Robotically Assisted Hysterectomy in Patients With Large Uteri

Payne, Thomas N.; Dauterive, Francis R.; Pitter, Michael C.; Giep, Hoang N.; Giep, Bang N.; Grogg, T.W.; Shanbour, K. Anthony; Goff, Darren W.; Hubert, Helen B.

doi:10.1097/aog.0b013e3181cf45ad

Cited by 51 publications

(30 citation statements)

References 13 publications

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“…All 135 robotic hysterectomies were successfully completed without increased complications or conversions to laparotomy occurring secondary to excessive uterine weight. Procedure duration increased with uterine weight, concurring with several other studies of robotic hysterectomy that also reported a relationship between uterine weight and operative time [10,[13][14][15]. Although usually attributed to the need for morcellation for extraction of a larger uterus, it is also related to the complexity of the case with more difficult detachment of the uterus, and the experience of the surgeon and assistant [15].…”

Section: Discussionsupporting

confidence: 78%

“…Thus, the daVinci system provides technology that may extend the ability to perform laparoscopic hysterectomy to more complex cases including those involving larger uteri. Information on its use on more complex procedures, including its use in hysterectomy for large uteri, are now appearing in the literature [14,15]. It is important that surgical outcomes and departmental experience with this new technology are shared in order to better define the role of robotic surgery in gynecology and help delineate circumstances in which daVinci hysterectomy should be considered.…”

Section: Introductionmentioning

confidence: 98%

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Does size matter? The effect of uterine weight on robot-assisted total laparoscopic hysterectomy outcomes

2011

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The objective of this study was to determine whether uterine weight affects the surgical outcomes of robot-assisted total laparoscopic hysterectomy (RH) procedures. The design of this study is retrospective cohort study. The classification of the study design is level II-2 evidence. The study setting is the Henry Ford Health System's Community Teaching Hospitals. One-hundred and thirty-five patients underwent RH for benign indications at one of two hospitals between January1, 2008, and June 1, 2010. Interventions were scheduled RH without concomitant uro-gynecologic procedures as the intention to treat. Patient demographics, age, height, weight, estimated blood loss (EBL), procedure duration, uterine weight, pathology, length of hospital stay (LOS), and any complications were obtained from a detailed review of electronic medical records. Uterine weight ranged from 47 to 1,290 g (<250 g, n = 87; 250-500 g, n = 28; >500 g, n = 18). Overall, uterine weight was highly correlated with procedure duration (r = .53, P < .001.). Median procedure duration increased from 150 min for the <250 g group, to 205 min for the 250-500 g group, and to 295 min for the >500 g group. Uterine weight was also moderately correlated with EBL (r = .30, P = .0005). Median EBL increased from 50 ml for uteri <250 g to 87.5 ml for the 250-500 g group, and 100 ml for the >500 g group. This correlation did not persist in the assessment of decrease in peri-operative hemoglobin (r = .09, P = .30). Ninety-one women had a LOS of 1 day (67.4%), 31 women had a LOS of 2 days (23%), and 13 women had a LOS of greater than 2 days (9.6%). Uterine weight was not correlated with LOS (r = .14, P = .10) and was not associated with increased major or minor complications (WRS P = .79) re-admission (WRS P = .35), or blood transfusion (n = 3). RH can be performed on patients with large uteri exceeding 500 g without associated adverse outcomes. Although procedure duration is increased, there is no significant effect on EBL and no increase in the occurrence of complications or length of stay.

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Section: Discussionsupporting

confidence: 78%

Section: Introductionmentioning

confidence: 98%

Does size matter? The effect of uterine weight on robot-assisted total laparoscopic hysterectomy outcomes

2011

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“…For urogynecologic and gynecologic surgery, Payne et al [33] used a multi-center cohort study of 256 patients. A retrospective chart review was used to evaluate roboticassisted (da Vinci) hysterectomy in patients with large uteri in five community practices.…”

Section: Level 4 Study Resultsmentioning

confidence: 99%

“…As can be seen in Table 1, robotic surgery has been used in urogynecologic surgery and gynecology [1,5,14,33], cardiovascular and neurologic surgeries [2,31], thoracic surgery [12], cancer treatment [20,22,27,30,32,34,36], [8,24], pediatric surgeries [13,23], and gastrointestinal studies [3,10,15,29,38]. Table 1 summarizes selected studies of robotic surgery, meeting the criteria below, in different surgical applications.…”

Section: Scope Of Applications Of Robotic Surgerymentioning

confidence: 98%

Robotic surgery: review of the latest advances, risks, and outcomes

et al. 2011

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Using differing levels of evidence, we developed criteria to critically review 21 scientifically peer-reviewed articles on robot-assisted surgeries in various medical fields. The advantages and limitations of robotic systems are discussed and compared with traditional surgical methods. Since training in the use of robotic skills is essential, various training models are discussed to teach the complex skills necessary for robotic surgery. There is a paucity of control studies on a sufficient number of subjects in robot-assisted surgeries in all fields. Studies that meet more stringent clinical trials criteria show that robot-assisted surgery appears comparable to traditional surgery in terms of feasibility and outcomes but that costs associated with robot-assisted surgery are higher because of longer operating times and expense of equipment. While a limited number of studies on the da Vinci robotic system have proven the benefit of this approach in regard to patient outcomes, including significantly reduced blood loss, lower percentage of postoperative complications, and shorter hospital stays, there are mechanical and institutional risks that must be more fully addressed. In addition, trials are needed to identify simulators for learners that can enhance the da Vinci performance in order to shorten the learning curve.

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“…La pérdida sanguínea promedio fue de 17 ml. Sólo tres pacientes sangraron más de 100 ml, todas con úteros de gran tamaño y marcada distorsión de la anatomía (24). En segundo lugar la ausencia de dolor postoperatorio con un índice de EVA 0-3 a las 24 horas en el 90% de las operadas.…”

Section: Discussionunclassified

Histerectomía total laparoscópica asistida por robot: Experiencia de Clínica Indisa

S¹,

N²,

F³

et al. 2013

Rev. chil. obstet. ginecol.

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Robotically Assisted Hysterectomy in Patients With Large Uteri

Abstract: Women with large uteri may successfully undergo robotically assisted hysterectomy with low morbidity, low blood loss, and minimal risk of conversion to laparotomy. Results were reproducible among general gynecologists from geographically diverse community settings.

Cited by 51 publications

References 13 publications

Does size matter? The effect of uterine weight on robot-assisted total laparoscopic hysterectomy outcomes

Does size matter? The effect of uterine weight on robot-assisted total laparoscopic hysterectomy outcomes

Robotic surgery: review of the latest advances, risks, and outcomes

Histerectomía total laparoscópica asistida por robot: Experiencia de Clínica Indisa

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