Day Case Robotic Hysterectomy:

Retrospective Analysis of Safety,

Complications and Cost

Jennifer HOH, Audrey KWONG, Tony CHALHOUB

Royal Victoria Infirmary, Newcastle-Upon-Tyne

Our Experience

Da Vinci System was first introduced into our trust in early 2012

Part of a multi-user group of 6 specialties with 2 Da Vinci Si robots

First case of robotic hysterectomy was performed in December

2014

Cases were performed by 2 gynaecology consultants

2-3 cases were performed on alternate Wednesday

259 cases were performed up to date (March 2019)

Intra-operative data collected prospectively

Individual case notes followed up for complications and outcomes

Results: Patients’ demographics

Indications

HMB

Endometriosis

Endometrial cancer

Endometrial hyperplasia

Symptomatic fibroids (fibroids 2-10cm diameter). Uterine size up to 18 weeks

Cervical pathology

Prophylactic surgery

Mean BMI 36.6 (20.1 – 55.2)

Results: Operative times

Mean time of robotic surgery

- 102 minutes (56-175) on the first 10 cases

- 45 minutes (23-96) on the subsequent cases

Mean time of vault suturing

- 17 minutes (11-28) on first 10 cases

- 7 minutes (4-14) on the subsequent cases

Average 2.5 cases (2-3) were done per day

Results

100% cases completed with 0% conversion

Average blood loss about 50mls

1 case had 300mls blood loss for severe endometriosis

(previously abandoned laparoscopy in another trust)

None of the patients had vault dehiscence

Results: Complications

Overall complications were 3/259 cases:

1 case of post-op urinary retention requiring 10 days indwelling catheter

1 case of full thickness rectal injury in a patient with AFS Stage 2

endometriosis – repaired robotically and discharged the following day with no

subsequent problem.

1 case return to theatre for bleeding (3 weeks post op). No obvious source of

bleeding during EUA & laparoscopy. Discharged the following day.

Hospital Stay

Length of stay (0-1 day; nearly all patients)

114 patients went home the same day (within 8 hours)

141 patients stayed 1 night and discharged the following morning

(within 16 hours)

2 patients stayed 2 nights (spinal/overnight catheter)

2 patients stayed 4 nights (due to co-morbidities)

Costs

Costs of procedures were based on 2 arms utilisation

Costs for robotic disposable instruments are refunded by

Newcastle Gateshead CCG; hence making the procedures per

case cheaper than TLH in our directorate (based on using an

advance sealing device for TLH)

Da Vinci Endo Wrist Instruments

Costs

Large needle driver £195.80

Monopolar shears £285.00

Maryland bipolar £241.00

Tip accessory for shears £18.15

Accessory drape pack £180.00

Total Cost £919.95

Conclusions

Costs of Total Robotic Hysterectomy in our unit is comparable to

standard Total Laparoscopic Hysterectomy (TLH)

Taking into account increased productivity, reduced

WLI/CWT/18 weeks target, the programme is deemed cost

effective by the trust board.

Most patients were discharged home within 8-16 hours

postoperatively.

Complication rates were low (3/259)

Acknowledgements

Mr CP Lim Consultant Obstetrician and Gynaecologist

Mr Mark Roberts Consultant Gynaecologist