Gynaecologic robot-assisted cancer and endoscopic surgery (GRACES) in a tertiary referral centre

Abstract

Introduction: Robotic-assisted gynaecologic surgery is gaining popularity and it offers theadvantages of laparoscopic surgery whilst overcoming the limitations of operative dexterity. Wedescribe our experience with the first 40 cases operated under the GRACES (Gynaecologic Robot-Assisted Cancer and Endoscopic Surgery) programme at the Department of Obstetrics & Gynecology,National University Hospital, Singapore. Materials and Methods: A review was performed for thefi rst 40 women who had undergone robotic surgery, analysing patient characteristics, surgical timingsand surgery-related complications. All cases were performed utilising the da Vinci® surgical system(Intuitive Surgical, Sunnyvale, CA) with 3 arms and 4 ports. Standardised instrumentation andsimilar cuff closure techniques were used. Results: Seventeen (56%) were for endometrial cancerand the rest, for benign gynaecological disease. The mean age of the patients was 52.3 years. Theaverage docking time was 11 minutes (SD 0.08). The docking and operative times were analysed intertiles. Data for patients with endometrial cancer and benign cases were analysed separately. Therewere 3 cases of complications- cuff dehiscence, bleeding from vaginal cuff and tumour recurrence atvaginal vault. Conclusion: Our caseload has enabled us to replicate the learning curve reported byother centres. We advocate the use of a standard instrument set for the fi rst 20 cases. We proposethe following sequence for successful introduction of robot-assisted gynaecologic surgery - basicsystems training, followed shortly with a clinical case, and progressive development of clinicalcompetence through a proctoring programme.