Ahmet DEMİR, Atalay EKİN, Emre MAT, Mehmet GOKCU, Ulas SOLMAZ, Alper BİLER

Robotik Total Histerektomi: Tersiyer Bir Merkezin İlk Deneyimi

Amaç: Robotik total histerektomi ile ilk deneyimimizi incelemek ve operasyonla ilişkili sonuçları değerlendirmektir. Gereç ve Yöntemler: Kliniğimizde Aralık 2015-Ağustos 2016 tarihleri arasında robotik total histerektomi yapılan 16 ardışık hastayı retrospektif olarak inceledik. Bulgular: On üç (% 81.25) hastaya benign nedenlerle, 2 (% 12.5) hastaya endometrium kanseri ve 1 (% 6.25) hastaya da mikroinvaziv serviks kanseri nedeniyle robotik total histerektomi yapıldı. Hastaların ortalama yaşı 48.75 ± 6.5, paritesi 2.8 ± 1.7, vücut kitle indeksi 28.2 ± 4.6, preoperatif hemoglobin 11.6 ± 1.0 g/dl, postoperatif hemoglobin 10.3 ± 1.0 g/dl, operasyon süresi 162.2 ± 39.4 dakika, docking süresi 7.3 ± 3.3 dakika, konsol süresi 147 ± 37.0 dakika, uterus ağırlıkları 178.8 ± 98.5 g ve hastanede kalış süresi 3.6 ± 1.8 gün olarak tespit edildi. Üç hastaya postoperative dönemde kan transfüzyonu yapıldı. Myoma uteri nedeniyle opera edilen bir hastada, pelvik yapıların yetersiz vizüalizasyonu nedeniyle laparotomiye geçildi. Hiçbir hastada intraoperative komplikasyon gelişmedi. Postoperatif komplikasyonlar cerrahiyi takiben ilk gün ateş yüksekliğinin görüldüğü astımı olan bir hastayla sınırlıydı. Sonuç: Robotik histerektomi sonuçları hem hasta hem de cerrah için tatminkardır. Öğrenme eğrisinin tamamlanmasını takiben, robotik total histerektomi laparoskopik histerektomi için önemli bir alternative olabilir. Ancak robot sistemlerinin kurulum, işletim ve bakım maliyetlerinin yüksek olması robotic cerrahinin yaygın kullanımı için hala önemli bir kısıtlılıktır.

Robotic Total Hysterectomy: Initial Experience in a Tertiary Center

Objective: To examine our initial experience with robotic total hysterectomyand evaluate operation related outcomes.Materials and Methods: We retrospectively analyzed 16 consecutivepatients who underwent robotic total hysterectomy between December2015 and August 2016 in our clinic.Results: Robotic total hysterectomy was performed for benign indications in13 (81.25%) patients, endometrial cancer in two patients (12.5%),microinvasive cervical cancer in one patient (6.25%). The mean age ofpatients was 48.7 ± 6.5 years, parity was 2.8 ± 1.7, body mass index was 28.2± 4.6 kg/m2, preoperative hemoglobin levels was 11.6 ± 1.0 g/dl,postoperative hemoglobin levels 10.3 ± 1.0 g/dl, operation time was 162.2 ±39.4 minutes, docking time was 7.3 ± 3.3 minutes, console time was 147 ±37.0 minutes, uterine weight was 178.8 ± 98.5 g and duration of hospital staywas 3.6 ± 1.8 days. Blood transfusion was administered to three patients inthe postoperative period. One patient was converted to laparotomy becauseof poor visualization of pelvic structures by a large uterus. No intraoperativecomplication was encountered. Postoperative complications were limited toone patient with asthma who had fever on the first day following surgery.Conclusion: The results of robotic total hysterectomy is satisfactory for bothpatient and surgeon. Following the completion of the learning curve, robotictotal hysterectomy could be an important alternative method forlaparoscopic hysterectomy. However, the installation of robotic systems,operating and maintenance costs still remain as crucial limitations for thewidespread use of robotic surgery.

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