Implementation of robotic gynecological surgery in a German University Hospital: patient safety after 110 procedures
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GENERAL GYNECOLOGY
Implementation of robotic gynecological surgery in a German University Hospital: patient safety after 110 procedures Dimitrios Balafoutas1 · Achim Wöckel1 · Christine Wulff1 · Ralf Joukhadar1 Received: 14 June 2020 / Accepted: 13 August 2020 © The Author(s) 2020
Abstract Purpose Robotic surgery represents the latest development in the field of minimally invasive surgery and offers many technical advantages. Despite the higher costs, this novel approach has been applied increasingly in gynecological surgery. Regarding the implementation of a new operative method; however, the most important factor to be aware of is patient safety. In this study, we describe our experience in implementing robotic surgery in a German University Hospital focusing on patient safety after 110 procedures. Methods We performed a retrospective analysis of 110 consecutive robotic procedures performed in the University Hospital of Würzburg between June 2017 and September 2019. During this time, 37 patients were treated for benign general gynecological conditions, 27 patients for gynecological malignancies, and 46 patients for urogynecological conditions. We evaluated patient safety through standardized assessment of intra- and postoperative complications, which were categorized according to the Clavien–Dindo classification. Results No complications were recorded in 90 (81.8%) operations. We observed Clavien–Dindo grade I complications in 8 (7.3%) cases, grade II complications in 5 (4.5%) cases, grade IIIa complications in 1 case (0.9%), and grade IIIb complications in 6 (5.5%) cases. No conversion to laparotomy or blood transfusion was needed. Conclusion Robotic surgery could be implemented for complex gynecological operations without relevant problems and was accompanied by low complication rates. Keywords Robotic hysterectomy · Robotic sacrocolpopexy · Implementation · Robotic complications · Polyvinylidene fluoride (PVDF)
Introduction Since the federal drug administration (FDA) approval of the daVinci system for gynecological operations in 2005, an increasing number of minimally invasive procedures have been performed robotically [1]. The main benefits of the system are the technical advantages like the visualization with high definition, three-dimensional stereo-sight, and the open surgical orientation during the instrument movement. Additionally, the design of the EndoWrist instruments enables intuitive precision movements along with tremor filtering. These technical advantages seem to improve surgical * Dimitrios Balafoutas [email protected] 1
Department of Obstetrics and Gynecology, University Hospital of Würzburg, Josef‑Schneider‑Str. 4, 97080 Würzburg, Germany
outcome, especially in cases of challenging anatomy or obesity [2]. Moreover, the robotic system seems to make endoscopic approach possible in highly complex cases, thus, reducing the need for laparotomy [3, 4]. Data suggest its advantages for enucleation of deep uterine fibroids [5], reconstruction of multicompartmental pelvic floor defect
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