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Timing of robotic hysterectomy after cervical excisional procedure
  1. Anna K. Melnikoff1,
  2. David W. Doo1,
  3. Alexander C. Cohen1,
  4. Emily Landers2,
  5. Christen Walters-Haygood3,
  6. Gerald McGwin4,
  7. J. Michael Straughn, Jr.1 and
  8. Kenneth H. Kim1
  1. 1University of Alabama at Birmingham, Birmingham, Alabama, USA
  2. 2Obstetrics/Gynecology, University of California Los Angeles, Los Angeles, California, USA
  3. 3St Dominic's Gynecologic Oncology, Jackson, Mississippi, USA
  4. 4Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
  1. Correspondence to Dr Anna K. Melnikoff, University of Alabama at Birmingham, Birmingham, AL 35233, USA; avkrueger{at}uabmc.edu

Abstract

Introduction While traditional teaching has been to wait 6 weeks between cervical excisional procedure and hysterectomy, studies have produced conflicting evidence, with data supporting a delay of anywhere between 48 hours to 6 weeks depending on surgical approach. Our study sought to evaluate if the time between cervical excisional procedure and robotic hysterectomy impacts peri-operative complication rates.

Methods A retrospective cohort of patients who underwent robotic hysterectomy from August 2006 to December 2013 for cervical dysplasia or International Federation of Gynecology and Obstetrics (FIGO) 2009 stage IA1–B1 cervical cancer at a single tertiary care center was performed. Patients were categorized into three groups: early surgical intervention (<6 weeks from excisional procedure), delayed surgical intervention (≥6 weeks from excisional procedure), and no excisional procedure. Secondary analysis was performed by hysterectomy type (simple vs radical). Peri-operative outcomes and complications were compared. Statistical analysis included Chi-square, Fisher’s exact test, and Wilcoxon rank sum test.

Results A total of 160 patients were identified. Of these, 32 (20.0%) had early surgical intervention, 52 (32.5%) had delayed surgical intervention, and 76 (47.5%) had no excisional procedure. There was no difference between groups in complication rates, including average estimated blood loss (82 vs 55 vs 71 mL; p=0.07), urologic injury (0% in all groups; p=1.0), anemia (3% vs 0% vs 1%; p=0.47), infection (0% vs 2% vs 3%; p=1.0), vaginal cuff separation (0% in all groups; p=1.0), or venous thromboembolism (0% vs 0% vs 1%; p=1.0). Additionally, there were no differences in length of stay (p=0.18) or 30-day readmission rates (p=1.0). Finally, there were no significant differences in peri-operative outcomes when stratified by radical versus simple hysterectomy.

Discussion Waiting 6 weeks between cervical excisional procedure and robotic hysterectomy does not impact peri-operative complication rates. This suggests that the time from excisional procedure should not factor into surgical planning for those who undergo robotic hysterectomy.

  • gynecology
  • postoperative complications
  • surgical procedures, operative
  • cervical cancer
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Footnotes

  • Contributors AKM and DWD reviewed data, assisted with data analysis, and wrote the manuscript. ACC, EL, and CLW-H assisted with data collection and review. GM performed data analysis. JMS assisted with data analysis and edited the manuscript. KHK provided the original research idea, assisted with data analysis, and edited the manuscript. All authors reviewed the final manuscript and agreed with all aspects of the work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.

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