Learning Curve and Analysis of the First Robot-assisted Gynecologic Surgeries in a Highly Specialised Center

Abstract

Abstract Background The da Vinci robotic system is a new operative tool and its exact role in a highly specialised centre for surgical cancer therapy has yet to be defined. Materials and Methods In a monocentric study, the first patients who underwent robot-assisted gynecological surgery between February 2014 and July 2015 by one surgeon at Charité Universitätsmedizin Berlin Campus Mitte have been compared 1:1 to patients, operated conventionally by laparoscopy. Matching was done by one of the principal investigators. The measured parameters were surgery time (ST), total surgery time (TST), loss of haemoglobin level, estimated blood loss and length of hospitalisation. The postoperative complications were evaluated using the international Clavien-Dindo classification. A learning curve was evaluated and thecomplication parameters of the robot-assisted group were compared within different learning phases. Results For the robot-assisted group, TST was longer (mean [SD] minutes, 212 [87], 185 [89], p = 0.005). There were no differences in blood loss (mean [SD] loss of haemoglobin in g/dl, 1.7 [1.1], 0.9 [1.6], p = 0.60; mean [SD] estimated blood loss in ml, 215 [190], 204 [195], p = 0.375) and length of stay (mean [SD] days, 7 [2], 7 [3], p = 0.972). The learning curve showed a three-phase division after an initial learning curve of only twelve robot-assisted surgeries. There was no difference in the overall complication rates between the two groups as well as between the three learning phases of the robot group. Conclusion Robot-assisted gynecological surgeries are associated with longer operating times. Differences regarding complication parameters and postoperative recovery were not observed.