The robot is broadly accessible less than 10 years after its introduction to gynecologic surgery

Use of the robot has skyrocketed in recent years, with 84% of reproductive and gynecologic surgeons reporting access to the technology less than 10 years after its approval for gynecologic surgery by the US Food and Drug Administration. This and other findings from a survey of members of the American Society for Reproductive Medicine (ASRM) and AAGL were presented in a poster at the 42nd AAGL Global Congress in Washington, DC.¹

Access to robotic assistance was highest among surgeons based in academic centers (93%) and lowest among those in private practice (77%), but remained high overall (84%).

Related article: The robot is gaining ground in gynecologic surgery.
Should you be using it? (An expert roundtable; April 2013)

Other findings of the survey:

• 85% of residents and fellows reported robotic training, with the greatest exposure to training reported in American Congress of Obstetricians and Gynecologists (ACOG) Districts IV (96%) and VI (100%) and less exposure in District I (72%). District IV comprises the District of Columbia, Georgia, Maryland, North Carolina, South Carolina, Virginia, West Virginia, Puerto Rico, and the West Indies. District VI comprises Illinois, Iowa, Minnesota, Nebraska, North Dakota, South Dakota, Wisconsin, Manitoba, and Saskatchewan. And District I comprises the Atlantic provinces (New Brunswick, Newfoundland, Nova Scotia, Prince Edward Island), Connecticut, Maine, Massachusetts, New Hampshire, Quebec, Rhode Island, and Vermont.

• Sixty-one percent of surgeons had earned or were planning to earn credentials in robotic surgery, with no difference between districts or types of practice. The figure did vary by subspecialty, however, with 100% of gynecologic oncologists reporting having earned or planning to earn credentials, compared with 79% of minimally invasive gynecologic surgeons, 77% of urogynecologists, 67% of ObGyns, 46% of gynecologists (no obstetric practice), and 44% of reproductive endocrinologists and infertility specialists.

• Some surgeons declined to use the robot. Surgeons who had access to a robot but who chose not to earn privileges gave the following reasons: high cost, 20%; increased time in the operating room (OR), 18%; need for additional training, 10%; additional OR time unavailable, 8%; cost of training, 4%; safety issues, 1%; and possible need for additional ports, 1%. There was greater concern about cost and increased operative time among private practitioners (24% and 25%, respectively) than academic physicians (13% and 15%, respectively).

A link to the online survey was emailed to all members of ASRM and AAGL in June 2012, with 561 practicing gynecologic laparoscopic surgeons and 138 residents and fellows responding, for a response rate of 15%.

Overall, investigators identified no single overriding barrier to use of the robot.

Most surgeons are satisfied with the energy sources they now use
The same survey included questions about surgeons’ attitudes toward various energy sources, including monopolar, bipolar, ultrasonic, laser, and other forms of energy. It found that 94% and 93% of respondents were satisfied or very satisfied with the primary energy source they currently used in the management of endometriosis and myomectomy, respectively. Seventy-nine percent reported having used a CO₂ laser.

For the surgical management of endometriosis, practicing surgeons preferred:

• monopolar energy, 33%
• bipolar energy, 22%
• ultrasonic devices, 21%
• laser energy, 12%
• other energy source, 9%.

For myomectomy, practicing surgeons preferred:

• monopolar energy, 43%
• bipolar energy, 21%
• ultrasonic devices, 14%
• laser energy, 2%
• other energy source, 12%.

For colpotomy, practicing surgeons preferred:

• monopolar energy, 35%
• bipolar energy, 17%
• ultrasonic devices, 19%
• other energy source, 10%.

Among residents and fellows, the preference was greatest for monopolar energy for endometriosis, myomectomy, and colpotomy (44%, 41%, and 41%, respectively).

As for complications, practicing surgeons reported 78 related to endometriosis surgery and 73 related to myomectomy. The most common sites of complications were the bladder, ureter, and bowel. Unanticipated bleeding was also common.