Routine cystoscopy after robotic gynecologic oncology surgery.
OBJECTIVE
Our aim was to determine whether the use of routine cystoscopy increases lower urinary tract injury detection (bladder and/or ureter) after robotic surgery performed by gynecologic oncologists.


METHODS
A retrospective chart review of patients who presented for robotic hysterectomy from 2009-2012 was performed at 2 separate academic medical centers, one that performed routine cystoscopy and one that did not. Statistical analysis was performed with t tests and χ2 tests.


RESULTS
We identified 140 cases without cystoscopy and 109 cases with routine cystoscopy. There were no intraoperative or postoperative urinary injuries detected in either group. There were no significant differences in age and body mass index. In the non-cystoscopy group, a larger specimen size (P<.001), less blood loss (P=.013), and a longer mean operative time were observed (P<.0001). In the routine cystoscopy group, more lymphadenectomies were performed with hysterectomy (P=.007) and more patients underwent hysterectomy for ovarian cancer (P=.0192). There were no differences in surgical indications or secondary procedures including bilateral salpingo-oophorectomy, radical hysterectomy, ureterolysis, and pelvic organ prolapse-related procedures. The minimum follow-up period was 30 days in both groups.


CONCLUSIONS
Routine use of cystoscopy did not appear to affect the detection rate of intraoperative lower urinary tract injury during robotic gynecologic surgery because this rate was zero in both groups. However, cystoscopy is relatively simple to perform and can be efficiently incorporated into robotic surgery to avoid the severe morbidity and possible litigation surrounding a urinary tract injury.
Department of Obstetrics and Gynecology, Westchester Medical Center of New York Medical College, Valhalla, New York, USA.
My-Linh T
ML
Nguyen
Department of Obstetrics and Gynecology, SUNY Downstate Medical Center, Brooklyn, New York, USA.
Erin
E
Stevens
Department of Obstetrics and Gynecology, Westchester Medical Center of New York Medical College, Valhalla, New York, USA.
Christopher J
CJ
LaFargue
Department of Obstetrics and Gynecology, Westchester Medical Center of New York Medical College, Valhalla, New York, USA.
Michael
M
Karsy
Department of Obstetrics and Gynecology, Westchester Medical Center of New York Medical College, Valhalla, New York, USA.
Tarah L
TL
Pua
Department of Obstetrics and Gynecology, SUNY Downstate Medical Center, Brooklyn, New York, USA.
Constantine
C
Gorelick
Department of Obstetrics and Gynecology, Westchester Medical Center of New York Medical College, Valhalla, New York, USA.
Sean S
SS
Tedjarati
Department of Obstetrics and Gynecology, Westchester Medical Center of New York Medical College, Valhalla, New York, USA.
Tana S
TS
Pradhan
D003558:Cystoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000601:surgery*; D011182:Postoperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000175:diagnosis*; D012189:Retrospective Studies; D012371:Robotics
Hysterectomy; Routine cystoscopy; Urinary tract injury; daVinci Robot