Effect of Robotic Surgery on Hysterectomy Trends: Implications for Resident Education

Study ObjectiveTo compare the surgical approach used for hysterectomy at 2 teaching hospitals before and after introduction of the robotic surgical system.DesignRetrospective cohort study (Canadian Task Force classification II-3).SettingTwo gynecologic training sites at the University of Hawaii.PatientsWomen who underwent hysterectomy between January 1, 2005, and December 31, 2011.Measurements and Main ResultsICD-9 procedural codes were used to identify hysterectomies performed between January 1, 2005, and December 31, 2011. Hysterectomies were categorized according to surgical approach: abdominal, vaginal, laparoscopic-assisted vaginal/total laparoscopic, and robotic. Each hysterectomy was also categorized according to primary preoperative diagnosis as general gynecology, gynecologic oncology, and urogynecology. The rates and numbers of hysterectomies performed during 2005–2006 (2 years before acquisition of the robot), 2007–2008 (first 2 years with the robot), and 2009–2011 (3–5 years after acquiring the robot) were compared using χ² tests and analysis of variance. The numbers of hysterectomies reported in resident case logs were also collected and compared. A total of 5894 hysterectomies were performed between 2005 and 2011. The total number of hysterectomies performed at Hospital A, which acquired the robotic surgical system, increased over time (p = .04) but remained stable at Hospital B, which did not acquire the robotic surgical system. At Hospital A, the number of robotic hysterectomies increased as the number of abdominal hysterectomies decreased (p < .001), a trend consistent across all diagnostic categories. The number of vaginal and laparoscopic hysterectomies remained stable. Resident case logs also reflected a decrease in the number of abdominal hysterectomies (p = .002) and an increase in the number of combined laparoscopic/robotic hysterectomies (p < .001) performed. The total number of hysterectomies performed by residents was unchanged.ConclusionIntroduction of the robotic surgical system was associated with significant changes in the numbers and types of hysterectomies performed in both general and subspecialty gynecology. Although abdominal hysterectomies decreased as robotic hysterectomies increased, other hysterectomies did not. These trends mirror reported resident surgical experience and have implications for resident education.     

A Comparison of Quality Outcome Measures in Patients Having a Hysterectomy for Benign Disease: Robotic vs. Non-robotic Approaches

Study ObjectiveTo measure procedure-related hospital readmissions within 30 days after discharge for patients who have a hysterectomy for benign disease. Secondary outcome quality measures evaluated were cost, estimated blood loss, length of stay and sum of costs associated with readmissions.DesignRetrospective cohort study (Canadian Task Force classification II-2).SettingAcademic community hospital.PatientsPatients who underwent hysterectomy to treat benign disease from January 2008 to December 2012.InterventionsPatients were grouped according to route of hysterectomy: robotic-assisted laparoscopic hysterectomy (robotic), laparoscopic hysterectomy (laparoscopic), abdominal hysterectomy (open via laparotomy), and vaginal hysterectomy (vaginal).Measurements and Main ResultsInclusion criteria were met by 2554 patients: 601 in the robotic group, 427 in the laparoscopic group, 1194 in the abdominal group, and 332 in the vaginal group. Readmission rates in the robotic cohort were significantly less (p<.05) than in non-robotic cohorts: Robotic (1%), laparoscopic (2.5%), open (3.5%), vaginal (2.4%). Estimated blood loss, length of stay, and sum of readmission costs were also significantly less in the robotic cohort (p<.05) compared with the other 3 cohorts.ConclusionPatients who undergo robotic-assisted laparoscopic hysterectomy have a significantly lower chance of readmission <30 days after surgery compared with those who undergo laparoscopic, abdominal (open) hysterectomy, and vaginal approaches. Patients in the robotics cohort also experienced a shorter length of stay, less estimated blood loss, and a cost savings associated with readmissions when compared to non-robotic approaches. Prospective registries describing quality outcomes, total sum of costs including 30 days follow-up, as well as patient-related quality of life benefits are recommended to confirm these findings and determine which surgical route offers the highest patient and societal value.     

全子宫切除术手术途径的发展现状

子宫切除术是妇科最常见的手术方法，随着医学理念及医疗器械领域的不断进步，各种手术方式层出不穷，目前采用的术式包括经腹子宫切除术（TAH）、经阴道子宫切除术（TVH）、经腹腔镜子宫切除术（TLH）以及单孔腹腔镜手术（LESS）、经阴道自然腔道内镜手术（v-NOTES）、机器人辅助腹腔镜手术（robotic assisted laparoscopy）进行子宫切除等。对于手术医师而言，应根据具体情况，在保证患者安全的前提下，合理地选择手术方式，制定规范化、人性化、个体化的治疗方案，以实现患者利益的最大化，这是每位医生的工作宗旨。通过查阅近年国内外相关文献，并结合临床实践经验，对每种子宫切除手术途径的安全性、可行性、优势以及局限性进行了全面系统的阐述，旨在通过对各种方式子宫切除术的比较，为临床医生更好地选择适合的子宫切除手术途径提供参考。     

Robotic Single-Incision Transumbilical Total Hysterectomy Using a Single-Site Robotic Platform: Initial Report and Technique

The benefits of laparoscopic surgery over open abdominal surgery have been well documented. Efforts continue for development of strategies that further reduce the size of abdominal incisions and the number of trocars used. Laparoendoscopic single-site surgery (LESS) is a promising approach that can further enhance cosmetic satisfaction and reduce the risks of laparoscopic surgery. Loss of triangulation, instrument crowding and clashing, poor visualization, and ergonomic problems are the most challenging issues associated with the use of LESS. The combination of LESS and the robotic system seems to be a promising choice to overcome the technical difficulties of LESS. The da Vinci Single-Site Surgical Platform is a novel semi-rigid robotic operating system. We present our initial clinical experience with robotic-assisted single-incision transumbilical total hysterectomy using the novel da Vinci Single-Site Surgical Platform.     

Robotic Radical Hysterectomy for Cervical Cancer: A Population-Based Study of Adoption and Immediate Postoperative Outcomes in the United States

Study Objective

To compare the use of robotic radical hysterectomy (RRH) and abdominal radical hysterectomy (ARH) in the United States, with secondary outcomes of perioperative complications, hospital length of stay (LOS), immediate postoperative mortality, cost and a subanalysis compared with laparoscopic radical hysterectomy (LRH).

Single-Site Robotic Total Hysterectomy: Standardization of Technique and Surgical Outcomes

Study ObjectivesTo evaluate the safety and feasibility of robotic single-site total hysterectomy and to compare the outcomes of newly implemented robotic single-site bipolar and external vessel-sealing device.DesignRetrospective study (Canadian Task Force classification II-1).SettingUniversity hospital.PatientsTwenty-four patients with benign indications for hysterectomy.InterventionsAll patients underwent robotic-assisted single-incision transumbilical total hysterectomy using the novel da Vinci Single-Site Platform. Vaginal cuff closures were performed intracorporeally using the same technique in all cases.Measurements and Main ResultsThe median age of the patients was 49.5 years (range, 40–61), and body mass index was 28.5 (range, 21–34). Blood loss was 22.5 mL (range, 7–120 mL). Docking time was 5.5 minutes (range, 3-10 minutes), console time was 74.5 minutes (range, 60–160 minutes), vaginal cuff closure time was 25 minutes (range, 16–41 minutes), and total operative time was 98.5 minutes (range, 71–183 minutes). When 2 groups were created according to the energy devices used during the procedures, console time in the newly implemented bipolar group was shorter than in the external sealing device group (69.5 minutes vs 77 minutes; p = .03); however, no differences were found for uterus removal time (50.5 minutes vs 53.5 minutes; p = .13). Differences were observed in vaginal cuff closure time (18.5 minutes vs 23 minutes; p = .01).ConclusionRobotic single-site total hysterectomy using a newly implemented bipolar grasping instrument and even with intracorporeal cuff closure is a safe and feasible procedure in appropriately selected patients.     

Oncologic and Surgical Outcomes of Robotic Versus Open Radical Hysterectomy for Cervical Cancer

Objective

In view of the recent controversy concerning the use of minimally invasive radical hysterectomy as primary treatment for early stage cervical cancer, this study compared the survival and perioperative outcomes in a cohort of patients who underwent radical hysterectomy either by laparotomy or by robotics.

Vaginal Versus Robotic Hysterectomy and Concomitant Pelvic Support Surgery: A Comparison of Postoperative Vaginal Length and Sexual Function

Study ObjectiveTo compare the change from pre- to postoperative total vaginal length (TVL) in women who underwent either a total vaginal hysterectomy (TVH) with uterosacral ligament suspension (USLS) or a robotic hysterectomy (RH) with colpopexy (SCP). Secondary objectives included comparing sexual function, pelvic floor function, and prolapse recurrence between routes of surgery.DesignThis was a retrospective cohort study (Canadian Task Force classification II-2).SettingThis was conducted at 1 tertiary academic medical center over a 2-year period.PatientsWomen who underwent either TVH/USLS or RH/SCP.InterventionsBaseline and postoperative POP-Q Pelvic Organ Prolapse Quantification exams were recorded as well as postoperative validated questionnaires. Twenty-nine subjects were needed in each group to detect a 1.5-cm difference in TVL.Measurements and Main ResultsThere were 38 TVH/USLS and 46 RH/SCP participants. RHs were either total (28/46 [61%]) or supracervical (18/46 [39%]). The mean postoperative follow-up was 9.5 ± 3.1 months. For the primary outcome, women in the TVH/USLS group had a decrease in TVL, whereas women in the RH/SCP group had an increase in TVL (−0.6 ± 1.0 cm vs 0.5 ± 0.8 cm, p < .001). Among sexually active women (55/84, 65.5%), there was no difference in postoperative sexual function between groups based on Pelvic Organ Prolapse/Urinary incontinence Sexual Function Questionnaire short form scores, with good sexual function in both groups (32.6 ± 6.2 TVH/USLS vs 35.1 ± 7.3 RH/SCP, p = .22). Although both groups showed good postoperative apical support, the TVH/USLS group had a slightly lower mean C point compared with the RH/SCP group (−6.8 ± 1.2 vs −7.7 ± 1.8, p = .02). Both groups showed good postoperative pelvic floor function, with no difference in mean postoperative Pelvic Organ Prolapse Distress Inventory scores (42.2 ± 45.4 vs 52.7 ± 46.6, p = .44). Recurrent prolapse (defined as any prolapse at or beyond the hymen) was not different between groups (13.2% for TVH/USLS vs 6.5% for RH/SCP, p = .46).ConclusionVaginal length decreased after vaginal hysterectomy with pelvic support surgery compared with RH with pelvic support surgery, with no differences in postoperative sexual function or pelvic floor function between groups.     

Development and Validation of Simulation Training for Vaginal Hysterectomy

Study ObjectiveTo develop and validate an educational intervention based on vaginal hysterectomy (VH) simulation.DesignProspective cohort study (Canadian Task Force classification II-2).SettingSurgical skills simulation center.PatientsThirty residents in Obstetrics and Gynecology (11 PGY-2, 11 PGY-3, and 8 PGY-4).InterventionVH educational intervention that included a lecture, a video, and surgical skill simulation using a new inexpensive model.Measurements and Main ResultsThe primary outcome was written test scores before and after the educational intervention, and the secondary outcome was self-rated confidence in performing VH. Baseline written scores were similar for all 3 training levels; however, baseline confidence scores were higher for PGY-3 and PGY-4 residents than for PGY-2 residents (p < .01). After the workshop, written test scores improved significantly for all trainees (median [range] improvement, 4 [3.5–5.0] points; p < .01). Mean (SD) improvement in confidence scores for PGY-4, PGY-3, and PGY-2 residents was 0 (0.5), 0.5 (0.8), and 1 (1.3), respectively, with improvement in confidence scores reaching significance only for PGY-2 residents (p < .02). All trainees expressed high satisfaction with the workshop.ConclusionAn educational intervention based on VH simulation is feasible and improves knowledge and confidence in junior residents with limited exposure to VH.     

Hysterectomy for the Transgendered Male: Review of Perioperative Considerations and Surgical Techniques with Description of a Novel 2-Port Laparoscopic Approach

Transgendered individuals can suffer a significant amount of psychological distress that can be alleviated through hormonal treatments and/or gender-affirming surgery. The World Professional Association for Transgender Health considers a hysterectomy and bilateral salpingo-oophorectomy medically necessary gender-affirming procedures for the interested transgendered male. Several surgical approaches have been described in the literature, most of which endorse a laparoscopic approach. This review summarizes the available literature on surgical techniques in addition to reporting our institutional outcomes using a novel 2-port laparoscopic approach. Additional preoperative and perioperative considerations are needed when caring for this patient population and are reviewed.     

Predictors of Surgical Site Infection in Women Undergoing Hysterectomy for Benign Gynecologic Disease: A Multicenter Analysis Using the National Surgical Quality Improvement Program Data

Study ObjectiveTo estimate the rate and predictors of surgical site infection (SSI) after hysterectomy performed for benign indications and to identify any association between SSI and other postoperative complications.DesignRetrospective cohort study (Canadian Task Force classification II-2).SettingNational Surgical Quality Improvement Program data.PatientsWomen who underwent abdominal or laparoscopic hysterectomy performed for benign indications from 2005 to 2011.InterventionsUnivariable and multivariable logistic regression analyses were used to identify predictors of SSI and its association with other postoperative complications. Odds ratios were adjusted for patient demographic data, comorbidities, preoperative laboratory values, and operative factors.Measurements and Main ResultsOf 28 366 patients, 758 (3%) were diagnosed with SSI. SSI occurred more often after abdominal than laparoscopic hysterectomy (4% vs 2%; p < .001). Among patients who underwent abdominal hysterectomy, predictors of SSI included diabetes, smoking, respiratory comorbidities, overweight or obesity, American Society of Anesthesiologists class ≥3, perioperative blood transfusion, and operative time >180 minutes. Among those who underwent laparoscopic hysterectomy, predictors of SSI included perioperative blood transfusion, operative time >180 minutes, serum creatinine concentration ≥2 mg/dL, and platelet count ≥350 000 cells/mL³. For patients with deep or organ/space SSI, significant predictors included perioperative blood transfusion and American Society of Anesthesiologists class ≥3 for abdominal hysterectomy, and non-white race, renal comorbidities, preoperative or perioperative blood transfusion, and operative time >180 minutes for laparoscopic hysterectomy. SSI was associated with longer hospital stay and higher rates of repeat operation, sepsis, renal failure, and wound dehiscence. SSI was not associated with increased 30-day mortality.ConclusionsSSI occurred more often after abdominal hysterectomy than laparoscopic hysterectomy performed to treat benign gynecologic disease. SSI was associated with increased postoperative complications but not mortality. Several risk factors for SSI after each abdominal and laparoscopic hysterectomy were identified in this study.     

Sexual Morbidity Assessment in Gyne-Oncology Follow-Up: Development of the Sexual Well-Being After Cervical or Endometrial Cancer (SWELL-CE) Patient-Reported Outcome Measure

BackgroundClinical assessment and management of sexual difficulties after gynecological cancer remain a neglected aspect of women’s rehabilitation.AimTo develop and validate a patient-reported outcome measure of sexual well-being for women experiencing sexual consequences of cervical and endometrial cancer treatment for use in routine follow-up.MethodsThis is a sequential mixed method study comprising (i) in-depth qualitative interviews (n=21 of 118) to generate items regarding sexual consequences of cervical or endometrial cancer and treatment; (ii) questionnaire construction with 51 core items (all respondents) and 4 subsections (18–58 items), depending on the relationship status and whether or not participants were sexually active (SA/NSA); (iii) item refinement following cognitive debriefing (n=13 of 21); (iv) validation of resultant items via postal survey (n=788 women) and Rasch analysis; and (v) creation of brief (14-item) clinical screener. Women attending routine follow-up (3 months to 5 years) at 6 English cancer centers and members of 3 UK cancer patient websites, who met the study inclusion criteria, were invited to participate.OutcomesThe primary outcome of this study was the construction and initial psychometric testing of SWELL-CE short and long form versions.Results21 women participated in interviews and 250 of 788 (32%) returned the postal survey (T1). 110 draft items were evaluated using cognitive testing (n=13) to refine instrument design and test face validity, comprehension, and acceptability. Exploratory factor analysis of survey data (n=250) produced an initial 6 domain structure as a guidance for the Rasch analysis. Subsequent Rasch analysis yielded a 3 domain structure: physical sexual function, sexual and relationship concerns, and sexual desire and sexual self-esteem, each satisfying Rasch model requirements within their respective SA (item pool =59) and NSA (item pool =53) categories, including the absence of local response dependency and all showing strict unidimensionality. The 3 subscales demonstrated good psychometric properties, external validity, and test-retest reliability. A valid Rasch short form of 14 items was created from the larger item pool.Clinical ImplicationsThis PROM may assist clinicians to improve identification, discussion, and management of women who could benefit from sexual rehabilitation.Strengths & LimitationsInitial evaluation supports psychometric validity and reliability in the assessment of physical sexual function, sexual interest and sexual self-esteem, and sexual and relationship concerns in this study sample. However, given this study’s modest response rate (32%, n=250), findings should be interpreted with caution. This PROM identifies sexual concerns in women who are sexually active or sexually non-active due to illness or treatment-associated sexual difficulties.ConclusionSexual Well-being after Cervical or Endometrial Cancer is a novel and psychometrically valid sexual well-being measure for clinical assessment of female sexual difficulties after cervical or endometrial cancer treatment.White ID, Tennant A, Taylor C, Sexual Morbidity Assessment in Gyne-Oncology Follow-Up: Development of the Sexual Well-Being After Cervical or Endometrial Cancer (SWELL-CE) Patient-Reported Outcome Measure. J Sex Med 2020;17:2005–2015.     

Systematic Review of Robotic Surgery in Gynecology: Robotic Techniques Compared With Laparoscopy and Laparotomy

The Society of Gynecologic Surgeons Systematic Review Group performed a systematic review of both randomized and observational studies to compare robotic vs nonrobotic surgical approaches (laparoscopic, abdominal, and vaginal) for treatment of both benign and malignant gynecologic indications to compare surgical and patient-centered outcomes, costs, and adverse events associated with the various surgical approaches. MEDLINE and the Cochrane Central Register of Controlled Trials were searched from inception to May 15, 2012, for English-language studies with terms related to robotic surgery and gynecology. Studies of any design that included at least 30 women who had undergone robotic-assisted laparoscopic gynecologic surgery were included for review. The literature yielded 1213 citations, of which 97 full-text articles were reviewed. Forty-four studies (30 comparative and 14 noncomparative) met eligibility criteria. Study data were extracted into structured electronic forms and reconciled by a second, independent reviewer. Our analysis revealed that, compared with open surgery, robotic surgery consistently confers shorter hospital stay. The proficiency plateau seems to be lower for robotic surgery than for conventional laparoscopy. Of the various gynecologic applications, there seems to be evidence that renders robotic techniques advantageous over traditional open surgery for management of endometrial cancer. However, insofar as superiority, conflicting data are obtained when comparing robotics vs laparoscopic techniques. Therefore, the specific method of minimally invasive surgery, whether conventional laparoscopy or robotic surgery, should be tailored to patient selection, surgeon ability, and equipment availability.     

Hysterectomy by Transvaginal Natural Orifice Transluminal Endoscopic Surgery (NOTES): A Series of 137 Patients

Study ObjectiveTo evaluate the feasibility and safety of hysterectomy in benign disease using transvaginal natural orifice transluminal endoscopic surgery (NOTES).DesignProspective observational study (Canadian Task Force classification II-3).SettingTertiary referral medical center.PatientsFrom May 2010 to August 2011, consecutive patients who were scheduled to undergo laparoscopic hysterectomy and without virginity or suspected pelvic inflammation or cul-de-sac obliteration were included.InterventionTotal hysterectomy via transvaginal NOTES.Measurements and Main ResultsThe study included 137 patients, with mean (SEM) age 46.0 (0.4) years and body mass index 24.7 (0.4). Transvaginal NOTES was successfully performed in 130 patients (94.9%). Fifteen patients underwent concurrent adhesiolysis, and 17 underwent adnexal procedures. Mean (SEM) uterine weight was 450.0 (24.1) g; in 45 patients (34.6%), uterine weight was >500 g, and in 7 (5.4%) it was >1000 g. Operative time was 88.2 (4.1) minutes, with blood loss of 257.7 (23.9) mL. In 2 patients there was intraoperative hemorrhage or unintended cystotomy, and in another 5 transvaginal colpotomy failed because of a narrow vagina, cul-de-sac obliteration by bowel adhesions, or mass obstruction. Complications in these 7 patients (5.1%) were successfully managed via transabdominal laparoscopy. Five patients (3.6%) experienced postoperative urinary retention or febrile morbidity, and recovered uneventfully with conservative treatment.ConclusionTransvaginal NOTES is a feasible technique for performance of hysterectomy and can be used in procedures that are difficult to complete via conventional vaginal surgery because posterior colpotomy is achievable. This procedure was not impeded by uterine volume, and had the advantage of no abdominal incision.     

Type of Pelvic Disease as a Risk Factor for Surgical Site Infectionin Women Undergoing Hysterectomy

Study ObjectiveTo quantify the relationship between type of benign pelvic disease and risk of surgical site infection (SSI) after hysterectomy.DesignRetrospective cohort study (Canadian Task Force classification II-2).SettingHospitals participating in the American College of Surgeons National Surgical Quality Improvement Program (NSQIP).PatientsWomen who underwent hysterectomy from 2006-2015 and recorded in NSQIP database.InterventionNone.Measurements and Main ResultsSSI risk was compared for type of benign pelvic disease, patient characteristics (i.e., age, race, and selected comorbidities) and process of care variables (i.e., admission status, type of hysterectomy, and operative time). SSI occurred in 2.48% of the 125,337 women who underwent hysterectomy. SSI was most frequent in patients with endometriosis and least frequent in those with genital prolapse (3.13% vs 1.39%; p <.0001). Following adjustment for potential confounders, the odds of SSI were higher in women undergoing hysterectomy for endometriosis (adjusted odds ratio [aOR], 1.79; 95% confidence interval [CI], 1.43– 2.25), uterine myomas (aOR, 1.28; 95% CI, 1.05–1.55), menstrual disorders (aOR, 1.46; 95% CI, 1.20–1.78), and pelvic pain (aOR, 1.75; 95% CI, 1.34–2.27) compared with women undergoing hysterectomy for genital prolapse. Other patient factors associated with SSI included age, body mass index, smoking, diabetes mellitus, chronic obstructive pulmonary disease, hypertension, and American Society of Anesthesiologists classification. Among process-of-care factors, inpatient status, route of hysterectomy, total vs subtotal hysterectomy, and operative time were also associated with SSI.ConclusionIn addition to various patient and process-of-care factors known to be associated with SSI, type of underlying pelvic disease is an independent risk factor for SSI in women undergoing hysterectomy for benign indications.     

Female Assessment of Male Erectile Dysfunction Detection Scale (FAME): Development and Validation

IntroductionAlthough erectile dysfunction (ED) affects both members of the couple, no tools exist for the detection of ED by the female partner.AimThe aim of this study was to develop a scale for the detection of ED, as assessed by the female partner.MethodsDevelopment and validation of the Female Assessment of Male Erectile dysfunction detection scale (FAME) consisted of five stages: (i) two focus group discussions conducted among female partners of ED sufferers; (ii) item construction; (iii) initial content validation to document face validity and reduce number of items; (iv) final selection of items and investigation of concurrent validity and reliability, sensitivity and specificity of the scale in 83 Spanish-speaking couples; and (v) multicenter study conducted in a group of 106 English-speaking couples. Concurrent validity was assessed using Spearman's rho correlation coefficients between FAME and clinical diagnosis, the Sexual Health Inventory for Men (SHIM), and the erectile function domain of the International Index of Erectile Function (IIEF-EF). Reliability was tested using Cronbach's alpha, and sensitivity and specificity was investigated using clinical diagnosis as the gold standard criterion.Main Outcome MeasuresValidity, reliability, specificity, and sensitivity of the FAME scale when correlated with SHIM, IIEF-EF, and clinical diagnosis.ResultsQualitative analysis yielded 44 clues; 21 items demonstrated statistical significance as the best discriminating items using a t-test for independent samples. A final scale of six items was tested for validity, reliability, specificity, and sensitivity. FAME correlated significantly with clinical diagnosis (0.791, P < 0.001), the SHIM (0.788, P < 0.001), and the IIEF-EF (0.777, P < 0.001). Additional support for discriminant validity was obtained with receiver operating characteristics analysis. Cronbach's alpha was 0.941. Sensitivity was 96.1% and specificity 86.0%.ConclusionsAccurate detection of ED in men by the female partner is possible. In this study, FAME demonstrated concurrent validity and very good reliability, as well as excellent sensitivity and specificity. Rubio-Aurioles E, Sand M, Terrein-Roccatti N, Dean J, Longworth J, Eardley I, Brock G, Lee J, Arango de Montis I, and Rampazzo-Bonaldo C. Female assessment of male erectile dysfunction detection scale (FAME): Development and validation. J Sex Med 2009;6:2255–2270.     

经阴道子宫广泛切除联合腹腔镜手术治疗子宫恶性肿瘤的临床研究

目的：探讨经阴道子宫广泛或次广泛切除加腹腔镜手术治疗子宫恶性肿瘤的可行性和临床效果。方法：对18例宫颈癌患者,5例子宫内膜癌患者,行经阴道子宫广泛或次广泛切除加腹腔镜盆腔淋巴结清除术。分析手术质量和术后恢复情况。结果：23例患者均顺利完成手术,无并发症发生。清除的盆腔淋巴结数平均29个,平均手术时间为216分钟,术中平均出血350 ml,3例需要输血。术后肛门排气时间平均1．8天,膀胱功能恢复时间平均11．5天,平均术后住院时间9．5天。术后第一天均可下地活动。22例无复发。结论：该术式损伤小、恢复快,能达到足够的切除范围,是目前治疗子宫恶性肿瘤较理想的术式。     

国内腹腔镜与经腹子宫切除术相关随机对照试验的系统评价

目的:比较腹腔镜子宫切除术和经腹子宫切除术的安全性和可行性差异.方法:计算机检索电子数据库,手工检索相关杂志.由两名评价员独立检索和提取资料并交叉核时,纳入高质量随机对照试验.Meta分析软件是Cochrane协作网提供的RevMan 5.0.结果:共纳入高质量的RCT试验9个,包括1290例患者,其中腹腔镜手术组664例,经腹手术组626例.Meta分析结果显示:两组间手术时间差异无统计学意义[MD 2.02,95%CI(-4.41,8.45);P=0.54];两组间术中出血量、术后住院时间、术后排气时间、术后病率、术后镇痛用药率、术后血红蛋白量、伤口愈合时间、疼痛强度及术后离床活动时间等指标,腹腔镜子宫切除术均优于经腹子宫切除术.结论:腹腔镜子宫切除术安全性、可行性及优越性均优于经腹子宫切除术.