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
