Risk of Upper-body Adverse Events in Robot-assisted Total Laparoscopic Hysterectomy for Benign Gynecologic Disease

Matsuo, Koji; Mandelbaum, Rachel S.; Nusbaum, David J.; Chang, Erica J.; Zhang, Renee H; Matsuzaki, Shinya; Klar, Maximilian; Roman, Lynda D.

doi:10.1016/j.jmig.2021.01.017

Cited by 4 publications

(2 citation statements)

References 45 publications

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“…Removing the small intestine from the pelvic cavity is important to obtain a clear view and to avoid inadvertent contact with the intestine during surgery. However, the steep Trendelenburg position has been reported to be associated with complications such as gas embolism, 1 increased intraocular pressure, [2][3][4] increased intracranial pressure, 5,6 decreased blood flow in the internal carotid artery, 7 spontaneous otorrhea, 8 upper-body complications, 9 nerve injury, 10,11 peripheral neuropathy, 12 venous thromboembolism, 13,14 and lower-extremity compartment syndrome caused by impaired blood flow. 15 Gould et al previously reported that a mean Trendelenburg angle of 28.0 was required to complete robotic gynecologic surgery.…”

Section: Introductionmentioning

confidence: 99%

Factors related to clearance of the small pelvic cavity during gynecologic laparoscopic surgery

Hiraishi,

Kitahara,

Kobayashi

et al. 2024

J of Obstet and Gynaecol

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AimTo identify factors influencing the Trendelenburg angle required during laparoscopic gynecological surgery.MethodsPatients who underwent laparoscopic surgery at a single university hospital between May 1, 2019, and March 31, 2021 were enrolled. Data were extracted from the medical records, while magnetic resonance imaging scans and all laparoscopic surgery videos were retrospectively reviewed to assess the presence of the small intestine in the pelvic cavity as well as the adhesions at each site. Groups with and without the small intestine in the pelvic cavity, and those requiring a Trendelenburg angle above or below 13° were compared.ResultsIn total, 219 patients were examined. The Trendelenburg angle was significantly higher (p = 0.004), while a significant increase in ovarian adhesions was observed (p = 0.033; odds ratio [OR], 2.30; 95% confidence interval [CI], 1.05–5.01) in the group without the presence of the small intestine in the pelvic cavity. Furthermore, the group requiring a Trendelenburg angle of ≥13° had significantly thicker subcutaneous fat (p = 0.044) and more ileal adhesions (p = 0.040, OR, 1.82; 95% CI, 1.03–3.23) than the group with an angle of <13°.ConclusionCases of ileal adhesions or thick subcutaneous fat are more likely to require a Trendelenburg angle of ≥13°. Therefore, Trendelenburg complications should be considered in this group. In addition, ovarian adhesions make it more difficult to exclude the small intestine from the small pelvic cavity, and may be associated with endometriosis.

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Section: Introductionmentioning

confidence: 99%

Factors related to clearance of the small pelvic cavity during gynecologic laparoscopic surgery

Hiraishi,

Kitahara,

Kobayashi

et al. 2024

J of Obstet and Gynaecol

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“…Furthermore, as for the surgical approach of radical hysterectomy, most of the clinical studies cited in NCCN Clinical Practice Guidelines for cervical cancer are based on the FIGO 2009 staging system (5)(6)(7)(8), and there is still a lack of clinical evidence based on the FIGO 2018 staging system. Therefore, it is necessary to compare the oncological outcomes of different surgical approaches based on the new FIGO 2018 staging system.…”

Section: Introductionmentioning

confidence: 99%

Comparison of the Oncological Outcomes Between Robot-Assisted and Abdominal Radical Hysterectomy for Cervical Cancer Based on the New FIGO 2018 Staging System: A Multicentre Retrospective Study

Zhan

et al. 2022

Front. Oncol.

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ObjectiveTo compare the 3-year oncological outcomes of robot-assisted radical hysterectomy (RRH) and abdominal radical hysterectomy (ARH) for cervical cancer.MethodsBased on the clinical diagnosis and treatment for cervical cancer in the China database, patients with FIGO 2018 stage IA with lymphovascular space invasion (LVSI)-IB2 cervical cancer disease who underwent RRH and ARH from 2004 to 2018 were included. Kaplan–Meier survival analysis was used to compare the 3-year overall survival (OS) and disease-free survival (DFS) rate between patients receiving RRH and those receiving ARH. The Cox proportional hazards model and propensity score matching were used to estimate the surgical approach-specific survival.ResultsA total of 1,137 patients with cervical cancer were enrolled in this study, including the RRH group (n = 468) and the ARH group (n = 669). The median follow-up time was 45 months (RRH group vs. ARH group: 24 vs. 60 months). Among the overall study population, there was no significant difference in 3-year OS and DFS between the RRH group and the ARH group (OS: 95.8% vs. 97.6% p = 0.244). The Cox proportional hazards analysis showed that RRH was not an independent risk factor for 3-year OS (HR: 1.394, 95% CI: 0.552–3.523, p = 0.482). However, RRH was an independent risk factor for 3-year DFS (HR: 1.985, 95% CI: 1.078–3.655 p = 0.028). After 1:1 propensity score matching, there was no significant difference in 3-year OS between the RRH group and the ARH group (96.6% vs. 98.0%, p = 0.470); however, the 3-year DFS of the RRH group was lower than that of the ARH group (91.0% vs. 96.1%, p = 0.025). The Cox proportional hazards analysis revealed that RRH was not an independent risk factor for 3-year OS (HR: 1.622, 95% CI: 0.449–5.860 p = 0.461), but RRH was an independent risk factor for 3-year DFS (HR: 2.498, 95% CI: 1.123–5.557 p = 0.025).ConclusionAmong patients with stage I A1 (LVSI +)-I B2 cervical cancer based on the FIGO 2018 staging system, RRH has a lower 3-year DFS than ARH, suggesting that RRH may not be suitable for early cervical cancer patients.

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Decreasing utilization of minimally invasive hysterectomy for cervical cancer in the United States

Matsuo

Mandelbaum

Klar

et al. 2021

Gynecologic Oncology

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Risk of Upper-body Adverse Events in Robot-assisted Total Laparoscopic Hysterectomy for Benign Gynecologic Disease

Cited by 4 publications

References 45 publications

Factors related to clearance of the small pelvic cavity during gynecologic laparoscopic surgery

Factors related to clearance of the small pelvic cavity during gynecologic laparoscopic surgery

Comparison of the Oncological Outcomes Between Robot-Assisted and Abdominal Radical Hysterectomy for Cervical Cancer Based on the New FIGO 2018 Staging System: A Multicentre Retrospective Study

Decreasing utilization of minimally invasive hysterectomy for cervical cancer in the United States

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