title: The effect of increased experience on complications in robotic hysterectomy for malignant and benign gynecological disease.
abstract: The study objective was to assess the effect of increased experience on complications in robotic hysterectomy for malignant and benign gynecological disease. This is a retrospective cohort study. It is a Canadian Task Force classification II-2 study conducted at the University Hospital, Sweden. The patients were 949 women planned for robotic hysterectomy for malignant (75 %) and benign (25 %) gynecological disease between October 2005 and December 2013. They were continuously evaluated for the rate of intraoperative and postoperative complications up to 1-year post-surgery, the latter according to Clavien-Dindo classification following the introduction of robotic surgery with special awareness of complications possibly related to robot-specific risk factors, the description of refinement of practice and assessment of the effect of these measures. The rate of intraoperative complications, the overall rate of complications and the rate of ≥grade 3 complications decreased from the first to the last time period (4.8 vs 2.6 %, p = 0.037, 34 vs 19 %, p = 0.003 and 13.5 vs 3.2 %, p = 0.0003, respectively). The rate of intraoperative complications and the rate of postoperative complications possibly related to robot-specific risk factors was reduced from the first to the last time period (3.8 vs 0.6 %, p = 0.028 and 7.7 vs 1.5 %, p = 0.003, respectively). In patients undergoing robotic hysterectomy for malignant and benign gynecological disease intraoperative and postoperative complications and complications possibly related to the robotic approach diminish with training, experience and refinement of practice.
authors.affiliation: Department of Obstetrics and Gynecology, Skåne University Hospital, Lund, Sweden. celine.lonnerfors@med.lu.se.|Lund University, SE-22185, Lund, Sweden. celine.lonnerfors@med.lu.se.
authors.forename: Celine
authors.initials: C
authors.lastname: Lönnerfors
authors.affiliation: Department of Obstetrics and Gynecology, Skåne University Hospital, Lund, Sweden.|Lund University, SE-22185, Lund, Sweden.
authors.forename: Petur
authors.initials: P
authors.lastname: Reynisson
authors.affiliation: Department of Obstetrics and Gynecology, Skåne University Hospital, Lund, Sweden.|Lund University, SE-22185, Lund, Sweden.
authors.forename: Barbara
authors.initials: B
authors.lastname: Geppert
authors.affiliation: Department of Obstetrics and Gynecology, Skåne University Hospital, Lund, Sweden.|Lund University, SE-22185, Lund, Sweden.
authors.forename: Jan
authors.initials: J
authors.lastname: Persson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005831:Genital Diseases, Female / Q000601:surgery*; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects* / Q000706:statistics & numerical data; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D065287:Robotic Surgical Procedures / Q000009:adverse effects* / Q000706:statistics & numerical data; D055815:Young Adult
keywords: Hysterectomy; Intraoperative complications; Postoperative complications; Robotic