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A Comparison of Surgical Outcomes Between Single-Site Robotic, Multiport Robotic and Conventional Laparoscopic Techniques in Performing Hysterectomy for Benign Indications
S132 389
Abstracts / Journal of Minimally Invasive Gynecology 24 (2017) S1–S201 Virtual Posters – Session 2 (12:45 PM–1:45 PM) 12:45 PM – STATION C
Utility of Anesthetic Block for Endometrial Ablation Pain: A Randomized Controlled Trial Klebanoff J, Patel NR, Sloan NL. Christiana Care Health System, Newark, Delaware Study Objective: To evaluate whether local anesthetic, in combination with general anesthesia, affects postoperative pain following endometrial ablation. Design: Single-blind randomized controlled trial. Setting: Academic-affiliated community hospital. Patients: English speaking premenopausal women, aged 30–55 years, undergoing outpatient endometrial ablation for benign disease. Intervention: Standardized paracervical injection of 20 mL 0.25% Bupivacaine or 20 mL Normal Saline at ablation completion. Measurements and Main Results: Between April 2016 and February 2017 108 women scheduled for endometrial ablation were screened (refusals n = 21, ineligible n = 3). Of the 84 randomized, 2 women <35 years were excluded. Intent-to-treat analyses included one incorrect randomization and 3 women having no ablation due to operative difficulties. Three were lost to follow-up. Two-tailed t-tests show treatment group patients experienced lower one hour postoperative visual analog pain scores than the control group(p = .02).The difference diminished by four hours and was negligible by eight hours (n.s.). Treatment group patients used less postoperative pain medication (p = .05). Backward stepwise logistic regressions controlled for confounding reduced the one hour postoperative treatment group pain score difference to 0.8 (CI −.6–.1) and the average postoperative morphine equivalents to 3.7 (CI −6.8–−.7). Table 1. Primary and secondary outcomes (unequal variances assumed)
1 Hour Pain Score 4 Hour Pain Score 8 Hour Pain Score Total Blood Loss (mL) Total Morphine Equivalents Total Day 1 Tylenol with Codeine Hours Between Surgery Initiation and Discharge
Study Group Control % or N Mean±SD
Treatment % or Mean±SD
N
p
2.71 ± 2.47 3.37 ± 2.48 2.47 ± 2.17 6.38 ± 3.70 7.80 ± 8.45 9.18 ± .98
41 38 38 37 41 38
1.44 ± 2.32 2.81 ± 2.22 2.24 ± 1.83 7.15 ± 6.06 4.41 ± 6.97 8.74 ± 1.52
41 37 37 33 41 38
.019 .31 .62 .53 .051 .13
1.63 ± 0.73
41
1.59 ± 0.55
41
.73
Conclusion: Low risk local anesthetic, utilized in conjunction with general anesthesia, decreases postoperative pain at one hour and postoperative narcotic use following endometrial ablation.
her first (11/20/2016) hospital visit ultrasonography showed only a singleton 8-week intrauterin fetus. LMP : 09/28/2016 The patient got pregnant by natural conception. Blood Pressure: 110/80 mm/Hg. During 2nd fetal ultrasonographic examination obstetrican measured a singleton 13-week intrauterin fetus but also found a 13-week extrauterine fetus on the right adnexial place. The patient was operated same day by laparoscopy. One 10 mm umbilical and two 5 mm auxiliary trocars were used. Pathologic specimen was extracted via 10 mm umbilical trocar site without enlarging any of 5 mm auxiliary trocar sites.
391
Virtual Posters – Session 2 (12:45 PM–1:45 PM) 12:45 PM – STATION E
A Clinical Observation of Preoperative Adjuvant Therapy for Intrauterine Adhesions Wu Y, Feng L. Ob/Gyn, Beijing Tiantan Hospital, The Capital Medical Univeristy, Beijing, China Study Objective: To study the clinical observation of estrogen, progesterone and vasodilator in the treatment of moderate to severe intrauterine adhesions. Design: Randomized, single-arm study. Setting: One university teaching hospital. Patients: 120 Patients with moderate to severe intrauterine adhesions, be compared before and after medicine treatment. Intervention: Estrogen, progesterone and vasodilator used for 3 cycles. Measurements and Main Results: 1. Course of the disease and the number of previous uterine cavity operations were correlated with severe adhesion (p < .05). Severe adhesion has no correlation with age and etiology (p > .05); 2. Changes in AFS score, endometrial thickness, endometrial hemodynamic parameters PI, RI, S/D before and after medicine treatment were statistically significant (p < .01); 3. After treatment, menstrual improvement rate was 84.35%. PBAC analyzed by paired t-test had statistically significance (p < .01); 4. 6 factors: course of disease, degree of adhesions, AFS score, menstrual mode, endometrial thickness and endometrial blood flow were significantly correlated with pregnancy (p < .05); 5. The type of endometrial blood flow (p = .001), the postmenopausal model (p = .04), and the endometrial thickness (p = .05) are independent factors that affecting pregnancy. Conclusion: After treatment, the thickness of endometrium and blood flow type were improved; blood flow resistance decreased; menstrual recovery and pregnancy rate improved. Physiological dose of hormone therapy combined with aspirin, vitamin C, vitamin E and Kirin pills to promote endometrial growth and vasodilator in patients with moderate to severe intrauterine adhesions is effective, safe and reliable thus can be extended in clinical practice.
392
Virtual Posters – Session 2 (12:45 PM–1:45 PM)
LAPAROSCOPY – CONVENTIONAL 12:45 PM – STATION F 390
Virtual Posters – Session 2 (12:45 PM–1:45 PM) 12:45 PM – STATION D
A 13-Week Heterotopic Pregnancy Managed by a Minimally Invasive Approach Sanverdi I, Kilicci C, Ayvaci H, Ozkaya E, Naki MM. Ob/Gyn, Zeynep Kamil Maternity and Children’s Health Training and Research Hospital, Istanbul, Turkey A 32-year-old nulliparous (Gravida 2 Parity 1 Abortus 1) woman came to the hospital for “First Trimester Screening test”. She had no complaint. During
A Comparison of Surgical Outcomes Between SingleSite Robotic, Multiport Robotic and Conventional Laparoscopic Techniques in Performing Hysterectomy for Benign Indications Gupta N, Blevins M, Radtke S, Holcombe J, Furr RS. University of Tennessee College of Medicine, Chattanooga, Tennessee Study Objective: To compare surgical outcomes between different minimally invasive approaches utilized to perform total hysterectomy for benign indications. To evaluate the patient or disease related factors that may influence the use of one approach over another. Design: Retrospective Study (Canadian Task Force Classification II-3).
Abstracts / Journal of Minimally Invasive Gynecology 24 (2017) S1–S201 Setting: Academic Community Based Hospital. Patients: Patients undergoing minimally invasive hysterectomy (daVinci or conventional laparoscopy) for benign indications from January 2015 to July 2016. Intervention: Use of conventional laparoscopy, multiport daVinci or singlesite daVinci platform for benign hysterectomy by a single surgeon, proficient in all 3 techniques. Measurements and Main Results: A total of 129 patients were identified and divided into 3 groups based on the surgical approach utilized; LSC (n = 44), MP-Rob (n = 36) and SS-Rob (n = 49). Patient factors and perioperative outcomes were compared using descriptive and nonparametric statistics as appropriate. There were statistically significant differences between groups in age (MP-Rob 46 ≠ LSC 39), BMI (MP-Rob 33 ≠ LSC 27 or SS-Rob 26.8), uterus weight in grams (MP-Rob 144 ≠ LSC 102 or SS-Rob 105), and operative time in minutes (LSC 192 ≠ SS-Rob 162.3 or MP-Rob 163). Length of stay (LOS) and estimated blood loss were not significantly different across surgery type. Chi-square analyses revealed history of endometriosis and presence of clinical endometriosis was statistically less common in MP-Rob, abnormal uterine bleeding was statistically less common in LSC and leiomyomas were statistically more common in MP-Rob. There was no statistically significant difference noted between intra-op and post-operative complications between different surgical types. Conclusion: Patients with higher age, BMI, uterus weight and abnormal uterine bleeding were noted to undergo multi-port robotic surgery. Operative time was significantly less for davinci hysterectomies (single-site and multiport) as compared to conventional laparoscopy. Patients with history of endometriosis were more likely to undergo conventional laparoscopy or single-site robotic surgery. There was no significant difference in perioperative outcomes of patients when LOS, EBL and complications were compared.
393
Virtual Posters – Session 2 (12:45 PM–1:45 PM) 12:45 PM – STATION G
A Randomized Controlled Trial Comparing Horizontal vs Vertical Cuff Closure During Laparoscopic Hysterectomy: Impacts on Total Vaginal Length and Sexual Function Pacis MM,1 Harkins G,1 Stetter C,2 Kunselman A,2 Benton A,1 Deimling T1. 1Department of Obstetrics and Gynecology, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania; 2 Department of Public Health and Sciences, Penn State Health Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, Pennsylvania Study Objective: To evaluate whether horizontal (HC) versus vertical (VC) vaginal cuff closure at the time of total laparoscopic hysterectomy (TLH)
Table 1. Baseline and postoperative TVL by vaginal cuff closure method Randomization
Horizontal Closure (HC) Baseline
n
Mean TVL (cm)
35
9.26
≥8 weeks postop Vertical Closure (VC) Baseline
34
8.26
34
8.93
≥8 weeks postop
32
8.44
* Based on prelimary data.
Mean TVL (cm) Change (95% CI)
p-value
−1.009 (−1.424, −0.593)
<.0001
−0.433 (−0.859, −0.006)
0.047
S133
best preserved vaginal length (TVL) and examine the impact of cuff closure method on female sexual function. Design: Single-blinded randomized controlled study. Setting: Academic tertiary care center. Patients: Women undergoing TLH for benign indications were consented and randomized to the HC or VC group. Intervention: TVL was measured at the time of TLH, prior to incision. Baseline female sexual function was assessed prior to surgery using the Female Sexual Function Index (FSFI), a 19-item validated questionnaire. Participants were randomized to either the HC or VC group intraoperatively. TVL was re-measured ≥8 weeks postoperatively. The FSFI was readministered at six and 12-months following TLH to reassess sexual function.
Fig. 1. FSFI Domain Scores and Full Scale Score.
Measurements and Main Results: Sixty-nine women were included in the study – 35 randomized to the HC group and 34 to the VC group. Of these, postoperative TVL was measured for 34 women in the HC group and 32 in the VC group. The mean change in postoperative TVL was −1.01 cm (95%CI −1.42–−0.59) in the HC group and −0.43 cm (95%CI −0.86– −0.01) in the VC group. There was a statistically significant change in preoperative versus postoperative TVL for both the HC and VC groups (p < .0001 and p < .05, respectively), though the difference in TVL between groups was marginal (p < .06). FSFI scores increased in the HC group, but decreased in the VC group. However, the change in FSFI scores from baseline to 6 months and 12 months following TLH did not reach statistical significance (p = .47 and p = .2, respectively). Conclusion: While both vertical and horizontal cuff closure methods resulted in decreased TVL, vertical closure better preserved TVL. Both vaginal cuff closure methods demonstrated similar outcomes in both TVL and longterm female sexual function.
Table 2. Change in FSFI scores from baseline to 6 and 12 months following TLH*,† Randomization
Horizontal Closure (HC) Baseline 6 months postop 12 months postop Vertical Closure (VC) Baseline 6 months postop 12 months postop
n
Baseline Mean FSFI Score Mean Change (95% CI) FSFI Score
p-value
35 26.73 30 26.79 23 27.71
−1.42 (−4.14, 1.31) 0.53 (−2.47, 3.53)
34 25.89 30 24.28 26 23.31
−0.001 (−2.73, 2.72) 0.31 −2.16 (−5.03, 0.7) 0.14
* Based on prelimary data. † FSFI score of ≥ 26.55 indicates sexual dysfunction.
0.99 0.73
Abstracts / Journal of Minimally Invasive Gynecology 24 (2017) S1–S201 Virtual Posters – Session 2 (12:45 PM–1:45 PM) 12:45 PM – STATION C
Utility of Anesthetic Block for Endometrial Ablation Pain: A Randomized Controlled Trial Klebanoff J, Patel NR, Sloan NL. Christiana Care Health System, Newark, Delaware Study Objective: To evaluate whether local anesthetic, in combination with general anesthesia, affects postoperative pain following endometrial ablation. Design: Single-blind randomized controlled trial. Setting: Academic-affiliated community hospital. Patients: English speaking premenopausal women, aged 30–55 years, undergoing outpatient endometrial ablation for benign disease. Intervention: Standardized paracervical injection of 20 mL 0.25% Bupivacaine or 20 mL Normal Saline at ablation completion. Measurements and Main Results: Between April 2016 and February 2017 108 women scheduled for endometrial ablation were screened (refusals n = 21, ineligible n = 3). Of the 84 randomized, 2 women <35 years were excluded. Intent-to-treat analyses included one incorrect randomization and 3 women having no ablation due to operative difficulties. Three were lost to follow-up. Two-tailed t-tests show treatment group patients experienced lower one hour postoperative visual analog pain scores than the control group(p = .02).The difference diminished by four hours and was negligible by eight hours (n.s.). Treatment group patients used less postoperative pain medication (p = .05). Backward stepwise logistic regressions controlled for confounding reduced the one hour postoperative treatment group pain score difference to 0.8 (CI −.6–.1) and the average postoperative morphine equivalents to 3.7 (CI −6.8–−.7). Table 1. Primary and secondary outcomes (unequal variances assumed)
1 Hour Pain Score 4 Hour Pain Score 8 Hour Pain Score Total Blood Loss (mL) Total Morphine Equivalents Total Day 1 Tylenol with Codeine Hours Between Surgery Initiation and Discharge
Study Group Control % or N Mean±SD
Treatment % or Mean±SD
N
p
2.71 ± 2.47 3.37 ± 2.48 2.47 ± 2.17 6.38 ± 3.70 7.80 ± 8.45 9.18 ± .98
41 38 38 37 41 38
1.44 ± 2.32 2.81 ± 2.22 2.24 ± 1.83 7.15 ± 6.06 4.41 ± 6.97 8.74 ± 1.52
41 37 37 33 41 38
.019 .31 .62 .53 .051 .13
1.63 ± 0.73
41
1.59 ± 0.55
41
.73
Conclusion: Low risk local anesthetic, utilized in conjunction with general anesthesia, decreases postoperative pain at one hour and postoperative narcotic use following endometrial ablation.
her first (11/20/2016) hospital visit ultrasonography showed only a singleton 8-week intrauterin fetus. LMP : 09/28/2016 The patient got pregnant by natural conception. Blood Pressure: 110/80 mm/Hg. During 2nd fetal ultrasonographic examination obstetrican measured a singleton 13-week intrauterin fetus but also found a 13-week extrauterine fetus on the right adnexial place. The patient was operated same day by laparoscopy. One 10 mm umbilical and two 5 mm auxiliary trocars were used. Pathologic specimen was extracted via 10 mm umbilical trocar site without enlarging any of 5 mm auxiliary trocar sites.
391
Virtual Posters – Session 2 (12:45 PM–1:45 PM) 12:45 PM – STATION E
A Clinical Observation of Preoperative Adjuvant Therapy for Intrauterine Adhesions Wu Y, Feng L. Ob/Gyn, Beijing Tiantan Hospital, The Capital Medical Univeristy, Beijing, China Study Objective: To study the clinical observation of estrogen, progesterone and vasodilator in the treatment of moderate to severe intrauterine adhesions. Design: Randomized, single-arm study. Setting: One university teaching hospital. Patients: 120 Patients with moderate to severe intrauterine adhesions, be compared before and after medicine treatment. Intervention: Estrogen, progesterone and vasodilator used for 3 cycles. Measurements and Main Results: 1. Course of the disease and the number of previous uterine cavity operations were correlated with severe adhesion (p < .05). Severe adhesion has no correlation with age and etiology (p > .05); 2. Changes in AFS score, endometrial thickness, endometrial hemodynamic parameters PI, RI, S/D before and after medicine treatment were statistically significant (p < .01); 3. After treatment, menstrual improvement rate was 84.35%. PBAC analyzed by paired t-test had statistically significance (p < .01); 4. 6 factors: course of disease, degree of adhesions, AFS score, menstrual mode, endometrial thickness and endometrial blood flow were significantly correlated with pregnancy (p < .05); 5. The type of endometrial blood flow (p = .001), the postmenopausal model (p = .04), and the endometrial thickness (p = .05) are independent factors that affecting pregnancy. Conclusion: After treatment, the thickness of endometrium and blood flow type were improved; blood flow resistance decreased; menstrual recovery and pregnancy rate improved. Physiological dose of hormone therapy combined with aspirin, vitamin C, vitamin E and Kirin pills to promote endometrial growth and vasodilator in patients with moderate to severe intrauterine adhesions is effective, safe and reliable thus can be extended in clinical practice.
392
Virtual Posters – Session 2 (12:45 PM–1:45 PM)
LAPAROSCOPY – CONVENTIONAL 12:45 PM – STATION F 390
Virtual Posters – Session 2 (12:45 PM–1:45 PM) 12:45 PM – STATION D
A 13-Week Heterotopic Pregnancy Managed by a Minimally Invasive Approach Sanverdi I, Kilicci C, Ayvaci H, Ozkaya E, Naki MM. Ob/Gyn, Zeynep Kamil Maternity and Children’s Health Training and Research Hospital, Istanbul, Turkey A 32-year-old nulliparous (Gravida 2 Parity 1 Abortus 1) woman came to the hospital for “First Trimester Screening test”. She had no complaint. During
A Comparison of Surgical Outcomes Between SingleSite Robotic, Multiport Robotic and Conventional Laparoscopic Techniques in Performing Hysterectomy for Benign Indications Gupta N, Blevins M, Radtke S, Holcombe J, Furr RS. University of Tennessee College of Medicine, Chattanooga, Tennessee Study Objective: To compare surgical outcomes between different minimally invasive approaches utilized to perform total hysterectomy for benign indications. To evaluate the patient or disease related factors that may influence the use of one approach over another. Design: Retrospective Study (Canadian Task Force Classification II-3).
Abstracts / Journal of Minimally Invasive Gynecology 24 (2017) S1–S201 Setting: Academic Community Based Hospital. Patients: Patients undergoing minimally invasive hysterectomy (daVinci or conventional laparoscopy) for benign indications from January 2015 to July 2016. Intervention: Use of conventional laparoscopy, multiport daVinci or singlesite daVinci platform for benign hysterectomy by a single surgeon, proficient in all 3 techniques. Measurements and Main Results: A total of 129 patients were identified and divided into 3 groups based on the surgical approach utilized; LSC (n = 44), MP-Rob (n = 36) and SS-Rob (n = 49). Patient factors and perioperative outcomes were compared using descriptive and nonparametric statistics as appropriate. There were statistically significant differences between groups in age (MP-Rob 46 ≠ LSC 39), BMI (MP-Rob 33 ≠ LSC 27 or SS-Rob 26.8), uterus weight in grams (MP-Rob 144 ≠ LSC 102 or SS-Rob 105), and operative time in minutes (LSC 192 ≠ SS-Rob 162.3 or MP-Rob 163). Length of stay (LOS) and estimated blood loss were not significantly different across surgery type. Chi-square analyses revealed history of endometriosis and presence of clinical endometriosis was statistically less common in MP-Rob, abnormal uterine bleeding was statistically less common in LSC and leiomyomas were statistically more common in MP-Rob. There was no statistically significant difference noted between intra-op and post-operative complications between different surgical types. Conclusion: Patients with higher age, BMI, uterus weight and abnormal uterine bleeding were noted to undergo multi-port robotic surgery. Operative time was significantly less for davinci hysterectomies (single-site and multiport) as compared to conventional laparoscopy. Patients with history of endometriosis were more likely to undergo conventional laparoscopy or single-site robotic surgery. There was no significant difference in perioperative outcomes of patients when LOS, EBL and complications were compared.
393
Virtual Posters – Session 2 (12:45 PM–1:45 PM) 12:45 PM – STATION G
A Randomized Controlled Trial Comparing Horizontal vs Vertical Cuff Closure During Laparoscopic Hysterectomy: Impacts on Total Vaginal Length and Sexual Function Pacis MM,1 Harkins G,1 Stetter C,2 Kunselman A,2 Benton A,1 Deimling T1. 1Department of Obstetrics and Gynecology, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania; 2 Department of Public Health and Sciences, Penn State Health Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, Pennsylvania Study Objective: To evaluate whether horizontal (HC) versus vertical (VC) vaginal cuff closure at the time of total laparoscopic hysterectomy (TLH)
Table 1. Baseline and postoperative TVL by vaginal cuff closure method Randomization
Horizontal Closure (HC) Baseline
n
Mean TVL (cm)
35
9.26
≥8 weeks postop Vertical Closure (VC) Baseline
34
8.26
34
8.93
≥8 weeks postop
32
8.44
* Based on prelimary data.
Mean TVL (cm) Change (95% CI)
p-value
−1.009 (−1.424, −0.593)
<.0001
−0.433 (−0.859, −0.006)
0.047
S133
best preserved vaginal length (TVL) and examine the impact of cuff closure method on female sexual function. Design: Single-blinded randomized controlled study. Setting: Academic tertiary care center. Patients: Women undergoing TLH for benign indications were consented and randomized to the HC or VC group. Intervention: TVL was measured at the time of TLH, prior to incision. Baseline female sexual function was assessed prior to surgery using the Female Sexual Function Index (FSFI), a 19-item validated questionnaire. Participants were randomized to either the HC or VC group intraoperatively. TVL was re-measured ≥8 weeks postoperatively. The FSFI was readministered at six and 12-months following TLH to reassess sexual function.
Fig. 1. FSFI Domain Scores and Full Scale Score.
Measurements and Main Results: Sixty-nine women were included in the study – 35 randomized to the HC group and 34 to the VC group. Of these, postoperative TVL was measured for 34 women in the HC group and 32 in the VC group. The mean change in postoperative TVL was −1.01 cm (95%CI −1.42–−0.59) in the HC group and −0.43 cm (95%CI −0.86– −0.01) in the VC group. There was a statistically significant change in preoperative versus postoperative TVL for both the HC and VC groups (p < .0001 and p < .05, respectively), though the difference in TVL between groups was marginal (p < .06). FSFI scores increased in the HC group, but decreased in the VC group. However, the change in FSFI scores from baseline to 6 months and 12 months following TLH did not reach statistical significance (p = .47 and p = .2, respectively). Conclusion: While both vertical and horizontal cuff closure methods resulted in decreased TVL, vertical closure better preserved TVL. Both vaginal cuff closure methods demonstrated similar outcomes in both TVL and longterm female sexual function.
Table 2. Change in FSFI scores from baseline to 6 and 12 months following TLH*,† Randomization
Horizontal Closure (HC) Baseline 6 months postop 12 months postop Vertical Closure (VC) Baseline 6 months postop 12 months postop
n
Baseline Mean FSFI Score Mean Change (95% CI) FSFI Score
p-value
35 26.73 30 26.79 23 27.71
−1.42 (−4.14, 1.31) 0.53 (−2.47, 3.53)
34 25.89 30 24.28 26 23.31
−0.001 (−2.73, 2.72) 0.31 −2.16 (−5.03, 0.7) 0.14
* Based on prelimary data. † FSFI score of ≥ 26.55 indicates sexual dysfunction.
0.99 0.73