• Vol. 40 No. 5, 208–212
  • 15 May 2011

Gynaecologic Robot-Assisted Cancer and Endoscopic Surgery (GRACES) in a Tertiary Referral Centre

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ABSTRACT

Introduction: Robotic-assisted gynaecologic surgery is gaining popularity and it offers the advantages of laparoscopic surgery whilst overcoming the limitations of operative dexterity. We describe our experience with the first 40 cases operated under the GRACES (Gynaecologic RobotAssisted Cancer and Endoscopic Surgery) programme at the Department of Obstetrics & Gynecology, National University Hospital, Singapore.

Materials and Methods: A review was performed for the first 40 women who had undergone robotic surgery, analysing patient characteristics, surgical timings and surgery-related complications. All cases were performed utilising the da Vinci® surgical system (Intuitive Surgical, Sunnyvale, CA) with 3 arms and 4 ports. Standardised instrumentation and similar cuff closure techniques were used.

Results: Seventeen (56%) were for endometrial cancer and the rest, for benign gynaecological disease. The mean age of the patients was 52.3 years. The average docking time was 11 minutes (SD 0.08). The docking and operative times were analysed in tertiles. Data for patients with endometrial cancer and benign cases were analysed separately. There were 3 cases of complications- cuff dehiscence, bleeding from vaginal cuff and tumour recurrence at vaginal vault.

Conclusion: Our caseload has enabled us to replicate the learning curve reported by other centres. We advocate the use of a standard instrument set for the first 20 cases. We propose the following sequence for successful introduction of robot-assisted gynaecologic surgery – basic systems training, followed shortly with a clinical case, and progressive development of clinical competence through a proctoring programme.


Hysterectomy is the most common major gynaecologic operation. Over 600,000 hysterectomies are performed annually in the US. In Singapore, almost 9000 hysterectomies are performed annually. Traditionally, gynaecologic surgeons approached the pelvis through a laparotomy incision. Since its introduction some 20 years ago, laparoscopy has become the preferred option compared to laparotomy because of the cost-effectiveness, patient satisfaction and superior quality of life indices associated with laparoscopy. Compared to laparotomy, laparoscopy is associated with significantly lower postoperative infection rates, shorter length of hospital stay and lower overall expenditures. However, laparoscopic hysterectomy has not been widely adopted by gynaecologic surgeons because of its longer operating time, the need for advanced training and the relatively steep learning curve required to consistently obtain good clinical outcomes. Currently, only 23% of all hysterectomies in the US are performed laparoscopically.

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