Implementation of a Robotic Gynecologic Surgery Program in a Rural Setting: Impact on Presence of Assistant Surgeon and Route of Hysterectomy.

Background and Objectives: Robotic surgical technology may obviate the need for an assistant surgeon when performing hysterectomy. In rural communities where physician shortages remain a major barrier to healthcare access, reducing the number of surgeons necessary to complete a hysterectomy would be of significant consequence. We sought to investigate the impact of robotic surgery on both the presence of an assistant surgeon and route of hysterectomy following implementation of a robotic surgery program at a single-site community hospital. Methods: Retrospective chart review of hysterectomies performed before and after implementation of a robotic surgical program. Hysterectomies were classified by presence of an assistant surgeon, and by mode of hysterectomy (abdominal, laparoscopic, robotic, and vaginal). We observed the distribution of outcomes between the two study periods and compared them with the χ2 test. Results: Following implementation of a robotic surgical program we observed a statistically significant decrease in the presence of an assistant surgeon at the time of hysterectomy from 86.7% to 29.7%, p ≤ 0.0001. There was also an increase in the percentage of hysterectomies performed by minimally invasive technique from 67.0% to 87.4%, p ≤ 0.0001. Conclusion: Following implementation of a robotic gynecologic surgery program at a single-site rural community hospital, we observed a reduction in the utilization of an assistant surgeon at time of hysterectomy. Additionally, we observed a significant increase in the rate of minimally invasive hysterectomies performed.

Risk Factors for Dyspareunia After First Childbirth.

OBJECTIVE: To investigate risk factors for dyspareunia among primiparous women. METHODS: This was a planned secondary analysis using data from the 1- and 6-month postpartum interviews of a prospective study of women who delivered their first neonate in Pennsylvania, 2009-2011. Participants who had resumed sexual intercourse by the 6-month interview (N=2,748) constituted the analytic sample. Women reporting a big or medium problem with painful intercourse at 6 months were categorized as having dyspareunia. Multivariable logistic regression was used to evaluate the effect of patient characteristics, obstetric and psychosocial factors, and breastfeeding on dyspareunia. RESULTS: There were 583 women (21.2%) who reported dyspareunia at 6 months postpartum. Nearly one third of those breastfeeding at 6 months reported dyspareunia (31.5%) compared with 12.7% of those not breastfeeding (adjusted odds ratio [OR] 2.89, 95% confidence interval [CI] 2.33-3.59, P<.001); 32.5% of those reporting a big or medium problem with perineal pain at 1 month reported dyspareunia at 6 months compared with 15.9% of those who did not (adjusted OR 2.45, 95% CI 1.93-3.10, P<.001); 28.3% of women who reported fatigue all or most of the time at 1 month reported dyspareunia at 6 months compared with 18.0% of those who reported fatigue less often (adjusted OR 1.60, 95% CI 1.30-1.98, P<.001); and 24.1% of those who scored in the upper third on the stress scale at 1 month reported dyspareunia at 6 months postpartum compared with 15.6% of those who scored in the lowest third (adjusted OR 1.55, 95% CI 1.18-2.02, P=.001). CONCLUSION: In this prospective cohort study, we identified specific risk factors for dyspareunia in primiparous women that can be discussed at the first postpartum visit, including breastfeeding, perineal pain, fatigue, and stress.

Breast cancer metastasis to the vulva 20 years remote from initial diagnosis: A case report and literature review.

•This is the 20th documented case of metastatic breast carcinoma to the vulva.•Greater than 21 years have passed from initial diagnosis to vulvar metastasis.•Existing literature supports long term surveillance in women with invasive lobular carcinoma of the breast.