What is the learning curve for robotic assisted gynecologic surgery?
OBJECTIVE
The purpose of this study was to estimate the learning curve when using the da Vinci Surgical System (Intuitive Surgical Inc., Sunnyvale, CA) in benign gynecologic cases by a team of 2 gynecologic laparoscopists.


METHODS
Retrospective case series (Canadian Task Force classification II-1).


METHODS
A private practice obstetrics/gynecology clinic.


METHODS
Patients requiring major benign gynecologic surgery who were candidates for a laparoscopic approach.


METHODS
All patients who would have otherwise been offered a transabdominal or conventional laparoscopic procedure were offered the option of having their procedure performed laparoscopically with robotic assistance. Data that were collected included robot set-up times by the operative room staff, operative times for use of robot, total operative times, and perioperative outcome. We analyzed the learning curve defined as the number of cases required to stabilize operative time to perform the various procedures.


RESULTS
One hundred thirteen patients were treated over a 22-month period with the da Vinci Surgical System. Most procedures were hysterectomies, whereas other gynecologic procedures included supracervical hysterectomy, laparoscopic vaginal assisted hysterectomy, myomectomy, sacrocolpopexy, and oophorectomy. Total operative times for hysterectomies studied sequentially stabilized at approximately 95 minutes after 50 cases. The decrease in robotic time did not depend on uterine size. The mean length of hospital stay was 24 hours, and return to normal activities averaged 2.8 weeks.


CONCLUSIONS
Robotic assisted surgery is an enabling technology that allows gynecologic surgeons the ability to offer laparoscopic procedures to most of their patients. In the hands of surgeons with advanced laparoscopic skills, the learning curve to stabilize operative times for the various surgical procedures in women requiring benign gynecolologic interventions is 50 cases.
Lenihan
John P
JP
Tacoma Women's Specialists and Tacoma General Hospital, University of Washington, Tacoma WA 98405, USA. jplenihan@tacomaobgyn.com
Kovanda
Carol
C
Seshadri-Kreaden
Usha
U
D000328:Adult; D002983:Clinical Competence; D015331:Cohort Studies; D004059:Diffusion of Innovation; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000193:education* / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008875:Middle Aged; D012371:Robotics