Yonsei Med J.  2015 Mar;56(2):474-481. 10.3349/ymj.2015.56.2.474.

Perioperative Complications of Robot-Assisted Laparoscopic Surgery Using Three Robotic Arms at a Single Institution

• Yim GW
• Kim SW
• Nam EJ
• Kim S
• Kim YT

• KMID: 2070027
• DOI: http://doi.org/10.3349/ymj.2015.56.2.474

Abstract

PURPOSE
The aim of this study was to evaluate perioperative complications of robot-assisted laparoscopic surgery in gynecology.
MATERIALS AND METHODS
Patients who underwent elective robot-assisted laparoscopic surgery between February 2006 and December 2013 were identified. Robotic procedures were performed using the da Vinci robotic system. Patient demographic data and operative outcomes were prospectively collected in a computerized database and extracted for this study.
RESULTS
Two hundred and ninety eight patients were identified during the study period. One case was converted to conventional laparoscopy due to mechanical failure of the robot system before the procedure and excluded from review. The median age and body mass index of patients were 48 years and 23.0 kg/m2, respectively. The majority (n=130, 43.6%) of operative procedures was radical hysterectomy, followed by endometrial cancer staging (n=112, 37.6%), total hysterectomy (n=39, 13.1%), and myomectomy (n=17, 5.7%). The median operative time, estimated blood loss, and postoperative hospital stay were 208.5 min, 184.8 mL, and 8.9 days, respectively. The overall complication rate was 18.8% and that for only oncologic cases was 16.1%. Intraoperative complications (n=5, 1.7%) consisted of three vessel injuries, one bowel content leakage during an appendectomy during endometrial cancer staging and one case of bladder injury during radical hysterectomy. Early and late postoperative complications were 14.4% and 2.7%, respectively. Five patients (1.7%) experienced grade 3 complications according to Clavien-Dindo classification and therefore needed further intervention.
CONCLUSION
Robot-assisted laparoscopic surgery is a feasible approach in gynecology with acceptable complications.

Keyword

Robotics; postoperative complications; laparoscopy

MeSH Terms

Adult
Aged
Body Mass Index
Endometrial Neoplasms/surgery
Female
Humans
Hysterectomy
Laparoscopy/*methods
Length of Stay
Lymph Node Excision/methods
Middle Aged
Neoplasm Staging
Pain, Postoperative/epidemiology
*Perioperative Period
Postoperative Complications
Prospective Studies
Robotics/*methods
Socioeconomic Factors
Treatment Outcome
Uterine Cervical Neoplasms/*surgery

Reference

Johnson N., Barlow D., Lethaby A., Tavender E., Curr E., Garry R. Surgical approach to hysterectomy for benign gynaecological disease. Cochrane Database Syst Rev. 2005. CD003677.

2. Johnson N, Barlow D, Lethaby A, Tavender E, Curr L, Garry R. Methods of hysterectomy: systematic review and meta-analysis of randomised controlled trials. BMJ. 2005; 330:1478.

3. Magrina JF, Kho RM, Weaver AL, Montero RP, Magtibay PM. Robotic radical hysterectomy: comparison with laparoscopy and laparotomy. Gynecol Oncol. 2008; 109:86–91.

4. Fanning J, Fenton B, Purohit M. Robotic radical hysterectomy. Am J Obstet Gynecol. 2008; 198:649.

5. Reynolds RK, Advincula AP. Robot-assisted laparoscopic hysterectomy: technique and initial experience. Am J Surg. 2006; 191:555–560.

6. Persson J, Reynisson P, Borgfeldt C, Kannisto P, Lindahl B, Bossmar T. Robot assisted laparoscopic radical hysterectomy and pelvic lymphadenectomy with short and long term morbidity data. Gynecol Oncol. 2009; 113:185–190.

7. Kim YT, Kim SW, Hyung WJ, Lee SJ, Nam EJ, Lee WJ. Robotic radical hysterectomy with pelvic lymphadenectomy for cervical carcinoma: a pilot study. Gynecol Oncol. 2008; 108:312–316.

8. Lowe MP, Chamberlain DH, Kamelle SA, Johnson PR, Tillmanns TD. A multi-institutional experience with robotic-assisted radical hysterectomy for early stage cervical cancer. Gynecol Oncol. 2009; 113:191–194.

9. Bedient CE, Magrina JF, Noble BN, Kho RM. Comparison of robotic and laparoscopic myomectomy. Am J Obstet Gynecol. 2009; 201:566.

10. Veljovich DS, Paley PJ, Drescher CW, Everett EN, Shah C, Peters WA 3rd. Robotic surgery in gynecologic oncology: program initiation and outcomes after the first year with comparison with laparotomy for endometrial cancer staging. Am J Obstet Gynecol. 2008; 198:679.

11. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004; 240:205–213.

12. Boggess JF, Gehrig PA, Cantrell L, Shafer A, Ridgway M, Skinner EN, et al. A comparative study of 3 surgical methods for hysterectomy with staging for endometrial cancer: robotic assistance, laparoscopy, laparotomy. Am J Obstet Gynecol. 2008; 199:360.

13. DeNardis SA, Holloway RW, Bigsby GE 4th, Pikaart DP, Ahmad S, Finkler NJ. Robotically assisted laparoscopic hysterectomy versus total abdominal hysterectomy and lymphadenectomy for endometrial cancer. Gynecol Oncol. 2008; 111:412–417.

14. Holloway RW, Ahmad S, DeNardis SA, Peterson LB, Sultana N, Bigsby GE 4th, et al. Robotic-assisted laparoscopic hysterectomy and lymphadenectomy for endometrial cancer: analysis of surgical performance. Gynecol Oncol. 2009; 115:447–452.

15. Zorn KC, Gofrit ON, Orvieto MA, Mikhail AA, Galocy RM, Shalhav AL, et al. Da Vinci robot error and failure rates: single institution experience on a single three-arm robot unit of more than 700 consecutive robot-assisted laparoscopic radical prostatectomies. J Endourol. 2007; 21:1341–1344.

16. Seamon LG, Backes F, Resnick K, Cohn DE. Robotic trocar site small bowel evisceration after gynecologic cancer surgery. Obstet Gynecol. 2008; 112(2 Pt 2):462–464.

17. Boone JD, Fauci JM, Barr ES, Estes JM, Bevis KS. Incidence of port site hernias and/or dehiscence in robotic-assisted procedures in gynecologic oncology patients. Gynecol Oncol. 2013; 131:123–126.

18. Tonouchi H, Ohmori Y, Kobayashi M, Kusunoki M. Trocar site hernia. Arch Surg. 2004; 139:1248–1256.

19. Jee SH, Sull JW, Park J, Lee SY, Ohrr H, Guallar E, et al. Body-mass index and mortality in Korean men and women. N Engl J Med. 2006; 355:779–787.

20. Kho RM, Akl MN, Cornella JL, Magtibay PM, Wechter ME, Magrina JF. Incidence and characteristics of patients with vaginal cuff dehiscence after robotic procedures. Obstet Gynecol. 2009; 114(2 Pt 1):231–235.

21. Kim MJ, Kim S, Bae HS, Lee JK, Lee NW, Song JY. Evaluation of risk factors of vaginal cuff dehiscence after hysterectomy. Obstet Gynecol Sci. 2014; 57:136–143.

22. Gehrig PA, Cantrell LA, Shafer A, Abaid LN, Mendivil A, Boggess JF. What is the optimal minimally invasive surgical procedure for endometrial cancer staging in the obese and morbidly obese woman? Gynecol Oncol. 2008; 111:41–45.

23. Lambaudie E, Houvenaeghel G, Walz J, Bannier M, Buttarelli M, Gurriet B, et al. Robot-assisted laparoscopy in gynecologic oncology. Surg Endosc. 2008; 22:2743–2747.

24. Drudi L, Press JZ, Lau S, Gotlieb R, How J, Eniu I, et al. Vaginal vault dehiscence after robotic hysterectomy for gynecologic cancers: search for risk factors and literature review. Int J Gynecol Cancer. 2013; 23:943–950.

25. ElSahwi KS, Hooper C, De Leon MC, Gallo TN, Ratner E, Silasi DA, et al. Comparison between 155 cases of robotic vs. 150 cases of open surgical staging for endometrial cancer. Gynecol Oncol. 2012; 124:260–264.

26. Chong GO, Lee YH, Hong DG, Cho YL, Park IS, Lee YS. Robot versus laparoscopic nerve-sparing radical hysterectomy for cervical cancer: a comparison of the intraoperative and perioperative results of a single surgeon's initial experience. Int J Gynecol Cancer. 2013; 23:1145–1149.

27. Seror J, Bats AS, Huchon C, Bensaïd C, Douay-Hauser N, Lécuru F. Laparoscopy vs robotics in surgical management of endometrial cancer: comparison of intraoperative and postoperative complications. J Minim Invasive Gynecol. 2014; 21:120–125.

28. Pakish J, Soliman PT, Frumovitz M, Westin SN, Schmeler KM, Reis RD, et al. A comparison of extraperitoneal versus transperitoneal laparoscopic or robotic para-aortic lymphadenectomy for staging of endometrial carcinoma. Gynecol Oncol. 2014; 132:366–371.

29. Coronado PJ, Herraiz MA, Magrina JF, Fasero M, Vidart JA. Comparison of perioperative outcomes and cost of robotic-assisted laparoscopy, laparoscopy and laparotomy for endometrial cancer. Eur J Obstet Gynecol Reprod Biol. 2012; 165:289–294.