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D. Querleu - One of the best experts on this subject based on the ideXlab platform.
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Robotic surgery in Gynecologic Oncology
Gynecological Surgery, 2011Co-Authors: Pierre Lèguevaque, S. Motton, F. Vidal, M. Soulé Tholy, J. Hoff, D. QuerleuAbstract:The goal of this paper is to review the current data documenting the advantages of robotic surgery over open or laparoscopic surgery. The aim of this study is to compare the complications and perioperative outcome of robotic surgery with open and laparocopic surgery, in Gynecologic Oncology. The terms radical robotic or robot- assisted hysterectomy in PubMed search lead to 41 references. We excluded one review of literature, ten studies with benign and malignant cases, eight cases reports, one letter to the editor. We kept the prospective studies and comparative studies (total abdominal hysterectomy (TAH) vs. total robotic hysterectomy (TRH), total laparoscopic hysterectomy (TLH) vs. TRH or TAH vs. TRH vs. TLH). The results are separated for endometrial cancers, early cervical cancers, pelvic and paraaortic lymph node dissections, radical parametrectomy and trachelectomy, and pelvic exenteration. The literature on robotic-assisted radical hysterectomy supports its safety and feasibility for the surgical management of early cervical cancer and endometrial cancer. However, the results of a phase III randomized clinical trial testing the equivalence of outcomes after laparoscopic or robotic radical hysterectomy with abdominal radical hysterectomy are expected.
Pedro F. Escobar - One of the best experts on this subject based on the ideXlab platform.
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Robotic Surgery in Gynecologic Oncology: Updates and Innovations
Current Obstetrics and Gynecology Reports, 2014Co-Authors: Pedro F. Escobar, Pilar E. Silva, Joshua A. Makhoul, Martin A. MartinoAbstract:Surgical advances in minimally invasive surgery, including laparoscopic and robotics, have revolutionized the practice of medicine and surgery in Gynecologic Oncology. During this time, an emphasis has been made to improve quality metrics such as complications, readmissions, and length of stay. The Institute for Healthcare Improvement has recommended health systems and surgeons to improve performance focused on better care, better quality, and better cost. Minimally invasive surgery may help to achieve these measures and serve as the foundation upon which these goals are reached. Despite the availability of laparoscopic tools at many hospitals, the majority of patients who had Gynecologic cancer surgery in the United States had a laparotomy prior to the introduction of robot-assisted surgery. Reasons for this have been attributed to limitations of laparoscopy, which include 2D vision and rigid instruments without articulation. One of the greatest advancements in Gynecologic surgery occurred in 2005, when the FDA approved the da Vinci surgical platform (Intuitive Surgical Inc, Sunnyvale, CA, USA) for use in Gynecologic surgery. This platform provides a 3D vision system paired with wristed articulating instruments. Together, these enhancements may overcome some of the limitations of laparoscopy allowing for surgeons to perform less open surgery. The introduction of robotics in 2005 has led to an increase in minimally invasive surgery and significantly less open surgery – especially for the Gynecologic Oncology patient. This review will focus on recent advancements in robotic surgery in the field of gynecology Oncology. It will also discuss the role for standardizing education and training through the development of training and educational networks to improve surgical outcomes.
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laparoendoscopic single site surgery less in Gynecologic Oncology technique and initial report
Gynecologic Oncology, 2009Co-Authors: Amanda Nickles Nickles Fader, Pedro F. EscobarAbstract:Abstract Objectives Recent reports suggest that laparoendoscopic single-site surgery (LESS), also known as single-port surgery, is technically feasible in treating a variety of disease processes. The purpose of this study was to assess the feasibility of LESS for the surgical treatment of various Gynecologic cancers or precancerous conditions through both laparoscopic and robotic-assisted approaches. Methods A single institution retrospective review of patients treated with LESS on the Gynecologic Oncology service in 2009 was performed. Patients underwent surgery through a single 2–3 cm umbilical incision with a multi-channel SILS™ port for laparoscopic cases or a single-channel Gelport® for robotic cases on the daVinci® Surgical System. Results Thirteen patients had LESS surgery performed, nine done laparoscopically and four robotically. Procedures included endometrial cancer staging ( n =1), ovarian cancer staging ( n =1), retroperitoneal pelvic lymph node dissection ( n =1), risk-reducing extrafascial hysterectomy/bilateral salpingo-oophorectomy (BSO, n =2) and BSO alone ( n =5), and an ovarian cystectomy ( n =1) and BSO ( n =2) for complex adnexal masses. Median patient age and BMI were 47 years and 28, respectively. Median operating time was 65 min. All procedures were successfully performed via a single incision and no post-operative complications occurred. The majority of patients required no narcotics post-operatively. Conclusion We present the first series of laparoendoscopic single-site surgery for the treatment of various Gynecologic Oncology conditions. LESS is feasible in select patients by laparoscopic or robotic-assisted techniques. Further studies are needed to better define the ideal Gynecologic procedures for single-site surgery and to assess the benefits of LESS compared with more conventional minimally invasive approaches.
Gregg Nelson - One of the best experts on this subject based on the ideXlab platform.
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guidelines for perioperative care in Gynecologic Oncology enhanced recovery after surgery eras society recommendations 2019 update
International Journal of Gynecological Cancer, 2019Co-Authors: Gregg Nelson, Eleftheria Kalogera, Jamie N Bakkumgamez, Gretchen E Glaser, Alon D Altman, Larissa A Meyer, Jolyn Sharpe Taylor, Maria D Iniesta, Javier Lasala, Gabriel E MenaAbstract:BACKGROUND: This is the first updated Enhanced Recovery After Surgery (ERAS) Society guideline presenting a consensus for optimal perioperative care in Gynecologic/Oncology surgery.METHODS: A datab ...
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enhanced recovery pathways in Gynecologic Oncology
Gynecologic Oncology, 2014Co-Authors: Gregg Nelson, Eleftheria Kalogera, Sean C DowdyAbstract:OBJECTIVE: Many commonplace perioperative practices are lacking in scientific evidence and may interfere with the goal of optimizing patient recovery. Individual components of perioperative care have therefore been scrutinized, resulting in the creation of so-called "enhanced recovery" pathways (ERP), with the goal of hastening surgical recovery through attenuation of the stress response. In this review we examine the evidence for ERP in Gynecologic Oncology using data from our specialty and general surgery. METHODS: We performed a systematic literature search on ERP in Gynecologic Oncology in June 2014 using PubMed/MEDLINE, EMBASE, and The Cochrane Library. All study types were included. References were hand reviewed to ensure completeness. The Enhanced Recovery After Surgery (ERAS) Society was contacted to identify any unpublished protocols. RESULTS: Seven investigations were identified that examined the role of ERP in Gynecologic Oncology. Common interventions included allowing oral intake of fluids up to 2 hours before induction of anesthesia, solids up to 6 hours before anesthesia, carbohydrate supplementation, intra- and postoperative euvolemia, aggressive nausea/vomiting prophylaxis, and oral nutrition and ambulation the day of surgery. In addition, bowel preparations, the NPO after midnight rule, nasogastric tubes, and intravenous opioids were discontinued. While no randomized data are available in Gynecologic Oncology, significant improvements in patient satisfaction, length of stay (up to 4 days), and cost (up to $7600 in savings per patient) were observed in ERP cohorts compared to historical controls. Morbidity, mortality, and readmission rates were no different between groups. CONCLUSION: Enhanced recovery is a safe perioperative management strategy for patients undergoing surgery for Gynecologic malignancies, reduces length of stay and cost, and is considered standard of care at a growing number of institutions. Our specialty would benefit from a formalized ERP such as ERAS which audits compliance to protocol care elements to optimize patient outcomes and value.
Rodney P. Rocconi - One of the best experts on this subject based on the ideXlab platform.
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Validation of a venous thromboembolism risk assessment model in Gynecologic Oncology
Gynecologic Oncology, 2014Co-Authors: William Stroud, J. Michael Straughn, Jenny M. Whitworth, Margaret Miklic, Kellie E. Schneider, Michael A. Finan, Jennifer Scalici, Eddie Reed, Lisa Bazzett-matabele, Rodney P. RocconiAbstract:Abstract Objectives Gynecologic Oncology patients undergoing surgery are at an increased risk for venous thromboembolism (VTE). We attempted to validate a VTE risk assessment model in Gynecologic Oncology patients. Methods All Gynecologic Oncology patients who underwent a laparotomy for the diagnosis or suspicion of Gynecologic malignancy from 2004 to 2010 were included. Demographic, surgicopathologic, and complication data were collected. VTE was based on the symptomatic diagnosis. Data for the Caprini risk assessment model (RAM) was used to score and stratify patients on their risk for VTE. Results 1123 Gynecologic Oncology patients were included within this study. Ovarian cancer was the most common diagnosis (39%) with a median age of 56.1. All patients received SCDs with 40% receiving double prophylaxis. The overall incidence of VTE was 3.3%, with lower extremity deep venous thrombosis (DVT) n=17 and pulmonary embolism (PE) n=20. Complication rates were similar in each group. Based on the Caprini scoring model 92% of patients scored in the "Highest Risk" category. The Caprini RAM accurately predicted all 37 VTEs, all of which scored in the "Highest Risk" category. The percentage of patients that received double prophylaxis increased with time from 12% in 2004 to 63% in 2010. Importantly, 25 of the 37 VTEs (68%) did not receive double prophylaxis. Conclusions The use of the Caprini RAM accurately predicted patients at the highest risk of experiencing VTE. Considering accurate identification of patients allows proper administration of double prophylaxis, we recommend the use of this scoring model preoperatively in patients undergoing surgery for Gynecologic malignancies.
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Overcoming technical challenges with robotic surgery in Gynecologic Oncology
Surgical Endoscopy, 2010Co-Authors: Michael A. Finan, Rodney P. RocconiAbstract:Background The majority of data published on robotic surgery in Gynecologic Oncology has focused on patient outcomes and surgical data. We have found that technical challenges due to the complexity of the robotic technology create a separate set of issues, adding time and difficulty to the actual surgical procedure. This study focuses on these technical problems and identifies pitfalls and potential solutions in robotics. Methods All patients who underwent robotic surgery for Gynecologic Oncology indications from August 2006 through July 2008 were eligible for inclusion in the study. Data collected prospectively included demographics, surgical and clinicopathologic data, and technical problems with the robotic equipment. Results One hundred thirty-seven patients underwent robotic surgery during the study period. A total of 11 cases (8.02%) were associated with problems with robotic technology: 2/11 (18.2%) involved malfunction of robotic arms, 2/11 (18.2%) involved light or camera cords, and the remainder included a variety of problems, including malfunction of Maylard bipolar instrument [1/11 (9.1%)], power failure requiring reboot of robot [1/11 (9.1%)], port problems [2/11 (18.2%)], and 3/1 (27.3%) had miscellaneous problems. An estimated average of 25 min was added to each of these 11 cases in order to solve robot-related technological problems. No cases required conversion to laparotomy. All problems were solved by the robotic surgeon with the assistance of robotic surgery staff. Conclusions Surgeons performing robotic surgery must become familiar with troubleshooting robotic technology. Several issues related to technical problems may arise, delaying progression of the case, and potential solutions were identified. As this technology is implemented, robotic surgeons must be trained to solve problems related to the robotic technology and associated equipment. Failure to do so may add time and technical difficulty to robotic cases.
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Comparison of transfusion rates between erythropoietic stimulating agents in Gynecologic Oncology patients with chemotherapy induced anemia
Journal of Clinical Oncology, 2005Co-Authors: Ashley S. Case, Rodney P. Rocconi, Mack N. Barnes, Larry C. KilgoreAbstract:5092 Objective: Chemotherapy induced anemia (CIA) commonly occurs in Gynecologic Oncology patients. This often leads to treatment with erythropoietic stimulating agents in order to prevent chemothe...
Amanda Nickles Nickles Fader - One of the best experts on this subject based on the ideXlab platform.
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Robotic-assisted surgery in Gynecologic Oncology
Fertility and Sterility, 2014Co-Authors: A.k. Sinno, Amanda Nickles Nickles FaderAbstract:The quest for improved patient outcomes has been a driving force for adoption of novel surgical innovations across surgical subspecialties. Gynecologic Oncology is one such surgical discipline in which minimally invasive surgery has had a robust and evolving role in defining standards of care. Robotic-assisted surgery has developed during the past two decades as a more technologically advanced form of minimally invasive surgery in an effort to mitigate the limitations of conventional laparoscopy and improved patient outcomes. Robotically assisted technology offers potential advantages that include improved three-dimensional stereoscopic vision, wristed instruments that improve surgeon dexterity, and tremor canceling software that improves surgical precision. These technological advances may allow the Gynecologic Oncology surgeon to perform increasingly radical oncologic surgeries in complex patients. However, the platform is not without limitations, including high cost, lack of haptic feedback, and the requirement for additional training to achieve competence. This review describes the role of robotic-assisted surgery in the management of endometrial, cervical, and ovarian cancer, with an emphasis on comparison with laparotomy and conventional laparoscopy. The literature on novel robotic innovations, special patient populations, cost effectiveness, and fellowship training is also appraised critically in this regard.
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Assessment of palliative care training in Gynecologic Oncology: A Gynecologic Oncology fellow research network study
Gynecologic Oncology, 2014Co-Authors: Ramez N. Eskander, Kathryn Osann, Elizabeth L. Dickson, Laura L. Holman, J. Alejandro Rauh-hain, Lori Spoozak, Eijean Wu, Lauren S. Krill, Amanda Nickles Nickles Fader, Krishnansu S. TewariAbstract:Objective Palliative care is recognized as an important component of oncologic care. We sought to assess the quality/quantity of palliative care education in Gynecologic Oncology fellowship.
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laparoendoscopic single site surgery less in Gynecologic Oncology technique and initial report
Gynecologic Oncology, 2009Co-Authors: Amanda Nickles Nickles Fader, Pedro F. EscobarAbstract:Abstract Objectives Recent reports suggest that laparoendoscopic single-site surgery (LESS), also known as single-port surgery, is technically feasible in treating a variety of disease processes. The purpose of this study was to assess the feasibility of LESS for the surgical treatment of various Gynecologic cancers or precancerous conditions through both laparoscopic and robotic-assisted approaches. Methods A single institution retrospective review of patients treated with LESS on the Gynecologic Oncology service in 2009 was performed. Patients underwent surgery through a single 2–3 cm umbilical incision with a multi-channel SILS™ port for laparoscopic cases or a single-channel Gelport® for robotic cases on the daVinci® Surgical System. Results Thirteen patients had LESS surgery performed, nine done laparoscopically and four robotically. Procedures included endometrial cancer staging ( n =1), ovarian cancer staging ( n =1), retroperitoneal pelvic lymph node dissection ( n =1), risk-reducing extrafascial hysterectomy/bilateral salpingo-oophorectomy (BSO, n =2) and BSO alone ( n =5), and an ovarian cystectomy ( n =1) and BSO ( n =2) for complex adnexal masses. Median patient age and BMI were 47 years and 28, respectively. Median operating time was 65 min. All procedures were successfully performed via a single incision and no post-operative complications occurred. The majority of patients required no narcotics post-operatively. Conclusion We present the first series of laparoendoscopic single-site surgery for the treatment of various Gynecologic Oncology conditions. LESS is feasible in select patients by laparoscopic or robotic-assisted techniques. Further studies are needed to better define the ideal Gynecologic procedures for single-site surgery and to assess the benefits of LESS compared with more conventional minimally invasive approaches.