vaginal cuff separation is a rare but serious complication following hysterectomy. The goal of our study was to determine the rate of vaginal cuff separation and associated risk factors in patients undergoing laparoscopic or robotic hysterectomy. METHODS: We retrospectively identified patients who underwent a minimally invasive simple or radical hysterectomy at one institution between January 2000 and 2009. Fisher’s exact test, Wilcoxon rank sum test and multiple logistic regression were used to determine associations between variables and increased risk of separation. RESULTS: A total of 417 patients underwent laparoscopic (n=285) or robotic (n=132) hysterectomy during the study period. Three hundred and sixty-two underwent simple hysterectomy (249 laparoscopic, 113 robotic) and 57 underwent radical hysterectomy (36 laparoscopic, 19 robotic). Seven (1.7%) patients developed a cuff complication and all had a diagnosis of malignancy. Three (1.1%) patients in the laparoscopy group suffered a vaginal cuff evisceration (n=2) or separation (n=1). Four patients in the robotic group (3.0%) had a vaginal evisceration (n=1) or separation (n=3). There was no difference based on surgical approach (p=0.22). Vaginal cuff complications were 9.46-fold higher among patients who had a radical hysterectomy (p<0.01). Median time to presentation of vaginal cuff complication was 128days (range, 58-175) in the laparoscopy group and 37days (range, 32-44) in the robotic group. CONCLUSIONS: The overall risk of vaginal cuff complication was 1.7%. There appears to be no difference in cuff complication rates based on surgical approach. Radical hysterectomy, however, was associated with a 9-fold increase in vaginal cuff complications.
“Comparing Robot-Assisted with Conventional Laparoscopic Hysterectomy: Impact on Cost and Clinical Outcomes.”
Pasic, R. P., J. A. Rizzo, et al. (2010).
Journal of Minimally Invasive Gynecology.
OBJECTIVE: To compare clinical and economic outcomes (hospital costs) in women undergoing laparoscopic hysterectomy performed with and without robotic assistance in inpatient and outpatient settings. METHODS: Using the Premier hospital database, we identified women >18 years of age with a record of minimally invasive hysterectomy performed in 2007 to 2008. Univariable and multivariable analyses examined the association between robot-assisted hysterectomy and adverse events, hospital costs, surgery time, and length of stay. RESULTS: Of 36 188 patient records analyzed from 358 hospitals, 95% (n = 34 527) of laparoscopic hysterectomies were performed without robotic assistance. Inpatient and outpatient settings did not differ substantively in frequency of adverse events. For cardiac, neurologic, wound, and vascular complications, frequencies were <1% for robot and non-robot procedures. In inpatient and outpatient settings alike, use of robotic assistance was consistently associated with statistically significant, higher per-patient average hospital costs. Inpatient procedures with and without robotic assistance cost $9640 (95% confidence interval [CI] = $9621, $9659) versus $6973 (95% CI = $6959, $6987), respectively. Outpatient procedures with and without robotic assistance cost $7920 (95% CI = $7898, $7942) versus $5949 (95% CI = $5932, $5966), respectively. Inpatient surgery times were significantly longer for robot-assisted procedures, 3.22 hours (95% CI = 3.21, 3.23) compared with non-robot procedures at 2.82 hours (95% CI = 2.81, 2.83). Similarly, outpatient surgery times with robot averaged 2.99 hours (95% CI = 2.98, 3.00) versus 2.46 hours (2.45, 2.47) for non-robot procedures. CONCLUSION: Our findings reveal little clinical differences in perioperative and postoperative events. This, coupled with the increased per-case hospital cost of the robot, suggests that further investigation is warranted when considering this technology for routine laparoscopic hysterectomies.
“Robotic surgery in gynecologic oncology fellowship programs in the USA: a survey of fellows and fellowship directors.”
Sfakianos, G. P., P. J. Frederick, et al. (2010).
Int J Med Robot.
BACKGROUND: In order to understand how robotic surgery impacts gynecologic oncology fellowship training and surgical practices, a survey of fellows and fellowship directors was conducted. METHODS: Questionnaires designed to determine the prevalence, application, and acceptance of robotics were sent to fellows and fellowship directors in approved U.S. programs. RESULTS: Of the respondents, 95% have a robot at their institution and 95% utilize it. Most responding fellowship directors (70%) reported that fellow education is enhanced by robotic surgery. Most fellows (65%) who responded feel comfortable using the robot, and 94% plan on performing robotic surgery upon completion of fellowship training. CONCLUSIONS: This survey demonstrates that robotic surgery is utilized in the majority of responding gynecologic oncology fellowship programs for a wide array of indications. Fellowship directors and fellows-in-training generally have a favorable view of this evolving technology. Based on these responses, robotic surgery will play an increasingly important role in the future. Copyright (c) 2010 John Wiley & Sons, Ltd.