G. Moawad

Comparison of cost and operative outcomes of robotic hysterectomy compared to laparoscopic hysterectomy across different uterine weights

Operative cost and outcomes between robotic and laparoscopic hysterectomy across different uterine weights. Retrospective cohort study including patients undergoing robotic and laparoscopic hysterectomy for benign disease at an Academic university hospital. One hundred and ninety six hysterectomies were identified (101 robotic versus 95 laparoscopic). Demographic and surgical characteristics were statistically equivalent. Robotic group had a higher body mass index (±SD) (32.9xa0±xa06.5 versus 30.4xa0±xa07.1, p 0.012) and more frequent history of adnexal surgery (12.9 versus 4.2%, p 0.031). Laparoscopic group had a higher number of concurrent salpingectomy (81 versus 66.3%, p 0.02). Estimated blood loss did not differ between procedures. Compared to robotic hysterectomies, laparoscopic procedures added 47xa0min (CI: 31–63xa0min; pxa0<xa00.001) of operative time, costed

Tips and Tricks: Single-Site Robotic-Assisted Myomectomy

1648 more (CI: 500–2797; pxa0=xa00. 005) and had triple the odds of having an overnight admission (ORxa0=xa02.94 CI: 1.34–6.44; pxa0=xa00.007). After stratification of cases by uterine weight, the mean operative time difference between the two groups in uteri between 750 and 1000xa0g and in uteri >1000xa0g was 81.3xa0min (CI: 51.3–111.3, pxa0<xa00.0001) and 70xa0min (CI: 26–114, pxa0<xa00.005), respectively, in favor of the robotic group. Mean direct cost difference in uteri between 750 and 1000xa0g and uteri >1000xa0g was 1859

Postoperative Hormonal Suppression for Prevention of Deeply Infiltrative Endometriosis Recurrence After Surgery

(CI: 629–3090, pxa0<xa00.006) and 4509

Surgical Variance Between Post-Conceptional and Pre-Conceptional Minimally Invasive Trans-Abdominal Cerclage Placement

(CI: 377–8641, pxa0<xa00.004), respectively, also in favor of the robotic group. In expert hands, robotic hysterectomy for uteri weighing more than 750xa0g may be associated with shorter operative time and improved cost profile.

Comparison of Methods of Morcellation: Manual Versus Power

STUDY OBJECTIVEnTo describe some tips and tricks that facilitate a single-site robotic- assisted (RA) myomectomy.nnnDESIGNnStepwise surgical tutorial using a narrated video (Canadian Task Force classification III).nnnSETTINGnAcademic tertiary care hospital.nnnINTERVENTIONSnSingle-incision RA myomectomy is a novel technique that presents unique surgical challenges. Although similar in outcomes to multiport myomectomy, single-site myomectomy is more cosmetically appealing. Traditional laparoscopic single- site myomectomy has been associated with a steep learning curve. The robotic single-site platform mitigates some of these difficulties, which allows for the reproducibility and safety of this technique in appropriately selected patients. In this surgical tutorial, we present a case of a 7-cm type 2-5 fibroid removed with this approach.nnnCONCLUSIONnSingle-site RA myomectomy is a safe, minimally invasive option for appropriately selected patients. Although it is a challenging procedure, it provides excellent cosmesis and is reproducible with adequate training and expertise.

Dual Port Hysterectomy: A Novel Technique and Initial Experience

Purpose of ReviewThe long-term management of deeply infiltrative endometriosis (DIE) remains debatable. Surgical excision improves pain and fertility in patients with endometriosis, however recurrence is common. In this article, we present an evidence-based approach of recurrence and postoperative hormonal suppression in DIE.Recent FindingsA clear understanding of recurrence patterns and methods for prevention of DIE are lacking. Repeat surgery in DIE patients is associated with increased morbidity. Older data has suggested the limited utility of short-term postoperative hormonal suppression for the prevention of pain or disease recurrence for patients with endometriosis (Yap et al., Cochrane Database Syst Rev. (3):CD003678, 2004). More recent studies suggest that long-term medical therapy with oral contraceptive pills (OCPs) or progesterone only pills (POPs) reduces recurrence of superficial disease and endometriomas. Limited data, however, exists for DIE.SummaryThis article reviews the literature of hormonal suppression for the prevention of postoperative recurrence of DIE. Despite the dearth of data, the current evidence suggests the utility of long-term postoperative hormonal suppression after surgery especially in those who underwent incomplete excision of DIE. Longer follow-up studies are greatly needed.

Identification and Resection of Extrauterine Adenomyosis after Hysterectomy and Non-Contained Power Morcellation

Recent data show that transabdominal cerclage placement via laparoscopy carries better obstetrical outcomes in comparison to transabdominal cerclage placement via laparotomy. In this surgical tutorial, we review the technique for minimally invasive abdominal cerclage and highlight the surgical differences between preconceptional and conceptional cerclage.