In this study, perioperative outcomes and survival data in patients with early cervical cancer operated with three surgical methods: robot-assisted, laparoscopic and open, are to be analyzed. From January 2006 to May 2010, 294 patients with T1в1 cervical cancer were studied retrospectively. Robot-assisted radical hysterectomy (RARH) was performed in 73 (24.8%) of them, laparoscopic-assisted radical vaginal hysterectomy (LARVH) in 46 (15.6%) and, in 175, (59.5%), abdominal radical hysterectomy (ARH). Mean hospital stay of patients with RARH and LARVH was 4.1± 0.7 and 4.8±0.5, respectively, and of those with ARH, 9.6± 1.0 days (p=0.001). Mean operative time was 152.2± 26.5 min for the robotic group as it was significantly shorter in comparison with the laparoscopic group (232.1±61.7 min) and laparotomy group (168.2±31.1 min) (p=0.001). The application of Cox regression analysis found that the regional lymph node metastases were of significant value for diseasefree survival (DSF), and the nodal status and recurrence presence-for overall survival (OS). Type of surgical procedure did not influence DSF, as well as OS. RARH has been established to be a safe procedure with proven advantages in regard to operative time and hospital stay. The absence of significant differences in DSF and OS is a substantial reason to continue, from an oncologic point of view, the application of this method on patients with T1в1 cervical cancer.
The presence of aberrant obturator vessels, arising from the external iliac circulatory system and their lesion during a surgical intervention in the area, may lead to bleeding, which is difficult to control. For a period of 5 years, 133 endoscopic bilateral pelvic lymph node dissections in patients with cervical cancer were performed, and the present aberrant vessels were registered and filmed. Aberrant obturator vessels were present in 58 cases (43.6 %). Eight obturator arteries and 58 obturator veins, branches of the external iliac vascular system, were visualized. Arterial type of obturator variation was found in one (0.07 %) case, venous type-in 50 (37.5 %), and combined (arterial and venous) type-in seven (5.26 %), out of all patients. Of the observed aberrant obturator arteries, three were found to arise from the inferior epigastric artery, and five from the external iliac artery. Of all available 73 veins, 51 (70 %) drained directly into the external iliac vein and 22 (30 %) in the inferior epigastric vein. The frequency of the aberrant obturator veins was 27.44 % (n =73), and of the arteries-3 %, related to the investigated pelvic halves (n =266). The presence of aberrant obturator vessels is a relatively common anatomic variation, important for the clinical practice.
The objective of this work is to present and analyze our da Vinci S robotic surgery results in the treatment of gynecologic tumors for a 1-year period. Fiftyone patients underwent da Vinci S (Intuitive Surgical, USA) robotic surgery at the Medical University-Pleven Gynecologic Oncology Clinic from January 2008 to January 2009. Robot-assisted radical hysterectomy with total pelvic lymph node dissection was performed in 28 (54.9%) of them, robot-assisted total hysterectomy in 21 (41.2%), and robot-assisted pelvic lymph node dissection in two (3.9%). The average length of the operative intervention, from the beginning of the CO 2 insufflation of the abdomen to closing trocar skin incision was 119.89 min (±43.441) and mean console time was 76.56 min (±32.904). The average patient body weight was 70.56 kg (±18.272; range, 41-114) with mean body mass index (BMI) of 27.30 (±6.938). No significant difference was observed between the BMI and operative time (p=0.49). No significant intra-operative complications were registered. An ureterovaginal fistula was diagnosed on the 10th postoperative day in one of the patients (2%). Robot-assisted endoscopic gynecologic surgery is a modern and advanced method for operative treatment of benign and malignant gynecological tumors. It is appropriate for obese patients as the obesity is not related to a prolonged operative time.
SummarySelection of an appropriate surgical method for hysterectomy in an individual patient is currently an issue that remains open and debatable. This study aimed to analyze perioperative outcomes in gynecologic patients who underwent laparoscopic hysterectomy at a single institution during a 6-year period and to compare the data for simple hysterectomy patients treated with different surgical approaches. The study included a retrospective analysis of demographics, pre- and post-operative characteristics of 1,023 patients, operated on using four types of simple hysterectomy approaches: 635 laparoscopic hysterectomies (62.1%), 289 total abdominal hysterectomies (28.3%), 45 total vaginal hysterectomies (4.4%) and 54 robotic-assisted hysterectomies (5.3%). For the laparoscopic hysterectomy group, the mean operative time was shorter as compared to the abdominal and vaginal hysterectomy groups (p<0.05), as well as a significantly shorter hospital length-of-stay when compared to the abdominal, robotic or vaginal hysterectomy groups (p<0.05). Regression analysis revealed significant linear correlation between operative time and body-mass index of laparoscopic hysterectomy patients (R2 =0.008; p=0.026). Complications emergence and hemotransfusion often prolonged the mean operative time significantly by 17.8 min (p=0.002) and 15.5 min, respectively (p<0.001). The rate of major complications was significantly higher in the laparoscopic vs. abdominal groups (p<0.05). Clinical outcomes in patients operated on with laparoscopic hysterectomy were better than in those operated with total abdominal and vaginal hysterectomy in terms of operative time and hospital length-of-stay. Prospective randomized multi-center studies would be desirable to further define the place of the modern minimally invasive hysterectomy approaches.
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