Objective: To estimate the impact of patient’s age on surgical
outcomes in patients undergoing robotic hysterectomy. Methods: A retrospective
review of prospectively collected cohort data for a consecutive series of
patients undergoing gynecologic robotic surgery. Patient’s age and
perioperative variables were collected from the database, charts, and other
hospital records of all patients undergoing robotic hysterectomy. Results: 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) (Table 1). 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 (Tables 1,
References
[1]
Lee, M., et al. (2011) Comparisons of Surgical Outcomes, Complications, and Costs between Laparotomy and Laparoscopy in Early-Stage Ovarian Cancer. International Journal of Gynecological Cancer, 21, 251-256.
http://dx.doi.org/10.1097/IGC.0b013e318208c71c
[2]
Kalogiannidis, I., et al. (2007) Laparoscopy-Assisted Vaginal Hysterectomy Compared with Abdominal Hysterectomy in Clinical Stage I Endometrial Cancer: Safety, Recurrence, and Long-Term Outcome. American Journal of Obstetrics & Gynecology, 196, e1-8.
[3]
Nezhat, C., et al. (2009) Laparoscopic Hysterectomy with and without a Robot: Stanford Experience. JSLS, 13, 125-128.
[4]
Soto, E., et al. (2011) Total Laparoscopic Hysterectomy versus da Vinci Robotic Hysterectomy: Is Using the Robot Beneficial? Journal of Gynecologic Oncology, 22, 253-259. http://dx.doi.org/10. 3802/jgo.2011.22.4.253
[5]
Payne, T.N. and Dauterive, F.R. (2008) A Comparison of Total Laparoscopic Hysterectomy to Robotically Assisted Hysterectomy: Surgical Outcomes in a Community Practice. Journal of Minimally Invasive Gynecology, 15, 286-291.
http://dx.doi.org/10.1016/j.jmig.2008.01.008
[6]
Wu, J.M., et al. (2007) Hysterectomy Rates in the United States, 2003. Obstetrics & Gynecology, 110, 1091-1095.
http://dx.doi.org/10.1097/01.AOG.0000285997.38553.4b
[7]
Merrill, R.M. (2008) Hysterectomy Surveillance in the United States, 1997 through 2005. Medical Science Monitor, 14, CR24-31.
[8]
Efron, D.T. and Bender, J.S. (2001) Laparoscopic Surgery in Older Adults. Journal of the American Geriatrics Society, 49, 658-663. http://dx.doi.org/10.1046/j.1532-5415.2001.49130.x
[9]
Nezhat, C., et al. (2009) Robot-Assisted Laparoscopic Surgery in Gynecology: Scientific Dream or Reality? Fertility and Sterility, 91, 2620-2622. http://dx.doi.org/10.1016/j.fertnstert.2008.03.070
[10]
Yoshikawa, T.T. (2012) Future Direction of Geriatrics: “Gerogeriatrics”. Journal of the American Geriatrics Society, 60, 632-634. http://dx.doi.org/10.1111/j.1532-5415.2012.03896.x
[11]
Leung, J.M. and Dzankic, S. (2001) Relative Importance of Preoperative Health Status versus Intraoperative Factors in Predicting Postoperative Adverse Outcomes in Geriatric Surgical Patients. Journal of the American Geriatrics Society, 49, 1080-1085. http://dx.doi.org/10.1046/j.1532-5415. 2001.49212.x
[12]
Ramesh, H.S., et al. (2005) Optimising Surgical Management of Elderly Cancer Patients. World Journal of Surgical Oncology, 3, 17. http://dx.doi.org/10.1186/1477-7819-3-17
[13]
Atiemo, H., Griebling, T.L. and Daneshgari, F. (2006) Advances in Geriatric Female Pelvic Surgery. BJU International, 98, 90-96. http://dx.doi.org/10.1111/j.1464-410X.2006.06301.x
[14]
Lau, S., et al. (2011) Relationship between Body Mass Index and Robotic Surgery Outcomes of Women Diagnosed with Endometrial Cancer. International Journal of Gynecological Cancer, 21, 722-729.
http://dx.doi.org/10.1097/IGC.0b013e318212981d
[15]
Vaknin, Z., et al. (2010) Outcome and Quality of Life in a Prospective Cohort of the First 100 Robotic Surgeries for Endometrial Cancer, with Focus on Elderly Patients. International Journal of Gynecological Cancer, 20, 1367-1373.
[16]
Falabella, A., et al. (2007) Cardiac Function during Steep Trendelenburg Position and CO2 Pneumoperitoneum for Robotic-Assisted Prostatectomy: A Trans-Oesophageal Doppler Probe Study. International Journal of Medical Robotics, 3, 312-315. http://dx.doi.org/10.1002/rcs.165
[17]
Lestar, M., et al. (2011) Hemodynamic Perturbations during Robot-Assisted Laparoscopic Radical Prostatectomy in 45 Degrees Trendelenburg Position. Anesthesia & Analgesia, 113, 1069-1075.
http://dx.doi.org/10.1213/ANE.0b013e3182075d1f
[18]
Halverson, A., et al. (1998) Evaluation of Mechanism of Increased Intracranial Pressure with Insufflation. Surgical Endoscopy, 12, 266-269. http://dx.doi.org/10.1007/s004649900648
[19]
Casati, A., et al. (2007) Monitoring Cerebral Oxygen Saturation in Elderly Patients Undergoing General Abdominal Surgery: A Prospective Cohort Study. European Journal of Anaesthesiology, 24, 59-65.
[20]
Kalmar, A.F., et al. (2010) Influence of Steep Trendelenburg Position and CO(2) Pneumoperitoneum on Cardiovascular, Cerebrovascular, and Respiratory Homeostasis during Robotic Prostatectomy. British Journal of Anaesthesia, 104, 433-439. http://dx.doi.org/10.1093/bja/aeq018
[21]
Awad, H., et al. (2009) The Effects of Steep Trendelenburg Positioning on Intraocular Pressure during Robotic Radical Prostatectomy. Anesthesia & Analgesia, 109, 473-478. http://dx.doi.org/10.1213/ ane.0b013e3181a9098f
[22]
Weber, E.D., et al. (2007) Posterior Ischemic Optic Neuropathy after Minimally Invasive Prostatectomy. Journal of Neuro-Ophthalmology, 27, 285-287. http://dx.doi.org/10.1097/WNO.0b0 13e31815b9f67
[23]
Vaknin, Z., et al. (2010) Outcome and Quality of Life in a Prospective Cohort of the First 100 Robotic Surgeries for Endometrial Cancer, with Focus on Elderly Patients. International Journal of Gynecological Cancer, 20, 1367-1373.