The use of robotic-assisted laparoscopic surgery has continued to grow since the Food and Drug Administration approval for robotic-assisted gynecologic surgery in 2005. However, despite this growth in utilization, the data supporting its use in benign gynecologic surgery has not strongly supported its advantages over conventional laparoscopy. Controversy exists between supporters of robotic-assisted laparoscopic surgery and conventional laparoscopy. This article discusses the current literature regarding the use of robotic-assisted surgery in benign gynecologic surgery.
Abstract This chapter provides six clinical case examples. Each case asks the reader to consider the patient’s history and which components should be included in an exam. Each case presents management options, key points, and references for further reading. The goal of this chapter is to provide hands-on experience from difficult to solve problems in the real practice and thus give guidlines for troubleshooting and management. Identifying the key points in each case is critical toward proper diagnosis, treatment and ultimately patient satisfaction. Since the approach to each case is geared toward management of the disease rather than cure, sharing real experience will equip the provider with tools enabling him to set realistic goals and delinate proper plan of action.
INTRODUCTION: Pelvic/perineal pain encompasses a wide spectrum of diseases. Despite its high prevalence, there are little national data on emergency department utilization for its management. METHODS: Analysis of data from the Nationwide Emergency Department Sample from 2016 to 2019 was performed. Women between 15 and 44 year old with a primary diagnosis of pelvic/perineal pain (PPP) were included (ICD-10 R10.2). Race was available for 2019 only. This study was deemed exempt by the University of Michigan IRB. RESULTS: There were 923,300 ED visits for PPP (0.672% of all ED visits) with an admission rate of 0.16% versus 6.60% for all other diagnoses ( P <.001). ED visits for PPP cost $4.7 billion USD over the 4 years. The average cost per visit was $5,136, compared to $4,143 for other diagnoses ( P <.001). Patients from the lowest income quartile by zip code accounted for 37% of ED visits. Medicaid was the largest single payment type representing 44.4% of visits. In 2019, White women represented 47% of visits but accounted for 69.4% of admissions. Admission rates were 0.2% for White patients and 0.1% for Black patients ( P <.001). CONCLUSION: While visits for PPP represent a small percentage of total ED visits, they reveal potential racial disparities with White women being admitted at twice the rate of Black women. Studies are needed to elucidate the etiologies of pelvic pain within different demographic groups and the potential contributions of structural inequities so that a goal of equitable care for all patients can be achieved.
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