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

Abstract

Purpose Robotic 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. Methods We 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. Results No 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. Conclusion Robotic surgery could be implemented for complex gynecological operations without relevant problems and was accompanied by low complication rates.

How does robotic surgery affect gynecology patient care?

“…Conversion was evaluated in six studies. Conversion was not required in two of the studies [ 21 , 25 ]. In a study comparing robotic surgery and laparoscopic treatments, the conversion rate of robotic surgery to open surgery was found to be lower than laparoscopy [ 24 ].…”

“…( P = 0.919) – – A total of 7 (3.4%) conversions to open surgery were registered ( P = 1.00) Herrinton et al [ 20 ], The average operative time was reduced ( P < 0.0001) mean length of stay was similar for the robotic and conventional group Among noncomplex cases, robotic surgery was associated with complications of the urinary tract ( P = 0.04). No other significant differences in risk of complications between conventional and robotic cases Robotic surgery reduction in estimated blood loss – – – Balafoutas et al [ 21 ], – – Ninety (81.8%) procedures were completed without any problems No blood transfusion was needed – – No need for conversion to laparotomy was observed Sofer et al [ 22 ], Robotic surgery was longer operating theater time ( P < 0.001) Robotic surgery was associated with shorter hospital stays ( P < 0.0001) Robotic surgery fewer postoperative complications ( P = 0.0008) – – 5-year survival was higher in the robotic surgery group. Quality of life measures were better after robotic surgery – Silva e Silva A et al [ 23 ], In our study, robotic surgery was more time consuming than traditional laparoscopic surgery The median hospital stay was was similar in both groups Eight major complications were registered in each group Estimated blood loss was higher in the robotic surgery group, but not significant ( P = 0.64) One patient in the robotic surgery group was converted to laparotomy Sinha R et al [ 24 ], Comparison of Robotic and Laparoscopic Hysterectomy for the Large Uterus Robotic surgery took longer operatin...…”

The role of minimally invasive surgery in gynaecological cancer: an overview of current trends

“…Currently there are no available data regarding the oncologic outcome of robotic vs. laparoscopic surgery, however it is fair to suggest that a non- inferiority must be expected. Additionally, the inherent capability of modern robotic systems to detect the sentinel lymph nodes, which is currently an important step of a large portion of guideline-conform hysterectomies ( Concin et al, 2021 ), increases the practicality of this procedure ( Balafoutas et al, 2020 ), in particular for morbidly obese patients, for which robotic surgery appears to improve the outcome in comparison to traditional laparoscopy ( Chan et al, 2015 ).…”