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Abstract：
BACKGROUND: The objective of the study was to provide a comprehensive description of perioperative morbidity associated with robot-assisted surgery (RAS) in a gynecological oncology setting in order to improve the preoperative counseling of women and support shared decision-making.
METHODS: All women scheduled for intended RAS between January 2015 and December 2022 were prospectively included in an electronic morbidity database for the analyses of perioperative complications.
RESULTS: In total, 2225 women were included. Sixty-four patients (2.9%) experienced an intraoperative complication. Intraoperative complications were associated with a higher rate of conversion to laparotomy (15.6% vs. 1.8%, p < 0.001), a higher rate of major postoperative morbidity (9.3% vs. 2.4%, p < 0.001), and a higher rate of reoperation (9.3% vs. 1.7%, p < 0.001), compared to cases without intraoperative complications. Thirty-day postoperative morbidity was evaluated according to the Memorial Sloan-Kettering Cancer Center Surgical Secondary Events Grading System. Grade 3-5 events were considered major. A total of 57 patients (2.6%) experienced a major event after surgery, postoperative rupture of the vaginal vault being the most common complication requiring surgical intervention. Conversion to laparotomy occurred in 49 cases (2.2%) and was associated with higher intraoperative blood loss (300 mL vs. 25 mL, p < 0.001), a higher rate of postoperative major events (20.4% vs. 2.2%, p < 0.001), and a higher rate of reoperation (11.8% vs. 1.6%, p < 0.001).
CONCLUSIONS: Our study demonstrates low rates of major perioperative morbidity and conversion to laparotomy after RAS performed by trained high-volume surgeons in a gynecological oncology setting.
METHODS: All women scheduled for intended RAS between January 2015 and December 2022 were prospectively included in an electronic morbidity database for the analyses of perioperative complications.
RESULTS: In total, 2225 women were included. Sixty-four patients (2.9%) experienced an intraoperative complication. Intraoperative complications were associated with a higher rate of conversion to laparotomy (15.6% vs. 1.8%, p < 0.001), a higher rate of major postoperative morbidity (9.3% vs. 2.4%, p < 0.001), and a higher rate of reoperation (9.3% vs. 1.7%, p < 0.001), compared to cases without intraoperative complications. Thirty-day postoperative morbidity was evaluated according to the Memorial Sloan-Kettering Cancer Center Surgical Secondary Events Grading System. Grade 3-5 events were considered major. A total of 57 patients (2.6%) experienced a major event after surgery, postoperative rupture of the vaginal vault being the most common complication requiring surgical intervention. Conversion to laparotomy occurred in 49 cases (2.2%) and was associated with higher intraoperative blood loss (300 mL vs. 25 mL, p < 0.001), a higher rate of postoperative major events (20.4% vs. 2.2%, p < 0.001), and a higher rate of reoperation (11.8% vs. 1.6%, p < 0.001).
CONCLUSIONS: Our study demonstrates low rates of major perioperative morbidity and conversion to laparotomy after RAS performed by trained high-volume surgeons in a gynecological oncology setting.
摘要：
背景：该研究的目的是全面描述妇科肿瘤学环境中与机器人辅助手术（RAS）相关的围手术期发病率，以改善妇女的术前咨询并支持共同决策。
方法：将2015年1月至2022年12月计划进行RAS的所有女性前瞻性纳入电子发病率数据库，以分析围手术期并发症。
结果：总计，包括2225名妇女。64例患者（2.9％）出现术中并发症。术中并发症与更高的中转开腹率相关(15.6%vs.1.8%,p<0.001)，术后主要发病率较高(9.3%vs.2.4%,p<0.001)，和更高的再手术率(9.3%vs.1.7%,p<0.001)，与没有术中并发症的病例相比。根据纪念斯隆-凯特琳癌症中心外科继发性事件分级系统评估术后30天的发病率。3-5级事件被认为是主要事件。共有57例患者（2.6%）在手术后经历了重大事件，术后阴道穹窿破裂是需要手术干预的最常见并发症。在49例（2.2％）中发生了剖腹手术，并且与术中失血量增加有关（300mLvs.25mL,p<0.001)，术后主要事件发生率较高（20.4%vs.2.2%,p<0.001)，和更高的再手术率(11.8%vs.1.6%,p<0.001)。
结论：我们的研究表明，在妇科肿瘤学环境中，由训练有素的高容量外科医生进行RAS后，主要围手术期发病率和剖腹手术的转化率较低。
方法：将2015年1月至2022年12月计划进行RAS的所有女性前瞻性纳入电子发病率数据库，以分析围手术期并发症。
结果：总计，包括2225名妇女。64例患者（2.9％）出现术中并发症。术中并发症与更高的中转开腹率相关(15.6%vs.1.8%,p<0.001)，术后主要发病率较高(9.3%vs.2.4%,p<0.001)，和更高的再手术率(9.3%vs.1.7%,p<0.001)，与没有术中并发症的病例相比。根据纪念斯隆-凯特琳癌症中心外科继发性事件分级系统评估术后30天的发病率。3-5级事件被认为是主要事件。共有57例患者（2.6%）在手术后经历了重大事件，术后阴道穹窿破裂是需要手术干预的最常见并发症。在49例（2.2％）中发生了剖腹手术，并且与术中失血量增加有关（300mLvs.25mL,p<0.001)，术后主要事件发生率较高（20.4%vs.2.2%,p<0.001)，和更高的再手术率(11.8%vs.1.6%,p<0.001)。
结论：我们的研究表明，在妇科肿瘤学环境中，由训练有素的高容量外科医生进行RAS后，主要围手术期发病率和剖腹手术的转化率较低。
