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Comparison of Robotic, Laparoscopic and Abdominal Myomectomy in a Community Hospital
Abstracts / Journal of Minimally Invasive Gynecology 18 (2011) S71–S90 Measurements and Main Results: Laparoscopic closure of the vaginal cuff was accomplished in all cases. Closure times ranged from 3 to 31 minutes with a mean of 9.3 and a median of 8.0 min. There was no correlation between closure times and type of hysterectomy or patient age. There was a correlation between cuff closure and BMI (P=0.004). Resident level correlated with closure times (PGY2 = 15.5 min, PGy3 = 11.0 min, PGY4 = 10.8 min, Attending = 8.3 min; P=0.02). The length of the suture was marginally correlated with closure time, with the shortest time in the 9’’ suture compared to the 12’’ suture (8.6 vs 9.8 min; P=0.06). Only one patient reported discomfort from their partner during intercourse. Although not statistically significant there were two cuff dehiscences with 90 day absorbable suture and none with the 180 day suture (P = 0.2). Conclusion: Barbed suturing appears to provide a very efficient means to close the vaginal cuff at the time of TLH and is associated with a low cuff dehiscence rate. Pain during intercourse after closure with this type of suture is uncommon. Although not statistically significant, the only cuff dehiscences were in women with 90 day suture.
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Open Communications 15dHysterectomy (3:38 PM d 3:43 PM)
Comparison of Robotic, Laparoscopic and Abdominal Myomectomy in a Community Hospital Gobern JM,1 Barter JF,2 Steren AJ.2 1Obstetrics and Gynecology, Walter Reed Army Medical Center, Washington, District of Columbia; 2Obstetrics and Gynecology, Holy Cross Hospital, Silver Spring, Maryland Study Objective: To evaluate operative outcomes between robotic, laparoscopic and abdominal myomectomies in a community hospital. Design: We compared robotic, laparoscopic and abdominal myomectomies from January 2007 through December 2009. All procedures were performed by a gynecologic oncologist skilled in advance laparoscopy. Demographic data and operative outcomes were collected in a retrospective review of 322 myomectomies utilizing the hospital’s electronic medical records. Setting: Washington DC area gynecologic oncology private practice and community hospital. Patients: Three hundred twenty-two women with symptomatic fibroid uterus. Intervention: Robotic, laparoscopic or abdominal myomectomy. Measurements and Main Results: We reviewed 322 consecutive myomectomies with complete data available for 308 patients including 169(54.9%) abdominal, 73(23.7%) laparoscopic and 66(21.4%) roboticassisted myomectomies. Patients were similar in age, BMI, parity and previous abdominopelvic surgery. Median operative time for robotic surgery 140(55, 328) was significantly longer when compared to laparoscopic 70(17, 218) and abdominal 72(13, 185) myomectomies (p\0.0005). Robotic and laparoscopic myomectomies had significantly less estimated blood loss when compared to abdominal myomectomy, 100, 100, 200cc, respectively (p\0.0005). Additionally, hospital stay was significantly shorter between robotic, laparoscopic and abdominal myomectomy (0, 1, 2 days, respectively) (p\0.0005). There was no significant difference in the median size of the largest myoma removed robotically 6.1cm (1.8, 18.4) as compared to laparoscopic 6.4cm (1, 14) or abdominally 6.1cm (2.2, 15). However, the median aggregate weight of myoma removed abdominally 200gm (1.4, 2682) was significantly larger than laparoscopically 115gm (1, 602) and robotically 129gm (9.4, 935) p\0.0005. Postoperative transfusion was significantly less frequent in robotic myomectomies when compared to laparoscopic and abdominal myomectomies (p\0.0005). There was no significant difference for postop complications (p=0.58). Conclusion: Robotic myomectomy demonstrated less blood loss than abdominal myomectomy as well as shorter hospital stay, and fewer transfusions than traditional laparoscopic and abdominal myomectomy. Robotic-assisted laparoscopic myomectomy offers a successful
S85
minimally-invasive alternative for management of symptomatic myoma in a community hospital setting. 276
Open Communications 15dHysterectomy (3:44 PM d 3:49 PM)
The Effect of Prior Hysterectomy on the Anterior and Posterior Vaginal Compartments in Women with Pelvic Organ Prolapse Lin SN,1 Shalom DF,2 Lind LR,2 Nosseir S,2 Winkler HA.2 1Obstetrics and Gynecology, NewYork Presbyterian Hospital Weill Cornell Medical Center, New York, New York; 2North Shore University Hospital/LIJ, Great Neck, New York Study Objective: To determine the effect of hysterectomy on the anterior and posterior vaginal compartments in women with symptomatic pelvic organ prolapse (POP). Design: Retrospective case control study. Setting: Outpatient tertiary care center. Patients: 520 patients presenting with POP between 2008 and 2011 were evaluated. 142 patients were included in the study. 71 patients in the hysterectomy group and 71 in the non hysterectomy group. The groups were matched for age and parity. No patients had a history of POP repair in either group. Intervention: POP-Q examination by a single experienced examiner. Measurements and Main Results: Mean age was 70, mean parity was 2.7. Mean BMI was 27.6 in the hysterectomy group vs. 26.3 in the non hysterectomy group (p=.1). In patients with a prior hysterectomy, 55(77.5%) had an abdominal hysterectomy, 4(5.6%) had a laparoscopic assisted vaginal hysterectomy, 3(4.2%) had a supracervical hysterectomy and 9(12.7%) had a vaginal hysterectomy. There was no difference in the rate or severity of anterior compartment prolapse between groups. Mean cystocele stage was 2.5(95%CI 2.3 to 2.8) in those with a prior hysterectomy compared to 2.4 in those without a hysterectomy (95%CI 2.2 to 2.6) p=.45. Mean rectocele stage was 1.5(95%CI 1.1 to 1.8) in those with a prior hysterectomy compared to 0.9(95%CI 0.6 to 1.2) p =.01 in those without a prior hysterectomy. 33(46.5%) of patients with a prior hysterectomy had stage 2 or greater rectocele compared to only 18(25.4%) of women without prior hysterectomy (OR 2.6 95%CI 1.3 to 5.2 p\.01). Conclusion: In our population of women with pelvic organ prolapse, having a prior hysterectomy significantly increased the likelihood of developing stage 2 or larger rectocele. There was no difference in the rate and severity of anterior compartment prolapse between groups. 277
Open Communications 15dHysterectomy (3:50 PM d 3:55 PM)
Total Laparoscopic Hysterectomy and Resident Education Sewell CA, Green IC, Kratz KG, Bienstock J. Gynecology and Obstetrics, Johns Hopkins Medicine, Baltimore, Maryland Study Objective: The purpose of this study was to evaluate the volume and outcomes of total laparoscopic hysterectomy (TLH) in Maryland by academic versus non-academic medical center to elucidate trends and provide guidance on maximizing resident exposure to the procedure. Design: Using the Maryland Health Services Cost Review Commission discharge database for 2008-2010, we identified all subjects by ICD-9 procedure code 68.41 (TLH) for benign diagnoses. Cases were compared on demographics and then stratified by type of hospital community hospital, community hospital with residency program, and academic, and then analyzed according to surgeon volume. Outcomes including length of stay (LOS), ICU stay, readmission, and death were assessed. Accreditation Council for Graduate Medical Education (ACGME) TLH numbers for a subset of residency programs in Maryland were queried for verification. Setting: Hospital discharge database. Patients: All patients undergoing hysterectomy for benign conditions in Maryland, 2008-2010.
275
Open Communications 15dHysterectomy (3:38 PM d 3:43 PM)
Comparison of Robotic, Laparoscopic and Abdominal Myomectomy in a Community Hospital Gobern JM,1 Barter JF,2 Steren AJ.2 1Obstetrics and Gynecology, Walter Reed Army Medical Center, Washington, District of Columbia; 2Obstetrics and Gynecology, Holy Cross Hospital, Silver Spring, Maryland Study Objective: To evaluate operative outcomes between robotic, laparoscopic and abdominal myomectomies in a community hospital. Design: We compared robotic, laparoscopic and abdominal myomectomies from January 2007 through December 2009. All procedures were performed by a gynecologic oncologist skilled in advance laparoscopy. Demographic data and operative outcomes were collected in a retrospective review of 322 myomectomies utilizing the hospital’s electronic medical records. Setting: Washington DC area gynecologic oncology private practice and community hospital. Patients: Three hundred twenty-two women with symptomatic fibroid uterus. Intervention: Robotic, laparoscopic or abdominal myomectomy. Measurements and Main Results: We reviewed 322 consecutive myomectomies with complete data available for 308 patients including 169(54.9%) abdominal, 73(23.7%) laparoscopic and 66(21.4%) roboticassisted myomectomies. Patients were similar in age, BMI, parity and previous abdominopelvic surgery. Median operative time for robotic surgery 140(55, 328) was significantly longer when compared to laparoscopic 70(17, 218) and abdominal 72(13, 185) myomectomies (p\0.0005). Robotic and laparoscopic myomectomies had significantly less estimated blood loss when compared to abdominal myomectomy, 100, 100, 200cc, respectively (p\0.0005). Additionally, hospital stay was significantly shorter between robotic, laparoscopic and abdominal myomectomy (0, 1, 2 days, respectively) (p\0.0005). There was no significant difference in the median size of the largest myoma removed robotically 6.1cm (1.8, 18.4) as compared to laparoscopic 6.4cm (1, 14) or abdominally 6.1cm (2.2, 15). However, the median aggregate weight of myoma removed abdominally 200gm (1.4, 2682) was significantly larger than laparoscopically 115gm (1, 602) and robotically 129gm (9.4, 935) p\0.0005. Postoperative transfusion was significantly less frequent in robotic myomectomies when compared to laparoscopic and abdominal myomectomies (p\0.0005). There was no significant difference for postop complications (p=0.58). Conclusion: Robotic myomectomy demonstrated less blood loss than abdominal myomectomy as well as shorter hospital stay, and fewer transfusions than traditional laparoscopic and abdominal myomectomy. Robotic-assisted laparoscopic myomectomy offers a successful
S85
minimally-invasive alternative for management of symptomatic myoma in a community hospital setting. 276
Open Communications 15dHysterectomy (3:44 PM d 3:49 PM)
The Effect of Prior Hysterectomy on the Anterior and Posterior Vaginal Compartments in Women with Pelvic Organ Prolapse Lin SN,1 Shalom DF,2 Lind LR,2 Nosseir S,2 Winkler HA.2 1Obstetrics and Gynecology, NewYork Presbyterian Hospital Weill Cornell Medical Center, New York, New York; 2North Shore University Hospital/LIJ, Great Neck, New York Study Objective: To determine the effect of hysterectomy on the anterior and posterior vaginal compartments in women with symptomatic pelvic organ prolapse (POP). Design: Retrospective case control study. Setting: Outpatient tertiary care center. Patients: 520 patients presenting with POP between 2008 and 2011 were evaluated. 142 patients were included in the study. 71 patients in the hysterectomy group and 71 in the non hysterectomy group. The groups were matched for age and parity. No patients had a history of POP repair in either group. Intervention: POP-Q examination by a single experienced examiner. Measurements and Main Results: Mean age was 70, mean parity was 2.7. Mean BMI was 27.6 in the hysterectomy group vs. 26.3 in the non hysterectomy group (p=.1). In patients with a prior hysterectomy, 55(77.5%) had an abdominal hysterectomy, 4(5.6%) had a laparoscopic assisted vaginal hysterectomy, 3(4.2%) had a supracervical hysterectomy and 9(12.7%) had a vaginal hysterectomy. There was no difference in the rate or severity of anterior compartment prolapse between groups. Mean cystocele stage was 2.5(95%CI 2.3 to 2.8) in those with a prior hysterectomy compared to 2.4 in those without a hysterectomy (95%CI 2.2 to 2.6) p=.45. Mean rectocele stage was 1.5(95%CI 1.1 to 1.8) in those with a prior hysterectomy compared to 0.9(95%CI 0.6 to 1.2) p =.01 in those without a prior hysterectomy. 33(46.5%) of patients with a prior hysterectomy had stage 2 or greater rectocele compared to only 18(25.4%) of women without prior hysterectomy (OR 2.6 95%CI 1.3 to 5.2 p\.01). Conclusion: In our population of women with pelvic organ prolapse, having a prior hysterectomy significantly increased the likelihood of developing stage 2 or larger rectocele. There was no difference in the rate and severity of anterior compartment prolapse between groups. 277
Open Communications 15dHysterectomy (3:50 PM d 3:55 PM)
Total Laparoscopic Hysterectomy and Resident Education Sewell CA, Green IC, Kratz KG, Bienstock J. Gynecology and Obstetrics, Johns Hopkins Medicine, Baltimore, Maryland Study Objective: The purpose of this study was to evaluate the volume and outcomes of total laparoscopic hysterectomy (TLH) in Maryland by academic versus non-academic medical center to elucidate trends and provide guidance on maximizing resident exposure to the procedure. Design: Using the Maryland Health Services Cost Review Commission discharge database for 2008-2010, we identified all subjects by ICD-9 procedure code 68.41 (TLH) for benign diagnoses. Cases were compared on demographics and then stratified by type of hospital community hospital, community hospital with residency program, and academic, and then analyzed according to surgeon volume. Outcomes including length of stay (LOS), ICU stay, readmission, and death were assessed. Accreditation Council for Graduate Medical Education (ACGME) TLH numbers for a subset of residency programs in Maryland were queried for verification. Setting: Hospital discharge database. Patients: All patients undergoing hysterectomy for benign conditions in Maryland, 2008-2010.