Risk factors for robotic gynecologic procedures requiring conversion to other surgical procedures

Unger, Cécile A.; Lachiewicz, Mark; Ridgeway, Beri

doi:10.1016/j.ijgo.2016.06.016

Cited by 18 publications

(8 citation statements)

References 24 publications

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“…Five studies of hysterectomy and one study combining all robotic gynaecology procedures were included; these studies demonstrated mixed results [19][20][21][22][23][24].…”

Section: Resultsmentioning

confidence: 99%

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Volume-outcome relationship in intra-abdominal robotic-assisted surgery: a systematic review

et al. 2022

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As robotic assisted surgery (RAS) expands to smaller centres, platforms are shared between specialities.Healthcare providers must consider case volume and mix required to maintain quality and cost-effectiveness. This can be informed, in-part, by the volume-outcome relationship. We perform a systematic review to describe the volume-outcome relationship in intra-abdominal robotic assisted surgery to report on suggested minimum volumes standards. A literature search of Medline, NICE Evidence Search, Health Technology Assessment Database and Cochrane Library using the terms: "robot*", "surgery", "volume" and "outcome" was performed. The included procedures were gynaecological: hysterectomy, urological: partial and radical nephrectomy, cystectomy, prostatectomy, and general surgical: colectomy, oesophagectomy. Hospital and surgeon volume measures and all reported outcomes were analysed. 41 studies, including 983149 procedures, met the inclusion criteria. Study quality was assessed using the Newcastle-Ottawa Quality Assessment Scale and the retrieved data was synthesised in a narrative review. Signi cant volume-outcome relationships were described in relation to key outcome measures, including operative time, complications, positive margins, lymph node yield and cost. Annual surgeon and hospital volume thresholds were described. We concluded that in centres with an annual volume of fewer than 10 cases of a given procedure, having multiple surgeons performing these procedures led to worse outcomes and, therefore, opportunities should be sought to perform other complimentary robotic procedures or undertake joint cases.

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“…Five studies of hysterectomy and one study combining all robotic gynaecology procedures were included; these studies demonstrated mixed results [19][20][21][22][23][24].…”

Section: Resultsmentioning

confidence: 99%

“…Brunes et al did nd a signi cant relationship between surgeon volume and peri-operative outcomes, including blood loss and operative time [24]. Unger et al pooled all robotic gynaecological procedures in their analysis and demonstrated that higher surgeon volume was associated with reduced rates of conversion to an alternative procedure [20].…”

Section: Resultsmentioning

confidence: 99%

Volume-outcome relationship in intra-abdominal robotic-assisted surgery: a systematic review

et al. 2022

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“…Common robotic gynecologic cancer surgery like pelvic and para-aortic lymphadenectomy can be associated with vascular injury. The incidence was about 1% [7,8], and was a major cause of conversion to laparotomy [12]. This can be caused by poor surgical view where the vessels are beyond the field of view, inadvertent clashing of robotic instrument which the surgeons are not aware of, or activating the wrong foot energy pedal.…”

Section: Inherent Risks Of Operationsmentioning

confidence: 99%

Tips for set-up to prevent complications in robotic gynecologic cancer surgery

Tse¹

2022

Gyne Robot Surg

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Robotic surgery (RS) is a breakthrough in gynecologic oncology in the past decade and it is now part of the routine in many centers. Although there is a concern about the oncological outcomes after RS in cervical cancer, it is proven to be safe and effective in endometrial cancer. However, RS has some drawbacks such as the loss of tactile feedback. Complications can therefore occur, and are usually multi-factorial. These can be related to the nature of the operations, the physical fitness of the patients, the control and choice of the devices, and more importantly, the experience and knowledge of the surgical team. To minimise the risk of complications, we need to understand the limitations of RS and have a proper set-up of the operations. It is important to anticipate these potential complications before and during the operations. And a careful setup of the operations, including the instrument set-up, patients’ positioning, port placement, and communication with the anesthetists and surgical team, are crucial in ensuring the safety and success of robotic surgery. In this article, different complications and their preventive measures at set-up were discussed.

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“…Unger et al28 attempted retrospectively to determine the incidence of, and risk factors for, conversion from robotic procedures to other surgical techniques. Patients’ demographic and perioperative data were retrieved, in addition to surgeon experience based upon monthly case volume.…”

Section: Robotic Surgery For Benign Indicationsmentioning

confidence: 99%

Review of Robotic Surgery in Gynecology—The Future Is Here

Lauterbach¹,

Matanes²,

Löwenstein³

2017

Rambam Maimonides Med J

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The authors present a systematic review of randomized and observational, retrospective and prospective studies to compare between robotic surgery as opposed to laparoscopic, abdominal, and vaginal surgery for the treatment of both benign and malignant gynecologic indications. The comparison focuses on operative times, surgical outcomes, and surgical complications associated with the various surgical techniques. PubMed was the main search engine utilized in search of study data. The review included studies of various designs that included at least 25 women who had undergone robotic gynecologic surgery. Fifty-five studies (42 comparative and 13 non-comparative) met eligibility criteria. After careful analysis, we found that robotic surgery was consistently connected to shorter post-surgical hospitalization when compared to open surgery, a difference less significant when compared to laparoscopic surgery. Also, it seems that robotic surgery is highly feasible in gynecology. There are quite a few inconsistencies regarding operative times and estimated blood loss between the different approaches, though in the majority of studies estimated blood loss was lower in the robotic surgery group. The high variance in operative times resulted from the difference in surgeon’s experience. The decision whether robotic surgery should become mainstream in gynecological surgery or remain another surgical technique in the gynecological surgeon’s toolbox requires quite a few more randomized controlled clinical trials. In any case, in order to bring robotic surgery down to the front row of surgery, training surgeons is by far the most important goal for the next few years.

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Risk factors for robotic gynecologic procedures requiring conversion to other surgical procedures

Abstract: The overall incidence of conversion from robotic surgery to laparotomy was low. Higher body mass index, previous laparotomy, history of asthma, using a single-port approach, and surgeon case volume were associated with the risk of conversion.

Cited by 18 publications

References 24 publications

Volume-outcome relationship in intra-abdominal robotic-assisted surgery: a systematic review

Volume-outcome relationship in intra-abdominal robotic-assisted surgery: a systematic review

Tips for set-up to prevent complications in robotic gynecologic cancer surgery

Review of Robotic Surgery in Gynecology—The Future Is Here

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