K.E. Patzkowsky

Perioperative outcomes of robotic versus laparoscopic hysterectomy for benign disease

Robotic assistance appears to enable the successful completion of complex hysterectomies with perioperative outcomes equivalent to laparoscopy.

Risk factors for postoperative urinary retention after laparoscopic and robotic hysterectomy for benign indications.

OBJECTIVE: To estimate the occurrence of postoperative urinary retention after traditional laparoscopic and robotic hysterectomy. METHODS: We performed a chart review of all patients who underwent total or supracervical hysterectomy using a laparoscopic (n=253) or robotic approach (n=281) from March 2001 until June 2010 for benign indications at the division for minimally invasive surgery. Urinary retention was defined as the inability to spontaneously void or as incomplete voiding requiring either self-catheterization or Foley catheter replacement in the first postoperative week. RESULTS: Urinary retention occurred in 7.3% (95% confidence interval [CI] 5.2–9.8%) of women and was more than twice as common among women who underwent robotic hysterectomy compared with laparoscopic hysterectomy (10.3%, 95% CI 7.0–14.5% compared with 4.0%, 95% CI 1.9–7.1%, P=.005). No statistically significant differences in those with and without urinary retention were seen in age, body mass index, smoking status, number of prior cesarean deliveries, operative time, presence of severe adhesions, or findings of endometriosis. In a multivariable logistic regression analysis, only the robotic approach relative to traditional laparoscopic approach was found to be significantly associated with urinary retention (odds ratio 2.6, 95% CI 1.2–5.6). Postoperative urinary retention was associated with a higher incidence of lower urinary tract infection, occurring in 15.4% (95% CI 5.9–30.5%) of cases compared with 4.0% (95% CI 2.5–6.2%) of those without urinary retention (P=.008). CONCLUSION: Transient urinary retention is relatively more common after robotic hysterectomy when compared with laparoscopic hysterectomy. We postulate that more aggressive bladder dissection performed with robot assistance may be associated with an increased risk of urinary retention. LEVEL OF EVIDENCE: II

Comparison of 2 minimally invasive routes for hysterectomy of large uteri

To compare the perioperative outcomes associated with 2 minimally invasive surgical routes for the hysterectomy of large fibroid uteri.

O475 Sustaining a gynecologic operative laparoscopic training program in Ghana

Design: Review of stillbirths and neonatal deaths. Setting: Muhimbili National Hospital (MNH), Dar es Salaam Tanzania. Methods: Perinatal deaths from 1st August, 2007 to 31st December, 2007 at MNH were identified. Only infants weighing 1500 grams or more were included in the analysis. Each auditor independently evaluated the case. Suboptimal factors were identified in the antenatal, intrapartum and early neonatal period and classified them into the three levels of delay. The contribution of each suboptimal factor to adverse perinatal outcome was identified and cases graded according to possible avoidability. Main outcome: Avoidability of stillbirths and neonatal deaths. Results: The PMR was 88 per 1,000 total births. Suboptimal factors were identified in 80 percent of audited cases and half of suboptimal factors were found to be the likely cause of adverse perinatal outcome and were preventable. Poor foetal heart monitoring during labour was associated with over 40% of perinatal death. There was a poor to fair agreement between external and internal auditors. Conclusion: Poor monitoring during labour is a major cause of avoidable perinatal mortality. There remain significant areas for care improvements. Regular perinatal audits to identify avoidable causes of perinatal deaths with feed back to the health care providers are useful to reduce perinatal mortality in this large African tertiary hospital.