Objective: To compare intra-operative and post-operative outcomes of total abdominal hysterectomy, total vaginal hysterectomy, total laparoscopic hysterectomy, and total robotic hysterectomy for benign conditions, as well as to conduct a cost approximation of each. Methods: Retrospective chart review of all hysterectomies by two surgeons between January 2017 and January 2019. For each patient, the following metrics were recorded and analyzed: age, BMI, medical history, abdominal/pelvic surgical history, surgical indication, route of hysterectomy, intra-operative complications, total operative time, time to discharge, estimated blood loss, post-operative complications, pain status, return to activities of daily living, and return to employment. Results: A total of 521 patients who underwent total abdominal hysterectomy (n=40), total vaginal hysterectomy (n=55), total laparoscopic hysterectomy (n=131), and total robotic hysterectomy (n=292) were analyzed. There were no significant differences among the groups in age, BMI, or surgical history. The total vaginal hysterectomy category included the highest percentage of pre-existing medical history (p=0.043, p=0.011). Of the four categories, total robotic and total laparoscopic hysterectomies involved shorter operative times (p=0.026, p=0.044), shorter inpatient stays (p= <0.001), fewer intra-operative complications (p= <0.001), decreased pain status (p= <0.001), and quicker return to both employment (p=0.039, 0.044) and activities of daily living (p=0.002). Total robotic hysterectomy showed less estimated blood loss (p= <0.001) and fewer post-operative complications (p=0.022, p=0.046) when compared to laparoscopic hysterectomy. Robotic hysterectomy was noted to have the highest OR-specific costs and total encounter costs. Conclusions: The two minimally invasive routes to hysterectomy, robotic and laparoscopic, appear to both be comparable in terms of intra-operative and post-operative outcomes, and are associated with improved outcomes when compared to abdominal and vaginal routes to hysterectomy. However, due to the high cost of robotic surgery, it may not be the most cost-effective approach.

Consumption of clean, pathogen-free water is vital in maintaining health. The water infrastructure in Puerto Penasco, Sonora is not sufficient in providing clean water for its residents. Water in this region is being overdrafted, meaning it is distributed from deep wells faster than it can be regenerated, which prevents more wells from being constructed. There is a high need for a cost-efficient solution to the clean water shortage in this impoverished town. The purpose of this study was to determine: (1) how clean drinking water affects health, (2) how contaminated water and water substitutes, such as soda and juices, negatively impact health, and (3) the impact on water consumption by local residents after providing them with a portable filtration system to create clean drinking water in their own homes. Water filters were distributed in two trials to a convenience sample of 45 participants, 27 of whom were successfully contacted for a post-implementation survey. Out of the 27 participants who took the survey, 27% reported that they drank more water after receiving the filter than before, 40% reported drinking less soda after receiving the filter, 63% reported using their filter on a daily basis, 63% believed that drinking clean water is important for their health, and 74% thought that it was difficult for them to obtain clean drinking water before receiving the filter. Providing residents with a filtration system was effective in increasing water consumption and saving residents money on water but did not provide conclusive data, negating the use of soda as a water substitute. This was an effective small-scale solution to a much larger problem that may be beneficial in other similarly impoverished communities.