Robotic Hysterectomy for Benign Indications: What Have We Learned from a Decade?

Abstract

Background and Objectives: Robotic surgery data need a setback on many years of practice with high-volume surgeons to evaluate its real value. Our main objective was to study the impact of a decade of robotic surgery on minimally-invasive hysterectomies for benign indications. Our secondary objectives were to evaluate our results for high-volume surgeons and complex cases. Methods: In this retrospective cohort study, we reviewed medical records at Foch Hospital, from 2010 to 2019, to evaluate the outcomes of robotic hysterectomies for benign disease. We compared the trends of benign hysterectomies done by laparoscopy and laparotomy during this period. We analyzed the proficiency group (≥ 75 cases per surgeon) and complex cases including obese patients and large uteri (>250 g). Results: 495 hysterectomies were performed by robotic, 275 by laparotomy, and 130 by laparoscopy. The laparotomy approach decreased from 62% to 29%, whereas the robotic approach increased from 26% to 61%. The operating room (OR) time decreased in the proficiency group (157.3 ± 43.32 versus 178.6 ± 48.05, P = 0.005); whereas the uterine weight was higher (194.6 ± 158.6 versus 161.3 ± 139.4, P = 0.04). Lower EBL and shorter OR time were seen with uteri ≤ 250 g subgroup (64.24 ± 110.2 ml versus 116.63 ± 146.98 ml, P = 0.0004) (169.62 ± 47.50 min versus 192.44 ± 45.82 min, P = 0.0001). The estimated blood loss (EBL) was less in the BMI ≤ 30 subgroup (68.83 ± 119.24 ml versus 124.53 ± 186.14 ml, P = 0.0005). Conclusion: A shift was observed between the laparotomy and robotic approaches. High-volume surgeons were more efficient and showed a decrease in OR time after 75 cases despite an increase in uterine weight.

Single centre experience in India for benign gynecological robotic surgery with da Vinci Si system: A real world data analysis of one decade

“…In the period 2005-2013, abdominal hysterectomy declined from 59% to 22% according to premier perspective database [9] and by 2012 the hysterectomies performed by minimally invasive surgery rose to 75% [10]. This was associated with parallel increase in RH which increased from 26% to 61% and the same study and showed that high-volume surgeons were more efficient and showed a decrease in OR time after 75 cases despite an increase in uterine weight [11].…”

Robotic surgery in obstetrics and gynecology: a bibliometric study

“…The previous increase in the number of publications found in our study is in line with the ongoing increased rate of robotic surgery in gynecology. The rate of hysterectomies performed robotically has increased parallel to a decrease in abdominal hysterectomies, as well as conventional laparoscopic and vaginal hysterectomies, during the last two decades [ 34 – 36 ]. The rate of myomectomies performed robotically has also increased since 2012 [ 21 ].…”

Improvement of Post-Operative Quality of Life in Patients 2 Years after Minimally Invasive Surgery for Pain and Deep Infiltrating Endometriosis

“…Although the study lacked power, with no preliminary effective calculation and non-comparable groups, the subgroups analysis showed that there was a greater improvement in quality of life, slightly greater in RL compared to the CL group. Most studies show no difference between the two courses of surgery except for operative length, which tends to be longer for robotic laparoscopy, and a tendency of decreased bleeding with robotic surgery [ 21 ]. The cost of robotic surgery also needs to be balanced with the surgeon’s comfort [ 22 ].…”