G.M. Jonsdottir

Costs and outcomes of abdominal, vaginal, laparoscopic and robotic hysterectomies.

Complication rates did not vary significantly among minimally invasive methods of hysterectomy; however, patient costs were significantly influenced by the technique used for hysterectomy.

Use of Bidirectional Barbed Suture in Laparoscopic Myomectomy: Evaluation of Perioperative Outcomes, Safety, and Efficacy

STUDY OBJECTIVE To compare perioperative outcomes during laparoscopic myomectomy using a bidirectional barbed suture vs conventional smooth suture. DESIGN Retrospective analysis of 138 consecutive laparoscopic myomectomies performed by a single surgeon over 3 years (Canadian Task Force classification II-2). SETTING Major university teaching hospital. PATIENTS One hundred thirty-eight women with symptomatic uterine myomas. INTERVENTIONS In women undergoing laparoscopic myomectomy from February 2007 through April 2010, conventional smooth sutures were used in 31 patients, and bidirectional barbed suture in 107 patients. MEASUREMENTS AND MAIN RESULTS The primary indications for laparoscopic myomectomy in either group were pelvic pain or pressure and abnormal uterine bleeding. Use of bidirectional barbed suture was found to significantly shorten the mean (SD) duration of surgery (118 [53] minutes vs 162 [69] minutes; p <.05) and reduce the duration of hospital stay (0.58 [0.46] days vs 0.97 [0.45] days; p <.05). No significant differences were observed between the 2 groups insofar as incidence of perioperative complications, estimated blood loss, and number or weight of myomas removed during surgery. CONCLUSION Use of bidirectional barbed suture seems to facilitate closure of the hysterotomy site in laparoscopic myomectomy.

The Feasibility of Societal Cost Equivalence between Robotic Hysterectomy and Alternate Hysterectomy Methods for Endometrial Cancer

Objectives. We assess whether it is feasible for robotic hysterectomy for endometrial cancer to be less expensive to society than traditional laparoscopic hysterectomy or abdominal hysterectomy. Methods. We performed a retrospective cohort analysis of patient characteristics, operative times, complications, and hospital charges from all (n = 234) endometrial cancer patients who underwent hysterectomy in 2009 at our hospital. Per patient costs of each hysterectomy method were examined from the societal perspective. Sensitivity analysis and Monte Carlo simulation were performed using a cost-minimization model. Results. 40 (17.1%) of hysterectomies for endometrial cancer were robotic, 91 (38.9%), were abdominal, and 103 (44.0%) were laparoscopic. 96.3% of the variation in operative cost between patients was predicted by operative time (R = 0.963, P < 0.01). Mean operative time for robotic hysterectomy was significantly longer than other methods (P < 0.01). Abdominal hysterectomy was consistently the most expensive while the traditional laparoscopic approach was consistently least expensive. The threshold in operative time that makes robotic hysterectomy cost equivalent to the abdominal approach is within the range of our experience. Conclusion. It is feasible for robotic hysterectomy to be less expensive than abdominal hysterectomy, but unlikely for robotic hysterectomy to be less expensive than traditional laparoscopy.

Dilute versus concentrated vasopressin administration during laparoscopic myomectomy: a randomised controlled trial

To determine if higher‐volume, fixed‐dose administration of vasopressin further reduces blood loss at the time of minimally invasive myomectomy.

Authors’ reply re: Dilute versus concentrated vasopressin administration during laparoscopic myomectomy: a randomised controlled trial

Sir, The authors thank Dr. Thangaswamy for his thoughts regarding our study on the administration of vasopressin at the time of laparoscopic myomectomy. Dr. Thangaswamy raises the interesting question of whether we can mitigate the physiologic changes related to vasopressin administration by altering the rate of injection while highlighting the dearth of information on this potential avenue for practice improvement. Details regarding shifts in pulse or blood pressure parameters were not measured in our study and are of unknown clinical significance. As noted in our manuscript, it is the practice of each author to notify the anesthesiology team prior to injection of vasopressin in order to monitor for hemodynamic changes. There were no anesthesiology concerns or adverse events related to vasopressin injection in either group and we concluded that both concentrations under study appeared safe. Much of what we know about vasopressin use is based on expert opinion alone, and although our study was welldesigned to address one aspect of vasopressin use, many unanswered questions remain. In the absence of further evidence on this topic, we are unable to extrapolate our findings to further comment on safety guidelines such as the small aliquot dosing recommended by Dr. Thangaswamy. Future prospective controlled studies are necessary to determine factors such as the minimal useful dose of vasopressin, variation of effect with location of injection or time elapsed since administration, and optimal interval for re-dosing if desired.&