Expect The Unexpected : Efficiency comes at a cost

Expect The Unexpected : Efficiency comes at a cost

This is one of six KS National Robotic Surgery video Awards Runner-up videos screened at the November 2019 Robotic Surgeons Council of India meeting.  Expect The Unexpected : Efficiency comes at a cost, was produced by Dr. Anupama Badahur.

From the Abstract:

Dr Anupama Bahadur

Additional Professor, Head Division of Robotic Surgery

All India Institute of Medical Sciences, Rishikesh (Uttarakhand)

Title– Expect The Unexpected : Efficiency comes at a cost

Background– Robotic platform is a logical step forward to laparoscopy and is gaining popularity amongst gynecological surgeons worldwide. The da Vinci Xi surgical system has several upgrades to facilitate minimally invasive surgery and is the logical step forward to laparoscopy. We present our experience of robotic gynecologic surgery and the unexpected complications faced. Since the application of a robotic platform in gynaecology is rapidly growing, accurate evaluations of the complication rates of robotic-assisted surgeries are crucial because they can help to determine whether using a robotic platform is truly feasible for treating gynaecological disorders.

Objectives– To evaluate overall and specific complications associated with robotic-assisted gynaecological surgeries and provide a critical evaluation of robot-assisted hysterectomy.

Materials and methods – Cross-sectional study conducted in Gynaecology OPD at AIIMS, Rishikesh over a period of one and a half years (April 2018 to October 2019) on 230 patients in age group 35-65 years. Inta-op complications in study subjects were made note of and the frequency of each complication was noted. Parameters such as total time of surgery, estimated blood loss, post-op complications and VAS score were compared amongst the cases with and without complications.

Results – Out of 230 patients who were part of study 220 (95.7%) had no complications. There were cases of bladder injury(1), gut injury(2), manipulator related complications(2), unexpected spurters posing challenges (3) and specimen retrieval difficulties(2). While intra-op spurter-related hurdles was the only recurring complication, all other complications were unique to their case .Difference in average blood loss, operating time and VAS score were not found to be statistically significant; however, the difference in post-operative stay was found to be statistically significant. Result was confirmed using Mann Whitney’s Test and similar results obtained.

Conclusion– In our preliminary experience in Robotic hysterectomy, intra-op complication rate was 4.3% thus making robotic hysterectomy a feasible approach for tackling gynaecological disorders.

Robotic surgery video, with photos, internal and external camera footage, narrated.  07:06