Reducing the cost of robotic hysterectomy: assessing the safety and efficacy of using prograsp forceps in lieu of needle holder for vaginal cuff closure

Abstract

Robotic-assisted surgery is criticized for its high cost. As surgeons get more experienced in robotic surgery, modifications to existing techniques are tried to reduce surgical costs. Vaginal cuff closure using prograsp forceps in lieu of needle holder can be safe and cost-effective in patients undergoing robotic-assisted hysterectomy. The objective of this study is to compare the safety, efficacy, and cost effectiveness of using prograsp forceps in lieu of needle holder for suturing the vaginal cuff after robotic-assisted hysterectomy. This was a single-institution retrospective review of patients who underwent robotic-assisted hysterectomy for benign and malignant conditions from October 2015 to August 2018. Patients were stratified based on whether prograsp forceps or needle holder was used for suturing vaginal cuff. Data obtained included demographic, surgical data, and postoperative outcomes. Mann–Whitney U test and Chi-square test were used to compare qualitative and quantitative data, respectively. 367 patients underwent robotic-assisted hysterectomies during this period. 75 patients belonged to the needle holder cohort; 292 patients had vaginal cuff closure using prograsp forceps. Vault closure time was comparable between the groups (6.4 vs. 6.6 p = 0.33). There were no significant differences in the postoperative vault-related complications between groups. There was no instrument damage in either group. Using prograsp saved 220 USD in instrument-related charges. This study shows that using prograsp in lieu of needle holder for suturing is safe, there is no increase in operative time or complications, and there is a cost advantage.

This is a preview of subscription content, access via your institution.

We’re sorry, something doesn't seem to be working properly.

Please try refreshing the page. If that doesn't work, please contact support so we can address the problem.

Fig. 1

References

  1. 1.

    Lim PC, Kang E, Park DH (2011) A comparative detail analysis of the learning curve and surgical outcome for robotic hysterectomy with lymphadenectomy versus laparoscopic hysterectomy with lymphadenectomy in treatment of endometrial cancer : a case-matched controlled study of the first one hundred twenty two patients. Gynecol Oncol 120(3):413–418

    Article  Google Scholar 

  2. 2.

    Iavazzo C, Gkegkes ID (2016) Robotic assisted hysterectomy in obese patients: a systematic review. Arch Gynecol Obstet 293(6):1169–1183

    Article  Google Scholar 

  3. 3.

    Coccolini F, Ansaloni L, Manfredi R, Campanati L, Poiasina E, Bertoli P et al (2013) Peritoneal adhesion index (PAI): proposal of a score for the “ignored iceberg” of medicine and surgery. World J Emerg Surg 8(1):6

    Article  Google Scholar 

  4. 4.

    Boggess JF, Gehrig PA, Cantrell L, Shafer A, Ridgway M, Skinner EN et al (2008) A comparative study of 3 surgical methods for hysterectomy with staging for endometrial cancer: robotic assistance, laparoscopy, laparotomy. Am J Obstet Gynecol 199(4):360.e1–9

    Article  Google Scholar 

  5. 5.

    Bogani G, Multinu F, Dowdy SC, Cliby WA, Wilson TO, Gostout BS et al (2016) Incorporating robotic-assisted surgery for endometrial cancer staging: analysis of morbidity and costs. Gynecol Oncol 141(2):218–224

    Article  Google Scholar 

  6. 6.

    Abitbol J, Cohn R, Hunter S, Rombaldi M, Cohen E, Kessous R et al (2017) Minimizing pain medication use and its associated costs following robotic surgery. Gynecol Oncol 144(1):187–192

    Article  Google Scholar 

  7. 7.

    Agarwal R, Rajanbabu A, Unnikrishnan UG (2018) A retrospective evaluation of the perioperative drug use and comparison of its cost in robotic vs open surgery for endometrial cancer. J Robot Surg 12(4):665–672. https://doi.org/10.1007/s11701-018-0799-0 (Epub 2018 Mar 22)

    Article  PubMed  Google Scholar 

  8. 8.

    Ramirez D, Ganesan V, Nelson RJ, Haber GP (2016) Reducing costs for robotic radical prostatectomy: three-instrument technique. Urology 95:213–215

    Article  Google Scholar 

  9. 9.

    Ludwig WW, Gorin MA, Allaf ME (2015) Reducing the cost of robotic partial nephrectomy through innovative instrument use. Eur Urol. 67:594–595

    Article  Google Scholar 

Download references

Funding

None.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Anupama Rajanbabu.

Ethics declarations

Conflict of interest

Authors Viral Patel and Akhila Appukuttan declare that they have no conflict of interest. Author Anupama Rajanbabu is a proctor and advanced trainer for Robotic surgery.

Ethical standards

Clearance Obtained.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Rajanbabu, A., Patel, V.J. & Appukuttan, A. Reducing the cost of robotic hysterectomy: assessing the safety and efficacy of using prograsp forceps in lieu of needle holder for vaginal cuff closure. J Robotic Surg 15, 31–35 (2021). https://doi.org/10.1007/s11701-020-01075-6

Download citation

Keywords

  • Prograsp for suturing
  • Robotic assisted hysterectomy
  • Vaginal cuff complications