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Implementation and applications of robotic surgery within gynecologic oncology and gynecology; Analysis of the first thousand cases

Lönnerfors, C. LU and Persson, Jan LU (2013) In Ceska gynekologie / Ceska lekarska spolecnost J. Ev. Purkyne 78(1). p.12-19
Abstract

Objective. To describe the effects of implementing a robotic surgical program within gynecologic oncology and gynecology at a tertiary referral hospital. Design: Prospective study. Setting: University Hospital, Lund and Lund University, Sweden. Methods. Based on prospective data retrieved for all patients, we evaluated intraoperative times, estimated blood loss, rate of conversion and rate of intraoperative complications in the first 1000 robotic surgeries to describe the effects of implementing the technology and the applications of robotic surgery over time. Results. Between the years 2005-2011, 606 women were operated on for a malignant disease and 394 for a benign disorder. The median age was 49 years (14-89 years) and the median... (More)

Objective. To describe the effects of implementing a robotic surgical program within gynecologic oncology and gynecology at a tertiary referral hospital. Design: Prospective study. Setting: University Hospital, Lund and Lund University, Sweden. Methods. Based on prospective data retrieved for all patients, we evaluated intraoperative times, estimated blood loss, rate of conversion and rate of intraoperative complications in the first 1000 robotic surgeries to describe the effects of implementing the technology and the applications of robotic surgery over time. Results. Between the years 2005-2011, 606 women were operated on for a malignant disease and 394 for a benign disorder. The median age was 49 years (14-89 years) and the median BMI 25,2 kg/m2 (14.7-61.7 kg/m2). The median blood loss was 100 ml (range 0-1300 ml). Nineteen (1.9%) intraoperative complications occurred. Conversion to laparotomy was necessary in 37 patients (3.7%) primarily due to excessive adhesions (n = 15) or unexpected disseminated cancer (n = 11). The proportion of minimally invasive surgery for cervical, endometrial, and early ovarian cancer increased from 26% in 2005 to 81% in 2011. A wide variety of procedures including rare and very complex surgery, otherwise operated by laparotomy, were gradually introduced. Overall, the total OR time per procedure decreased by 159 minutes between the first and last two-year periods, mainly due to a reduction in surgical time by 132 minutes, mainly seen in oncology cases. Conclusion. Robotic surgery enables minimally invasive surgery for a larger proportion of patients with malignant and select benign gynecological disorders with low rates of conversions and intraoperative complications. The effort and time needed to build a successful robotic team should not be underestimated. An adequate surgical volume with a large proportion of complex cases is necessary to motivate a robotic program.

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organization
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Contribution to journal
publication status
published
subject
keywords
Robotic surgery, Surgical applications
in
Ceska gynekologie / Ceska lekarska spolecnost J. Ev. Purkyne
volume
78
issue
1
pages
8 pages
publisher
Ceska Lekarska Spolecnost J. E. Purkyne
external identifiers
  • Scopus:84883679313
ISSN
1210-7832
language
English
LU publication?
yes
id
0b46dea9-d05b-4849-8555-1b9f2d855bcd
date added to LUP
2016-04-12 14:22:55
date last changed
2016-10-13 05:06:03
@misc{0b46dea9-d05b-4849-8555-1b9f2d855bcd,
  abstract     = {<p>Objective. To describe the effects of implementing a robotic surgical program within gynecologic oncology and gynecology at a tertiary referral hospital. Design: Prospective study. Setting: University Hospital, Lund and Lund University, Sweden. Methods. Based on prospective data retrieved for all patients, we evaluated intraoperative times, estimated blood loss, rate of conversion and rate of intraoperative complications in the first 1000 robotic surgeries to describe the effects of implementing the technology and the applications of robotic surgery over time. Results. Between the years 2005-2011, 606 women were operated on for a malignant disease and 394 for a benign disorder. The median age was 49 years (14-89 years) and the median BMI 25,2 kg/m2 (14.7-61.7 kg/m2). The median blood loss was 100 ml (range 0-1300 ml). Nineteen (1.9%) intraoperative complications occurred. Conversion to laparotomy was necessary in 37 patients (3.7%) primarily due to excessive adhesions (n = 15) or unexpected disseminated cancer (n = 11). The proportion of minimally invasive surgery for cervical, endometrial, and early ovarian cancer increased from 26% in 2005 to 81% in 2011. A wide variety of procedures including rare and very complex surgery, otherwise operated by laparotomy, were gradually introduced. Overall, the total OR time per procedure decreased by 159 minutes between the first and last two-year periods, mainly due to a reduction in surgical time by 132 minutes, mainly seen in oncology cases. Conclusion. Robotic surgery enables minimally invasive surgery for a larger proportion of patients with malignant and select benign gynecological disorders with low rates of conversions and intraoperative complications. The effort and time needed to build a successful robotic team should not be underestimated. An adequate surgical volume with a large proportion of complex cases is necessary to motivate a robotic program.</p>},
  author       = {Lönnerfors, C. and Persson, Jan},
  issn         = {1210-7832},
  keyword      = {Robotic surgery,Surgical applications},
  language     = {eng},
  number       = {1},
  pages        = {12--19},
  publisher    = {ARRAY(0x5fe8f90)},
  series       = {Ceska gynekologie / Ceska lekarska spolecnost J. Ev. Purkyne},
  title        = {Implementation and applications of robotic surgery within gynecologic oncology and gynecology; Analysis of the first thousand cases},
  volume       = {78},
  year         = {2013},
}