A Karim Nawfal

Henry Ford Hospital, Detroit, Michigan, United States

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Publications (10)6.45 Total impact

  • Article: Reply.
    Journal of Minimally Invasive Gynecology 03/2012; 19(2):266. · 1.61 Impact Factor
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    ABSTRACT: To estimate the impact of body mass index (BMI) on the surgical outcomes of patients undergoing robotic-assisted total laparoscopic hysterectomy. Retrospective cohort study. Henry Ford Health System academic medical center (Henry Ford and Henry Ford West Bloomfield Hospitals) A total of 135 patients who underwent scheduled robotic-assisted total laparoscopic hysterectomy for benign indications, without concomitant urogynecologic procedures between January 2008 and June 2010. Patients underwent robotic-assisted total laparoscopic hysterectomy as the intention to treat. Two cases were converted to laparotomy. MEASUREMENTS & MAIN RESULTS: Electronic medical records of all patients that underwent robotic-assisted total laparoscopic hysterectomy at Henry Ford Health System were reviewed. Data on demographics, BMI (kg/m(2)), estimated blood loss, perioperative hemoglobin change, procedure duration, hospital length of stay, specimen weight, pathology, and postoperative complications were obtained. The women's median age was 45 years (range 30-68), 61.5% were black, and BMI ranged from 14.8-56.2 kg/m2; 23.4% of women were normal weight or less (BMI <25, n = 31), 52.7% of women were obese (BMI >30, n = 70) and 36 of these patients (27.1%) were morbidly obese (BMI ≥35). BMI did not correlate with procedure duration (Spearman r = .12, p = .16), length of stay (Spearman r = .10, p = .24), or estimated blood loss (Spearman r = .12, p =.18). Our analysis did not identify any meaningful associations between BMI and absolute change in hemoglobin. In addition BMI was not associated with an increase in major or minor complications. BMI is not associated with blood loss, duration of surgery, length of stay, or complication rates in patients undergoing robotic-assisted total laparoscopic hysterectomy. Robotic assistance may help surgeons overcome adverse outcomes sometimes found in obese patients.
    Journal of Minimally Invasive Gynecology 03/2011; 18(3):328-32. · 1.61 Impact Factor
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    ABSTRACT: Empirical evidence is needed to assess clinical appropriateness of any new surgical device or material. Differences in surgical outcomes between Vicryl figure-of-8 and V-Loc barbed sutures for vaginal cuff closure during robotic hysterectomy were assessed. We examined the electronic medical records of 202 patients who underwent scheduled robotic-assisted total laparoscopic hysterectomy for benign indications, without concomitant urogynecologic procedures, between January 2008 and November 2010 at the Henry Ford Health System academic medical center. Cuff closure approach was selected by the surgeon. Data on demographics, vaginal cuff suture type, body mass index (BMI), estimated blood loss (EBL), perioperative hemoglobin change, procedure duration, hospital length of stay (LOS), specimen weight, and postoperative complications were obtained. The average age was 46 y (SD = 8.0 y). Women with Vicryl figure-of-8 closures (n = 133) were more likely than women with V-Loc barbed suture closures (n = 69) to have had a LOS > 1 d (48/133, 36.1% vs. 12/69, 17.4%; chi square P < .006), greater EBL (median 75 vs. 50 mL, Wilcoxon Rank Sum WRS P < .001), and longer procedure durations (175 vs. 135 min, WRS P < .001). These differences persisted even after considering uterine weight, BMI, smoking status, and concomitant oophorectomy. No differences with respect to the frequency of major (2 in each closure type) or minor complications were observed (P < .36). There were no differences in complications between the Vicryl figure-of-8 and V-Loc barbed sutures in our sample. However, the latter had lower EBL and shorter procedure duration and LOS.
    JSLS: Journal of the Society of Laparoendoscopic Surgeons / Society of Laparoendoscopic Surgeons 01/2011; 16(4):525-9. · 0.81 Impact Factor
  • Mona E. Orady, A. Karim Nawfal, Ganesa Wegienka
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    ABSTRACT: The objective of this study was to determine whether uterine weight affects the surgical outcomes of robot-assisted total laparoscopic hysterectomy (RH) procedures. The design of this study is retrospective cohort study. The classification of the study design is level II-2 evidence. The study setting is the Henry Ford Health System’s Community Teaching Hospitals. One-hundred and thirty-five patients underwent RH for benign indications at one of two hospitals between January1, 2008, and June 1, 2010. Interventions were scheduled RH without concomitant uro-gynecologic procedures as the intention to treat. Patient demographics, age, height, weight, estimated blood loss (EBL), procedure duration, uterine weight, pathology, length of hospital stay (LOS), and any complications were obtained from a detailed review of electronic medical records. Uterine weight ranged from 47 to 1,290g (<250g, n=87; 250–500g, n=28; >500g, n=18). Overall, uterine weight was highly correlated with procedure duration (r=.53, P<.001.). Median procedure duration increased from 150min for the <250g group, to 205min for the 250–500g group, and to 295min for the >500g group. Uterine weight was also moderately correlated with EBL (r=.30, P=.0005). Median EBL increased from 50ml for uteri <250g to 87.5ml for the 250–500g group, and 100ml for the >500g group. This correlation did not persist in the assessment of decrease in peri-operative hemoglobin (r=.09, P=.30). Ninety-one women had a LOS of 1day (67.4%), 31 women had a LOS of 2days (23%), and 13 women had a LOS of greater than 2days (9.6%). Uterine weight was not correlated with LOS (r=.14, P=.10) and was not associated with increased major or minor complications (WRS P=.79) re-admission (WRS P=.35), or blood transfusion (n=3). RH can be performed on patients with large uteri exceeding 500g without associated adverse outcomes. Although procedure duration is increased, there is no significant effect on EBL and no increase in the occurrence of complications or length of stay. KeywordsUterine fibroids–Robotic hysterectomy–DaVinci hysterectomy–Uterine weight–Large uterus
    Journal of Robotic Surgery 01/2011; 5(4):267-272.
  • Journal of Minimally Invasive Gynecology - J MINIM INVASIVE GYNECOL. 01/2011; 18(6).
  • D. I. Eisenstein, A. K. Nawfal
    Journal of Minimally Invasive Gynecology - J MINIM INVASIVE GYNECOL. 01/2011; 18(6).
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    ABSTRACT: Pregnancy in a rudimentary uterine horn is a rare and potentially lethal condition. The highest risk of rupture is reported to be during the late first and second trimester. The risk of rupture correlates with the thickness of the myometrium surrounding the fetal pole. In 2005, a 20-year-old woman was incompletely diagnosed by imaging studies and laparoscopy to have an absent right kidney, a bicornate uterus with a right rudimentary uterine horn and a single cervix, a transverse vaginal septum with hematocolpos, and endometriosis caused by reflux menstruation. The transverse vaginal septum was excised, and the surgeon observed a single cervix. Oral contraceptives were prescribed as complementary treatment for the endometriosis and associated dysmenorrhea. In 2009, magnetic resonance imaging confirmed resolution of hematocolpos and revealed a right cervix connected to the right horn of a uterus didelphys and covered by a partial longitudinal vaginal septum. The patient had a contraception failure and presented in 2010 at 9(6/7) weeks' gestation. By ultrasonography and subsequent magnetic resonance imaging, the pregnancy was in the right uterus and the corpus luteum was on the left ovary. The myometrium was thinned to 2 to 3 mm atop the gestational sac. Using the Harmonic ACE, laparoscopic excision of the right fallopian tube and a supracervical right hysterectomy with an intact pregnancy was performed. This case supports the Acién hypothesis that the vagina forms from both Müllerian and Wolffian duct elements, and it illustrates the risk for uterine rupture when pregnancy forms in a rudimentary structure; presumed transperitoneal migration of an ovum that was captured by the opposite fallopian tube; and surgical management of the in situ pregnancy by laparoscopic supracervical excision of the rudimentary uterine body.
    Journal of Minimally Invasive Gynecology 01/2011; 18(3):381-5. · 1.61 Impact Factor
  • Journal of Minimally Invasive Gynecology - J MINIM INVASIVE GYNECOL. 01/2010; 17(6).
  • Journal of Minimally Invasive Gynecology - J MINIM INVASIVE GYNECOL. 01/2010; 17(6).
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    ABSTRACT: To compare surgical outcomes for roboticassisted total laparoscopic hysterectomy (RH) to other minimally invasive hysterectomy (MIH) types, including total laparoscopic hysterectomy (TLH), laparoscopic-assisted vaginal hysterectomy (LAVH), and vaginal hysterectomy (VH). Retrospective cohort study of all patients who underwent RH or MIH for benign indications between January 2007 and May 2010 at 2 Henry Ford Health System teaching hospitals. Age, race, body mass index (BMI), procedure duration, estimated blood loss (EBL), peri-operative hemoglobin change, uterine weight, length of hospital stay (LOS), and complications were collected from electronic medical records and were compared between RH and MIH groups. Included in the analysis were 135 RH and 162 MIH cases (n = 34 VH, n = 82 LAVH, n = 46 TLH). There were no differences in age, race, or BMI between groups, but RH patients had significantly larger uteri (P = .007; RH, 13.5%>500g; MIH 4.0%>500g). MIH patients had significantly greater EBL (P < .001) and drop in hemoglobin (P = .02) than RH patients with a 150 mL difference in median EBL (200 mL versus 50 mL) between groups. RH had longer procedure durations than MIH (P = .0002) overall, but not compared to the TLH subgroup. RH patients had a shorter LOS than MIH patients had (P = .02) who had a longer LOS for LAVH patients. Although readmission and major complication rates were similar in both groups, minor adverse events occurred more frequently in the MIH group (21.6%) than the RH group (8.9%) (P = .003). RH has comparable surgical outcomes, and possibly decreased blood loss, shorter length of stay, and fewer minor complications than other methods of MIH.
    JSLS: Journal of the Society of Laparoendoscopic Surgeons / Society of Laparoendoscopic Surgeons 16(4):542-8. · 0.81 Impact Factor