Association of demographic, clinical, and hospital‐related factors with use of robotic hysterectomy for benign indications: A national database study

Smith, Anna Jo Bodurtha; AlAshqar, Abdelrahman; Chaves, K.F.; Borahay, Mostafa A.

doi:10.1002/rcs.2107

Cited by 15 publications

(18 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In our study, African American women underwent most myomectomies but had the lowest proportion of MIM. A large body of research has shown racial disparities in women undergoing hysterectomy 6 , 12 , 14 with an independent increase in surgical complications in African American and Asian American women; one study showing an elevated odds of almost every category of medical/surgical complications in African American women as well as risk of readmission. 21 – 23 A 2020 study by Pollack et al showed that African American, Hispanic, and Asian/Pacific Islander women eligible for minimally invasive hysterectomy were more likely than Caucasian women to undergo an open hysterectomy.…”

Section: Discussionmentioning

confidence: 99%

Predictors of Minimally Invasive Myomectomy in the National Inpatient Sample Database, 2010–2014

Frost¹,

McMahon²,

Smith³

et al. 2021

JSLS

Self Cite

View full text Add to dashboard Cite

Background and Objectives: This study aims to characterize the utilization of minimally invasive myomectomy in the United States and to identify the patient and hospital factors associated with surgical approach to myomectomy. Methods: This is a cross-sectional study using the National Inpatient Sample database. We extracted women aged 18–50 years who underwent open and minimally invasive (laparoscopic and robotic) myomectomy (MIM) from January 1, 2010–December 31, 2014. Descriptive statistics were obtained for patient and hospital characteristics. We then performed multivariable logistic regression to examine the association of patient (age, race, insurance status, median household income) and hospital (bed size, teaching status, for-profit status, census region, cases volume) characteristics with the likelihood of undergoing MIM. Results: Of 114,850 myomectomy cases, 8,330 (7%) underwent MIM and 106,520 (93%) were open. Over time, the proportion of MIM remained very low and slightly decreased from 8.2% in 2010 to 6.1% in 2014 (p-for-trend: 0.001). Most hospitals performed few MIM per year, with 50% performing five or less, and 25% performing three or fewer per year. African American, Hispanic, and women of other races were less likely to undergo MIM compared to Caucasian women (adjusted odds ration [OR] 0.57, 95% confidence interval [CI] 0.50–0.64; 0.71, 95% CI 0.60–0.83; 0.62, 95% CI 0.52–0.74, respectively). Women in the West (adjusted odds ratio (aOR) 1.23, 95% CI 1.04–1.46) and Midwest (aOR 1.27, 95% CI 1.07–1.52) had higher odds of undergoing MIM. Conclusion: MIM appears to be an underutilized modality, accounting for less than10% of myomectomies. This underutilization disproportionally affects minority women.

show abstract

Section: Discussionmentioning

confidence: 99%

Predictors of Minimally Invasive Myomectomy in the National Inpatient Sample Database, 2010–2014

Frost¹,

McMahon²,

Smith³

et al. 2021

JSLS

Self Cite

View full text Add to dashboard Cite

show abstract

“…9 Gynecological patients with benign (i.e., fibroids) or malignant disease or comorbidities (i.e., obesity) no longer have to be subjected to open laparotomy, but instead benefit from both surgical and post-surgical advantages offered by robotic minimally invasive surgery. 6,7,10 Once laparoscopic assisted hysterectomy techniques began being used, patient recovery and satisfaction were remarkably improved compared to prior patients receiving either the AH or VH procedures. Not long afterwards, most of our clinic hysterectomy patients received the 2006 McCarus Technique of TLH which required both 5 mm and 10 mm trocars and the use of an ultrasonic energy device.…”

Section: Discussionmentioning

confidence: 99%

“…There have been barriers to robotic surgical platforms in the past; namely the expense of the platform for hospitals and patient billing, training of users, and justification of use via clinical evidence of benefit. 4,7,9 The robotic systems have been in larger institutions for 20 years and in gynecological use for 15. 4 Short and long term clinical benefit data for surgeons and patients have been established.…”

Section: Discussionmentioning

confidence: 99%

“…Procedures that are complicated by the disease such as severe endometriosis, extensive LV adhesions, and patient comorbidities often appear to receive the greatest benefit of the robotic precision. 4,6,7 Introduction and acceptance of the robotic surgical technique was initially slow. The first robotic surgical platform, Robotic Assisted Laparoscopy (RAL) was developed in the 1970s as a project by the US military and NASA.…”

Section: Disclosure: Nonementioning

confidence: 99%

“…The first systems had a large cost and space requirement which limited the use to hospitals that could afford and house them. 4,7 The first robotic systems also had a steep learning curve because of reduced visual and haptic feedback and were better suited for experienced surgeons. 4 Like any surgical tool or technique, robotic surgery platforms and tools have continuously improved over the years.…”

Section: Disclosure: Nonementioning

confidence: 99%

See 2 more Smart Citations

Senhance Robotic Platform System for Gynecological Surgery

McCarus¹

2021

JSLS

View full text Add to dashboard Cite

Background and Objectives: Laparoscopic hysterectomy provides patients and surgeons with benefits of less pain, quicker recovery, and better scar cosmesis. Previously, robotic surgical hysterectomy was reserved for patients with complicated disease issues. The objective of this case series was evaluating a new robotic surgical platform, Senhance Surgical System, as a surgical tool in common gynecological procedures. Methods:The clinic routinely collects surgical and outcome data for all patients and procedures. Data on robotic surgery in hysterectomy, salpingectomy, endometriosis excision, and lysis of adhesions was evaluated.Results: Fifteen consecutive patients that underwent gynecological surgery using the Senhance System were assessed. Average age was 47.27 years (31 -63 years). Ten procedures were robotic total laparoscopic hysterectomy and 14 of 15 procedures had at least one salpingectomy. Average blood loss was 52.7 mL (10 -100 mL). Pain scores at discharge averaged 1.42 and 2.73 at two weeks post-surgery. Minimal pain medication was used. Patient satisfaction with the surgery was 98% and satisfaction with scarring was 100%. Return to normal activities and to work averaged 7.93 and 11.1 days respectively. The haptic feedback and the platform visualization of the procedure was useful. The system provided more surgeon control over both camera and tools compared to previously used robotic systems and traditional laparoscopic surgery. Conclusion:This initial experience with Senhance Surgical System provided a stable, precise surgical technique with enhanced visualization within the confined space of the abdomen during gynecological surgery. The initial results suggest high patient satisfaction with gynecological surgery and resulting scars. Further study is needed to validate the findings.

show abstract

Predictors of same‐day discharge after minimally invasive hysterectomy for benign indications

AlAshqar

Wildey

Yazdy

et al. 2021

Intl J Gynecology & Obste

Self Cite

View full text Add to dashboard Cite

Objective: To identify predictors of same-day discharge after benign minimally invasive hysterectomy. Methods:In this retrospective cohort study, we identified women (n = 1084) undergoing benign minimally invasive hysterectomy from 2009 to 2016. Multivariate logistic regression was used to examine demographic, operative, and surgeon factors associated with discharge on postoperative day 0.Results: In our study population, 238 women (22%) were discharged on the same day.Robotic hysterectomy (risk ratio [RR] 2.24; 95% confidence interval [CI] 1.13-4.44), shorter operative time (lowest quartile; RR 5.28; 95% CI 2.66-10.46), and minimal blood loss (lowest quartile; RR 3.01; 95% CI 1.68-6.23) were associated with higher same-day discharge likelihood whereas later procedure start time (2-5 pm; RR 0.38; 95% CI 0.17-0.85) and postoperative complications (RR 0.19; 95% CI 0.06-0.55) significantly decreased its likelihood. The strongest predictor was surgeon's number of years in practice, with recently graduated surgeons more likely to discharge their patients on the same day (RR 3.15; 95% CI 2.09-4.77). Conclusion:Same-day discharge after minimally invasive hysterectomy is determined by several patient, operative, and surgeon factors that can be incorporated into an implementation plan to promote earlier discharge. Most especially, scheduling patients based on perceived case complexity and targeted surgeon education can qualify a larger cohort for same-day discharge.

show abstract

Association of demographic, clinical, and hospital‐related factors with use of robotic hysterectomy for benign indications: A national database study

Cited by 15 publications

References 29 publications

Predictors of Minimally Invasive Myomectomy in the National Inpatient Sample Database, 2010–2014

Predictors of Minimally Invasive Myomectomy in the National Inpatient Sample Database, 2010–2014

Senhance Robotic Platform System for Gynecological Surgery

Predictors of same‐day discharge after minimally invasive hysterectomy for benign indications

Contact Info

Product

Resources

About