Perioperative data
Mean operation time was 285.85 minutes (ranged 112-595 minutes, including robotic installation time). Blood loss volume varied greatly in MDT gynaecological surgeries. The median value was 200 ml. Blood transfusion volume ranged 0-2340 ml (Table 2).
Four departments always participated in robotic-assisted MDT gynaecological surgeries shown in Table 2. They were general surgery department, urological surgery department, hepatological surgery department and vascular surgery department, respectively. Among them general surgeons and urological surgeons were the most common partners to gynecologists. Twenty-one patients (53.85%) accepted the combined surgeries with gynaecological and general surgeons. The percentage of surgeries gathered gynaecological and urological surgeons was 38.46%. There were 4 patients needing hepatological surgeons. Occasionally vascular surgeons would appear when we needed vascular repair. A robotic-assisted MDT gynaecological surgery usually consisted of 2 to 3 departments.
After the surgery, all the patients discharged to home successfully. Eighteen patients were proved to return to the hospital in 30 days. Most of them came back for the follow-up treatment including chemotherapy or radiotherapy. Only 2 patients aimed to treat the complication. And one of them finally finished the double nephrostomy for vesicovaginal fistula, which we defined as the only one 30-day intervention. No one returned in 30 days for a reoperation in our study. Rafique et.al has discussed the outcomes of robot-assisted laparoscopic gynaecological surgeries (RA-LGS) that the lack of a trained team assisting in RA-LGS lead to poor outcomes22, which came to the similar conclusion with us.
Actually, only a little complication broke out in the robotic MDT gynaecological surgery. One patient had bladder wall damaged during the operation while another one had rectum damaged. Two patients suffered from vascular damage (one is left common iliac vein injury, the other is left external iliac artery injury). Two vascular injury cases and one difficult rectal resection and anastomosis conversed to open surgeries, others were all completed laparoscopically (Table 2). Three people transferred to ICU after the surgery, their ICU stay were 3,4 and 2 days respectively. That’s because they had wider surgical area.
We found that 23.08% of the cases had postoperative infection (Table 2). Especially 10.3% of the cases undergone multi-site infection. Meanwhile, 3 cases (7.7%) only suffered from urinary tract infection (data not shown). Besides, two patients had intestinal obstruction. Two cases appeared vesicovaginal fistula and one case followed up with rectovaginal fistula.