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. 2016 Sep;38(9):450-455.
doi: 10.1055/s-0036-1592345. Epub 2016 Sep 19.

Early Experience of Robotic Hysterectomy for Treatment of Benign Uterine Disease

Ana Luiza Gutierrez  1 , Márcia Luisa Montalvão Appel Binda  1 , José Geraldo Lopes Ramos  1
Affiliations

Early Experience of Robotic Hysterectomy for Treatment of Benign Uterine Disease

Ana Luiza Gutierrez et al. Rev Bras Ginecol Obstet. 2016 Sep.

Abstract
in English, Undetermined language

Objectives To demonstrate the initial experience of robotic hysterectomy to treat benign uterine disease at a university hospital in Brazil. Methods A cross-sectional study was conducted to review data from the first twenty patients undergoing robotic hysterectomy at our hospital. The surgeries were performed from November 2013 to August 2014, all of them by the same surgeon. The patients were reviewed for preoperative characteristics, including age, body mass index (BMI), indications for the hysterectomy and previous surgeries. Data of operative times, complications, postoperative pain and length of hospital stay were also collected. Results The total operating room time was 252.9 minutes, while the operative time was 180.7 minutes and the console time was 136.6 minutes. Docking time was 4.2 minutes, and the average undocking time was 1.9 minutes. There was a strong correlation between the operative time and the patient's BMI (r = 0.670; p = 0.001). The console time had significant correlation with the uterine weight and the patient's BMI (r = 0.468; p = 0.037). A learning curve was observed during docking and undocking times. Conclusion Despite its high cost, the robotic surgery is gaining more space in gynecological surgery. By the results obtained in our hospital, this surgical proposal proved to be feasible and safe. Our initial experience demonstrated a learning curve in some ways.

Resumo: Objetivos O presente projeto visa à documentação da experiência inicial do Hospital de Clínicas de Porto Alegre na realização da histerectomia robótica.

Métodos Um estudo transversal foi realizado a fim de revisar dados das primeiras vinte pacientes submetidas à histerectomia robótica em nosso hospital. As cirurgias foram realizadas no período de novembro de 2013 a agosto de 2014, e todas tiveram o mesmo cirurgião. Foram analisadas características pré-operatórias, incluindo idade, índice de massa corporal, cirurgias prévias abdominais, paridade, indicação da histerectomia. Dados referentes aos tempos operatórios, complicações, dor pós-operatória e tempo de internação pós-operatória também foram coletados.

Resultados O tempo de sala total foi de 252,9 minutos, enquanto o tempo cirúrgico total foi 180,7 minutos, e o tempo de console foi 136,6 minutos. O tempo médio de docking foi 4,2 minutos; e o tempo médio de undocking foi 1,9 minutos. Foi observada forte correlação entre o tempo cirúrgico total e o índice de massa corporal da paciente (r = 0,670; p = 0,001). O tempo de console teve correlação significativa com o peso uterino e com o índice de massa corporal das pacientes (r = 0,468; p = 0,037). Foi observada curva de aprendizado nos tempos de docking e undocking.

Conclusão Apesar do alto custo, a robótica vem ganhando espaço na cirurgia ginecológica. Pelos resultados obtidos no nosso hospital, a proposta provou ser factível e segura. Nossa experiência inicial demonstrou curva de aprendizado em alguns aspectos.

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Figures

Fig. 1
Fig. 1
A strong correlation was observed between the operative time and the patient's BMI (r = 0.670; p = 0.001).
Fig. 2
Fig. 2
Learning curve for the operative (A), console (B), docking (C) and undocking (D) times. There was no correlation between the operative time and the number of surgeries (A). No significant association between the console time and the number of surgeries (rs = -0.245; p = 0.298) was observed (B). However, there was an inverse correlation between the docking time and the number of surgeries (r = -0.568; p = 0.009–Figure 2C) and between the undocking time and the number of surgeries (r = -0.861; p < 0.001–Figure 2D).
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