Journal of the European Society for Gynaecological Endoscopy


Strategies to optimize the performance of Robotic-assisted ­laparoscopic hysterectomy

N. Lambrou1, R.E. Diaz1, P. Hinoul3, D. Parris2, K. Shoemaker3, A. Yoo3, M. Schwiers3

1Division of Gynecologic Oncology, Baptist Health South Florida, South Miami Hospital, 6200 Sunset Drive, Suite 502, Miami, FL 33143, United States.

2Center for Research & Grants, Baptist Health South Florida, United States.

3Ethicon Endo-Surgery, Inc. 4545 Creek Rd. Cincinnati OH, United States.

Correspondence at:


ENSEAL, hysterectomy, laparoscopy, robot-assisted, robotic, surgery

Published online: Sep 30 2014


A hybrid technique of robot-assisted, laparoscopic hysterectomy using the ENSEAL® Tissue Sealing Device is described in a retrospective, consecutive, observational case series. Over a 45 month period, 590 robot-assisted total laparoscopic hysterectomies +/- oophorectomy for benign and malignant indications were performed by a single surgeon with a bedside assistant at a tertiary healthcare center. Patient demographics, indications for surgery, comorbidities, primary and secondary surgical procedures, total operative and surgical time, estimated blood loss (EBL), length of stay (LOS), complications, transfusions and subsequent readmissions were analyzed. The overall complication rate was 5.9% with 35 patients experiencing 69 complications. Mean (SD) surgery time, operating room (OR) time, EBL, and LOS for the entire cohort were 75.5 (39.42) minutes, 123.8 (41.15) minutes, 83.1 (71.29) millilitres, and 1.2 (0.93) days, respectively. Mean surgery time in the first year (2009) was 91.6 minutes, which declined significantly each year by 18.0, 19.0, and 24.3 minutes, respectively. EBL and LOS did not vary ­significantly across the entire series. Using the cumulative sum method, an optimization curve for surgery time was evaluated, with three distinct optimization phases observed.

In summary, the use of an advanced laparoscopic tissue-sealing device by a bedside surgical assistant provided an improved operative efficiency and reliable vessel sealing during robotic hysterectomy.