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Robotic Sacrocolpopexy – Cumulative Summation (CUSUM) Analysis
S90
Abstracts / Journal of Minimally Invasive Gynecology 19 (2012) S71–S122
minutes (95% CI 9.21 to 35.24 minutes, p \0.001). The RATLH group also had significantly greater mean hospital costs of $21,537 + $3108.76 compared to TLH with mean cost of $17,194 + $2607.89. The mean difference in hospital costs was $4342.41 + $550.70 (95% CI $3252.92 to $5431.91, p \0.001). There was no significant clinical difference between the groups in estimated blood loss, uterine weight, length of hospital stay, and intraoperative or postoperative complications. Conclusion: Robotic assisted TLH did not offer any clinical advantage over traditional TLH, but was associated with longer operative times and higher per case costs. 264
Open Communications 16dRobotics (2:51 PM d 2:56 PM)
Vaginal Cuff Dehiscence in Robotic Assisted Total Hysterectomies, Incidence, Prevention and Management Kashani S,1 Silasi D-A,2 Gallo T,1 Sargent A,2 ElSahwi K,2 Azodi M.2 1 Department of Obstetrics & Gynecology, Yale New Haven Health/ Bridgeport Hospital, Bridgeport, Connecticut; 2Department of Obstetrics, Gynecology & Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
when proficiency was achieved, and whether it was maintained over time. A second surgeon had previously performed RSCPS’s and therefore CUSUM analysis was used to determine whether proficiency was maintained. An increase in score was given for each complication and a decrease in the score was given for each procedure without complications. An acceptable (P0) and unacceptable complication rate (P1) were determined as 5% and 10% respectively. After proficiency was defined for the first surgeon and observed in the second surgeon, CUSUM analysis was applied to each successive case to monitor proficiency for each surgeon. Setting: University of North Carolina Hospital. Patients: All patients undergoing RSCP between September 2008 and December 2011. Intervention: None Measurements and Main Results: Over 27 months, the first surgeon performed 108 RSCP’s (including all initial cases) and the second surgeon performed 62 RSCP’s (all cases at this academic institution) with 9 (8.3%) and 3 (4.8%) intra-operative complications respectively. Total complications included 8 cystotomies (4.7%), 2 vaginal lacerations (1.2%), 1 blood transfusion (0.6%), and 1 bowel perforation (0.6%). CUSUM charts are shown for each surgeon in Figures 1 and 2.
Study Objective: The aim of this study was to estimate the cumulative incidence of vaginal cuff dehiscence in robotic assisted total hysterectomies in our patients and to provide recommendations to decrease the incidence of vaginal cuff dehiscence. Design: Observational case series, Canadian Task Force Classification II-3. Setting: Academic and community teaching hospital. Patients: A total of 1014 patients underwent robotic assisted total laparoscopic hysterectomy for both malignant and benign reasons from September 01, 2006 to March 01, 2011. Intervention: The da Vinci Surgical System was used for the robotic assisted total laparoscopic hysterectomy. Measurements and Main Results: There were 6 cases of vaginal cuff dehiscence among 1014 robotic assisted total laparoscopic hysterectomy that make the cumulative incidence of vaginal cuff dehiscence 0.5% after this procedure in our patients. The mean time between the procedures and vaginal cuff dehiscence was 44.7 days (6.3 weeks). All patients were followed up twice after surgery, in 3-4 wks and 12-16 wks. Conclusion: In our study the incidence of vaginal cuff dehiscence after robotic assisted total laparoscopic hysterectomy compares favorably to total abdominal and vaginal hysterectomy. Our study suggests that the incidence of vaginal cuff dehiscence is more likely related to the technique of colpotomy and vaginal cuff suturing rather than with robotic assisted total hysterectomy per se. With proper technique and patient education our vaginal dehiscence rate has been 0.5% which is 2.5 to 10 times less than previously reported vaginal cuff dehiscence in the literature. 265
Figure 1.
Open Communications 16dRobotics (2:57 PM d 3:02 PM)
Robotic Sacrocolpopexy – Cumulative Summation (CUSUM) Analysis Myers EM,1 Geller EJ,1 Bowling JM,2 Matthews CA.1 1OB/GYN Urogynecology and Reconstructive Pelvic Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; 2Biostatistics, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina Study Objective: To understand the learning curve and determine proficiency for robotic sacrocolpopexy (RSCP) based on intraoperative complication rates utilizing CUSUM analysis. Design: All women undergoing RSCP between September 2008 and December 2011 were identified. Intra-operative complications were identified using operative reports and discharge summaries for each case, as well as an operating room database, discharge database, and transfusion database. Complications included: genitourinary or gastrointestinal tract injury, conversion to laparotomy, pulmonary embolus, hemorrhage, or blood transfusion. Data from one surgeon included all RSCP’s performed. CUSUM analysis was used to sum complications for each successive case to determine
Figure 2. Conclusion: CUSUM analysis is useful in determining and monitoring proficiency for robotic sacrocolpopexy and may alert providers when they deviate from a previously acceptable level of performance.
266
Open Communications 16dRobotics (3:03 PM d 3:08 PM)
The Effect of Body Mass Index (BMI) in Perioperative Outcomes in Patients Undergoing Robotic Assisted Sacrocolpopexy for Pelvic Organ Prolapse Cornwell LB, Azadi A, Ostergard DR. Urogynecology, University of Louisville, Louisville, Kentucky
Abstracts / Journal of Minimally Invasive Gynecology 19 (2012) S71–S122
minutes (95% CI 9.21 to 35.24 minutes, p \0.001). The RATLH group also had significantly greater mean hospital costs of $21,537 + $3108.76 compared to TLH with mean cost of $17,194 + $2607.89. The mean difference in hospital costs was $4342.41 + $550.70 (95% CI $3252.92 to $5431.91, p \0.001). There was no significant clinical difference between the groups in estimated blood loss, uterine weight, length of hospital stay, and intraoperative or postoperative complications. Conclusion: Robotic assisted TLH did not offer any clinical advantage over traditional TLH, but was associated with longer operative times and higher per case costs. 264
Open Communications 16dRobotics (2:51 PM d 2:56 PM)
Vaginal Cuff Dehiscence in Robotic Assisted Total Hysterectomies, Incidence, Prevention and Management Kashani S,1 Silasi D-A,2 Gallo T,1 Sargent A,2 ElSahwi K,2 Azodi M.2 1 Department of Obstetrics & Gynecology, Yale New Haven Health/ Bridgeport Hospital, Bridgeport, Connecticut; 2Department of Obstetrics, Gynecology & Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
when proficiency was achieved, and whether it was maintained over time. A second surgeon had previously performed RSCPS’s and therefore CUSUM analysis was used to determine whether proficiency was maintained. An increase in score was given for each complication and a decrease in the score was given for each procedure without complications. An acceptable (P0) and unacceptable complication rate (P1) were determined as 5% and 10% respectively. After proficiency was defined for the first surgeon and observed in the second surgeon, CUSUM analysis was applied to each successive case to monitor proficiency for each surgeon. Setting: University of North Carolina Hospital. Patients: All patients undergoing RSCP between September 2008 and December 2011. Intervention: None Measurements and Main Results: Over 27 months, the first surgeon performed 108 RSCP’s (including all initial cases) and the second surgeon performed 62 RSCP’s (all cases at this academic institution) with 9 (8.3%) and 3 (4.8%) intra-operative complications respectively. Total complications included 8 cystotomies (4.7%), 2 vaginal lacerations (1.2%), 1 blood transfusion (0.6%), and 1 bowel perforation (0.6%). CUSUM charts are shown for each surgeon in Figures 1 and 2.
Study Objective: The aim of this study was to estimate the cumulative incidence of vaginal cuff dehiscence in robotic assisted total hysterectomies in our patients and to provide recommendations to decrease the incidence of vaginal cuff dehiscence. Design: Observational case series, Canadian Task Force Classification II-3. Setting: Academic and community teaching hospital. Patients: A total of 1014 patients underwent robotic assisted total laparoscopic hysterectomy for both malignant and benign reasons from September 01, 2006 to March 01, 2011. Intervention: The da Vinci Surgical System was used for the robotic assisted total laparoscopic hysterectomy. Measurements and Main Results: There were 6 cases of vaginal cuff dehiscence among 1014 robotic assisted total laparoscopic hysterectomy that make the cumulative incidence of vaginal cuff dehiscence 0.5% after this procedure in our patients. The mean time between the procedures and vaginal cuff dehiscence was 44.7 days (6.3 weeks). All patients were followed up twice after surgery, in 3-4 wks and 12-16 wks. Conclusion: In our study the incidence of vaginal cuff dehiscence after robotic assisted total laparoscopic hysterectomy compares favorably to total abdominal and vaginal hysterectomy. Our study suggests that the incidence of vaginal cuff dehiscence is more likely related to the technique of colpotomy and vaginal cuff suturing rather than with robotic assisted total hysterectomy per se. With proper technique and patient education our vaginal dehiscence rate has been 0.5% which is 2.5 to 10 times less than previously reported vaginal cuff dehiscence in the literature. 265
Figure 1.
Open Communications 16dRobotics (2:57 PM d 3:02 PM)
Robotic Sacrocolpopexy – Cumulative Summation (CUSUM) Analysis Myers EM,1 Geller EJ,1 Bowling JM,2 Matthews CA.1 1OB/GYN Urogynecology and Reconstructive Pelvic Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; 2Biostatistics, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina Study Objective: To understand the learning curve and determine proficiency for robotic sacrocolpopexy (RSCP) based on intraoperative complication rates utilizing CUSUM analysis. Design: All women undergoing RSCP between September 2008 and December 2011 were identified. Intra-operative complications were identified using operative reports and discharge summaries for each case, as well as an operating room database, discharge database, and transfusion database. Complications included: genitourinary or gastrointestinal tract injury, conversion to laparotomy, pulmonary embolus, hemorrhage, or blood transfusion. Data from one surgeon included all RSCP’s performed. CUSUM analysis was used to sum complications for each successive case to determine
Figure 2. Conclusion: CUSUM analysis is useful in determining and monitoring proficiency for robotic sacrocolpopexy and may alert providers when they deviate from a previously acceptable level of performance.
266
Open Communications 16dRobotics (3:03 PM d 3:08 PM)
The Effect of Body Mass Index (BMI) in Perioperative Outcomes in Patients Undergoing Robotic Assisted Sacrocolpopexy for Pelvic Organ Prolapse Cornwell LB, Azadi A, Ostergard DR. Urogynecology, University of Louisville, Louisville, Kentucky