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.
|Completed cases N||184||137||<0.001|
|Contaminants N(%)||4 (2.2%)||16 (11.7%)||<0.001|
|No Contaminants||Contaminants||p value|
|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|