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Pregnancy after Robotic Myomectomy: Preliminary Experience
S106
Abstracts / Journal of Minimally Invasive Gynecology 18 (2011) S91–S113
Setting: Our population were 50 patients, who attended the outpatient unit of the Hospital San Angel Inn Chapultepec in Mexico City, from March 2008 to March 2009. 25 patients underwent laparoscopic and 25 patients by laparotomy, both groups were comparable in age, size and location of fibroids, and preoperative conditions. Patients: 25 patients underwent laparoscopic and 25 patients by laparotomy, both groups were comparable in age, size and location of fibroids, and preoperative conditions. Intervention: Laparoscopic myomectomy and abdominal myomectomy. Measurements and Main Results: Statistical analysis of the results was made with T tests for independent samples with p \.0.05 in most of the variables to laparoscopic myomectomy. Conclusion: Laparoscopic myomectomy is a safe technique, with a shorter hospital stay and less intraoperative bleeding, fewer postoperative complications which determined a speedy recovery, but requires longer operating time, attributed to the morcellation of fibroids and the higher cost.
351
Open Communications 18dLaparoscopy (8:24 AM d 8:29 AM)
Pregnancy after Robotic Myomectomy: Preliminary Experience Pitter MC,1 Bonaventura L,2 Lehman JS,3 Hubert HB.4 1Obstetrics & Gynecology, Newark Beth Israel Medical Center, Newark, New Jersey; 2 Reproductive Endocrinology, Indiana University Health North Hospital, Carmel, Indiana; 3Obstetrics & Gynecology, Newark Beth Israel Medical Center, Newark, New Jersey; 4Epidemiology, Palo Alto VA Hospital, Palo ALto, California Study Objective: To assess the reproductive outcomes in women who became pregnant after robotic-assisted myomectomy for symptomatic leiomyomata uteri. Design: Retrospective analysis. Setting: Two community based gynecologists; one practicing in the Northeast US, the other practicing in the Midwest US. Patients: Forty women (ages 23 – 41 yrs) who experienced 43 pregnancies following robotic myomectomy. Intervention: Medical records were reviewed for robotic-assisted laparoscopic myomectomy procedures performed over a 5- year period, 2006 - 2010. Measurements and Main Results: Of the forty women, 53 % had never been pregnant and 88% were nulliparous. The average age at time of conception was 34 years. Mean number of myomas removed was 3.4 +/ 3.0 with as many as 14 removed in one case. The weight of the myoma specimens ranged from 45 to 665 grams with average size 7.5 +/ 3.5 cm. Cesarean section was performed in 97% of deliveries and 19% were preterm. There was one uterine dehiscence noted. The average
number of myomas was 6.5 among women who delivered prematurely versus 2.4 among those who delivered at term (p\0.001). There was no difference in APGAR scores between premature and term deliveries. Conclusion: Pregnancy with good delivery outcome is feasible after robotic myomectomy. While a greater number of surgically removed myomas was associated with preterm delivery, this did not compromise patient or neonatal outcomes. This treatment modality may be offered to women seeking a minimally invasive option in the conservative management of fibroid uteri.
352
Open Communications 18dLaparoscopy (8:30 AM d 8:35 AM)
Retrospective Study of Single Incision Laparoscopic Supracervical Hysterectomy Versus Traditional Laparoscopic Supracervical Hysterectomy: The Vanderbilt Experience Scheib SA, Curlin H, Anderson TL. Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, Tennessee Study Objective: To determine if there was a difference in surgical and postoperative outcomes between single incision laparoscopic supracervical hysterectomy (LSH) and traditional LSH. Design: Retrospective cohort study. Setting: Academic teaching hospital. Patients: A total of 201 patients that had received a laparoscopic supracervical hysterectomy between June 2009 and March 2011 and Vanderbilt University Medical Center. Intervention: Laparoscopic supracervical hysterectomy with or without adnexectomy. Measurements and Main Results: Data from 65 single incision LSH and 136 traditional LSH were included in the analysis. The patient demographics were equivalent in both groups. Conclusion: Single incision laparoscopic supracervical hysterectomy is equivalent to traditional laparoscopic supracervical hysterectomy. There was a decreased conversion to laparotomy and major complication rate in the single incision LSH group, but this could be a function that all the single incision LSHs were performed by attendings with advanced laparoscopic training and that there was decreased resident participation in the single incision LSH group. There was a greater need for narcotics initial in the hospital prior to discharge, but it is not clear why. It could be because the single incision is a larger single incision. This is confounding because anecdotally there was decreased narcotic use postoperatively, with most patients off narcotics with in 72 hours, and a decreased time to routine activities with the single incision group. This prompts a prospective study to evaluate postoperative pain.
Patient Demographics
age (years) parity BMI Comorbidities hypertension, cardiac, renal diabetes mellitus pulmonary neurologic previous pelvic surgery previous narcotic use
Single Incision LSH (n = 65)
Traditional LSH (n = 136)
p-value
42.68 (20-67) 2.06 (0-7) 29.77 (19.2-62.9)
44.37 (28-70) 1.74 (0-6) 28.81 (16.4-47.2)
0.1236 0.0916 0.3702
23 3 18 12
(35.38%) (4.62%) (27.69%) (18.46%)
44 (67.69%) 8 (12.31%)
50 5 43 35
(36.76%) (3.68%) (31.62%) (25.74%)
0.849 0.75 0.571 0.254
87 (63.97%) 10 (7.35%)
0.604 0.25
There was a decreased conversion to laparotomy and major complication rate in the single incision LSH group, but otherwise the two groups were not significantly different from one another.
Abstracts / Journal of Minimally Invasive Gynecology 18 (2011) S91–S113
Setting: Our population were 50 patients, who attended the outpatient unit of the Hospital San Angel Inn Chapultepec in Mexico City, from March 2008 to March 2009. 25 patients underwent laparoscopic and 25 patients by laparotomy, both groups were comparable in age, size and location of fibroids, and preoperative conditions. Patients: 25 patients underwent laparoscopic and 25 patients by laparotomy, both groups were comparable in age, size and location of fibroids, and preoperative conditions. Intervention: Laparoscopic myomectomy and abdominal myomectomy. Measurements and Main Results: Statistical analysis of the results was made with T tests for independent samples with p \.0.05 in most of the variables to laparoscopic myomectomy. Conclusion: Laparoscopic myomectomy is a safe technique, with a shorter hospital stay and less intraoperative bleeding, fewer postoperative complications which determined a speedy recovery, but requires longer operating time, attributed to the morcellation of fibroids and the higher cost.
351
Open Communications 18dLaparoscopy (8:24 AM d 8:29 AM)
Pregnancy after Robotic Myomectomy: Preliminary Experience Pitter MC,1 Bonaventura L,2 Lehman JS,3 Hubert HB.4 1Obstetrics & Gynecology, Newark Beth Israel Medical Center, Newark, New Jersey; 2 Reproductive Endocrinology, Indiana University Health North Hospital, Carmel, Indiana; 3Obstetrics & Gynecology, Newark Beth Israel Medical Center, Newark, New Jersey; 4Epidemiology, Palo Alto VA Hospital, Palo ALto, California Study Objective: To assess the reproductive outcomes in women who became pregnant after robotic-assisted myomectomy for symptomatic leiomyomata uteri. Design: Retrospective analysis. Setting: Two community based gynecologists; one practicing in the Northeast US, the other practicing in the Midwest US. Patients: Forty women (ages 23 – 41 yrs) who experienced 43 pregnancies following robotic myomectomy. Intervention: Medical records were reviewed for robotic-assisted laparoscopic myomectomy procedures performed over a 5- year period, 2006 - 2010. Measurements and Main Results: Of the forty women, 53 % had never been pregnant and 88% were nulliparous. The average age at time of conception was 34 years. Mean number of myomas removed was 3.4 +/ 3.0 with as many as 14 removed in one case. The weight of the myoma specimens ranged from 45 to 665 grams with average size 7.5 +/ 3.5 cm. Cesarean section was performed in 97% of deliveries and 19% were preterm. There was one uterine dehiscence noted. The average
number of myomas was 6.5 among women who delivered prematurely versus 2.4 among those who delivered at term (p\0.001). There was no difference in APGAR scores between premature and term deliveries. Conclusion: Pregnancy with good delivery outcome is feasible after robotic myomectomy. While a greater number of surgically removed myomas was associated with preterm delivery, this did not compromise patient or neonatal outcomes. This treatment modality may be offered to women seeking a minimally invasive option in the conservative management of fibroid uteri.
352
Open Communications 18dLaparoscopy (8:30 AM d 8:35 AM)
Retrospective Study of Single Incision Laparoscopic Supracervical Hysterectomy Versus Traditional Laparoscopic Supracervical Hysterectomy: The Vanderbilt Experience Scheib SA, Curlin H, Anderson TL. Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, Tennessee Study Objective: To determine if there was a difference in surgical and postoperative outcomes between single incision laparoscopic supracervical hysterectomy (LSH) and traditional LSH. Design: Retrospective cohort study. Setting: Academic teaching hospital. Patients: A total of 201 patients that had received a laparoscopic supracervical hysterectomy between June 2009 and March 2011 and Vanderbilt University Medical Center. Intervention: Laparoscopic supracervical hysterectomy with or without adnexectomy. Measurements and Main Results: Data from 65 single incision LSH and 136 traditional LSH were included in the analysis. The patient demographics were equivalent in both groups. Conclusion: Single incision laparoscopic supracervical hysterectomy is equivalent to traditional laparoscopic supracervical hysterectomy. There was a decreased conversion to laparotomy and major complication rate in the single incision LSH group, but this could be a function that all the single incision LSHs were performed by attendings with advanced laparoscopic training and that there was decreased resident participation in the single incision LSH group. There was a greater need for narcotics initial in the hospital prior to discharge, but it is not clear why. It could be because the single incision is a larger single incision. This is confounding because anecdotally there was decreased narcotic use postoperatively, with most patients off narcotics with in 72 hours, and a decreased time to routine activities with the single incision group. This prompts a prospective study to evaluate postoperative pain.
Patient Demographics
age (years) parity BMI Comorbidities hypertension, cardiac, renal diabetes mellitus pulmonary neurologic previous pelvic surgery previous narcotic use
Single Incision LSH (n = 65)
Traditional LSH (n = 136)
p-value
42.68 (20-67) 2.06 (0-7) 29.77 (19.2-62.9)
44.37 (28-70) 1.74 (0-6) 28.81 (16.4-47.2)
0.1236 0.0916 0.3702
23 3 18 12
(35.38%) (4.62%) (27.69%) (18.46%)
44 (67.69%) 8 (12.31%)
50 5 43 35
(36.76%) (3.68%) (31.62%) (25.74%)
0.849 0.75 0.571 0.254
87 (63.97%) 10 (7.35%)
0.604 0.25
There was a decreased conversion to laparotomy and major complication rate in the single incision LSH group, but otherwise the two groups were not significantly different from one another.