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Robotic-Assisted vs Conventional Laparoscopic Hysterectomy for Endometrial Cancer
Abstracts / Journal of Minimally Invasive Gynecology 26 (2019) S1−S97
S74 Open Communications 19: Robotics (2:00 PM − 3:00 PM) 2:28 PM Single-Port Robotic-Assisted Sacrocolpopexy Using the Sp Surgical System: First Clinical Experience Lee SR,1,* KIM S,2 Chae H,3 Kang BM3. 1Obstetrics and Gynecology, Seoul Asan Medical Center, Seoul, Korea, Republic of (South); 2Obstetrics and Gynecology, University of Ulsan College of Medicine, Seoul Asan Medical Center, Seoul, Korea, Republic of (South); 3University of Ulsan College of Medicine, Seoul Asan Medical Center, Seoul, Korea, Republic of (South) *Corresponding author. Study Objective: To describe the result of robotic-assisted single port sacÒ rocolpopexy (SCP) using the da Vinci SP surgical system. Design: Retrospective case series study Setting: Robot Surgery Center of Ewha Womans University Hospital. Patients or Participants: 7 patients with advanced pelvic organ prolapse (POP-Q stage III and IV). Ò Interventions: Robotic-assisted single port SCP using the da Vinci SP th surgical system performed by a single surgeon from January 8 -28th 2019. Ò Measurements and Main Results: The recently introduced da Vinci SP surgical system includes three multi-jointed wristed instruments with a fully wristed camera. This surgical system offers the patients the same cosmetic benefits and make surgeon to perform suturing and tying more easily compared to the da Vinci Single-SiteÒ platform. We present the operation results of the first seven cases of robotic-assisted single port SCP using the da Vinci SPÒ system and provide a detailed description of the technique. All consecutive cases were completed successfully without conversion. The mean patient age was 65.3 years and the mean operative time was 140.71 minutes. The mean docking time was only 2.3 min and the mean estimated blood loss was 60 mL. No operative or major postoperative complications occurred. To the best of our knowledge, this is the first report of robotic-assisted single port SCP, and we found this procedure is feasible and safe. Ò Conclusion: Robotic-assisted single port SCP using the da Vinci SP surgical system is a feasible and safe option for advanced stage pelvic organ prolapse.
SP SCP case
Age (year)
BMI (kg/m2)
Total OP time (min)
Docking time (min)
Skin incision (mm)
EBL (ml)
1 2 3 4 5 6 7 Mean
69 56 56 77 71 59 69 65.2
28.5 21.9 24.0 25.0 25.4 21.3 20.6 23.8
150 175 140 115 135 105 165 140.7
0.5 5.0 2.0 1.5 2.0 2.0 3.0 2.3
30 26 27 26 27 27 27 27.1
40 50 100 100 30 50 50 60
Open Communications 19: Robotics (2:00 PM − 3:00 PM) 2:35 PM Incidence of Post-Up Urinary Tract Infections After Routine Cystoscopy in Minimally Invasive Robotic Gynecologic Surgery Kleinberg KA,1,* Saldivar JS2. 1Burrell College of Osteopathic Medicine, Las Cruces, NM; 2Gynecologic Oncology, RGU Cancer Center, El Paso, TX *Corresponding author.
Study Objective: The aim of this study is to investigate the incidence of post-op urinary tract infections (UTIs) after routine cystoscopy in robotic-assisted gynecologic surgery and to compare the rate to reported incidence of similar gynecologic surgeries without the use of routine cystoscopy. Design: Retrospective study utilizing a single gynecologic oncologist database (July 1, 2017 to March 30, 2019) in which routine cystoscopy was performed to detect urinary tract injury following robotic total hysterectomies (RTH) for surgical treatment of benign and malignant pathologies (N= 151). Data was analyzed using Chi-square test, unpaired t-test, and bivariate correlation. Setting: Patients were in low lithotomy, Trendelenburg position for enhanced manipulation of uterus. Patients or Participants: 151 patients underwent robotic total hysterectomy with bilateral salpingo-oophorectomy and total pelvic lymphadenectomy, after which a cystoscopy was performed to evaluate integrity of ureteral function and any bladder injury. Interventions: Routine cystoscopy after surgery. Measurements and Main Results: Routine cystoscopy did not find urinary tract injuries in any of the patients. Out of 151 patients, 21 (13.9%) has post-op UTIs within 30 days of routine cystoscopy. Patients with post-op UTIs had higher median operating room time, younger age, more complex surgeries, and higher estimated blood loss (EBL) (Table 1). Patients with a post-op UTI had a higher incidence of a malignant post-op diagnosis. Increased incidence of post-op UTIs were also statistically significantly associated with longer surgery duration, p < 0.05 (Table 2). Conclusion: Younger patients with an increased EBL and longer surgeries were associated with a higher rate of post-op UTI after routine cystoscopy in robotic-assisted gynecologic surgery. UTI’s are common in women undergoing gynecologic surgery; however, the rate appears to be higher with routine cystoscopy in this small cohort. Consideration of a larger sample size merits further investigation. Open Communications 19: Robotics (2:00 PM − 3:00 PM) 2:42 PM Robotic-Assisted vs Conventional Laparoscopic Hysterectomy for Endometrial Cancer Johansson C,1,* Chan F2. 1Obstetrics and Gynaecology, Liverpool Hospital, Liverpool, NSW, Australia; 2Department of Cancer Services, Liverpool Hospital, Liverpool, NSW, Australia *Corresponding author. Introduction: The adoption of robotic surgery by Australian gynecologists has increased in the past seven years but remains dominated by the private sector. Robotic assisted laparoscopic hysterectomy (RALH) is associated with improved outcomes when compared with open surgery in women with endometrial cancer. However, the comparison of RALH with conventional laparoscopic hysterectomy (TLH) is met with conflicting data. Study Objective: To evaluate the short-term operative outcomes of patients with endometrial cancer who underwent RALH and to compare these outcomes with those of a historical cohort who underwent TLH. Design: Retrospective observational study. Setting: Tertiary public hospital in New South Wales, Australia. Patients or Participants: Outcomes of patients who underwent RALH for endometrial cancer by a single surgeon from June 2017 to November 2018 were compared with cases of TLH for endometrial cancer performed by the same surgeon from June 2013 to September 2018. Interventions: N/A Measurements and Main Results: Thirty-nine cases of RALH and 41 cases of TLH were performed for endometrial cancer. The cohorts were well-matched in age but women who underwent RALH were higher in
Abstracts / Journal of Minimally Invasive Gynecology 26 (2019) S1−S97 BMI. RALH was associated with a longer total operative time (mean 132 minutes) than TLH (mean 107 minutes). There were no intra-operative complications and no conversions to laparotomy. Three minor post-operative complications occurred in each group. The average length of stay was significantly higher in the TLH group (1.78 days vs 1.26 days) than the RALH group. Six patients (15.4%) in the RALH group were discharged on the day of surgery. Majority of cases of RALH reported <20mL EBL compared with average of 78mL for TLH, a statistically significant difference. Conclusion: The establishment of a robotic gynecological surgery program at our institution is safe and feasible. Complication rate and blood loss are low and patient recovery is excellent. Length of stay is reduced, and same-day discharge is achievable, allowing significant reductions in health care costs. Open Communications 19: Robotics (2:00 PM − 3:00 PM) 2:49 PM Retroperitoneal Approach to Laparoscopic Hysterectomy in Patient with Complete Uterus Didelphys Radtke SJ*. Obstetrics and Gynecology, Texas Tech University Health and Science Center, El Paso, TX *Corresponding author. Video Objective: Demonstrate how a retroperitoneal dissection can facilitate hysterectomy in cases of uterine anomalies Setting: University affiliated hospital Interventions: 55 year old patient presented with severe abnormal uterine bleeding and dysmenorrhea. Imaging was suspicious for a M€ullerian anomaly. A laparoscopic hysterectomy was planned. On entry into the abdomen, complete uterine didelphys was noticed. Using a retroperitoneal dissection we were able to identify all critical structures and maintain adequate hemostasis during the case, resulting in a satisfactory outcome for the patient. Conclusion: Developing the retroperitoneal space is paramount in order to successfully perform surgery in a uterus with distorted anatomy Open Communications 20: Laparoscopy (2:00 PM − 3:00 PM) 2:00 PM Laparoscopic Uterine Cerclage: A 10 Year Experience at a Tertiary Referral Centre Ma K,* Lim K, Majumder K, Edi-Osagie E. Gynaecology, Manchester Foundation Trust, Manchester, United Kingdom *Corresponding author. Study Objective: To determine the safety and efficacy of all cases of laparoscopic uterine cerclage performed in a tertiary referral center in the last 10 years. Design: Retrospective Cohort Study. Setting: Tertiary referral center and university teaching hospital. Patients or Participants: All patients who underwent laparoscopic uterine cerclage from March 2010 to March 2019. Interventions: Laparoscopic insertion of uterine cerclage. Measurements and Main Results: A total of 14 cases were identified. 14/ 14 patients presented with a history of recurrent pregnancy loss or extreme premature labor (below 26 weeks). Indication included further mid-trimester loss or extreme premature labor despite elective cervical cerclage (8/ 14), failed rescue cerclage (3/14) and a short cervix on ultrasound or failure to insert cervical cerclage (3/14). No intra-operative complications were noted. Mean operating time was 98 minutes (Range 68-124). No post-operative complications or readmissions were noted. Of the 12 patients who underwent surgery greater than 12 months ago, there were 12
S75 spontaneous conceptions (11/12 patients), 1 miscarriage and 11 livebirths after 37 weeks gestation by elective or emergency caesarean section. In the patient who suffered a miscarriage a surgical evacuation was carried out without complication. Conclusion: Laparoscopic uterine cerclage remains a novel technique with a strict inclusion criteria requiring regular surveillance and audit of outcomes. This has limited the number of cases performed and there are currently no robust randomized control trials comparing management options for women with recurrent pregnancy loss after cervical cerclage. Despite the small numbers our results indicate that this technique has a good safety profile and outcomes in livebirths rates >34 weeks are good. Our results supports expansion of this service at a regional level through multi-disciplinary assessment to enable this technique can becoming established practice.
Open Communications 20: Laparoscopy (2:00 PM − 3:00 PM) 2:07 PM Laparoscopic Specimen Containment Using a Large Isolation Bag Putman JG,* Biest SW. Obstetrics and Gynecology, Washington University In St. Louis/Barnes-Jewish Hospital, St. Louis, MO *Corresponding author. Video Objective: To demonstrate laparoscopic specimen containment for extraction using a large isolation bag inserted through the vagina. Setting: A 41-year-old G2P2 who presented with an enlarged 18 weeks size myomatous uterus desiring definitive surgical management. Interventions: Specimen placement into a large containment bag introduced into the abdomen through the vagina after total laparoscopic hysterectomy with bilateral salpingectomy. Conclusion: This video demonstrates a viable method of tissue containment for large specimens. This method allows for safe extraction and morcellation of contained specimens when required and appropriate. Open Communications 20: Laparoscopy (2:00 PM−3:00 PM) 2:14 PM The Inspire Comparative Cost Study: One-Year Medical Resource Utilization, and Payer Cost Analysis Associated with Hysterectomy and Myomectomy Compared to Sonography-Guided Transcervical Ablation for the Treatment Of Uterine Fibroids Brooks E,1 Mihalov LS,2 Delvadia D,*,3 Hudgens JL,4 Mama ST,5 Makai GE,6 Yuen M,1 Little C,1 Zambelli-Weiner A,1 Levine DJ7. 1TTi Health Research & Economics, Westminster, MD; 2Gynecology, Virginia Mason Medical Center, Seattle, WA; 3Drexel University College of Medicine, Philadelphia, PA; 4Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA; 5Ob/Gyn, Cooper Medical School of Rowan University, Camden, NJ; 6Obstetrics and Gynecology, Christiana Care Health Systems, Newark, DE; 7Gynecology Minimally Invasive Surgery, Mercy Clinical Minimally Invasive Gynecology, St. Louis, MO *Corresponding author. Study Objective: The INSPIRE study compared health care resource utilization (HCRU) and payor costs associated with transcervical radiofrequency (RF) ablation, hysterectomy, and myomectomy. Design: Data for transcervical RF ablation were derived from a prospective, multicenter, single-arm clinical trial (the SONATA trial); data for hysterectomy and myomectomy arms were derived from the Truven Health MarketScan Commercial Claims Database. Setting: 6 clinical sites in the US.
S74 Open Communications 19: Robotics (2:00 PM − 3:00 PM) 2:28 PM Single-Port Robotic-Assisted Sacrocolpopexy Using the Sp Surgical System: First Clinical Experience Lee SR,1,* KIM S,2 Chae H,3 Kang BM3. 1Obstetrics and Gynecology, Seoul Asan Medical Center, Seoul, Korea, Republic of (South); 2Obstetrics and Gynecology, University of Ulsan College of Medicine, Seoul Asan Medical Center, Seoul, Korea, Republic of (South); 3University of Ulsan College of Medicine, Seoul Asan Medical Center, Seoul, Korea, Republic of (South) *Corresponding author. Study Objective: To describe the result of robotic-assisted single port sacÒ rocolpopexy (SCP) using the da Vinci SP surgical system. Design: Retrospective case series study Setting: Robot Surgery Center of Ewha Womans University Hospital. Patients or Participants: 7 patients with advanced pelvic organ prolapse (POP-Q stage III and IV). Ò Interventions: Robotic-assisted single port SCP using the da Vinci SP th surgical system performed by a single surgeon from January 8 -28th 2019. Ò Measurements and Main Results: The recently introduced da Vinci SP surgical system includes three multi-jointed wristed instruments with a fully wristed camera. This surgical system offers the patients the same cosmetic benefits and make surgeon to perform suturing and tying more easily compared to the da Vinci Single-SiteÒ platform. We present the operation results of the first seven cases of robotic-assisted single port SCP using the da Vinci SPÒ system and provide a detailed description of the technique. All consecutive cases were completed successfully without conversion. The mean patient age was 65.3 years and the mean operative time was 140.71 minutes. The mean docking time was only 2.3 min and the mean estimated blood loss was 60 mL. No operative or major postoperative complications occurred. To the best of our knowledge, this is the first report of robotic-assisted single port SCP, and we found this procedure is feasible and safe. Ò Conclusion: Robotic-assisted single port SCP using the da Vinci SP surgical system is a feasible and safe option for advanced stage pelvic organ prolapse.
SP SCP case
Age (year)
BMI (kg/m2)
Total OP time (min)
Docking time (min)
Skin incision (mm)
EBL (ml)
1 2 3 4 5 6 7 Mean
69 56 56 77 71 59 69 65.2
28.5 21.9 24.0 25.0 25.4 21.3 20.6 23.8
150 175 140 115 135 105 165 140.7
0.5 5.0 2.0 1.5 2.0 2.0 3.0 2.3
30 26 27 26 27 27 27 27.1
40 50 100 100 30 50 50 60
Open Communications 19: Robotics (2:00 PM − 3:00 PM) 2:35 PM Incidence of Post-Up Urinary Tract Infections After Routine Cystoscopy in Minimally Invasive Robotic Gynecologic Surgery Kleinberg KA,1,* Saldivar JS2. 1Burrell College of Osteopathic Medicine, Las Cruces, NM; 2Gynecologic Oncology, RGU Cancer Center, El Paso, TX *Corresponding author.
Study Objective: The aim of this study is to investigate the incidence of post-op urinary tract infections (UTIs) after routine cystoscopy in robotic-assisted gynecologic surgery and to compare the rate to reported incidence of similar gynecologic surgeries without the use of routine cystoscopy. Design: Retrospective study utilizing a single gynecologic oncologist database (July 1, 2017 to March 30, 2019) in which routine cystoscopy was performed to detect urinary tract injury following robotic total hysterectomies (RTH) for surgical treatment of benign and malignant pathologies (N= 151). Data was analyzed using Chi-square test, unpaired t-test, and bivariate correlation. Setting: Patients were in low lithotomy, Trendelenburg position for enhanced manipulation of uterus. Patients or Participants: 151 patients underwent robotic total hysterectomy with bilateral salpingo-oophorectomy and total pelvic lymphadenectomy, after which a cystoscopy was performed to evaluate integrity of ureteral function and any bladder injury. Interventions: Routine cystoscopy after surgery. Measurements and Main Results: Routine cystoscopy did not find urinary tract injuries in any of the patients. Out of 151 patients, 21 (13.9%) has post-op UTIs within 30 days of routine cystoscopy. Patients with post-op UTIs had higher median operating room time, younger age, more complex surgeries, and higher estimated blood loss (EBL) (Table 1). Patients with a post-op UTI had a higher incidence of a malignant post-op diagnosis. Increased incidence of post-op UTIs were also statistically significantly associated with longer surgery duration, p < 0.05 (Table 2). Conclusion: Younger patients with an increased EBL and longer surgeries were associated with a higher rate of post-op UTI after routine cystoscopy in robotic-assisted gynecologic surgery. UTI’s are common in women undergoing gynecologic surgery; however, the rate appears to be higher with routine cystoscopy in this small cohort. Consideration of a larger sample size merits further investigation. Open Communications 19: Robotics (2:00 PM − 3:00 PM) 2:42 PM Robotic-Assisted vs Conventional Laparoscopic Hysterectomy for Endometrial Cancer Johansson C,1,* Chan F2. 1Obstetrics and Gynaecology, Liverpool Hospital, Liverpool, NSW, Australia; 2Department of Cancer Services, Liverpool Hospital, Liverpool, NSW, Australia *Corresponding author. Introduction: The adoption of robotic surgery by Australian gynecologists has increased in the past seven years but remains dominated by the private sector. Robotic assisted laparoscopic hysterectomy (RALH) is associated with improved outcomes when compared with open surgery in women with endometrial cancer. However, the comparison of RALH with conventional laparoscopic hysterectomy (TLH) is met with conflicting data. Study Objective: To evaluate the short-term operative outcomes of patients with endometrial cancer who underwent RALH and to compare these outcomes with those of a historical cohort who underwent TLH. Design: Retrospective observational study. Setting: Tertiary public hospital in New South Wales, Australia. Patients or Participants: Outcomes of patients who underwent RALH for endometrial cancer by a single surgeon from June 2017 to November 2018 were compared with cases of TLH for endometrial cancer performed by the same surgeon from June 2013 to September 2018. Interventions: N/A Measurements and Main Results: Thirty-nine cases of RALH and 41 cases of TLH were performed for endometrial cancer. The cohorts were well-matched in age but women who underwent RALH were higher in
Abstracts / Journal of Minimally Invasive Gynecology 26 (2019) S1−S97 BMI. RALH was associated with a longer total operative time (mean 132 minutes) than TLH (mean 107 minutes). There were no intra-operative complications and no conversions to laparotomy. Three minor post-operative complications occurred in each group. The average length of stay was significantly higher in the TLH group (1.78 days vs 1.26 days) than the RALH group. Six patients (15.4%) in the RALH group were discharged on the day of surgery. Majority of cases of RALH reported <20mL EBL compared with average of 78mL for TLH, a statistically significant difference. Conclusion: The establishment of a robotic gynecological surgery program at our institution is safe and feasible. Complication rate and blood loss are low and patient recovery is excellent. Length of stay is reduced, and same-day discharge is achievable, allowing significant reductions in health care costs. Open Communications 19: Robotics (2:00 PM − 3:00 PM) 2:49 PM Retroperitoneal Approach to Laparoscopic Hysterectomy in Patient with Complete Uterus Didelphys Radtke SJ*. Obstetrics and Gynecology, Texas Tech University Health and Science Center, El Paso, TX *Corresponding author. Video Objective: Demonstrate how a retroperitoneal dissection can facilitate hysterectomy in cases of uterine anomalies Setting: University affiliated hospital Interventions: 55 year old patient presented with severe abnormal uterine bleeding and dysmenorrhea. Imaging was suspicious for a M€ullerian anomaly. A laparoscopic hysterectomy was planned. On entry into the abdomen, complete uterine didelphys was noticed. Using a retroperitoneal dissection we were able to identify all critical structures and maintain adequate hemostasis during the case, resulting in a satisfactory outcome for the patient. Conclusion: Developing the retroperitoneal space is paramount in order to successfully perform surgery in a uterus with distorted anatomy Open Communications 20: Laparoscopy (2:00 PM − 3:00 PM) 2:00 PM Laparoscopic Uterine Cerclage: A 10 Year Experience at a Tertiary Referral Centre Ma K,* Lim K, Majumder K, Edi-Osagie E. Gynaecology, Manchester Foundation Trust, Manchester, United Kingdom *Corresponding author. Study Objective: To determine the safety and efficacy of all cases of laparoscopic uterine cerclage performed in a tertiary referral center in the last 10 years. Design: Retrospective Cohort Study. Setting: Tertiary referral center and university teaching hospital. Patients or Participants: All patients who underwent laparoscopic uterine cerclage from March 2010 to March 2019. Interventions: Laparoscopic insertion of uterine cerclage. Measurements and Main Results: A total of 14 cases were identified. 14/ 14 patients presented with a history of recurrent pregnancy loss or extreme premature labor (below 26 weeks). Indication included further mid-trimester loss or extreme premature labor despite elective cervical cerclage (8/ 14), failed rescue cerclage (3/14) and a short cervix on ultrasound or failure to insert cervical cerclage (3/14). No intra-operative complications were noted. Mean operating time was 98 minutes (Range 68-124). No post-operative complications or readmissions were noted. Of the 12 patients who underwent surgery greater than 12 months ago, there were 12
S75 spontaneous conceptions (11/12 patients), 1 miscarriage and 11 livebirths after 37 weeks gestation by elective or emergency caesarean section. In the patient who suffered a miscarriage a surgical evacuation was carried out without complication. Conclusion: Laparoscopic uterine cerclage remains a novel technique with a strict inclusion criteria requiring regular surveillance and audit of outcomes. This has limited the number of cases performed and there are currently no robust randomized control trials comparing management options for women with recurrent pregnancy loss after cervical cerclage. Despite the small numbers our results indicate that this technique has a good safety profile and outcomes in livebirths rates >34 weeks are good. Our results supports expansion of this service at a regional level through multi-disciplinary assessment to enable this technique can becoming established practice.
Open Communications 20: Laparoscopy (2:00 PM − 3:00 PM) 2:07 PM Laparoscopic Specimen Containment Using a Large Isolation Bag Putman JG,* Biest SW. Obstetrics and Gynecology, Washington University In St. Louis/Barnes-Jewish Hospital, St. Louis, MO *Corresponding author. Video Objective: To demonstrate laparoscopic specimen containment for extraction using a large isolation bag inserted through the vagina. Setting: A 41-year-old G2P2 who presented with an enlarged 18 weeks size myomatous uterus desiring definitive surgical management. Interventions: Specimen placement into a large containment bag introduced into the abdomen through the vagina after total laparoscopic hysterectomy with bilateral salpingectomy. Conclusion: This video demonstrates a viable method of tissue containment for large specimens. This method allows for safe extraction and morcellation of contained specimens when required and appropriate. Open Communications 20: Laparoscopy (2:00 PM−3:00 PM) 2:14 PM The Inspire Comparative Cost Study: One-Year Medical Resource Utilization, and Payer Cost Analysis Associated with Hysterectomy and Myomectomy Compared to Sonography-Guided Transcervical Ablation for the Treatment Of Uterine Fibroids Brooks E,1 Mihalov LS,2 Delvadia D,*,3 Hudgens JL,4 Mama ST,5 Makai GE,6 Yuen M,1 Little C,1 Zambelli-Weiner A,1 Levine DJ7. 1TTi Health Research & Economics, Westminster, MD; 2Gynecology, Virginia Mason Medical Center, Seattle, WA; 3Drexel University College of Medicine, Philadelphia, PA; 4Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA; 5Ob/Gyn, Cooper Medical School of Rowan University, Camden, NJ; 6Obstetrics and Gynecology, Christiana Care Health Systems, Newark, DE; 7Gynecology Minimally Invasive Surgery, Mercy Clinical Minimally Invasive Gynecology, St. Louis, MO *Corresponding author. Study Objective: The INSPIRE study compared health care resource utilization (HCRU) and payor costs associated with transcervical radiofrequency (RF) ablation, hysterectomy, and myomectomy. Design: Data for transcervical RF ablation were derived from a prospective, multicenter, single-arm clinical trial (the SONATA trial); data for hysterectomy and myomectomy arms were derived from the Truven Health MarketScan Commercial Claims Database. Setting: 6 clinical sites in the US.