- Email: [email protected]
2920 A Retrospective Look at Gynecological Surgical Complications
Abstracts / Journal of Minimally Invasive Gynecology 26 (2019) S98−S231
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Group 1-SC and IP anesthesia; Group 2- SC anesthesia and IP placebo; Group 3- SC placebo and IP anesthesia; Group 4- SC and IP placebo. The patients, surgeons, and pain evaluators were all blinded to the patient’s allocation. Setting: A single tertiary hospital. Patients or Participants: Patients who underwent elective laparoscop and gave their informed consent. Exclusion criteria were: malignancy, active infection, pregnancy, known sensitivity to Bupivacaine-Hydrochloride, chronic pelvic pain, conversion to laparotomy, or additional vaginal procedures. Interventions: A total of 9 ml of Bupivacaine-Hydrochloride (Marcaine) 0.5%, or Sodium-Chloride 0.9%, as a placebo, were injected sub-cutaneously to the trocar site, prior to skin incision. In addition, 10 ml of Bupivacaine-Hydrochloride 0.5%, diluted with 40 ml of Sodium-Chloride 0.9%, or 50 ml of Sodium-Chloride 0.9%, as a placebo, were injected intra-peritoneally at the end of the surgery. Measurements and Main Results: By using 10 cm Visual-analogue-scale (VAS) we assessed the pain at rest at 3, 8, and 24 hours, and pain during movement at 8 and 24 hours after surgery. One hundred and twenty women were included (30 patients in each). Demographic data, as well as operations’ characteristics, were similar between the groups. The level of post-operative pain, either at rest or movement, was not significantly different between the groups, in all points of time. There were also no differences in pain levels when all SC analgesia groups (1&2) were compared to all SC placebo groups (3&4), and when all IP analgesia groups (1&3) were compared to all IP placebo groups (2&4). Conclusion: Sub-cutaneous and/ or intra-peritoneal anesthesia were not effective in reducing post-operative pain.
Conclusion: There was no difference in the risk of repeat surgery within 2 years whether endometriosis was excised or ablated. Excision using robot-assisted technique showed a non-significant trend toward a decrease in reoperation rate. In this clinical center, endometriosis ablation and excision are equally effective to prevent repeat surgery. The method should be selected based on surgeon experience.
Virtual Poster Session 4: Endometriosis (1:40 PM — 1:50 PM) 1:40 PM: STATION F 1582 Laparoscopic Excision of Endometriosis does not Reduce the Risk of Reoperation within 2 Years Compared with Ablation of Implants Vettathu MS,1,2,* Allswede MT,1,2 Martin M,1 Lewis MG1,2. 1Obstetrics and Gynecology, Sparrow Hospital, Lansing, MI; 2Obstetrics and Gynecology, Michigan State University College of Human Medicine, East Lansing, MI *Corresponding author. Study Objective: To evaluate local patterns of surgical diagnosis and treatment of endometriosis and to determine whether excision versus ablation altered the need for repeat surgery within 2 years in a community hospital setting. Design: Retrospective cohort analysis. Setting: Community teaching hospital. Patients or Participants: All patients who underwent conservative surgery between 1/2013-12/2016 for endometriosis, excluding hysterectomy and unilateral or bilateral oophorectomy. 294 patients met inclusion criteria. Interventions: Laparoscopic excision or ablation of endometriosis. Measurements and Main Results: 74(25.2%) of the patients had a repeat surgery within two years, 22 (20.6%) after excision and 52 (27.8%) after ablation (RR 0.74, 95% CI 0.48-1.15). Endometriosis was diagnosed by tissue biopsy in 151(51.4%) and by visual inspection alone in 143(48.6%). 107(36.4%) underwent endometriosis excision; 80(27.2%) underwent excision alone while 27(9.2%) had both excision and ablation. 187(63.6%) underwent endometriosis ablation; 140(47.7%) had radiofrequency (RF) ablation only, 44 (14.9%) had RF ablation with biopsy and 3 (1.0%) had laser ablation. The 2 year reoperation risk was lower with robotic (6%) vs traditional laparoscopic excision (28%) but did not achieve statistical significance (RR 0.28 95% CI 0.07 to 1.16).
Virtual Poster Session 4: Basic Science/Research/Education (1:40 PM — 1:50 PM) 1:40 PM: STATION G 1469 Comparison of Neovaginoplasty Using Acellular Porcine Small Intestinal Submucosa Graft or Interceed in Patients with Mayer-Rokitansky-K€ uster-Hauser Syndrome Zhang X,1,* Ding J,1 Hua K2. 1OBS & GYN hospital, Fudan University, Shanghai, China; 2Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China *Corresponding author. Study Objective: To compare using the acellular porcine small intestinal submucosa (SIS) graft or the Interceed in patients with MRKH syndrome undergoing creation of a neovagina. Design: Retrospective study. Setting: Academic affiliated community hospital. Patients or Participants: Patients with MRKH syndrome undergoing creation of a neovagina from 2016 to 2018 were retrospectively investigated. Interventions: Wharton-Sheares-George neovaginoplasty was performed using the acellular porcine small intestinal submucosa (SIS) graft or the Interceed. Measurements and Main Results: Overall 67 patients were included (24 for the SIS graft, 43 for the Interceed) for analysis. The operating time, the estimated blood loss and return of bowel activity in the SIS graft group were similar with that in the Interceed group. However, the total cost in the SIS group was significantly higher than that in the Interceed group due to the cost of the SIS graft ($2570 per graft). All patients had a continuous mold wearing time for 6 months postoperatively and then returned for their follow-up. The mean length and width of the neovagina in the SIS graft group were similar with the Interceed group (7.0§0.6 cm vs 7.1§0.8 cm, P=.54, 2.8§0.3 cm vs 2.7§0.5 cm, P=.74, respectively). However, the incidence of granulation at the vaginal apex was higher in the SIS graft group than that in the Interceed group (6/24 vs 4/43, p<.001). Sixteen (66.7%) patients in the SIS group and thirty-one (72.1%) in the Interceed group subsequently had a sexual partner. There was no statistically significant difference in the total FSFI scores (27.54§4.50 vs 26.81§3.21, p=.71) between the two groups. Conclusion: Our results demonstrated that Wharton-Sheares-George provided the patients to have satisfactory sexual intercourse. The Interceed played a role in the reconstruction of neovagina no less than the SIS graft. Virtual Poster Session 4: Basic Science/Research/Education (1:40 PM — 1:50 PM) 1:40 PM: STATION H 2920 A Retrospective Look at Gynecological Surgical Complications Patel AA,1,* Nimaroff ML2. 1OBGYN, Northwell Health, Manhasset, NY; 2 Minimally Invasive Gynecologic Surgery, North Shore University Hospital, Manhasset, NY *Corresponding author. Study Objective: The objective of this study is to evaluate the gynecology caseload in our health system and readdress major and minor complications during gynecological surgery.
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Abstracts / Journal of Minimally Invasive Gynecology 26 (2019) S98−S231
Design: A retrospective chart review from 2017-2018 of all gynecology cases performed by attending of various gynecological training including Minimally Invasive Gyn Surgery, Gyn Oncology, Urogynecology and general OBGYN. The chart review looks at all major and minor documented complications from surgery. Setting: OR cases from 2017-2018 collected over an entire health system, 21 hospitals in total. Cases include abdominal, laparoscopic and robotic cases in the Northwell health system. Patients or Participants: A total of 7375 cases were reviewed, all cases were performed in the OR during 2017-2018. Interventions: N/A Measurements and Main Results: A total of 7375 cases were reviewed: 4326 laparoscopic, 1653 abdominal, and 1396 robotic. 682 cases were noted to have complications from surgery, which is a 9.2% incidence. Complications were seen in 175 open cases (10.59%), 415 laparoscopic cases (9.59%) and 92 robotic procedures (6.59 %). There were GU complications in 25.14%, intraoperative puncture of an organ in 11.26%, post operative hematoma in 9.2%, intra-operative hematoma/ hemorrhage 3.95%, sepsis in 3.5%, surgical site infection in 3.07%, pulmonary embolism in 2%, DVT was found in 1.90%, intestinal obstruction 0.58%, CV in 0.23%, other in 0.21% Conclusion: More surgical complications were seen in abdominal cases versus minimally invasive cases. Out of all the major and minor complications seen in gyn surgery the more common complication were GU complications. Currently in the process of analyzing complications based on surgeon experience and training with the hypothesis that surgeons who operate more and have gynecological training after residency will have fewer complications
Patients or Participants: All patients who underwent unilateral ovarian cystectomy with pathology confirmed dermoid cyst from 1/2013 to 12/ 2018. 101 patients met inclusion criteria. Interventions: Unilateral ovarian cystectomy Measurements and Main Results: Intraoperative spillage rates were not significantly different for LAP 19/38 (50%), SLA 28/45 (62%), and RAL 12/18 (67%). See table below for complete results. Conclusion: Robot-assisted laparoscopy did not reduce intraoperative spillage of dermoid cyst contents compared to traditional laparoscopy or laparotomy. In patients with large (>6cm) dermoid cysts the use of RAL decreased blood loss, length of postoperative hospital stay, need for inpatient admission and conversion to LAP (compared to SLA), but increased the length of surgery and hospital cost compared to LAP. We conclude that larger dermoid cysts may be treated with RAL instead of LAP. Smaller cysts may have equivalent outcomes with traditional laparoscopic techniques.
Virtual Poster Session 4: Robotics (1:40 PM — 1:50 PM) 1:40 PM: STATION I 1783 Does Robot-Assisted Laparoscopy Improve Outcomes in Ovarian Dermoid Cystectomy? Vettathu MS,1,2,* Allswede MT,1,2 Martin M,1 Hoffman JT1,2. 1Obstetrics and Gynecology, Sparrow Hospital, Lansing, MI; 2Obstetrics and Gynecology, Michigan State University College of Human Medicine, East Lansing, MI *Corresponding author. Study Objective: To evaluate whether using robot assisted laparoscopic technique (RAL) reduces cyst disruption with spillage during benign ovarian teratoma cystectomy compared to straight laparoscopic technique (SLA) and laparotomy (LAP). Design: Retrospective cross-sectional analysis. Setting: Community teaching hospital.
Primary Outcome Intraoperative spillage rates Secondary Characteristics Preoperative cyst size (cm) Length of surgery (minutes) Length of postoperative stay(minutes) Postoperative level of service(inpatient) Hospital cost (US Dollars) Average blood loss (ml) Other complications Convert to laparotomy
Virtual Poster Session 4: Urogynecology (1:40 PM — 1:50 PM) 1:40 PM: STATION J 1463 Postvoid Residual Measurements by Bladder Ultrasound in Obese Women: Are They Accurate? Bastawros D,1,* Hendley N,2 Zhao J,3 Myers EM,4 Taylor GB,1 Kennelly MJ,1 Stepp KJ,1 Tarr ME1. 1Atrium Health, Charlotte, NC; 2 University of Chicago, Chicago, IL; 3Center for Outcomes Research and Evaluation (CORE), Charlotte, NC; 4Obstetrics and Gynecology, Division of Female Pelvic Reconstructive Surgery, Atrium Health, Charlotte, NC *Corresponding author. Study Objective: To evaluate the accuracy of bladder scanner measurements in assessing post-void residual (PVR) volumes in obese women [body mass index (BMI)≥30 kg/m2] as compared to non-obese women (BMI<30 kg/m2). Design: Prospective. Setting: Academic center. Patients or Participants: Women undergoing multichannel urodynamic studies from June to September 2018. Interventions: After uroflowmetry, PVR was measured with the BVI 3000. The largest volume of three attempts was recorded. Sterile straight catheterization was performed immediately after. The primary outcome was the difference between bladder scanner PVR and catheterized PVR in obese and non-obese women. Measurements and Main Results: 133/157 women (57 obese, 76 nonobese) were eligible for inclusion. Obese women were younger (54.9§ 11.5 vs 63.0§11.8 years, p<0.01). Both groups had a median pelvic organ prolapse quantification (POP-Q) stage of 2, however, there was a significant difference with the non-obese women having a range of higher grade prolapse
p value
LAP
SLA
RAL
19 (50%)
28 (62%)
12 (67%)
0.39
7.5 (1.6-18.6) 76 (40-142) 1289 (110-6177) 27 (71%) $4393(3079-6729) 64 (10-400) 3 (7%)
5.9 (1.9-11.8) 79 (24-140) 263 (114-1320) 6 (15%) $4585 (2818-6729) 37 (10-200) 1 (2%) 6 (13%)
8.4 (3.9-16.4) 130 (64-275) 445 (158-2790) 2 (11%) $7037 (4118-12851) 51(10-200) 1 (5%) 0 (0%)
0.007 0.0003 0.000001 0.0001 0.008 0.144 0.49 0.17
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Group 1-SC and IP anesthesia; Group 2- SC anesthesia and IP placebo; Group 3- SC placebo and IP anesthesia; Group 4- SC and IP placebo. The patients, surgeons, and pain evaluators were all blinded to the patient’s allocation. Setting: A single tertiary hospital. Patients or Participants: Patients who underwent elective laparoscop and gave their informed consent. Exclusion criteria were: malignancy, active infection, pregnancy, known sensitivity to Bupivacaine-Hydrochloride, chronic pelvic pain, conversion to laparotomy, or additional vaginal procedures. Interventions: A total of 9 ml of Bupivacaine-Hydrochloride (Marcaine) 0.5%, or Sodium-Chloride 0.9%, as a placebo, were injected sub-cutaneously to the trocar site, prior to skin incision. In addition, 10 ml of Bupivacaine-Hydrochloride 0.5%, diluted with 40 ml of Sodium-Chloride 0.9%, or 50 ml of Sodium-Chloride 0.9%, as a placebo, were injected intra-peritoneally at the end of the surgery. Measurements and Main Results: By using 10 cm Visual-analogue-scale (VAS) we assessed the pain at rest at 3, 8, and 24 hours, and pain during movement at 8 and 24 hours after surgery. One hundred and twenty women were included (30 patients in each). Demographic data, as well as operations’ characteristics, were similar between the groups. The level of post-operative pain, either at rest or movement, was not significantly different between the groups, in all points of time. There were also no differences in pain levels when all SC analgesia groups (1&2) were compared to all SC placebo groups (3&4), and when all IP analgesia groups (1&3) were compared to all IP placebo groups (2&4). Conclusion: Sub-cutaneous and/ or intra-peritoneal anesthesia were not effective in reducing post-operative pain.
Conclusion: There was no difference in the risk of repeat surgery within 2 years whether endometriosis was excised or ablated. Excision using robot-assisted technique showed a non-significant trend toward a decrease in reoperation rate. In this clinical center, endometriosis ablation and excision are equally effective to prevent repeat surgery. The method should be selected based on surgeon experience.
Virtual Poster Session 4: Endometriosis (1:40 PM — 1:50 PM) 1:40 PM: STATION F 1582 Laparoscopic Excision of Endometriosis does not Reduce the Risk of Reoperation within 2 Years Compared with Ablation of Implants Vettathu MS,1,2,* Allswede MT,1,2 Martin M,1 Lewis MG1,2. 1Obstetrics and Gynecology, Sparrow Hospital, Lansing, MI; 2Obstetrics and Gynecology, Michigan State University College of Human Medicine, East Lansing, MI *Corresponding author. Study Objective: To evaluate local patterns of surgical diagnosis and treatment of endometriosis and to determine whether excision versus ablation altered the need for repeat surgery within 2 years in a community hospital setting. Design: Retrospective cohort analysis. Setting: Community teaching hospital. Patients or Participants: All patients who underwent conservative surgery between 1/2013-12/2016 for endometriosis, excluding hysterectomy and unilateral or bilateral oophorectomy. 294 patients met inclusion criteria. Interventions: Laparoscopic excision or ablation of endometriosis. Measurements and Main Results: 74(25.2%) of the patients had a repeat surgery within two years, 22 (20.6%) after excision and 52 (27.8%) after ablation (RR 0.74, 95% CI 0.48-1.15). Endometriosis was diagnosed by tissue biopsy in 151(51.4%) and by visual inspection alone in 143(48.6%). 107(36.4%) underwent endometriosis excision; 80(27.2%) underwent excision alone while 27(9.2%) had both excision and ablation. 187(63.6%) underwent endometriosis ablation; 140(47.7%) had radiofrequency (RF) ablation only, 44 (14.9%) had RF ablation with biopsy and 3 (1.0%) had laser ablation. The 2 year reoperation risk was lower with robotic (6%) vs traditional laparoscopic excision (28%) but did not achieve statistical significance (RR 0.28 95% CI 0.07 to 1.16).
Virtual Poster Session 4: Basic Science/Research/Education (1:40 PM — 1:50 PM) 1:40 PM: STATION G 1469 Comparison of Neovaginoplasty Using Acellular Porcine Small Intestinal Submucosa Graft or Interceed in Patients with Mayer-Rokitansky-K€ uster-Hauser Syndrome Zhang X,1,* Ding J,1 Hua K2. 1OBS & GYN hospital, Fudan University, Shanghai, China; 2Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China *Corresponding author. Study Objective: To compare using the acellular porcine small intestinal submucosa (SIS) graft or the Interceed in patients with MRKH syndrome undergoing creation of a neovagina. Design: Retrospective study. Setting: Academic affiliated community hospital. Patients or Participants: Patients with MRKH syndrome undergoing creation of a neovagina from 2016 to 2018 were retrospectively investigated. Interventions: Wharton-Sheares-George neovaginoplasty was performed using the acellular porcine small intestinal submucosa (SIS) graft or the Interceed. Measurements and Main Results: Overall 67 patients were included (24 for the SIS graft, 43 for the Interceed) for analysis. The operating time, the estimated blood loss and return of bowel activity in the SIS graft group were similar with that in the Interceed group. However, the total cost in the SIS group was significantly higher than that in the Interceed group due to the cost of the SIS graft ($2570 per graft). All patients had a continuous mold wearing time for 6 months postoperatively and then returned for their follow-up. The mean length and width of the neovagina in the SIS graft group were similar with the Interceed group (7.0§0.6 cm vs 7.1§0.8 cm, P=.54, 2.8§0.3 cm vs 2.7§0.5 cm, P=.74, respectively). However, the incidence of granulation at the vaginal apex was higher in the SIS graft group than that in the Interceed group (6/24 vs 4/43, p<.001). Sixteen (66.7%) patients in the SIS group and thirty-one (72.1%) in the Interceed group subsequently had a sexual partner. There was no statistically significant difference in the total FSFI scores (27.54§4.50 vs 26.81§3.21, p=.71) between the two groups. Conclusion: Our results demonstrated that Wharton-Sheares-George provided the patients to have satisfactory sexual intercourse. The Interceed played a role in the reconstruction of neovagina no less than the SIS graft. Virtual Poster Session 4: Basic Science/Research/Education (1:40 PM — 1:50 PM) 1:40 PM: STATION H 2920 A Retrospective Look at Gynecological Surgical Complications Patel AA,1,* Nimaroff ML2. 1OBGYN, Northwell Health, Manhasset, NY; 2 Minimally Invasive Gynecologic Surgery, North Shore University Hospital, Manhasset, NY *Corresponding author. Study Objective: The objective of this study is to evaluate the gynecology caseload in our health system and readdress major and minor complications during gynecological surgery.
S230
Abstracts / Journal of Minimally Invasive Gynecology 26 (2019) S98−S231
Design: A retrospective chart review from 2017-2018 of all gynecology cases performed by attending of various gynecological training including Minimally Invasive Gyn Surgery, Gyn Oncology, Urogynecology and general OBGYN. The chart review looks at all major and minor documented complications from surgery. Setting: OR cases from 2017-2018 collected over an entire health system, 21 hospitals in total. Cases include abdominal, laparoscopic and robotic cases in the Northwell health system. Patients or Participants: A total of 7375 cases were reviewed, all cases were performed in the OR during 2017-2018. Interventions: N/A Measurements and Main Results: A total of 7375 cases were reviewed: 4326 laparoscopic, 1653 abdominal, and 1396 robotic. 682 cases were noted to have complications from surgery, which is a 9.2% incidence. Complications were seen in 175 open cases (10.59%), 415 laparoscopic cases (9.59%) and 92 robotic procedures (6.59 %). There were GU complications in 25.14%, intraoperative puncture of an organ in 11.26%, post operative hematoma in 9.2%, intra-operative hematoma/ hemorrhage 3.95%, sepsis in 3.5%, surgical site infection in 3.07%, pulmonary embolism in 2%, DVT was found in 1.90%, intestinal obstruction 0.58%, CV in 0.23%, other in 0.21% Conclusion: More surgical complications were seen in abdominal cases versus minimally invasive cases. Out of all the major and minor complications seen in gyn surgery the more common complication were GU complications. Currently in the process of analyzing complications based on surgeon experience and training with the hypothesis that surgeons who operate more and have gynecological training after residency will have fewer complications
Patients or Participants: All patients who underwent unilateral ovarian cystectomy with pathology confirmed dermoid cyst from 1/2013 to 12/ 2018. 101 patients met inclusion criteria. Interventions: Unilateral ovarian cystectomy Measurements and Main Results: Intraoperative spillage rates were not significantly different for LAP 19/38 (50%), SLA 28/45 (62%), and RAL 12/18 (67%). See table below for complete results. Conclusion: Robot-assisted laparoscopy did not reduce intraoperative spillage of dermoid cyst contents compared to traditional laparoscopy or laparotomy. In patients with large (>6cm) dermoid cysts the use of RAL decreased blood loss, length of postoperative hospital stay, need for inpatient admission and conversion to LAP (compared to SLA), but increased the length of surgery and hospital cost compared to LAP. We conclude that larger dermoid cysts may be treated with RAL instead of LAP. Smaller cysts may have equivalent outcomes with traditional laparoscopic techniques.
Virtual Poster Session 4: Robotics (1:40 PM — 1:50 PM) 1:40 PM: STATION I 1783 Does Robot-Assisted Laparoscopy Improve Outcomes in Ovarian Dermoid Cystectomy? Vettathu MS,1,2,* Allswede MT,1,2 Martin M,1 Hoffman JT1,2. 1Obstetrics and Gynecology, Sparrow Hospital, Lansing, MI; 2Obstetrics and Gynecology, Michigan State University College of Human Medicine, East Lansing, MI *Corresponding author. Study Objective: To evaluate whether using robot assisted laparoscopic technique (RAL) reduces cyst disruption with spillage during benign ovarian teratoma cystectomy compared to straight laparoscopic technique (SLA) and laparotomy (LAP). Design: Retrospective cross-sectional analysis. Setting: Community teaching hospital.
Primary Outcome Intraoperative spillage rates Secondary Characteristics Preoperative cyst size (cm) Length of surgery (minutes) Length of postoperative stay(minutes) Postoperative level of service(inpatient) Hospital cost (US Dollars) Average blood loss (ml) Other complications Convert to laparotomy
Virtual Poster Session 4: Urogynecology (1:40 PM — 1:50 PM) 1:40 PM: STATION J 1463 Postvoid Residual Measurements by Bladder Ultrasound in Obese Women: Are They Accurate? Bastawros D,1,* Hendley N,2 Zhao J,3 Myers EM,4 Taylor GB,1 Kennelly MJ,1 Stepp KJ,1 Tarr ME1. 1Atrium Health, Charlotte, NC; 2 University of Chicago, Chicago, IL; 3Center for Outcomes Research and Evaluation (CORE), Charlotte, NC; 4Obstetrics and Gynecology, Division of Female Pelvic Reconstructive Surgery, Atrium Health, Charlotte, NC *Corresponding author. Study Objective: To evaluate the accuracy of bladder scanner measurements in assessing post-void residual (PVR) volumes in obese women [body mass index (BMI)≥30 kg/m2] as compared to non-obese women (BMI<30 kg/m2). Design: Prospective. Setting: Academic center. Patients or Participants: Women undergoing multichannel urodynamic studies from June to September 2018. Interventions: After uroflowmetry, PVR was measured with the BVI 3000. The largest volume of three attempts was recorded. Sterile straight catheterization was performed immediately after. The primary outcome was the difference between bladder scanner PVR and catheterized PVR in obese and non-obese women. Measurements and Main Results: 133/157 women (57 obese, 76 nonobese) were eligible for inclusion. Obese women were younger (54.9§ 11.5 vs 63.0§11.8 years, p<0.01). Both groups had a median pelvic organ prolapse quantification (POP-Q) stage of 2, however, there was a significant difference with the non-obese women having a range of higher grade prolapse
p value
LAP
SLA
RAL
19 (50%)
28 (62%)
12 (67%)
0.39
7.5 (1.6-18.6) 76 (40-142) 1289 (110-6177) 27 (71%) $4393(3079-6729) 64 (10-400) 3 (7%)
5.9 (1.9-11.8) 79 (24-140) 263 (114-1320) 6 (15%) $4585 (2818-6729) 37 (10-200) 1 (2%) 6 (13%)
8.4 (3.9-16.4) 130 (64-275) 445 (158-2790) 2 (11%) $7037 (4118-12851) 51(10-200) 1 (5%) 0 (0%)
0.007 0.0003 0.000001 0.0001 0.008 0.144 0.49 0.17