Abstract
We aim to analyze the surgical outcomes and learning curve of single-site robot-assisted hysterectomy. This was a retrospective cohort study from a single academic medical center. A total of 123 patients who underwent single-site robotic surgery for gynecologic disease were enrolled. Gynecologic surgeries were performed by a single surgeon using single-site robot-assisted hysterectomy. The median age of enrolled patients was 49 years (range: 30–74 years). The median operation time was 131 min (range: 59–502 min) and the median docking time was 3 min (range: 1–10 min). In addition, the median console time was 76 min (range: 29–465 min). The cumulative sum (CUSUM) graph for total operation time indicated an initial decrease at case 41, generating 3 distinct performance phases: learning (n = 41 initial cases), competence (n = 54 middle cases), and mastery (n = 28 final cases). There was one case conversion to open surgery due to the difficulty in securing the field of view because of a 16-cm bulky mass protruding from the left pelvic wall. No patients required a transfusion and two complications including vaginal cuff dehiscence were identified. The single-site robot-assisted hysterectomy is a safe and feasible procedure. The learning curve consisted of 41 cases to significantly decrease the total operation time.
Highlights
This study investigated the impact of a single surgeon’s robotic surgical experience on the surgical outcomes of hysterectomy utilizing a single-site robotic platform technology
Steep learning curves imply that skills are acquired rapidly, which usually means the procedure is simple [9]
The cumulative sum (CUSUM) curve showed that operative time stabilized after gaining experience by the surgeon
Summary
Invasive surgery, including robot-assisted surgery, has been established as a new treatment option in the gynecological field over the past decade [1]. Conventional laparoscopic surgery has become the standard surgical method due to the advantages of shorter hospital stays, reduced postoperative pain, faster recovery, lower perioperative morbidity, and improved quality of life [2]. Robotic surgery overcomes barriers of traditional laparoscopic surgery, such as the limitations of the human hand through seven degrees of movement and eliminating hand tremors. Robotic arms imitate the movement of a surgeon’s hand and limit the fulcrum effect, improve visualization, and increase independence of the operating surgeon [3]. Robotic surgery typically requires a specially trained team and may have some limitations, such as unarticulated semi-rigid instruments (i.e., harmonic scalpel device), the lack of monopolar scissors, and an unfamiliar docking process [4]. Robotic surgery typically requires a specially trained team and may have some limitations, such as unarticulated semi-rigid instruments (i.e., harmonic scalpel device), the lack of monopolar scissors, and an unfamiliar docking process [4]. iations.
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