Robotic Applications for Benign Gynecologic Procedures

Introduction: Robotic systems provide a platform for surgeons to expand their capabilities, allowing them to perform complex procedures safely and efficiently. Within the field of benign gynecology, this has become an increasingly popular option since receiving Food and Drug Administration (FDA) approval in 2005. However, the appropriate indications for robotic versus laparoscopic surgery continue to be debated. Materials and Methods: Literature was reviewed to provide a comprehensive, evidence-based evaluation of the advantages and pitfalls of robotic surgery, the applications of robotic surgery for benign gynecologic procedures in comparison to conventional laparoscopy, and the role of robotic surgery as an educational tool. Results: Robotic surgery has favorable outcomes for surgeons in the areas of ergonomics, dexterity, and fatigue. Cost comparisons are widely varied and elaborate. Most patient outcomes are comparable between robotic and laparoscopic hysterectomies and endometriosis resections. In patients with a body mass index >30mg/m2 and uteri >750mg, hysterectomy outcomes are improved when surgery is done robotically. The use of the robotic system may be beneficial for patients undergoing myomectomy. Robotic surgery confers advantages for trainees and novice surgeons. There is no consensus on a standardized curriculum for robotic training or credentialing process for experienced surgeons. Conclusion: Robotic surgery has distinct features that make it a valuable tool for gynecologic surgeons. There are no clear indications regarding when a robotic route should be chosen but could be considered when above average complexity is anticipated and when training new surgeons.

The use of intra-operative ultrasound in gynecological surgery: a review

Ultrasound is a readily available, safe and portable imaging modality that is widely applied in gynecology. However, there is limited guidance for its use intra-operatively especially with complex gynecological procedures. This narrative review examines the existing literature published on the use of intraoperative ultrasound (IOUS) in benign gynecology and in gynecological oncology. We searched for the following terms: ‘intraoperative,’ ‘ultrasonography,’ ‘gynecology’ and ‘oncology’ using Pubmed/Medline. IOUS can minimize complications and facilitate difficult benign gynecological procedures. There is also a role for its use in gynecological oncology surgery and fertility-sparing surgery. The use of IOUS in gynecological surgery is an emerging field which improves visualization in the surgical field and aids completion of minimally invasive techniques.

Emergency Department Utilization of Case Managed Patients Following Benign Gynecologic Surgery

Background Case management has been shown to reduce the amount of unnecessary emergency department visits among Medicaid or uninsured patients. This study aims to determine whether case management is associated with decreased unnecessary emergency department visits among benign gynecology surgical patients in the first thirty days following surgery.Results Out of 875 patients, there were a total of 58 return visits to the Emergency Department within thirty days and only 6 readmissions. Twenty-four emergency department visits occurred in the case managed group and thirty-eight emergency department visits occurred in the non-case managed group. The two factors that were statistically significant for increase odds of return to the emergency department were type of surgery (inpatient versus outpatient) and case management. The odds for returning to the Emergency Department for those not receiving case management was found to be 4.53 that of the case managed group when controlling for BMI, age, marital status, and type of surgery.Conclusion In an effort to reduce healthcare costs, case management is a promising intervention to help postoperative patients manage their care while minimizing emergency department visits.