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SAN DIEGO – The demand for gynecologic oncologists to perform robotic hysterectomies – even for benign indications – has increased to the point that additional fellowship training spots will be necessary to meet the need, Dr. Kayla M. Wishall said at the annual meeting of the Society of Gynecologic Oncology.
More and more patients want their hysterectomies performed robotically. They find the high-quality optics and minimally invasive nature of the robotic procedure appealing – smaller incisions, less blood loss, shorter hospital stay, and faster recovery. And gynecologic oncologists are getting an increasing number of referrals because of their special expertise in robotic surgery and extensive experience with higher-risk patients, explained Dr. Wishall, a gynecologic oncologist at Hahnemann University Hospital/Drexel University in Philadelphia.
“This trend will likely tax the limited resources of gynecologic oncologists,” she added.
Another possible reason for the growing demand for gynecologic oncologist–performed robotic hysterectomies is that these subspecialists achieve better outcomes than gynecologists who do robotic hysterectomies, at least according to the findings of a retrospective study performed by Dr. Wishall, which included all of the 468 robotic hysterectomies performed at a large academic medical center in a recent 5-year period.
Gynecologic oncologists performed 64 (16.5%) of the 387 robotic hysterectomies done for benign indications. All told, gynecologists did 254 of the robotic hysterectomies; gynecologic oncologists performed 214.
Even though patients referred to gynecologic oncologists for these procedures were older, heavier, more likely to have had previous abdominal surgery, more often members of racial minorities, and had a higher prevalence of cardiac comorbidities, they experienced significantly fewer intra- and postoperative complications than patients whose robotic hysterectomies were performed by gynecologists, Dr. Wishall reported.
The combined intraoperative and postoperative complication rate for robotic hysterectomies performed by gynecologic oncologists was 5.2%, compared with 16% for gynecologists. But the rate of cardiac comorbidities, for instance, was 36.4% among patients seeing gynecologic oncologists, compared with 23.6% among those seeing gynecologists.
Moreover, gynecologists were about 10-fold more likely than gynecologic oncologists to call for an intraoperative consultation and sixfold more likely to convert their robotic hysterectomy to an open procedure. Their average operating room time was about 40% longer (244 minutes versus 171 minutes), too, in this single-center experience.
Dr. Wishall reported having no financial conflicts related to her study, which was conducted free of commercial support.
I read this article initially with amusement and then with outrage and disdain. This article summarizes the single-site, retrospective study by Dr. Kayla Wishall at the annual meeting of the Society of Gynecologic Oncology. Not only is this nonscience, but nonsensical science. As a single center retrospective study, conclusions must be suspect.
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Dr. Charles E. Miller |
The comparison numbers of the two groups are small. While confounders would appear to be greater in the oncology group, we know nothing about the difficulty of the surgeries themselves – size of uterus, adnexal disease, endometriosis, pelvic adhesions, etc. Oftentimes, gynecologic oncologists dealing with endometrial carcinoma are going to face a less difficult challenge than a generalist dealing with an 18-weeks–size uterus in a woman who has undergone three prior C-sections, an open myomectomy, or stage IV endometriosis.
We are also not privy to the experience of the surgeons involved; that is, the number of procedures performed by each surgeon in the compared groups. It is certainly well known that complications decrease with surgeon experience. In a multicenter analysis by Peter Lim et al., looking at robotic assisted hysterectomies performed by high-volume surgeons (60 or more prior procedures), the intraoperative complication rate was only 0.7% and the postoperative complication rate 6.3% (Int J Gynaecol Obstet. 2016 Jun;133[3]:359-64).
As a benign gynecologist who has been performing minimally invasive gynecologic surgery for 30 years and more recently, robotic surgery, I am shocked with the tenor of this study, as it would imply that unless someone is boarded in gynecologic oncology, he or she should not be performing robotic hysterectomies.
I would advise Dr. Wishall to reevaluate her surgeon population and look at the impact of experience as well as procedure difficultly. I am absolutely sure that she will find that many of the surgeons with excellent outcomes will be generalists, who are well experienced in robotic hysterectomy.
Dr. Charles E. Miller is a clinical associate professor at the University of Illinois at Chicago, and a reproductive endocrinologist and minimally invasive gynecologic surgeon in private practice in Naperville and Schaumburg, Ill. He reported having no financial disclosures relevant to this article.
I read this article initially with amusement and then with outrage and disdain. This article summarizes the single-site, retrospective study by Dr. Kayla Wishall at the annual meeting of the Society of Gynecologic Oncology. Not only is this nonscience, but nonsensical science. As a single center retrospective study, conclusions must be suspect.
|
Dr. Charles E. Miller |
The comparison numbers of the two groups are small. While confounders would appear to be greater in the oncology group, we know nothing about the difficulty of the surgeries themselves – size of uterus, adnexal disease, endometriosis, pelvic adhesions, etc. Oftentimes, gynecologic oncologists dealing with endometrial carcinoma are going to face a less difficult challenge than a generalist dealing with an 18-weeks–size uterus in a woman who has undergone three prior C-sections, an open myomectomy, or stage IV endometriosis.
We are also not privy to the experience of the surgeons involved; that is, the number of procedures performed by each surgeon in the compared groups. It is certainly well known that complications decrease with surgeon experience. In a multicenter analysis by Peter Lim et al., looking at robotic assisted hysterectomies performed by high-volume surgeons (60 or more prior procedures), the intraoperative complication rate was only 0.7% and the postoperative complication rate 6.3% (Int J Gynaecol Obstet. 2016 Jun;133[3]:359-64).
As a benign gynecologist who has been performing minimally invasive gynecologic surgery for 30 years and more recently, robotic surgery, I am shocked with the tenor of this study, as it would imply that unless someone is boarded in gynecologic oncology, he or she should not be performing robotic hysterectomies.
I would advise Dr. Wishall to reevaluate her surgeon population and look at the impact of experience as well as procedure difficultly. I am absolutely sure that she will find that many of the surgeons with excellent outcomes will be generalists, who are well experienced in robotic hysterectomy.
Dr. Charles E. Miller is a clinical associate professor at the University of Illinois at Chicago, and a reproductive endocrinologist and minimally invasive gynecologic surgeon in private practice in Naperville and Schaumburg, Ill. He reported having no financial disclosures relevant to this article.
I read this article initially with amusement and then with outrage and disdain. This article summarizes the single-site, retrospective study by Dr. Kayla Wishall at the annual meeting of the Society of Gynecologic Oncology. Not only is this nonscience, but nonsensical science. As a single center retrospective study, conclusions must be suspect.
|
Dr. Charles E. Miller |
The comparison numbers of the two groups are small. While confounders would appear to be greater in the oncology group, we know nothing about the difficulty of the surgeries themselves – size of uterus, adnexal disease, endometriosis, pelvic adhesions, etc. Oftentimes, gynecologic oncologists dealing with endometrial carcinoma are going to face a less difficult challenge than a generalist dealing with an 18-weeks–size uterus in a woman who has undergone three prior C-sections, an open myomectomy, or stage IV endometriosis.
We are also not privy to the experience of the surgeons involved; that is, the number of procedures performed by each surgeon in the compared groups. It is certainly well known that complications decrease with surgeon experience. In a multicenter analysis by Peter Lim et al., looking at robotic assisted hysterectomies performed by high-volume surgeons (60 or more prior procedures), the intraoperative complication rate was only 0.7% and the postoperative complication rate 6.3% (Int J Gynaecol Obstet. 2016 Jun;133[3]:359-64).
As a benign gynecologist who has been performing minimally invasive gynecologic surgery for 30 years and more recently, robotic surgery, I am shocked with the tenor of this study, as it would imply that unless someone is boarded in gynecologic oncology, he or she should not be performing robotic hysterectomies.
I would advise Dr. Wishall to reevaluate her surgeon population and look at the impact of experience as well as procedure difficultly. I am absolutely sure that she will find that many of the surgeons with excellent outcomes will be generalists, who are well experienced in robotic hysterectomy.
Dr. Charles E. Miller is a clinical associate professor at the University of Illinois at Chicago, and a reproductive endocrinologist and minimally invasive gynecologic surgeon in private practice in Naperville and Schaumburg, Ill. He reported having no financial disclosures relevant to this article.
SAN DIEGO – The demand for gynecologic oncologists to perform robotic hysterectomies – even for benign indications – has increased to the point that additional fellowship training spots will be necessary to meet the need, Dr. Kayla M. Wishall said at the annual meeting of the Society of Gynecologic Oncology.
More and more patients want their hysterectomies performed robotically. They find the high-quality optics and minimally invasive nature of the robotic procedure appealing – smaller incisions, less blood loss, shorter hospital stay, and faster recovery. And gynecologic oncologists are getting an increasing number of referrals because of their special expertise in robotic surgery and extensive experience with higher-risk patients, explained Dr. Wishall, a gynecologic oncologist at Hahnemann University Hospital/Drexel University in Philadelphia.
“This trend will likely tax the limited resources of gynecologic oncologists,” she added.
Another possible reason for the growing demand for gynecologic oncologist–performed robotic hysterectomies is that these subspecialists achieve better outcomes than gynecologists who do robotic hysterectomies, at least according to the findings of a retrospective study performed by Dr. Wishall, which included all of the 468 robotic hysterectomies performed at a large academic medical center in a recent 5-year period.
Gynecologic oncologists performed 64 (16.5%) of the 387 robotic hysterectomies done for benign indications. All told, gynecologists did 254 of the robotic hysterectomies; gynecologic oncologists performed 214.
Even though patients referred to gynecologic oncologists for these procedures were older, heavier, more likely to have had previous abdominal surgery, more often members of racial minorities, and had a higher prevalence of cardiac comorbidities, they experienced significantly fewer intra- and postoperative complications than patients whose robotic hysterectomies were performed by gynecologists, Dr. Wishall reported.
The combined intraoperative and postoperative complication rate for robotic hysterectomies performed by gynecologic oncologists was 5.2%, compared with 16% for gynecologists. But the rate of cardiac comorbidities, for instance, was 36.4% among patients seeing gynecologic oncologists, compared with 23.6% among those seeing gynecologists.
Moreover, gynecologists were about 10-fold more likely than gynecologic oncologists to call for an intraoperative consultation and sixfold more likely to convert their robotic hysterectomy to an open procedure. Their average operating room time was about 40% longer (244 minutes versus 171 minutes), too, in this single-center experience.
Dr. Wishall reported having no financial conflicts related to her study, which was conducted free of commercial support.
SAN DIEGO – The demand for gynecologic oncologists to perform robotic hysterectomies – even for benign indications – has increased to the point that additional fellowship training spots will be necessary to meet the need, Dr. Kayla M. Wishall said at the annual meeting of the Society of Gynecologic Oncology.
More and more patients want their hysterectomies performed robotically. They find the high-quality optics and minimally invasive nature of the robotic procedure appealing – smaller incisions, less blood loss, shorter hospital stay, and faster recovery. And gynecologic oncologists are getting an increasing number of referrals because of their special expertise in robotic surgery and extensive experience with higher-risk patients, explained Dr. Wishall, a gynecologic oncologist at Hahnemann University Hospital/Drexel University in Philadelphia.
“This trend will likely tax the limited resources of gynecologic oncologists,” she added.
Another possible reason for the growing demand for gynecologic oncologist–performed robotic hysterectomies is that these subspecialists achieve better outcomes than gynecologists who do robotic hysterectomies, at least according to the findings of a retrospective study performed by Dr. Wishall, which included all of the 468 robotic hysterectomies performed at a large academic medical center in a recent 5-year period.
Gynecologic oncologists performed 64 (16.5%) of the 387 robotic hysterectomies done for benign indications. All told, gynecologists did 254 of the robotic hysterectomies; gynecologic oncologists performed 214.
Even though patients referred to gynecologic oncologists for these procedures were older, heavier, more likely to have had previous abdominal surgery, more often members of racial minorities, and had a higher prevalence of cardiac comorbidities, they experienced significantly fewer intra- and postoperative complications than patients whose robotic hysterectomies were performed by gynecologists, Dr. Wishall reported.
The combined intraoperative and postoperative complication rate for robotic hysterectomies performed by gynecologic oncologists was 5.2%, compared with 16% for gynecologists. But the rate of cardiac comorbidities, for instance, was 36.4% among patients seeing gynecologic oncologists, compared with 23.6% among those seeing gynecologists.
Moreover, gynecologists were about 10-fold more likely than gynecologic oncologists to call for an intraoperative consultation and sixfold more likely to convert their robotic hysterectomy to an open procedure. Their average operating room time was about 40% longer (244 minutes versus 171 minutes), too, in this single-center experience.
Dr. Wishall reported having no financial conflicts related to her study, which was conducted free of commercial support.
AT THE ANNUAL MEETING ON WOMEN’S CANCER
Key clinical point: Gynecologic oncologists achieved better robotic hysterectomy outcomes than gynecologists despite challenging referrals.
Major finding: The combined intraoperative and postoperative complication rate for robotic hysterectomies performed by gynecologic oncologists was 5.2%, compared with 16% for gynecologists.
Data source: A retrospective observational study conducted at a single center included 254 women whose robotic hysterectomies were performed by gynecologists and 214 done by gynecologic oncologists.
Disclosures: Dr. Wishall reported having no financial conflicts related to the study, which was conducted free of commercial support.
