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Comparison between Robot-Assisted Laparoscopic Hysterectomy and Total Laparoscopic Hysterectomy – A Cohort Study
S20
Abstracts / Journal of Minimally Invasive Gynecology 16 (2009) S1eS51
Setting: South Miami Hospital. Patients: A total of 63 female patients, 21 and older, with cervical cancer. Intervention: Prospective analysis of thirty-two consecutive patients undergoing robotic radical hysterectomy were compared to 17 patients undergoing laparoscopic radical hysterectomy and 14 patients undergoing radical abdominal hysterectomy. Measurements and Main Results: Operative time for the robotic group was 2.4 hours 0.8 and not significantly different from the laparoscopic group at 2.2 hours 0.7, nor the laparotomy group (1.9 hours 0.6, p 5 0.05). The estimated blood loss for patients undergoing robotic hysterectomy was 130 cc 119.4. This was significantly less than the laparotomy group (621.4 mL 294.0, p ! 0.0001), but not the laparoscopic group (209.4 mL 169.9, p 5 0.09). The robotic group had an average of 32.4 total nodes retrieved, as compared to 18.6 and 25.7 nodes retrieved in the laparoscopy and laparotomy cohorts, respectively. All differences were significant (p ! 0.0001 and p ! 0.05). Mean length of hospital stay was 2.6, 2.3 and 4.0 days in the robotic, laparoscopic, and laparotomy cohorts respectively. The incidence of postoperative complications was less in the robotic cohort (18.8%) as compared to the laparoscopic (23.5%), and laparotomy cohorts (28.6%). Table 2 Comparison of intraoperative and postoperative complications and blood transfusions rates for radical hysterectomy; robotic, laparoscopic and laparotomy Robotic Laparoscopic Laparotomy (n 5 32) (n 5 17) (n 5 14) Intraoperative Complications Cystotomy Total intraoperative incidence, n (%) Postoperative COPD/Atelectasis Fever Hypokalemia Ileus Ileus/Wound Cellulitis Pelvic abscess Pneumonia SVT Ureter Dilation Urine Retention UV Fistula Vaginal Evisceration Total postoperative complications, n (%) Blood Transfusions, n (%)
1 1/32 (3.1%)
2 2 (11.8%)
-
1 1 1 1 1 1 6/32 (18.8%) 1 (3.13%)
1 1 1 1 4/17 (23.5%)
1 1 1 1 4/14 (28.6%) 5 (35.7%))
0
)p 5 0.007, Significant differences in transfusion rates between robotic and laparotomy groups Conclusion: Robotic total laparoscopic radical hysterectomy with pelvic and para aortic lymphadenectomy is feasible and may be preferable over laparoscopic or radical abdominal hysterectomy.
66
Plenary Session 4dRobotics (2:59 PM d 3:09 PM)
Comparison between Robot-Assisted Laparoscopic Hysterectomy and Total Laparoscopic Hysterectomy e A Cohort Study Sakhel K,1 Kirakosyan A,2 Lukban JC,1 Hines J.3 1Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA; 2Obstetrics and Gynecology, Synergy Medical, Michigan State University, Saginaw, MI; 3Valley OB-GYN PC, Saginaw, MI Study Objective: Laparoscopic approach currently accounts for about 10% of hysterectomies performed in the US. The aim of this study was to
compare robot-assisted laparoscopic hysterectomy (RLH) to total laparoscopic hysterectomy (TLH). Design: A cohort study. Setting: Tertiary Hospital. Patients: Female patients referred for hysterectomy. Intervention: Robot-Assisted Laparoscopic Hysterectomy (RLH) and Total Laparoscopic Hysterectomy (TLH). Measurements and Main Results: Patients who underwent RLH or TLH between January 2007 to December 2008 at two tertiary referral teaching hospitals were included. All procedures were performed by one surgeon (JH). The patients were divided into 2 groups. Group 1 patients underwent surgery at Hospital A which had a robot and underwent RLH. Group 2 patients underwent TLH at Hospital B which did not have a robot. Total induction time was the time the patient entered the room until the incision time (this did not include docking time). The total procedure time was incision to closure. There were a total of 136 hysterectomies performed of which 73 were RLH and 63 were TLH. There were no significant differences in demographics between the 2 groups. There were 3 sling procedures in the RLH group. There were 3 complications noted including 2 cystotomies in TLH group and a retained Asepto bulb in RLH group. The outcomes of the study are shown in table 1. Table 1 The Main Outcomes of the Study
BSO Weight uterus (grs) EBL Conversion to Laparotomy Induction Time (mins) Procedure Time (mins) Discharge POD#0 Discharge POD #0 and 1
RLH Group (n 5 73)
TLH Group (n 5 63)
Total (n 5 136)
21 (28.8%) 151 113 46 52
18 (28.6%) 177 160 114 101 7 (11.1%)
39 163 78 7
p
(28.7%) 0.566 137 0.276 85 !0.001 (5.1%) 0.004
27 8
21 5
24 8
!0.001
82 21
108 33
95 30
!0.001
64 (90.1%) 73 (100%)
44 (69.8%) 59 (93.7%)
108 (80.6%) 132 (97.1%)
0.003 0.044
Conclusion: Robot-assisted Laparoscopic Hysterectomy (RLH) is a safe alternative to Total Laparoscopic Hysterectomy (TLH) The total room time usage for RLH is less than that of TLH despite the fact that RLH may lengthen the induction time The mean blood loss was significantly less in the RLH group There were no conversion to laparotomy cases in the RLH group whereas there was an 11% conversion rate in the TLH group Patients in the RLH group were discharged earlier than TLH group.
67
Plenary Session 5dUrogynecology (2:15 PM d 2:25 PM)
Correlation between Contraction and Infection of Implanted Synthetic Meshes, Used for Vaginal Surgery, Using an Animal Model of Mesh Infection Mamy L,1 Letouzey V,2 Garric X,3 Lavigne JP,4 Mares P,2 de Tayrac R.2 1 Gynecology, CHU Amiens CGO, Amiens, France; 2Gynecology, CHU Caremeau, Nimes, France; 3Biopolymere, CRBA, Montpellier, France; 4 Bacteriology, INSERM ESPRI 26, Nimes, France Study Objective: The aim of the study was to highlight the link between mesh infection and shrinkage of synthetic mesh, used in vaginal surgery, in an animal validated model of meshes infection. Design: Animal model study, basic science. Setting: University hospital. Patients: Wistar rats (n 5 28). Intervention: Wistar rats, with abdominal hernia, were repaired with synthetic meshes, either non absorbable and absorbable (poly (lacticacid)94 using a validated incisionnal abdominal hernia model.
Abstracts / Journal of Minimally Invasive Gynecology 16 (2009) S1eS51
Setting: South Miami Hospital. Patients: A total of 63 female patients, 21 and older, with cervical cancer. Intervention: Prospective analysis of thirty-two consecutive patients undergoing robotic radical hysterectomy were compared to 17 patients undergoing laparoscopic radical hysterectomy and 14 patients undergoing radical abdominal hysterectomy. Measurements and Main Results: Operative time for the robotic group was 2.4 hours 0.8 and not significantly different from the laparoscopic group at 2.2 hours 0.7, nor the laparotomy group (1.9 hours 0.6, p 5 0.05). The estimated blood loss for patients undergoing robotic hysterectomy was 130 cc 119.4. This was significantly less than the laparotomy group (621.4 mL 294.0, p ! 0.0001), but not the laparoscopic group (209.4 mL 169.9, p 5 0.09). The robotic group had an average of 32.4 total nodes retrieved, as compared to 18.6 and 25.7 nodes retrieved in the laparoscopy and laparotomy cohorts, respectively. All differences were significant (p ! 0.0001 and p ! 0.05). Mean length of hospital stay was 2.6, 2.3 and 4.0 days in the robotic, laparoscopic, and laparotomy cohorts respectively. The incidence of postoperative complications was less in the robotic cohort (18.8%) as compared to the laparoscopic (23.5%), and laparotomy cohorts (28.6%). Table 2 Comparison of intraoperative and postoperative complications and blood transfusions rates for radical hysterectomy; robotic, laparoscopic and laparotomy Robotic Laparoscopic Laparotomy (n 5 32) (n 5 17) (n 5 14) Intraoperative Complications Cystotomy Total intraoperative incidence, n (%) Postoperative COPD/Atelectasis Fever Hypokalemia Ileus Ileus/Wound Cellulitis Pelvic abscess Pneumonia SVT Ureter Dilation Urine Retention UV Fistula Vaginal Evisceration Total postoperative complications, n (%) Blood Transfusions, n (%)
1 1/32 (3.1%)
2 2 (11.8%)
-
1 1 1 1 1 1 6/32 (18.8%) 1 (3.13%)
1 1 1 1 4/17 (23.5%)
1 1 1 1 4/14 (28.6%) 5 (35.7%))
0
)p 5 0.007, Significant differences in transfusion rates between robotic and laparotomy groups Conclusion: Robotic total laparoscopic radical hysterectomy with pelvic and para aortic lymphadenectomy is feasible and may be preferable over laparoscopic or radical abdominal hysterectomy.
66
Plenary Session 4dRobotics (2:59 PM d 3:09 PM)
Comparison between Robot-Assisted Laparoscopic Hysterectomy and Total Laparoscopic Hysterectomy e A Cohort Study Sakhel K,1 Kirakosyan A,2 Lukban JC,1 Hines J.3 1Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA; 2Obstetrics and Gynecology, Synergy Medical, Michigan State University, Saginaw, MI; 3Valley OB-GYN PC, Saginaw, MI Study Objective: Laparoscopic approach currently accounts for about 10% of hysterectomies performed in the US. The aim of this study was to
compare robot-assisted laparoscopic hysterectomy (RLH) to total laparoscopic hysterectomy (TLH). Design: A cohort study. Setting: Tertiary Hospital. Patients: Female patients referred for hysterectomy. Intervention: Robot-Assisted Laparoscopic Hysterectomy (RLH) and Total Laparoscopic Hysterectomy (TLH). Measurements and Main Results: Patients who underwent RLH or TLH between January 2007 to December 2008 at two tertiary referral teaching hospitals were included. All procedures were performed by one surgeon (JH). The patients were divided into 2 groups. Group 1 patients underwent surgery at Hospital A which had a robot and underwent RLH. Group 2 patients underwent TLH at Hospital B which did not have a robot. Total induction time was the time the patient entered the room until the incision time (this did not include docking time). The total procedure time was incision to closure. There were a total of 136 hysterectomies performed of which 73 were RLH and 63 were TLH. There were no significant differences in demographics between the 2 groups. There were 3 sling procedures in the RLH group. There were 3 complications noted including 2 cystotomies in TLH group and a retained Asepto bulb in RLH group. The outcomes of the study are shown in table 1. Table 1 The Main Outcomes of the Study
BSO Weight uterus (grs) EBL Conversion to Laparotomy Induction Time (mins) Procedure Time (mins) Discharge POD#0 Discharge POD #0 and 1
RLH Group (n 5 73)
TLH Group (n 5 63)
Total (n 5 136)
21 (28.8%) 151 113 46 52
18 (28.6%) 177 160 114 101 7 (11.1%)
39 163 78 7
p
(28.7%) 0.566 137 0.276 85 !0.001 (5.1%) 0.004
27 8
21 5
24 8
!0.001
82 21
108 33
95 30
!0.001
64 (90.1%) 73 (100%)
44 (69.8%) 59 (93.7%)
108 (80.6%) 132 (97.1%)
0.003 0.044
Conclusion: Robot-assisted Laparoscopic Hysterectomy (RLH) is a safe alternative to Total Laparoscopic Hysterectomy (TLH) The total room time usage for RLH is less than that of TLH despite the fact that RLH may lengthen the induction time The mean blood loss was significantly less in the RLH group There were no conversion to laparotomy cases in the RLH group whereas there was an 11% conversion rate in the TLH group Patients in the RLH group were discharged earlier than TLH group.
67
Plenary Session 5dUrogynecology (2:15 PM d 2:25 PM)
Correlation between Contraction and Infection of Implanted Synthetic Meshes, Used for Vaginal Surgery, Using an Animal Model of Mesh Infection Mamy L,1 Letouzey V,2 Garric X,3 Lavigne JP,4 Mares P,2 de Tayrac R.2 1 Gynecology, CHU Amiens CGO, Amiens, France; 2Gynecology, CHU Caremeau, Nimes, France; 3Biopolymere, CRBA, Montpellier, France; 4 Bacteriology, INSERM ESPRI 26, Nimes, France Study Objective: The aim of the study was to highlight the link between mesh infection and shrinkage of synthetic mesh, used in vaginal surgery, in an animal validated model of meshes infection. Design: Animal model study, basic science. Setting: University hospital. Patients: Wistar rats (n 5 28). Intervention: Wistar rats, with abdominal hernia, were repaired with synthetic meshes, either non absorbable and absorbable (poly (lacticacid)94 using a validated incisionnal abdominal hernia model.