Robot-assisted laparoscopy for benign uterine disease. Feasibility, outcome and hospital cost.

Research output: ThesisDoctoral Thesis (compilation)

Abstract

The introduction of the laparoscope was a milestone within gynecologic surgery. Despite evidence of better
perioperative outcome compared to laparotomy, laparoscopy is mostly performed for less advanced surgical
procedures and the uptake of laparoscopic hysterectomy has been slow. An effort to preserve the clinical benefits
of laparoscopic surgery and facilitate the performance of more advanced surgery has led to the development of
robot-assisted laparoscopic surgery. Technical progress has been advantageous for the patient from a historical
point of view, but this cannot be assumed without proper evaluation. As for all surgical approaches, it is important
to recognize the possible applications of robotic surgery as well as proper patient selection both from a clinical and
economical point of view. The overall aim of this thesis was to investigate the possible applications, clinical
outcome and hospital cost of robot-assisted laparoscopic surgery for benign uterine disease at a single institution
following the introduction of robotic surgery.
Study I: Evaluating the first 1000 robotic surgeries performed showed that a surgical robot provides the possibility
to offer minimally invasive surgery to a larger patient population with low rates of conversions and intraoperative
complications. Study II: 31 women with symptomatic, deep intramural myomas and either otherwise unexplained
infertility or myomas with a possible effect on conception had a pregnancy rate following robotic myomectomy of
68%. Study III: All women (n=114) with a BMI ≥ 30 kg/m2 who underwent a simple hysterectomy by robotics or
laparotomy during the study period were included. Robot-assisted laparoscopic hysterectomy in obese women was
associated with shorter hospital stay, less bleeding, and fewer complications and longer operative time compared
to laparotomy although the operative times for morbidly obese women were similar between robotics and
laparotomy. Study IV: 122 women planned for minimally invasive hysterectomy for benign disease were
randomly allocated to either robot-assisted- or traditional, minimally invasive hysterectomy in a 1:1 proportion
with vaginal hysterectomy as a primary choice in the latter. From the perspective of hospital costs, robotic-assisted
hysterectomy is not advantageous for treating non-complex benign conditions when a vaginal approach is feasible
in a high proportion of patients. A similar hospital cost is attainable for laparoscopy and robotics when the robot is
a preexisting investment. Study V: Complication rates in 949 women planned for robotic hysterectomy for
malignant (75%) and benign (25%) gynecological disease over an 8-year period with special awareness of
complications possibly related to robot specific risk factors. Intraoperative- and postoperative complications and
complications possibly related to the robotic approach diminish with training, experience and refinement of
practice. Study VI: All women (n=483) undergoing hysterectomy for benign disease during 2013 and 2014.
Vaginal hysterectomy was associated with the lowest hospital cost and robotic hysterectomy with the lowest rate of perioperative complications. Procedure-specific proficiency influences outcome. Robotic hysterectomy for
benign disease is clinically advantageous and economically feasible in complex cases, when performed by high
volume surgeons.

Details

Authors
Organisations
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Obstetrics, Gynecology and Reproductive Medicine

Keywords

  • hysterectomy, myomectomy, robotic surgery, complications, outcome, hospital cost
Original languageEnglish
QualificationDoctor
Awarding Institution
Supervisors/Assistant supervisor
Award date2015 Dec 11
Publisher
  • Department of Obstetrics and Gynecology, Lund University
Print ISBNs978-91-7619-219-1
Publication statusPublished - 2015
Publication categoryResearch

Bibliographic note

Defence details Date: 2015-12-11 Time: 09:00 Place: Department of Obstetrics and Gynecology, SUS, Lund External reviewer(s) Name: Mäkinen, Juha Title: Professor Affiliation: Turku University Hospital, Finland ---

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