- Email: [email protected]
Quality of Life after Single-Port Laparoscopic Surgery Versus Conventional Laparoscopic Surgery for Gynecologic Disease
Abstracts / Journal of Minimally Invasive Gynecology 20 (2013) S1–S49 Surgical experience was negatively associated with suture to incision distance (rs=-0.53, p=0.016). Inter-suture distance was also negatively associated with experience (rs=-0.30, p=0.22), though not statistically significant. Conclusion: In vivo distances are significantly underestimated during robotic suture placement. Interestingly, the most experienced surgeons had the worst distance estimation from the incision to the suture. This may contribute to various consequences, such as the increased vaginal dehiscence rates seen with robotic hysterectomies. Efforts must be made to increase the accuracy of minimally invasive suturing. 108
Plenary 4dRobotics (4:40 PM d 4:49 PM)
Nationwide Frequency of Robotic Sacrocolpopexy and Associated Factors Nijjar JB, Dalton V, As-Sanie S. Obstetrics & Gynecology, University of Michigan, Ann Arbor, Michigan Study Objective: To determine the nationwide frequency of robotic sacrocolpopexy and examine patient and hospital factors associated with undergoing robotic versus abdominal sacrocolpopexy. Design: Cross-sectional study using the 2010 Nationwide Inpatient Sample. The Nationwide Inpatient is the largest all-payer inpatient care database that is publically available in the United States. Multivariable statistical analysis was used to compare patient demographic information and health system factors associated with surgical route of sacrocolpopexy. This study was deemed IRB-exempt. Setting: United States. Patients: All patients undergoing sacrocolpopexy. Measurements and Main Results: Among 20,121 women who underwent a sacrocolpopexy during the study period, 2,887 (14.3%) were performed with robotic assistance. Most women undergoing sacrocolpopexy were white (83%), had higher SES status (32.2%), private insurance (52.1%), and lived in large metropolitan areas (58.3%). Most sacrocolpopexies were performed in large (69.7%), urban (93.8%), teaching (62.1%) hospitals that were privately owned (92.2%). Patient age, race, income, health insurance status, and hospital location and teaching status were not independently associated with surgical approach (p>0.05). The control/ ownership of the hospital was the only independent predictor of robotic surgery of all variables tested. The odds of robotic sacrocolpopexy were higher for patients who underwent surgery in a private, non-profit, voluntary hospital (OR 2.8, 95%CI 1.1-7.1) and lower for patients who underwent surgery at a private, investor-owned hospital (OR 4.1, 95%CI 1.3-12.7) when compared to patients at a government controlled, nonfederal, public hospital. Conclusion: Despite the clear benefits of minimally invasive surgery, the vast majority of sacrocolpopexies in the US continue to be performed through an abdominal approach. Many patient and hospital factors tested did not predict whether patients received a robotic procedure, and women of various races and socioeconomic status were equally likely to undergo a minimally invasive approach. 109
Plenary 4dRobotics (4:50 PM d 4:59 PM)
Dual Console Robotic Platforms as Novel and Extremely Effective Teaching/Learning Modalities in Collaborative Dual Specialty Cases,Resident Education and Surgeon Training Breen MT. Ob Gyn, UT Southwestern Ob GYN Austin, Austin, Texas Study Objective: Dual Console Robotic platforms provide a unique and extremely effective way to allow dual specialty collaborative surgery as illustrated by a case of post renal transplant hysterectomy with aberrant ureteral course and adhesions.The FAA model of dual cockpit safety flight instruction is contrasted with single console training of residents and training of practicing surgeons.Utilizing lickert questionairre and in depth instructor insight the percieved advantages and effectiveness of dual console platforms is examined as it relates to learner satisfaction and anxiety.Also looked at was instructor satisfaction and anxiety. The data supports the hypothesis that the dual console systems while adding an
S35
expense to an already expensive technology provide a unique and invaluable tool as evidenced by patient safety and outcomes particularly in the relatively worrisome first 20 cases of the Robotics learning curve. Design: Lickert retrospective, observational. Setting: University and private setting with resident clinic patients and private gyn,gyn onc and urogyn cases. Patients: Private, indigent, mixed demographic population. Measurements and Main Results: Lickert tables conclusively supporting dual console over single inall questioned areas. Conclusion: Learning institutions can use this data to help justify dual consoles for teaching. 110
Open Communications 7dLaparoscopy (3:20 PM d 3:25 PM)
Menstrual Blood Loss Reduction in Subjects with Intramural Uterine Fibroids Treated by Radiofrequency Volumetric Thermal Ablation (RFVTA) Isaacson KB,1 Galen DI,2 Lee BB.3 1Newton-Wellesley Hospital, Newton, Massachusetts; 2Reproductive Science Center of the San Francisco Bay Area, San Ramon, California; 3Halt Medical Inc., Brentwood, California Study Objective: To evaluate the effect intramural fibroids have upon menstrual bleeding. Design: Retrospective analysis of a recently completed prospective trial of laparoscopic ultrasound-guided RFVTA in which 135 subjects had objectively measured heavy menstrual bleeding and confirmed submucosal, intramural and subserosal fibroids. We analyzed the pretreatment monthly menstrual blood loss and response to treatment based on the types of fibroids. Setting: Outpatient hospital and private surgery centers. Patients: Premenopausal women (mean age, 42.4 4.5 years; mean BMI, 30.5 6.2) with symptomatic uterine fibroids and objectively confirmed heavy menstrual bleeding (R160 to %500 mL). Intervention: Laparoscopic ultrasound-guided RFVTA. Measurements and Main Results: Menstrual blood loss (MBL) at baseline and at 12 months postprocedure was quantified in 122 subjects with intramural fibroids (including those that abutted the endometrium, those that were within the myometrium, and those that extended from the serosa into the myometrium) and/or submucous fibroids. Although 91.8% (112/122) of these subjects had one or more intramural fibroids, submucous fibroids were present in fewer than half of the subjects (48.4%, 59/122). We identified 10 patients who had submucous but no intramural fibroids. This group had a significant (-45.1%) posttreatment decrease in monthly bleeding (95% CI: -78.0% to -12.2%; p = .013). There were 63 subjects with intramural fibroids and no submucosal fibroids; their post-treatment decrease in MBL of -31.8% was also clinically and statistically significant (95% CI: -41.4% to -22.2%; p \ .001). A third set of patients had intramural fibroids (n = 27) without fibroids abutting the endometrium nor submucous fibroids; this third set also resulted in clinically and statistically significant reduction in menstrual blood loss: -25.0% (95% CI: -38.8% to -11.2%; p = .001). Conclusion: This is the first study to demonstrate that radiofrequency ablative therapy for intramural myomas without a submucosal component results in significant reduction in menstrual blood loss. 111
Open Communications 7dLaparoscopy (3:26 PM d 3:31 PM)
Quality of Life after Single-Port Laparoscopic Surgery Versus Conventional Laparoscopic Surgery for Gynecologic Disease Eom JM,1 Lim MC,2 Park H,3 Lee JH.4 1Obstetrics and Gynecology, National Medical Center, Seoul, Republic of Korea; 2Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, Goyang-si, Gyeonggi-do, Republic of Korea; 3Comprehensive Gynecologic Cancer Center, CHA Bundang Medical Center, CHA University, Sungnam-si, Gyunggi-do, Republic of Korea; 4Obstetrics and Gynecology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Abstracts / Journal of Minimally Invasive Gynecology 20 (2013) S1–S49
Study Objective: The aim of current study was to evaluate the quality of life(QOL) after single-port laparoscopic surgery (SP-LS) compared with conventional laparoscopic surgery (conventional LS) in patients with gynecologic benign disease. Design: Prospective case control study (Canadian Task Force Classification II-1). Setting: A university hospital and a tertiary care center. Patients: From October 2010 to December 2011, 273 women with gynecologic benign disease who fulfilled both the inclusion and exclusion criteria participated in this study; of these women, 135 were in the SP-LS group and 138 in the conventional-LS group. Intervention: Single-port laparoscopic surgery and conventional laparoscopic surgery. Measurements and Main Results: All patients were asked to the short-form (SF)-36 Health Status and the quality of life preoperatively and postoperatively on regular follow-up visit. Clinical characteristics and operative outcome were no significant. differences between the two groups. Total SF-36 questionnaire score were higher in conventional LS group at 6 months later after surgery. Significantly higher scores were found on the domains role function, bodily pain, general health, vitality, emotional well-being. Conclusion: With a follow-op of 6 months, comparison of SP-LS and conventional LS in patients with gynecologic benign disease resulted in better outcomes in the conventional LS group. However still we need longer follow up period and bigger population. 112
Open Communications 7dLaparoscopy (3:32 PM d 3:37 PM)
Does the Trendelenburg Position Actually Make Mechanical Ventilation More Difficult? A Prospective Study of Women Undergoing Major Gynecologic Laparoscopic Surgery Bates SK, Syrett A, Li J, Sobel M, Namazie A. Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada Study Objective: To determine in women undergoing major gynecologic laparoscopic surgery whether moving from the horizontal to the head-down-tilt (Trendelenburg) position results in higher airway pressures. Design: Prospective Study with concurrent data extraction at the time of surgery. Setting: Community Teaching Hospital performing over 200 major laparoscopic gynecologic laparoscopic procedures/year. Patients: Thirty sequential women undergoing major laparoscopic surgery at the Hospital for the period ending April 2013. Intervention: All women were placed in the lithotomy position and had standard general anesthetics with endotracheal intubation and volumecontrolled mechanical ventilation. The Peak Inspiratory Pressures (PIP), in cm H2O, was the metric chosen to reflect airway pressure. This was measured at the following points in the surgery: a) in the supine position with pneumoperitoneum pressures of 3, 15 and 25 mm Hg respectively and, b) with a pneumoperitoneum pressures of 15 mmHg in the degree of Trendelenburg that provided adequate exposure for the surgeon to safely start the procedure. Data was analyzed using ANOVA and multiple regression models. Measurements and Main Results: With all interventions/manoeuvres PIP equilibrated within five ventilator cycles in 100 % of women. BMI was a strong predictor of PIP at baseline (r = 0.66, p\0.0001). There was a strong positive and statistically significant linear relationship between pneumoperitoneum pressures and PIP (p\.0001). Tilting to the Trendelenburg position resulted in a trivial, 1.1 cm H2O (4%) mean increase in PIP. BMI did not have a statistically significant influence on this increase. (p=0.47). Conclusion: Pneumperitoneum pressures, but not the Trendelenburg position were strong predictors of airway pressures. In this patient population each 5 mmHg decrease in pneumperitoneum pressure caused approximately a 10 % decline in ventilator pressures. During procedures involving higher-than-ideal-ventilator pressures anesthesiologists and gynecologic surgeons should consider minimizing pneumperitoneum pressures rather than reducing the degree of Trendelenburg.
113
Open Communications 7dLaparoscopy (3:38 PM d 3:43 PM)
The Surgical Approach to Myomectomy: A Comparison of Abdominal, Laparoscopic, and Robotic Outcomes Fenster TB, Nimaroff ML, Wade LA, Schachar J, Ciampa C, Rosen L. OBGyn, North Shore University Hospital, Manhasset, New York Study Objective: To compare patient outcomes following myomectomy performed by a single practitioner over three year period using different surgical approaches; abdominal (A), laparoscopic (L) robotic (R). Outcome variables assessed were operative time, hospital stay (LOS), cost, and complications. Design: Retrospective cohort study of 149 myomectomy patients. Methods: Linear and logistic regression were used to model each outcome as a function of surgery type, age, BMI, tumor burden, number of fibroids, submucosal fibroids and prior surgery. Fisher’s exact test compared complication rates between A, L and R. Setting: North Eastern Teaching Hospital. Patients: One hundred and forty nine patients; 49 A, 49 L and 51 R (average ages A-39, L-37, R-36). Patients who had concomitant surgery at the time of myomectomy were excluded. Intervention: Myomectomies. Measurements and Main Results: Operative time was associated with surgery type (P \ 0.0001) and fibroid volume (P \ 0.0026). Larger fibroid volumes were associated with longer surgeries. R patients had significantly longer surgery times (mean = 229.79 minutes) compared to L (mean = 196.96 min.) (P \ 0.0004) and A (mean = 163.17 min.) (P \ 0.0001). L patients had significantly longer surgery times compared to A (P \ 0.0003). There was no significant association between surgery type and abnormal LOS (P \ 0.3962). Total costs were affected by surgery type and BMI. Higher BMIs were associated with higher cost (P \ 0.0110). Subjects undergoing L had lower cost (mean = $7854.73) as compared to A (mean = $9950.71) (P \ 0.0004) and R (mean = $10639.69) (P \ 0.0001). Excluding transfusions, the overall complication rate was low (1.3%). Twelve subjects (8.05%) required transfusions; A: 10 (20.41%), L 1 (2.04%) and R 1 (1.96%) (P \ 0.0008). Conclusion: Robotic myomectomies accrued the highest cost and had the longest operative times.
114
Open Communications 7dLaparoscopy (3:44 PM d 3:49 PM)
Intraoperative and Postoperative Gastrointestinal Complications Associated with Laparoscopy Versus Laparotomy in Primary Gynecologic Surgeries Desai KN, Nezhat FR. St. Luke’s Roosevelt Hospital, New York, New York Study Objective: To determine incidence of bowel injury associated with laparoscopy versus laparotomy for primary gynecologic surgeries. To elucidate the prevalence of deserosalization, enterotomy, and postoperative complications in laparotomy versus laparoscopy. Design: Retrospective cohort study. Setting: St Lukes Roosevelt, a university-affiliated hospital. Patients: Patient database was scanned for ICD9 codes congruent with bowel injury from 2007-2012. Intervention: Inclusion criteria included primary gynecologic procedures. Both benign and malignant cases were included. Exclusion criteria consisted of history of prior abdominal surgery or bowel pathology. Postoperative complication included ileus, thermal injury, or small bowel obstruction. Fisher’s exact test was used for analysis where statistical significance defined as p-value \ 0.05. Measurements and Main Results: Seven hundred and sixty one medical records were reviewed. Forty-one surgeries met both inclusion and exclusion criteria.
Plenary 4dRobotics (4:40 PM d 4:49 PM)
Nationwide Frequency of Robotic Sacrocolpopexy and Associated Factors Nijjar JB, Dalton V, As-Sanie S. Obstetrics & Gynecology, University of Michigan, Ann Arbor, Michigan Study Objective: To determine the nationwide frequency of robotic sacrocolpopexy and examine patient and hospital factors associated with undergoing robotic versus abdominal sacrocolpopexy. Design: Cross-sectional study using the 2010 Nationwide Inpatient Sample. The Nationwide Inpatient is the largest all-payer inpatient care database that is publically available in the United States. Multivariable statistical analysis was used to compare patient demographic information and health system factors associated with surgical route of sacrocolpopexy. This study was deemed IRB-exempt. Setting: United States. Patients: All patients undergoing sacrocolpopexy. Measurements and Main Results: Among 20,121 women who underwent a sacrocolpopexy during the study period, 2,887 (14.3%) were performed with robotic assistance. Most women undergoing sacrocolpopexy were white (83%), had higher SES status (32.2%), private insurance (52.1%), and lived in large metropolitan areas (58.3%). Most sacrocolpopexies were performed in large (69.7%), urban (93.8%), teaching (62.1%) hospitals that were privately owned (92.2%). Patient age, race, income, health insurance status, and hospital location and teaching status were not independently associated with surgical approach (p>0.05). The control/ ownership of the hospital was the only independent predictor of robotic surgery of all variables tested. The odds of robotic sacrocolpopexy were higher for patients who underwent surgery in a private, non-profit, voluntary hospital (OR 2.8, 95%CI 1.1-7.1) and lower for patients who underwent surgery at a private, investor-owned hospital (OR 4.1, 95%CI 1.3-12.7) when compared to patients at a government controlled, nonfederal, public hospital. Conclusion: Despite the clear benefits of minimally invasive surgery, the vast majority of sacrocolpopexies in the US continue to be performed through an abdominal approach. Many patient and hospital factors tested did not predict whether patients received a robotic procedure, and women of various races and socioeconomic status were equally likely to undergo a minimally invasive approach. 109
Plenary 4dRobotics (4:50 PM d 4:59 PM)
Dual Console Robotic Platforms as Novel and Extremely Effective Teaching/Learning Modalities in Collaborative Dual Specialty Cases,Resident Education and Surgeon Training Breen MT. Ob Gyn, UT Southwestern Ob GYN Austin, Austin, Texas Study Objective: Dual Console Robotic platforms provide a unique and extremely effective way to allow dual specialty collaborative surgery as illustrated by a case of post renal transplant hysterectomy with aberrant ureteral course and adhesions.The FAA model of dual cockpit safety flight instruction is contrasted with single console training of residents and training of practicing surgeons.Utilizing lickert questionairre and in depth instructor insight the percieved advantages and effectiveness of dual console platforms is examined as it relates to learner satisfaction and anxiety.Also looked at was instructor satisfaction and anxiety. The data supports the hypothesis that the dual console systems while adding an
S35
expense to an already expensive technology provide a unique and invaluable tool as evidenced by patient safety and outcomes particularly in the relatively worrisome first 20 cases of the Robotics learning curve. Design: Lickert retrospective, observational. Setting: University and private setting with resident clinic patients and private gyn,gyn onc and urogyn cases. Patients: Private, indigent, mixed demographic population. Measurements and Main Results: Lickert tables conclusively supporting dual console over single inall questioned areas. Conclusion: Learning institutions can use this data to help justify dual consoles for teaching. 110
Open Communications 7dLaparoscopy (3:20 PM d 3:25 PM)
Menstrual Blood Loss Reduction in Subjects with Intramural Uterine Fibroids Treated by Radiofrequency Volumetric Thermal Ablation (RFVTA) Isaacson KB,1 Galen DI,2 Lee BB.3 1Newton-Wellesley Hospital, Newton, Massachusetts; 2Reproductive Science Center of the San Francisco Bay Area, San Ramon, California; 3Halt Medical Inc., Brentwood, California Study Objective: To evaluate the effect intramural fibroids have upon menstrual bleeding. Design: Retrospective analysis of a recently completed prospective trial of laparoscopic ultrasound-guided RFVTA in which 135 subjects had objectively measured heavy menstrual bleeding and confirmed submucosal, intramural and subserosal fibroids. We analyzed the pretreatment monthly menstrual blood loss and response to treatment based on the types of fibroids. Setting: Outpatient hospital and private surgery centers. Patients: Premenopausal women (mean age, 42.4 4.5 years; mean BMI, 30.5 6.2) with symptomatic uterine fibroids and objectively confirmed heavy menstrual bleeding (R160 to %500 mL). Intervention: Laparoscopic ultrasound-guided RFVTA. Measurements and Main Results: Menstrual blood loss (MBL) at baseline and at 12 months postprocedure was quantified in 122 subjects with intramural fibroids (including those that abutted the endometrium, those that were within the myometrium, and those that extended from the serosa into the myometrium) and/or submucous fibroids. Although 91.8% (112/122) of these subjects had one or more intramural fibroids, submucous fibroids were present in fewer than half of the subjects (48.4%, 59/122). We identified 10 patients who had submucous but no intramural fibroids. This group had a significant (-45.1%) posttreatment decrease in monthly bleeding (95% CI: -78.0% to -12.2%; p = .013). There were 63 subjects with intramural fibroids and no submucosal fibroids; their post-treatment decrease in MBL of -31.8% was also clinically and statistically significant (95% CI: -41.4% to -22.2%; p \ .001). A third set of patients had intramural fibroids (n = 27) without fibroids abutting the endometrium nor submucous fibroids; this third set also resulted in clinically and statistically significant reduction in menstrual blood loss: -25.0% (95% CI: -38.8% to -11.2%; p = .001). Conclusion: This is the first study to demonstrate that radiofrequency ablative therapy for intramural myomas without a submucosal component results in significant reduction in menstrual blood loss. 111
Open Communications 7dLaparoscopy (3:26 PM d 3:31 PM)
Quality of Life after Single-Port Laparoscopic Surgery Versus Conventional Laparoscopic Surgery for Gynecologic Disease Eom JM,1 Lim MC,2 Park H,3 Lee JH.4 1Obstetrics and Gynecology, National Medical Center, Seoul, Republic of Korea; 2Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, Goyang-si, Gyeonggi-do, Republic of Korea; 3Comprehensive Gynecologic Cancer Center, CHA Bundang Medical Center, CHA University, Sungnam-si, Gyunggi-do, Republic of Korea; 4Obstetrics and Gynecology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
S36
Abstracts / Journal of Minimally Invasive Gynecology 20 (2013) S1–S49
Study Objective: The aim of current study was to evaluate the quality of life(QOL) after single-port laparoscopic surgery (SP-LS) compared with conventional laparoscopic surgery (conventional LS) in patients with gynecologic benign disease. Design: Prospective case control study (Canadian Task Force Classification II-1). Setting: A university hospital and a tertiary care center. Patients: From October 2010 to December 2011, 273 women with gynecologic benign disease who fulfilled both the inclusion and exclusion criteria participated in this study; of these women, 135 were in the SP-LS group and 138 in the conventional-LS group. Intervention: Single-port laparoscopic surgery and conventional laparoscopic surgery. Measurements and Main Results: All patients were asked to the short-form (SF)-36 Health Status and the quality of life preoperatively and postoperatively on regular follow-up visit. Clinical characteristics and operative outcome were no significant. differences between the two groups. Total SF-36 questionnaire score were higher in conventional LS group at 6 months later after surgery. Significantly higher scores were found on the domains role function, bodily pain, general health, vitality, emotional well-being. Conclusion: With a follow-op of 6 months, comparison of SP-LS and conventional LS in patients with gynecologic benign disease resulted in better outcomes in the conventional LS group. However still we need longer follow up period and bigger population. 112
Open Communications 7dLaparoscopy (3:32 PM d 3:37 PM)
Does the Trendelenburg Position Actually Make Mechanical Ventilation More Difficult? A Prospective Study of Women Undergoing Major Gynecologic Laparoscopic Surgery Bates SK, Syrett A, Li J, Sobel M, Namazie A. Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada Study Objective: To determine in women undergoing major gynecologic laparoscopic surgery whether moving from the horizontal to the head-down-tilt (Trendelenburg) position results in higher airway pressures. Design: Prospective Study with concurrent data extraction at the time of surgery. Setting: Community Teaching Hospital performing over 200 major laparoscopic gynecologic laparoscopic procedures/year. Patients: Thirty sequential women undergoing major laparoscopic surgery at the Hospital for the period ending April 2013. Intervention: All women were placed in the lithotomy position and had standard general anesthetics with endotracheal intubation and volumecontrolled mechanical ventilation. The Peak Inspiratory Pressures (PIP), in cm H2O, was the metric chosen to reflect airway pressure. This was measured at the following points in the surgery: a) in the supine position with pneumoperitoneum pressures of 3, 15 and 25 mm Hg respectively and, b) with a pneumoperitoneum pressures of 15 mmHg in the degree of Trendelenburg that provided adequate exposure for the surgeon to safely start the procedure. Data was analyzed using ANOVA and multiple regression models. Measurements and Main Results: With all interventions/manoeuvres PIP equilibrated within five ventilator cycles in 100 % of women. BMI was a strong predictor of PIP at baseline (r = 0.66, p\0.0001). There was a strong positive and statistically significant linear relationship between pneumoperitoneum pressures and PIP (p\.0001). Tilting to the Trendelenburg position resulted in a trivial, 1.1 cm H2O (4%) mean increase in PIP. BMI did not have a statistically significant influence on this increase. (p=0.47). Conclusion: Pneumperitoneum pressures, but not the Trendelenburg position were strong predictors of airway pressures. In this patient population each 5 mmHg decrease in pneumperitoneum pressure caused approximately a 10 % decline in ventilator pressures. During procedures involving higher-than-ideal-ventilator pressures anesthesiologists and gynecologic surgeons should consider minimizing pneumperitoneum pressures rather than reducing the degree of Trendelenburg.
113
Open Communications 7dLaparoscopy (3:38 PM d 3:43 PM)
The Surgical Approach to Myomectomy: A Comparison of Abdominal, Laparoscopic, and Robotic Outcomes Fenster TB, Nimaroff ML, Wade LA, Schachar J, Ciampa C, Rosen L. OBGyn, North Shore University Hospital, Manhasset, New York Study Objective: To compare patient outcomes following myomectomy performed by a single practitioner over three year period using different surgical approaches; abdominal (A), laparoscopic (L) robotic (R). Outcome variables assessed were operative time, hospital stay (LOS), cost, and complications. Design: Retrospective cohort study of 149 myomectomy patients. Methods: Linear and logistic regression were used to model each outcome as a function of surgery type, age, BMI, tumor burden, number of fibroids, submucosal fibroids and prior surgery. Fisher’s exact test compared complication rates between A, L and R. Setting: North Eastern Teaching Hospital. Patients: One hundred and forty nine patients; 49 A, 49 L and 51 R (average ages A-39, L-37, R-36). Patients who had concomitant surgery at the time of myomectomy were excluded. Intervention: Myomectomies. Measurements and Main Results: Operative time was associated with surgery type (P \ 0.0001) and fibroid volume (P \ 0.0026). Larger fibroid volumes were associated with longer surgeries. R patients had significantly longer surgery times (mean = 229.79 minutes) compared to L (mean = 196.96 min.) (P \ 0.0004) and A (mean = 163.17 min.) (P \ 0.0001). L patients had significantly longer surgery times compared to A (P \ 0.0003). There was no significant association between surgery type and abnormal LOS (P \ 0.3962). Total costs were affected by surgery type and BMI. Higher BMIs were associated with higher cost (P \ 0.0110). Subjects undergoing L had lower cost (mean = $7854.73) as compared to A (mean = $9950.71) (P \ 0.0004) and R (mean = $10639.69) (P \ 0.0001). Excluding transfusions, the overall complication rate was low (1.3%). Twelve subjects (8.05%) required transfusions; A: 10 (20.41%), L 1 (2.04%) and R 1 (1.96%) (P \ 0.0008). Conclusion: Robotic myomectomies accrued the highest cost and had the longest operative times.
114
Open Communications 7dLaparoscopy (3:44 PM d 3:49 PM)
Intraoperative and Postoperative Gastrointestinal Complications Associated with Laparoscopy Versus Laparotomy in Primary Gynecologic Surgeries Desai KN, Nezhat FR. St. Luke’s Roosevelt Hospital, New York, New York Study Objective: To determine incidence of bowel injury associated with laparoscopy versus laparotomy for primary gynecologic surgeries. To elucidate the prevalence of deserosalization, enterotomy, and postoperative complications in laparotomy versus laparoscopy. Design: Retrospective cohort study. Setting: St Lukes Roosevelt, a university-affiliated hospital. Patients: Patient database was scanned for ICD9 codes congruent with bowel injury from 2007-2012. Intervention: Inclusion criteria included primary gynecologic procedures. Both benign and malignant cases were included. Exclusion criteria consisted of history of prior abdominal surgery or bowel pathology. Postoperative complication included ileus, thermal injury, or small bowel obstruction. Fisher’s exact test was used for analysis where statistical significance defined as p-value \ 0.05. Measurements and Main Results: Seven hundred and sixty one medical records were reviewed. Forty-one surgeries met both inclusion and exclusion criteria.