Minimally
invasive surgical methods are becoming more common in the treatment of
gynecologic conditions, both benign and malignant diseases. And robotically-assisted
surgery has been developed to overcome the limitations of pre-existing
minimally-invasive surgical procedures and to enhance the capabilities of
surgeons performing open surgery. In this study, the authors aimed to estimate the
impact of patient’s age on surgical outcomes in patients undergoing robotic
hysterectomy.
This was a
retrospective review of prospectively collected data on a consecutive series of
robotic assisted gynecologic surgeries in a single institution. Robotic surgeries were performed on the da Vinci Surgical System
(Intuitive Surgical, Sunnydale, CA) using a four-arm robot. Patient’s age and
perioperative variables were collected from the database, charts, and other
hospital records of all patients undergoing robotic hysterectomy.
399 patients underwent
robotic surgery for gynecologic disease. 370 patients who were under age 70
were compared with 29 patients who were over age 70. When comparing all
patients under age 70 with patients over age 70, the mean age was 48.4 and 77
(P < 0.05), mean BMI was 32.1 and 28.3 kg/m2 (P
< 0.05), mean procedure time was 185 and 211 minutes (min)
(P = 0.09), mean console time was 123 and 148 min
(P = 0.056), mean OR (Operating room) time was 237 and 273,
mean EBL (Estimated blood loss) was 71 and 65 ml (P = 0.74), Hb
(Hemoglobin) drop was 1.4 and 1.2 (P = 0.45), uterine
weight was 212 and 95 gm (P = 0.98), and length of stay was 1.4 and 1.6
days (P = 0.33).
The results
indicated that the patients over age 70, when procedures were combined, had a
statistically significant lower mean BMI, uterine weight and longer Operating
room (OR) time. However, when stratified by the type of procedure performed,
there was no difference in surgery times among those under 70 and over 70 years
of age. The elderly patients were more likely to have cancer, which was in
almost half the elderly patients, and thus necessitate staging. Thus adding the
performance of lymph node dissection likely resulted in the increased length of
the surgery time that was noted in the combined group. Besides, there were no
operative deaths.
In conclusion, advanced
age does not appear to be associated with an increased risk of morbidity, or
adverse perioperative outcomes in patients undergoing gynecologic
robotic-assisted minimally invasive surgery. Additional research should be
performed in the elderly to ensure safety of minimally invasive surgery for
this expanding population.
Article by A.
Eddib, et al, from USA.
Full access: http://mrw.so/4GbdiG
Image by UCHealth, from Flickr-cc.
评论
发表评论