Robotically assisted hysterectomy: 100 cases after the learning curve

Abstract

To report on perioperative outcomes of robotic hysterectomy after the learning curve, we performed a retrospective review of our second 100 consecutive robotic hysterectomies performed by two surgeons between January 2007 and February 2008. Operative time following our learning curve was 79.3 ± 36.1 min. Patient age was 44.2 ± 9.6 years, body mass index (BMI) was 30.9 ± 8.3 kg/m(2), and uterine weight was 223.7 ± 195.8 g. Indications for surgery included fibroids, menstrual disorders, and endometriosis. We performed total robotic-assisted laparoscopic hysterectomy type IVE. There were no conversions, no blood transfusions, and one cystotomy, repaired intraoperatively. Blood loss was 68.8 ± 105.8 cc, and average length of stay was 1.1 ± 0.3 days. There were no postoperative complications. Perioperative outcomes demonstrate low average operative times with a high level of safety on a broadened patient population, suggesting a potential advantage to using the robotic platform.

Comparison of Robotic-Assisted Hysterectomy to Other Minimally Invasive Approaches

“…7,8,21,23,24 In our study, estimated blood loss was also less in robotic hysterectomy compared to other types of hysterectomy, and this was statistically significant. This held true for all subgroups as well and was supported by a statistically significant difference in change in hemoglobin.…”

“…Several studies 7,8,21,23,24 have commented on the low estimated blood loss associated with robotic hysterectomy procedures, and this can be attributed to the better vision and easier dissection allowing the avoidance of bleeding. 7,8,21,23,24 In our study, estimated blood loss was also less in robotic hysterectomy compared to other types of hysterectomy, and this was statistically significant.…”

Does size matter? The effect of uterine weight on robot-assisted total laparoscopic hysterectomy outcomes

“…Our cohort analysis of all cases performed included those within the learning curve of all six surgeons trained at our institution, which may account for procedure durations that may be perceived as prolonged. Greater experience of the surgeon has been demonstrated to decrease operative time and blood loss for robotic surgery [13,18,19]. Therefore, although a relationship between uterine weight and procedure duration is likely to persist, overall operative time is expected to decrease with further experience.…”

DeRAS I – deutsche Situation der robotisch assistierten Chirurgie – eine Online-Survey-Studie

“…Die RAS nahm ihren Anfang in der HC [ 3 , 15 ] zum Wechsel des Jahrtausends, konnte sich hier aber aufgrund der begrenzten Performance der frühen Systemgenerationen ([ 14 ]; S‑System, Intuitive Surgical Inc., CA USA) nicht etablieren. Einige Jahre später tritt sie ihren Siegeszug in der URO mit der Prostatektomie an [ 6 , 12 ] und setzt diesen Trend in der GYN fort [ 4 , 11 ]. In diesen Fachbereichen wird auf komplexe, onkologische Eingriffe fokussiert (Tab.…”