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Russian Experience in Robotic Surgery (Da Vinci) in Gynecology
S208
Abstracts / Journal of Minimally Invasive Gynecology 21 (2014) S191–S227
Study Objective: To assess the impact of 4 different routes of hysterectomies, abdominal, laparoscopic, robotic, and vaginal on unexpected hospital visits postoperatively. Design: Retrospective. Setting: Clinformatics Data Mart, managed by OPTUM Insight from 2009-2012. Patients: 33902 Female patients >18 years of age who had a benign hysterectomy performed either abdominally, laparascopically, robotically or vaginally. Intervention: Patients that were then split into 4 surgical methods. There were those that had a hysterectomy abdominally (19154), laparascopically (7905), robotically (2125) or vaginally (4718). Patients were selected using icd-9 codes and scheduled for benign hysterectomies between 2009-2012. In assessing unexpected hospital visits, we compared all ER visits, and clinic visits more than 2 times within 90 days of surgery. Measurements and Main Results: The mean number of ER visits for patients who underwent hysterectomy abdominally, laparascopically, robotically, vaginally were 2058 (10.74%), 878 (11.11%), 241 (11.34%), and 457 (10.72%) respectively (p>0.05). When >2 numbers of outpatient visits were compared we observed some differences among the 4 groups. 3449 (18.0%) abdominal patients, 1365 (17.3%) laparoscopic patients, 250 (12.3%) robotic patients and 702 (14.9%) vaginal patients required a third outpatient visit (p\0.001). Readmission within 90 days of surgery were significantly different between the four groups (p\0.001) and lowest ratio was found in vaginal group (p\0.0083). Conclusion: Patients who had a vaginal hysterectomy had the least number of readmission. With regard to >2 outpatient visits, our data suggest that this was more prevalent in the abdominal group and seemed to decrease as the approach became less invasive. Patients undergoing a robotic hysterectomy seemed to have least length of hospital stay among patients with similar postoperative ER visits. 648 Robotic-Assisted Anterior Pelvic Excentration for Adenocarcinoma of the Urinary Bladder with Uterine Metastasis: A Case Report Kwon Y, Lee S. Gynecologic Oncology, Kangdong Sacred Heart Hospital, Seoul, Korea Study Objective: The robotic-assisted laparoscopic approach to anterior pelvic exenteration is evaluated in patients with advanced cervical cancer undergoing anterior pelvic exenteration for involvement of the urinary bladder during primary cytoreduction surgery. Design: A 63-year-old woman was admitted to our hospital and whose chief complaints were dysuria and severe hematuria. This patient undergo preoperative lab work, imaging studies and bowel preparation prior to surgery. Setting: The results of physical examination, tissue biopsy and imaging studies suggested adenocarcinoma of the uterine cervix with bladder metastasis. Robotic-assisted anterior pelvic excentration was performed. Patients: A 63-year-old woman was admitted to our hospital and whose chief complaints were dysuria and severe hematuria. The results of physical examination, tissue biopsy and imaging studies suggested adenocarcinoma of the urinary bladder with uterine metastasis. Intervention: The Davinci S surgical system is used to perform urinary cystectomy, radical hysterectomy. 649 Russian Experience in Robotic Surgery (Da Vinci) in Gynecology Politova A, Popov A, Fedorov A, Koval A, Mironenko K. Moscow Regional Scientific Research Institute of Obstetrics and Gynecology, Moscow, Russian Federation Study Objective: The surgical robot ‘‘Da Vinci’’ (DV; Intuitive Surgical, USA) is the biggest technological development of the recent decades. Currently,over 1300 robotic surgical systems in 40 developed countries have been used successfully.
Intervention: In Russia, the first surgery with a robot DV was performed in Ekaterinburg in November 2007. Now there are 20 centers in seven cities (Moscow, St. Petersburg, Ekaterinburg, Khanty-Mansiysk, Novosibirsk, Vladivostok, Tuapse) equipped with DV.Today the leader of this technology is ‘‘Pirogov’’ National Surgical Institute (Moscow),where by the end of 2013 about 1000 operations had been performed in urology, gynecology,oncology,abdominal and thoracic surgery. In gynecological surgery the DV-robotic complex is used in six medical centers of the country. From March 2009,311 women were operated.The type of gynecological interventions is variable. Measurements and Main Results: Since 2011 76 DV-assisted procedures have been performed in St. Petersburg: myomectomy - 12, endometriosis surgery – 64. Since 2011 16 DV-assisted procedures have been performed in Khanty-Mansiysk: myomectomy –10,hysterectomy–6. Since 2012 12 DV-assisted procedures have been performed in Ekaterinburg: hysterectomy –12. Since 2013 3 DV-assisted procedures have been performed in Clinic EMC (Moscow): hysterectomy – 3. Since 2012 33 DV-assisted procedures have been performed in Moscow Regional Institute of O/G:SVP–27 (10 of these with supracervical hysterectomy; hysterectomy - 5; myomectomy –1). Since 2009 181 DV-assisted procedures have been performed in ‘‘Pirogov’’ National Surgical Institute (Moscow): hysterectomy–66, hysterectomy with lymphadenectomy–32,hysterectomy with omentectomy–2, myomectomy– 39, resection of rectovaginal endometriosis–14, SVP–14, peritoneal colpopoiesis–8, simultaneous operations-2, other –4. Conclusion: The surgical system DV allows to go beyond the limitations of open and conventional Laparoscopic surgery, expanding the surgeon’s capacity, due to technical innovation, improvement of visualization and manipulation in difficult surgical areas. The surgeon’s ergonomy is also important. 650 Comparative Analysis of Laparoscopic Sacrocolpopexy and Da Vinci-Assisted Sacrocolpopexy Popov A, Manannikova T, Fedorov A, Ramazanov M, Krasnopolskaya I, Slobodyanuyk B, Mironenko K. Moscow Regional Scientific Research Institute of Obstetrics and Gynecology, Moscow, Russian Federation Study Objective: We try to compare conventional laparoscopic and da Vinci-assisted sacrocolpopexy (DV SCP) for apical prolapse. Intervention: Since 2010 we have done 100 LsSCP (1 group) in patients with symptomatic POP II–IV stage (POP-Q).We combine SCP with amputation of cervix in 18%,supracervical hysterectomy in 86%,anterior vaginal wall repair in 40%,posterior colporrhaphy in 41%,TVT-O in 11% cases. Since 2013 we have done 31 DVSCP (2 group).Concomitant procedures were:amputation of cervix in 6,5%,supracervical hysterectomy (54,8%),anterior vaginal wall repair (35,5%),posterior colporrhaphy (54,8%),TVT-O in 6,5% cases.We use Gynecare Gynemesh PS soft. Beside standard clinical methods we used following: 1.staging POP-Q, 2.QOL, 3.detailed ultrasound examination of pelvic floor. Measurements and Main Results: Total operative time was longer in 2 group (155min.12) compared with 1 group (113min.9).Anesthesia time (142 min.19-LsSCP,159min.11-DVSCP),time of itself SCP (38min.11-LsSCP, 47min.8-DVSCP),and total suturing time were all significantly longer in 2 group.In 2 group postoperative pain at rest and during movement was significantly higher compared with 1 group (32,p\0,05;52,p\0,05) after surgery.The blood loss (70ml10) in both groups were about same (31 day).In 1 group there were 23(24%) II POP-Q st,58(60%)-III,15(16%)-IV;in 2 group there were 5(21%)II,11(46%)-III,8(33%)-IVst.Mean follow up were 189 mounts in 1 group and 82 mounts in 2 group. Recurrences (III-IV Ba or C prolapse) were 6(6,3%) only in 1 group.During follow up both groups demonstrated significant improvement in vaginal support and functional outcomes with no special differences between groups. Conclusion: The most important advantages of DVSCP in compare with other methods are:less physical strength of the surgical team,the relative ease of learning,three-dimensional image,the possibility of manipulation in deep pelvic areas.However, disadvantages are:long operation time and increased pain compared with the conventional laparoscopic approach. Anesthesia time,total SCP time,and total suturing time were all significantly
Abstracts / Journal of Minimally Invasive Gynecology 21 (2014) S191–S227
Study Objective: To assess the impact of 4 different routes of hysterectomies, abdominal, laparoscopic, robotic, and vaginal on unexpected hospital visits postoperatively. Design: Retrospective. Setting: Clinformatics Data Mart, managed by OPTUM Insight from 2009-2012. Patients: 33902 Female patients >18 years of age who had a benign hysterectomy performed either abdominally, laparascopically, robotically or vaginally. Intervention: Patients that were then split into 4 surgical methods. There were those that had a hysterectomy abdominally (19154), laparascopically (7905), robotically (2125) or vaginally (4718). Patients were selected using icd-9 codes and scheduled for benign hysterectomies between 2009-2012. In assessing unexpected hospital visits, we compared all ER visits, and clinic visits more than 2 times within 90 days of surgery. Measurements and Main Results: The mean number of ER visits for patients who underwent hysterectomy abdominally, laparascopically, robotically, vaginally were 2058 (10.74%), 878 (11.11%), 241 (11.34%), and 457 (10.72%) respectively (p>0.05). When >2 numbers of outpatient visits were compared we observed some differences among the 4 groups. 3449 (18.0%) abdominal patients, 1365 (17.3%) laparoscopic patients, 250 (12.3%) robotic patients and 702 (14.9%) vaginal patients required a third outpatient visit (p\0.001). Readmission within 90 days of surgery were significantly different between the four groups (p\0.001) and lowest ratio was found in vaginal group (p\0.0083). Conclusion: Patients who had a vaginal hysterectomy had the least number of readmission. With regard to >2 outpatient visits, our data suggest that this was more prevalent in the abdominal group and seemed to decrease as the approach became less invasive. Patients undergoing a robotic hysterectomy seemed to have least length of hospital stay among patients with similar postoperative ER visits. 648 Robotic-Assisted Anterior Pelvic Excentration for Adenocarcinoma of the Urinary Bladder with Uterine Metastasis: A Case Report Kwon Y, Lee S. Gynecologic Oncology, Kangdong Sacred Heart Hospital, Seoul, Korea Study Objective: The robotic-assisted laparoscopic approach to anterior pelvic exenteration is evaluated in patients with advanced cervical cancer undergoing anterior pelvic exenteration for involvement of the urinary bladder during primary cytoreduction surgery. Design: A 63-year-old woman was admitted to our hospital and whose chief complaints were dysuria and severe hematuria. This patient undergo preoperative lab work, imaging studies and bowel preparation prior to surgery. Setting: The results of physical examination, tissue biopsy and imaging studies suggested adenocarcinoma of the uterine cervix with bladder metastasis. Robotic-assisted anterior pelvic excentration was performed. Patients: A 63-year-old woman was admitted to our hospital and whose chief complaints were dysuria and severe hematuria. The results of physical examination, tissue biopsy and imaging studies suggested adenocarcinoma of the urinary bladder with uterine metastasis. Intervention: The Davinci S surgical system is used to perform urinary cystectomy, radical hysterectomy. 649 Russian Experience in Robotic Surgery (Da Vinci) in Gynecology Politova A, Popov A, Fedorov A, Koval A, Mironenko K. Moscow Regional Scientific Research Institute of Obstetrics and Gynecology, Moscow, Russian Federation Study Objective: The surgical robot ‘‘Da Vinci’’ (DV; Intuitive Surgical, USA) is the biggest technological development of the recent decades. Currently,over 1300 robotic surgical systems in 40 developed countries have been used successfully.
Intervention: In Russia, the first surgery with a robot DV was performed in Ekaterinburg in November 2007. Now there are 20 centers in seven cities (Moscow, St. Petersburg, Ekaterinburg, Khanty-Mansiysk, Novosibirsk, Vladivostok, Tuapse) equipped with DV.Today the leader of this technology is ‘‘Pirogov’’ National Surgical Institute (Moscow),where by the end of 2013 about 1000 operations had been performed in urology, gynecology,oncology,abdominal and thoracic surgery. In gynecological surgery the DV-robotic complex is used in six medical centers of the country. From March 2009,311 women were operated.The type of gynecological interventions is variable. Measurements and Main Results: Since 2011 76 DV-assisted procedures have been performed in St. Petersburg: myomectomy - 12, endometriosis surgery – 64. Since 2011 16 DV-assisted procedures have been performed in Khanty-Mansiysk: myomectomy –10,hysterectomy–6. Since 2012 12 DV-assisted procedures have been performed in Ekaterinburg: hysterectomy –12. Since 2013 3 DV-assisted procedures have been performed in Clinic EMC (Moscow): hysterectomy – 3. Since 2012 33 DV-assisted procedures have been performed in Moscow Regional Institute of O/G:SVP–27 (10 of these with supracervical hysterectomy; hysterectomy - 5; myomectomy –1). Since 2009 181 DV-assisted procedures have been performed in ‘‘Pirogov’’ National Surgical Institute (Moscow): hysterectomy–66, hysterectomy with lymphadenectomy–32,hysterectomy with omentectomy–2, myomectomy– 39, resection of rectovaginal endometriosis–14, SVP–14, peritoneal colpopoiesis–8, simultaneous operations-2, other –4. Conclusion: The surgical system DV allows to go beyond the limitations of open and conventional Laparoscopic surgery, expanding the surgeon’s capacity, due to technical innovation, improvement of visualization and manipulation in difficult surgical areas. The surgeon’s ergonomy is also important. 650 Comparative Analysis of Laparoscopic Sacrocolpopexy and Da Vinci-Assisted Sacrocolpopexy Popov A, Manannikova T, Fedorov A, Ramazanov M, Krasnopolskaya I, Slobodyanuyk B, Mironenko K. Moscow Regional Scientific Research Institute of Obstetrics and Gynecology, Moscow, Russian Federation Study Objective: We try to compare conventional laparoscopic and da Vinci-assisted sacrocolpopexy (DV SCP) for apical prolapse. Intervention: Since 2010 we have done 100 LsSCP (1 group) in patients with symptomatic POP II–IV stage (POP-Q).We combine SCP with amputation of cervix in 18%,supracervical hysterectomy in 86%,anterior vaginal wall repair in 40%,posterior colporrhaphy in 41%,TVT-O in 11% cases. Since 2013 we have done 31 DVSCP (2 group).Concomitant procedures were:amputation of cervix in 6,5%,supracervical hysterectomy (54,8%),anterior vaginal wall repair (35,5%),posterior colporrhaphy (54,8%),TVT-O in 6,5% cases.We use Gynecare Gynemesh PS soft. Beside standard clinical methods we used following: 1.staging POP-Q, 2.QOL, 3.detailed ultrasound examination of pelvic floor. Measurements and Main Results: Total operative time was longer in 2 group (155min.12) compared with 1 group (113min.9).Anesthesia time (142 min.19-LsSCP,159min.11-DVSCP),time of itself SCP (38min.11-LsSCP, 47min.8-DVSCP),and total suturing time were all significantly longer in 2 group.In 2 group postoperative pain at rest and during movement was significantly higher compared with 1 group (32,p\0,05;52,p\0,05) after surgery.The blood loss (70ml10) in both groups were about same (31 day).In 1 group there were 23(24%) II POP-Q st,58(60%)-III,15(16%)-IV;in 2 group there were 5(21%)II,11(46%)-III,8(33%)-IVst.Mean follow up were 189 mounts in 1 group and 82 mounts in 2 group. Recurrences (III-IV Ba or C prolapse) were 6(6,3%) only in 1 group.During follow up both groups demonstrated significant improvement in vaginal support and functional outcomes with no special differences between groups. Conclusion: The most important advantages of DVSCP in compare with other methods are:less physical strength of the surgical team,the relative ease of learning,three-dimensional image,the possibility of manipulation in deep pelvic areas.However, disadvantages are:long operation time and increased pain compared with the conventional laparoscopic approach. Anesthesia time,total SCP time,and total suturing time were all significantly