Implementing robotic surgery to gynecologic oncology: the first 300 operations performed at a tertiary hospital

Abstract

Objective: To investigate the initial experience with robotic-assisted laparoscopic surgery in gynecologic oncology.

Design: A retrospective survey.

Setting: Tertiary referral center.

Population: The first 300 patients operated on using robotic assistance at the Department of Obstetrics and Gynecology of Tampere University Hospital, from March 2009 through January 2013.

Methods: Retrospective patient chart review.

Main outcome measures: The primary outcome measure was the learning curve events, and the complication and conversion rates were secondary outcome measures.

Results: The commonest type of operation was hysterectomy, bilateral salpingoophorectomy and pelvic lymphadenectomy (LH + BSO + PLND, n = 89), followed by the same procedure amended by para-aortic lymphadenectomy (PALND, n = 74), type II radical hysterectomy (n = 24), and PLND + PALND ± omentectomy (n = 15). A learning curve was most evident for LH + BSO + PLND: whereas the median operative time of all 89 operations was 167 min (range 403-104), it was 260 (range 403-135) and 153 (range 247-104) min in the case of the first and last 20 operations, respectively. The learning curve was short, or 10 procedures. A learning curve was also seen for the preoperative time in the operation room and for the number of lymph nodes harvested. The median blood loss during all 300 operations was 100 mL (range 5-3200). The median postoperative hospital stay was 1 day. The conversion rate was 4.0%, and the complication rate 19.3% (major in 9%).

Conclusion: The learning curve of robotic-assisted laparoscopic surgery appears to be short, or 10 operations. Robotic-assisted procedures seem to offer a safe and useful alternative to traditional techniques.

Keywords: Learning curve; endometrial cancer; gynecology; lymph node; lymphadenectomy; operative time; robotic-assisted laparoscopic surgery.