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1369 Cost and Outcomes Analysis of Robotic, Laparoscopic, and Abdominal Hysterectomy for Benign Disease in a Community Hospital Setting
Abstracts / Journal of Minimally Invasive Gynecology 26 (2019) S98−S231
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Conclusion: In conclusion, an obliterated anterior cul-de-sac due to previous surgeries makes it difficult to access the uterine arteries secondary to poor visualization. By approaching uterine artery ligation from the posterior aspect, one may avoid inadvertent injury to vasculature or the bladder and reduce the amount of bleeding during the bladder dissection.
procedure performed. Patients undergoing robotic assisted hysterectomies and laparoscopic hysterectomies were placed in the dorsal lithotomy position with trendelenberg. Those undergoing abdominal hysterectomies were placed in the dorsal supine position. Patients or Participants: The study included 288 women who underwent benign hysterectomy by any method at Saint Peters University Hospital from March 2017 to Dec 2018. 86 (40.4%) patients underwent a robotic assisted laparoscopic hysterectomy, 60 (28.0%) underwent a laparoscopic hysterectomy, and 68 (31.7%) underwent an abdominal hysterectomy. Interventions: All patients received a hysterectomy in one of the three following methods: robotic assisted laparoscopic hysterectomy, laparoscopic hysterectomy, and abdominal hysterectomy. Concomitant procedures of a salpingo-oophrectomy and/or cystoscopy were performed if indicated. Measurements and Main Results: A retrospective chart review was performed for all benign hysterectomies from March 2017 to December 2018 using student t test and a multivariate regression analysis. The primary outcome was the direct total cost of the patient’s hospitalization related to their hysterectomy. Secondary outcomes included estimated blood loss, surgery time, days in the hospital postoperatively, and complications postoperatively. Mean total costs of robotically assisted hysterectomies were $26,452 less than abdominal hysterectomies (p<0.001) and $10,401 less than laparoscopic hysterectomies (p<0.001). These savings held true even after controlling for age, prior surgery, and uterine weight. Conclusion: Overall, total cost was significantly influenced by the mode of hysterectomy, with robotic assisted hysterectomies being the most cost effective.
Virtual Poster Session 4: Robotics (1:20 PM — 1:30 PM) 1:20 PM: STATION D 2180 Experience of Centro Medico Nacional “20 De Noviembre“ in Robotic-assisted Hysterectomy for Large Uteri: A Case Series of 20 Women Cortes AL,1,* Cortes Vazquez A,1 Gallardo Valencia LE Sr,1 Gongora Rodriguez A,2 Reyes Santillan VN,1 Goitia GA1. 1Laparoscopic and Robotic Surgery, Centro M edico Nacional 20 de Noviembre, Mexico City, DF, Mexico; 2Reproductive Endocrinology, Centro M edico Nacional 20 de Noviembre, Mexico City, DF, Mexico *Corresponding author. Study Objective: To determine the outcomes of robotic-assisted laparoscopic hysterectomy for benign conditions in women with large uteri. Design: A prospective and recruting cases for robotic-assisted laparoscopic hysterectomy for benign indications at Centro Medico Nacional “20 de Noviembre” by one surgeon with trainning in minimally invasive and Robotic surgery between May 2016 to August 2018. Setting: Centro Medico Nacional “20 de Noviembre” ISSSTE. Patients or Participants: Only women with large uteri (defined as greater than 750g) were included in this study. Interventions: Robotic hysterectomy. Measurements and Main Results: A total of 20 women were included in the analysis: 11 patients had uterine weights 750-999g and 9 had uterine weights greater than 1000g with the largest being 1,450g. The average surgical times were 131 min (53-301 min) and 156 min (82-338 min), respectively. The average estimated blood loss was 50cc; no blood transfusions were required. There were no intra- operative conversions. There were none major intraoperative complications. There were 2 minor postoperative complications (acute urinary retention and a wound dehiscence of an umbilical port site); both were in the 750-999g group. All patients in both groups were hospitalized 0-1 days. Conclusion: In skilled hands, robotic-assisted laparoscopic hysterectomy in women with large uteri is an acceptable option, associated with minimal complications. Virtual Poster Session 4: Robotics (1:20 PM — 1:30 PM) 1:20 PM: STATION E 1369 Cost and Outcomes Analysis of Robotic, Laparoscopic, and Abdominal Hysterectomy for Benign Disease in a Community Hospital Setting Yoo N,* Cernadas M, Perisic D. Saint Peters University Hospital, New Brunswick, NJ *Corresponding author. Study Objective: To compare overall costs and quality measures of various methods of benign hysterectomies at a community based hospital system Design: A retrospective review of all hysterectomies for benign indications at Saint Peters University Hospital between March 2017 to Dec 2018. Robotic assisted laparoscopic hysterectomies, laparoscopic hysterectomies, and abdominal hysterectomies were compared. Setting: Data was collected from admission to discharge. In the OR, all patients were in comparable sized OR rooms and staff were trained in the
Virtual Poster Session 4: Robotics (1:20 PM — 1:30 PM) 1:20 PM: STATION F 2751 A New Approach to the 4-Point Transversus Abdominis Plane Block Ladanyi C,1,* Mohling S2. 1Minimally Invasive Gynecologic Surgery, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN; 2Obstetrics and Gynecology, Minimally Invasive Gynecology, University of Tennessee, College of Medicine, Chattanooga, TN *Corresponding author. Study Objective: To educate gynecologic surgeons on the background, indications, technique, and outcomes of a four-point transversus abdominis plane (TAP) block delivered under laparoscopic guidance. Design: We devised a technique for a laparoscopic assisted four-point TAP block. We have described the indications, supplies needed, and medications administered. We performed a cadaveric dissection of the anteriorlateral abdominal wall to identify the neurovascular plane used for anesthetic injection. To the best of our knowledge, we are the first to perform a four-point TAP block at the subcostal and lateral positions, under laparoscopic visualization, for robotic-assisted gynecologic procedures including hysterectomies. Setting: Academic community hospital setting and institutional cadaver lab. Patients or Participants: N/A Interventions: We perform laparoscopic assisted four-point TAP blocks on all robotic-assisted gynecologic procedures unless there is a contraindication. Blocks are placed by the surgeon after insertion of the laparoscope. For the subcostal injection the lower costal margin is palpated, and the injection site is identified two centimeters inferior and medial to the midaxillary line. For the inferior injection the anterior superior iliac spine is palpated, and the injection is two centimeters superior and medial to the mid-axillary line. Introduction of a regional anesthesia needle is simultaneously observed externally and laparoscopically. This method along with detailed anatomical landmarks are described in our technique paper. Measurements and Main Results: N/A Conclusion: A four-point TAP block is a safe, efficacious, yet simple procedure which can be performed by the surgeon under laparoscopic visualization.
S217
Conclusion: In conclusion, an obliterated anterior cul-de-sac due to previous surgeries makes it difficult to access the uterine arteries secondary to poor visualization. By approaching uterine artery ligation from the posterior aspect, one may avoid inadvertent injury to vasculature or the bladder and reduce the amount of bleeding during the bladder dissection.
procedure performed. Patients undergoing robotic assisted hysterectomies and laparoscopic hysterectomies were placed in the dorsal lithotomy position with trendelenberg. Those undergoing abdominal hysterectomies were placed in the dorsal supine position. Patients or Participants: The study included 288 women who underwent benign hysterectomy by any method at Saint Peters University Hospital from March 2017 to Dec 2018. 86 (40.4%) patients underwent a robotic assisted laparoscopic hysterectomy, 60 (28.0%) underwent a laparoscopic hysterectomy, and 68 (31.7%) underwent an abdominal hysterectomy. Interventions: All patients received a hysterectomy in one of the three following methods: robotic assisted laparoscopic hysterectomy, laparoscopic hysterectomy, and abdominal hysterectomy. Concomitant procedures of a salpingo-oophrectomy and/or cystoscopy were performed if indicated. Measurements and Main Results: A retrospective chart review was performed for all benign hysterectomies from March 2017 to December 2018 using student t test and a multivariate regression analysis. The primary outcome was the direct total cost of the patient’s hospitalization related to their hysterectomy. Secondary outcomes included estimated blood loss, surgery time, days in the hospital postoperatively, and complications postoperatively. Mean total costs of robotically assisted hysterectomies were $26,452 less than abdominal hysterectomies (p<0.001) and $10,401 less than laparoscopic hysterectomies (p<0.001). These savings held true even after controlling for age, prior surgery, and uterine weight. Conclusion: Overall, total cost was significantly influenced by the mode of hysterectomy, with robotic assisted hysterectomies being the most cost effective.
Virtual Poster Session 4: Robotics (1:20 PM — 1:30 PM) 1:20 PM: STATION D 2180 Experience of Centro Medico Nacional “20 De Noviembre“ in Robotic-assisted Hysterectomy for Large Uteri: A Case Series of 20 Women Cortes AL,1,* Cortes Vazquez A,1 Gallardo Valencia LE Sr,1 Gongora Rodriguez A,2 Reyes Santillan VN,1 Goitia GA1. 1Laparoscopic and Robotic Surgery, Centro M edico Nacional 20 de Noviembre, Mexico City, DF, Mexico; 2Reproductive Endocrinology, Centro M edico Nacional 20 de Noviembre, Mexico City, DF, Mexico *Corresponding author. Study Objective: To determine the outcomes of robotic-assisted laparoscopic hysterectomy for benign conditions in women with large uteri. Design: A prospective and recruting cases for robotic-assisted laparoscopic hysterectomy for benign indications at Centro Medico Nacional “20 de Noviembre” by one surgeon with trainning in minimally invasive and Robotic surgery between May 2016 to August 2018. Setting: Centro Medico Nacional “20 de Noviembre” ISSSTE. Patients or Participants: Only women with large uteri (defined as greater than 750g) were included in this study. Interventions: Robotic hysterectomy. Measurements and Main Results: A total of 20 women were included in the analysis: 11 patients had uterine weights 750-999g and 9 had uterine weights greater than 1000g with the largest being 1,450g. The average surgical times were 131 min (53-301 min) and 156 min (82-338 min), respectively. The average estimated blood loss was 50cc; no blood transfusions were required. There were no intra- operative conversions. There were none major intraoperative complications. There were 2 minor postoperative complications (acute urinary retention and a wound dehiscence of an umbilical port site); both were in the 750-999g group. All patients in both groups were hospitalized 0-1 days. Conclusion: In skilled hands, robotic-assisted laparoscopic hysterectomy in women with large uteri is an acceptable option, associated with minimal complications. Virtual Poster Session 4: Robotics (1:20 PM — 1:30 PM) 1:20 PM: STATION E 1369 Cost and Outcomes Analysis of Robotic, Laparoscopic, and Abdominal Hysterectomy for Benign Disease in a Community Hospital Setting Yoo N,* Cernadas M, Perisic D. Saint Peters University Hospital, New Brunswick, NJ *Corresponding author. Study Objective: To compare overall costs and quality measures of various methods of benign hysterectomies at a community based hospital system Design: A retrospective review of all hysterectomies for benign indications at Saint Peters University Hospital between March 2017 to Dec 2018. Robotic assisted laparoscopic hysterectomies, laparoscopic hysterectomies, and abdominal hysterectomies were compared. Setting: Data was collected from admission to discharge. In the OR, all patients were in comparable sized OR rooms and staff were trained in the
Virtual Poster Session 4: Robotics (1:20 PM — 1:30 PM) 1:20 PM: STATION F 2751 A New Approach to the 4-Point Transversus Abdominis Plane Block Ladanyi C,1,* Mohling S2. 1Minimally Invasive Gynecologic Surgery, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN; 2Obstetrics and Gynecology, Minimally Invasive Gynecology, University of Tennessee, College of Medicine, Chattanooga, TN *Corresponding author. Study Objective: To educate gynecologic surgeons on the background, indications, technique, and outcomes of a four-point transversus abdominis plane (TAP) block delivered under laparoscopic guidance. Design: We devised a technique for a laparoscopic assisted four-point TAP block. We have described the indications, supplies needed, and medications administered. We performed a cadaveric dissection of the anteriorlateral abdominal wall to identify the neurovascular plane used for anesthetic injection. To the best of our knowledge, we are the first to perform a four-point TAP block at the subcostal and lateral positions, under laparoscopic visualization, for robotic-assisted gynecologic procedures including hysterectomies. Setting: Academic community hospital setting and institutional cadaver lab. Patients or Participants: N/A Interventions: We perform laparoscopic assisted four-point TAP blocks on all robotic-assisted gynecologic procedures unless there is a contraindication. Blocks are placed by the surgeon after insertion of the laparoscope. For the subcostal injection the lower costal margin is palpated, and the injection site is identified two centimeters inferior and medial to the midaxillary line. For the inferior injection the anterior superior iliac spine is palpated, and the injection is two centimeters superior and medial to the mid-axillary line. Introduction of a regional anesthesia needle is simultaneously observed externally and laparoscopically. This method along with detailed anatomical landmarks are described in our technique paper. Measurements and Main Results: N/A Conclusion: A four-point TAP block is a safe, efficacious, yet simple procedure which can be performed by the surgeon under laparoscopic visualization.