Major Gynaecological Surgery Research Articles

Postoperative Delirium in Indian Patients Following Major Abdominal Surgery for Cancer: Risk Factors and Associations.

Postoperative delirium (POD) is not uncommon following major abdominal surgery with its incidence ranging between five and 51%. As cancer affects disproportionately, the population older than 65years and as delirium is more common in the elderly, surgical oncology patients are at a higher risk of developing POD. The present study was undertaken to explore the impact and associations of POD in Indian patients undergoing oncological major abdominal surgery. A retrospective review of the electronic medical records in a tertiary cancer care institution of all postoperative patients who had undergone major gastrointestinal gynaecological and urological abdominal surgery for cancer and required psycho-oncology referral was performed. Patient, surgery and postoperative outcome-related data were collected. Statistical analysis was performed using univariate and multivariate logistic regression analysis. Out of 824 patients who underwent major abdominal surgery, 33 patients (4.0%) were diagnosed with POD. In univariate analysis, older age and history of addiction were found to be statistically significantly associated with POD (p<0.001). Among the postoperative factors, respiratory complications (p<0.001), sepsis (p<0.05), ICU stay >24h (p<0.05) and electrolyte impairment (p<0.05) were the significant associations with the POD. Thirty-day mortality was higher in the POD group (p<0.05). In multivariate logistic regression analysis, advanced age, addictions, respiratory complications and sepsis were found to be significant associations with POD, p<0.001. Postoperative delirium is associated with higher mortality. Older age, postoperative respiratory complications and sepsis are common contributory factors of postoperative delirium.

Patients on Long-Term Warfarin Undergo Gynecological Surgeries: A 10-Year Review of Perioperative Anticoagulation.

The aim of this study was to review our experience with patients having gynaecological surgeries while on long-term anticoagulation and to postulate a better guide for their perioperative management. A retrospective review of all women on long-term warfarin who underwent gynaecological surgeries from January 2003 to December 2012. Data from medical records including operation reports and inpatient and outpatient charts were reviewed and analyzed. Sixty-seven cases from 58 patients were identified. Twenty and 38 patients underwent major and minor gynaecological surgeries, respectively. The incidence of postoperative bleeding was higher after major surgery (4 cases, 20%) than after minor surgery (1 case, 2.1%; P = 0.025). All bleeding complications occurred between postoperative day 3 and day 10. Three patients, who had resumption of warfarin at a lower dose and slowly stepped up, had no bleeding complications. None of our patients developed venous thromboembolic complications. There was one mortality due to septic shock. Patients on long-term anticoagulation have a trend of increased bleeding complications after major gynaecological surgeries than in minor gynaecological surgeries. We suggest that delaying resumption of warfarin at a lower dose may have a role in reducing the risk of postoperative bleeding without increasing the risk of venous thromboembolism.

Diagnostic value of plasma NGAL and intraoperative diuresis for AKI after major gynecological surgery in patients treated within an intraoperative goal-directed hemodynamic algorithm: A substudy of a randomized controlled trial.

ISRCTN 53154834.

Development of a 2-dof uterine manipulator with LED illumination system as a new transvaginal uterus amputation device for gynecological surgeries

Background: Hysterectomy, the most common major gynecological operation worldwide, consists of removal of the uterus and can be performed abdominally, vaginally, or laparoscopically. A uterine manipulator is a key device used for uterine manipulation and cannulation in hysterectomies. The challenges of conventional manipulators are to move the uterus in two distinct planes and to identify cervical landmarks during circular cut and coagulation.Material and methods: In this study, a structural synthesis of the two degrees of freedom parallel manipulator was performed considering the constraints noted by surgeons. Computer-aided design and assembly of the manipulator, the cervicovaginal cap with LEDs, and the external parts were performed before rapid prototyping. The final design of the uterine manipulator was then manufactured from stainless steel and tested on an artificial uterus model using a test chamber.Results: This article presents the design, production and testing processes of an innovative manipulator with a motion capability up to 80° workspace both in the sagittal and coronal planes and an illumination system, easily detectable by the laparoscope, was successfully implemented on the manipulator’s cervical cap in order to overcome the drawbacks of conventional uterine manipulators.Conclusions: Despite all the current studies and uterine manipulators on the market, no research has incorporated all the features mentioned above.

Effects Of Mouth Dissolving Mosapride Tablets (Mdmts) On Gut Recovery After Major Abdominal Gynecological Surgery (Mags)

Aim. To access whether receiving mouth dissolving mosaperide tablets (MDMTs) in immediate postoperative period in addition to routine care accelerates the recovery of upper and lower gastrointestinal function after major abdominal gynecological surgery (MAGS).Patients & Methods: A randomized controlled study was conducted from December 2014 to December 2015. Patients scheduled to undergo abdominal hysterectomy were assigned to receive MDMTs beside routine care immediately postoperatively or routine care alone after surgery. patient's postoperative charts were reviewed to establish incidence of postoperative nausea, vomiting, use of analgesics, use of antiemetics, cases developing postoperative ileus (P01) (nausea, vomiting, distention, absence of bowel sounds) and its degree mild (resolved spontaneously on basic support), moderate (required nasogastric tube insertion beside basic support), severe (POI that resist management lines including antiemetic and persist for > 2 days), time to discharge and time from end of surgery to first postoperative hearing intestinal sounds, toleration of fluids intake, toleration to solid foods intake, passage of flatus, as well as first defecation.Results: A total of 120 patients were randomly assigned to receive MDMTs (n=60, 2 were excluded, 58 were available for intension to treat analysis) or routine postoperative care alone (n =60, 4 were excluded, 56 were available for intension to treat analysis). The mean time to first hunger, toleration of liquids and solids, bowel movement, flatus as well as first defecation were significantly shorter in participants whom assigned to receive MDMTs (P = 0002, P = 0.027, P < 0.0001, P = 0.0001, P < 0.000, P = 0.0006 respectively). Participants assigned to receiving MDMTs than routine care experienced significant postoperative nausea (P = 0.004) vomiting (P = 0.005) and mild and moderate POI (P = 0.008, P = 0.02 respectively). MDMTs intake was well tolerated and well accepted by patients and no intervention — related side effects were observed.Conclusion: Receiving MDMTs after MAGS accelerates the time of gut recovery, shortened the length of hospital stay as well as reduce the incidence of POI. This simple, inexpensive and well tolerated treatment could be added to routine postoperative care of major gynecological abdominal surgery patients.

Do prophylactic antibiotics in gynecologic surgery prevent postoperative inflammatory complications? A systematic review.

The aim of this study was to systematically review the literature on antibiotic prophylaxis in gynaecologic surgeries to prevent inflammatory complications after gynaecological operations. The study was carried out as a systematic review. Only randomised controlled trials of women undergoing gynaecological surgery were included. The Medline and the Cochrane library databases were searched from 1966 to 2016. The trials must have investigated an antibiotic intervention to prevent an inflammatory complication after gynaecological surgery. Trials were excluded if they were not randomised, uncontrolled or included obstetrical surgery. Prophylactic antibiotics prevent inflammatory complications after gynaecological surgery. Prophylactic antibiotics are more effective in surgery requiring access to the peritoneal cavity or the vagina. Cefotetan appears to be more capable in preventing the overall inflammatory complication rate than cefoxitin or cefazolin. No benefit has been shown for the combination of antibiotics as prophylaxis. No difference has been shown between the long-term and short-term use of antibiotics. There is no need for the primary use of an anaerobic antibacterial agent. Antibiotics help to prevent postoperative inflammatory complications after major gynecologic surgeries.

A study of Complications and Outcome of Major Gynaecological Operations-Analysis of 100 Cases

Objective: To demonstrate complications and difficulties that had been encountered during major gynaecological surgery.Materials &amp; Methods: This retrospective hospital based study was carried out in the department of Obstetrics &amp; Gynecology of Rajshahi Medical College &amp; Hospital, Rajshahi, between 1st January 2002 to 30th june 2002.Result: Among 266 operated patients during the above mentioned 6 months period 100 samples were taken randomly. Regarding age distribution of the operated patients, 38% were in the age group of 31 to 40 years, more than ¼ th (33%) were in the age group of 41 to 50 years. Out of 100 patients about half (54%) of them were in the parous group of 1 - 5 children, next to this 28% had more than 5 and above babies. After sugery, 70 patients had no postoperative complications; only in 30 patients minor complications were noted. Among these, pyrexia above 100.0F was noted in 15 patients, lower abdominal pain in 8 patients and urinary tract infection in 5 patients.Conclusion: This study revealed a low rate of complications and difficulties encountered during major gynaecological surgery. In most cases due to highly skilled personnel, improvement of surgical technique, safe anaesthesia and appropriate use of antibiotics with blood transfusion, the mortality rate has remarkably decreased to nil.KYAMC Journal Vol. 5, No.-1, Jul 2014, Page 444-448

Improvement of Perioperative Outcomes in Major Gynecological and Gynecologic-Oncological Surgery with Hemostatic Gelatin-Thrombin Matrix.

To assess the impact of the use of intraoperative hemostatic gelatin-thrombin matrix (HM) (Floseal®, Baxter Healthcare) on transfusion rates and short-term perioperative outcomes in gynecological surgery. In this retrospective, single-center study, we evaluated data of 215 patients (83 cases and 132 controls) undergoing extensive gynecological surgery (e.g. oncological procedures) with and without intraoperative HM application. Cases and controls did not differ according to age, preoperative hemoglobin (Hb) concentration, and Hb or C-reactive protein (CRP) levels at discharge. Patients receiving HM had significantly reduced operative (168 vs. 199 min, p=0.02) and hospitalization (9 vs. 14 days, p<0.001) times. The mean postoperative Hb drop (3.33 vs. 4.51 g/dl, p<0.001), and the mean postoperative increase in CRP (94.9 vs. 149.1 mg/l, p<0.001) were significantly less pronounced within the HM group. Despite more prevalent coagulopathy (48 vs. 31%, p=0.02), e.g. due to anticoagulant use (15.7 vs. 3%, p<0.001), patients treated using HM needed less frequent transfusions of packed red blood cells [odds ratio (OR)= 0.13, 95% confidence interval (CI)=0.07-0.24) and fresh frozen plasma (OR=0.51, 95% CI=0.24-1.05). In comparison to controls, the need for surgical revisions (OR 0.1, CI 95% 0.02-0.42) and intensive-care unit admissions (OR 0.15, 95% CI=0.08-0.30) was lower in patients treated with HM. To our knowledge, our study is the largest case-control study focusing on Floseal® use in gynecology. The use of HM was associated with significantly better short-term perioperative outcomes. Due to its local action, HM seems to be particularly useful in patients in which anticoagulant medication cannot be paused.

Prevalence and Microbial Etiology of Surgical Site Infections Following Major Abdominal Gynecologic Surgeries in a Tertiary Care Center

Prevalence and Microbial Etiology of Surgical Site Infections Following Major Abdominal Gynecologic Surgeries in a Tertiary Care Center

Elective abdominal hysterectomy: Appraisal of indications and complications at Aminu Kano Teaching Hospital – An 8-year review

Background: Hysterectomy is a safe and a major gynecological operation. It could be performed using abdominal, vaginal, or laparoscopic approach. It is performed for different indications such as dysfunctional uterine bleeding, endometriosis, fibroids, or prolapse. This procedure is however not without complications especially in resource‑poor countries. An overview of the outcome of the procedure is essential in facilities like ours that is located in resource‑poor countries. Objectives: To determine the rate, indications, and complications of elective abdominal hysterectomy at Aminu Kano Teaching Hospital (AKTH), Kano, Nigeria. Methodology: This was a retrospective study of all cases of elective abdominal hysterectomies performed over an 8‑year period (January 2009 to December 2016) at AKTH, Kano. Outcome measures were demographic characteristics, indication for surgery, type of hysterectomy, and postoperative complications. Results: During the period of study, there were 7632 major gynecological operations, among them were 251 cases of elective abdominal hysterectomy, giving a rate of 3.3%. The most common indication was uterine fibroid (51.8%). Total abdominal hysterectomy (TAH) was more commonly performed (93.0%) compared to subtotal hysterectomy (7.0%). Postoperative pyrexia (45.9%) was the most common complication, while ureteric injury (2.4%) was the least. Duration of hospital stay was 6–10 days in 89.2% of cases, and there was no mortality recorded. Conclusion: Elective abdominal hysterectomy is a fairly common and safe procedure in AKTH. Uterine fibroid and postoperative pyrexia was the most common indication and complication, respectively. TAH was commonly performed compared to subtotal hysterectomy. Keywords: Abdominal hysterectomy; complications; indications; Kano

Enhanced Recovery Implementation in Major Gynecologic Surgeries: Effect of Care Standardization

(Abstracted from Obstet Gynecol 2016;128:457–466) The concept of enhanced recovery after surgery (ERAS) emerged as a multimodal approach focused on optimizing patient experience, standardizing perioperative care, and improving surgical outcomes. This concept has been refined in several different surgical fields including both colorectal and gynecologic.

Consensus Bundle on Prevention of Surgical Site Infections After Major Gynecologic Surgery.

Surgical site infections are the most common complication of surgery in the United States. Of surgeries in women of reproductive age, hysterectomy is one of the most frequently performed, second only to cesarean birth. Therefore, prevention of surgical site infections in women undergoing gynecologic surgery is an ideal topic for a patient safety bundle. The primary purpose of this safety bundle is to provide recommendations that can be implemented into any surgical environment in an effort to reduce the incidence of surgical site infection. This bundle was developed by a multidisciplinary team convened by the Council on Patient Safety in Women's Health Care. The bundle is organized into four domains: Readiness, Recognition and Prevention, Response, and Reporting and Systems Learning. In addition to recommendations for practice, each of the domains stresses communication and teamwork between all members of the surgical team. Although the bundle components are designed to be adaptable to work in a variety of clinical settings, standardization within institutions is encouraged.

Consensus Bundle on Prevention of Surgical Site Infections After Major Gynecologic Surgery.

Surgical site infections are the most common complication of surgery in the United States. Of surgeries in women of reproductive age, hysterectomy is one of the most frequently performed, second only to cesarean birth. Therefore, prevention of surgical site infections in women undergoing gynecologic surgery is an ideal topic for a patient safety bundle. The primary purpose of this safety bundle is to provide recommendations that can be implemented into any surgical environment in an effort to reduce the incidence of surgical site infection. This bundle was developed by a multidisciplinary team convened by the Council on Patient Safety in Women's Health Care. The bundle is organized into four domains: Readiness, Recognition and Prevention, Response, and Reporting and Systems Learning. In addition to recommendations for practice, each of the domains stresses communication and teamwork between all members of the surgical team. Although the bundle components are designed to be adaptable to work in a variety of clinical settings, standardization within institutions is encouraged.

Implementation of an enhanced recovery after surgery (ERAS) protocol in a gynaecology department - the follow-up at 1 year.

Aim of the studyAn ERAS protocol provides the latest perioperative care principles, whose primary aim is to reduce complication rates, and therefore mortality. The aim of this study is to establish the progress of the ERAS pathway implementation in our gynaecology department.Material and methodsThis was a retrospective analysis of two sets of 100 consecutive medical records: patients treated before (PRE-ERAS) and after (ERAS) introduction of the ERAS protocol. All patients were comparable and all underwent major gynaecological surgery. Patients as well as medical and nursing staff were informed about the proposed preparation, surgical management and postoperative routine.Results and conclusionsPatients were given supper and drank water during the night. Laparoscopic surgery was used in 44% and spinal anaesthesia was given for open surgery in 43 study patients. Use of drains was reduced only by 23%, bowel preparation by 15%. Intravenous fluid administration was reduced by 22%. Use of postoperative morphine was minimised to 12 patients. Postoperative nausea was managed with the regular use of anti-emetics. Anti-coagulation was given to 80% of the study group. Difficulties in the introduction of the ERAS protocol were due to refusal by some patients to mobilise and eat early postoperatively. Patients in the ERAS programme group were discharged earlier.Further information about the ERAS protocol in the media would facilitate patients’ education among conservative society. In order to introduce new and innovative treatment methods, one has to take into account the cultural and ideological factors, especially when patient involvement is essential.

Nerve-Sparing Laparoscopic Colposacropexy Using a Percutaneous Surgical System: A Case Report

Study ObjectiveThe primary aim of this study was to evaluate the feasibility, efficacy, and safeness of nerve-sparing laparoscopic colposacropexy performed with a minimally invasive approach by using 2.9-mm Percuvance percutaneous surgical system (PSS; The Percuvance System; Teleflex Inc., Wayne, PA). The secondary aim was to investigate the technical performance of these instruments as needle holder in the placement of the mesh. The final aim was to establish the rate of prolapse recurrence. DesignStep-by-step video demonstration of the surgical technique. SettingThe Internal Department Committee approved this study. PatientThe patient was adequately informed about the possible risks and benefits of this experimental technique, and a written consent agreeing to undergo the described procedure was signed. InterventionNerve-sparing laparoscopic colposacropexy with positioning of two polypropylene titanized meshes and concomitant subtotal hysterectomy and salpingo-oophorectomy entirely performed with a 2.9-mm PSS. Measurements and Main ResultsPelvic organ prolapse is a condition affecting up to 50% of multiparous women. It may be considered a significant public health problem with an important impact on general health-related quality of life. A conservative and/or medical treatment may be considered only for women with a mild degree of prolapse, women with a reproductive desire, or women unable to undergo surgery. In the remaining cases, surgery seems to be the most effective treatment. The surgical approach may be abdominal (colposacropexy by laparotomy, laparoscopy, or robot-assisted) or vaginal (autologous or prosthesic reinforcement). The aims of the surgical procedures include not only the anatomic correction of the prolapse but also the improvement of patient quality of life and prolapse symptom relief, guaranteeing normal bladder, bowel, and sexual functions and avoiding iatrogenic dysfunctional symptoms. At present, the laparoscopic technique of sacral colpopexy offers a number of important advantages, including an excellent visualization of the pelvis, reduction in adhesions formation, and decreased postoperative pain and recovery, with reported success rates of 90% to 96% with a mesh erosion rate of 1% to 8%. ConclusionThis case report is the first to report a nerve-sparing laparoscopic colposacropexy performed with a 2.9-mm PSS. The major advance of this technique is the possibility of performing a major gynecologic surgery with a scarless approach, which results in fewer traumas for the patient in the postoperative time. The use of these instruments does not increase the operation time or the rate early or late complications, most of all prolapse recurrence. Considering that this is the first case report in literature, more clinical data are needed to confirm these findings.

Hysterectomy in a Southwestern Tertiary Unit in Nigeria: A 5-Year Review

Background: Hysterectomy is one of the commonest major gynecologic surgeries performed worldwide. While the procedure is highly successful for curing diseases, especially nonmalignant conditions, it is not without risks. Objective: The aim of this research was to review hysterectomies in Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria, with respect to indications, types, outcomes, and complications over a 5-year period. Materials and Methods: This was a descriptive retrospective study conducted from January 1, 2005 to December 31, 2009. Case records of patients who underwent hysterectomy were retrieved to obtain information on sociodemographics, types of hysterectomy, elective or emergency surgeries, blood losses, blood units transfused, and surgical complications. Results: Of 1859 major gynecologic surgeries during the study period, there were 196 hysterectomies, an incidence of 10.5%. Mean ages of the patients were 46.83 ± 9.18 years (elective surgery) and 40.28 ± 6.82 years (emergency surgery). Mean parity was 3.67 ± 2.06 for elective surgery and 3.86 ± 0.9 for emergency surgery. Uterine fibroid was the commonest indication at 61.44%, followed by ovarian mass at 7.84%. Mean blood loss was higher (3510 ± 1384) mL in emergency surgery, compared to (886.6 ± 587) mL in elective surgery (p = 0.023). Thus, the mean unit of blood transfusion was 6.57 ± 2.23 units in emergency surgery versus 1.82 ± 2.0 units in elective surgery (p = 0.031). Complications included hemorrhage at 8.3%, urinary tract infection at 3.5%, wound infection at 2.1% and intestinal obstruction at 0.7%. Three death (1.8%) were all attributed to severe hemorrhage. Conclusions: To achieve the most favorable outcome, appropriateness of the surgery must be evaluated carefully along with available options in the context of the patient's disease process. (J GYNECOL SURG 32:335)

The importance of albumin infusion rate for plasma volume expansion following major abdominal surgery - AIR: study protocol for a randomised controlled trial.

BackgroundAdministration of fluids to restore normovolaemia is one of the most common therapeutic interventions performed peri-operatively and in the critically ill, but no study has evaluated the importance of infusion rate for the plasma volume-expanding effect of a resuscitation fluid. The present study is designed to test the hypothesis that a slow infusion of resuscitation fluid results in better plasma volume expansion than a rapid infusion.Methods/designThe study is a single-centre, assessor-blinded, parallel-group, randomised prospective study. Patients over 40 years of age admitted to the post-operative care unit after a Whipple procedure or major gynaecological surgery and presenting with signs of hypovolaemia are eligible for inclusion. Patients are randomised in a 1:1 fashion with no stratification to either rapid (30 minutes) or slow (180 minutes) infusion of 5% albumin at a dose of 10 ml/kg ideal body weight. Plasma volume is measured using 125I human serum albumin at baseline (prior to albumin infusion) as well as at 30 minutes and 180 minutes after infusion start. The primary endpoint is change in plasma volume from baseline to 180 minutes after the start of 5% albumin infusion. Secondary endpoints include the integral of plasma volume over time from baseline to 180 minutes after the start of the infusion and transcapillary escape rate of albumin (%/h) from 180 minutes to 240 minutes after the start of albumin infusion. In addition, diuresis, change in central venous oxygen saturation, lactate and blood pressure will be evaluated. A total of 70 patients will be included in the study, and the study has 80% power to detect a difference of 4 ml/kg in plasma volume expansion between the two groups.DiscussionThe present study is the first clinical investigation of the importance of infusion rate for the plasma volume-expanding effect of a resuscitation fluid.Trial registrationEudraCT identifier: 2013-004446-42. Registration date: 20 December 2013.ClinicalTrials.gov identifier: NCT02728921. Registration date: 31 March 2016.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-016-1714-5) contains supplementary material, which is available to authorized users.

Effects of parecoxib on postoperative pain and opioid-related symptoms following gynecologic surgery.

ObjectiveTo examine the analgesic and opioid-sparing effects of parecoxib following major gynecologic surgery.MethodsThis is a large subset analysis of patients from a multicenter, randomized, double-blind, placebo-controlled study of parecoxib/valdecoxib (PAR/VAL) for postoperative pain. Pain severity, pain interference with function, opioid use, occurrence of opioid-related symptoms, and Patient/Physician Global Evaluation of Study Medication were compared between placebo and PAR/VAL treatment groups in the days following surgery.ResultsPain scores were reduced in the PAR/VAL group (n=98), relative to placebo (n=97), on Day 2 (−21%, P<0.001) and Day 3 (−23%, P=0.004). Pain interference with function scores were also significantly lower in the PAR/VAL group, compared with placebo, on Day 2 (−29%, P<0.001) and Day 3 (−28%, P=0.013). Consumption of supplemental morphine was significantly lower in the PAR/VAL group relative to placebo at 24 hours (−37%, P=0.010) and trended lower at 48 (−28%) and 72 hours (−26%). Patients in the PAR/VAL group also had a reduced risk of experiencing specific opioid-related symptoms, including “inability to concentrate” (relative risk =0.53) and “nausea” (relative risk =0.60) on Day 2. Both Patient and Physician Global Evaluation of Study Medication scores were better in the PAR/VAL group than in the placebo group.ConclusionThe current study adds support for the use of parecoxib in patients following major gynecologic surgery.

Does Decreased Insufflation Pressure During Major Robotic-Assisted Gynecologic Surgery Have an Influence on Intraoperative Respiratory Parameters

Does Decreased Insufflation Pressure During Major Robotic-Assisted Gynecologic Surgery Have an Influence on Intraoperative Respiratory Parameters

Electronic patient-reported outcomes from home in patients recovering from major gynecologic cancer surgery: A prospective study measuring symptoms and health-related quality of life

PurposeWe previously reported on the feasibility of a Web-based system to capture patient-reported outcomes (PROs) in the immediate postoperative period. The purpose of this study was to update the experience of these patients and assess patient and provider satisfaction and feedback regarding the system. MethodsThis is a prospective cohort study of patients scheduled to undergo laparotomy for presumed gynecologic malignancy. Patients completed a Web-based Symptom Tracking and Reporting (STAR) questionnaire preoperatively and weekly during a 6-week postoperative period. Email alerts were sent to study nurses when concerning patient responses were entered. The patient and the nurse assessments of STAR's usefulness were measured via an exit survey. ResultsThe study enrolled 96 eligible patients. Of these, 71 patients (74%) completed at least four of seven total sessions. Of the patients who completed the exit satisfaction survey, 98% found STAR easy to use; 84% found it useful; and 82% would recommend it to other patients. Despite positive feedback from patients, clinical personnel found that the STAR system increased their current workload without enhancing patient care. ConclusionsApplication of an electronic program for PROs in those recovering from major gynecologic cancer surgery is feasible, and acceptable to most patients. While most clinicians did not find STAR clinically helpful, the majority of patients reported a positive experience with the system and would recommend its use. The program helped many patients feel more empowered in their postoperative recovery.