Comparing Suture-Less Method between Robotic and Laparoscopic Total Hysterectomy

Comparing Suture-Less Method between Robotic and Laparoscopic Total Hysterectomy

Abstracts / Journal of Minimally Invasive Gynecology 21 (2014) S191–S227 S207 Summary of Patient Questionnaire Results TVH TAH RLH p* Comparison...

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Abstracts / Journal of Minimally Invasive Gynecology 21 (2014) S191–S227

S207

Summary of Patient Questionnaire Results TVH

TAH

RLH

p*

Comparisons/Significant Differences

Total patients Responses Post-operative Pain Level [mean]

62 4

63 7

21 5

\.0001

Days of Analgesic Use [mean]

6

12

7

0.0072

Days until Self Care [mean] Days until Work [mean]

3 37

6 39

6 28

0.4659 0.0164

Days until First BM [mean] Weeks until First Intercourse [mean]

2 9

2 11

2 9

0.0882 0.1128

TAH > RLH, TVH no significant difference between TVH & RLH ‘‘TAH > RLH, TVH no significant difference between TVH & RLH’’ none ‘‘TAH > RLH no significant difference between TVH & RLH or between TVH & TAH’’ none none

Setting: Community Hospital. Patients: Patients were divided into three surgical groups: Total vaginal hysterectomy (TVH), abdominal hysterectomy (TAH), and Robotic laparoscopic hysterectomy (RLH). Two hundred and three cases were reviewed, and 149 patient questionnaires were completed. Intervention: Surgical Hysterectomy procedures. Measurements and Main Results: Retrospective study for all consecutive hysterectomy cases performed by the author from 1/01/2008 to 07/31/2013. Data collected from the EMR of the office and the hospital. Patient records were used to determine patient demographics, length of hospital stay, operative time, estimated blood loss (EBL) and total hospital charges. TAH had a significantly higher hospital stay at 2.71 days versus TVH at 1.62 days, and RLH at 1.38 days. RLH had a significantly higher operative time versus TVH and TAH. No significant differences in hospital charges between RLH and TAH. TAH had significantly higher total charges versus TVH. TAH had higher reported post-operative pain level than TVH and RLH. Compare to RLH and TVH, TAH had significantly higher EBL. Conclusion: Our study reveals a significant difference in hospital stay in TAH versus the other methods of hysterectomy. TAH and RLH have a significant difference in hospital charges versus TVH. No significant difference between TAH and RLH in hospital charges. TAH had higher level of post operative pain than RLH and TVH. 646 Comparing Suture-Less Method between Robotic and Laparoscopic Total Hysterectomy Huang Y-S, Chen C-H, Chiu L-H, Liu W-M. Department of Obstetrics and Gynecology, Taipei Medical University Hospital, Taipei, Taiwan Study Objective: The aim of this study is to demonstrate a modified ‘‘suture-less’’ robotic total hysterectomy which consisted of robotic total hysterectomy and transvaginal colporrhaphy. The ‘‘suture-less’’ procedure provide advantages including: 1) the dissected large uterine / tumor can be easily and quickly removed via vagina; 2) reduce the chance of cuff dehiscence by suturing the vagina cuff transvaginally. To assess the feasibility and safety of this method, we compare the peri-operative

surgical parameters of the procedure with conventional laparoscopic total hysterectomy. Design: We retrospectively reviewed 125 cases of benign indications receiving total hysterectomy managed by robotic suture-less method (60 cases) or laparoscopic total hysterectomy (65 cases). Setting: University-affiliated teaching hospital. Patients: Women who laparoscopic total hysterectomy or suture-less robotic total hysterectomy for managing adenomyosis or leiomyoma. Intervention: Both hysterectomies were performed with the setting of 3 ports; a port for laparoscopic camera and 2 accessory ports. For complicated cases, an additional port was applied for the assistant arm. Both the colporrhaphy were performed transvaginally instead of intracorporeally. Measurements and Main Results: Blood loss (158.8113.5 v.s. 235.8264.4, p\0.05) and 24-hour pain score (1.81.3 v.s. 2.51.4, p\0.05) were significant lower in the suture-less robotic group. As to the conversion to laparotomy rate, the laparoscopic group showed a higher percentage than the suture-less robotic hysterectomy group (4.6% v.s. 0%). The post-operative complication rate showed no significant difference between the groups. Though not significant, the average uterine weight was higher in the suture-less robotic group, implying that this method could manage larger tumor mass with not longer operation time than the laparoscopic group. Conclusion: Suture-less robotic total hysterectomy is a feasible, efficient and safe procedure for managing benign gynecological disease such as adenomyosis or leiomyoma with favorable peri-operative outcomes. 647 Unexpected Hospital Visits after Hysterectomy Based on Clinformatics Data Mart Database Kilic GS,1 Guirguis ME,2 Rodriguez AM,1 Oge T,3 Tapisiz OL,4 Borahay M.1 1Ob/Gyn Gynecology, University of Texas Medical Branch at Galveston, Galveston, Texas; 2University of Texas Medical Branch at Galveston, Galveston, Texas; 3Ob-Gyn, Eskisehir Osmangazi University Hospital, Osmangazi, Eskisehir, Turkey; 4Ob-Gyn, Etlik Hospital, Ankara, Etlik, Turkey

Peri-operative parameters of the enrolled patients

Uterine Weight (gm) Adhesion Score Operation Time (min) Blood Loss (mL) Conversion Rate Pain Score (post-operative) Pain Score (24-hour) Hospital Stay (days) Complication rate, % *Data presented as meanSD or percentage.

Suture-less Robotic Total Hysterectomy (n=60)

Laparoscopic Total Hysterectomy (n=65)

Significance

277.2177.5 1.21.9 138.135.1 158.8113.5 0% 2.91.9 1.81.3 2.90.9 6.7%

230.9197.6 1.31.8 142.249.1 235.8264.4 4.6% 2.82.0 2.51.4 2.80.9 4.6%

0.16 0.65 0.58 \0.05 0.65 \0.05 0.33 0.71