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2026 Robot-Assisted Laparoscopic Adenomyomectomy is a Feasible Option of Uterus-Sparing Surgery: Adenomyomectomy Cohort Study
S216
Abstracts / Journal of Minimally Invasive Gynecology 26 (2019) S98−S231
Meridian Health, Neptune, NJ; 2Obstetrics and Gynecology, Hackensack Meridian Health, Neptune, NJ; 3Gynecologic Oncology, Hackensack Meridian Health, Neptune, NJ *Corresponding author.
Virtual Poster Session 4: Robotics (1:20 PM — 1:30 PM)
Video Objective: To Demonstrate Robot-assisted total laparoscopic hysterectomy, bilateral salpingo-oopherectomy (TLHBSO) using 3 arms and a uterine manipulator Setting: The da Vinci XI Platform is used to perform a simple extrafascial TLHBSO Interventions: A step-by-step choreography demonstrates 5 main exercises of a robot-assisted TLHBSO mainly; 1- The posterior dissection, 2- The anterior dissection, 3- The lateral dissection, 4- The colpotomy, 5- The cuff closure and suspension. Attention is drawn to the position of the uterus and the direction of counter-traction necessary to complete each step. The function of the third arm is emphasized. Relevant anatomy shown. Necessary laparoscopic surgical techniques demonstrated. Conclusion: The principles of this step-by-step choreographed method can be reproducible with every platform, docking preference, and surgeon handedness. The 5 exercises break down the procedure for the trainee as specific tasks to complete and master separately. This facilitates the learning process and maintains operating room efficiency. Virtual Poster Session 4: Robotics (1:20 PM — 1:30 PM) 1:20 PM: STATION A 2529 Increased Surgical Site Infections in Robotic Hysterectomies in a Large Health System Mandelberger A,1,* Neal KL,1 Bueser R,1 Nimaroff ML2. 1OB/GYN, Northwell Health, Manhasset, NY; 2Minimally Invasive Gynecologic Surgery, North Shore University Hospital, Manhasset, NY *Corresponding author. Study Objective: To describe cases of surgical site infection (SSI) after hysterectomy in a large health system and investigate adherence to infection prevention guidelines Design: Retrospective observational study Setting: 6 hospitals in New York, both community and academic centers Patients or Participants: Patients with surgical site infections as defined by CDC after hysterectomy in 2016 and 2017 Interventions: n/a Measurements and Main Results: Available data from 6 hospitals across a large health system in New York were analyzed. A total of 4589 inpatient open, robotic, and laparoscopic hysterectomies were performed in 2016 and 2017 of which 48 cases of surgical site infection were identified and reviewed. Overall SSI incidence was found to be 1.05%. Mean age of SSI cases was 53.5, and mean BMI 33.7. Among the SSI cases, 20 (41.7%) originated from a robotic approach, 1 (2.1%) straight laparoscopic, and 27 (56.2%) were open. This gave an SSI incidence of 1.98% for robotic, 0.13% for straight laparoscopic, and 0.97% for open approach. 41 (85.4%) SSI cases had total hysterectomies vs 7 (14.6%) supracervical. 34 (70.8%) of cases had a history of prior abdominal surgery. The most common infection type was intraabdominal at 19 cases (39.6%). Incisional infections accounted for 11 cases (22.9%), and vaginal cuff infection accounted for 4 (8.3%). The most common pathogens encountered were bacteroides fragilis (16.2%) and staphylococcus aureus (16.2%). Of 10 cases that used second-line antibiotics, 70% did not adhere to system protocol for dosing or antibiotic choice. Conclusion: A review of cases reveals robotic hysterectomies as having the largest rate of SSI in the 6 hospitals examined at 1.98% as compared to laparoscopic hysterectomies with an SSI rate of 0.13% over 2 years. Further research is needed to validate these findings over time and geographic location, and examine reasons why robotic surgery may confirm a higher infection rate than laparoscopic in these locations.
1:20 PM: STATION B 2026 Robot-Assisted Laparoscopic Adenomyomectomy is a Feasible Option of Uterus-Sparing Surgery: Adenomyomectomy Cohort Study Kang HJ,1,* Chung YJ2. 1Obstetrics & Gynecology, Seoul St. Mary’s Hospital, The Catholic university of Korea, Seoul, Korea, Republic of (South); 2Department of Obstetrics and Gynecology, Seoul Saint Mary’s Hospital, The Catholic University of Korea, Seoul, Korea, Republic of (South) *Corresponding author. Study Objective: To compare surgical outcomes of open adenomyomectomy and robot-assisted laparoscopic adenomyomectomy. Design: Cohort study. Setting: Fibroid Center of tertiary university hospital. Patients or Participants: Among adenomyomectomy cohort, forty-two patients who underwent robot-assisted laparoscopic adenomyomectomy and 16 patients who underwent open adenomyomectomy. Interventions: N/A Measurements and Main Results: All 58 patients with severe secondary dysmenorrhea and pelvic pain visited Seoul St. Mary’s hospital between 2012 and 2017. Eighty-one percent of patients were nulliparous woman (47 patients among 58 patients). Adenomyosis was diagnosed by pelvic ultrasonography. To determine the exact location and size of the lesion and its relation to the uterine cavity, pelvic MRI was performed in all patients. Their mean age, pre-operative CA-125 level, hemoglobin changes after surgery, estimated blood loss were comparable between two groups. The size of adenomyosis was larger in open than robot surgery group. Operation time was longer in robot than open surgery group (open vs robot 244.8§44.2 vs 281.8§77.1 min). Percentage of packed RBC transfusion during surgery was higher in open than robot surgery group (open vs robot 50% vs 14.3%). Hospital stay was shorter in robot than open surgery group (open vs robot 6.1§1.1 vs 2.7§0.7 days). All patients discharged without major complication. Conclusion: Adenomyosis is a common benign gynecologic disease, however, conservative surgical option for preserving fertility is challenging. Adenomyomectomy is a conservative surgical option for preserving fertility. Comparing with open surgery, robot-assisted laparoscopic adenomyomectomy is a feasible option of uterus-sparing surgery using minimally invasive approach.
Virtual Poster Session 4: Robotics (1:20 PM — 1:30 PM) 1:20 PM: STATION C 2878 Posterior Approach to Uterine Artery Ligation Fiori C,1,* Patel NR,2 Namaky DD1. 1OB/GYN, TriHealth, Cincinnati, OH; 2Medical Education, OB/GYN, TriHealth/Good Samaritan Hospital, Cincinnati, OH *Corresponding author. Video Objective: This video demonstrates an alternative approach to uterine artery ligation during a Robotic Assisted Total Laparoscopic Hysterectomy in the setting of an obliterated anterior cul-de-sac. Setting: This a case of a 29 year old with two prior cesarean sections presenting for Robotic Assisted Total Laparoscopic Hysterectomy for abnormal uterine bleeding. Upon entry, the uterus is found to be densely adherent to the anterior abdominal wall. Interventions: The uterine arteries were dissected out, desiccated, and transected from the posterior aspect of the uterus due to the limited access anteriorly secondary to bladder adhesions.
Abstracts / Journal of Minimally Invasive Gynecology 26 (2019) S98−S231
Meridian Health, Neptune, NJ; 2Obstetrics and Gynecology, Hackensack Meridian Health, Neptune, NJ; 3Gynecologic Oncology, Hackensack Meridian Health, Neptune, NJ *Corresponding author.
Virtual Poster Session 4: Robotics (1:20 PM — 1:30 PM)
Video Objective: To Demonstrate Robot-assisted total laparoscopic hysterectomy, bilateral salpingo-oopherectomy (TLHBSO) using 3 arms and a uterine manipulator Setting: The da Vinci XI Platform is used to perform a simple extrafascial TLHBSO Interventions: A step-by-step choreography demonstrates 5 main exercises of a robot-assisted TLHBSO mainly; 1- The posterior dissection, 2- The anterior dissection, 3- The lateral dissection, 4- The colpotomy, 5- The cuff closure and suspension. Attention is drawn to the position of the uterus and the direction of counter-traction necessary to complete each step. The function of the third arm is emphasized. Relevant anatomy shown. Necessary laparoscopic surgical techniques demonstrated. Conclusion: The principles of this step-by-step choreographed method can be reproducible with every platform, docking preference, and surgeon handedness. The 5 exercises break down the procedure for the trainee as specific tasks to complete and master separately. This facilitates the learning process and maintains operating room efficiency. Virtual Poster Session 4: Robotics (1:20 PM — 1:30 PM) 1:20 PM: STATION A 2529 Increased Surgical Site Infections in Robotic Hysterectomies in a Large Health System Mandelberger A,1,* Neal KL,1 Bueser R,1 Nimaroff ML2. 1OB/GYN, Northwell Health, Manhasset, NY; 2Minimally Invasive Gynecologic Surgery, North Shore University Hospital, Manhasset, NY *Corresponding author. Study Objective: To describe cases of surgical site infection (SSI) after hysterectomy in a large health system and investigate adherence to infection prevention guidelines Design: Retrospective observational study Setting: 6 hospitals in New York, both community and academic centers Patients or Participants: Patients with surgical site infections as defined by CDC after hysterectomy in 2016 and 2017 Interventions: n/a Measurements and Main Results: Available data from 6 hospitals across a large health system in New York were analyzed. A total of 4589 inpatient open, robotic, and laparoscopic hysterectomies were performed in 2016 and 2017 of which 48 cases of surgical site infection were identified and reviewed. Overall SSI incidence was found to be 1.05%. Mean age of SSI cases was 53.5, and mean BMI 33.7. Among the SSI cases, 20 (41.7%) originated from a robotic approach, 1 (2.1%) straight laparoscopic, and 27 (56.2%) were open. This gave an SSI incidence of 1.98% for robotic, 0.13% for straight laparoscopic, and 0.97% for open approach. 41 (85.4%) SSI cases had total hysterectomies vs 7 (14.6%) supracervical. 34 (70.8%) of cases had a history of prior abdominal surgery. The most common infection type was intraabdominal at 19 cases (39.6%). Incisional infections accounted for 11 cases (22.9%), and vaginal cuff infection accounted for 4 (8.3%). The most common pathogens encountered were bacteroides fragilis (16.2%) and staphylococcus aureus (16.2%). Of 10 cases that used second-line antibiotics, 70% did not adhere to system protocol for dosing or antibiotic choice. Conclusion: A review of cases reveals robotic hysterectomies as having the largest rate of SSI in the 6 hospitals examined at 1.98% as compared to laparoscopic hysterectomies with an SSI rate of 0.13% over 2 years. Further research is needed to validate these findings over time and geographic location, and examine reasons why robotic surgery may confirm a higher infection rate than laparoscopic in these locations.
1:20 PM: STATION B 2026 Robot-Assisted Laparoscopic Adenomyomectomy is a Feasible Option of Uterus-Sparing Surgery: Adenomyomectomy Cohort Study Kang HJ,1,* Chung YJ2. 1Obstetrics & Gynecology, Seoul St. Mary’s Hospital, The Catholic university of Korea, Seoul, Korea, Republic of (South); 2Department of Obstetrics and Gynecology, Seoul Saint Mary’s Hospital, The Catholic University of Korea, Seoul, Korea, Republic of (South) *Corresponding author. Study Objective: To compare surgical outcomes of open adenomyomectomy and robot-assisted laparoscopic adenomyomectomy. Design: Cohort study. Setting: Fibroid Center of tertiary university hospital. Patients or Participants: Among adenomyomectomy cohort, forty-two patients who underwent robot-assisted laparoscopic adenomyomectomy and 16 patients who underwent open adenomyomectomy. Interventions: N/A Measurements and Main Results: All 58 patients with severe secondary dysmenorrhea and pelvic pain visited Seoul St. Mary’s hospital between 2012 and 2017. Eighty-one percent of patients were nulliparous woman (47 patients among 58 patients). Adenomyosis was diagnosed by pelvic ultrasonography. To determine the exact location and size of the lesion and its relation to the uterine cavity, pelvic MRI was performed in all patients. Their mean age, pre-operative CA-125 level, hemoglobin changes after surgery, estimated blood loss were comparable between two groups. The size of adenomyosis was larger in open than robot surgery group. Operation time was longer in robot than open surgery group (open vs robot 244.8§44.2 vs 281.8§77.1 min). Percentage of packed RBC transfusion during surgery was higher in open than robot surgery group (open vs robot 50% vs 14.3%). Hospital stay was shorter in robot than open surgery group (open vs robot 6.1§1.1 vs 2.7§0.7 days). All patients discharged without major complication. Conclusion: Adenomyosis is a common benign gynecologic disease, however, conservative surgical option for preserving fertility is challenging. Adenomyomectomy is a conservative surgical option for preserving fertility. Comparing with open surgery, robot-assisted laparoscopic adenomyomectomy is a feasible option of uterus-sparing surgery using minimally invasive approach.
Virtual Poster Session 4: Robotics (1:20 PM — 1:30 PM) 1:20 PM: STATION C 2878 Posterior Approach to Uterine Artery Ligation Fiori C,1,* Patel NR,2 Namaky DD1. 1OB/GYN, TriHealth, Cincinnati, OH; 2Medical Education, OB/GYN, TriHealth/Good Samaritan Hospital, Cincinnati, OH *Corresponding author. Video Objective: This video demonstrates an alternative approach to uterine artery ligation during a Robotic Assisted Total Laparoscopic Hysterectomy in the setting of an obliterated anterior cul-de-sac. Setting: This a case of a 29 year old with two prior cesarean sections presenting for Robotic Assisted Total Laparoscopic Hysterectomy for abnormal uterine bleeding. Upon entry, the uterus is found to be densely adherent to the anterior abdominal wall. Interventions: The uterine arteries were dissected out, desiccated, and transected from the posterior aspect of the uterus due to the limited access anteriorly secondary to bladder adhesions.