Background and Objectives:Robotic surgery has introduced unique challenges to surgical workflow. The association between quality of communication in robotic-assisted laparoscopic surgery and surgical outcomes was evaluated.Methods:After each gynecologic robotic surgery, the team members involved in the surgery completed a survey regarding the quality of communication. A composite quality-of-communication score was developed using principal component analysis. A higher composite quality-of-communication score signified poor communication.Objective parameters, such as operative time and estimated blood loss (EBL), were gathered from the patient's medical record and correlated with the composite quality-of-communication scores.Results:Forty robotic cases from March through May 2013 were included. Thirty-two participants including surgeons, circulating nurses, and surgical technicians participated in the study. A higher composite quality-of-communication score was associated with greater EBL (P = .010) and longer operative time (P = .045), after adjustment for body mass index, prior major abdominal surgery, and uterine weight. Specifically, for every 1-SD increase in the perceived lack of communication, there was an additional 51 mL EBL and a 31-min increase in operative time. The most common reasons reported for poor communication in the operating room were noise level (28/36, 78%) and console-to-bedside communication problems (23/36, 64%).Conclusion:Our study demonstrates a significant association between poor intraoperative team communication and worse surgical outcomes in robotic gynecologic surgery. Employing strategies to decrease extraneous room noise, improve console-to-bedside communication and team training may have a positive impact on communication and related surgical outcomes.

Chronic pelvic pain (CPP) is related to psychological distress and interference in daily activities; however, CPP is not as extensively researched as other forms of chronic pain. Therefore, the purpose of this study was to investigate the relationships among pain, psychological distress, and functional impairment in patients with CPP. There were chart reviews conducted of 107 female patients who completed a psychiatric evaluation at a specialty, CPP clinic as a part of a multidisciplinary evaluation. Results suggest that psychological distress and impairment in daily activities are common in CPP patients. Most areas of functional impairment were not associated with pain variables. Rather, several forms of functional impairment were related to higher levels of depression and anxiety. Results from this study suggest the possibility that psychiatric symptoms are contributing to functional impairment in this population. These findings highlight the importance of a multidisciplinary approach in the evaluation and treatment of CPP patients to help decrease functional impairment in these patients.

Single-dose methotrexate is a cost-saving, nonsurgical, fallopian tube-sparing treatment for ectopic pregnancy.

There were no differences in complications between O Vicryl™ figure-of-eight vaginal cuff closure and closure with V-Loc™ barbed sutures in this study.

A retrospective cohort of 100 robotic-assisted laparoscopic myomectomy (RM) patients and 48 laparotomic myomectomy (LM) patients at Henry Ford Hospital in Detroit, MI, USA was examined to compare surgical outcomes of RM with LM. Details of age, race, body mass index (BMI), procedure duration, estimated blood loss (EBL), length of stay (LOS), diameter of the largest leiomyoma and number of leiomyomata removed were collected. Procedure duration was significantly longer among RM patients (median: 194 min vs. 127.5 min; Wilcoxon rank sum (WRS) P < 0.001). EBL and LOS were both significantly greater among LM patients (EBL medians 200 vs. 100 ml, WRS P < 0.001; LOS medians 3 vs. 1, WRS P < 0.01). Among the RM patients, 39.4% had a LOS of at least 2 days compared to 89.4% among LM patients. Leiomyomata characteristics did not affect the observed associations. RM could enable widespread use of a minimally invasive approach for leiomyoma treatment.

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