Robotic Hysterectomy and Pelvic–Aortic Lymphadenectomy for Endometrial Cancer

Seamon, Leigh G.; Cohn, David E.; Richardson, Debra L.; Valmadre, Sue; Carlson, Matthew J.; Phillips, Gary; Fowler, Jeffrey M.

doi:10.1097/aog.0b013e31818e4416

Cited by 121 publications

(58 citation statements)

References 25 publications

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“…While in our study the operative time for robotic-assisted cases was longer than traditional laparoscopic cases, this may have been precipitated by the fact that our mean operative time for traditional laparoscopic staging was shorter than that reported elsewhere [8]. A reduction in operative times after the learning curve without compromise in comprehensive staging was reported by previous publication [15][16][17]. According to Lowe and Seamon the learning curve for robotic-assisted surgical staging for endometrial cancer lies between 9 and 20 cases.…”

Section: Discussioncontrasting

confidence: 35%

Surgical Outcomes of Robotic-Assisted Surgical Staging for Endometrial Cancer Are Equivalent to Traditional Laparoscopic Staging at a Minimally Invasive Surgical Center

Cardenas-Goicoechea¹,

Adams²,

Bhat³

et al. 2010

Obstetrical &Amp; Gynecological Survey

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Objective-To compare peri-and post-operative complications and outcomes of robotic-assisted surgical staging with traditional laparoscopic surgical staging for women with endometrial cancer.Methods-A retrospective chart review of cases of women undergoing minimally invasive total hysterectomy and pelvic and para-aortic lymphadenectomy by a robotic-assisted approach or traditional laparoscopic approach was conducted. Major intraoperative complications, including vascular injury, enterotomy, cystotomy, or conversion to laparotomy, were measured. Secondary outcomes including operative time, blood loss, transfusion rate, number of lymph nodes retrieved, and the length of hospitalization were also measured.Results-275 cases were identified-102 patients with robotic-assisted staging and 173 patients with traditional laparoscopic staging. There was no significant difference in the rate of major complications between groups (p=0.13). The mean operative time was longer in cases of roboticassisted staging (237 min vs. 178 min, p<0.0001); however, blood loss was significantly lower (109 ml vs. 187 ml, p<0.0001). The mean number of lymph nodes retrieved were similar between groups (p=0.32). There were no significant differences in the time to discharge, re-admission, or re-operation rates between the two groups.Conclusion-Robotic-assisted surgery is an acceptable alternative to laparoscopy for minimally invasive staging of endometrial cancer. In addition to the improved ease of operation, visualization, and range of motion of the robotic instruments, robotic surgery results in a lower mean blood loss, although longer operative time. More data are needed to determine if the rates of urinary tract injuries and other surgical complications can be reduced with the use of robotic surgery.

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Section: Discussioncontrasting

confidence: 35%

Surgical Outcomes of Robotic-Assisted Surgical Staging for Endometrial Cancer Are Equivalent to Traditional Laparoscopic Staging at a Minimally Invasive Surgical Center

Cardenas-Goicoechea¹,

Adams²,

Bhat³

et al. 2010

Obstetrical &Amp; Gynecological Survey

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“…Both microsurgical learning curves and robotic learning curves have previously been described, but robotic microsurgery has not been rigorously studied elsewhere. 14,15 The SARMS evaluation system is unique in that it combines previously validated skill assessment parameters for both microsurgery and robotic surgery. Attempting to define learning curves in a clinical setting is fraught with challenges.…”

Section: Discussionmentioning

confidence: 99%

Robotic Microsurgical Training and Evaluation

Selber

Alrasheed

2014

Seminars in Plastic Surgery

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Robotic surgery has expanded rapidly over the past two decades and is in widespread use among the surgical subspecialties. Clinical applications in plastic surgery have emerged gradually over the last few years. One of the promising applications is robotic-assisted microvascular anastomosis. Here the authors first describe a process by which an assessment instrument they developed called the Structured Assessment of Robotic Microsurgical Skills (SARMS) was validated. The instrument combines the previously validated Structured Assessment of Microsurgical Skills (SAMS) with other skill domains in robotic surgery. Interrater reliability for the SARMS instrument was excellent for all skill areas among four expert, blinded evaluators. They then present a process by which the learning curve for robotic-assisted microvascular anastomoses was measured and plotted. Ten study participants performed five robotic microanastomoses each that were recorded, deidentified and scored. Trends in SARMS scores were plotted. All skill areas and overall performance improved significantly for each participant over the five microanastomotic sessions, and operative time decreased for all participants. The results showed an initial steep ascent in technical skill acquisition followed by more gradual improvement, and a steady decrease in operative times for the cohort. Participants at all levels of training, ranging from minimal microsurgical experience to expert microsurgeons gained proficiency over the course of five robotic sessions.

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“…This clinical impression is supported by a recent investigation looking at the development of proficient operating times using a newly implemented robotic approach for hysterectomy with lymph node dissection by gynecologic oncologists. 15 Using the Contrasting Groups method, we divided trainees into competent (Ն20 vaginal hysterectomies) and noncompetent (Ͻ20 vaginal hysterectomies). The distributions of scores were plotted from the 3 intraoperative scales, and the Contrasting Groups method was applied to each scale.…”

Section: Methodsmentioning

confidence: 99%

Establishing cutoff scores on assessments of surgical skills to determine surgical competence

Jelovsek

Walters

Korn

et al. 2010

American Journal of Obstetrics and Gynecology

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OBJECTIVE:The aim of this study was to establish minimum cutoff scores on intraoperative assessments of surgical skills to determine surgical competence for vaginal hysterectomy.STUDY DESIGN: Two surgical rating scales, the Global Rating Scale of Operative Performance and the Vaginal Surgical Skills Index, were used to evaluate trainees while performing vaginal hysterectomy. Cutoff scores were determined using the Modified Angoff method. RESULTS:Two hundred twelve evaluations were analyzed on 76 surgeries performed by 27 trainees. Trainees were considered minimally competent to perform vaginal hysterectomy if total absolute scores (95% confidence interval) on Global Rating Scale ϭ 18 (16.5-20.3) and Vaginal Surgical Skills Index ϭ 32 (27.7-35.5). On average, trainees met new cutoffs after performing 21 and 27 vaginal hysterectomies, respectively. With the new cutoffs applied to the same cohort of fourth-year obstetrics and gynecology trainees, all residents achieved competency in performing vaginal hysterectomy by the end of their gynecology rotations.CONCLUSION: Standard-setting methods using cutoff scores may be used to establish competence in vaginal surgery.

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Robotic Hysterectomy and Pelvic–Aortic Lymphadenectomy for Endometrial Cancer

Abstract: III.

Cited by 121 publications

References 25 publications

Surgical Outcomes of Robotic-Assisted Surgical Staging for Endometrial Cancer Are Equivalent to Traditional Laparoscopic Staging at a Minimally Invasive Surgical Center

Surgical Outcomes of Robotic-Assisted Surgical Staging for Endometrial Cancer Are Equivalent to Traditional Laparoscopic Staging at a Minimally Invasive Surgical Center

Robotic Microsurgical Training and Evaluation

Establishing cutoff scores on assessments of surgical skills to determine surgical competence

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