The impact of institutional experience on robotic sacrocolpopexy

To evaluate the institutional learning curve for robotic sacrocolpopexy (RSC) at three different institutions. This is an ancillary study of data collected for a multicenter retrospective review on complications of sacrocolpopexy. Outcomes of RSC were collected at three health networks from January 2007 to December 2010. We collected baseline patient characteristics as well as surgical data. Anatomical failure was defined as prolapse at or below the hymen. Novice cases were the first 25 cases at each institution and experienced cases were the last 25 during the study period. Two hundred and twenty-two RSC were performed during the study period. Patient demographic data was similar between groups. There was a significant difference in operative time when comparing the novice group to the experienced group (362 vs. 311 min, p < 0.01). There was statistically significant decrease in the mean operative time between the novice and experienced groups at both WHC and CHH (362 vs. 271, p < 0.01 and 331 vs. 261, p < 0.01) but not at Penn (389 vs. 404, p = 0.26). There were no significant differences between groups with respect to individual or composite complications (12.0 vs. 4.0 %, p = 0.12), anatomic failures (10.0 vs. 5.6 %, p = 0.68) and repeat surgery for prolapse (5.3 vs. 2.7 %, p = 0.7). Operative time decreases by nearly 1 h at institutions performing >80 cases with no change in rate of complications, anatomic failures, and repeat surgeries.