• 1626 Citations
  • 25 Scopus h-Index
20062020
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Research Output 2006 2020

2020

Routine Continuous Electrocardiographic Monitoring Following Percutaneous Coronary Interventions

Al-Hijji, M. A., Gulati, R., Bell, M., Kaplan, R. J., Feind, J. L., Lewis, B. R., Borah, B. J., Moriarty, J. P., Yoon Park, J., El Sabbagh, A., Kanwar, A., Barsness, G., Munger, T., Asirvatham, S., Lerman, A. & Singh, M., Jan 1 2020, In : Circulation. Cardiovascular interventions. 13, 1, p. e008290

Research output: Contribution to journalArticle

Percutaneous Coronary Intervention
Cost Savings
Costs and Cost Analysis
Mortality
Guidelines
2019

Association between smoking cessation and post-hospitalization healthcare costs: A matched cohort analysis

Nolan, M. B., Borah, B. J., Moriarty, J. P. & Warner, D. O., Dec 2 2019, In : BMC health services research. 19, 1, 924.

Research output: Contribution to journalArticle

Open Access
Smoking Cessation
Health Care Costs
Hospitalization
Cohort Studies
Smoking

Behavioral and psychological impact of returning breast density results to Latinas: Study protocol for a randomized clinical trial

Patel, B. K., Ridgeway, J. L., Ghosh, K., Rhodes, D. J., Borah, B., Jenkins, S., Suman, V. J., Norman, A., Jewett, M., Singh, D., Vachon, C. M. & Radecki Breitkopf, C., Dec 18 2019, In : Trials. 20, 1, 744.

Research output: Contribution to journalArticle

Open Access
Hispanic Americans
Randomized Controlled Trials
Psychology
Mammography
Breast Neoplasms
1 Citation (Scopus)

Cost-Effectiveness of Active Surveillance, Radical Prostatectomy and External Beam Radiotherapy for Localized Prostate Cancer: An Analysis of the ProtecT Trial

Sharma, V., Wymer, K. M., Borah, B. J., Barocas, D. A., Thompson, R. H., Karnes, R. J. & Boorjian, S. A., Nov 1 2019, In : The Journal of urology. 202, 5, p. 964-972 9 p.

Research output: Contribution to journalArticle

Prostatectomy
Cost-Benefit Analysis
Quality-Adjusted Life Years
Prostatic Neoplasms
Radiotherapy
4 Citations (Scopus)

Neoadjuvant vs. adjuvant chemotherapy for cholangiocarcinoma: A propensity score matched analysis

Yadav, S., Xie, H., Bin-Riaz, I., Sharma, P., Durani, U., Goyal, G., Borah, B. J., Borad, M. J., Smoot, R., Roberts, L. R., Go, R. S., Mc Williams, R. R. & Mahipal, A., Jan 1 2019, In : European Journal of Surgical Oncology.

Research output: Contribution to journalArticle

Propensity Score
Cholangiocarcinoma
Adjuvant Chemotherapy
Drug Therapy
Survival

Predictors of High Costs of Care among Otolaryngology Patients

Balakrishnan, K., Moriarty, J. P., Rosedahl, J., Driscoll, C. L. & Borah, B. J., Jan 1 2019, In : Otolaryngology - Head and Neck Surgery (United States).

Research output: Contribution to journalArticle

Otolaryngology
Inpatients
Costs and Cost Analysis
Outpatients
Pediatrics

Short-Term Health-Related Quality of Life After Hysterectomy Compared With Myomectomy for Symptomatic Leiomyomas

Nicholson, W. K., Wegienka, G., Zhang, S., Wallace, K., Stewart, E., Laughlin-Tommaso, S., Thomas, L., Jacoby, V. L., Marsh, E. E., Wise, L., Borah, B. J., Spies, J., Venable, S., Anchan, R. M., Larry Maxwell, G., Diamond, M., Lytle, B. & Myers, E. R., Aug 1 2019, In : Obstetrics and gynecology. 134, 2, p. 261-269 9 p.

Research output: Contribution to journalArticle

Uterine Myomectomy
Leiomyoma
Hysterectomy
Quality of Life
Registries
1 Citation (Scopus)

Systematic review of the evidence on the cost-effectiveness of pharmacogenomics-guided treatment for cardiovascular diseases

Zhu, Y., Swanson, K. M., Rojas, R. L., Wang, Z., St. Sauver, J. L., Visscher, S. L., Prokop, L. J., Bielinski, S. J., Wang, L., Weinshilboum, R. & Borah, B. J., Jan 1 2019, (Accepted/In press) In : Genetics in Medicine.

Research output: Contribution to journalReview article

Open Access
Pharmacogenetics
Cost-Benefit Analysis
Cardiovascular Diseases
Costs and Cost Analysis
Cost of Illness
2018
5 Citations (Scopus)

Cost analysis of enhanced recovery after surgery in microvascular breast reconstruction

Oh, C., Moriarty, J., Borah, B. J., Mara, K. C., Harmsen, W. S., Saint-Cyr, M. & Lemaine, V., Jan 1 2018, (Accepted/In press) In : Journal of Plastic, Reconstructive and Aesthetic Surgery.

Research output: Contribution to journalArticle

Mammaplasty
Costs and Cost Analysis
Length of Stay
Free Tissue Flaps
Quality of Health Care
1 Citation (Scopus)

Economic Analysis of a Geographically Defined Cohort of Hospitalized Patients Who Smoke

Nolan, M. B., Borah, B. J., Moriarty, J. P. & Warner, D. O., Aug 1 2018, In : Mayo Clinic Proceedings. 93, 8, p. 1034-1042 9 p.

Research output: Contribution to journalArticle

Smoke
Hospital Costs
Smoking
Economics
Costs and Cost Analysis

FIRSTT study: randomized controlled trial of uterine artery embolization vs focused ultrasound surgery

Laughlin-Tommaso, S. K., Barnard, E. P., AbdElmagied, A. M., Vaughan, L. E., Weaver, A. L., Hesley, G. K., Woodrum, D. A., Jacoby, V. L., Kohi, M. P., Price, T. M., Nieves, A., Miller, M. J., Borah, B. J., Moriarty, J. P., Gorny, K. R., Leppert, P. C., Severson, A. L., Lemens, M. A. & Stewart, E. A., Jan 1 2018, (Accepted/In press) In : American Journal of Obstetrics and Gynecology.

Research output: Contribution to journalArticle

Uterine Artery Embolization
Leiomyoma
Randomized Controlled Trials
Magnetic Resonance Spectroscopy
Hormones

Identifying high-cost episodes in lower extremity joint replacement

Philpot, L. M., Swanson, K. M., Inselman, J., Schoellkopf, W. J., Naessens, J. M., Borah, B. J., Peterson, S., Gladders, B., Shah, N. D. & Ebbert, J. O., Jan 1 2018, (Accepted/In press) In : Health Services Research.

Research output: Contribution to journalArticle

Replacement Arthroplasties
Lower Extremity
Fee-for-Service Plans
Costs and Cost Analysis
Delivery of Health Care

Improving Value of Care for Older Adults With Advanced Medical Illness and Functional Decline: Cost Analyses of a Home-Based Palliative Care Program

Chen, C. Y., Naessens, J. M., Takahashi, P. Y., McCoy, R., Borah, B. J., Borkenhagen, L. S., Kimeu, A. K., Rojas, R. L., Johnson, M. G., Visscher, S. L., Cha, S. S., Thorsteinsdottir, B. B. & Hanson, G. J., Jan 1 2018, (Accepted/In press) In : Journal of Pain and Symptom Management.

Research output: Contribution to journalArticle

Palliative Care
Costs and Cost Analysis
Medicare
Control Groups
Health Expenditures
3 Citations (Scopus)

Methods for Measuring Multiple Medication Adherence: A Systematic Review

Pednekar, P. P., Ágh, T., Malmenäs, M., Raval, A. D., Bennett, B. M., Borah, B. J., Hutchins, D. S., Manias, E., Williams, A. F., Hiligsmann, M., Turcu-Stiolica, A., Zeber, J. E., Abrahamyan, L., Bunz, T. J. & Peterson, A. M., Jan 1 2018, (Accepted/In press) In : Value in Health.

Research output: Contribution to journalArticle

Medication Adherence
Polypharmacy
PubMed
Reproducibility of Results
Libraries
8 Citations (Scopus)

Optimizing Blood Transfusion Practices Through Bundled Intervention Implementation in Patients With Gynecologic Cancer Undergoing Laparotomy

Wallace, S. K., Halverson, J. W., Jankowski, C. J., DeJong, S. R., Weaver, A. L., Weinhold, M. R., Borah, B. J., Moriarty, J. P., Cliby, W. A., Kor, D. J., Higgins, A. A., Otto, H. A., Dowdy, S. C. & Bakkum-Gamez, J. N., May 1 2018, In : Obstetrics and gynecology. 131, 5, p. 891-898 8 p.

Research output: Contribution to journalArticle

Endometrial Neoplasms
Blood Transfusion
Ovarian Neoplasms
Laparotomy
Tranexamic Acid

Reply to L. Kennedy et al

Shapiro, C. L., Moriarty, J. P. & Borah, B. J., Jan 1 2018, In : Journal of Clinical Oncology. 36, 10, p. 1052-1053 2 p.

Research output: Contribution to journalLetter

5 Citations (Scopus)

The Comparing Options for Management: PAtient-centered REsults for Uterine Fibroids (COMPARE-UF) registry: rationale and design

Stewart, E. A., Lytle, B. L., Thomas, L., Wegienka, G. R., Jacoby, V., Diamond, M. P., Nicholson, W. K., Anchan, R. M., Venable, S., Wallace, K., Marsh, E. E., Maxwell, G. L., Borah, B. J., Catherino, W. H. & Myers, E. R., Jul 1 2018, In : American Journal of Obstetrics and Gynecology. 219, 1, p. 95.e1-95.e10

Research output: Contribution to journalArticle

Leiomyoma
Registries
Uterine Myomectomy
Robotics
Therapeutics

When flawed modeling justifies cost-effectiveness: Making sense of “Band-Aid” modeling

Borah, B. J., John, D. & Moriarty, J. P., Aug 1 2018, In : Cancer. 124, 15, p. 3266-3267 2 p.

Research output: Contribution to journalLetter

Cost-Benefit Analysis
2017
4 Citations (Scopus)

An integrated digital/clinical approach to smoking cessation in lung cancer screening: Study protocol for a randomized controlled trial

Graham, A. L., Burke, M. V., Jacobs, M. A., Cha, S., Croghan, I. T., Schroeder, D. R., Moriarty, J. P., Borah, B. J., Rasmussen, D. F., Brookover, M. J., Suesse, D. B., Midthun, D. E. & Hays, J. T., Nov 28 2017, In : Trials. 18, 1, 568.

Research output: Contribution to journalArticle

Smoking Cessation
Early Detection of Cancer
Text Messaging
Lung Neoplasms
Randomized Controlled Trials
6 Citations (Scopus)
Uterine Myomectomy
Leiomyoma
Insurance
Uterine Artery Embolization
Databases
24 Citations (Scopus)

Cost-effectiveness analysis of monthly zoledronic acid, zoledronic acid every 3 months, and monthly denosumab in women with breast cancer and skeletal metastases: CALGB 70604 (Alliance)

Shapiro, C. L., Moriarty, J. P., Dusetzina, S., Himelstein, A. L., Foster, J. C., Grubbs, S. S., Novotny, P. J. & Borah, B. J., Dec 10 2017, In : Journal of Clinical Oncology. 35, 35, p. 3949-3955 7 p.

Research output: Contribution to journalArticle

zoledronic acid
Cost-Benefit Analysis
Breast Neoplasms
Neoplasm Metastasis
Costs and Cost Analysis
2 Citations (Scopus)

Cost-Effectiveness of a Care Transitions Program in a Multimorbid Older Adult Cohort

Hanson, G. J., Borah, B. J., Moriarty, J. P., Ransom, J. E., Naessens, J. M. & Takahashi, P. Y., Jan 1 2017, (Accepted/In press) In : Journal of the American Geriatrics Society.

Research output: Contribution to journalArticle

Patient Transfer
Cost-Benefit Analysis
Costs and Cost Analysis
Cohort Studies
Confidence Intervals
1 Citation (Scopus)

Cost-effectiveness of acupuncture in an employee population: A retrospective analysis

Borah, B. J., Naessens, J. M., Glasgow, A. E., Bauer, B. A. & Chon, T. Y., Apr 1 2017, In : Complementary Therapies in Medicine. 31, p. 14-19 6 p.

Research output: Contribution to journalArticle

Acupuncture
Cost-Benefit Analysis
Office Visits
Population
Costs and Cost Analysis
24 Citations (Scopus)

Developing a standardized healthcare cost data warehouse

Visscher, S. L., Naessens, J. M., Yawn, B. P., Reinalda, M. S., Anderson, S. S. & Borah, B. J., Jun 12 2017, In : BMC Health Services Research. 17, 1, 396.

Research output: Contribution to journalArticle

Health Care Costs
Costs and Cost Analysis
Information Storage and Retrieval
Registries
Fee Schedules

Implementation of prospective, surgeon-driven, risk-based pathway for pancreatoduodenectomy results in improved clinical outcomes and first year cost savings of $1 million

Shubert, C. R., Kendrick, M. L., Habermann, E. B., Glasgow, A. E., Borah, B. J., Moriarty, J. P., Cleary, S. P., Smoot, R., Farnell, M. B., Nagorney, D. M., Truty, M. & Que, F., Jan 1 2017, (Accepted/In press) In : Surgery (United States).

Research output: Contribution to journalArticle

Pancreaticoduodenectomy
Cost Savings
Pancreatic Fistula
Costs and Cost Analysis
Interventional Radiology
5 Citations (Scopus)
Leiomyoma
Hemorrhage
Steroids
Leuprolide
Contraceptive Agents
4 Citations (Scopus)

Perioperative Complications and Cost of Vaginal, Open Abdominal, and Robotic Surgery for Apical Vaginal Vault Prolapse

Anand, M., Weaver, A. L., Fruth, K. M., Borah, B. J., Klingele, C. J. & Gebhart, J. B., Jan 1 2017, In : Female Pelvic Medicine and Reconstructive Surgery. 23, 1, p. 27-35 9 p.

Research output: Contribution to journalArticle

Pelvic Organ Prolapse
Robotics
Costs and Cost Analysis
Length of Stay
Uterine Prolapse

Periprocedural Outcomes Comparing Fibroid Embolization and Focused Ultrasound: A Randomized Controlled Trial and Comprehensive Cohort Analysis

Barnard, E. P., Abdelmagied, A. M., Vaughan, L. E., Weaver, A. L., Laughlin-Tommaso, S. K., Hesley, G. K., Woodrum, D. A., Jacoby, V. L., Kohi, M. P., Price, T. M., Nieves, A., Miller, M. J., Borah, B. J., Gorny, K. R., Leppert, P. C., Peterson, L. G. & Stewart, E. A., Sep 1 2017, In : Obstetrical and Gynecological Survey. 72, 9, p. 531-533 3 p.

Research output: Contribution to journalComment/debate

Platelet Aggregation Inhibitors
Percutaneous Coronary Intervention
Acute Coronary Syndrome
Cost-Benefit Analysis
Costs and Cost Analysis

Response

Krishnamoorthi, R., Borah, B. J., Heien, H., Das, A., Chak, A. & Iyer, P. G., Feb 1 2017, In : Gastrointestinal Endoscopy. 85, 2, p. 463-464 2 p.

Research output: Contribution to journalLetter

2016
20 Citations (Scopus)

Abdominal Incision Injection of Liposomal Bupivacaine and Opioid Use after Laparotomy for Gynecologic Malignancies

Kalogera, E., Bakkum-Gamez, J. N., Weaver, A. L., Moriarty, J. P., Borah, B. J., Langstraat, C. L., Jankowski, C. J., Lovely, J. K., Cliby, W. A. & Dowdy, S. C., Nov 1 2016, In : Obstetrics and Gynecology. 128, 5, p. 1009-1017 9 p.

Research output: Contribution to journalArticle

Bupivacaine
Laparotomy
Opioid Analgesics
Injections
Neoplasms
13 Citations (Scopus)
Leiomyoma
Uterine Myomectomy
Hysterectomy
Endometrial Ablation Techniques
Uterine Artery Embolization
13 Citations (Scopus)

Disparities in Surgical Care among Women with Endometrial Cancer

Mannschreck, D., Matsuno, R. K., Moriarty, J. P., Borah, B. J., Dowdy, S. C., Tanner, E. J., Makary, M. A., Stone, R. L., Levinson, K. L., Temkin, S. M. & Fader, A. N., Sep 1 2016, In : Obstetrics and Gynecology. 128, 3, p. 526-534 9 p.

Research output: Contribution to journalArticle

Endometrial Neoplasms
Odds Ratio
Confidence Intervals
Hysterectomy
Minimally Invasive Surgical Procedures
14 Citations (Scopus)

Periprocedural outcomes comparing fibroid embolization and focused ultrasound: A randomized controlled trial and comprehensive cohort analysis

Barnard, E. P., AbdElmagied, A. M., Vaughan, L. E., Weaver, A. L., Laughlin-Tommaso, S. K., Hesley, G. K., Woodrum, D. A., Jacoby, V. L., Kohi, M. P., Price, T. M., Nieves, A., Miller, M. J., Borah, B. J., Gorny, K. R., Leppert, P. C., Peterson, L. G. & Stewart, E. A., Sep 2 2016, (Accepted/In press) In : American Journal of Obstetrics and Gynecology.

Research output: Contribution to journalArticle

Leiomyoma
Cohort Studies
Randomized Controlled Trials
Uterine Artery Embolization
Therapeutics
46 Citations (Scopus)

Utilization of minimally invasive surgery in endometrial cancer care: A Quality and cost disparity

Fader, A. N., Matsuno Weise, R., Sinno, A. K., Tanner, E. J., Borah, B. J., Moriarty, J. P., Bristow, R. E., Makary, M. A., Pronovost, P. J., Hutfless, S. & Dowdy, S. C., 2016, In : Obstetrics and Gynecology. 127, 1, p. 91-100 10 p.

Research output: Contribution to journalArticle

Minimally Invasive Surgical Procedures
Quality of Health Care
Endometrial Neoplasms
Hysterectomy
Confidence Intervals
2015
1 Citation (Scopus)

Association between atrial fibrillation and costs after myocardial infarction: A community study

Borah, B. J., Roger, V. L., Mills, R. M., Weston, S. A., Anderson, S. S. & Chamberlain, A., Sep 1 2015, In : Clinical Cardiology. 38, 9, p. 548-554 7 p.

Research output: Contribution to journalArticle

Atrial Fibrillation
Myocardial Infarction
Costs and Cost Analysis
Inpatients
Cohort Studies
8 Citations (Scopus)
Fitness Centers
Cost Savings
Workplace
Health Care Costs
Weight Loss
1 Citation (Scopus)

Can statistical linkage of missing variables reduce bias in treatment effect estimates in comparative effectiveness research studies?

Crown, W., Chang, J., Olson, M., Kahler, K., Swindle, J., Buzinec, P., Shah, N. D. & Borah, B. J., Sep 1 2015, In : Journal of Comparative Effectiveness Research. 4, 5, p. 455-463 9 p.

Research output: Contribution to journalArticle

Comparative Effectiveness Research
Hepatitis C
Therapeutics
11 Citations (Scopus)

Cost-effectiveness of proton beam therapy for intraocular melanoma

Moriarty, J. P., Borah, B. J., Foote, R. L., Pulido, J. S. & Shah, N. D., May 18 2015, In : PLoS One. 10, 5, e0127814.

Research output: Contribution to journalArticle

quality-adjusted life year
Proton Therapy
cost effectiveness
Cost effectiveness
melanoma
5 Citations (Scopus)
Menstruation
Leiomyoma
Cohort Studies
Lubrication
Menstrual Cycle
17 Citations (Scopus)

Evaluating the Structure of the Patient Assessment of Chronic Illness Care (PACIC) Survey from the Patient’s Perspective

Fan, J., McCoy, R., Ziegenfuss, J. Y., Smith, S. A., Borah, B. J., Deming, J. R., Montori, V. M. & Shah, N. D., 2015, In : Annals of Behavioral Medicine. 49, 1, p. 104-111 8 p.

Research output: Contribution to journalArticle

Patient Care
Chronic Disease
Delivery of Health Care
Statistical Factor Analysis
Patient Participation
7 Citations (Scopus)

Fibroid interventions: Reducing symptoms today and tomorrow: Extending generalizability by using a comprehensive cohort design with a randomized controlled trial

AbdElmagied, A. M., Vaughan, L. E., Weaver, A. L., Laughlin-Tommaso, S. K., Hesley, G. K., Woodrum, D. A., Jacoby, V. L., Kohi, M. P., Price, T. M., Nieves, A., Miller, M. J., Borah, B. J., Gorny, K. R., Leppert, P. C., Lemens, M. A. & Stewart, E. A., Dec 17 2015, (Accepted/In press) In : American Journal of Obstetrics and Gynecology.

Research output: Contribution to journalArticle

Leiomyoma
Randomized Controlled Trials
Hysterectomy
Cohort Studies
Random Allocation
50 Citations (Scopus)

Impact of ibrutinib and idelalisib on the pharmaceutical cost of treating chronic lymphocytic leukemia at the individual and societal levels

Shanafelt, T. D., Borah, B. J., Finnes, H. D., Chaffee, K. G., Ding, W. D., Leis, J. F., Chanan Khan, A. A., Parikh, S. A., Slager, S. L., Kay, N. E. & Call, T. G., May 1 2015, In : Journal of Oncology Practice. 11, 3, p. 252-258 7 p.

Research output: Contribution to journalArticle

B-Cell Chronic Lymphocytic Leukemia
Costs and Cost Analysis
Pharmaceutical Preparations
Medicare Part D
PCI 32765
39 Citations (Scopus)

Incorporating robotic-assisted surgery for endometrial cancer staging: Analysis of morbidity and costs

Bogani, G., Multinu, F., Dowdy, S. C., Cliby, W. A., Wilson, T. O., Gostout, B. S., Weaver, A. L., Borah, B. J., Killian, J. M., Bijlani, A., Angioni, S. & Mariani, A., Nov 24 2015, (Accepted/In press) In : Gynecologic Oncology.

Research output: Contribution to journalArticle

Neoplasm Staging
Robotics
Endometrial Neoplasms
Morbidity
Costs and Cost Analysis
23 Citations (Scopus)

Rates and predictors of progression to esophageal carcinoma in a large population-based Barrett's esophagus cohort

Krishnamoorthi, R., Borah, B. J., Heien, H., Das, A., Chak, A. & Iyer, P. G., Aug 30 2015, (Accepted/In press) In : Gastrointestinal Endoscopy.

Research output: Contribution to journalArticle

Barrett Esophagus
Esophageal Neoplasms
Carcinoma
Population
Hydroxymethylglutaryl-CoA Reductase Inhibitors

Utility of intraoperative cystoscopy in detecting ureteral injury during vaginal hysterectomy

Anand, M., Casiano, E. R., Heisler, C. A., Weaver, A. L., Borah, B. J., Wagie, A. E., Moriarty, J. P. & Gebhart, J. B., Jul 13 2015, In : Obstetrical and Gynecological Survey. 70, 7, p. 440-442 3 p.

Research output: Contribution to journalArticle

5 Citations (Scopus)

Utility of intraoperative cystoscopy in detecting ureteral injury during vaginal hysterectomy

Anand, M., Casiano, E. R., Heisler, C. A., Weaver, A. L., Borah, B. J., Wagie, A. E., Moriarty, J. P. & Gebhart, J. B., Mar 10 2015, In : Female Pelvic Medicine and Reconstructive Surgery. 21, 2, p. 70-76 7 p.

Research output: Contribution to journalArticle

Vaginal Hysterectomy
Cystoscopy
Wounds and Injuries
Confidence Intervals
Creatinine
2014
16 Citations (Scopus)
Comparative Effectiveness Research
Propensity Score
Safety
Observational Studies
Guidelines
4 Citations (Scopus)

Cost comparison between uterine-sparing fibroid treatments one year following treatment

Borah, B. J., Carls, G. S., Moore, B. J., Gibson, T. B., Moriarty, J. P. & Stewart, E. A., Mar 31 2014, In : Journal of Therapeutic Ultrasound. 2, 1, 7.

Research output: Contribution to journalArticle

Leiomyoma
Uterine Myomectomy
Uterine Artery Embolization
Costs and Cost Analysis
Magnetic Resonance Spectroscopy

Cost differences among robotic, vaginal, and abdominal hysterectomy

Woelk, J. L., Borah, B. J., Trabuco, E. C., Heien, H. C. & Gebhart, J. B., 2014, In : Obstetrical and Gynecological Survey. 69, 8, p. 465-466 2 p.

Research output: Contribution to journalArticle

Vaginal Hysterectomy
Robotics
Costs and Cost Analysis