title: Robotic Trachelectomy After Supracervical Hysterectomy for Benign Gynecologic Disease.
abstract: OBJECTIVE
  A renewed interest in the supra cervical approach to hysterectomy has created a cohort of patients with a retained cervix at risk of persistent symptoms requiring a subsequent trachelectomy. The objective of this study was to evaluate the efficacy of robotic trachelectomy after a previous supracervical hysterectomy.
  
  
  METHODS
  This is a retrospective chart review of women who had robotic trachelectomy after supracervical hysterectomy for benign gynecologic disease from January 2009 through October 2014.
  
  
  RESULTS
  Eleven patients underwent robotic trachelectomy for benign conditions during the observed period. Prior supracervical hysterectomy had been performed for pelvic pain (8/11, 73%), abnormal uterine bleeding (7/11, 64%), and dysmenorrhea (5/11, 45%). In 10 of 11 patients, the symptoms leading to robotic trachelectomy were the same as those leading to supracervical hysterectomy. The time from hysterectomy to recurrence of symptoms ranged from 0.5 to 26 months (median, 6), whereas the time interval from previous surgery to robotic trachelectomy ranged from 1 to 57 months (median, 26). Mean age and body mass index at robotic trachelectomy were 42 ± 5.4 years and 32 ± 6.1 kg/m(2). Mean length of surgery was 218 ± 88 minutes (range, 100-405). There was 1 major postoperative complication involving bladder perforation and subsequent vesicovaginal fistula (VVF). Endometriosis was seen in 27% of pathologic specimens and cervicitis in another 27%; 45% showed normal tissue histology. In 6 (55%) cases, symptoms leading to trachelectomy resolved completely after surgery, and the other 5 (45%) patients reported a significant improvement.
  
  
  CONCLUSIONS
  Although trachelectomy can be a challenging surgery, our experience suggests that the robotic approach may be a valuable means of achieving safe and reproducible outcomes.
authors: Division of Minimally Invasive Gynecology, Department of Obstetrics and Gynecology, Henry Ford Health System, Detroit, Michigan, USA.
authors: Ziv
authors: Z
authors: Tsafrir
authors: Division of Minimally Invasive Gynecology, Department of Obstetrics and Gynecology, Henry Ford Health System, Detroit, Michigan, USA.
authors: Joelle
authors: J
authors: Aoun
authors: Division of Minimally Invasive Gynecology, Department of Obstetrics and Gynecology, Henry Ford Health System, Detroit, Michigan, USA.
authors: Rabbie
authors: R
authors: Hanna
authors: Beaumont Health System, Department of Obstetrics and Gynecology Royal Oak, Michigan, USA.
authors: Eleni
authors: E
authors: Papalekas
authors: Division of Advanced Laparoscopy and Pelvic Pain, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina, USA.
authors: Lauren
authors: L
authors: Schiff
authors: Division of Minimally Invasive Gynecology, Department of Obstetrics and Gynecology, Henry Ford Health System, Detroit, Michigan, USA.
authors: Evan
authors: E
authors: Theoharis
authors: Division of Minimally Invasive Gynecology, Department of Obstetrics and Gynecology, Henry Ford Health System, Detroit, Michigan, USA.
authors: David
authors: D
authors: Eisenstein
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005831:Genital Diseases, Female / Q000601:surgery*; D006801:Humans; D007044:Hysterectomy / Q000379:methods; D008875:Middle Aged; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000379:methods*; D000069339:Trachelectomy / Q000379:methods*; D016896:Treatment Outcome
keywords: Benign gynecologic disease; Robotic trachelectomy technique; Supracervical hysterectomy