Robotic Total Hysterectomy: Initial Experience in a Tertiary Center

  • Alper Biler Tepecik Training and Research Hospital, Izmir, Turkey
  • Ulaş Solmaz Tepecik Training and Research Hospital, Izmir, Turkey
  • Mehmet Gökçü Tepecik Training and Research Hospital, Izmir, Turkey
  • Emre Mat Tepecik Training and Research Hospital, Izmir, Turkey
  • Atalay Ekin Tepecik Training and Research Hospital, Izmir, Turkey
  • Ahmet Demir Tepecik Training and Research Hospital, Izmir, Turkey
Keywords: Robotic total hysterectomy, da Vinci, laparoscopic hysterectomy

Abstract

Objective: To examine our initial experience with robotic total hysterectomy and evaluate operation related outcomes.Materials and Methods: We retrospectively analyzed 16 consecutive patients who underwent robotic total hysterectomy between December 2015 and August 2016 in our clinic.Results: Robotic total hysterectomy was performed for benign indications in 13 (81.25%) patients, endometrial cancer in two patients (12.5%), microinvasive cervical cancer in one patient (6.25%). The mean age of patients was 48.7 ± 6.5 years, parity was 2.8 ± 1.7, body mass index was 28.2 ± 4.6 kg/m2, preoperative hemoglobin levels was 11.6 ± 1.0 g/dl, postoperative hemoglobin levels 10.3 ± 1.0 g/dl, operation time was 162.2 ± 39.4 minutes, docking time was 7.3 ± 3.3 minutes, console time was 147 ± 37.0 minutes, uterine weight was 178.8 ± 98.5 g and duration of hospital stay was 3.6 ± 1.8 days. Blood transfusion was administered to three patients in the postoperative period. One patient was converted to laparotomy because of poor visualization of pelvic structures by a large uterus. No intraoperative complication was encountered. Postoperative complications were limited to one patient with asthma who had fever on the first day following surgery.Conclusion: The results of robotic total hysterectomy is satisfactory for both patient and surgeon. Following the completion of the learning curve, robotic total hysterectomy could be an important alternative method for laparoscopic hysterectomy. However, the installation of robotic systems, operating and maintenance costs still remain as crucial limitations for the widespread use of robotic surgery. 

Author Biographies

Alper Biler, Tepecik Training and Research Hospital, Izmir, Turkey
Department of Obstetrics and Gynecology
Ulaş Solmaz, Tepecik Training and Research Hospital, Izmir, Turkey
Department of Obstetrics and Gynecology
Mehmet Gökçü, Tepecik Training and Research Hospital, Izmir, Turkey
Department of Obstetrics and Gynecology
Emre Mat, Tepecik Training and Research Hospital, Izmir, Turkey
Department of Obstetrics and Gynecology
Atalay Ekin, Tepecik Training and Research Hospital, Izmir, Turkey
Tepecik Training and Research Hospital, Izmir, Turkey
Ahmet Demir, Tepecik Training and Research Hospital, Izmir, Turkey
Tepecik Training and Research Hospital, Izmir, Turkey

References

Garry R. The future of hysterectomy. BJOG 2005;112:133–9.

Reich H, De Caprio J, Mac Glynn F. Laparoscopic hysterectomy. J GynecolCollSurg 1989;5:213.

Desimone CP, Ueland FR. Gynecologic laparoscopy. SurgClin North Am 2008;88:319–41.

He H, Zeng D, Ou H, Tang Y, Li J, Zhong H. Laparoscopic treatment of endometrial cancer: systematic review. J Minim Invasive Gynecol 2013;20:413–23.

Reynolds RK, Advincula AP. Robot-assisted laparoscopic hysterectomy: technique and initial experience. Am J Surg 2006;191:555–60.

Visco AG, Advincula AP. Robotic gynecologic surgery. ObstetGynecol 2008;112:1369–84.

Magrina JF, Kho RM, Weaver AL, Montero RP, Magtibay PM. Robotic radical hysterectomy: comparison with laparoscopy and laparotomy. GynecolOncol 2008;109:86–91.

Wattiez A, Cohen SB, Selvaggi L. Laparoscopic hysterectomy. Cur OpinObstetGynecol 2002;14:417-22.

Garry R, Fountain J, Mason S,Hawe J, Napp V, Abbott J, et al. The eVALuate study: two paralel randomized trials, one comparing laparoscopic with abdominal hysterectomy, the other comparing laparoscopic with vaginal hysterectomy. BMJ 2004;328:1229-36.

Twijnstra AR, Blikkendaal MD, Kolkman W, Smeets MJ, Rhemrev JP, Jansen FW. Implementation of laparoscopic hysterecomy: maintenance of skills after a mentorship program. GynecolObstet Invest 2010;70:173-8.

Terzi H, Biler A, Demirtas O, Guler OT, Peker N, Kale A. Total laparoscopic hysterectomy: Analysis of the surgical learning curve in benign conditions. Int J Surg 2016;35:51-7.

Lenihan JP, Jr, Kovanda C, Seshadri-Kreaden U. What is the learning curve for robotic assisted gynecologic surgery? J Minim Invasive Gynecol 2008;15:589–94.

Pitter MC, Anderson P, Blissett A, Pemberton N. Robotic-assisted gynaecological surgery – establishing training criteria: minimizing operative time and blood loss. Int J Med Robot 2008;4:114–20.

Sendag F, Zeybek B, Akdemir A, Ozgurel B, Oztekin K. Analysis of the learning curve for robotic hysterectomy for benign gynaecological disease. Int J Med Robotics Comput Assist Surg 2014;10:275-9.

Luciano AA, Luciano DE, Gabbert J, Seshadri-Kreaden U. The impact of robotics on the mode of benign hysterectomy and clinical outcomes. Int J Med Robotics Comput Assist Surg 2016;12:114-24.

Boggess JF, Gehrig PA, Cantrell L, Shafer A, MendivilA,,Rossi E, et al. Perioperative outcomesof robotically assisted hysterectomy for benign cases withcomplex pathology. ObstetGynecol 2009;114:585–93.

Fiorentino RP, Zepeda MA, Goldstein BH, John CR, Rettenmaier MA. Pilot study assessing robotic laparoscopic hysterectomy and patient outcomes. J Minim Invasive Gynecol 2006;13:60-3.

Payne TN, Dauterive FR. A comparison of total laparoscopic hysterectomy to robotically assisted hysterectomy: surgical outcomes in a community practice. J Minim Invasive Gynecol 2008;15:286-91.

Published
2017-03-29
Section
Original Research