International Urogynecology Journal

, Volume 24, Issue 11, pp 1893–1897 | Cite as

Trainee performance at robotic console and benchmark operative times

  • Andrea K. Crane
  • Elizabeth J. Geller
  • Catherine A. Matthews
Original Article


Introduction and hypothesis

It is an ongoing challenge to maintain surgical efficiency while integrating trainee participation. We hypothesize that a program of graduated surgical responsibility for trainees does not hinder operative efficiency.


This was a retrospective cohort study of trainee performance times, collected prospectively in real time, for robotic cases performed at one university hospital between September 2008 and August 2011. The primary aim was to compare overall operative times between cases performed by trainees versus attendings. Secondary aims were to compare operative times for major portions of each operation by level of training and to establish benchmark operative times for trainees.


During the study period, 98 cases had recorded trainee performance times. Total robot docked time was longer for trainees than for attendings (155 vs 132 min, p = 0.011), but mean performance times for hysterectomy (70 vs 59 min, p = 0.096) and sacrocolpopexy (76 vs 79 min, p = 0.545) were similar. Within the trainees, there was no correlation between surgical time and rank for each step of the procedures. Utilizing mean performance times for all trainees, benchmark operative times were established for each step of hysterectomy in minutes: right side (21), left side (21), bladder flap (10), colpotomy (15), and cuff closure (19); similarly, for sacrocolpopexy: sacral and peritoneal dissection (12), anterior cuff dissection (10), posterior cuff dissection (8), anterior mesh attachment (15), posterior mesh attachment (18), sacral mesh attachment (12), and peritoneal closure (9).


In a program of graduated surgical responsibility, robotic operative efficiency was comparable when trainees were involved as console surgeons.


Trainee Hysterectomy Sacrocolpopexy Console surgeons 



No funding was received for this project.

Conflicts of interest

Andrea Crane: no conflicts of interest. Elizabeth Geller: received honoraria from Intuitive Surgical for a satellite symposia. Catherine Matthews: received honoraria from Intuitive Surgical for a satellite symposia, and serves as a case observation site for Intuitive Surgical. She serves as a consultant for American Medical Systems for a project on sacrocolpopexy.


  1. 1.
    Schreuder HW, Verheijen RH (2009) Robotic surgery. BJOG 116:198–213PubMedCrossRefGoogle Scholar
  2. 2.
    Wilson EB (2009) The evolution of robotic general surgery. Scand J Surg 98:125–129PubMedGoogle Scholar
  3. 3.
    Ahmed K, Khan MS, Vats A et al (2009) Current status of robotic assisted pelvic surgery and future developments. Int J Surg 7:431–440PubMedCrossRefGoogle Scholar
  4. 4.
    Boggess JF, Gehrig PA, Cantrell L et al (2008) A comparative study of 3 surgical methods for hysterectomy with staging for endometrial cancer: robotic assistance, laparoscopy, laparotomy. Am J Obstet Gynecol 199:360.e1–360.e9CrossRefGoogle Scholar
  5. 5.
    Geller EJ, Siddiqui NY, Wu JM, Visco AG (2008) Short-term outcomes of robotic sacrocolpopexy compared with abdominal sacrocolpopexy. Obstet Gynecol 112:1201–1206PubMedCrossRefGoogle Scholar
  6. 6.
    Tan-Kim J, Menefee S, Luber K et al (2011) Robotic-assisted and laparoscopic sacrocolpopexy: comparing operative times, costs and outcomes. Female Pelvic Med Reconstr Surg 17:44–49PubMedCrossRefGoogle Scholar
  7. 7.
    Paraiso MF, Jelovsek JE, Frick A et al (2011) Laparoscopic compared with robotic sacrocolpopexy for vaginal prolapse: a randomized controlled trial. Obstet Gynecol 118:1005–1013PubMedCrossRefGoogle Scholar
  8. 8.
    Lenihan JP Jr, Kovanda C, Seshadri-Kreaden U (2008) What is the learning curve for robotic assisted gynecologic surgery? J Minim Invasive Gynecol 15:589–594PubMedCrossRefGoogle Scholar
  9. 9.
    Akl MN, Long JB, Giles DL et al (2009) Robotic-assisted sacrocolpopexy: technique and learning curve. Surg Endosc 23:2390–2394PubMedCrossRefGoogle Scholar
  10. 10.
    Geller EJ, Schuler KM, Boggess JF (2011) Robotic surgical training program in gynecology: how to train residents and fellows. J Minim Invasive Gynecol 18:224–229PubMedCrossRefGoogle Scholar
  11. 11.
    Finan MA, Silver S, Otts E, Rocconi RP (2010) A comprehensive method to train resident in robotic hysterectomy techniques. J Robotic Surg 4:183–190CrossRefGoogle Scholar
  12. 12.
    Finan MA, Clark ME, Rocconi RP (2010) A novel method for training residents in robotic hysterectomy. J Robotic Surg 4:33–39CrossRefGoogle Scholar
  13. 13.
    Parnell BA, Matthews CA (2011) Robot-assisted techniques and outcomes in the realm of pelvic reconstructive surgery. Clin Obstet Gynecol 54:412–419PubMedCrossRefGoogle Scholar
  14. 14.
    Schreuder HW, Wolswijk R, Zweemer RP et al (2012) Training and learning robotic surgery, time for a more structured approach: a systematic review. BJOG 119:137–149PubMedCrossRefGoogle Scholar

Copyright information

© The International Urogynecological Association 2013

Authors and Affiliations

  • Andrea K. Crane
    • 1
  • Elizabeth J. Geller
    • 1
  • Catherine A. Matthews
    • 1
  1. 1.Department of Obstetrics and GynecologyUniversity of North CarolinaChapel HillUSA

Personalised recommendations