Variance in abdominal wall anatomy and port placement in women undergoing robotic gynecologic surgery.

STUDY OBJECTIVES: To estimate whether variability in the size and ratios of the lower and upper abdomen exist in women undergoing robotic gynecologic surgery and whether demographic variables are significantly associated, and to determine the association between abdominal wall dimensions and supraumbilical robotic port placement. DESIGN: Prospective cohort study (Canadian Task Force classification II-2). SETTING: University teaching hospital. PATIENTS: Seventy-eight women undergoing robotic surgery between May 2008 and March 2009. INTERVENTION: Measurements from the symphysis pubis to the umbilicus (lower abdomen), umbilicus to the xyphoid process (upper abdomen), and distance between the anterior superior iliac crests were obtained at surgery. A multiple linear regression model was created to determine the relationships between abdominal wall measurements, demographic variables, and need for supraumbilical robotic port placement. MEASUREMENTS AND MAIN RESULTS: Fifty-six white and 22 black women were enrolled. Mean lower abdominal length was significantly affected by body mass index (BMI) (p <.001) and race (p = .006), with white women having longer measurements (17.1 cm vs 15 cm). Mean lower abdominal width was independent of age (p = .95) or race (p = .98), but was significantly correlated with BMI (p <.001). Mean upper abdominal length correlated with BMI (p <.001) and age (p = .03) but not race (p = .13). Ratios of bottom to top were significantly affected by race (p = .002) and age (p = .008) but not BMI (p = .07). Adjustments to port placement above the umbilicus were made in 44 of the 74 women (59.5%). Those who required supraumbilical port placement had a significantly shorter mean (SD) distance between the symphysis pubis and the umbilicus (14.99 [1.36] vs 18.55 [2.21]; p <.001). CONCLUSIONS: Significant variability in abdominal wall anatomy exists in women undergoing robotic gynecologic surgery, and the need for supraumbilical robotic port placement is common.

Outcomes of revision perineoplasty for persistent postpartum dyspareunia.

OBJECTIVE: : To determine outcomes of revision perineoplasty for women with persistent pain and anatomic distortion of the perineum following obstetric perineal laceration repair. METHODS: : A prospective cohort study of 9 women who underwent revision perineoplasty for persistent dyspareunia and perineal scarring was performed. Symptoms of perineal pain, coital activity, dyspareunia, impact on self-esteem, and vaginal scarring were compared. Statistical analysis was performed using paired t-tests. RESULTS: : All women had anatomic distortion of the perineum prior to surgical revision. Postoperatively, no woman had persistent scarring or granulation tissue. There was a significant decline in perineal pain from 6.1 ± 2.89 to 0.5 ± 1.13 (P = 0.02) and 89% of subjects reported an increase in coital frequency and satisfaction (P = 0.0002). An improvement in self-esteem and lifestyle were reported by 77% and 89%, respectively. CONCLUSION: : In women with dyspareunia and perineal defects following perineal laceration repair, early consideration should be made for revision perineoplasty as a significant impact is noted on sexual function and quality of life.