Safety Model for the Introduction of Robotic Surgery in Gynecology.
| Autor: | Gomes MTV; Hospital Israelita Albert Einstein, São Paulo, SP, Brazil., Costa Porto BTD; Hospital Israelita Albert Einstein, São Paulo, SP, Brazil., Parise Filho JP; Hospital Israelita Albert Einstein, São Paulo, SP, Brazil., Vasconcelos AL; Hospital Israelita Albert Einstein, São Paulo, SP, Brazil., Bottura BF; Hospital Israelita Albert Einstein, São Paulo, SP, Brazil., Marques RM; Hospital Israelita Albert Einstein, São Paulo, SP, Brazil. |
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| Jazyk: | angličtina |
| Zdroj: | Revista brasileira de ginecologia e obstetricia : revista da Federacao Brasileira das Sociedades de Ginecologia e Obstetricia [Rev Bras Ginecol Obstet] 2018 Jul; Vol. 40 (7), pp. 397-402. Date of Electronic Publication: 2018 May 18. |
| DOI: | 10.1055/s-0038-1655746 |
| Abstrakt: | Objective: To analyze the perioperative results and safety of performing gynecological surgeries using robot-assisted laparoscopy during implementation of the technique in a community hospital over a 6-year period. Methods: This was a retrospective observational study in which the medical records of 274 patients who underwent robotic surgery from September 2008 to December 2014 were analyzed. We evaluated age, body mass index (BMI), diagnosis, procedures performed, American Society of Anesthesiologists (ASA) classification, the presence of a proctor (experienced surgeon with at least 20 robotic cases), operative time, transfusion rate, perioperative complications, conversion rate, length of stay, referral to the intensive care unit (ICU), and mortality. We compared transfusion rate, perioperative complications and conversion rate between procedures performed by experienced and beginner robotic surgeons assisted by an experienced proctor. Results: During the observed period, 3 experienced robotic surgeons performed 187 surgeries, while 87 surgeries were performed by 20 less experienced teams, always with the assistance of a proctor. The median patient age was 38 years, and the median BMI was 23.3 kg/m 2 . The most frequent diagnosis was endometriosis (57%) and the great majority of the patients were classified as ASA I or ASA II (99.6%). The median operative time was 225 minutes, and the median length of stay was 2 days. We observed a 5.8% transfusion rate, 0.8% rate of perioperative complications, 1.1% conversion rate to laparoscopy or laparotomy, no patients referred to ICU, and no deaths. There were no differences in transfusion, complications and conversion rates between experienced robotic surgeons and beginner robotic surgeons assisted by an experienced proctor. Conclusion: In our casuistic, robot-assisted laparoscopy demonstrated to be a safe technique for gynecological surgeries, and the presence of an experienced proctor was considered a highlight in the safety model adopted for the introduction of the robotic gynecological surgery in a high-volume hospital and, mainly, for its extension among several surgical teams, assuring patient safety. Competing Interests: The authors have no conflicts of interest to disclose. (Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil.) |
| Databáze: | MEDLINE |
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