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- Aardal Lönnerfors, Celine, et al.
(författare)
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Pregnancy following robot-assisted laparoscopic myomectomy in women with deep intramural myomas.
- 2011
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Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 1600-0412 .- 0001-6349. ; 90, s. 972-977
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Tidskriftsartikel (refereegranskat)abstract
- Objective. To describe fecundity after robot-assisted laparoscopic myomectomy for deep intramural myomas. Design. Prospective observational study. Setting. University Hospital. Population. Women undergoing robot-assisted laparoscopic myomectomy. Methods. Expanding on a previous prospective feasibility study 31 consecutive women in whom a robot-assisted laparoscopic myomectomy was performed between April 2006 and July 2010 were included. The women, of which 14 had known infertility, were selected for having symptomatic, deep intramural myomas with a possible impact on fertility. Using a prospective protocol, relevant peri-operative and follow-up data were retrieved. Main Outcome Measures. Fertility and pregnancy outcome. Results. The 31 women included had a median age of 35 years (range 28-42 years) and median Body Mass Index of 22.0 kg/m(2) (range 20.1-24.7 kg/m(2) ). Fifteen of the 22 (68%) women with an active wish of conceiving have become pregnant at a median time of 10 months after surgery. A total of 18 pregnancies occurred resulting in three miscarriages, two terminated pregnancies, 10 successful term deliveries and three ongoing pregnancies. The subgroup of 14 women with a known but otherwise unexplained infertility had a similar pregnancy rate (69%) and of those, (55%) conceived naturally. The women who conceived naturally were on average eight years younger than the women becoming pregnant after IVF and all miscarriages occurred in an IVF pregnancy. Conclusions. In women with symptomatic, deep intramural myomas and either otherwise unexplained infertility or myomas with possible effect on conception the pregnancy rate following robot-assisted laparoscopic myomectomy was 68%.
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- Aardal Lönnerfors, Celine
(författare)
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Robot-assisted laparoscopy for benign uterine disease. Feasibility, outcome and hospital cost.
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The introduction of the laparoscope was a milestone within gynecologic surgery. Despite evidence of better perioperative outcome compared to laparotomy, laparoscopy is mostly performed for less advanced surgical procedures and the uptake of laparoscopic hysterectomy has been slow. An effort to preserve the clinical benefits of laparoscopic surgery and facilitate the performance of more advanced surgery has led to the development of robot-assisted laparoscopic surgery. Technical progress has been advantageous for the patient from a historical point of view, but this cannot be assumed without proper evaluation. As for all surgical approaches, it is important to recognize the possible applications of robotic surgery as well as proper patient selection both from a clinical and economical point of view. The overall aim of this thesis was to investigate the possible applications, clinical outcome and hospital cost of robot-assisted laparoscopic surgery for benign uterine disease at a single institution following the introduction of robotic surgery. Study I: Evaluating the first 1000 robotic surgeries performed showed that a surgical robot provides the possibility to offer minimally invasive surgery to a larger patient population with low rates of conversions and intraoperative complications. Study II: 31 women with symptomatic, deep intramural myomas and either otherwise unexplained infertility or myomas with a possible effect on conception had a pregnancy rate following robotic myomectomy of 68%. Study III: All women (n=114) with a BMI ≥ 30 kg/m2 who underwent a simple hysterectomy by robotics or laparotomy during the study period were included. Robot-assisted laparoscopic hysterectomy in obese women was associated with shorter hospital stay, less bleeding, and fewer complications and longer operative time compared to laparotomy although the operative times for morbidly obese women were similar between robotics and laparotomy. Study IV: 122 women planned for minimally invasive hysterectomy for benign disease were randomly allocated to either robot-assisted- or traditional, minimally invasive hysterectomy in a 1:1 proportion with vaginal hysterectomy as a primary choice in the latter. From the perspective of hospital costs, robotic-assisted hysterectomy is not advantageous for treating non-complex benign conditions when a vaginal approach is feasible in a high proportion of patients. A similar hospital cost is attainable for laparoscopy and robotics when the robot is a preexisting investment. Study V: Complication rates in 949 women planned for robotic hysterectomy for malignant (75%) and benign (25%) gynecological disease over an 8-year period with special awareness of complications possibly related to robot specific risk factors. Intraoperative- and postoperative complications and complications possibly related to the robotic approach diminish with training, experience and refinement of practice. Study VI: All women (n=483) undergoing hysterectomy for benign disease during 2013 and 2014. Vaginal hysterectomy was associated with the lowest hospital cost and robotic hysterectomy with the lowest rate of perioperative complications. Procedure-specific proficiency influences outcome. Robotic hysterectomy for benign disease is clinically advantageous and economically feasible in complex cases, when performed by high volume surgeons.
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- Aardal Lönnerfors, Celine, et al.
(författare)
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The effect of increased experience on complications in robotic hysterectomy for malignant and benign gynecological disease.
- 2015
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Ingår i: Journal of Robotic Surgery. - : Springer Science and Business Media LLC. - 1863-2491 .- 1863-2483. ; 9:4, s. 321-330
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Tidskriftsartikel (refereegranskat)abstract
- The study objective was to assess the effect of increased experience on complications in robotic hysterectomy for malignant and benign gynecological disease. This is a retrospective cohort study. It is a Canadian Task Force classification II-2 study conducted at the University Hospital, Sweden. The patients were 949 women planned for robotic hysterectomy for malignant (75 %) and benign (25 %) gynecological disease between October 2005 and December 2013. They were continuously evaluated for the rate of intraoperative and postoperative complications up to 1-year post-surgery, the latter according to Clavien-Dindo classification following the introduction of robotic surgery with special awareness of complications possibly related to robot-specific risk factors, the description of refinement of practice and assessment of the effect of these measures. The rate of intraoperative complications, the overall rate of complications and the rate of ≥grade 3 complications decreased from the first to the last time period (4.8 vs 2.6 %, p = 0.037, 34 vs 19 %, p = 0.003 and 13.5 vs 3.2 %, p = 0.0003, respectively). The rate of intraoperative complications and the rate of postoperative complications possibly related to robot-specific risk factors was reduced from the first to the last time period (3.8 vs 0.6 %, p = 0.028 and 7.7 vs 1.5 %, p = 0.003, respectively). In patients undergoing robotic hysterectomy for malignant and benign gynecological disease intraoperative and postoperative complications and complications possibly related to the robotic approach diminish with training, experience and refinement of practice.
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- Geppert, Barbara, et al.
(författare)
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Robot-assisted laparoscopic hysterectomy in obese and morbidly obese women: surgical technique and comparison with open surgery.
- 2011
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Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 1600-0412 .- 0001-6349. ; 90, s. 1210-1217
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Tidskriftsartikel (refereegranskat)abstract
- Objective. Comparison of surgical results on obese patients undergoing hysterectomy by robot-assisted laparoscopy or laparotomy. Setting. University hospital. Methods. All women (n=114) with a BMI ≥30 kg/m(2) who underwent a simple hysterectomy as the main surgical procedure between November 2005 and November 2009 were identified. Robot-assisted procedures (n=50) were separated into an early (learning phase) and a late (consolidated phase) group; open hysterectomy was considered an established method. Relevant data was retrieved from prospective protocols (robot) or from computerized patient charts (laparotomy) until 12 months after surgery. Complications leading to prolonged hospital stay, readmission/reoperation, intravenous antibiotic treatment or blood transfusion were considered significant. The surgical technique used for morbidly obese patients is described. Results. Women in the late robot group (n=25) had shorter inpatient time (1.6 compared to 3.8 days, p<0.0001), less bleeding (100 compared to 300 mL, p<0.0001) and fewer complications (2/25 compared to 23/64, p=0.006) than women with open surgery (n=64) but a longer operating time (136 compared to 110 minutes, p=0.0004). For women with a BMI ≥35 kg/m(2) , surgical time in the late robot group and the laparotomy group was equal (136 compared to 128 minutes, p=0.31). Conclusions. Robot-assisted laparoscopic hysterectomy in a consolidated phase in obese women is associated with shorter hospital stay, less bleeding and fewer complications compared to laparotomy but, apart from women with BMI ≥35, a longer operative time.
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- Johansen, Gry, et al.
(författare)
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Reproductive and oncologic outcome following robot-assisted laparoscopic radical trachelectomy for early stage cervical cancer.
- 2016
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Ingår i: Gynecologic Oncology. - : Elsevier BV. - 1095-6859 .- 0090-8258.
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Tidskriftsartikel (refereegranskat)abstract
- Objective To investigate the reproductive and oncologic outcome following robotic radical trachelectomy for early stage cervical cancer. Methods All women with early stage cervical cancer planned for fertility-sparing robotic trachelectomy between December 2007 and April 2015 at two tertiary referral centers in Sweden were identified. Perioperative- and follow-up data was retrieved from prospective databases used for all robotic procedures at the respective institution and an additional review of computerized patient files was performed. Reproductive outcome evaluation was restricted to women with ≥ 12 months follow-up and an active wish to conceive. Oncological outcome was evaluated for all patients. Results Fifty-six women (3 stage IA1, 14 stage IA2 and 39 stage IB1) were included. The median age was 29 years (range 23-41). Median follow-up was 24 months (range 1-89). Seven trachelectomies were aborted in favor of a radical hysterectomy and/or chemoradiation due to nodal metastases or insufficient margins; two distant recurrences occurred in these women. A local recurrence was seen in two of the 49 women (4%) in whom the procedure was completed as planned. Seventeen of the 21 women (81%) in the reproductive follow-up group conceived - 16 naturally and one following IVF. Sixteen women (94%) delivered in the third trimester, 12 women (71%) in gestational week ≥ 36. One (6%) second trimester delivery occurred. Conclusion The high fertility rate, low rate of premature deliveries and an acceptable rate of recurrence support the feasibility of robotic fertility-sparing radical trachelectomy in women with early stage cervical cancer.
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