Novel port placement and 5-mm instrumentation for robotic-assisted hysterectomy

Ceana H. Nezhat, Adi Katz, Erica C. Dun, Kimberly A. Kho, Friedrich A. Wieser

Research output: Contribution to journalArticle

Abstract

Background and Objectives: The value of robotic surgery for gynecologic procedures has been critically evaluated over the past few years. Its drawbacks have been noted as larger port size, location of port placement, limited instrumentation, and cost. In this study, we describe a novel technique for robotic-assisted laparoscopic hysterectomy (RALH) with 3 important improvements: (1) more aesthetic triangular laparoscopic port configuration, (2) use of 5-mm robotic cannulas and instruments, and (3) improved access around the robotic arms for the bedside assistant with the use of pediatric-length laparoscopic instruments. Methods: We reviewed a series of 44 women who underwent a novel RALH technique and concomitant procedures for benign hysterectomy between January 2008 and September 2011. Results: The novel RALH technique and concomitant procedures were completed in all of the cases without conversion to larger ports, laparotomy, or video-assisted laparoscopy. Mean age was 49.9 years (SD 8.8, range 33-70), mean body mass index was 26.1 (SD 5.1, range 18.9-40.3), mean uterine weight was 168.2 g (SD 212.7, range 60-1405), mean estimated blood loss was 69.7 mL (SD 146.9, range 20-1000), and median length of stay was <1 day (SD 0.6, range 0-2.5). There were no major and 3 minor peri-and postoperative complications, including 2 urinary tract infections and 1 case of intravenous site thrombophlebitis. Mean follow-up time was 40.0 months (SD 13.6, range 15-59). Conclusion: Use of the triangular gynecology laparoscopic port placement and 5-mm robotic instruments for RALH is safe and feasible and does not impede the surgeon's ability to perform the procedures or affect patient outcomes.

Original languageEnglish (US)
Pages (from-to)167-173
Number of pages7
JournalJournal of the Society of Laparoendoscopic Surgeons
Volume18
Issue number2
DOIs
StatePublished - 2014

Fingerprint

Robotics
Hysterectomy
Thrombophlebitis
Gynecologic Surgical Procedures
Aptitude
Gynecology
Esthetics
Urinary Tract Infections
Laparoscopy
Laparotomy
Length of Stay
Body Mass Index
Pediatrics
Weights and Measures
Costs and Cost Analysis

Keywords

  • 5-mm robotic ports
  • Aesthetics
  • Robotic-assisted laparoscopic hysterectomy
  • Short laparoscopic instruments

ASJC Scopus subject areas

  • Surgery

Cite this

Novel port placement and 5-mm instrumentation for robotic-assisted hysterectomy. / Nezhat, Ceana H.; Katz, Adi; Dun, Erica C.; Kho, Kimberly A.; Wieser, Friedrich A.

In: Journal of the Society of Laparoendoscopic Surgeons, Vol. 18, No. 2, 2014, p. 167-173.

Research output: Contribution to journalArticle

Nezhat, Ceana H. ; Katz, Adi ; Dun, Erica C. ; Kho, Kimberly A. ; Wieser, Friedrich A. / Novel port placement and 5-mm instrumentation for robotic-assisted hysterectomy. In: Journal of the Society of Laparoendoscopic Surgeons. 2014 ; Vol. 18, No. 2. pp. 167-173.
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abstract = "Background and Objectives: The value of robotic surgery for gynecologic procedures has been critically evaluated over the past few years. Its drawbacks have been noted as larger port size, location of port placement, limited instrumentation, and cost. In this study, we describe a novel technique for robotic-assisted laparoscopic hysterectomy (RALH) with 3 important improvements: (1) more aesthetic triangular laparoscopic port configuration, (2) use of 5-mm robotic cannulas and instruments, and (3) improved access around the robotic arms for the bedside assistant with the use of pediatric-length laparoscopic instruments. Methods: We reviewed a series of 44 women who underwent a novel RALH technique and concomitant procedures for benign hysterectomy between January 2008 and September 2011. Results: The novel RALH technique and concomitant procedures were completed in all of the cases without conversion to larger ports, laparotomy, or video-assisted laparoscopy. Mean age was 49.9 years (SD 8.8, range 33-70), mean body mass index was 26.1 (SD 5.1, range 18.9-40.3), mean uterine weight was 168.2 g (SD 212.7, range 60-1405), mean estimated blood loss was 69.7 mL (SD 146.9, range 20-1000), and median length of stay was <1 day (SD 0.6, range 0-2.5). There were no major and 3 minor peri-and postoperative complications, including 2 urinary tract infections and 1 case of intravenous site thrombophlebitis. Mean follow-up time was 40.0 months (SD 13.6, range 15-59). Conclusion: Use of the triangular gynecology laparoscopic port placement and 5-mm robotic instruments for RALH is safe and feasible and does not impede the surgeon's ability to perform the procedures or affect patient outcomes.",
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