Omar Y Kudsi, MD, MBA, FACS, Nivedh Paluvoi, MD, Partha Bhurtel, MD. Tufts University School of Medicine
In community hospital setting, surgical trainees are not around to first assist and physician assistants may not be provided. The aim of our study was to assess the feasibility and safety of using a robot in lieu of a first assistant.
This is a retrospective review of prospectively collected data between December 2012 and September 2014. One board certified general surgeon performed total 321 consecutive robotic cases during his transition to practice. The need of first surgical assistant was waived after completion of the first 74 cases. The remaining cases were done with a robotic trained scrub technician only unless the surgeon needed another assistant then it was made available for conversion to open. The study was designed to evaluate the results of robotics in replacing human first assistant in the operating room by evaluating the operative time, console time, outcomes including morbidities and mortalities, and utilizing human assist in the conversion to open approach once needed.
We reviewed 321 consecutive patients. 247 patients were identified after excluding the first 74 patients where a first assist was mandatory. Hiatal hernia repair and nissen fundoplication (N=4), Single site cholecystectomy (N=35), Multi port Cholecystectomy (N= 174), Ventral hernia repair (N= 16), Inguinal hernia repair (N=9), Adrenalectomy (N=1), partial gastrectomy (N=2), partial colectomy (N=4). 3.3% was the conversion to open (N= 8) and none of the cases were converted to laparoscopy only. (N= 97) were emergency robotic surgery cases and (N= 150) were elective robotic surgery cases. Demographics were the following (N= 158) women and (N= 89) men. Mean age was 53.9 years (20-89 years) with a mean BMI of 31.01 (18-71). Out of the 240 cases, (N=8) were converted to open and another surgeon was requested to assist. Mean operative time was 73.5 Minutes (20-259 minutes), mean console operative time was 43.9 (8-229 minutes) with mean EBL of 15 mL (2 -300 mL). Mean length of stay was 0.58 days (0-7 days). Post-operative morbidities (N=4) included readmission for Ileus (N=2) and post-operative ERCP for retained common bile duct stone (N=1), and IR aspiration of hematoma (N=1). There was no mortality.
The rationale for robotic surgery may be in cases in which a first assistant is preferable but not readily available. We demonstrated in a large series that robotic surgery can be safe in a wide range of operations. Further studies are planned for cost analysis and comparison to open operations.