Abstrakt Gynekologie Listopad 2009

“Incidence and characteristics of patients with vaginal cuff dehiscence after robotic procedures.”

Bradshaw, A. D. and A. P. Advincula (2009).

Obstet Gynecol 114(6): 1372.




“Analysis of the impact of body mass index on the surgical outcomes after robot-assisted laparoscopic myomectomy.”

George, A., D. Eisenstein, et al. (2009).

Journal of minimally invasive gynecology 16(6): 730-733.


STUDY OBJECTIVE: To estimate the impact of body mass index (BMI) on surgical outcomes in patients undergoing robotic myomectomy. DESIGN: A retrospective cohort data analysis (Canadian Task Force classification II-2). SETTING: Community-based teaching hospital. PATIENTS: A total of 77 consecutive patients from January 2005 through November 2008 with symptomatic leiomyomata. INTERVENTION: Robotic-assisted laparoscopic myomectomy. MEASUREMENTS AND MAIN RESULTS: Body mass index ([BMI] expressed as kg/m(2)) was abstracted from the medical charts of all patients undergoing robotic myomectomy. Data on estimated blood loss, procedure time, length of hospital stay, diameter of the largest fibroid, and specimen weight were also extracted. Overall patient demographics between the groups were similar. Thirty-two patients (41.6%) were obese or morbidly obese (BMI>30). The parameters analyzed for associations with the continuous measure of BMI included length of postoperative hospital stay (LOS), estimated blood loss (EBL), and procedure duration. Median (range) procedure time among all patients was (195 minutes, 98-653 minutes), estimated blood loss was (100 mL, 10-700 mL), and length of hospital stay was (1 day, 1-5 days). No associations were determined between BMI and LOS (r=0.14, p=.22), EBL (r=0.25, p=.03), or procedure duration (r=0.16, p=.22) with Spearman correlations. The size of the largest leiomyoma diameter did not affect these associations. CONCLUSION: Preoperative obesity is not a risk factor for poor surgical outcome in patients undergoing robotic myomectomy.




“Turkey’s experience of robotic-assisted laparoscopic hysterectomy: a series of 25 consecutive cases.”

Göçmen, A., F. Şanlikan, et al. (2009).

Archives of Gynecology and Obstetrics: 1-9.


Purpose: To present the outcomes of the first 25 robotic-assisted hysterectomies from Turkey. Method: A total of 25 patients who underwent robotic-assisted hysterectomy (RAH) for benign conditions were included in the study. Patients’ demographics, surgical procedures, operative and postoperative complications, hospital stay, conversion to laparotomy, time data including all operative times, uterus weight and estimated blood loss (EBL) were recorded. All hysterectomies were American Association of Gynecologic Laparoscopists type IVE. Results: All hysterectomies were completed robotically with no conversion to laparotomy. The mean and range of the operating time were 104.1 and 47-176 min, respectively. The mean hysterectomy time was 40.5 min (range 14-77). The mean cuff incision time and cuff suturation time were 6.8 min (range 2-18) and 16.4 min (range 7-40), respectively. The mean set-up time was 30.4 min (range 17-41 min). The mean docking time was 4.3 min (range 2-9 min). The mean console time was 74.2 min (range 30-137). The mean and range of the anesthesia time were 133.8 min and 75-210 min, respectively. The averages of EBL and uterus weight were calculated as 38.2 cc and 221.9 g, respectively. Three complications occurred: one postoperative paralytic ileus and the others were peroperative vaginal cuff lacerations during the removal of the specimen through the vagina. Conclusion: Robotic-assisted hysterectomy (RAH) is feasible and safe for women with benign uterine pathologies, although it has limitations that may be overcome in the future. © 2009 Springer-Verlag.




“Incidence and characteristics of patients with vaginal cuff dehiscence after robotic procedures.”

Kho, R. M. and J. F. Magrina (2009).

Obstet Gynecol 114(6): 1372-1373.




“Robotic assisted total pelvic exenteration: a case report.”

Lim, P. C. (2009).

Gynecol Oncol 115(2): 310-311.




“Robotic-assisted total laparoscopic hysterectomy versus conventional total laparoscopic hysterectomy.”

Shashoua, A. R., D. Gill, et al. (2009).

Journal of the Society of Laparoendoscopic Surgeons 13(3): 364-369.


Objectives: To compare patient characteristics, operative variables, and outcomes of 24 patients who underwent robotic-assisted total laparoscopic hysterectomy (TLH with 44 patients who underwent conventional TLH. We retrospectively reviewed the charts of 44 patients with TLH and 24 patients with robotic TLH. Results: Robotic TLH was associated with a shorter hospital stay (1.0 vs 1.4 days, P=0.011) and a significant decrease in narcotic use (1.2 vs 5.0 units, P=0.002). EBL and drop in hemoglobin were not significantly different. The operative time was significantly longer in patients undergoing robotic TLH (142.2 vs 122.1 minutes P=0.027). However, only need for laparoscopic morcellation BMI, and uterine weight, not robotic use, were independently associated with increased operative times. Conclusions: Robotic hysterectomy can be performed safely with comparable operative times to those of conventional laparoscopic hysterectomy. Postoperative measures were improved over measures for conventional laparoscopy. © 2009 by JSLS, Journal of the Society of Laparoendoscopic Surgeons. Published by the Society of Laparoendoscopic Surgeons, Inc.




“Surgical treatment of early endometrial cancer: What are the benefits of laparoscopy?”

Capmas, P., A. S. Bats, et al. (2009).

Place de la cœlioscopie dans le traitement des cancers de l’endomètre à un stade précoce (stade I) 38(7): 537-544.


The development of gynaecologic laparoscopic surgery has also spread into some areas of the pelvic cancer surgery. Nevertheless, in France, less than 5% of interventions for endometrial cancer are currently performed by laparoscopy. As compared with laparotomy, laparoscopy, which is equally effective, provides per- and postoperative benefits, with comparable recurrence and survival rates. Operators’ training seems to be the most significant limitation to the development of laparoscopy in the surgical treatment of early endometrial cancer. © 2009 Elsevier Masson SAS. All rights reserved.




“Robotics and gynecologic oncology: review of the literature.”

Cho, J. E. and F. R. Nezhat (2009).

Journal of minimally invasive gynecology 16(6): 669-681.


The objectives of this article were to review the published scientific literature about robotics and its application to gynecologic oncology to date and to summarize findings of this advanced computerenhanced laparoscopic technique. Relevant sources were identified by a search of PUBMED from January 1950 to January 2009 using the key words Robot or Robotics and Cervical cancer, Endometrial cancer, Gynecologic oncology, and Ovarian cancer. Appropriate case reports, case series, retrospective studies, prospective trials, and review articles were selected. A total of 38 articles were identified on the subject, and 27 were included in the study. The data for gynecologic cancer show comparable results between robotic and laparoscopic surgery for estimated blood loss, operative time, length of hospital stay, and complications. Overall, there were more wound complications with the laparotomy approach compared with laparoscopy and robotic-assisted laparoscopy. There were more lymphocysts, lymphoceles, and lymphedema in the robotic-assisted laparoscopic group compared with the laparoscopy and laparotomy groups in patients with cervical cancer. Infectious and lung-related morbidity, postoperative ileus, and bleeding or clot formation were more commonly reported in the laparotomy group compared with the other 2 cohorts in patients with endometrial cancer. Computer-enhanced technology may enable more surgeons to convert laparotomies to laparoscopic surgery with its associated benefits. It seems that in the hands of experienced laparoscopic surgeons, final outcomes are the same with or without use of the robot. There is good evidence that robotic surgery facilitates laparoscopic surgery, with equivalent if not better operative time and comparable surgical outcomes, shorter hospital stay, and fewer major complications than with surgeries using the laparotomy approach.




“Robot-assisted staging using three robotic arms for endometrial cancer: Comparison to laparoscopy and laparotomy at a single institution.”

Jung, Y. W., D. W. Lee, et al. (2009).

J Surg Oncol.


PURPOSE: To demonstrate the feasibility of robot-assisted staging surgery using three arms in patients with endometrial cancer. METHODS: One hundred nine patients with clinical stage I endometrial cancer who underwent staging surgery at Yonsei University Health System were enrolled from May 2006 to January 2009. Patient demographics and operative outcomes were prospectively collected. RESULTS: Robotic surgery using three arms was performed in 28 patients, laparoscopy in 25, and laparotomy in 56. There were no differences among the three groups in terms of patient demographics. The number of harvested pelvic lymph nodes was lower in the laparoscopy group than in the laparotomy group (18.36 +/- 7.25 vs. 24.39 +/- 10.08, respectively, P = 0.025), but there was no difference between the robot and laparotomy groups. The number of resected para-aortic lymph nodes and operative time did not differ among the three groups. The average hospital stay was longer for the laparotomy group than the robot and laparoscopy groups (10.78 days vs. 7.92 days vs. 7.67 days, respectively, P < 0.001). Operative complications and transfusions developed more frequently in the laparotomy group than in the robot and laparoscopy groups (25.0% vs. 7.1% vs. 8.0%, respectively, P = 0.049; 42.9% vs. 14.3% vs. 16.0%, respectively, P = 0.006). CONCLUSION: Robot-assisted surgery using three arms is a feasible method for surgical staging in patients with clinical stage I endometrial cancer. J. Surg. Oncol. (c) 2009 Wiley-Liss, Inc.




“Robotic surgery in gynecologic oncology.”

Soliman, P. (2009).

Journal of Gynecologic Oncology Nursing 19(2): 12-15.




“Post-operative care and complications of the gynecologic oncology patient.”

Washington, R. (2009).

Journal of Gynecologic Oncology Nursing 19(2): 6-11.


Care of the post-operative gynecologic oncology patient is a challenge secondary to the emotional component of the diagnosis; however, new surgical procedures make it critical that the oncology nurse stays abreast of the ever changing care of these unique patients. This article will review the basics of gynecologic surgery, give updates on the new surgical procedures, post-operative complications, and give “Pearls” that the author has learned along the way. Post-Operative Care and Complications of the Gynecologic Oncology Patient.




“Will robots transform gynecologic surgery?”

Akl, M. N. and J. F. Magrina (2009).

Contemporary Ob/Gyn 54(9): 26-33.




“The management of pelvic organ prolapse: a review.”

Porena, M., E. Costantini, et al. (2009).

Minerva Urol Nefrol 61(4): 363-371.


The increase of the prevalence of pelvic organ prolapse (POP) and urinary incontinence (UI), associated to changes in longevity, population demographics, and lifestyle expectation, is leading to a different set of urogynecological surgical challenges for 21st century women The objective of this review is to determine the characteristics and the effects of the different surgical technique in the management of POP. Here, we reviewed traditional techniques as well as we are going to take in consideration the introduction of several new procedures involving the use of different meshes or grafts, with or without introducer kits. Finally the laparoscopic approaches and the rapidly evolving robotic surgery will be discussed. Waiting for studies with high level of evidence, due to the plethora of techniques, mesh or graft material, absorbable (synthetic and biological) and non-absorbable, at present, there seems to be no final evidences about the best management.



“Is robotic surgery suitable for all gynecologic procedures?”

Zapardiel, I. (2009).

Acta Obstetricia et Gynecologica Scandinavica 88(10): 1175-1176.