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Comparison of robot-assisted laparoscopic myomectomy (RALM) to classic robotic myomectomy
significantly increased in aneuploid relative to paired sibling euploid human embryos at the cleavage stage (n¼6 pairs; P¼0.02), but not at the blastocyst stage (n¼4 pairs; P¼0.46) of development. CONCLUSION: Increased mtDNA content is associated with elevated aneuploidy risk in sibling embryos during early development. Given that mtDNA biogenesis is quiescent prior to compaction, it is reasonable to speculate that differing mtDNA content was present during meiosis when most chromosomal errors occur. Further studies into the putative role of ROS and other aspects of energy metabolism during this interval are warranted.
REPRODUCTIVE SURGERY (SRS) O-301 Wednesday, October 27, 2010 03:45 PM COMPARISON OF ROBOT-ASSISTED LAPAROSCOPIC MYOMECTOMY (RALM) TO CLASSIC ROBOTIC MYOMECTOMY. S. S. Srouji, N. Robinson, A. R. Gargiulo. Obstetrics and Gynecology, Brigham and Women’s Hospital, Boston, MA. OBJECTIVE: To compare variables and outcomes in women who underwent standard robotic myomectomy (RM) as compared to a hybrid robot-assisted laparoscopic myomectomy (RALM). DESIGN: Retrospective cohort study. MATERIALS AND METHODS: All women who underwent a laparoscopic myomectomy with use of the robot at our Center between January 2007 and March 2010 were studied. Demographics and outcome variables were compared. Analysis was performed with t-test and the Mann Whitney Rank Sum Test. Correlation analysis was performed with Spearman rank order. p<0.05 was considered statistically significant. RESULTS: 100 women underwent a RM, and 113 women underwent a RALM. Women did not differ in regards to age or body mass index. They also had a similar number of fibroids removed (see table).
OBJECTIVE: Ovarian transplantation (OTx) with frozen-banked ovarian tissue is evolving since the first report in 1999. One of the limitations of OTx is the large follicle loss due to initial ischemia. Our aim was to develop a new surgical technique to improve tissue vascularization and graft survival with the utilization of a human regenerative matrix (alloderm, AD) and robotically assisted surgery (DaVinci). DESIGN: Experimental. MATERIALS AND METHODS: Ovarian tissue (OT)/AD integration and neo-vascularization were studied in SCID mice using AD thicknesses 0.38-2.08 mm. GV oocytes were co-cultured with AD for 24h to test for ovo-toxicity. OTx was then simulated in porcine and inanimate models. The patient was a 36-year-old breast cancer survivor. Ovarian cortical biopsies were slow frozen before chemotherapy. Because the patient experienced ovarian failure, as confirmed by multiple FSH and LH levels > 40 mIU/mL, and she desired pregnancy, we performed OTx 2 years later. Larger pieces (2x2-2x4-mm) were sutured on AD microscopically, and then grafted onto L ovary using DaVinci. Small OT pieces (1x1-1x2mm) were injected subcortically into the R ovary and the ovarian fossa, using a 14-gauge needle. Ovarian blood flow was measured by Doppler-ultrasound pre and post OTx. RESULTS: Optimal neo-vascularization, integration, and surgical handling were achieved with medium thickness (0.79-1.27 mm) AD (vascular density 27.0 5.5 vs 15.5 3.7 in controls, p< .001)., which was used for OTx. No ovo-toxicity was observed with AD (n¼28, 89% survival) vs. none (n¼26, 96% survival) (p¼0.6). Compared to preop, ovarian blood flow significantly improved in the L (RI: from 0.8 to 0.5 and PSV 16.5 to 32.6 cm/s) but not the R ovary (RI: from 0.9 to 0.8, PSV 21 to 22 cm/s), 2 wk post op. Follow up by 4 weeks showed antral follicle development in both ovaries. CONCLUSION: We described for the first time a robotically assisted OTx involving the novel use of a regenerative matrix (ROBOTx), which may improve tissue revascularization and OTx outcomes.
O-303 Wednesday, October 27, 2010 04:15 PM Robotic myomectomy vs. RALM: Comparison of Outcome variables
Parameter (median/ range)
Robotic Myomectomy
RALM
p value
Length of procedure (minutes) EBL (mL) Number of fibroids Weight of fibroids (gm) Size of largest fibroid (cm)
171.5 (88-370)
223 (97-472)
<0.001
50 (10-700) 2.5 (1-16) 102 (8-430)
200 (10-1000) 3 (1-14) 245 (37-788)
<0.001 0.206 <0.001
6 (2-12)
8.8 (3.7-15.9)
<0.001
Groups were compared using Mann Whitney Rank Sum test. p<0.05 was significant However women who underwent RALM had larger fibroids, higher specimen weight, longer operative times and more blood loss. These results did not change when accounting for the 50 case learning curve in robotic surgery. CONCLUSION: RALM allows more women with uterine fibroids to be considered for a minimally invasive surgical approach. Benefits of the RALM approach include use of a traditional laparoscopic tenaculum, full range of motion in the upper abdominal quadrants and tactile feedback. Higher blood loss observed in RALM is directly correlated to tumor burden.
O-302 Wednesday, October 27, 2010 04:00 PM IMPROVING AUTOLOGOUS OVARIAN TRANSPLANTATION WITH FROZEN-BANKED TISSUE: ROBOTIC ASSISTANCE AND THE UTILIZATION OF A HUMAN REGENERATIVE MATRIX. K. Oktay, R. Soleimani, S. Lee, S. Ozkavukcu, M. M. Brito, S. Babayev. Institute for Fertility Preservation/Department of Obstetrics & Gynecology, New York Medical College, Valhalla, NY.
FERTILITY & STERILITYÒ
INCIDENCE OF MUSCULOSKELETAL INJURIES IN ROBOTIC ASSISTED LAPAROSCOPIC SURGERY COMPARED TO CONVENTIONAL LAPAROSCOPY. G. E. Ekpo, S. Nayak, C. Fitzgerald, M. Milad. Obstetrics and Gynecology, Northwestern Memorial Hospital, Chicago, IL; Physical Medicine and Rehabilitation, Northwestern Memorial Hospital, Chicago, IL. OBJECTIVE: To determine the incidence, degree and type of musculoskeletal injuries among surgeons performing robotic assisted laparascopic surgery compared to conventional laparoscopy. DESIGN: IRB approved single institution cohort study involving surgeons who perform conventional laparoscopy and robotic assisted laparoscopy. MATERIALS AND METHODS: 8 gynecologic surgeons proficient in conventional and robotic assisted laparoscopic hysterectomy were included in this study. Data was gathered from administration of of 3 surveys as well as strength assessment performed on the individual surgeon over multiple cases. The first survey collected basic demographic information, surgical experience, as well as an assessment of baseline physical fitness and activity using the personal health information survery (PHI), or SF12. A second survey was completed before and after each case and was used to assess the degree of strain pre- and post-operatively. This survey included a visual analog scale to assess the level of strain in the neck, wrist, back and shoulder, as well as a Borg scale to assess exertional strength. A complete musculoskeletal examination was also performed in order to evaluate strength and range of motion of key body regions of common injury. This included assessment of core body strength and posture, and manual muscle strenth assessment using a dynanometer. A third survey administered post-surgery explored total operative time and description of any intra-operative techniques used to minimize strain. RESULTS: There was a difference in types of musculoskeletal strain injuries sustained by surgeons performing conventional laparoscopic hysterectomy versus robotic assisted hysterectomy. Also observed was a difference in grip strength after conventional laparoscopy, when compared to robotic assisted laparoscopy. CONCLUSION: There appears to be a significant difference in musculoskeletal strain injuries that occur among surgeons who perform conventional laparascopic hysterectomy as compared to robotic assisted hysterectomy.
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REPRODUCTIVE SURGERY (SRS) O-301 Wednesday, October 27, 2010 03:45 PM COMPARISON OF ROBOT-ASSISTED LAPAROSCOPIC MYOMECTOMY (RALM) TO CLASSIC ROBOTIC MYOMECTOMY. S. S. Srouji, N. Robinson, A. R. Gargiulo. Obstetrics and Gynecology, Brigham and Women’s Hospital, Boston, MA. OBJECTIVE: To compare variables and outcomes in women who underwent standard robotic myomectomy (RM) as compared to a hybrid robot-assisted laparoscopic myomectomy (RALM). DESIGN: Retrospective cohort study. MATERIALS AND METHODS: All women who underwent a laparoscopic myomectomy with use of the robot at our Center between January 2007 and March 2010 were studied. Demographics and outcome variables were compared. Analysis was performed with t-test and the Mann Whitney Rank Sum Test. Correlation analysis was performed with Spearman rank order. p<0.05 was considered statistically significant. RESULTS: 100 women underwent a RM, and 113 women underwent a RALM. Women did not differ in regards to age or body mass index. They also had a similar number of fibroids removed (see table).
OBJECTIVE: Ovarian transplantation (OTx) with frozen-banked ovarian tissue is evolving since the first report in 1999. One of the limitations of OTx is the large follicle loss due to initial ischemia. Our aim was to develop a new surgical technique to improve tissue vascularization and graft survival with the utilization of a human regenerative matrix (alloderm, AD) and robotically assisted surgery (DaVinci). DESIGN: Experimental. MATERIALS AND METHODS: Ovarian tissue (OT)/AD integration and neo-vascularization were studied in SCID mice using AD thicknesses 0.38-2.08 mm. GV oocytes were co-cultured with AD for 24h to test for ovo-toxicity. OTx was then simulated in porcine and inanimate models. The patient was a 36-year-old breast cancer survivor. Ovarian cortical biopsies were slow frozen before chemotherapy. Because the patient experienced ovarian failure, as confirmed by multiple FSH and LH levels > 40 mIU/mL, and she desired pregnancy, we performed OTx 2 years later. Larger pieces (2x2-2x4-mm) were sutured on AD microscopically, and then grafted onto L ovary using DaVinci. Small OT pieces (1x1-1x2mm) were injected subcortically into the R ovary and the ovarian fossa, using a 14-gauge needle. Ovarian blood flow was measured by Doppler-ultrasound pre and post OTx. RESULTS: Optimal neo-vascularization, integration, and surgical handling were achieved with medium thickness (0.79-1.27 mm) AD (vascular density 27.0 5.5 vs 15.5 3.7 in controls, p< .001)., which was used for OTx. No ovo-toxicity was observed with AD (n¼28, 89% survival) vs. none (n¼26, 96% survival) (p¼0.6). Compared to preop, ovarian blood flow significantly improved in the L (RI: from 0.8 to 0.5 and PSV 16.5 to 32.6 cm/s) but not the R ovary (RI: from 0.9 to 0.8, PSV 21 to 22 cm/s), 2 wk post op. Follow up by 4 weeks showed antral follicle development in both ovaries. CONCLUSION: We described for the first time a robotically assisted OTx involving the novel use of a regenerative matrix (ROBOTx), which may improve tissue revascularization and OTx outcomes.
O-303 Wednesday, October 27, 2010 04:15 PM Robotic myomectomy vs. RALM: Comparison of Outcome variables
Parameter (median/ range)
Robotic Myomectomy
RALM
p value
Length of procedure (minutes) EBL (mL) Number of fibroids Weight of fibroids (gm) Size of largest fibroid (cm)
171.5 (88-370)
223 (97-472)
<0.001
50 (10-700) 2.5 (1-16) 102 (8-430)
200 (10-1000) 3 (1-14) 245 (37-788)
<0.001 0.206 <0.001
6 (2-12)
8.8 (3.7-15.9)
<0.001
Groups were compared using Mann Whitney Rank Sum test. p<0.05 was significant However women who underwent RALM had larger fibroids, higher specimen weight, longer operative times and more blood loss. These results did not change when accounting for the 50 case learning curve in robotic surgery. CONCLUSION: RALM allows more women with uterine fibroids to be considered for a minimally invasive surgical approach. Benefits of the RALM approach include use of a traditional laparoscopic tenaculum, full range of motion in the upper abdominal quadrants and tactile feedback. Higher blood loss observed in RALM is directly correlated to tumor burden.
O-302 Wednesday, October 27, 2010 04:00 PM IMPROVING AUTOLOGOUS OVARIAN TRANSPLANTATION WITH FROZEN-BANKED TISSUE: ROBOTIC ASSISTANCE AND THE UTILIZATION OF A HUMAN REGENERATIVE MATRIX. K. Oktay, R. Soleimani, S. Lee, S. Ozkavukcu, M. M. Brito, S. Babayev. Institute for Fertility Preservation/Department of Obstetrics & Gynecology, New York Medical College, Valhalla, NY.
FERTILITY & STERILITYÒ
INCIDENCE OF MUSCULOSKELETAL INJURIES IN ROBOTIC ASSISTED LAPAROSCOPIC SURGERY COMPARED TO CONVENTIONAL LAPAROSCOPY. G. E. Ekpo, S. Nayak, C. Fitzgerald, M. Milad. Obstetrics and Gynecology, Northwestern Memorial Hospital, Chicago, IL; Physical Medicine and Rehabilitation, Northwestern Memorial Hospital, Chicago, IL. OBJECTIVE: To determine the incidence, degree and type of musculoskeletal injuries among surgeons performing robotic assisted laparascopic surgery compared to conventional laparoscopy. DESIGN: IRB approved single institution cohort study involving surgeons who perform conventional laparoscopy and robotic assisted laparoscopy. MATERIALS AND METHODS: 8 gynecologic surgeons proficient in conventional and robotic assisted laparoscopic hysterectomy were included in this study. Data was gathered from administration of of 3 surveys as well as strength assessment performed on the individual surgeon over multiple cases. The first survey collected basic demographic information, surgical experience, as well as an assessment of baseline physical fitness and activity using the personal health information survery (PHI), or SF12. A second survey was completed before and after each case and was used to assess the degree of strain pre- and post-operatively. This survey included a visual analog scale to assess the level of strain in the neck, wrist, back and shoulder, as well as a Borg scale to assess exertional strength. A complete musculoskeletal examination was also performed in order to evaluate strength and range of motion of key body regions of common injury. This included assessment of core body strength and posture, and manual muscle strenth assessment using a dynanometer. A third survey administered post-surgery explored total operative time and description of any intra-operative techniques used to minimize strain. RESULTS: There was a difference in types of musculoskeletal strain injuries sustained by surgeons performing conventional laparoscopic hysterectomy versus robotic assisted hysterectomy. Also observed was a difference in grip strength after conventional laparoscopy, when compared to robotic assisted laparoscopy. CONCLUSION: There appears to be a significant difference in musculoskeletal strain injuries that occur among surgeons who perform conventional laparascopic hysterectomy as compared to robotic assisted hysterectomy.
S89