Report of a Mississippi Hospital’s Experience with Rapid Conversion to Robotic-Assisted Gynecological Surgery

Abstract

The use of robotic-assisted gynecological surgery has grown at an unprecedented rate since its approval by the United States Food and Drug Administration in 2005. This rapid adoption of new technology has been demonstrated at Merit Health Woman's Hospital, a medical and surgical facility in Flowood, Mississippi, outside of Jackson. Woman's Hospital operates 60 patient beds with five operating rooms and began its robotic-assisted gyn surgical program in December 2010. The facility now has three fully functional daVinci Si robotic systems utilized by 27 gynecologists as well as by general surgeons and urologists. Through the end of 2014, a total of 1943 robotic-assisted total laparoscopic hysterectomies (with or without removal of the adnexa) were performed, nearly eliminating laparotomy procedures. Robotic-assisted surgery also replaced total laparoscopic surgical techniques performed straight-stick or rigid (i.e., without the utilization of wristed laparoscopic instruments) and has nearly replaced vaginal hysterectomies. Average length of procedure defined as skin-to-skin or start of first incision to complete skin closure was less for robot-assisted total laparoscopic hysterectomy (RATLH) than total abdominal hysterectomy (TAH), each with or without bilateral salpingo-oophorectomy (BSO). Physicians have found robotic-assisted techniques to be less physically taxing. Likewise, among Woman's Hospital patients surveyed, patient satisfaction remained high as minimally invasive robotic techniques replaced laparotomy. The surgical site patient infection rate has fallen from 3.9% of total hysterectomy cases performed in 2009 prior to initiation of our robotic program to an even lower 1.3% in 2014 after nearly all hysterectomies were performed using robot- assisted techniques. Quality control standards regarding operating times and surgical credentialing are enforced in the program.