Ching-Hui Chen

Background: Robotic total hysterectomies have been considered contraindicated for patients with intra-abdominal adherences, but the evidence for this is not strong, and we hypothesized that the procedure can be of benefit even in these cases. In our research, we analyzed how the severity of pelvic adhesions affects robotic total hysterectomy, and by comparing different types of adhesions, we can further identify the outcomes differences in between, which may aid in future surgical decision making. Methods: Prospective cohort study (Canadian Task Force classification II-2). All 410 patients with uterine myoma or adenomyosis undergoing robotic total hysterectomies between 2011 and 2016 using the da Vinci Si system by the same surgeon in Taipei Medical University Hospital were included in the study. Results: Baseline characteristics, blood loss, docking time, operation time, time to perform uterine artery ligation (UAL), pain score, hospital stay, complication rate, and laparotomy conversion rate were analyzed between benign cases with or without pelvic adhesions undergoing robotic total hysterectomy. Furthermore, in our subgroups analysis, we have divided the patients with adhesion into different groups according to the severity of adhesion. The abdomen and pelvic cavity was divided into nine sections, and the outcomes of different adhesion condition were compared. We found that patients with adhesions had increased docking time and operation time, but other differences between groups were not statistically significant. The results of the adhesion group showed no significant increases in blood loss, intra- and postoperative complications, and length of hospital stay. Only significantly longer surgical time compared with the normal group was noted. Conclusion: Our results suggest that robotic total hysterectomies with UAL are effective and safe for patients with benign gynecologic conditions, and the surgical method should be considered even for patients with adhesion risks.

To summarize available evidence from randomized-controlled trials which have evaluated triggering of final oocyte maturation with concomitant GnRH agonists and hCG in patients undergoing IVF, and to analyze whether dual triggering is as efficacious as hCG triggering in terms of oocyte and pregnancy outcomes.

Background: The aim of this study is to evaluate perioperative complications related to robotic-assisted laparoscopic surgery for management of gynaecologic disorders. Materials and Methods: Eight hundred and fifty-one women who underwent robotic procedures between December 2011 and April 2015 were retrospectively included for analysis. Patient demographics, surgical outcomes and complications were evaluated. Results: The overall complication rate was 5.5%, whereas the rate of complications for oncologic cases was 8.4%. Intra-operative complications (n = 7, 0.8%) consisted of five cases of bowel lacerations, one case of ureter laceration and one case of bladder injury. Early and late post-operative complications were 4.0% (n = 34) and 0.8% (n = 6), respectively. Six patients (0.7%) experienced Grade III complications based on the Clavien-Dindo classification and required further surgical intervention. Conclusion: Robotic-assisted laparoscopic surgery is a feasible approach for management of gynaecologic disorders; the complication rates for this type of procedure are acceptable.

Background and objective: A number of clinical factors play pivotal roles in weaning and successful extubation of patients requiring long‐term mechanical ventilator (LTMV) support. Many patients fail extubation even after passing weaning protocols and spontaneous breathing trials. This study aimed to assess the effectiveness of using a modified Burns Wean Assessment Program (m‐BWAP) scoring instrument to predict extubation outcome in patients requiring LTMV.Methods: All patients with a diagnostic coding for respiratory failure requiring LTMV for longer than 21 days over a 5‐year period in a single centre (total 527 patients) were included. Advanced practice nurses trained in the use of the m‐BWAP scored the items according to standard definitions. All patients were weaned by pressure support weaning and spontaneous breathing trails. Patients were divided into successful and unsuccessful groups according to the weaning and extubation outcomes. Baseline data, traditional weaning parameters and m‐BWAP of the groups were analysed. The sensitivity and specificity of m‐BWAP for predicting successful extubation were calculated.Results: Of the 527 patients included, 145 (27.5%) had successful weaning trials. Of the 130 patients extubated, 102 (78.5%) had successful extubation. The m‐BWAP score was higher in the patients with successful weaning trials and successful extubation outcome. Using a cut‐off value of 60, the sensitivity and specificity of the m‐BWAP to predict successful extubation were 81.4% and 82.1%, respectively. This was better than traditional weaning parameters.Conclusions: The m‐BWAP is a good predictor for weaning and extubation outcome in patients requiring LTMV for longer than 21 days.