scholarly journals Initial experience with single-port robotic hysterectomy

2017 ◽  
Vol 15 (4) ◽  
pp. 476-480
Author(s):  
Mariano Tamura Vieira Gomes ◽  
Andréa Maria Novaes Machado ◽  
Sérgio Podgaec ◽  
Gustavo Anderman Silva Barison

ABSTRACT Objective: This article presents the first series of robotic single-port hysterectomy cases performed at a hospital in Brazil. Methods: From November 2014 to October 2016, 11 patients were indicated to undergo, and nine of them were submitted to single-port hysterectomy using da Vinci Single-Site® platform. However, in two patients, due to multiple previous abdominal surgeries, large uterine volume, and/or a uterus with no mobility, a pneumoperitoneum was performed with a Verres needle, and the pelvic cavity was assessed using a 5mm optics endoscope. In these cases, single-port surgery was not recommended; therefore, multiportal robotic access was chosen, and no intercurrent events were reported. Nine single-port cases were operated on by the same surgeon at Hospital Israelita Albert Einstein. Patient data analyzed included age, body mass index, previous surgeries, and clinical diagnosis. Surgical data included operative time, skin incision, report of intraoperative complications, need for conversion to laparotomy, need for transfer to intensive care unit, need for blood transfusion, inadvertent injury to other organs, length of hospital stay, and death. Results: All cases were completed with da Vinci Single-Site® system, with no intercurrent events. Four patients presented with adenomyosis as the surgical indication, two had uterine myoma, one endometrial cancer, one endometrial polyp, and one desquamative inflammatory vaginitis. The mean age of patients was 44 years (range, 40 to 54 years), and body mass index varied between 23.4 and 33.2kg/m2 (mean 26.4). No complications occurred in any of the cases, such as intestinal or bladder injury, bleeding, or the need for a second surgery. All nine procedures were completed with the robotic single-port access, and no patient required a blood transfusion. Conclusion: Although this study merely presented an initial series of patients submitted to robotic single-port surgery, it demonstrated that the method is feasible and safe, suggesting the possible use of this technique in elective hysterectomy and other gynecological procedures in the future, as described in large reference centers of advanced surgery worldwide. Specifically, in gynecological practice, existing evidence on the use of robot-assisted, single-port surgery seems promising, and although it is not indicated in all cases, it should be considered as a surgical option. Nonetheless, further randomized and controlled clinical studies are necessary to establish the preeminence of robot-assisted, single-port surgery versus single-incision and conventional laparoscopy.

2020 ◽  
pp. 101550
Author(s):  
Mahmoud Khalil ◽  
Alexander Cranwell ◽  
John Ouyang ◽  
Zaheer Alam ◽  
Jean Joseph

2017 ◽  
Vol 120 (5) ◽  
pp. 689-694 ◽  
Author(s):  
Nariman Ahmadi ◽  
Thomas G. Clifford ◽  
Gus Miranda ◽  
Jie Cai ◽  
Monish Aron ◽  
...  

2015 ◽  
Vol 81 (3) ◽  
pp. 239-244 ◽  
Author(s):  
Justin E. Richards ◽  
Brent J. Morris ◽  
Oscar D. Guillamondegui ◽  
Kyle R. Sweeney ◽  
Marc A. Tressler ◽  
...  

The impact of body mass index (BMI) on posttraumatic blood transfusion after pelvic trauma is not well known. We conducted a retrospective review of trauma registry data over a 5-year period. Patients were stratified by BMI as normal: less than 25 kg/m2, overweight: 25 to 29.9 kg/m2, obese: 30 to 39.9 kg/m2, and morbidly obese: 40 kg/m2 or greater. Fractures were identified as “likely to receive transfusion” based on literature. Multivariable logistic regression modeling evaluated the relationship between BMI and initial posttraumatic transfusion. A second regression model was created to test the effect of BMI after adjusting for fractures “less likely to receive transfusion.” Sixty-six of 244 patients (27.3%) received transfusion (mean: 1.1 ± 2.3 units). Morbid obesity was associated with transfusion (less than 55.6 vs 24.8%; P < 0.05) and units of total blood transfused (2.2 ± 2.9 vs 1.0 ± 2.2 mL; P < 0.05). The average age of patients who received a blood transfusion was significantly older compared with patients who did not receive a transfusion (45.4 ± 18.8 vs 36.1 ± 16.1 years; P < 0.05). After adjusting for potential confounders, morbid obesity was a significant risk factor for transfusion (odds ratio [OR], 4.1; 95% confidence interval [CI], 1.4 to 12.0). Adjusting by age and fracture patterns “less likely to receive transfusion,” morbid obesity remained a risk factor for transfusion (OR, 4.5; 95% CI, 1.5 to 12.9). Morbid obesity represented a significant risk factor for posttraumatic transfusion in isolated pelvic trauma, even for fracture patterns “less likely to receive transfusion.”


2020 ◽  
Vol 203 ◽  
pp. e180
Author(s):  
Sungku Kang ◽  
Won Sik Jang ◽  
Sang Woon Kim ◽  
Tae Hyun Hwang* ◽  
Sang Won Han ◽  
...  
Keyword(s):  
Da Vinci ◽  

2011 ◽  
Vol 25 (11) ◽  
pp. 3566-3573 ◽  
Author(s):  
Matthew Kroh ◽  
Kevin El-Hayek ◽  
Steven Rosenblatt ◽  
Bipan Chand ◽  
Pedro Escobar ◽  
...  

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