Herbert Gretz

White Plains Hospital, White Plains, New York, United States

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Publications (47)112.05 Total impact

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    ABSTRACT: Robotic single-site (RSS) surgery has emerged as a novel minimally invasive approach in gynecology. Retrospective cohort study of consecutive RSS gynecologic procedures undertaken between October 2013 and March 2014. The 25 RSS completed cases consisted of 11 adnexal and 14 hysterectomy cases of which three included pelvic lymphadenectomies. Mean age, body mass index and estimated blood loss were 51 years, 25 kg/m(2) , 30 mL in the adnexal group, respectively, and 58 years, 27 kg/m(2) , 96 mL in the hysterectomy group, respectively. Mean console time was 20 and 45 min and mean total operative time was 56 and 93 min in adnexal and hysterectomy cases, respectively. The CUSUM method identified two learning phases with significant reduction in console time after the 7th adnexal case and the 5th hysterectomy. When performed by advanced minimally invasive surgeons and in appropriately selected patients, RSS surgery is feasible and safe. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.
    International Journal of Medical Robotics and Computer Assisted Surgery 06/2015; DOI:10.1002/rcs.1675 · 1.53 Impact Factor
  • Gynecologic Oncology 04/2015; 137:144-145. DOI:10.1016/j.ygyno.2015.01.361 · 3.77 Impact Factor
  • Gynecologic Oncology 04/2015; 137:103. DOI:10.1016/j.ygyno.2015.01.255 · 3.77 Impact Factor
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    ABSTRACT: To review the responses of advance directives signed by Jehovah's Witness patients prior to undergoing surgery at a gynecologic oncology service. A retrospective chart review of gynecologic oncology patients undergoing surgery at a bloodless surgery center from 1998-2007 was conducted. Demographic, pathologic, and clinical data were recorded. The proportion of patients who accepted and refused various blood-derived products was determined and was compared to previously published results from a similar study of labor and delivery unit patients. No gynecologic oncology patients agreed to accept transfusions of whole blood, red cells, white cells, platelets, or plasma under any circumstance, whereas 9.8% of pregnant patients accepted transfusion (P=0.0385). However, 98% of gynecologic oncology patients agreed to accept some blood products, including fractions such as albumin, immunoglobulins, and clotting factors, while only 39% of pregnant patients agreed (P<0.0001). In addition, all gynecologic oncology patients (100%) accepted intraoperative hemodilution, compared to 55% of pregnant patients (P<0.0001). Our results confirm the commonly held belief that the majority of Jehovah's Witness patients refuse to accept major blood components. However, Jehovah's Witness patients at a gynecologic oncology service will accept a variety of blood-derived products (minor fractions) and interventions designed to optimize outcomes when undergoing transfusion-free surgery. Patients presenting to a gynecologic oncology service respond differently to advanced directives related to bloodless surgery, as compared to patients from an obstetrical service.
    Hematology Research and Reviews 01/2015; 6:17-23. DOI:10.2147/JBM.S70981
  • Journal of Minimally Invasive Gynecology 11/2014; 21(6):S206. DOI:10.1016/j.jmig.2014.08.660 · 1.83 Impact Factor
  • L. El Hachem · K. Friedman · M. Momeni · P. Rojas · H.F. Gretz
    Journal of Minimally Invasive Gynecology 11/2014; 21(6):S35. DOI:10.1016/j.jmig.2014.08.135 · 1.83 Impact Factor
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    ABSTRACT: Objective: The objective of the study was to determine whether transversus abdominis plane (TAP) block reduces postoperative pain when compared with trocar site infiltration of bupivacaine in gynecological laparoscopy. Study design: This was a prospective, randomized, double-blinded clinical trial using patients as their own controls. Women undergoing gynecologic laparoscopy using a 4-port symmetrical technique were randomly assigned to right- or left-sided TAP block using 30 mL of 0.25% bupivacaine with epinephrine. Two cohorts of patients were studied. Cohort 1 consisted of anesthesiologist-administered ultrasound-guided TAP block. Cohort 2 consisted of surgeon-administered laparoscopic-guided TAP block. In both cohorts, contralateral port sites were infiltrated with an equal amount of bupivacaine in divided doses. All patients received intraoperative acetaminophen and ketorolac. Postoperative abdominal pain was assessed at 1, 2, 4, 6, 8, 12, 18, 24, and 48 hours on the block and contralateral sides, before and after palpation, using the 10 point visual analog scale. A 2 point difference in the reported pain scores was considered clinically meaningful. Results: Eighty-eight patients were eligible for statistical analysis: 45 and 43 patients in cohorts 1 and 2, respectively. In both cohorts, most patients reported equal pain on the block side and local side. In cohort 1, there was a statistically significant difference in mean reported pain scores at 2 hours and across time favoring the ultrasound-guided block; however, this did not reach clinical significance. There was no statistically significant difference found at all other time points or when pain scores were objectively assessed after palpation of the incisions. When comparing laparoscopic-guided block with local infiltration, there was no statistically significant difference in reported mean pain scores at all time points or after palpation. Conclusion: As part of this multimodal analgesic regimen, neither block method provided a significant clinical benefit compared with trocar site bupivacaine infiltration.
    American Journal of Obstetrics and Gynecology 07/2014; 212(2). DOI:10.1016/j.ajog.2014.07.049 · 4.70 Impact Factor
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    ABSTRACT: Study Objective: To compare the outcome of robotic-assisted laparoscopy vs conventional laparoscopy in the management of ovarian masses. Design: Retrospective cohort (Canadian Task Force classification II-3). Setting: Academic medical centre in the northeast United States. Patients: Retrospective medical record review of 71 consecutive patients with presumed benign ovarian masses. Intervention: Robotic-assisted laparoscopy in 30 patients with presumed benign ovarian masses was compared with conventional laparoscopy in 41 patients. Measurements and Main Results: Operative outcomes including operative time, estimated blood loss, length of hospital stay, and complications were recorded. Standard statistical analysis was used to compare the outcomes in the 2 groups. Mean (SD) operative time in the robotic group was 1.95 (0.63) hours, which was significantly longer than in the conventional laparoscopic group, 1.28 (0.83) hours (p = .04). Estimated blood loss in the robotic group was 74.52 (56.23) mL, which was not significantly different from that in the conventional laparoscopic group, 55.97 (49.18) mL. There were no significant differences in length of hospital stay between the robotic and conventional laparoscopic groups: 1.20 (0.78) days and 1.48 (0.63). Conversion to laparotomy was not necessary in either group of patients. Intraoperative and postoperative complications were similar between the 2 groups. Conclusion: Robotic-assisted laparoscopy is a safe and efficient technique for management of various types of ovarian masses. However, conventional laparoscopy is preferred for management of ovarian masses because of shorter operative time. Prospective studies are needed to evaluate the outcomes of robotic-assisted laparoscopic management of benign and malignant ovarian neoplasms.
    Journal of Minimally Invasive Gynecology 05/2014; 21(6). DOI:10.1016/j.jmig.2014.05.007 · 1.83 Impact Factor
  • Journal of Minimally Invasive Gynecology 11/2013; 20(6):S49. DOI:10.1016/j.jmig.2013.08.150 · 1.83 Impact Factor
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    ABSTRACT: The purpose of this study was to compare the survival of women with endometrial cancer managed by robotic and laparoscopic assisted surgery. Retrospective study conducted at two academic centers. Primary outcomes were overall survival, disease free survival, and disease recurrence. Between 2003 and 2010, 415 women met the study criteria. One hundred and eighty three women had robotic and 232 women had laparoscopic assisted surgery. Both groups were comparable in age, body mass index, comorbid conditions, histology, surgical stage, tumor grade, total nodes retrieved and adjuvant therapy. With a median follow-up of 38 months (range 4-61 months) for the robotic and 58 months (range 4 to 118 months) for the traditional laparoscopic group, there were no significant differences in survival (3-year survival 93.3% and 93.6% for robotic and laparoscopic group respectively), disease free survival (DFS) (3-year-DFS 83.3% and 88.4% for robotic and laparoscopic group respectively), and tumor recurrence (14.8% vs. 12.1 %). Univariate and multivariate analysis showed that surgery is not an independent prognostic factor of survival. Robotic assisted surgery yields equivalent oncologic outcomes when compared to traditional laparoscopic surgery for endometrial adenocarcinoma.
    American journal of obstetrics and gynecology 10/2013; 210(2). DOI:10.1016/j.ajog.2013.10.871 · 4.70 Impact Factor
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    ABSTRACT: Rigosertib (ON 01910.Na), a synthetic novel benzyl styryl sulfone, was administered to 28 patients with advanced cancer in a Phase I trial in order to characterize its pharmacokinetic profile, determine the dose-limiting toxicities (DLT), define the recommended phase II dose (RPTD) and to document any antitumor activity. Patients with advanced malignant neoplasms refractory to standard therapy were given escalating doses of rigosertib (50, 100, 150, 250, 325, 400, 650, 850, 1,050, 1,375, 1,700 mg/m(2)/24h) as a 3-day continuous infusion (CI) every 2 weeks. An accelerated Fibonacci titration schedule with specified decreases for toxicities was used for escalation until grade ≥2 toxicity occurred. Intrapatient dose escalation was allowed if toxicity was grade ≤2 and the disease remained stable. Plasma pharmacokinetics (PK) and urinary PK assessments were studied in the 1st and 4th cycles. Twenty-nine patients (12 men and 17 women; age 36-87 y with a median of 63 y) were registered, but one died before study drug was given. Twenty-eight patients received a median of 3 cycles of therapy. Most common grade ≥2 toxicities attributable to rigosertib included fatigue, anorexia, vomiting and constipation. DLTs included muscular weakness, hyponatremia, neutropenia, delirium and confusional state. Risk factors for severe toxicities include pre-existing neurological dysfunction or advanced gynecologic cancer after pelvic surgery. Rigosertib pharmacokinetics showed rapid plasma distribution phases and urinary excretion. Elevations in plasma Cmax and AUC due to decreases in plasma clearance were associated with acute grade ≥3 toxicities. Of 22 evaluable patients, 9 (41%) achieved a best overall response of stable disease; all other patients (n=13; 59%) progressed. The median progression-free survival time was 50 days (95% confidence interval [CI]: 37-80 days). Nine (41%) patients survived for over 1 y. In summary, prolonged IV infusions of rigosertib were generally well tolerated. Nine (41%) patients achieved stable disease and 9 (41%) patients survived for over 1 year. The RPTD appears to be 850 mg/m(2)/24hr CI x 3 days. (ClinicalTrials.gov identifier: NCT01538537).
    American Journal of Cancer Research 07/2013; 3(3):323-38. · 4.17 Impact Factor
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    ABSTRACT: To compare peri- and postoperative outcomes and complications of laparoscopic vs. robotic-assisted surgical staging for women with endometrial cancer at two established academic institutions. Retrospective chart review of all women that underwent total hysterectomy with pelvic and para-aortic lymphadenectomy by robotic-assisted or laparoscopic approach over a four-year period by three surgeons at two academic institutions. Intraoperative and postoperative complications were measured. Secondary outcomes included operative time, blood loss, transfusion rate, number of lymph nodes retrieved, length of hospital stay and need for re-operation or re-admission. Four hundred and thirty-two cases were identified: 187 patients with robotic-assisted and 245 with laparoscopic staging. Both groups were statistically comparable in baseline characteristics. The overall rate of intraoperative complications was similar in both groups (1.6% vs. 2.9%, p=0.525) but the rate of urinary tract injuries was statistically higher in the laparoscopic group (2.9% vs. 0%, p=0.020). Patients in the robotic group had shorter hospital stay (1.96 days vs. 2.45 days, p=0.016) but an average 57 minutes longer surgery than the laparoscopic group (218 vs. 161 minutes, p=0.0001). There was less conversion rate (0.5% vs. 4.1%; relative risk, 0.21; 95% confidence interval, 0.03 to 1.34; p=0.027) and estimated blood loss in the robotic than in the laparoscopic group (187 mL vs. 110 mL, p=0.0001). There were no significant differences in blood transfusion rate, number of lymph nodes retrieved, re-operation or re-admission between the two groups. Robotic-assisted surgery is an acceptable alternative to laparoscopy for staging of endometrial cancer and, in selected patients, it appears to have lower risk of urinary tract injury.
    Journal of Gynecologic Oncology 01/2013; 24(1):21-8. DOI:10.3802/jgo.2013.24.1.21 · 2.49 Impact Factor
  • S. Silverman Fenske · V. Kolev · H. Gretz
    Journal of Minimally Invasive Gynecology 11/2012; 19(6):S183. DOI:10.1016/j.jmig.2012.08.547 · 1.83 Impact Factor
  • Journal of Minimally Invasive Gynecology 11/2012; 19(6):S11. DOI:10.1016/j.jmig.2012.08.043 · 1.83 Impact Factor
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    ABSTRACT: Introduction: A carcinoid tumor occurring in the endometrium has been documented in the literature, but there is no report in regard to carcinoid tumor metastasis to endometrium. Presentation of case: We report a case of a malignant carcinoid metastasis to an endometrial polyp. Patient underwent hysteroscopy, and polypectomy. The pathology demonstrated an endometrial polyp containing a 4 mm x 5 mm nodule of metastatic carcinoid tumor, consistent with metastasis from patient's known pulmonary carcinoid. The tumor was morphologically similar to the tumors of the right lung, with similar immune-profile. Discussion: This patient presented with a suspicious pelvic ultrasound. Due to her age, the first priority was to exclude uterine cancer. The endometrial polyp, which was found, had a small focus of metastatic carcinoid tumor. To the best of our knowledge, this finding has not been previously recorded in the literature. Our patient also had a history of metastatic carcinoid tumor to breast. This finding is also very uncommon. Conclusion: This is the first case in the literature described a malignant carcinoid metastasis to an endometrial polyp.
    International Journal of Surgery Case Reports 10/2012; 4(1):91-93. DOI:10.1016/j.ijscr.2012.10.007
  • Enrique Soto · Herbert Gretz
    Journal of Gynecologic Oncology 04/2012; J Gynecol Oncol(2012 Apr;23(2)):134-5.. DOI:10.3802/jgo.2012.23.2.135 · 2.49 Impact Factor
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    ABSTRACT: To compare the outcomes of total laparoscopic to robotic approach for hysterectomy and all indicated procedures after controlling for surgeon and other confounding factors. Retrospective chart review of all consecutive cases of total laparoscopic and da Vinci robotic hysterectomies between August 2007 and July 2009 by two gynecologic oncology surgeons. Our primary outcome measure was operative procedure time. Secondary measures included complications, conversion to laparotomy, estimated blood loss and length of hospital stay. A mixed model with a random intercept was applied to control for surgeon and other confounders. Wilcoxon rank-sum, chi-square and Fisher's exact tests were used for the statistical analysis. The 124 patients included in the study consisted of 77 total laparoscopic hysterectomies and 47 robotic hysterectomies. Both groups had similar baseline characteristics, indications for surgery and additional procedures performed. The difference between the mean operative procedure time for the total laparoscopic hysterectomy group (111.4 minutes) and the robotic hysterectomy group (150.8 minutes) was statistically significant (p=0.0001) despite the fact that the specimens obtained in the total laparoscopic hysterectomy group were significantly larger (125 g vs. 94 g, p=0.002). The robotic hysterectomy group had statistically less estimated blood loss than the total laparoscopic hysterectomy group (131.5 mL vs. 207.7 mL, p=0.0105) however no patients required a blood transfusion in either group. Both groups had a comparable rate of conversion to laparotomy, intraoperative complications, and length of hospital stay. Total laparoscopic hysterectomy can be performed safely and in less operative time compared to robotic hysterectomy when performed by trained surgeons.
    Journal of Gynecologic Oncology 12/2011; 22(4):253-9. DOI:10.3802/jgo.2011.22.4.253 · 2.49 Impact Factor
  • L. Chuang · S. Silverman · N. Astill · V. Kolev · H. Gretz
    Journal of Minimally Invasive Gynecology 11/2011; 18(6). DOI:10.1016/j.jmig.2011.08.235 · 1.83 Impact Factor
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    Enrique Soto · Carlos Soto · Farr R Nezhat · Herbert F Gretz · Linus Chuang
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    ABSTRACT: Chylous ascites is an uncommon postoperative complication of gynecological surgery. We report a case of chylous ascites following a robotic lymph node dissection for a cervical carcinoma. A 38-year-old woman with IB2 cervical adenocarcinoma with a palpable 3 cm left external iliac lymph node was taken to the operating room for robotic-assisted laparoscopic pelvic and para-aortic lymph node dissection. Patient was discharged on postoperative day 2 after an apparent uncomplicated procedure. The patient was readmitted the hospital on postoperative day 9 with abdominal distention and a CT-scan revealed free fluid in the abdomen and pelvis. A paracentesis demonstrated milky-fluid with an elevated concentration of triglycerides, confirming the diagnosis of chylous ascites. She recovered well with conservative measures. The risk of postoperative chylous ascites following lymph node dissection is still present despite the utilization of new technologies such as the da Vinci robot.
    Journal of Gynecologic Oncology 03/2011; 22(1):61-3. DOI:10.3802/jgo.2011.22.1.61 · 2.49 Impact Factor
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    ABSTRACT: To compare the feasibility and safety of the laparoscopic management of adnexal masses appearing preoperatively benign with those suspicious for malignancy. Retrospective study of 694 women that underwent laparoscopic management of an adnexal mass. Laparoscopic management of an adnexal mass was completed in 678 patients. Six hundred and thirty five patients had benign pathology (91.5%) and 53 (7.6%) had primary ovarian cancers. Sixteen patients (2.3%) were converted to laparotomy; there were 13 intraoperative (1.9%) and 16 postoperative complications (2.3%). Patients divided in 2 groups: benign and borderline/malignant tumors. Patients in the benign group had a higher incidence of ovarian cyst rupture (26% vs. 8.7%, p<0.05). Patients in the borderline/malignant group had a statistically significant higher conversion rate to laparotomy (0.9% vs. 16.9%, p<0.001), postoperative complications (1.9% vs. 12.2%, p<0.05), blood loss, operative time, and duration of hospital stay. The incidence of intraoperative complications was similar between the 2 groups. Laparoscopic management of masses that are suspicious for malignancy or borderline pathology is associated with an increased risk in specific intra-operative and post-operative morbidities in comparison to benign masses. Surgeons should tailor the operative risks with their patients according to the preoperative likelihood of the mass being carcinoma or borderline malignancy.
    Journal of Gynecologic Oncology 03/2011; 22(1):18-24. DOI:10.3802/jgo.2011.22.1.18 · 2.49 Impact Factor

Publication Stats

280 Citations
112.05 Total Impact Points


  • 2014–2015
    • White Plains Hospital
      White Plains, New York, United States
  • 2002–2015
    • Icahn School of Medicine at Mount Sinai
      • Department of Obstetrics, Gynecology, and Reproductive Science
      Borough of Manhattan, New York, United States
  • 2007–2012
    • Mount Sinai Medical Center
      New York, New York, United States
  • 2005
    • Mount Sinai Hospital
      New York, New York, United States