Robotic-assisted gynaecological surgery-establishing training criteria; minimizing operative time and blood loss.

Full Abstract

BACKGROUND:
The objective was an evaluation of operative time and estimated blood loss (EBL) as a function of experience in gynaecological robotic surgery.

METHOD:
A retrospective analysis of 40 consecutive cases (approximately one case/week) over a 1 year period using the da Vinci) robotic system was performed, using data from two institutions, Newark Beth Israel Medical Center and Hackensack University Medical Center. Information was obtained from a single surgeon. Among the 40 cases there were 17 hysterectomies and 23 myomectomies. Each patient met the criteria of benign disease. In each institution, a da Vinci) system using three instrument arms and a camera arm was employed for every operation.

RESULTS:
Tests of differences in means were performed to compare the two groups. In group I (cases 1-20) the mean uterine volume was 863.0 cc and was similar to Group II (cases 21-40) at 632.6 cc. There was no significant difference between the groups when comparing blood loss; means were 86 cc for group I and 62.5 cc for group II. Operative time between groups, however, showed a significant difference (mean of 211.8 min for group 1 compared to 151 min for group 2; p < 0.05) and console time demonstrated a similar trend (mean for group 1 was 159.8 min compared to 90.8 min for group 2; p < 0.05). There were no conversions to laparotomy. Body mass index (BMI) and prior abdominal surgery were not significantly different. Multivariate regressions on operative time and EBL were performed, controlling for uterine weight and volume. The effect of experience on operative time was significant and negative; the coefficient on EBL was not significant.

CONCLUSION:
This study demonstrates statistical improvement in operative time after the first 20 cases for a single surgeon. This information could be used to establish criteria for training surgeons.(c) 2008 John Wiley & Sons, Ltd.

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Author information

Author/s: Pitter, Michael C (MC); Anderson, Patrick (P); Blissett, Amelia (A); Pemberton, Nicola (N);

Affiliation: Department of Minimally Invasive Gynecology, Newark Beth Israel Medical Center, Newark, NJ, USA. mptmd(-atsign-)aol.com

Journal and publication information

Publication Type: Journal Article

Journal: The international journal of medical robotics + computer assisted surgery : MRCAS (Int J Med Robot), published in England. (Language: eng)

Reference: 2008-Jun; vol 4 (issue 2) : pp 114-20

Dates: Created 2008/05/22; Completed 2008/08/07;

PMID: 18382994, status: MEDLINE (last retrieval date: 11/6/2008)

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MeSH headings (categories)

This article was linked to the MESH Headings shown below.

Blood Loss, Surgical - prevention & control; statistics & numerical data
Blood Volume
Clinical Competence - standards
Education, Medical, Continuing - standards
Female
Gynecologic Surgical Procedures - adverse effects; education; standards
Humans
Hysterectomy - adverse effects; statistics & numerical data

Hysterectomy - adverse effects; statistics & numerical data
Intraoperative Period - statistics & numerical data
Practice (Psychology)
Problem-Based Learning - standards
Retrospective Studies
Robotics - education; utilization
Surgery, Computer-Assisted - education; standards
Time and Motion Studies

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