Jim Y. Wan

Study ObjectiveTo directly compare perioperative morbidity and hospital stay after robotic-assisted staging and laparotomy in patients with early stage endometrial endometrioid adenocarcinoma and uterine weight under 480 g.DesignRetrospective cohort study.SettingThe West Clinic in Memphis, TN, USA.PatientsPatients with Stage IA and Stage IB endometrial endometrioid adenocarcinoma and uterine weight less than 480 g from June 2007 to January 2011.InterventionsPatients underwent hysterectomy, bilateral salpingo-oophorectomy, and pelvic lymph node dissection with or without para-aortic lymph node dissection using robotic-assisted surgery or open laparotomy.MeasurementsPerioperative complications and morbidity, length of hospital stay, progression-free survival, overall survival, time to recurrence, and time do death from disease.Main ResultsA total of 160 patients who underwent laparotomy and 165 patients who received robotic-assisted staging were identified. Compared with robotic-assisted staging, laparotomy was associated with increased hospital stay (3 days vs. 1.4 days, p < 0.001), greater estimated blood loss (237 cm3 vs. 102 cm3, p < 0.001), larger uterine weight (136 g vs. 116 g, p < 0.001), as well as higher incidence of postoperative complications [29.3% vs. 6.7%, odds ratio (OR) 5.82, 95% confidence interval (CI) 2.1–11.7] including postoperative ileus (9.0% vs. 1.0%, OR 7.82, 95% CI 1.7–35.0), wound infection (6.0% vs. 1.0%, OR 5.43, 95% CI 1.2–25.2), and postoperative atelectasis (4.0% vs. 0%, p < 0.01). There were no differences in projected 5-year progression-free and overall survival rates.ConclusionUse of the daVinci robotic system was associated with less intraoperative blood loss, fewer postoperative complications, and shorter hospital stay compared with laparotomy for patients with uterine weight less than 480 g

Objective. To assess the risk of classical hysterotomy and surgical morbidity among women with a body mass index (BMI) greater than 40kg/m2 who underwent a supraumbilical incision at the time of cesarean delivery. Methods. We conducted a retrospective cohort study in women having a BMI greater than 40kg/m2 who underwent a cesarean delivery of a live, singleton pregnancy from 2007 to 2011 at a single tertiary care institution. Intraoperative and postoperative outcomes were compared between patients undergoing supraumbilical vertical (cohort, ) or Pfannenstiel (controls, ) skin incisions. Results. Women undergoing supraumbilical incisions had a higher risk of classical hysterotomy (OR, 24.6; 95% CI, 9.066.8), surgical drain placement (OR, 6.5; 95% CI, 2.616.2), estimated blood loss greater than 1 liter (OR, 3.4; 95% CI, 1.48.4), and longer operative time (97 ± 38 minutes versus 68 ± 30 minutes; ) when compared to subjects with Pfannenstiel incisions (controls). There was no difference in the risk of wound complication between women undergoing supraumbilical or Pfannenstiel incisions (OR, 2.7; 95% CI, 0.98.0). Conclusion. In women with a BMI above 40kg/m2, supraumbilical incision at the time of cesarean delivery is associated with a greater risk of classical hysterotomy and operative morbidity.

Objectives/Hypothesis: To evaluate the hearing changes and quality‐of‐life outcomes of 393 cases of streptomycin/dexamethasone inner ear perfusion performed by the primary author on 312 ears of 299 patients with Meniere's disease between July 2002 and May 2010.Study Design: Retrospective chart review.Methods: Objective arm: A database was used to compile pretreatment and post‐treatment audiograms as well as basic demographic information, dates of treatment, number of treatments, and which ear was treated. All patients met the 1995 American Academy of Otolaryngology–Head and Neck Surgery Committee on Hearing and Equilibrium Guidelines for the diagnosis and evaluation of therapy in Meniere's disease. All patients underwent one or more 3‐day treatments consisting of daily intratympanic injections of a low‐dose streptomycin/high‐dose dexamethasone mixture plus intravenous dexamethasone. The end point for treatment was adequate control of vertigo. Subjective arm: The Meniere's Disease Outcomes Questionnaire survey was used to assess patients' quality of life after receiving streptomycin/dexamethasone inner ear perfusion. All procedures were performed by the primary author at the Shea Ear Clinic, a tertiary‐referral otology clinic and outpatient surgery center.Results: After a single 3‐day treatment, the average change in pure tone average was 0.89 dB (±11). The average change in word recognition score was 0.49% (±17). The average number of days from treatment to follow‐up audiogram was 94 with a range of 8 to 1,603. Clinically significant hearing loss occurred after 62 of 393 (15.7%) treatments. Severe hearing loss occurred after 20 of 393 treatments (5.0%). The percentage of ears with clinically significant hearing loss after all treatments was 56 of 312 (17.9%). A total of 215 surveys were returned from 383 patients (56.1%) to whom they were mailed. There were 90% of patients who indicated improvement in quality of life after treatment and 88% who indicated improvement in their “vertigo subscore,” a domain within the survey that focuses on vertigo control.Conclusions: Streptomycin/dexamethasone inner ear perfusion is as safe to the hearing of patients with Meniere's disease as other aminoglycoside regimens and provides a significant improvement in quality of life.Laryngoscope, 122:204–211, 2012