Had time to read the latest journals? Catch up on some recent research by reading these mini-reviews by Dr Brett Daniels.
Hysterectomy for benign conditions remains a common gynaecological surgery, with surgeons now having more choices with regard to the route of surgery. This column previously reported a study analysing trends in the route of hysterectomy at a single US hospital from 2004–12, showing an increase in laparoscopic hysterectomy accompanied by a decrease in abdominal hysterectomy over the same period.1 A new study has compared robotic, laparoscopic, vaginal and abdominal routes in terms of intraoperative and postoperative complications.2 Interestingly, the authors believed that previous studies analysing robotic hysterectomy may have been adversely affected by the lack of experience of many surgeons with the robotic approach, such that the results compared surgeons still in their learning curve with robotic hysterectomy against surgeons very experienced at laparoscopic, abdominal or vaginal approaches. Consequently, the current study only included cases performed by surgeons who had performed more than 60 previous robotic hysterectomies for benign conditions. The study analysed 2300 robotic-assisted, 9745 abdominal, 8121 vaginal and 11 952 laparoscopic hysterectomies performed across multiple US centres in 2012 and 2013. The robotic-assisted patient cohort had a significantly higher rate of morbid obesity than the vaginal or laparoscopic cohorts, and a significantly higher rate of large uteri (>250g) than the abdominal, vaginal or laparoscopic cohorts. The robotic cohort experienced significantly fewer intraoperative complications (including damage to other organs or blood transfusion) than the abdominal and vaginal routes, and experienced significantly fewer postoperative complications compared with all the other routes. The authors report that an economic analysis of their results is underway. At this stage their results suggest, in experienced hands, robotic-assisted hysterectomy for benign conditions may have benefits compared to the other routes.
- Daniels B. Journal Club. O&G Magazine. 2015; 17(4):79.
- Lim PC, Crane JT, English EJ, et al. Multicenter analysis comparing robotic, open, laparoscopic, and vaginal hysterectomies performed by high-volume surgeons for benign indications.International Journal of Gynecology and Obstetrics. 2016. http://dx.doi.org/10.1016/j.ijgo.2015.11.010.