Perioperative surgical outcome of conventional and robot-assisted total laparoscopic hysterectomy

Weelden, Willem Jan van; Gordon, Beverley; Roovers, Elisabeth A.; Kraayenbrink, Arjan A.; Aalders, C. I. M.; Hartog, Francis E.; Dijkhuizen, F. P. H. L. J.

doi:10.1186/s10397-017-1008-2

Cited by 16 publications

(10 citation statements)

References 21 publications

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“…Our findings reveal that robotic surgery reduced the length of hospitalization by 0.90 days and any reduction in the length of hospitalization means the recovery is faster, due that an early incorporation to usual activities after the primary intervention was obtained by patients of RAH group (a difference of 1.62 days). While some authors concur on this point [17, 18, 32, 33], the biggest comparative analysis by Pasic et al [16] showed no difference in postoperative hospital stay between the robotic hysterectomy group and the CLH group.…”

Section: Discussionmentioning

confidence: 99%

Long term COST-minimization analysis of robot-assisted hysterectomy versus conventional laparoscopic hysterectomy

et al. 2019

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BackgroundThe aim of this study is to carry out the economic evaluation, in term of a cost-minimization analysis that considers healthcare costs and indirect costs, of robot-assisted hysterectomy (RAH) compared with conventional laparoscopic hysterectomy (CLH) in female adults scheduled for total laparoscopic hysterectomy for benign conditions.MethodsCost-minimization analysis based on an analytic observational study of prospective cohorts with a five-year time horizon. Eligible participants were all female adults scheduled for total laparoscopic hysterectomy for benign conditions at tertiary hospital. The economic evaluation was conducted from a Spanish National Health Service and societal perspective, including healthcare costs and indirect costs. The costs are expressed in Euros from the year 2015.ResultsOne hundred sixty nine patients were analyzed, 68 in the RAH group and 101 in the CLH group. Average cost for the RAH group was €8982.42 compared to €8015.14 for the CLH group (incremental cost €967.27; p = 0.054). Healthcare cost is the most important component of total cost and represents 86.4% for the RAH group and 82.3% for the CLH group. The difference of €1169 (p = 0.01) in the average healthcare cost is mainly due to the cost of purchasing and maintaining the equipment (difference of €1206.39 in favor of RAH; p < 0.005). With regard to indirect costs, for patients in the RAH group the costs associated with loss of productivity were lower (difference of €203.42; p = 0.17), while the cost of trips to the hospital was higher (difference of €1.98; p = 0.66) in respect to CLH.ConclusionsOur findings reveal similar effectiveness between RAH and CLH, although CLH is the more efficient option from the point of view of an economic analysis based on cost-minimization.

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Section: Discussionmentioning

confidence: 99%

Long term COST-minimization analysis of robot-assisted hysterectomy versus conventional laparoscopic hysterectomy

et al. 2019

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“…TLH, which is associated with less complication, shorter hospital stays, and faster return to normal activities, offers a safe and feasible alternative to abdominal hysterectomy [1]. Despite the benefits, laparoscopic hysterectomy has some limitations, such as a long learning curve and requirements of high-level surgical skills [2]. Robotic surgery could overcome these difficulties, making laparoscopic surgery possible for more patients [2].…”

Section: Introductionmentioning

confidence: 99%

“…Despite the benefits, laparoscopic hysterectomy has some limitations, such as a long learning curve and requirements of high-level surgical skills [2]. Robotic surgery could overcome these difficulties, making laparoscopic surgery possible for more patients [2]. Robotic surgery also enables surgeons to perform complex procedures more easily through improved visualization, more accurate instrument control, and easi-er use of instruments [3].…”

Section: Introductionmentioning

confidence: 99%

“…Since the Food and Drug Administration approval of the da Vinci Robotic Surgical System for gynecologic surgery in 2005, robot-assisted surgery has become popular among both gynecologic surgeons and their patients [4]. Robotic surgical system offers a three-dimensional (3D) vision and EndoWrist instruments that mimic the human wrist and optimal ergonomics [2]. In Korea, the first robotic laparoscopic hysterectomy was performed by Kim et al.…”

Section: Introductionmentioning

confidence: 99%

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Robotic Single-Site Hysterectomy versus Robot-Assisted Multiport Hysterectomy in Benign Gynecologic Diseases: A Retrospective Comparison of Clinical and Surgical Outcomes

Park

Lee

et al. 2018

Soonchunhyang Med Sci

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Objective: The purpose of this study was to compare clinical and surgical outcomes of robotic single-site hysterectomy (RSSH) and robot-assisted multiport hysterectomy (RH) in benign disease. Methods: We retrospectively reviewed the medical records of 38 women who underwent RSSH (N= 12) or RH (N= 26) for the treatment of benign uterine disease between June 2015 and November 2017. Results: There were no intergroup differences in parity, comorbidities, and number of previous abdominal surgery. Mean age was older (49.5± 5.05 years vs. 44.4± 3.54 years, P= 0.001) and mean body mass index was higher (27.4± 2.47 kg/m 2 vs. 25.3± 3.12 kg/ m 2 , P = 0.045) in RSSH group than RH group. Surgical outcomes, including operative time (165.0 minutes vs. 159.2 minutes, P= 0.727), estimated blood loss (115.8± 33.15 mL vs. 108.1± 56.42 mL, P= 0.662), uterus weight (445.9± 157.21 g vs. 374.5± 197.91 g, P= 0.291), postoperative hospital stay (5.4± 0.51 days vs. 5.8± 1.20 days, P= 0.289), postoperative hemoglobin change in day 1 (1.8 ± 0.89 g/dL vs. 1.4 ± 1.53 g/dL, P = 0.431) and day 3 (2.1 ± 1.32 g/dL vs. 1.7 ± 1.83 g/dL, P = 0.601), and perioperative complications did not significantly differ between two groups. The use of additional analgesics after 6 hours, 24 hours, and 48 hours, and mean NRS score after 6 hours, 24 hours, and 48 hours were not significantly different between two groups. Conclusion: RSSH might be an effective and safe alternative to RH, even if in older and/or obese women with large uteri.

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“…Conversion rate was lower in two large, register‐based cohort studies 16,17 . A lower estimated blood loss or a lower transfusion rate in RATLH compared with TLH has been shown in several previous observational studies, all with a study population over 1000 women 9,10,13,15,18,19 …”

Section: Discussionmentioning

confidence: 77%

Assessment of surgeon and hospital volume for robot‐assisted and laparoscopic benign hysterectomy in Sweden

Brunes

Forsgren

Warnqvist

et al. 2021

Acta Obstet Gynecol Scand

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Introduction:The study aims to analyze differences between robotic-assisted total laparoscopic hysterectomy (RATLH) and total laparoscopic hysterectomy (TLH) in benign indications, emphasizing surgeon and hospital volume.Material and methods: All women in Sweden undergoing a total hysterectomy on benign indications with or without a bilateral salpingo-oophorectomy from 1 January 2015 to 31 December 2017 (n=12 386) were identified from three national Swedish registers. Operative time, blood loss, conversion rate, complications, readmission, reoperation, length of hospital stays and time to daily life activity were evaluated by uni-and multivariable regression models in RATLH and TLH. Surgeon and hospital volume were obtained from the were obtained from the Swedish National Quality Register of Gynecological Surgery and divided into subclasses.Results: TLH was associated with a higher rate of intraoperative complications (adjusted odds ratios (aOR) 2.8, 95% confidence interval (CI) 1.3-5.8) and postoperative bleeding complications (aOR 1.8, 95% CI 1.2-2.9) compared with RATLH. Intraoperative data showed a higher conversion rate (aOR 13.5, 95% CI 7.2-25.4), a higher blood loss (200-500 ml aOR 3.5, 95% CI 2.7-4.7; > 500 ml aOR 7.6, 95% CI 4.0-14.6) and a longer operative time (1-2 h aOR 16.7 95% CI 10.2-27.5; > 2 h aOR 47.6, 95% CI 27.9-81.1) in TLH compared with RATLH. The TLH group had a lower caseload per year than the RATLH group. Higher surgical volume was associated with lower median blood loss, shorter operative time, a lower conversion rate and a lower perioperative complication rate. Differences in conversion rate or operative time in RATLH were not affected by surgeon volume when compared with TLH. One year after surgery patient satisfaction was higher in RATLH than in TLH (aOR 0.6 95% CI 0.4-0.9). Conclusions: RATLH led to better perioperative outcome and higher patient satisfaction one year after surgery. These outcome differences were slightly more pronounced in very low-volume surgeons but persisted across all surgeon volume groups.

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Perioperative surgical outcome of conventional and robot-assisted total laparoscopic hysterectomy

Cited by 16 publications

References 21 publications

Long term COST-minimization analysis of robot-assisted hysterectomy versus conventional laparoscopic hysterectomy

Long term COST-minimization analysis of robot-assisted hysterectomy versus conventional laparoscopic hysterectomy

Robotic Single-Site Hysterectomy versus Robot-Assisted Multiport Hysterectomy in Benign Gynecologic Diseases: A Retrospective Comparison of Clinical and Surgical Outcomes

Assessment of surgeon and hospital volume for robot‐assisted and laparoscopic benign hysterectomy in Sweden

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