Trends in Route of Hysterectomy after the Implementation of a Comprehensive Robotic Training Program

Abstract

Objective To evaluate trends in surgical approach for hysterectomy following the introduction and implementation of a comprehensive robotic surgery program. Methods A retrospective review of all hysterectomies done at two institutions, a community hospital and a suburban, tertiary-care teaching hospital, in the same health system over a five-year period, January 2010 through December 2014. A robotic surgery training program was implemented during the first year of the study and trends in route of hysterectomy were evaluated in the subsequent years. Results A total of 5175 patients undergoing hysterectomy, for both benign and malignant indications, were included in the study. There was a significant decrease in the percent of cases performed through an abdominal approach at both the community and teaching hospitals (19.3% decline at each institution). There was an inversely related significant increase in the percent of robotic procedures at both the community and teaching hospitals (44.5% and 17%, respectively). A decrease in number of cases performed vaginally over this period was only noted in the community hospital site (25.2% decrease), and there was a slightly higher rate of vaginal hysterectomies at the teaching hospital over this study period (21.9% in 2010, 24.1% in 2014). Conclusion The decrease in number of abdominal and laparoscopic hysterectomies and increase in number of robotic hysterectomies that was seen are consistent with national trends. The initiation of a robotic training program did not prevent the proliferation of use of the robot but did aim to ensure proficiency on the robot prior to gaining privileges for patient use. This type of comprehensive training and monitoring program could be applied to future technologic advances to ensure a standard level of surgical proficiency. Trends in route of hysterectomy are clearly multifactorial and involve patient, provider, and location-specific factors that are likely to continue to change.

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

“…This is consistent with previous reports. 17 , 18 , 27 , 28 We did not observe a decrease in traditional laparoscopy route. Robotic surgery introduction shifted complex laparotomies to a minimally invasive approach, which benefited our patients by reducing complications, LOS, pain, and postoperative recovery.…”

“… 11 – 16 Robotic surgery demonstrated a rapid adoption in minimally invasive hysterectomy because of the shorter learning curve. 17 , 18 The increase in minimally invasive surgery attributed to robotic surgery could be one of the most interesting aspects of its use, especially for benign conditions, offering patients shorter hospital stay, smaller incisions, less postoperative pain, and fewer complications when compared to laparotomy. 19 The impact of highly skilled surgeons in robotic surgery on different peri-operative parameters should be further evaluated.…”

Decline in surgeon volume after successful implementation of advanced laparoscopic surgery in gynecology: An undesired side effect?

“…[1][2][3][4] Indications have broadened and in addition to laparoscopy, robotic surgery is on the rise since its approval by the US Food and Drug Administration for gynecological procedures in 2005. 5 With further development of these techniques and improvement of surgical skills, a shift towards a minimally invasive approach as opposed to conventional surgery is observed, leading to beneficial patient outcomes, especially for laparoscopy. [6][7][8][9][10][11] To master a new surgical technique, one has to go through a procedure-specific learning curve until a plateau is reached.…”

Seguridad del alta temprana en pacientes con histerectomía laparoscópica en una institución de alto nivel de complejidad en Bogotá, Colombia, 2013 - 2019. Cohorte histórica

“…La histerectomía, o extirpación quirúrgica del útero, es uno de los procedimientos ginecológicos realizados con mayor frecuencia 1 . Se estima que en Estados Unidos cada año se programan 600.000 histerectomías por patología benigna 2 . Las indicaciones más frecuentes incluyen la miomatosis uterina asociada a hemorragia uterina anormal, el prolapso pélvico, la endometriosis, dismenorrea y dispareunia.…”