Learning Curve Analysis of Single-Site Robot-Assisted Hysterectomy
Abstract
:1. Introduction
2. Materials and Methods
Statistical Analysis
3. Results
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Acknowledgments
Conflicts of Interest
References
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Total | Phase 1 | Phase 2 | Phase 3 | ||||||
---|---|---|---|---|---|---|---|---|---|
(n = 123) | (n = 41) | (n = 54) | (n = 28) | ||||||
N | % | n | % | n | % | n | % | p-Value | |
Age (yr), median (range) | 49 (30–74) | 50 (35–68) | 48.5 (34–67) | 50 (30–74) | 0.8960 * | ||||
BMI (kg/m2), median (range) | 23.2 (18.0–34.9) | 22.9 (18.0–34.9) | 23 (18.0–32.6) | 24.4 (18.6–29.8) | 0.2640 * | ||||
Parity | 106 | 86.2 | 34 | 82.9 | 50 | 92.6 | 22 | 78.6 | 0.1662 † |
Menopause | 48 | 39 | 16 | 39 | 20 | 37 | 12 | 42.9 | 0.8770 † |
Chronic illness | 45 | 36.6 | 12 | 29.3 | 17 | 31.5 | 16 | 57.1 | 0.0359 † |
Vaginal delivery | 73 | 59.4 | 24 | 58.5 | 32 | 59.3 | 17 | 60.7 | 0.9836 † |
Previous cesarean section | 38 | 30.9 | 13 | 31.7 | 19 | 35.2 | 6 | 21.4 | 0.4375 † |
Previous abdominal surgery | 47 | 38.2 | 11 | 26.8 | 19 | 35.2 | 17 | 60.7 | 0.0145 † |
ASA classification | <0.0001 ‡ | ||||||||
I | 74 | 60.2 | 33 | 80.5 | 37 | 68.5 | 4 | 14.3 | |
II | 48 | 39 | 8 | 19.5 | 17 | 31.5 | 23 | 82.1 | |
III | 1 | 0.8 | 0 | 0 | 0 | 0 | 1 | 3.6 | |
Indication of surgery | 0.5755 ‡ | ||||||||
Adenomyosis | 16 | 13 | 6 | 14.6 | 8 | 14.8 | 2 | 7.1 | |
Myoma | 56 | 45.5 | 20 | 48.8 | 26 | 48.2 | 10 | 35.7 | |
Adenomyosis and myoma | 27 | 22 | 8 | 19.5 | 12 | 22.2 | 7 | 25 | |
Endometrial hyperplasia | 1 | 0.8 | 0 | 0 | 0 | 0 | 1 | 3.6 | |
Malignancy | 3 | 2.4 | 0 | 0 | 1 | 1.9 | 2 | 7.1 | |
Ovarian cyst | 20 | 16.3 | 7 | 17.1 | 7 | 13 | 6 | 21.4 | |
Concomitant procedure | |||||||||
Adnexectomy | 0.9466 ‡ | ||||||||
USO | 2 | 1.6 | 1 | 2.4 | 1 | 1.9 | 0 | 0 | |
BSO | 64 | 52 | 23 | 56.1 | 27 | 50 | 14 | 50 | |
Ovarian cystectomy | 8 | 6.5 | 3 | 7.3 | 4 | 7.4 | 1 | 3.6 | 0.8078 ‡ |
Peritonectomy | 2 | 1.6 | 1 | 2.4 | 1 | 1.9 | 0 | 0 | 1.0000 ‡ |
Adhesiolysis | 61 | 49.6 | 23 | 56.1 | 28 | 51.9 | 10 | 35.7 | 0.2275 † |
Pelvic washing cytology | 122 | 99.2 | 40 | 97.6 | 54 | 100 | 28 | 100 | 0.5610 ‡ |
Pelvic LND | 19 | 15.5 | 6 | 14.6 | 9 | 16.7 | 4 | 14.3 | 0.9459 † |
Para-aortic LND | 1 | 0.8 | 0 | 0 | 1 | 1.9 | 0 | 0 | 1.0000 ‡ |
Total | Phase 1 | Phase 2 | Phase 3 | ||||||
---|---|---|---|---|---|---|---|---|---|
(n = 123) | (n = 41) | (n = 54) | (n = 28) | ||||||
n | % | n | % | n | % | n | % | p-Value | |
Uterine mass size (cm), median (range) | 6.8 (0–26) | 5 (0.5–13.5) | 7.5 (0–22) | 9.75 (6–26) | <0.0001 * | ||||
Operation time (min), median (range) | 131 (59–502) | 140 (73–274) | 130.5 (59–502) | 129 (83–208) | 0.6943 * | ||||
Docking time (min), median (range) | 3 (1–10) | 3 (1–6) | 2 (1–10) | 3 (1–10) | 0.0242 * | ||||
Console time (min), median (range) | 76 (29–465) | 77 (41–208) | 77 (29–465) | 74 (40–147) | 0.4023 * | ||||
Adnexal surgery | 66 | 53.7 | 24 | 58.5 | 28 | 51.9 | 14 | 50 | 0.7357 † |
EBL (mL) | 10 (5–500) | 20 (5–160) | 10 (5–480) | 5 (5–500) | 0.0007 * | ||||
Uterus weight (g) | 180 (44–1230) | 200.5 (50–730) | 180 (44–1230) | 159 (45–580) | 0.2371 * | ||||
NA = 8 | NA = 5 | NA = 3 | |||||||
Postoperative hospital stay (days), median (range) | 4 (3–10) | 4 (3–6) | 4 (3–10) | 4 (3–7) | 0.7595 * | ||||
Conversion | |||||||||
Open laparotomy | 1 | 0.8 | 0 | 0 | 0 | 0 | 1 | 3.6 | 0.2276 ‡ |
Drain insertion | 9 | 7.3 | 7 | 17.1 | 1 | 1.9 | 1 | 3.6 | 0.0187 ‡ |
Readmission | 5 | 4.1 | 1 | 2.4 | 3 | 5.6 | 1 | 3.6 | 0.8479 ‡ |
Complications | |||||||||
Immediate complication | |||||||||
Abdominal pain | 3 | 2.4 | 0 | 0 | 3 | 5.6 | 0 | 0 | 0.3225 ‡ |
Postoperative pain (NRS) | |||||||||
Use of additional pain killer: NSAIDs, Opioids | 90 | 73.2 | 33 | 80.5 | 39 | 72.2 | 18 | 64.3 | 0.3216 † |
PCA use on operation day | 11 | 8.9 | 8 | 19.5 | 3 | 5.6 | 0 | 0 | 0.0119 ‡ |
PCA use after 24 h | 5 | 4.1 | 4 | 9.8 | 1 | 1.9 | 0 | 0 | 0.1188 ‡ |
Pain killer not used | 28 | 22.8 | 4 | 9.8 | 14 | 25.9 | 10 | 35.7 | 0.0314 † |
Delayed postoperative complication | 0.0296 ‡ | ||||||||
Umbilical incisional hernias | 3 | 2.4 | 0 | 0 | 3 | 5.6 | 0 | 0 | |
Vaginal cuff dehiscence | 2 | 1.6 | 0 | 0 | 0 | 0 | 2 | 7.1 |
Univariable | Multivariable (p < 0.05) | ||||||
---|---|---|---|---|---|---|---|
Beta | SE | p-Value | Beta | SE | p-Value | ||
Age (yr) | −1.10 | 0.66 | 0.1012 | ||||
BMI (kg/m2) | 2.44 | 1.48 | 0.1015 | ||||
Uterus weight (g) | Missing = 8 | 0.19 | 0.02 | <0.0001 | 0.18 | 0.02 | <0.0001 |
Parity | No | 1(ref) | 1(ref) | ||||
Yes | −51.19 | 14.74 | 0.0007 | −36.49 | 12.42 | 0.0040 | |
Menopause | No | 1(ref) | |||||
Yes | −16.03 | 10.84 | 0.1416 | ||||
Chronic illness | No | 1(ref) | |||||
Yes | −11.75 | 11.02 | 0.2883 | ||||
Vaginal delivery | No | 1(ref) | |||||
Yes | −6.26 | 10.84 | 0.5646 | ||||
Previous cesarean section | No | 1(ref) | |||||
Yes | −15.87 | 11.45 | 0.1683 | ||||
Previous abdominal surgery | No | 1(ref) | |||||
Yes | −22.57 | 10.78 | 0.0385 | ||||
ASA classification | I | 1(ref) | |||||
II, III | −9.95 | 10.86 | 0.3614 | ||||
Adnexectomy | None | 1(ref) | |||||
USO, BSO | −15.47 | 10.60 | 0.1471 | ||||
Ovarian cystectomy | No | 1(ref) | |||||
Yes | 19.05 | 21.56 | 0.3788 | ||||
Other (Peritonectomy, Adhesiolysis, | No | 1(ref) | |||||
Pelvic LND, Para-aortic LND) | Yes | 19.63 | 10.62 | 0.0671 |
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Lee, Y.J.; Lee, D.-E.; Bae, J.; Ha, H.I.; Lim, M.C. Learning Curve Analysis of Single-Site Robot-Assisted Hysterectomy. J. Clin. Med. 2022, 11, 1378. https://doi.org/10.3390/jcm11051378
Lee YJ, Lee D-E, Bae J, Ha HI, Lim MC. Learning Curve Analysis of Single-Site Robot-Assisted Hysterectomy. Journal of Clinical Medicine. 2022; 11(5):1378. https://doi.org/10.3390/jcm11051378
Chicago/Turabian StyleLee, Yeon Jee, Dong-Eun Lee, Jaekyung Bae, Hyeong In Ha, and Myong Cheol Lim. 2022. "Learning Curve Analysis of Single-Site Robot-Assisted Hysterectomy" Journal of Clinical Medicine 11, no. 5: 1378. https://doi.org/10.3390/jcm11051378