Robotic Assisted Hysterectomies The Sarawak Experience

1. Robotic Assisted Hysterectomies The Sarawak Experience Wee W Sim, SuharjonoHaris, AlifahMdZizi, GaneshanMuniswaran Department of Obstetrics & Gynaecology, SARAWAK GENERAL HOSPITAL Conclusions Objectives The evolution in robotic system over the decade has been dramatic. The results in Sarawak General Hospital shows that gynaecological robotics assisted surgery is safe with excellent outcomes despite still in it’s infancy in terms of the surgeon’s experience. We are currently embarking on the next phase by performing gynae-oncology and more complex cases. Although the cost effectiveness of robotic surgeries still remains debatable, the ability of the robot to ensure more precise surgeries and in reducing surgeon’s fatigue should be considered. It remains a promising revolution in our quest towards a safer and superior alternative of performing gynaecological surgeries. Hysterectomy remains the commonest gynecological surgery performed worldwide. Minimally invasive surgeries has revolutionized gynecological practice and would be the standard of care in the near future. The precision and fatigueless act of robotic surgeries has been proven to overcome the shortcomings of laparoscopic surgeries. It has shown great promise as the next evolution of surgical techniques although there is paucity of evidence on the outcomes and complications. The noble aim of our study is to review the outcomes of robotic assisted hysterectomies performed in Sarawak General Hospital in our search towards more concrete evidence with regards to robotic assisted surgeries. References Methods • Reynolds RK, Advincula AP. Robot assisted laparoscopy hysterectomy: technique and initial experience. AM J Surg. 2006;191:555-560. • Stylopoulos N, Rattner D. Robotics and ergonomics. SurgClin North Am 2003:83:1321-27 • Anthony G, Visco MD, Arnold P, Advincula MD. Robotic Gynaecology Surgery. ObstetGynaecol 2008;112:1369-84. • Khaled SK. Robotic Assisted Laparoscopy Hysterectomy. Eastern Virginia Medical School, USA. • Dupont NC, Chandasekhar R, Wilding G, Guru KA. Current trends in robot assisted surgery: a survey of gynaecologic oncologists. Int J Med Robot 2010;6:468-72. • Bogges JF, Gehring AP, Cantrell I et al. Perioperative outcomes of robotically assisted hysterectomy for benign cases with complex pathology. ObstetGynaecol 2009;114:585-93 • Payne TN, Dauterive FR. A comparison of total laparoscopic hysterectomy to robotically assisted hysterectomy: surgical outcomes in a community practice. J Minimal Invasive Gynaecol 2008;15:286-9. • Shashoua AR, Gill D, Locher SR. Robotic assisted total laparoscopic hysterectomy versus conventional total laparoscopic hysterectomy. JSLS 2009;13:364-69. • Barnett JC, Judd JP, Wu JM et al. Cost comparison among robotic, laparoscopic and open hysterectomy for endometrial cancer. ACOG 2010;116 • Sarlos D, Kots L, Stevanovic N, Schaer G. Robotic hysterectomy versus conventional laparoscopic hysterectomy: outcome and cost analyses of matched case control study. Eur J ObstetGynaecolReprodBiol 2010;150:90-92 • Giep BN, Giep HN, Hubert HB. Comparison of minimally invasive surgical approaches for hysterectomy at a community hospital: robotic assisted laparoscopic hysterectomy, laparoscopic assisted vaginal hysterectomy. J Robot Surg 2010;4:167-175 • Fiorentino RP, Zepeda MA, Goldstein Bh, John CR. Pilot study assessing robotic laparoscopic hysterectomy and patient outcomes. J Mini Invasive Gynaecol. 2006;13:60-63 This is a retrospective cohort study. All patients who had robotic assisted hysterectomy in Sarawak General Hospital between 1st January 2009 till 31st January 2012 were included in this study. The patients were identified from the operating theater registry and the case notes were retrieved. Data were extracted systematically using a standardized performa which included patient demography, indication, complications and outcome of surgeries. The results were analyzed using SPSS 20. Results P 0.088 22 patients had robotic assisted hysterectomies in Sarawak during the study period. Only one case was converted to laparotomy in 2009 during the initial learning curve.