Routine cystoscopy after robotic gynecologic oncology surgery

Area of Science:

• Gynecologic Oncology
• Urology
• Minimally Invasive Surgery

Background:

• Robotic surgery is increasingly utilized in gynecologic procedures.
• Lower urinary tract injuries are potential complications of these surgeries.
• The role of routine cystoscopy in detecting these injuries requires evaluation.

Purpose of the Study:

• To determine if routine cystoscopy improves detection of bladder or ureter injuries after robotic gynecologic surgery.
• To compare injury detection rates between patients undergoing robotic hysterectomy with and without routine cystoscopy.

Main Methods:

• Retrospective chart review of patients undergoing robotic hysterectomy between 2009-2012.
• Comparison of two academic medical centers: one with routine cystoscopy, one without.
• Statistical analysis using t tests and chi-squared tests.

Main Results:

• No intraoperative or postoperative urinary tract injuries were detected in either the cystoscopy or non-cystoscopy group.
• The routine cystoscopy group had more lymphadenectomies and hysterectomies for ovarian cancer.
• The non-cystoscopy group had larger specimen sizes, less blood loss, and longer operative times.

Conclusions:

• Routine cystoscopy did not enhance the detection rate of lower urinary tract injuries, as the rate was zero in both groups.
• Despite the zero detection rate, cystoscopy is a simple procedure that can be incorporated to mitigate risks of severe morbidity and litigation.
• The study highlights the importance of vigilance in preventing urinary tract injuries during robotic gynecologic surgery.