Robot-assisted laparoscopy — and a strategy to introduce it in hospitals — were found to be a safe surgical technique for endometriosis and other gynecological complications, according to Brazilian researchers.
Their study, “Safety Model for the Introduction of Robotic Surgery in Gynecology,” appeared in the journal RBGO Gynecology and Obstetrics.
Robots are used in minimally invasive laparocopic surgery, including in gynecology. Compared to conventional laparoscopy, the use of robots could provide safer and more reproducible procedures. Complications such as the ability to perform difficult sutures, the instruments’ range of motion, or surgeons’ tremors, could be overcome by robotic assistance.
To guarantee appropriate training and prioritize patient safety, the study’s authors said that at the Hospital Israelita Albert Einstein in Sao Paulo, Brazil, proctors experienced in laparoscopy and proficient in robotics are designated to support less experienced teams throughout the surgery.
The proctors also evaluate the surgeons’ skills and enable them to conduct surgeries on their own once they show consistent skill.
The researchers analyzed the success and safety of performing gynecological surgeries with robot-assisted laparoscopy during its implementation over six years, considering procedures performed with and without an experienced proctor.
They analyzed the records of 274 patients who underwent surgeries for benign or malignant gynecological diseases. The investigators considered patients’ diagnoses, addressing factors such as specific procedures performed, surgery duration, length of hospital stay, surgery complications, blood transfusion, and mortality.
Results revealed that three experienced robotic surgeons performed 187 surgeries, while 87 surgeries were conducted by 20 less experienced surgeons, always under the guidance of a proctor.
The most common diagnosis was endometriosis (57%). The vast majority of patients (99.6%) were classified as ASA I or II before surgery, which refers to normal, healthy people or those with mild systemic disease, respectively.
The median procedure time was 225 minutes and the median length of hospital stay was two days. The blood transfusion rate was 5.8%. Complications during surgery were seen in only 0.8% of cases, and there were no deaths.
Only 1.1% of cases converted from laparoscopy to laparotomy, a more invasive procedure to open the abdomen that requires a large incision.
Of note, the data did not reveal differences in transfusion, complications, and conversion to laparotomy between experienced and beginner robotic surgeons assisted by a proctor.
“Robot-assisted laparoscopy in gynecological surgeries has been shown to be safe, with the presence of a proctor being critical for a successful transition for less-experienced teams,” the researchers wrote.
However, “the rapid development in robot-assisted surgery calls for long-term prospective randomized controlled trials,” they added.