[1072] Robotic Assisted Hysterectomies Increase Tubal Contaminants

DF DeLair, RA Soslow, MM Leitao, Jr. Memorial Sloan-Kettering Cancer Center, New York, NY

Background: Robotic surgery has recently been incorporated into gynecologic surgery and is increasingly being performed for endometrial cancer. The amount of uterine manipulation appears to be greater in robotic assisted hysterectomies (RBT) compared to laparoscopic assisted vaginal hysterectomies (LSC). It has previously been shown that uterine manipulation may increase the incidence of displaced tumor and subsequent contamination beyond the endometrium. The objective of this study was to determine if there is an association with RBT and tubal contamination.
Design: All RBT and LSC cases performed for endometrial cancer from 5/07 to 8/09 were reviewed. Of the cases not converted to laparotomy, 137 RBT and 184 LSC were identified. The patient's age, BMI, operative (OP) and hysterectomy (HYST) time, type and grade of tumor, stage, pelvic wash, and the presence of detached tumor fragments in the lumina of the fallopian tubes were recorded. Appropriate statistical tests were applied.
Results: The cases with tubal contaminants and their characteristics are listed below (tables 1&2). The majority of the patients with RBT and tubal contaminants had stage I disease (9/16, 56.2%) and grade 1 tumors (9/16, 56.2%). Four (4/16, 25%) of the patients had stage IIIa disease due to positive pelvic washes; they were otherwise stage I.

Table 1. Tubal contaminants
LSCRBTp value
Completed cases N184137<0.001
Contaminants N(%)4 (2.2%)16 (11.7%)<0.001




Table 2. Tubal contaminants in robotic cases
No ContaminantsContaminantsp value
N12116
BMI (kg/m2)/Median (range)25.8 (18.6-60.6)28.7 (23.3-47.9)0.06
Age (yr)/Median (range)60 (27-85)59 (47-68)0.2
OP time (min)238 (115-497)230.5 (153-533)0.71
HYST time (min)47.5 (16-230)53 (27-283)0.45



Conclusions: Tubal contaminants are much more frequent in RBT compared to LSC. The procedure duration does not appear to contribute to contamination. Those with contaminants seem to have a higher BMI, but this is not statistically significant, possibly due to small numbers. The majority of the patients had low grade and low stage disease. All four patients with stage IIIa disease were classified as such due to positive pelvic washes, which has previously been reported with uterine manipulation. In conclusion, these data demonstrate an association of RBT and tubal contamination. The clinical significance of this remains to be determined.
Category: Gynecologic & Obstetrics

Wednesday, March 24, 2010 9:30 AM

Poster Session V # 143, Wednesday Morning

 

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