Introduction of Robot-assisted Surgery for Benign Total Hysterectomy with Salpingectomy: Learning Curve, Safety and Experience in a Tertiary Surgical Center.

Abstract

Background: The dynamic advances in robot-assisted surgery have particularly affected gynecological surgery. An analysis of the surgical data of robot-assisted procedures, starting when the procedure is first introduced into a surgical center, provides valuable insights into the initial use and integration of the da Vinci system in routine clinical practice and the impact on patient care. This article aims to investigate the learning curve and show the increased proficiency with this approach. This analysis focuses on the most common procedure performed during the introductory phase: benign total hysterectomy with salpingectomy.

Material and method: A retrospective data analysis was carried out of the first 250 patients operated on between February 2020 and June 2022 by five different surgeons in Freiburg University Hospital using the da Vinci surgical system. The evaluation includes classic surgical parameters such as preparation times, incision-to-suture times, and console times as well as the learning curves of the surgeons and the surgical team (incl. CUSUM analysis). Perioperative patient characteristics (e.g., blood loss, hospitalization times, conversion rate) are also presented.

Results: Most procedures (30%) were carried out for uterine fibroids. Operating times decreased significantly over time as more and more robot-assisted procedures were carried out: the surgical preparation time decreased over the first 30 procedures from 28.1 ± 8.6 min to 23.8 ± 7.2 min. The initial incision-to-suture time for benign total hysterectomies with salpingectomy was 94.0 ± 42.2 min and had decreased significantly by the end of the first 20 procedures. The average console time was 66.8 ± 36.1 min, and the decrease was particularly visible over the first 20 procedures. The individual learning curves of the surgeons showed significant decreases in time. For example, the average console time of surgeon A decreased over the first ten procedures from 70.5 ± 23.0 min to 46.9 ± 13.5 min. The conversion rate for the whole cohort was 0.8%.

Discussion: The evaluation of the first 250 da Vinci surgeries demonstrates the easy learnability of robot-assisted surgery. The conversion rate was very low, coming in at just 0.8%. A positive effect on the learning curve of individual surgeons was found after about 20 procedures. Both the preparation times and the incision-to-suture times decreased rapidly, meaning that there were no problems integrating the new approach into routine clinical practice.