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#Grand Rounds

Is There a Benefit to Robotic Teams for Minimally Invasive Sacrocolpopexy Surgeries?

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BACKGROUND AND PURPOSE: 

  • Robotic-assisted sacrocolpopexy is criticized for high and potentially avoidable cost 
  • There is evidence that dedicated robotic teams can improve operating room efficiency in general surgery, urological, and colorectal surgery literature 
  • Carter-Brooks et al. (Female Pelvic Medicine & Reconstructive Surgery, 2018) investigated whether a determined and dedicated robotic team can significantly reduce operative time, and therefore cost 

METHODS: 

  • Retrospective cohort study  
  • Inclusion: All robotic-assisted sacrocolpopexy performed by a single surgeon at two different institutions 
    • One institution had a dedicated robotic team, while the other did not 
  • Differences were assessed using the chi-squared and t tests  
  • Multivariable linear regression identified confounders that may impact operative time 
  • Primary objective  
    • Impact of dedicated robotic team during robotic-assisted sacrocolpopexy (RASC) on operative time  
  • Secondary objective  
    • Impact of dedicated robotic team during RASC for other surgical outcomes, specifically perioperative complications and pelvic organ prolapse (POP) recurrence rates 

RESULTS: 

  • 88 cases were analyzed  
  • Cohort constitution 
    • White 92.8% | Postmenopausal 85.5% | Stage III prolapse 71.1% | Mean age 60.6 | Mean BMI 28.5 kg/m2  
  • 19.3% of cases were performed by a dedicated robotic team 
  • Mean operative time for cases with vs without a dedicated robotics team  
    •  131.8 vs 160.2 minutes  
      • 17.7% decrease (P < 0.001) 
  • Significance persisted following multivariable regression and adjusting for case order and prior to or after hysterectomy 
  • Operative complications for cases with and without a dedicated robotic team did not differ between groups  
    • 0% vs 2.9%, P = 0.50  
  • POP recurrence for cases with and without dedicated robotic team did not differ between groups 
    • 0% vs 7.5%, P = 0.29 

CONCLUSION:  

  • A dedicated robotic team for RASC is efficient, reducing mean operative team by almost a half hour 
  • Even without cost analysis, the authors state that the time reduction can be used to advocate for dedicated robotic teams for RASC procedures  

 Learn More – Primary Sources: 

The Impact of a Dedicated Robotic Team on Robotic-Assisted Sacrocolpopexy Outcomes 

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Related ObG Topics:

Prolapse and Stress Incontinence: Burch Procedure vs Midurethral Sling
What is the Best Approach to Repair Vaginal Vault Prolapse following Hysterectomy?
Restricted vs. Liberal Activity Following Reconstructive Pelvic Surgery

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