Kimberly A. Kho

Evaluating the Risks of Electric Uterine Morcellation

Gynecologic surgeons, like many other surgical specialists, have embraced laparoscopic surgical techniques because they offer quicker recovery, less postoperative pain, and fewer wound complications than open procedures. The removal of large pieces of tissue through the small incisions of laparoscopy is difficult. However, this problem can be overcome by tissue morcellation, a technique of fragmenting tissue into smaller pieces that often prevents the need to enlarge established incisions. Surgeons have long used manual morcellation with a scalpel or scissors to remove masses abdominally and vaginally, but use of the technique has increased with wide adoption of laparoscopic approaches and with the introduction of laparoscopic electric morcellators in 1993.

Comparison of Robotic and Laparoscopic Hysterectomy for Benign Gynecologic Disease

OBJECTIVE: Use of robotically assisted hysterectomy for benign gynecologic conditions is increasing. Using the most recent, available nationwide data, we examined clinical outcomes, safety, and cost of robotic compared with laparoscopic hysterectomy. METHODS: Women undergoing robotic or laparoscopic hysterectomy for benign disease were identified from the United States 2009 and 2010 Nationwide Inpatient Sample. Propensity scores derived from a logistic regression model were used to assemble matched cohorts of patients undergoing robotic and laparoscopic hysterectomy. Differences in in-hospital complications, hospital length of stay, and hospital charges were assessed between the matched groups. RESULTS: Of the 804,551 hysterectomies for benign conditions performed in 2009 and 2010, 20.6% were laparoscopic and 5.1% robotically assisted. Among minimally invasive hysterectomies, the use of robotic hysterectomy increased from 9.5% to 13.6% (P=.002). In a propensity-matched analysis, the overall complication rates were similar between robotic and laparoscopic hysterectomy (8.80% compared with 8.85%, relative risk 0.99, 95% confidence interval [CI] 0.89–1.09, P=.910). There was a lower incidence of blood transfusions in robotic cases (2.1% compared with 3.1%; P<.001), but patients undergoing robotic hysterectomy were more likely to experience postoperative pneumonia (relative risk 2.2, 95% CI 1.24–3.78, P=.005). The median cost of hospital care was

Use of neutral argon plasma in the laparoscopic treatment of endometriosis.

9,788 (interquartile range

Iatrogenic myomas: new class of myomas?

7,105–12,780) for robotic hysterectomy and

Intracorporeal electromechanical tissue morcellation: a critical review and recommendations for clinical practice.

7,299 (interquartile range

Risk of Occult Uterine Sarcoma in Women Undergoing Hysterectomy for Benign Indications.

5,650–9,583) for laparoscopic hysterectomy (P<.001). Hospital costs were on average

Vaginal extraction of large uteri with the Alexis retractor.

2,489 (95% CI

Surgical Treatment of Uterine Fibroids Within a Containment System and Without Power Morcellation.

2,313–2,664) higher for patients undergoing robotic hysterectomy. CONCLUSION: The use of robotic hysterectomy has increased. Perioperative outcomes are similar between laparoscopic and robotic hysterectomy, but robotic cases cost substantially more. LEVEL OF EVIDENCE: II

Endometriosis in adolescents.

Neutral argon plasma energy can be used as a multifunctional device that has vaporization, coagulation and superficial cutting capabilities with little thermal spread.

Vaginal cuff dehiscence and evisceration: A review of the literature

Parasitic myomas, defined as extrauterine seeding of leiomyoma, have been reported since the early 1900s. These myomas were thought to be spontaneously occuring, separate from the uterus but still hormone-dependent and can cause symptoms. What seemed to be a rare disorder developing from the natural history of pedunculated myomas has become increasingly reported over the last decade. Because it is still a rare disorder, the literature is limited to case reports. Herein, we review the literature and provide an analytic review of recent case reports, with emphasis on etiology, trends, and risk factors, to increase awareness of this problematic entity.