Laparoscopic-assisted Hysterectomy Research Articles

Trends in surgical approach to hysterectomy and perioperative outcomes in Michigan hospitals from 2010 through 2020.

The objective of this study was to determine the trends in surgical approach to hysterectomy over the last decade and compare perioperative outcomes and complications. This retrospective cohort study used clinical registry data from the Michigan Hospitals that participated in Michigan Surgical Quality Collaborative (MSQC) from January 1st, 2010 through December 30th, 2020. A multigroup time series analysis was performed to determine how surgical approachto hysterectomy [open/TAH, laparoscopic (TLH/LAVH), and robotic-assisted (RA)] has changed over the last decade. Abnormal uterine bleeding, uterine fibroids, chronic pelvic pain, pelvic organ prolapse, endometriosis, pelvic mass, and endometrial cancer were the most common indications for hysterectomy. The open approach to hysterectomy declined from 32.6 to 16.9%, a 1.9-fold decrease, with an average decline of 1.6% per year (95% CI - 2.3 to - 0.9%). Laparoscopic-assisted hysterectomies decreased from 27.2 to 23.8%, a 1.5-fold decrease, with an average decrease of 0.1% per year (95% CI - 0.7 to 0.6%). Finally, the robotic-assisted approach increased from 38.3 to 49.3%, a 1.25-fold increase, with an average of 1.1% per year (95% CI 0.5 to 1.7%). For malignant cases, open procedures decreased from 71.4 to 26.6%, a 2.7-fold decrease, while RA-hysterectomy increased from 19.0 to 58.7%, a 3.1-fold increase. After controlling for the confounding variables age, race, and gynecologic malignancy, RA hysterectomy was found to have the lowest rate of complications when compared to the vaginal, laparoscopic and open approaches. Finally, after controlling for uterine weight, black patients were twice as likely to undergo an open hysterectomy compared to white patients.

Spillage and displacement of indocyanine green-stained tissues from uterine cervix to pelvic peritoneum: A proof of concept study for colpotomy approach in minimally invasive surgery

ObjectiveTo analyze peritoneal spillage and displacement of indocyanine green (ICG)-stained tissues from uterine cervix to pelvis during intracorporeal/vaginal colpotomy in laparoscopic-assisted hysterectomy. Materials and methodsEleven patients undergoing laparoscopic-assisted hysterectomy were included. One patient with an incidental diagnosis of endometrial cancer was excluded. Of the 10 patients, five underwent intracorporeal colpotomy (IC) and five received vaginal colpotomy (VC) during laparoscopic-assisted hysterectomy. Approximately 5 cm of resected round ligament from each patient was stained with ICG and cut to 1.0 × 1.0 cm in size. Four to five fragments of ICG-stained tissues were placed and sutured on the uterine cervix before colpotomy. During and after colpotomy, serial pictures under white and fluorescence light were taken to document peritoneal spillage and displacement of ICG-stained tissues to the pelvic peritoneum. ResultsPeritoneal spillage of ICG occurred in the entire IC group. Displacement of ICG-stained tissues from uterine cervix to pelvic peritoneum were visualized in three (60%) patients undergoing IC. In the five patients who received VC, peritoneal spillage of ICG and displacement of ICG-stained tissue to pelvic peritoneum did not occur. There were no perioperative complications. ConclusionsIC in minimally invasive radical hysterectomy should not be performed because peritoneal spillage of ICG and displacement of ICG-stained tissues from uterine cervix to pelvis frequently occurs during IC. Therefore, specific measures to prevent tumor exposure during colpotomy should be implemented in cervical cancer patients.

Effects of hysterectomy on pelvic floor function and sexual function-A prospective cohort study.

Hysterectomy is one of the most common major surgical procedures in women. The effects of hysterectomy on pelvic floor and sexual function are uncertain. Our objective was to investigate the effects of hysterectomy for benign indications on pelvic floor and sexual function and to compare different modes of surgery. We performed a prospective clinical cohort study. In all, 260 women scheduled for hysterectomy answered validated questionnaires (Pelvic Floor Impact Questionnaire, Pelvic Floor Distress Inventory and Female Sexual Function Index). Participants were followed 6 months and 1 year after surgery. Data were analyzed using nonparametric statistics and mixed effect models. Women with subtotal hysterectomy, vaginal hysterectomy, laparoscopic assisted vaginal hysterectomy, and previous prolapse/incontinence surgery were excluded from further analysis, leaving the remaining cohort to 242 patients. The response rate at 6 months and 1 year follow-up was 180/242 (74.3%) and 169/242 (69.8%), respectively. There was an improvement of pelvic floor function at both follow-ups; mean score of Pelvic Floor Impact Questionnaire at baseline was 42.5 (51.7), at 6 months 19.9 (42.2) and at 1 year 23.7 (50.3) (p< 0.001). The mean score of Pelvic Floor Distress Inventory at baseline was 69.6 (51.1), at 6 months 49 (43.2) and at 1 year 49 (43.2) (p< 0.001). There was an improvement of sexual function after 6 months (mean score of Female Sexual Function Index at baseline 17.9 [SD 11.7] and at 6 months 21.0 [SD 11.7]) (p< 0.001). There was no difference in pelvic floor or sexual function when comparing surgical techniques. Robotic assisted laparoscopic hysterectomy, laparoscopic hysterectomy and abdominal hysterectomy improve pelvic floor function to the same extent at 6 months and 1 year after surgery. There was an overall improvement of sexual function 6 months after hysterectomy, but this did not persist after 1 year.

Complications of laparoscopic assisted hysterectomy

Hysterectomy remains the most common gynecological procedure for both benign and malignant causes. Throughout the years, various surgical methods have been studied with the purpose of avoiding immediate and late complications. Laparoscopic surgeries have gained momentum in all surgical specialties, and gynecology is no exception.

Spillage and displacement of ICG-stained tissue from the uterine cervix to the pelvic peritoneum: A proof of concept study for colpotomic approach in minimally invasive surgery

Objective: The aim of this study was to analyze peritoneal spillage and artificial displacement of indocyanine green (ICG)-stained tissues from the uterine cervix to the pelvis during intracorporal and vaginal colpotomy in laparoscopic-assisted hysterectomy.

Minimally Invasive Surgery Is Feasible in Patients with Liver and Kidney Transplantation.

BackgroundMinimally invasive surgery (MIS) has rapidly advanced, but its use in transplant patients has lagged. We share our experience of MIS for patients after kidney and liver transplantation and compare our results with similar studies in the literature.Material/MethodsThis study included 14 MIS (12 laparoscopic, 2 transvaginal) procedures for 13 transplant cases (6 liver and 7 kidney) done from May 2006 to May 2018. Gastrointestinal surgery was performed in 6 cases: appendectomy performed 8 months after liver transplant and 16 months after kidney transplant in 2 cases, radical right hemi-colectomy performed 6 weeks after liver transplant in 1 case; exploration for chylous ascites 6 months after liver transplant in 1 case, sleeve gastrectomy performed 3 years after kidney transplant in 1 case, and partial hepatectomy performed 12 years after kidney transplant in 1 case. For urological problems, 2 patients received ipsilateral right-side nephroureterectomy performed 10 and 12 years after kidney transplant, and 1 patient received contralateral left-side nephroureterectomy performed 12 years after kidney transplant. The 2 liver transplant patients with huge incisional hernias received repair approximately 3 and 2 years after liver transplant. Three patients underwent gynecological surgery: 2 transvaginal for pelvic floor reconstruction in 1 patient with liver transplant and 1 hysterectomy in a kidney transplant patient, and 1 laparoscopic-assisted hysterectomy in a kidney transplant patient. We retrospectively analyzed the clinical presentation, operative findings, operation time, postoperative complications, and length of stay.ResultsThe postoperative course was uneventful, with early resumption of oral intake, including immunosuppressants administered the same as in the non-transplant patients. All surgical procedures in these transplant patients were achieved without conversion, showed stable kidney and liver function, had better surgical outcomes in comparison with traditional surgery, and most of them were discharged within 1 week.ConclusionsLaparoscopic and non-laparoscopic MIS surgery are feasible and safe for abdominal organ transplant patients and are helpful for timely intervention in cases with acute abdomen. No adjustment of immunosuppressant is usually needed, as oral intake can be resumed very soon after surgery.

Infectious complications of laparoscopic and robotic hysterectomy: a systematic literature review and meta-analysis.

We performed a systematic review of the literature and meta-analysis of the infectious complications of hysterectomy, comparing robotic-assisted hysterectomy to conventional laparoscopic-assisted hysterectomy. We searched PubMed, CINAHL, CDSR, and EMBASE through July 2018 for studies evaluating robotic-assisted hysterectomy, laparoscopic-assisted hysterectomy, and infectious complications. We employed random-effect models to obtain pooled OR estimates. Heterogeneity was evaluated with I2 estimation and the Cochran Q statistic. Pooled ORs were calculated separately based on the reason for hysterectomy (eg, benign uterine diseases, endometrial cancer, and cervical cancer). Fifty studies were included in the final review for the meta-analysis with 176 016 patients undergoing hysterectomy. There was no statistically significant difference in the number of infectious complication events between robotic-assisted hysterectomy and laparoscopic-assisted hysterectomy (pooled OR 0.97; 95 % CI 0.74 to 1.28). When we performed a stratified analysis, similar results were found with no statistically significant difference in infectious complications comparing robotic-assisted hysterectomy to laparoscopic-assisted hysterectomy among patients with benign uterine disease (pooled OR 1.10; 95 % CI 0.70 to 1.73), endometrial cancer (pooled OR 0.97; 95 % CI 0.55 to 1.73), or cervical cancer (pooled OR 1.09; 95 % CI 0.60 to 1.97). In our meta-analysis the rate of infectious complications associated with robotic-assisted hysterectomy was no different than that associated with conventional laparoscopic-assisted hysterectomy.

3D Ultrasonography Compared with Magnetic Resonance Imaging for the Diagnosis of Adenomyosis

Background: Adenomyosis is a common benign gynecological affecting premenopausal woman, in which there is increased overgrowth of the endometrium with invasion of the underlying myometrium. The precise pathogenesis of adenomyosis remains unknown with many theories being proposed that consider it to be a pathology that initially affects the endomyometrial junctional zone (JZ). Aim of the Work: The study aims to compare 3D transvaginal ultrasound with MRI in diagnosing adenomyosis in comparison with the gold standard histopathology. Patients and Methods: This cross-sectional study was carried out on 77 patients who were recruited from women presenting to the outpatient clinic at Ain Shams University Maternity Hospital planned to undergo hysterectomy (abdominal, vaginal or laparoscopic assisted hysterectomy) for adenomyosis according to the inclusion/ exclusion criteria. Results: Out of 77 patients included in the study, 67(87%) were +ve for adenomyosis by 3D TVUS, confirmed in 46(59.74%) by histopathology, while 52(67.53%) were +ve by MRI, confirmed in 39(50.64%) by histopathology.3D transvaginal US was able to diagnose adenomyosis in 67(87%) patients and fibroid in 23(29.9%) patients, while MRI was able to diagnose adenomyosis in 52(67.5%) and fibroid in 36 (46.8%). Conclusion: our study results indicated that, 3D transvaginal ultrasound is highly accurate as MRI in diagnosing adenomyosis and leiomyoma as a preoperative diagnostic tool. Recommendations: As the 3D ultrasonography is more available, cheaper, less time consuming and easier technique, it is recommended to be used in every day clinical practice, helping the clinicians to reach an accurate diagnosis, select an appropriate treatment, and individualize management for each patient to reach the best outcome therapeutic rates.

Factors Associated With Hemostatic Agent Use During Laparoscopic Hysterectomy

Study ObjectiveTo evaluate factors associated with the use of hemostatic agents during traditional laparoscopic or robotic hysterectomy. DesignA retrospective cohort trial (Canadian Task Force classification III). SettingA single medical center in Cincinnati, OH, from August 1, 2013, to July 31, 2014. PatientsWomen undergoing traditional laparoscopic or robotic hysterectomies with and without the use of hemostatic agents. InterventionThe use of a hemostatic agent at the time of hysterectomy. MeasurementsPatient characteristics and pre- and postoperative metrics were recorded for each subject. Associations between categoric variables were analyzed using chi-square testing, whereas continuous variables were analyzed using analysis of variance. Modeling of study variables to predict hemostatic agent use was performed using chi-square–assisted interaction detection methods. Main ResultsThe study sample included 176 cases performed by 30 surgeons. In our sample, 42% of minimally invasive hysterectomies were performed with the surgical robot (robotic-assisted laparoscopic hysterectomy); the remainder of minimally invasive hysterectomies by approach was as follows: total laparoscopic hysterectomy, 27%; laparoscopic-assisted vaginal hysterectomy, 16%; and laparoscopic supracervical hysterectomy, 15%. Forty-six percent (81/176) of cases recorded the use of a fibrin hemostat, 26% (46/176) involved an alternative hemostat, and 28% (49/176) of cases did not use any hemostat. By surgical approach, no hemostatic agent use was noted most often among laparoscopic-assisted hysterectomy; alternative hemostats were most often used during total laparoscopic hysterectomy. Robotic-assisted laparoscopic hysterectomy and laparoscopic supracervical hysterectomy were most often associated with fibrin-based hemostats. The use of any hemostatic agent did not result in clinical significant blood loss relative to cases in whino product was used. The study variable identified most predictive of hemostat use by the chi-square–assisted interaction detection regression tree model was surgeon identity. ConclusionHemostatic agent use during traditional laparoscopic and robotic hysterectomy does not appear to be associated with operative bleeding but is related to surgeon identity.

Abdominal Hysterectomy: Reduced Risk of Surgical Site Infection Associated with Robotic and Laparoscopic Technique.

Hysterectomy is one of the most common procedures performed in the United States. New techniques utilizing laparoscopic and robotic technology are becoming increasingly common. It is unknown if these minimally invasive surgical techniques alter the risk of surgical site infections (SSI). We performed a retrospective review of all patients undergoing abdominal hysterectomy at our institution between January 2011 and June 2013. International Classification of Diseases, Ninth edition (ICD-9) codes and chart review were used to identify patients undergoing hysterectomy by open, laparoscopic, or robotic approach and to identify patients who developed SSI subsequently. Chi-square and analysis of variance (ANOVA) tests were used to identify univariate risk factors and logistic regression was used to perform multivariable analysis. During this time period, 986 patients were identified who had undergone abdominal hysterectomy, with 433 receiving open technique (44%), 116 laparoscopic (12%), 407 robotic (41%), and 30 cases that were converted from minimally invasive to open (3%). Patients undergoing laparoscopic-assisted hysterectomy were significantly younger and had lower body mass index (BMI) and American Society of Anesthesiologists (ASA) scores than those undergoing open or robotic hysterectomy. There were no significant differences between patients undergoing open versus robotic hysterectomy. The post-operative hospital stay was significantly longer for open procedures compared with those using laparoscopic or robotic techniques (5.1, 1.7, and 1.6 d, respectively; p<0.0001). The overall rate of SSI after all hysterectomy procedures was 4.2%. More SSI occurred in open cases (6.5%) than laparoscopic (0%) or robotic (2.2%) (p<0.0001). Cases converted to open also had an increased rate of SSI (13.3%). In both univariate and multivariable analyses, open technique, wound class of III/IV, age greater than 75 y, and morbid obesity were all associated with increased risk of SSI. Laparoscopic and robotic hysterectomies were associated with a significantly lower risk of SSI and shorter hospital stays. Body mass index, advanced age, and wound class were also independent risk factors for SSI.

Urogenital Fistulae in India

To review our experience with urogenital fistulae with respect to etiology and management. Retrospective analysis of electronic records from January 2004 to June 2011. A retrospective analysis of electronic records of all urogenital fistulae presenting to our institution from January 2004 to June 2011 was undertaken. Etiology, presentation, management, and outcome of these cases were noted and analyzed. A total of 210 cases were identified, with vesicovaginal fistulae being the most common. The etiology was predominantly gynecological (58.6%) with laparoscopic assisted hysterectomy seeming to play an increasingly important role. Success rates of more than 90% were achieved in all cases, even in complex fistulae. No factors predicting successful repair were identified. Laparoscopic repair was successful in well-selected cases. The etiology of urogenital fistulae in India seems to be changing to one in line with developed countries. High success rates are possible even in complex cases.

The efficacy of the time-scheduled decremental continuous infusion of fentanyl for postoperative patient-controlled analgesia after total intravenous anesthesia

BackgroundIntravenous fentanyl has been used for acute postoperative pain management, but has not always provided reliable adequate analgesia, including patient-controlled analgesia (PCA). The purpose of this study was to investigate the efficacy of time-scheduled decremental infusion of fentanyl for postoperative analgesia.MethodsNinety-nine patients, aged 20-65 years, undergoing laparoscopic-assisted hysterectomy using total intravenous anesthesia (TIVA) were randomly assigned into one of the three groups. Their background infusions of fentanyl diluent (2 ml/hr of diluent was equivalent with 0.5 µg/kg/hr of fentanyl) with PCA were maintained at the fixed-rate of 2 ml/hr until the postoperative 24 hr (FX2-2-2), or at the decremental rates of 6.0, 4.0, 2.0 ml/hr (D6-4-2) and 8.0, 4.0, 2.0 ml/hr (D8-4-2). The visual analogue score (VAS), incidence of inadequate analgesia, frequency of PCA intervention, and side effects were evaluated.ResultsVAS was significantly higher in FX2-2-2 than in D6-4-2 and D8-4-2 until postoperative 3 hr (P < 0.05). After postoperative 4 hr, VAS was significantly higher in FX2-2-2 than D8-4-2 (P < 0.05). The incidence of inadequate analgesia of FX2-2-2 was significantly greater than D6-4-2 (P = 0.038) and D8-4-2 (P < 0.001) until postoperative 1 hr. None of the patients had ventilatory depression, and postoperative nausea and vomiting were not significant among the groups.ConclusionsThe time-scheduled decremental background infusion regimens of fentanyl, based on the pharmacokinetic model, could provide more effective postoperative pain management after TIVA, and the side effects and the risk for morbidity were not different from the fixed-rate infusion regimen.

Technicity as a Quality Indicator of Excellence in Gynaecology = معدل التقنية كمؤشر جودة للتميز في أمراض النساء

The objective of this study was to calculate the technicity index (TI) for hysterectomies at a tertiary care university hospital in Oman. This is a retrospective chart review of patients who had hysterectomies at Sultan Qaboos University Hospital (SQUH), a tertiary care university hospital. Profiles were reviewed for all patients who had hysterectomies at SQUH in the period 2003-2009. The cumulative frequencies for all types of hysterectomies were tallied and the year-specific TI was calculated. Overall, we enumerated a total of 258 hysterectomies, of which 6 (2.3%) were laparoscopic assisted hysterectomies, 42 (16.3%) vaginal hysterectomies, and 208 (80.6%) total abdominal hysterectomies. The average TI was 19% (48/258), and it ranged from 11% to 24%. The trend of change fluctuated over the years starting with 16% (2003) and increasing gradually during 2004-2006, but then declining again during 2007-2008 (trend P value 0.02). This low and fluctuating trend was mainly attributed to the inconsistency in the availability of trained surgeons and laparoscopic equipment. TI at our institution can be improved by increasing the number of minimally invasive hysterectomies through providing more trained surgeons and laparoscopic equipment.

Gynecologists’ characteristics associated with the likelihood of performing laparoscopic-assisted hysterectomy: a nationwide population-based study

With continuing development of minimally invasive techniques in gynecology, hysterectomy with laparoscopic assistance is increasingly performed. This study aimed to examine the relationship between the characteristics of gynecologists and the likelihood of performing laparoscopic-assisted hysterectomy (LH) under the case payment system of Taiwan's National Health Insurance. A retrospective population-based study was conducted based on the data from Taiwan's National Health Insurance Research Database. A total of 56,532 female residents aged 20 years and older who underwent total hysterectomy with or without laparoscopic assistance between 2004 and 2006 were included in the study. The gender, age and practice volume of their gynecologists were noted. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated by univariate and multivariate logistic regression analyses. Of the women selected, 30,478 underwent traditional total hysterectomy (TH) and 26,054 underwent LH. After controlling for clinical and nonclinical factors, male gynecologists (OR 1.65, 95% CI 1.55-1.76) were more likely to perform LH than their female colleagues. Gynecologists aged 60 years and older (OR 0.31, 95% CI 0.29-0.39) had the lowest likelihood of performing LH compared with their counterparts. In addition, surgeons with low-volume practice (OR 0.31, 95% CI 0.29-0.33) also had a significantly lower probability of performing LH compared with other surgeons. A higher likelihood of performing LH was observed among male and younger gynecologists with high-volume practice in Taiwan. This finding suggests that differences in practice patterns and surgical treatment decision may explain the variation in the approaches to laparoscopy-assisted hysterectomies. Differences in practice patterns and surgical treatment decisions may explain the variation in the approaches to laparoscopic-assisted hysterectomies.

Robotic Assisted, Total Laparoscopic, and Total Abdominal Hysterectomy for Management of Uterine Cancer

The purpose was to compare robotic assisted total laparoscopic hysterectomy (TRH), laparoscopic assisted hysterectomy (TLH) and total abdominal hysterectomy (TAH) with surgical staging +/- lymphadenectomy for the management of uterine cancer. Institutional review board approval was obtained and patient characteristics, pathologic data, and data related to the surgical procedure were collected from chart review. Data were analyzed with SAS statistical software. A total of 102 TRHs were compared to 115 TLHs and 79 TAHs. There were more grade I and endometrial intraepithelial (EIN) lesions in the preoperative pathology of TLHs (P < 0.01). Pelvic lymphadenectomy was performed in 71 (70%) TRH, 46 (58%) TAH, and 28 (24%) TLH cases (P < 0.01). Mean surgical time was 203, 133 and 132 minutes for TRHs, TLHs, and TAHs (P < 0.05). Estimated blood loss was 69, 86, and 215 ml for TRH, TLH, and TAH (P < 0.05). Blood transfusions were 19% in TAHs versus 3% and 2% in TLHs and TRHs (P < 0.01). There were fewer wound infections (2% vs. 10%) in TRHs versus TAHs (P < 0.01). Length of stay was shorter for the TRH and TLH groups (P < 0.05). Despite longer surgical times, benefits of minimally invasive technology included shortened length of stay, decreased wound infections, transfusions, and blood loss. In our population, procedure selection for TLH versus TRH may have been influenced by lower preoperative grade, with reservation of robotic technology for cases anticipated to be more complex, and therefore justifying increased technology costs and operating times.

Laparoscopic supracervical hysterectomy (LASH), a retrospective study of 1,584 cases regarding intra- and perioperative complications

The main interest of this study was to assess the rate of intraoperative and perioperative complications of laparoscopic supracervical hysterectomy (LASH) in a teaching hospital. A retrospective analysis of 1,584 laparoscopic assisted hysterectomies between 2005 and 2010 by different surgeons. In 2,577 patients undergoing simple hysterectomy, an indication for LASH was present in 1,584 cases. Indications were uterine myomas (71.6%), dysfunctional uterine bleeding (12.6%), suspicion of adenomyosis uteri (8.9%), descensus uteri (2.8%), dysmenorrhea (2.8%), hysterectomy on demand (1.2%) and benign hyperplasia of the endometrium (0.2%). Mean duration of the procedure was 76.5 ± 33.4 min (95% CI, ± 1.66). The average age of patients was 45.9 ± 5.4 years (95% CI, ± 0.27). Mean body mass index (BMI) was 25.3 ± 4.9 (95% CI, ± 0.24). Adhesiolysis due to earlier surgery had to be performed in 190 (12%) cases. The total complication rate was 1.07%. The total conversion rate to laparotomy was 0.88%. The rate of conversion after laparoscopic assessment of the situs was 0.57%. In five cases, conversion to laparotomy was necessary due to intraoperative complications (0.32%). On the whole, six bleedings (0.38%), four bladder injuries (0.25%), three intestinal injuries (0.19%), one ureter injury (0.06%), one injury of the epigastric vein (0.06%) and two omental incarcerations (0.13%) occurred. In this retrospective analysis, the rate of complications for LASH was very low in a hospital of standard care and residency. LASH has to be considered as a minimally invasive method with a low perioperative morbidity to treat benign uterine pathologies even in a teaching setting and should therefore be the method of choice if the cervix can be preserved.

A cost analysis of postoperative management in endometrial cancer patients treated by robotics versus laparoscopic approach

Objective The purpose of this study is to compare postoperative pain management and costs in endometrial cancer patients who had a robotic-assisted or laparoscopic-assisted hysterectomy. Methods This is a retrospective cohort study of all endometrial cancer patients from 9/2005 to 6/2010 who had a completed robotic-assisted or laparoscopic-assisted hysterectomy. All surgeries were performed by gynecologic oncologists on the da Vinci S surgical system. Demographic data, patient-recorded pain scores, pain-management interventions, and postoperative pain medication costs were compared. Data was analyzed using Student's t-tests and Pearson's χ 2 tests in SPSS. Results Two-hundred fifteen (101 robotic and 114 laparoscopic) patients met the inclusion criteria. There were no significant differences between the groups in age, BMI, clinical stage, comorbidities, lymph nodes retrieved, and the number of narcotic vs. non-narcotic drug interventions administered. Robotic patients had a lower number of initial drug interventions (21 vs. 52; P < .001) and total drug interventions (162 vs. 219; P < .001) than laparoscopic patients. Robotics had a lower initial pain score (2.1 vs. 3.0; P = .012). There was a 50% reduction in the pain medication cost on the day of surgery for robotic patients ($12.24 vs. $24.45; P < .01), and a 56% cost reduction for the rest of their length of stay ($3.63 vs. $8.17; P < .01). Conclusion Endometrial cancer patients who have robotic surgery experience less initial postoperative pain and have fewer drug interventions. The cost associated for their pain management represents a savings of greater than 50%. These factors demonstrate the value of robotic surgery in regard to postoperative pain management by delivering higher quality care at a lower cost.

Laparoscopic intraoperative sentinel lymph node detection by technetium-99 hysteroscopically injected in endometrial cancer patients.

5104 Background: Systematic lymphadenectomy in old, obese, and/or polymorbid patients with endometrial cancer is a challenging procedure. Sentinel lymph node (SN) biopsy can potentially reduce morbidity not jeopardizing oncologic safety. The goals of this prospective study are to determine the feasibility and accuracy of sentinel lymph node biopsy, in endometrial cancer patients, following hysteroscopic Technetium-99 (Tc-99) injection. Methods: From January 2008 till December 2009, 30 women with endometrial cancer were consecutively included into the study. We injected 20 mBq Tc-99 hysteroscopically beneath the tumor, at the beginning of surgery SN biopsy, pelvic, and paraaortic lymphadenectomy, laparoscopic-assisted hysterectomy and bilateral salpingo-oophorectomy were carried out through laparoscopy in 26 patients, or by laparotomy in 4 patients. Results: We detected SN in 25 women (82%). The total number of removed lymph nodes was 821, including 59 SN and among them, 35% (20) were located in the paraao...

A cost analysis of postoperative pain management in patients with endometrial cancer: Robotics versus laparoscopy

Objective: The purpose of this study was to compare postoperative pain management and associated costs in patients with endometrial cancer who had a robot-assisted or laparoscopy-assisted hysterectomy. Primary outcomes included patient-recorded pain scores and nursing pain management interventions. Secondary outcomes included the cost of postoperative pain medication.

Laparoscopic surgical field function fully multi-joint surgery department

Objective To investigate the application of laparoscopic surgical field full of multi-functional co-operation department of clinical value. Methods 2 years in our hospital 45 case of laparoscopic general surgical, maternity, secretion outside the joint operation of multi-section method, the effect of surgery. 19 cases of gallbladder Hysteromyoma merger, the combined 11 cases of cystic ovarian cyst, 9 cases with ovarian cystic teratoma, 1 case of uterine leiomyoma combined spleen, left lobe 1 cases of benign liver nodules Hysteromyoma merger, the combined three cases of appendiceal uterine leiomyoma, 1 case of splenic cyst fenestration combined left kidney. In the laparoscopic resection of the gallbladder, kidney cyst wall fenestration electrocoagulation, left lobe of liver, spleen, ovarian cyst, ovarian teratoma, appendicitis,9 cases of uterine resection. 15 cases of laparoscopic assisted vaginal hysterectomy. Results Some of the need to increase 1 to 2 puncture holes to increase the operation time 10 ～40 min, a good recovery after the whole group, not to increase the length of stay without complications. Conclusion Completed a variety of diseases of narcotic operation, make full use of laparoscopic surgical field the complete functions, multi-section joint intra-abdominal surgery for a variety of diseases, not only the advantages of minimally invasive, but also shorten the anesthesia, surgery and hospitalization time, so as to reduce the the financial burden of patients. Key words: Laparoscopy; More sections; Joint Surgery