Abstract | Value-based Evaluation Of Minimally Invasive Hysterectomy Approaches

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Abstract Accepted by AAGL, Presented in 2017

Manuscript has been submitted JOGR. Pending.

Danilyants, N, MacKoul, P, Baxi, R, van der Does, L. Haworth, L. A Value-Based Evaluation of Minimally Invasive Hysterectomy Approaches.

Aim: By evaluating operative outcomes relative to cost, we compared the value of minimally invasive hysterectomy approaches, including a technique discussed less often in the literature, laparoscopic retroperitoneal hysterectomy, which incorporates retroperitoneal dissection and ligation of the uterine arteries at their vascular origin.

Methods: Retrospective chart review of all women (N = 2,689) >18 years old who underwent hysterectomy for benign conditions from 2011 through 2013 at a high-volume hospital in Maryland, USA. Procedures included: laparoscopic supracervical hysterectomy, robotically-assisted laparoscopic hysterectomy, total laparoscopic hysterectomy, laparoscopically-assisted vaginal hysterectomy, total vaginal hysterectomy, and laparoscopic retroperitoneal hysterectomy.

Results: Total vaginal hysterectomy had the highest intraoperative complication rate (9.6%; p<.0001) but lowest postoperative complication rate (1.8%; p <.0001). Robotics had the highest postoperative complication rate (11.4%; p <.0001). Laparoscopic retroperitoneal hysterectomy had the shortest operative time (71.2 min; p <.0001) and lowest intraoperative complication rates (2.1%; p <.0001). Taking both operative outcomes and cost into account, laparoscopic retroperitoneal hysterectomy, total vaginal hysterectomy, and laparoscopically-assisted vaginal hysterectomy yielded the highest value scores; total laparoscopic hysterectomy, robotically-assisted laparoscopic hysterectomy, and laparoscopic supracervical hysterectomy yielded the lowest.

Conclusions: Understanding the value of surgical interventions requires an evaluation of both operative outcomes and direct hospital costs. Using a quality-cost framework, the laparoscopic retroperitoneal hysterectomy technique emerged as having the highest calculated value.