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One Institute Experience of Robotic Single-Site Surgery: 500 Cases in Benign Gynecology
Abstracts / Journal of Minimally Invasive Gynecology 24 (2017) S1–S201
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robotic hysterectomy as compared to laparoscopic hysterectomy. This could be due to surgeon expertise, the efficiency of the surgical team, or the ergonomic advantage of robotic surgery in obese patients. More research is needed to further clarify the factors contributing to this significant advantage.
69
Open Communications 2 – Robotics (11:00 AM–12:00 PM) 11:32 AM – GROUP B
One Institute Experience of Robotic Single-Site Surgery: 500 Cases in Benign Gynecology Jeong K, Lee SR, Moon H-S. Obstetrics and Gynecology, College of Medicine, Ewha Womans University, Seoul, Republic of Korea Study Objective: To report 500 cases of robotic single-site surgery(RSSS) and to evaluate feasibility and safety of RSSS in benign gynecology using the da Vinci Si system. Design: Retrospective study. Setting: Robot Surgery Center of Ewha Womans University Mokdong Hospital. Patients: 500 patients with gynecologic disease. Intervention: RSSSs by three surgeons from November 2014 to April 2017. Measurements and Main Results: During two and a half years, 500 cases of RSSSs were performed. Three surgeons who were skilled robotic multi-site surgery, conducted mainly hysterectomy, myomectomy, and ovarian cystectomy. We analyzed patient’s characteristics and surgical variables including docking time. The mean age was 39.3 ± 10.2 years old. The age distribution of patients according to type of RSSS. RSSS Number of cases Mean age Hysterectomy Myomectomy Adnexal surgery Others Total
167 138 180 14 500
47.5 ± 7.1 36.9 ± 6.0 32.7 ± 8.8 51.9 ± 13.4 39.3 ± 10.2
Range of age 30–75 20–51 18–70 32–70 18–75
RSSS: robotic single-site surgery. 167 cases of robotic single-site hysterectomy, 138 cases of myomectomy, and 180 cases of adnexal surgery were performed. The other 14 cases were sacrocolpopexy for pelvic organ prolapse and neurogenic tumor resection. Dividing 500 cases into trisections, the first period was one year (November 2014-October 2015), the second time was 10 months (November 2015August 2016), and it took just 8 months (September 2016- April 2017) to accomplish last one-third cases. The mean docking time was 4.6 ± 2.5 minute. According trisections of period, the docking time was decreased significantly (1st term: 5.8 ± 3.1 min, 2nd term: 4.6 ± 2.4 min, 3rd term: 3.7 ± 1.6 min, p < .001). In only three cases (0.6%), RSSS converted to a couple of explo-laparotomy and one of conventional laparoscopy due to unmanageable huge size of uterus or ovarian cysts. The complications occurred in four patients (0.8%). There were a bowel injury, a vault dehiscence, a pelvic infection after robotic singlesite hysterectomy with adhesiolysis and one foot drop after neurogenic tumor resection. Conclusion: In our experience, the cases of RSSS have been increased rapidly. The shorter docking times in process of time, fewer conversions and fewer complications support feasibility and safety of RSSS in gynecology.
Fig. 1. The change of docking time by trisections of period.
70
Open Communications 2 – Robotics (11:00 AM–12:00 PM) 11:39 AM – GROUP B
Robotic-Assisted Radical Hysterectomy Results in Better Surgical Outcomes Compared to the Traditional Laparoscopic Radical Hysterectomy for the Treatment of Cervical Cancer Nie J, Yan A, Liu X. Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China Study Objective: The aim of this study was to compare the surgical outcomes of robotic-assisted radical hysterectomy (RRH) to traditional laparoscopic radical hysterectomy for the treatment of early-stage cervical cancer in a retrospective cohort of a total of 933 patients. Design: Retrospective cohort study. Setting: Academic affiliated community hospital. Patients: We have enrolled 100 patients into the RRH and 833 patients into the TLRH group between July 2009 and June 2016 by a single surgeon. Intervention: The surgical outcomes include operating time, blood loss, transfusion rate, pelvic lymph node yield, hospitalization days, duration of bowel function recovery, Catheter removal before and after three weeks, conversion to laparotomy and intra- and postoperative complications. Follow-up results were also analyzed for all patients. Measurements and Main Results: Both groups have similar patient and tumor characteristics but patients with a larger lesion size were preferably enrolled in the TLRH treatment group. The treatment with RRH was generally superior to TLRH with respect to operating time, blood loss, length of hospitalization, duration of bowel function recovery and postoperative complications. On follow-up of patients, there were no relapses reported in the RRH group compared to 4% of relapse cases and 2.9% of deaths due to metastasis in the TLRH group. No conversion of laparotomy occurred in the RRH group. No significant difference was found with respect to intraoperative complications and blood transfusion between both groups. Conclusion: The results from this study suggest that RRH is superior to TLRH with regard to surgical outcome and may pose a safe and feasible alternative to TLRH. The operating time and lymph node yield is acceptable. Our study is one of the largest single center studies of surgical outcomes comparing RRH and TLRH during cervical cancer treatment and our findings will significantly contribute to the safety of alternative treatment options for patients.
S27
robotic hysterectomy as compared to laparoscopic hysterectomy. This could be due to surgeon expertise, the efficiency of the surgical team, or the ergonomic advantage of robotic surgery in obese patients. More research is needed to further clarify the factors contributing to this significant advantage.
69
Open Communications 2 – Robotics (11:00 AM–12:00 PM) 11:32 AM – GROUP B
One Institute Experience of Robotic Single-Site Surgery: 500 Cases in Benign Gynecology Jeong K, Lee SR, Moon H-S. Obstetrics and Gynecology, College of Medicine, Ewha Womans University, Seoul, Republic of Korea Study Objective: To report 500 cases of robotic single-site surgery(RSSS) and to evaluate feasibility and safety of RSSS in benign gynecology using the da Vinci Si system. Design: Retrospective study. Setting: Robot Surgery Center of Ewha Womans University Mokdong Hospital. Patients: 500 patients with gynecologic disease. Intervention: RSSSs by three surgeons from November 2014 to April 2017. Measurements and Main Results: During two and a half years, 500 cases of RSSSs were performed. Three surgeons who were skilled robotic multi-site surgery, conducted mainly hysterectomy, myomectomy, and ovarian cystectomy. We analyzed patient’s characteristics and surgical variables including docking time. The mean age was 39.3 ± 10.2 years old. The age distribution of patients according to type of RSSS. RSSS Number of cases Mean age Hysterectomy Myomectomy Adnexal surgery Others Total
167 138 180 14 500
47.5 ± 7.1 36.9 ± 6.0 32.7 ± 8.8 51.9 ± 13.4 39.3 ± 10.2
Range of age 30–75 20–51 18–70 32–70 18–75
RSSS: robotic single-site surgery. 167 cases of robotic single-site hysterectomy, 138 cases of myomectomy, and 180 cases of adnexal surgery were performed. The other 14 cases were sacrocolpopexy for pelvic organ prolapse and neurogenic tumor resection. Dividing 500 cases into trisections, the first period was one year (November 2014-October 2015), the second time was 10 months (November 2015August 2016), and it took just 8 months (September 2016- April 2017) to accomplish last one-third cases. The mean docking time was 4.6 ± 2.5 minute. According trisections of period, the docking time was decreased significantly (1st term: 5.8 ± 3.1 min, 2nd term: 4.6 ± 2.4 min, 3rd term: 3.7 ± 1.6 min, p < .001). In only three cases (0.6%), RSSS converted to a couple of explo-laparotomy and one of conventional laparoscopy due to unmanageable huge size of uterus or ovarian cysts. The complications occurred in four patients (0.8%). There were a bowel injury, a vault dehiscence, a pelvic infection after robotic singlesite hysterectomy with adhesiolysis and one foot drop after neurogenic tumor resection. Conclusion: In our experience, the cases of RSSS have been increased rapidly. The shorter docking times in process of time, fewer conversions and fewer complications support feasibility and safety of RSSS in gynecology.
Fig. 1. The change of docking time by trisections of period.
70
Open Communications 2 – Robotics (11:00 AM–12:00 PM) 11:39 AM – GROUP B
Robotic-Assisted Radical Hysterectomy Results in Better Surgical Outcomes Compared to the Traditional Laparoscopic Radical Hysterectomy for the Treatment of Cervical Cancer Nie J, Yan A, Liu X. Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China Study Objective: The aim of this study was to compare the surgical outcomes of robotic-assisted radical hysterectomy (RRH) to traditional laparoscopic radical hysterectomy for the treatment of early-stage cervical cancer in a retrospective cohort of a total of 933 patients. Design: Retrospective cohort study. Setting: Academic affiliated community hospital. Patients: We have enrolled 100 patients into the RRH and 833 patients into the TLRH group between July 2009 and June 2016 by a single surgeon. Intervention: The surgical outcomes include operating time, blood loss, transfusion rate, pelvic lymph node yield, hospitalization days, duration of bowel function recovery, Catheter removal before and after three weeks, conversion to laparotomy and intra- and postoperative complications. Follow-up results were also analyzed for all patients. Measurements and Main Results: Both groups have similar patient and tumor characteristics but patients with a larger lesion size were preferably enrolled in the TLRH treatment group. The treatment with RRH was generally superior to TLRH with respect to operating time, blood loss, length of hospitalization, duration of bowel function recovery and postoperative complications. On follow-up of patients, there were no relapses reported in the RRH group compared to 4% of relapse cases and 2.9% of deaths due to metastasis in the TLRH group. No conversion of laparotomy occurred in the RRH group. No significant difference was found with respect to intraoperative complications and blood transfusion between both groups. Conclusion: The results from this study suggest that RRH is superior to TLRH with regard to surgical outcome and may pose a safe and feasible alternative to TLRH. The operating time and lymph node yield is acceptable. Our study is one of the largest single center studies of surgical outcomes comparing RRH and TLRH during cervical cancer treatment and our findings will significantly contribute to the safety of alternative treatment options for patients.