The first 100 da Vinci hysterectomies: an analysis of the learning curve for a single surgeon

Abstract

Background: Robotic gynecologic procedures were FDA-approved in March 2005. Published average times for robotic hysterectomies vary from 192 minutes to 242 minutes and one report indicated operative times ranging from 4.5 to ten hours. Many critics cite learning curves and increased operative times as a deterrent to performing robotic hysterectomies.

Methods: This is a retrospective review of surgical times (learning curve) for the first 100 consecutive extrafascial hysterectomies with or without salpingo-oophorectomy for a single surgeon. Operating times were recorded by operating room nursing staff for each case. The times reported are from "skin to skin," which is defined as from when the surgeon started to place anything vaginally until the last suture was placed to close the trocar sites. We report average times for hysterectomy per 20 cases.

Results: The average time for hysterectomies was as follows: First 20 cases--124 minutes, second 20 cases--94 minutes, third 20 cases--85 minutes, fourth 20 cases--88 minutes, fifth 20 cases--81 minutes. Age, body mass index and uterine weights were comparable between groups. Complications were highest in the first 20 at 15 percent, compared with 5 percent for the remaining groups, but this did not reach statistical significance.

Conclusions: The learning curve for da Vinci hysterectomies is steep, with the maximum improvement in surgical times in the first 20 cases. Minimal improvement was demonstrated after this.