First 200 Robotic General Surgery Cases in a Community Hospital

Background and Objectives: A retrospective series and learning curve of the first 101 robotic general surgery cases from a single surgeon in a small community hospital has been previously reported. This study serves as a continuation and offers a more detailed statistical analysis while demonstrating the efficacy and safety of a general surgery robotics program in a community hospital with quality assessment measures. Methods: Measurements included total operative time, console time, conversion rates, complications, surgical site infections, surgical site occurrences, length of stay, and patient demographics. Descriptive statistics were included for all variables. Linear regression was used to test the hypothesis of a learning curve, reflected by a decrease in console time with experience. Results: Between March 2014 and February 2017, 200 robotic general surgery cases were performed by a single surgeon in a 266-bed community hospital, including laparoscopic cholecystectomies; ventral, incisional, and umbilical hernia repairs; colorectal; foregut and bariatric; inguinal hernia repairs; and miscellaneous procedures. One hundred and ninety-eight of the cases (99%) were completed robotically. Thirteen patients were readmitted within 30 days, and 21 had complications (11%). There were no mortalities, and all complications were resolved positively. The mean operative and console times of all 200 cases were 214.8 and 105.7 minutes, respectively. Decreased console time was significantly associated with increasing case load, even after controlling for surgery type. Conclusion: With increased operative volume, general surgeons who utilize the robotic platform can improve operative outcomes, decrease operative times and perform increasingly complicated procedures while maintaining low complication rates.