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Length of Hospital Stay Following Laparoscopic Versus Mini-Laparotomy Hysterectomy
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Abstracts / Journal of Minimally Invasive Gynecology 18 (2011) S47–S70
cervical stromal invasion. The patient was thus unstaged and returned to the operating room for a robotic-assisted radical parametrectomy, upper vaginectomy, bilateral salpingo-oophorectomy with pelvic and para-aortic lymph-node dissection. The post-operative course was uncomplicated and the patient was discharged home on post-operative day number one. On final pathology, all surgical specimens were free of disease and the patient was dispositioned to observation, with follow up in 3 months. For patients with an unexpected histopathologic diagnosis of endometrial cancer following inadequate primary surgery, standardized treatment recommendations do not exist. Treatment options include radiotherapy or re-operation with radical parametrectomy, upper vaginectomy and pelvic and para-aortic lymphadenectomy. Radiotherapy carries the risk of premature ovarian failure and radiation-related bowel, bladder and vaginal complications. Furthermore, in cases of incidental malignant findings, only a minority of patients will be discovered to require radiation therapy if re-operation and complete surgical staging are preformed. However, without knowledge of the true extent of disease, it is not possible to determine the appropriate therapeutic approach and patients are at risk for both under and over treatment. Re-operation with surgical staging accrues additional information that allows treatment to be individualized and appropriate to disease severity. Conclusion: Robotic radical parametrectomy with lymphadenectomy can be safe and efficacious in a patient diagnosed with endometrial cancer following an inadequate primary surgery. 194
195
Open Communications 10dLaparoscopy (12:11 PM d 12:16 PM)
Laparoscopic Creation of Neovagina by Vecchietti’s Technique Gomez NA, Uppal S, Shehu G, Chatwani A, Quintero-Arias C. Department of Obstetrics and Gynecology, Temple University Hospital, Philadelphia, Pennsylvania Study Objective: The aim of this case report is to describe the laparoscopic Vecchietti technique for creation of a vagina in vaginal agenesis. Design: Case Report Setting: Temple University Hospital Patients: One Intervention: Laparoscopic Vecchietti Technique Measurements and Main Results: After general anesthesia, patient was placed in dorsolithotomy, foley catheter was inserted, and exam revealed a 1 cm blind vaginal pouch and Tanner Stage IV female phenotype (Figure 1A). Instruments used were a traction device (Figure 1C), a curved suture carrier, and an olive (Figure 1D). Upon abdominal entry, the laparoscope revealed bilateral ovaries with rudimentary ends of fallopian tubes and an absent uterus (Figure 2a-c). Under direct visualization, nonabsorbable
Open Communications 10dLaparoscopy (12:05 PM d 12:10 PM)
Length of Hospital Stay Following Laparoscopic Versus MiniLaparotomy Hysterectomy Calhoun A,2 Idowu D,1 Pressman A,3 Perron-Burdick M,1 Zaritsky E.1 1 OB/GYN, Kaiser Permanente Oakland Medical Center, Oakland, California; 2OB/GYN, Kaiser Permanente Oakland Medical Center, Richmond, California; 3Division of Research, Kaiser Permanente Northern California, Oakland, California Study Objective: To date, there have been no large published investigations evaluating key differences between laparoscopic hysterectomy (LH) and minilaparotomy hysterectomy (MH), as defined by an incision %8 cm. Our primary objective was to compare LH to MH in terms of length of stay. Secondary objectives included blood loss, surgical time, uterine weight, and re-admission rates. Design: This was a retrospective cohort study. A chart review of 576 patients with hysterectomies was conducted from a 3 month time period. The cases were identified by database chart review of procedure and diagnosis codes followed by manual chart review for specific case characteristics. Length of stay was determined by electronic hospital admission and discharge records. Baseline patient characteristics, age, BMI, blood loss, surgical time, uterine weight, and re-admission rates were extracted from the integrated electronic medical record. To compare the length of hospital stay, and other adverse events between the two groups, we used t-tests and chi-square analysis. Setting: Kaiser-Permanente-Northern-California Patients: All LH and MH performed for benign, non urogynecologic indications in Kaiser Permanente Northern California from October 2009 through December 2009. Measurements and Main Results: Our analysis demonstrated a significantly shorter hospital stay for LH compared to MH (P \0.0001). The median length of stay was, 19 hours compared to 43 hours for LH and MH respectively. Blood loss was also statistically significantly lower for LH, 126 ml, compared to MH, 241 ml, (P \0.0001). The laparoscopic group experienced a longer surgical time 197 versus 113 minutes (P\0.0001). Although not statistically significant, the uterine weights were slightly smaller for LH versus MH, 245 gm versus 301 gm. There were no significant differences between the groups with respect to age, BMI, peri-operative complications or hospital re-admissions. Conclusion: LH in comparison to MH resulted in significantly decreased length of hospital stay and less blood loss without an increase in perioperative patient morbidity.
Figure 1A. Blind vaginal pouch approximately 1cm B. Two abdominal incisions approximately 8 cm from umbilicus with nonabsorbable sutures penetrating through skin C. Vecchietti traction device with traction sutures D. Removal of Lucite olive on post-operative day 10.
Figure 2. (a-b) pelvic survey demonstrating normal ovaries bilateral with rudimentary fallopian tubes d) bilateral traction sutures in place at end of procedure.
Abstracts / Journal of Minimally Invasive Gynecology 18 (2011) S47–S70
cervical stromal invasion. The patient was thus unstaged and returned to the operating room for a robotic-assisted radical parametrectomy, upper vaginectomy, bilateral salpingo-oophorectomy with pelvic and para-aortic lymph-node dissection. The post-operative course was uncomplicated and the patient was discharged home on post-operative day number one. On final pathology, all surgical specimens were free of disease and the patient was dispositioned to observation, with follow up in 3 months. For patients with an unexpected histopathologic diagnosis of endometrial cancer following inadequate primary surgery, standardized treatment recommendations do not exist. Treatment options include radiotherapy or re-operation with radical parametrectomy, upper vaginectomy and pelvic and para-aortic lymphadenectomy. Radiotherapy carries the risk of premature ovarian failure and radiation-related bowel, bladder and vaginal complications. Furthermore, in cases of incidental malignant findings, only a minority of patients will be discovered to require radiation therapy if re-operation and complete surgical staging are preformed. However, without knowledge of the true extent of disease, it is not possible to determine the appropriate therapeutic approach and patients are at risk for both under and over treatment. Re-operation with surgical staging accrues additional information that allows treatment to be individualized and appropriate to disease severity. Conclusion: Robotic radical parametrectomy with lymphadenectomy can be safe and efficacious in a patient diagnosed with endometrial cancer following an inadequate primary surgery. 194
195
Open Communications 10dLaparoscopy (12:11 PM d 12:16 PM)
Laparoscopic Creation of Neovagina by Vecchietti’s Technique Gomez NA, Uppal S, Shehu G, Chatwani A, Quintero-Arias C. Department of Obstetrics and Gynecology, Temple University Hospital, Philadelphia, Pennsylvania Study Objective: The aim of this case report is to describe the laparoscopic Vecchietti technique for creation of a vagina in vaginal agenesis. Design: Case Report Setting: Temple University Hospital Patients: One Intervention: Laparoscopic Vecchietti Technique Measurements and Main Results: After general anesthesia, patient was placed in dorsolithotomy, foley catheter was inserted, and exam revealed a 1 cm blind vaginal pouch and Tanner Stage IV female phenotype (Figure 1A). Instruments used were a traction device (Figure 1C), a curved suture carrier, and an olive (Figure 1D). Upon abdominal entry, the laparoscope revealed bilateral ovaries with rudimentary ends of fallopian tubes and an absent uterus (Figure 2a-c). Under direct visualization, nonabsorbable
Open Communications 10dLaparoscopy (12:05 PM d 12:10 PM)
Length of Hospital Stay Following Laparoscopic Versus MiniLaparotomy Hysterectomy Calhoun A,2 Idowu D,1 Pressman A,3 Perron-Burdick M,1 Zaritsky E.1 1 OB/GYN, Kaiser Permanente Oakland Medical Center, Oakland, California; 2OB/GYN, Kaiser Permanente Oakland Medical Center, Richmond, California; 3Division of Research, Kaiser Permanente Northern California, Oakland, California Study Objective: To date, there have been no large published investigations evaluating key differences between laparoscopic hysterectomy (LH) and minilaparotomy hysterectomy (MH), as defined by an incision %8 cm. Our primary objective was to compare LH to MH in terms of length of stay. Secondary objectives included blood loss, surgical time, uterine weight, and re-admission rates. Design: This was a retrospective cohort study. A chart review of 576 patients with hysterectomies was conducted from a 3 month time period. The cases were identified by database chart review of procedure and diagnosis codes followed by manual chart review for specific case characteristics. Length of stay was determined by electronic hospital admission and discharge records. Baseline patient characteristics, age, BMI, blood loss, surgical time, uterine weight, and re-admission rates were extracted from the integrated electronic medical record. To compare the length of hospital stay, and other adverse events between the two groups, we used t-tests and chi-square analysis. Setting: Kaiser-Permanente-Northern-California Patients: All LH and MH performed for benign, non urogynecologic indications in Kaiser Permanente Northern California from October 2009 through December 2009. Measurements and Main Results: Our analysis demonstrated a significantly shorter hospital stay for LH compared to MH (P \0.0001). The median length of stay was, 19 hours compared to 43 hours for LH and MH respectively. Blood loss was also statistically significantly lower for LH, 126 ml, compared to MH, 241 ml, (P \0.0001). The laparoscopic group experienced a longer surgical time 197 versus 113 minutes (P\0.0001). Although not statistically significant, the uterine weights were slightly smaller for LH versus MH, 245 gm versus 301 gm. There were no significant differences between the groups with respect to age, BMI, peri-operative complications or hospital re-admissions. Conclusion: LH in comparison to MH resulted in significantly decreased length of hospital stay and less blood loss without an increase in perioperative patient morbidity.
Figure 1A. Blind vaginal pouch approximately 1cm B. Two abdominal incisions approximately 8 cm from umbilicus with nonabsorbable sutures penetrating through skin C. Vecchietti traction device with traction sutures D. Removal of Lucite olive on post-operative day 10.
Figure 2. (a-b) pelvic survey demonstrating normal ovaries bilateral with rudimentary fallopian tubes d) bilateral traction sutures in place at end of procedure.