title: Gynaecologic robot-assisted cancer and endoscopic surgery (GRACES) in a tertiary referral centre.
abstract: BACKGROUND
  Robotic-assisted gynaecologic surgery is gaining popularity and it offers the advantages of laparoscopic surgery whilst overcoming the limitations of operative dexterity. We describe our experience with the fi rst 40 cases operated under the GRACES (Gynaecologic Robot- Assisted Cancer and Endoscopic Surgery) programme at the Department of Obstetrics & Gynecology, National University Hospital, Singapore.
  
  
  METHODS
  A review was performed for the fi rst 40 women who had undergone robotic surgery, analysing patient characteristics, surgical timings and surgery-related complications. All cases were performed utilising the da Vinci® surgical system (Intuitive Surgical, Sunnyvale, CA) with 3 arms and 4 ports. Standardised instrumentation and similar cuff closure techniques were used.
  
  
  RESULTS
  Seventeen (56%) were for endometrial cancer and the rest, for benign gynaecological disease. The mean age of the patients was 52.3 years. The average docking time was 11 minutes (SD 0.08). The docking and operative times were analysed in tertiles. Data for patients with endometrial cancer and benign cases were analysed separately. There were 3 cases of complications- cuff dehiscence, bleeding from vaginal cuff and tumour recurrence at vaginal vault.
  
  
  CONCLUSIONS
  Our caseload has enabled us to replicate the learning curve reported by other centres. We advocate the use of a standard instrument set for the fi rst 20 cases. We propose the following sequence for successful introduction of robot-assisted gynaecologic surgery - basic systems training, followed shortly with a clinical case, and progressive development of clinical competence through a proctoring programme.
authors.affiliation: Department of Obstetrics and Gynaecology, National University Hospital, Yong Loo Lin School of Medicine, National University of Singapore. drjoeng@nus.edu.sg
authors.forename: Joseph Sy
authors.initials: JS
authors.lastname: Ng
authors.forename: Yoke Fai
authors.initials: YF
authors.lastname: Fong
authors.forename: Pearl Sy
authors.initials: PS
authors.lastname: Tong
authors.forename: Eu Leong
authors.initials: EL
authors.lastname: Yong
authors.forename: Jeffrey J H
authors.initials: JJ
authors.lastname: Low
mesh_terms: D000328:Adult; D000368:Aged; D016889:Endometrial Neoplasms / Q000191:economics / Q000601:surgery*; D005260:Female; D005831:Genital Diseases, Female / Q000191:economics / Q000601:surgery*; D013509:Gynecologic Surgical Procedures / Q000191:economics / Q000295:instrumentation* / Q000379:methods; D006784:Hospitals, Teaching; D006801:Humans; D007858:Learning; D008875:Middle Aged; D012189:Retrospective Studies; D012371:Robotics / Q000191:economics / Q000295:instrumentation*; D012846:Singapore; D025321:Surgery, Computer-Assisted / Q000191:economics / Q000295:instrumentation* / Q000379:methods; D013997:Time Factors; D016896:Treatment Outcome