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.