Analysis of Robotic Performance Times to Improve Operative Efficiency

Study ObjectiveTo estimate the efficiency of procedural steps in robotic sacrocolpopexy and concomitant hysterectomy.DesignRetrospective study (Canadian Task Force classification II-2).SettingUniversity hospital.PatientsOne hundred forty-seven patients who underwent robotic-assisted procedures from November 2007 through December 2010.InterventionsRobotic-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 ResultsComparison 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).ConclusionRobotic 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.