Implementation of robotic gynecologic surgery in a rural setting: impact on presence of assistant surgeon and route of hysterectomy

Philadelphia, PA

Objective: Robot-assisted hysterectomy allows the surgeon improved visualization, range of motion, and ergonomics which in some cases may obviate the need for an assistant surgeon. In rural hospitals where physician shortages remain a major barrier to care, reducing the number of surgeons necessary to perform hysterectomy would be of significant consequence. We sought to evaluate the impact of robotic surgery on the need for an assistant surgeon at time of hysterectomy at a rural community hospital.

Methods and Procedures: We performed a retrospective chart review of hysterectomies performed at a rural community hospital by general gynecologists, focusing on the 12-month period prior to, and the 12-month period 2 years following, implementation of a robotic surgical program. We chose 2 years to allow for gradual surgeon adoption of robotic technology. Our primary outcome was need for an assistant surgeon at time of hysterectomy. Our secondary outcome was route of hysterectomy. Billing records were cross-referenced against the medical record, and statistical analyses performed.

Results: Following implementation of a robotic surgical program, we observed a statistically significant decrease in the need for an assistant surgeon at the time of hysterectomy from 86.7% to 4.9% (p<0.05). The percentage of hysterectomies performed by minimally-invasive technique (laparoscopic, robotic, and vaginal) versus open technique (total abdominal) increased from 66.8% to 96.6% following implementation of a robotic surgical program.

Conclusion: Access to robotic surgical technology reduced the need for an assistant surgeon at time of hysterectomy and increased the rate of minimally-invasive hysterectomy performed. These findings are of particular relevance to rural hospitals facing physician shortages.