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A comparison of surgical outcomes among robotic cases performed with an employed surgical assist versus a second surgeon as the assist

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Abstract

To examine whether utilizing an employed surgical first assistant or a physician as an assistant during gynecologic robotic cases affects surgical variables. A high volume gynecologic oncologist’s robotic case data spanning fourteen years (2005–2018) was analyzed. We separated the cases based on the type of assistant used: either an employed surgical first assist or another physician. The assisting physicians were either members of the same practice or general gynecologists in the community. The two groups were compared for console time and estimated blood loss. We controlled for patient Body Mass Index (BMI), uterine weight, use of the fourth robotic arm, benign versus malignant pathology, and the surgeon’s subjective estimate of the difficulty of the case using a conventional laparoscopic versus robotic approach. Cases with an employed surgical assist had a mean adjusted robotic console time that was 0.32 h (19.2 min) faster than cases with a physician as the assist (95% CI 0.26 h–0.37 h faster, p < 0.001). Cases with an employed surgical assist also had an estimated blood loss (EBL) that was 47.5 cc lower than cases with a physician assisting (95% CI 38.8 cc–56.3 cc lower EBL, p < 0.001). The use of an employed surgical assist was associated with a faster console time and lower blood loss compared to using an available physician even adjusting for confounding factors. This deserves further exploration, particularly in regards to complication rates, operating room efficiency, utilization of health care personnel, and cost.

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Code availability

Data were analyzed in STATA version 16.

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Funding

No funds, grants, or other support was received.

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Authors and Affiliations

  1. Touro University Nevada College of Osteopathic Medicine, Henderson, NV, USA

    Lindsey K. Leggett

  2. Minimally Invasive Gynecology Surgery Fellow, Vanderbilt University, Nashville, USA

    Olga Muldoon

  3. Department of Obstetrics, Gynecology and Reproductive Health, Rutgers New Jersey Medical School, Newark, NJ, USA

    David L. Howard & Lynn D. Kowalski

  4. Department of Obstetrics and Gynecology, MountainView Hospital, Nevada Surgery and Cancer Care, Las Vegas, NV, USA

    Lynn D. Kowalski

Authors
  1. Lindsey K. Leggett
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  2. Olga Muldoon
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  3. David L. Howard
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  4. Lynn D. Kowalski
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Corresponding author

Correspondence to David L. Howard.

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Conflicts of interest

Lindsey K Leggett, Olga Muldoon, David L Howard, and Lynn D Kowalski declare that they have no conflicts of interest.

Ethical standards

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. This research study was conducted retrospectively from data obtained for clinical purposes. We consulted extensively with the IRB of Touro University Nevada and due to the nature of the retrospective design, informed consent was not obtained prior to data collection. This study was approved by the Institutional Review Board at Touro University Nevada (9/19/2019–TUNIRB000078).

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Leggett, L.K., Muldoon, O., Howard, D.L. et al. A comparison of surgical outcomes among robotic cases performed with an employed surgical assist versus a second surgeon as the assist. J Robotic Surg 16, 229–233 (2022). https://doi.org/10.1007/s11701-021-01230-7

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  • DOI: https://doi.org/10.1007/s11701-021-01230-7

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