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ORIGINAL RESEARCH article
Front. Med.
Sec. Obstetrics and Gynecology
Volume 11 - 2024 |
doi: 10.3389/fmed.2024.1462632
This article is part of the Research Topic Changing Backgrounds and Groundbreaking Changes: Gynecological surgery in the third decade of the 21st century Volume II View all 8 articles
Identifying Key Predictors for Uterine Manipulator Use in Robotic Simple Hysterectomy: A Retrospective Cohort Analysis
Provisionally accepted
Shogo Kawamura
1*
Kuniaki Ota
1,2
Yoshiaki Ota
1*
Toshifumi Takahashi
2*
Hitomi Fujiwara
1*
Keitaro Tasaka
1*
Hana Okamoto
1*
Yumiko Morimoto
1*
Wataru Saito
1*
Mika Sugihara
1*
Takehiko Matsuyama
3*
Eiji Koike
4*
Mitsuru Shiota
1*
Koichiro Shimoya
1*- 1 Kawasaki Medical School, Kurashiki, Okayama, Japan
- 2 Fukushima Medical University, Fukushima, Japan
- 3 Koujin Hospital, Marugame, Japan
- 4 Koike Hospital, Fukuyama, Japan
Background: Robotic simple hysterectomy (RSH) is the most common robotic gynecologic surgery in the United States. Uterine manipulators are commonly used to handle the uterus during laparoscopic surgery, but few studies have examined their necessity in RSH. This study retrospectively compares RSH cases with and without the use of manipulators, and identifies predictors for their intraoperative use. Materials and methods: This retrospective cohort study included patients undergoing RSH for benign pathologies at Kawasaki Medical School from October 2020 to December 2022. Patients with malignancies were excluded. The robotic surgeries were performed by three skilled surgeons using the four-arm da Vinci Xi surgical system. Data on perioperative and operative parameters were collected, including age, body mass index (BMI), history of abdominal surgery, disease type, presence of ovarian cysts, and operative time. Statistical analyses were performed using EZR software, with multivariate logistic regression to identify predictive factors for uterine manipulator use. Results: The study included 113 patients who underwent RSH without a uterine manipulator and 58 with one. Patients without a manipulator were older, while those with a manipulator had higher BMIs and a higher prevalence of ovarian chocolate cysts and Douglas obliteration. Operating time was shorter without a manipulator. Independent predictors for manipulator use were higher BMI, presence of ovarian endometrioid cysts, and Douglas obliteration. Conclusions: RSH without a uterine manipulator is feasible and can reduce the need for surgical assistants. Predictors for manipulator use include higher BMI, ovarian cysts, and Douglas obliteration. The use of a fourth robotic arm can enhance surgical independence and resource efficiency. Further research is needed to assess the long-term cost-effectiveness and outcomes of this approach.
Keywords: Robotic simple hysterectomy, robot-assisted simple hysterectomy, Uterine manipulator, da Vinci Xi surgical system, pouch of Douglas obliteration, operative assistant
Received: 10 Jul 2024; Accepted: 26 Aug 2024.
Copyright: © 2024 Kawamura, Ota, Ota, Takahashi, Fujiwara, Tasaka, Okamoto, Morimoto, Saito, Sugihara, Matsuyama, Koike, Shiota and Shimoya. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Shogo Kawamura, Kawasaki Medical School, Kurashiki, Okayama, Japan
Yoshiaki Ota, Kawasaki Medical School, Kurashiki, Okayama, Japan
Toshifumi Takahashi, Fukushima Medical University, Fukushima, Japan
Hitomi Fujiwara, Kawasaki Medical School, Kurashiki, Okayama, Japan
Keitaro Tasaka, Kawasaki Medical School, Kurashiki, Okayama, Japan
Hana Okamoto, Kawasaki Medical School, Kurashiki, Okayama, Japan
Yumiko Morimoto, Kawasaki Medical School, Kurashiki, Okayama, Japan
Wataru Saito, Kawasaki Medical School, Kurashiki, Okayama, Japan
Mika Sugihara, Kawasaki Medical School, Kurashiki, Okayama, Japan
Takehiko Matsuyama, Koujin Hospital, Marugame, Japan
Eiji Koike, Koike Hospital, Fukuyama, Japan
Mitsuru Shiota, Kawasaki Medical School, Kurashiki, Okayama, Japan
Koichiro Shimoya, Kawasaki Medical School, Kurashiki, Okayama, Japan
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