Abstract


Introduction: Robotic hysterectomy using standard diathermy instruments has been reported in benign gynaecology over the past decade, however, perioperative outcomes, such as pain scores, for this procedure between small and large uteri using a sealing device are not well reported in large series. Hence, we aimed to investigate, in a large retrospective cohort study of 156 consecutive patients, the rate of complications between small and large uteri in robotic benign hysterectomy using a sealing device which enables simultaneous dissection, sealing, and cutting of tissues. As secondary outcomes, we investigated the differences in pain scores, operative times, and lengths of hospitalisation between the two groups. To differentiate between small and large uteri, the commonly used threshold of 250 grams was used. Eighty-two cases were included in the small uteri group and 70 in the large uteri group. For four cases, no weight was reported.
Results: There was a statistically significant longer operative time for the large uteri group—105 minutes versus 85 minutes for the small uteri group. This difference was due to the longer duration of vaginal removal. The postoperative pain scores were comparable between small and large uteri. The overall complication rate in our series was very low, with 3.2% intraoperative complications and 4.4% postoperative complications. There was no significant difference in peri- and postoperative complication rate, as well as length of hospitalisation between the small and large uteri group.
Conclusion: In this retrospective cohort study of robotic hysterectomy using a sealing device, there was no difference in perioperative outcome between small and large uteri, but we could demonstrate shorter operative times compared to previous reports on large uteri, most likely due to the versatility of the application of the EndoWrist® Vessel Sealer (Intuitive Surgical, Inc., Sunnyvale, California). Given the known difference in complication rate and length of hospitalization between small and large uteri in laparoscopic hysterectomy, this study shows that robotic hysterectomy is a recommended procedure for benign indications in small, and especially large uteri.

Abstract


As a major institute in the field of minimally invasive gynecologic surgery, we constantly endeavor to develop and perform the least-invasive surgeries possible. In laparoscopy and robot-assisted laparoscopy, we should expect that complex surgeries that are currently undertaken with the use of many ports of a given diameter will eventually be accomplished with smaller incisions and fewer ports. There will always be clinical scenarios that require a more invasive approach, either because of adhesive tissues or a complex pathology. However, many routine cases will yield themselves to extremely minimally invasive techniques. In this report, we explain how we designed and ultimately used an improvised 11mm laparoscopic single-port system to perform a single-port hysterectomy through a bluntly created 11mm incision. The system was completely devised using currently available and easily obtainable surgical equipment approved in the United States, to maximize the reproducibility of the surgery. The surgery includes the creation of a working incision using an 11mm blunt laparoscopic trocar, to consistently produce a repeatedly small footprint. The surgery was performed successfully and without complication. To the best of our knowledge, this is the smallest reported single-incision hysterectomy.

Abstract


Urologic involvement is seen in 1.2–3.9% of women with endometriosis. The bladder (84%) is the most common location of urinary tract endometriosis and the retro-trigone and dome of the bladder are the most frequently affected sites. Ureteral involvement is commonly extrinsic and leads to compression and fibrosis of peri-ureteral tissue, leading to obstruction. Robotic-assisted laparoscopy provides additional advantages of 3D visualization, shorter learning curve compared to conventional laparoscopy, improved dissection in tight pelvic spaces, and facilitation of suturing techniques. In this review, we present the multidisciplinary management of four cases of deep infiltrating endometriosis of the urinary tract in a tertiary referral center of expertise and a review of the literature.

Abstract


Objective: Outpatient hysteroscopy can be a painful procedure for some patients and there is still no consensus regarding analgesia use. We evaluated which types and modalities of analgesia are most commonly used in a select group of hysteroscopists.
Study design: A 15-item questionnaire was created to assess the use of routine analgesia during office hysteroscopy. The SurveyMonkey portal (https://www.surveymonkey.com/) was used to administer the questionnaire. Of the 400 hysteroscopists who were approached, 229 replied.
Results: Routine pre-procedural or intra-procedural analgesia was used by 34% of hysteroscopists (67% of these reported using NSAIDs, 12% paracetamol, 7% opioids 13.5% other). Among hysteroscopists who routinely used intra-procedural analgesia, 46.1% reported using a paracervical block, 15.4% used an intracervical blockage, 15.4% had the patient listen to music during the procedure, 3.8% used local anesthetics, as in a spray or gel on the surface of the cervix, and 19.2% used some other method. Regarding misoprostol use, 75% of hysteroscopists reported not using it routinely.
Conclusion: Our results are consistent with poor evidence from published studies that there is a low prevalence of routine analgesia use during outpatient hysteroscopy.