Robot-assisted gynecological surgery in a community setting

The objective of this study is to review our experience using the da Vinci robotic system to perform various gynecological surgeries for benign indications. Between July 2005 and April 2008, 110 patients underwent robot-assisted gynecological surgeries in Rochester General Hospital, NY. The records of these patients were retrospectively reviewed by an independent data collector to analyze the safety, effectiveness, and outcome of the surgeries done using the robotic system. The parameters reviewed include indication for surgery, type of procedure, operative time, blood loss, hospital stay, and intraoperative and post operative complications. The procedures completed include 74 hysterectomies including hysterectomies with bilateral salpingoophorectomy, 15 hysterectomies with sacrocolpopexy and other concomitant procedures, 18 myomectomies, and 3 oophorectomies. All procedures were completed robotically without the need for conversion to an open approach. The mean operation time was 2.15 h. Average estimated blood loss was 160 cc. Complications encountered include one cystotomy which was identified immediately and repaired in addition to one vault dehiscence and two post operative infections. The mean hospital stay was 1 day, with more than half of the patients being discharged within 24 h after the surgery. Post operative pain level was in the range of 0-6 in a scale of 0-10 (0: no pain, 10: worst pain in their life) and relieved by non-steroidal anti-inflammatory drugs. Robot-assisted laparoscopic benign surgical procedures are feasible techniques in a community setting. Robot-assisted laparoscopy has a promising future in minimally invasive surgery as it proved beneficial for our patients who experienced low complication rate and overall fast recovery compared to other approaches.