Robotic-assisted gynecologic/oncologic surgery: experience of early cases in a Saudi Arabian tertiary care facility

Abstract

We report early experience of a case-mix series of robotic-assisted (RA) gynecologic/oncologic surgery in an Arabian population from a tertiary care facility, and discuss the emergence/growth of robotic surgery in the Arab world (Middle East). From December 2005 to December 2010, 60 consecutive patients [benign with complex pathology (BN, n = 34) and 26 cases with various malignancies; i.e., endometrial cancer (EC, n = 13), ovarian cancer (OC, n = 4), cervical cancer (CC, n = 1), and other cancers (OTH, n = 8), underwent RA procedures for the diagnosis/treatment/management of gynecologic/oncologic diseases at a single institution using the da Vinci(®) Surgical System. Data were analyzed for demographics, clinico-pathologic and peri/post-operative factors using intent-to-treat analysis. Despite continuous growth in the number of cases performed each year, the establishment of the robotic surgery program at our institution has been rather challenging due to patient acceptance, public awareness, and administrative resistance. The mean age of the case-mix was 43 ± 15 years (distribution: BN 39 ± 14, EC 61 ± 6, OC 36 ± 15, CC 50, OTH 41 ± 12 years). The body mass index for the case-mix was 30.3 ± 6.9 kg/m(2) (distribution: BN 29.7 ± 6.2, EC 34.0 ± 3.6, OC 20.0 ± 1.7, CC 48, OTH 30.2 ± 6.2 kg/m(2)). The histology of most EC cases was endometrioid adenocarcinoma. The mean operative time was case-mix 95 ± 43, BN 77 ± 26, EC 156 ± 30, OC 80 ± 35, CC 150, OTH 79 ± 23 min. Mean blood loss was case-mix 126, BN 129, EC 177, OC 67, CC 50, OTH 71 min. Two cases (3.3%) were converted to laparotomy (one each in EC and BN groups). Mean hospital length of stay was 2 days. Four cases (6.7%) experienced complications. Only 4/26 (15.4%) of cancer cases required adjuvant therapy. The data suggest that RA gynecologic/oncologic procedures are feasible and satisfactory to our Arabian patient population and comparable to the existing literature for Caucasian counterparts. We believe this report is the first (and perhaps largest) case-mix series on the early experience of RA surgery for gynecologic/oncologic cases from the Middle East.