To assess pregnancy outcomes following robot-assisted laparoscopic myomectomy (RM). IRB-approved mailed survey. University hospital tertiary referral center. Women who underwent consecutive robot-assisted laparoscopic myomectomies at the University of Michigan from 4/7/2004 through 6/18/2010 were identified. Mailed survey to collect pregnancy information following myomectomy. Mailed surveys were sent to 163 women whose addresses could be identified, and 45 completed surveys were returned for a response rate of 45/163 (25.7%). Mean time to follow up was 53.7 months (range 24 to 89). After myomectomy, 22/45 (48.9%) attempted pregnancy, and 7/22 (31.8%) required fertility treatments. Sixteen of 22 (72.7%) subjects became pregnant. The average age at the time of delivery was 31.6 years (range 22-42.2), and there was an average of 13.6 months (range 3 to 46) from time of myomectomy to first pregnancy. There were a total of 26 pregnancies, and live births occurred in 16/26 (61.5%) pregnancies. Mean gestational age at the time of delivery was 37 weeks (range 33-39). Ten of 16 live births (62.5%) delivered at or beyond 37 weeks, 5/16 (31.2%) delivered between 35 and 37 weeks, and there was one delivery (6.2%) at 33 weeks. Cesarean deliveries were performed in 15/16 (93.75%), and there were no reports of uterine dehiscence. Miscarriages occurred in 7/26 (26.9%) pregnancies, two pregnancies were ongoing at the time of data collection, and data was not available for one pregnancy. Successful pregnancies can result after robot-assisted laparoscopic myomectomy. Though preterm delivery rate was 47.5%, there were no deliveries at less than 33 weeks gestation, and there were no instances of uterine dehiscence. Further research is needed to evaluate the relationship of this procedure to preterm delivery.

To compare long-term outcomes and satisfaction in women undergoing myomectomy via traditional laparotomy (L), robot-assisted laparoscopy (RM) and mini-laparotomy (ML). IRB-approved mailed survey. University hospital tertiary referral center. 456 women who underwent myomectomy at the University of Michigan from 4/7/2004 through 6/18/2010 were identified (150 via L, 203 via RM, and 103 via ML). Mailed surveys were sent to 366 women whose addresses could be identified, 31 of those were returned for incorrect addresses, and 16 opted out. One hundred twenty-eight surveys were returned; 40 (L), 61 (RM) and 27 (ML). Mailed survey assessing change in symptoms, subsequent medical and surgical interventions for fibroids and general satisfaction. The response rate was 128/335 (38.2%). Mean age at the time of myomectomy was 37.6 years (range 22-55) and the mean follow-up time was 4.5 years (range 1.7-7.7), Overall, 68.2% of women reported improvement in heavy menstrual bleeding (67.6% after L, 64.2% after RM, and 78.3% after ML, p = 0.5), while 65.0% reported improvement in painful periods (64.7% after L, 56.6% after RM and 84.2% after ML, p = 0.1) and 78% had improvement in their bulk symptoms (74.2% after L, 73.9% after RM and 89.5% after ML, p = 0.4). Nine (7.1%) women subsequently underwent hysterectomy, and 8 (6.4%) women underwent another myomectomy. One hundred (78.1%) women were satisfied with their surgery (L 75.0%, RM 82.0%, ML 74.1%, p = 0.1) and 97 (80.8%) women would recommend the surgery to a friend (L 80.0%, RM 85.2%, ML 74.1%, p = 0.8). Myomectomy by each of the three surgical routes is a procedure with high satisfaction rates and improvement in symptoms. The surgical approach in this study did not confer any significant advantage for the long term outcomes studied.

To compare perioperative outcomes of myomectomies via traditional laparotomy (L) and two minimally invasive approaches: robot-assisted laparoscopy (RL) and mini-laparotomy (ML). IRB-approved retrospective chart review. University Hospital tertiary referral center. All women who underwent myomectomy at the University of Michigan from 4/7/2004 through 6/18/2010 (n=456); 150 via traditional laparotomy, 203 via robotic-assisted laparoscopy, and 103 via mini-laparotomy (skin incision 6 cm or less). Myomectomy via traditional laparotomy (L), robotic-assisted laparoscopy (RL), or mini-laparotomy (ML). There was no significant difference in age, BMI, gravidity, or number of previous abdominal surgeries or cesarean sections between groups. There was no difference in history of diabetes, hypertension, smoking, infertility or menopausal status, as well. RL had the lowest estimated blood loss compared with L and ML, but the longest operative time. Although more fibroids were removed during L, the median diameter of the largest fibroid and fibroid weight were similar in the ML and L groups. Patients undergoing L were more likely to receive intraoperative blood transfusions than RM and ML. Two cases resulted in urgent hysterectomy, one each in the TL (0.7%) and RM (0.5%) groups. Mean hospital stay was shortest after RM. After L, there were more overall post-op complications, including blood transfusions, postoperative fever, and incisional seromas requiring drainage and packing. There was no significant difference in other major post-operative complications, such as reoperation, hospital readmissions, or ER evaluations.Table 1Patient characteristics and perioperative outcomes.*Data presented as median (95% CI), mean (± standard deviation), and number (%).Robot-assisted (RL) n = 203Mini-laparotomy (ML) n = 103Laparotomy (L) n = 150p-valueAge, years36.87 ± 6.0236.56 ± 6.5636.76 ± 6.790.92Gravidity1.09 ± 1.41.26 ± 1.71.16 ± 1.730.66History of previous abdominal surgery42 (20.69%)22 (21.36%)35 (23.33%)0.83BMI25.21 (24.04, 26.25)25.68 (24.63, 27.09)26.37 (25.77, 28.61)0.17Diameter of largest fibroid, cm6.53 ± 2.099.76 ± 4.349.03 ± 3.9<0.001EBL, ml50 (50, 75)†p<0.05 when comparing this variable to the two other variables in this row.150 (100, 200)†p<0.05 when comparing this variable to the two other variables in this row.250 (200, 300)†p<0.05 when comparing this variable to the two other variables in this row.<0.001OR time, mins (intubation to PACU)216 (201, 224.3)†p<0.05 when comparing this variable to the two other variables in this row.144 (134, 156)179.5 (164.5, 193)<0.001Intraoperative blood transfusion0 (0%)2 (1.94%)18 (12%)†p<0.05 when comparing this variable to the two other variables in this row.<0.001Weight fibroids removed, grams120 (103, 145)†p<0.05 when comparing this variable to the two other variables in this row.427 (305, 470)320 (235, 440)<0.001Hospital length of stay, days0.28 ± 0.66†p<0.05 when comparing this variable to the two other variables in this row.1.43 ± 0.96†p<0.05 when comparing this variable to the two other variables in this row.2.81 ± 1.96†p<0.05 when comparing this variable to the two other variables in this row.<0.001∗ Data presented as median (95% CI), mean (± standard deviation), and number (%).† p<0.05 when comparing this variable to the two other variables in this row. Open table in a new tab Robot-assisted laparoscopy and mini-laparotomy are both minimally invasive surgical options for fibroid removal resulting in fewer intra and post-operative blood transfusions and shorter hospital stay compared to traditional laparotomy. Although similar size and number of fibroids can be removed with mini- versus traditional laparotomy, mini-laparotomy is associated with less blood loss and lower risk of transfusion when compared to traditional laparotomy.

Study ObjectiveThe rationale for the introduction of the robotic approach for hysterectomy is to increase the total number of hysterectomies completed via minimally invasive approach. This study aims to compare the frequency of a minimally invasive surgical approach to hysterectomy between two time periods, during which the use of the robotic technique has rapidly increased.DesignIRB-approved retrospective chart review (Canadian Task Force Classification III).SettingDivision of minimally invasive gynecologic surgery at a university-based referral center.Patients623 consecutive patients who underwent hysterectomy for benign indications via laparoscopic, robotic, laparotomy, mini-laparotomy and vaginal approach during a 6 year period from July 2004 to June 2010. "Early period" refers to the first 311 patients, and "late period" to the next 312 patients.InterventionTotal or supracervical hysterectomy performed by laparotomy or a minimally invasive approach (i.e. laparoscopic, robotic, mini-laparotomy or vaginal).Measurements and Main ResultsThe characteristics of patients from the early and late periods were comparable in the terms of mean age (43.6 ± 6.9 versus 43.6 ± 6.8 years, P>0.05), median BMI (28.2 versus 29.1 kg/m2, P>0.05) and mean uterine weight (319.5 ± 350.4 g versus 368.1 ± 520.0 g, P>0.05). For all indications, the rates of hysterectomy by laparotomy, traditional laparoscopy, robotic, vaginal, and mini-laparotomy was significantly different between the early and late periods (17.7% to 5.4%, 39.5% to 17.6%, 23.8% to 64.1%, 5.8% to 4.8% and 13.2% to 8%, respectively, P<.0001), with the overall rates of hysterectomies completed via minimally invasive approach increasing from 82.3% to 94.6% respectively (P<.0001). A similar trend was observed for hysterectomies performed for Stage III/IV endometriosis (55% to 97.1%, P<.0001) and for uterine weight>350 g (62.7% to 84%, P<.0001).ConclusionIncreased utilization of a robotic approach to hysterectomy correlates with the increased utilization of a minimally invasive approach to hysterectomy for benign indications, particularly for cases of higher surgical complexity. Study ObjectiveThe rationale for the introduction of the robotic approach for hysterectomy is to increase the total number of hysterectomies completed via minimally invasive approach. This study aims to compare the frequency of a minimally invasive surgical approach to hysterectomy between two time periods, during which the use of the robotic technique has rapidly increased. The rationale for the introduction of the robotic approach for hysterectomy is to increase the total number of hysterectomies completed via minimally invasive approach. This study aims to compare the frequency of a minimally invasive surgical approach to hysterectomy between two time periods, during which the use of the robotic technique has rapidly increased. DesignIRB-approved retrospective chart review (Canadian Task Force Classification III). IRB-approved retrospective chart review (Canadian Task Force Classification III). SettingDivision of minimally invasive gynecologic surgery at a university-based referral center. Division of minimally invasive gynecologic surgery at a university-based referral center. Patients623 consecutive patients who underwent hysterectomy for benign indications via laparoscopic, robotic, laparotomy, mini-laparotomy and vaginal approach during a 6 year period from July 2004 to June 2010. "Early period" refers to the first 311 patients, and "late period" to the next 312 patients. 623 consecutive patients who underwent hysterectomy for benign indications via laparoscopic, robotic, laparotomy, mini-laparotomy and vaginal approach during a 6 year period from July 2004 to June 2010. "Early period" refers to the first 311 patients, and "late period" to the next 312 patients. InterventionTotal or supracervical hysterectomy performed by laparotomy or a minimally invasive approach (i.e. laparoscopic, robotic, mini-laparotomy or vaginal). Total or supracervical hysterectomy performed by laparotomy or a minimally invasive approach (i.e. laparoscopic, robotic, mini-laparotomy or vaginal). Measurements and Main ResultsThe characteristics of patients from the early and late periods were comparable in the terms of mean age (43.6 ± 6.9 versus 43.6 ± 6.8 years, P>0.05), median BMI (28.2 versus 29.1 kg/m2, P>0.05) and mean uterine weight (319.5 ± 350.4 g versus 368.1 ± 520.0 g, P>0.05). For all indications, the rates of hysterectomy by laparotomy, traditional laparoscopy, robotic, vaginal, and mini-laparotomy was significantly different between the early and late periods (17.7% to 5.4%, 39.5% to 17.6%, 23.8% to 64.1%, 5.8% to 4.8% and 13.2% to 8%, respectively, P<.0001), with the overall rates of hysterectomies completed via minimally invasive approach increasing from 82.3% to 94.6% respectively (P<.0001). A similar trend was observed for hysterectomies performed for Stage III/IV endometriosis (55% to 97.1%, P<.0001) and for uterine weight>350 g (62.7% to 84%, P<.0001). The characteristics of patients from the early and late periods were comparable in the terms of mean age (43.6 ± 6.9 versus 43.6 ± 6.8 years, P>0.05), median BMI (28.2 versus 29.1 kg/m2, P>0.05) and mean uterine weight (319.5 ± 350.4 g versus 368.1 ± 520.0 g, P>0.05). For all indications, the rates of hysterectomy by laparotomy, traditional laparoscopy, robotic, vaginal, and mini-laparotomy was significantly different between the early and late periods (17.7% to 5.4%, 39.5% to 17.6%, 23.8% to 64.1%, 5.8% to 4.8% and 13.2% to 8%, respectively, P<.0001), with the overall rates of hysterectomies completed via minimally invasive approach increasing from 82.3% to 94.6% respectively (P<.0001). A similar trend was observed for hysterectomies performed for Stage III/IV endometriosis (55% to 97.1%, P<.0001) and for uterine weight>350 g (62.7% to 84%, P<.0001). ConclusionIncreased utilization of a robotic approach to hysterectomy correlates with the increased utilization of a minimally invasive approach to hysterectomy for benign indications, particularly for cases of higher surgical complexity. Increased utilization of a robotic approach to hysterectomy correlates with the increased utilization of a minimally invasive approach to hysterectomy for benign indications, particularly for cases of higher surgical complexity.

Study Objective: To assess the incidence and risk factors for vaginal cuff dehiscence after robotic and traditional laparoscopic hysterectomies for benign indications.Design: IRB-approved retrospective chart.Setting: University hospital, tertiary referral center.Patients: All patients who underwent a robotic (n=182) or traditional laparoscopic hysterectomy (n=175) for a benign indication at the University of Michigan from 3/31/2000 until 12/31/2009.Intervention: Robotic or traditional laparoscopic total hysterectomy, with or without unilateral or bilateral salpingo-ophorectomy.Measurements and Main Results: A total of 357 charts were reviewed, of which 182 patients underwent robotic hysterectomies (RH), and 175 patients underwent traditional laparoscopic hysterectomies (LH). There was one vaginal cuff dehiscence (0.55%) in the RH cohort and four (2.29%) in the LH cohort, p=0.163. Average patient age was 37.6 years. All four women were premenopausal at time of surgery; three of the four LH patients had concomitant bilateral-salingoophorectomies. BMI was ≤30 in all LH cases; BMI was 45 in the RH case. Monopolar cautery was used for colpotomy in all cases except one traditional laparoscopic case where bipolar was used. The vaginal cuff was primarily closed with 0-vicryl sutures in an interrupted fashion. All patients reported coitus immediately preceding cuff dehiscence. However, not all episodes were associated with first coitus after hysterectomy. Days from initial surgery to dehiscence were 36 (RH), 51, 74, 90 and 209.Conclusion: The incidence of vaginal cuff dehiscence within our RH and LH cohorts is much lower than that reported in the literature. Coitus was the uniform precipitating event in all cases. Additional studies are needed to further identify risk factors, however, our data suggests that laparoscopic and robotic hysterectomies can be performed with a very low risk of cuff dehiscence. Study Objective: To assess the incidence and risk factors for vaginal cuff dehiscence after robotic and traditional laparoscopic hysterectomies for benign indications. Design: IRB-approved retrospective chart. Setting: University hospital, tertiary referral center. Patients: All patients who underwent a robotic (n=182) or traditional laparoscopic hysterectomy (n=175) for a benign indication at the University of Michigan from 3/31/2000 until 12/31/2009. Intervention: Robotic or traditional laparoscopic total hysterectomy, with or without unilateral or bilateral salpingo-ophorectomy. Measurements and Main Results: A total of 357 charts were reviewed, of which 182 patients underwent robotic hysterectomies (RH), and 175 patients underwent traditional laparoscopic hysterectomies (LH). There was one vaginal cuff dehiscence (0.55%) in the RH cohort and four (2.29%) in the LH cohort, p=0.163. Average patient age was 37.6 years. All four women were premenopausal at time of surgery; three of the four LH patients had concomitant bilateral-salingoophorectomies. BMI was ≤30 in all LH cases; BMI was 45 in the RH case. Monopolar cautery was used for colpotomy in all cases except one traditional laparoscopic case where bipolar was used. The vaginal cuff was primarily closed with 0-vicryl sutures in an interrupted fashion. All patients reported coitus immediately preceding cuff dehiscence. However, not all episodes were associated with first coitus after hysterectomy. Days from initial surgery to dehiscence were 36 (RH), 51, 74, 90 and 209. Conclusion: The incidence of vaginal cuff dehiscence within our RH and LH cohorts is much lower than that reported in the literature. Coitus was the uniform precipitating event in all cases. Additional studies are needed to further identify risk factors, however, our data suggests that laparoscopic and robotic hysterectomies can be performed with a very low risk of cuff dehiscence.

Study Objective: To investigate the occurrence of urinary retention following laparoscopic hysterectomy by traditional laparoscopic approach and robot-assisted approach.Design: IRB-approved retrospective chart review.Setting: A university hospital tertiary referral center.Patients: All patients who underwent laparoscopic hysterectomy via a traditional laparoscopic approach (N=242) and a robotic-assisted approach (n=248) from 3/2000 until 12/2009 for benign indications at the University of Michigan Health System. Urinary retention was defined as an inability to spontaneously void following removal of the Foley catheter on post-operative day 1, and requiring either self catheterization or Foley replacement.Intervention: Laparoscopic or robot-assisted total/supracervical hysterectomy.Measurements and Main Results: Urinary retention occurred in 36/490 (7.4%) women. There were no statistically significant differences between women who developed urinary retention compared with those who did not in terms of age, BMI, presence of diabetes, smoking status, number of previous abdominal surgeries, and number of prior cesarean sections. Regarding the surgical characteristics, urinary retention was more common among women who underwent a robot-assisted hysterectomy compared with traditional laparoscopic hysterectomy [25 (10.1%) cases versus 11 (4.5%) cases, p=.02]. Other surgical characteristics such as uterine weight, severe adhesions, total versus supracervical hysterectomy and presence of endometriosis were similar in women who developed urinary retention compared with those who did not. The main complication from urinary retention was lower urinary tract infection, occurring in 5/36 (13.9%) cases. However, none of these women developed pyelonephritis, and none required readmission.Conclusion: Urinary retention appears to be a relatively common complication of robot-assisted hysterectomy. We postulate that more aggressive bladder dissection performed with robot-assistance may be associated with an increased risk of urinary retention when compared to traditional laparoscopic hysterectomy. Early diagnosis and proper management with self catheterization may reduce the morbidity associated with urinary retention. Study Objective: To investigate the occurrence of urinary retention following laparoscopic hysterectomy by traditional laparoscopic approach and robot-assisted approach. Design: IRB-approved retrospective chart review. Setting: A university hospital tertiary referral center. Patients: All patients who underwent laparoscopic hysterectomy via a traditional laparoscopic approach (N=242) and a robotic-assisted approach (n=248) from 3/2000 until 12/2009 for benign indications at the University of Michigan Health System. Urinary retention was defined as an inability to spontaneously void following removal of the Foley catheter on post-operative day 1, and requiring either self catheterization or Foley replacement. Intervention: Laparoscopic or robot-assisted total/supracervical hysterectomy. Measurements and Main Results: Urinary retention occurred in 36/490 (7.4%) women. There were no statistically significant differences between women who developed urinary retention compared with those who did not in terms of age, BMI, presence of diabetes, smoking status, number of previous abdominal surgeries, and number of prior cesarean sections. Regarding the surgical characteristics, urinary retention was more common among women who underwent a robot-assisted hysterectomy compared with traditional laparoscopic hysterectomy [25 (10.1%) cases versus 11 (4.5%) cases, p=.02]. Other surgical characteristics such as uterine weight, severe adhesions, total versus supracervical hysterectomy and presence of endometriosis were similar in women who developed urinary retention compared with those who did not. The main complication from urinary retention was lower urinary tract infection, occurring in 5/36 (13.9%) cases. However, none of these women developed pyelonephritis, and none required readmission. Conclusion: Urinary retention appears to be a relatively common complication of robot-assisted hysterectomy. We postulate that more aggressive bladder dissection performed with robot-assistance may be associated with an increased risk of urinary retention when compared to traditional laparoscopic hysterectomy. Early diagnosis and proper management with self catheterization may reduce the morbidity associated with urinary retention.

Study Objective: To compare the perioperative complications associated with robot-assisted laparoscopic hysterectomy for benign indication in women with smaller (<14 weeks' size) versus larger (≥14 weeks' size) uteri. Design: IRB-approved retrospective chart review. Setting: University hospital tertiary referral center. Patients: Included were 213 women who underwent robot-assisted laparoscopic hysterectomy for benign indications (except for advanced endometriosis) at the University of Michigan from 12/2001 to 12/2009. Of those, 138 (64.8%) women were included in the smaller (<14 weeks' size) uteri group and 75 (35.2%) in the larger (≥14 weeks' size) uteri group. The classification to uterine size was based on pelvic exam under anesthesia. Intervention: Robot-assisted total or supracervical laparoscopic hysterectomy. Measurements and Main Results: Women with <14 weeks' size uteri were significantly younger (42.3 ± 7.6 years vs. 45.2 ± 5.9 years, p<.01), but there were no differences terms of parity, BMI and menopausal status. The main indication for surgery among women with smaller uteri were pelvic pain and abnormal uterine bleeding, compared with symptomatic fibroids among women with larger uteri (p<.01). There were no statistically significant differences in the occurrence of major intraoperative complications (including hemorrhage and viscus injury, 1.4% vs 2.67%, p=.5), conversion to laparotomy, (0.72% vs. 2.67%, p=.3), major postoperative complications (including vaginal cuff complications, 5.1% vs. 6.7%, p=.6) and minor postoperative complications (9.4% vs. 4.0%, p=.1). However, the estimated blood loss and operative time were both increased in the larger uteri group (58.2 ± 3.9 ml vs. 110.7 ± 23.9 ml, p<.005, and 201.9 ± 4.8 minutes vs. 255.0 ± 6.7 minutes, p<.001, respectively). Conclusion: Robot-assisted hysterectomy appears to be as feasible and safe in women with larger uteri, and is associated with a similar and low risk of intraoperative complications, conversion to laparotomy, and postoperative complications when compared to robot-assisted hysterectomy in women with smaller uteri.

Study Objective: This is an educational video demonstrating hysteroscopic resection of an intrauterine septum using the twizzle bipolar electrode performed under ultrasound guidance. The case patient is a 40 year old nulligravida with a known history of a septate uterus and worsening menorrhagia. Her past medical history was significant for severe congenital aortic insufficiency requiring aortic valve replacements and subsequent life-long anticoagulation with coumadin. Due to this medical history, her cardiologist deemed that she was not a candidate for any type of hormonal therapy. After further counseling, she decided to proceed with a D&C, hysteroscopy, resection of an intrauterine septum followed by a Novasure ablation. The video illustrates a unique approach to the treatment of a patient with a septate uterus, menorrhagia and limited options secondary to a complex set of medical problems.

Study Objective: To examine perioperative complications associated with robot-assisted laparoscopic hysterectomy performed for benign indications. Design: IRB-approved retrospective chart review. Setting: University hospital tertiary referral center in Michigan. Patients: All patients (n=157) who underwent a robot-assisted laparoscopic hysterectomy for a benign indication at the University of Michigan from 12/5/2001 until 10/16/08. Intervention: Robot-assisted total or supracervical laparoscopic hysterectomy, with or without unilateral or bilateral salpingoophorectomy. Measurements and Main Results: Of the 157 cases evaluated, 76.6% of the patients had a total hysterectomy and 23.4% had a supracervical hysterectomy. The majority of surgeries (94.3%) were performed by three benign gynecologists who all had specialty training in minimally invasive surgery. The mean patient age was 42.7 years (SD 7.3) with a mean BMI 28.0 (SD 6.7). Most patients (88.0%) had at least one previous abdominal or pelvic surgery. The two most frequent indications for hysterectomy were chronic pelvic pain (34.8%) and uterine fibroids (31.0%). The mean estimated blood loss was 76.5 cc (SD 98.1) and the mean uterine weight was 180.1 g (SD 136.6). The mean OR time, defined as skin incision to dressing, was 194 min (SD 58.2). On average, patients were admitted for 1.2 days (SD 0.8). Intraoperative organ/vascular injury occurred in 1.9% (n=3) of cases; one bladder injury and two bowel injuries. Conversion to laparotomy occurred in 0.6% of cases. There were no cases of vaginal cuff dehiscence. The rate of major post-operative complications was 5.7% (n=9); 2 vaginal cuff hematomas, 3 cuff abscesses, one SBO, one delayed viscus injury, one vaginoperitoneal fistula, and one separation of vaginal mucosa. There were eleven (7.0%) unplanned hospital readmissions within sixty days of surgery, and the overall reoperation rate was 2.5% (n=4). Conclusion: Our experience from 2001 to 2008 indicates that robotic hysterectomies can be performed safely by experienced surgeons with a low perioperative complication rate.

Study Objective: To assess the feasibility and perioperative complications of robot-assisted laparoscopic hysterectomy in women with high body mass indices (BMIs). Design: Retrospective cohort study. IRB-approval was obtained. Setting: A university hospital tertiary referral center. Patients: Consecutive patients who underwent a robot-assisted laparoscopic hysterectomy for benign indications at the University of Michigan Health System from 12/5/2001 until 10/16/2008 were included in this analysis. Twenty-four patients with BMI 35 or greater were compared with 133 patients with BMI of less than 35. Intervention: N/A Measurements and Main Results: The mean BMI in the high BMI group was 40.2 ± 3.9 (ranging 35.5–50.8) and the mean BMI in the low BMI group was 25.7 ± 4.2 (17.3–35.9). There were no significant differences between the two cohorts in terms of age, parity, history of laparotomy, uterine weight, and the type of hysterectomy that was performed. The intraoperative organ/vascular injury (0.6 versus 1.3%, p = 0.39), conversion to laparotomy (0.6 versus 0%, p = 0.15), postoperative vaginal cuff complications (0.6 versus 3.8%, p = 0.94), unplanned readmission within 60 days (1.3 versus 5.7%, p = 0.68), reoperation (0 versus 2.6%, p = 0.51), estimated blood loss (97.3 versus 73.2 mL, p = 0.27), length of hospital stay (1.3 versus 1.2 days, p = 0.58) did not differ significantly between women with high BMIs and low BMIs. However, women with BMIs 35 or greater had a significantly longer operative time (214.2 versus 189.4 minutes, p < 0.05). Conclusion: Robot-assisted laparoscopic hysterectomy is feasible in women with high BMIs. Although women with BMI 35 or greater tend to have a slightly longer operative time, the overall perioperative complications and conversion to laparotomy are low and similar to those among women with BMI less than 35.

Study Objective: To evaluate change in symptom severity and health related quality of life in patients who have had robot-assisted laparoscopic myomectomy.

OBJECTIVE: Abnormal uterine bleeding is a common complaint presenting to gynecology clinics. Work-up of this is varied given the multiple diagnostic tools that can be utilized. Studies have demonstrated that saline infusion sonography (SIS) and office hysteroscopy have similar diagnostic ability. Few studies have examined which procedure is better tolerated. The purpose of this study is to determine if there is a difference in pain perception and satisfaction in patients undergoing SIS compared to flexible office hysteroscopy (fOHS). DESIGN: Prospective, randomized, cross-over study. MATERIALS AND METHODS: Women who were scheduled to have fOHS from 6/2006-4/2008 were eligible. Following enrollment, participants were randomized to either having the fOHS first or the SIS. A fifteen minute washout period was allowed prior to the subsequent procedure. After each procedure, participants completed a questionnaire regarding their experience. Pain and tolerance were analyzed with a Visual Analogue Scale (VAS). RESULTS: 42 women enrolled. Average age was 40.5 years. No significant difference was noted in demographics between the two groups.76% Caucasian, 79% parous, and 12% menopausal. Average time taken for fOHS was 255 seconds vs. 296 seconds for SIS. There was no significant difference between identification of pathology between with the two imaging modalities. Overall pain and tolerance scores were significantly lower for fOHS than SIS. When performing the sub-analysis, pain and tolerance scores for subjects undergoing fOHS first were lower than those undergoing it secondarily. SIS scores did not differ between the two groups. No participants were unsatisfied with fOHS whereas 9 were unsatisfied with SIS. If requiring this type of procedure again, 78% of women preferred to have the fOHS. Six women preferred the SIS, all of whom were in the group that had the SIS first. Comfort during the procedure was most important for 74%. Time for the procedure was least important for 43%.Table 1VAS of Pain and Tolerance During and After the ProceduresfOHS (cm)SIS (cm)p valuePain during1.723.74<0.05Tolerance during1.293.04<0.05Pain after1.122.31<0.05Overall tolerance0.782.8<0.05 Open table in a new tab CONCLUSIONS: Consistent with the reported literature, there was no significant difference in diagnosis of pathology for SIS and fOHS in this study. fOHS is the preferred procedure with respect to patient tolerance, pain levels, and satisfaction.

SGS Abstracts: 2005 Scientific Meeting The Society of Gynecologic Surgeons: Tips/Tricks Presentations

Video Presentations: AUGS-SGS Abstracts: 2004 Joint Scientific Meeting The American Urogynecologic Society and The Society of Gynecologic Surgeons