Implementation of robotic gynecological surgery in a German University Hospital: patient safety after 110 procedures

Dimitrios Balafoutas,Ralf Joukhadar,Achim Wöckel,Christine Wulff

doi:10.1007/s00404-020-05751-8

Dimitrios Balafoutas, Ralf Joukhadar + Show 2 more

Open Access

https://doi.org/10.1007/s00404-020-05751-8

Copy DOI

Abstract

PurposeRobotic surgery represents the latest development in the field of minimally invasive surgery and offers many technical advantages. Despite the higher costs, this novel approach has been applied increasingly in gynecological surgery. Regarding the implementation of a new operative method; however, the most important factor to be aware of is patient safety. In this study, we describe our experience in implementing robotic surgery in a German University Hospital focusing on patient safety after 110 procedures.MethodsWe performed a retrospective analysis of 110 consecutive robotic procedures performed in the University Hospital of Würzburg between June 2017 and September 2019. During this time, 37 patients were treated for benign general gynecological conditions, 27 patients for gynecological malignancies, and 46 patients for urogynecological conditions. We evaluated patient safety through standardized assessment of intra- and postoperative complications, which were categorized according to the Clavien–Dindo classification.ResultsNo complications were recorded in 90 (81.8%) operations. We observed Clavien–Dindo grade I complications in 8 (7.3%) cases, grade II complications in 5 (4.5%) cases, grade IIIa complications in 1 case (0.9%), and grade IIIb complications in 6 (5.5%) cases. No conversion to laparotomy or blood transfusion was needed.ConclusionRobotic surgery could be implemented for complex gynecological operations without relevant problems and was accompanied by low complication rates.

Highlights

Since the federal drug administration (FDA) approval of the daVinci system for gynecological operations in 2005, an increasing number of minimally invasive procedures have been performed robotically [1]
We examined the frequency of complications in regard to surgical experience and found it to be evenly distributed over time without a tendency of cumulated occurrence during the initial implementation phase (Fig. 1)
This study represents one of the few reports on robotic surgery in gynecology in German hospitals and, to our knowledge, the first description of the implementation process of this new technique for gynecological surgery focusing on patient safety

Summary

Introduction

Since the federal drug administration (FDA) approval of the daVinci system for gynecological operations in 2005, an increasing number of minimally invasive procedures have been performed robotically [1]. The design of the EndoWrist instruments enables intuitive precision movements along with tremor filtering. These technical advantages seem to improve surgical. In Germany, an increase in the availability of the robotic systems could be observed in the recent years [8]; the utilization in gynecological surgery remains relatively scarce. The main reasons for this seem to be the increased costs of obtaining and running the system, as well as the logistic obstacles of the implementation of the novel technique.

Objectives

Results

Conclusion