Analysis of Robotic Performance Times to Improve Operative Efficiency

Study Objective: To estimate the efficiency of procedural steps in robotic sacrocolpopexy and concomitant hysterectomy. Design: Retrospective study (Canadian Task Force classification II-2). Setting: University hospital. Patients: One hundred forty-seven patients who underwent robotic-assisted procedures from November 2007 through December 2010. Interventions: Robotic-assisted sacrocolpopexy. Sixty patients (40.8%) underwent concomitant hysterectomy; 37 (25.2%), mid-urethral sling placement; and 7 (4.8%), concomitant colporrhaphy. Measurements and Main Results: Comparison of the first 20 procedures with the subsequent 127 demonstrated that there was considerable improvement in time of cuff closure (p = .04); sacral dissection (p = .004); anterior (p = .006), posterior, (p = .003), and sacral (p = .003) mesh attachment; peritoneal closure (p < .001); total docked time (p = .02); and total incision time (p < .001). Conclusion: Robotic efficiency improves over a short learning period, with greatest differences in intracorporeal suturing and overall times. Identifying these steps may aid surgeons and learners in improving overall efficiency and establishing benchmarks for performance. Journal of Minimally Invasive Gynecology (2013) 20, 43-48 (c) 2013 AAGL. All rights reserved.