A case matched analysis of robotic radical hysterectomy with lymphadenectomy compared with laparoscopy and laparotomy

Estape, Ricardo; Lambrou, Nicholas C; Díaz, Roberto; Estape, Eric; Dunkin, Natalie; Rivera, Angel M. Rodriguez

doi:10.1016/j.ygyno.2009.03.009

Cited by 151 publications

(112 citation statements)

References 18 publications

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“…The shortest operating time was reported by 2 previously published studies with a mean time of 144 and 185 minutes. 31,32 In contrast to this, there were also several other studies that had a much longer operating time in the RRH group compared with our study. 11,22 Thus, the duration of the operating time is quite variable as the definition of ''operating time'' differs between studies.…”

Section: International Journal Of Gynecologicalcontrasting

confidence: 92%

“…22,34 In addition to that, blood loss was highest when using traditional radical hysterectomy surgery with a mean blood loss of 450 to 1000 mL. 11,30,32,33 The reason for a decrease in blood loss during RRH surgery compared with TLRH is that the sacral afferent fibers and deep uterine veins can be more easily differentiated because of the robotic arm. In addition, the movement of the robotic arm results in stable traction and counter traction and excellent 3-dimensional view within a narrow space.…”

Section: International Journal Of Gynecologicalmentioning

confidence: 99%

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Robotic-Assisted Radical Hysterectomy Results in Better Surgical Outcomes Compared to the Traditional Laparoscopic Radical Hysterectomy for the Treatment of Cervical Cancer

Nie

Liu

2017

Journal of Minimally Invasive Gynecology

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Objective: The aim of this study was to compare the surgical outcomes of robotic-assisted radical hysterectomy (RRH) with traditional laparoscopic radical hysterectomy (TLRH) for the treatment of early-stage cervical cancer in a large retrospective cohort of a total of 933 patients. Methods: We have enrolled 100 patients into the RRH and 833 patients into the TLRH group. The surgical outcomes include operating time, blood loss, transfusion rate, pelvic lymph node yield, hospitalization days, duration of bowel function recovery, catheter removal before and after 3 weeks, conversion to laparotomy, and intraoperative and postoperative complications. Follow-up results were also analyzed for all patients. Results: Both groups have similar patient and tumor characteristics but patients with a larger lesion size were preferably enrolled in the TLRH treatment group. The treatment with RRH was generally superior to TLRH with respect to operating time, blood loss, length of hospitalization, duration of bowel function recovery, and postoperative complications. On follow-up of patients, there were no relapses reported in the RRH group compared with 4% of relapse cases and 2.9% of deaths because of metastasis in the TLRH group. No conversion of laparotomy occurred in the RRH group. No significant difference was found with respect to intraoperative complications and blood transfusion between both groups. Conclusions: The results from this study suggest that RRH is superior to TLRH with regard to surgical outcome and may pose a safe and feasible alternative to TLRH. The operating time and lymph node yield is acceptable. Our study is one of the largest single-center studies of surgical outcomes comparing RRH with TLRH during cervical cancer treatment and will significantly contribute to the safety of alternative treatment options for patients. Furthermore, the difference detected between TLRH and RRH group is further strengthened by the great expertise of the surgeon performing laparoscopic surgeries.

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Section: International Journal Of Gynecologicalcontrasting

confidence: 92%

Section: International Journal Of Gynecologicalmentioning

confidence: 99%

Robotic-Assisted Radical Hysterectomy Results in Better Surgical Outcomes Compared to the Traditional Laparoscopic Radical Hysterectomy for the Treatment of Cervical Cancer

Nie

Liu

2017

Journal of Minimally Invasive Gynecology

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“…Estap et al report a single cystotomy in a patient who has had three previous cesarean section and two cystotomies in the laparoscopic group [41]. Ko [43].…”

Section: Robotic Surgery For Uterine Cervical Cancermentioning

confidence: 99%

Minimally Invasive Surgery: A New Approach for Uterine Cervical Cancer

Gavrilescu¹,

Todosi²,

Ioanid³

et al. 2015

Surgery

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IntroductionIn the early 1990s, the laparoscopic approach in uterine cervical cancer has started to become quite popular among oncologist surgeons in order to minimize postoperative morbidity. When a new surgical technique is taken into consideration or suggested, it is compared with the standard therapy hitherto. Important issues to be taken into account include the feasibility and applicability of the new technique, intraoperative and postoperative complications and in oncological cases, survival and risk of recurrence.Gold standard for uterine cervical cancer in the early stages was abdominal radical hysterectomy with pelvic lymphadenectomy for more than 100 years. This technique, described for the first time Wertheim, Meigs subsequently underwent some changes. The first laparoscopic hysterectomy was performed and published in 1989 [1], but the first laparoscopic radical hysterectomy with pelvic and paraaortic lymphadenectomy in a patient with cervical cancer stage IA2 was performed by Nezha et al. in June 1989 and reported in 1992 [2]. Since then, it has been reported in the literature over 1000 cases [3]. Laparoscopic Surgery versus Open Surgery in Uterine Cervical CancerInitially used for diagnostic, laparoscopy has become a method of treatment in the field of gynecological surgery, but also in many other field. The results of laparoscopic surgery are now comparable with those obtained by laparotomy in benign and malignant pathologies. The most important advantages of the laparoscopic technique include more pleasing cosmetic appearance, or minimum parietal infectious complications, low incidence of adhesion formation, low cost associated with hospitalization and recovery period smaller resumption of daily activities in a shorter period [4]. In a study comparing the two surgical techniques, the results show an average of operating time with significant differences statistically 231.7 minutes for cases treated laparoscopically and 207 minutes to classical surgery, which can be explained by the fact that laparoscopic hysterectomies implemented quite recently requires a learning curve. The surgeons will become more familiar with laparoscopic procedure; the operative time is expected to become shorter. Intraoperative blood loss was lower in the laparoscopy (161.1 ml) compared with the traditional method (394.4 ml), with blood transfusions in 3 patients. Postoperative complications, represented mostly wound infections were recorded only in the group that received radical abdominal hysterectomy. The hospital stay was less in laparoscopic interventions (mean=2.9 days) compared with the second procedure (mean=5. A randomized, multicenter study including 116 patients demonstrated that laparoscopic assisted vaginal hysterectomy can be performed in a similar operating time classic surgery with intraoperative blood loss less and a relatively shorter period of hospitalization (p<0.01). Postoperative pain, another important parameter discussed, is lower for the first 3 days of laparoscopy versus open surgery (p<0.5) [7]....

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“…[11][12][13][14][15][16] Magrina et al 17 reported that robotic and conventional laparoscopic surgeries are preferable to laparotomy for patients requiring radical hysterectomy in terms of blood loss and length of hospital stay. Boggess et al 16 conducted a case-control study of robot assisted laparoscopic radical hysterectomy compared with laparotomic approach, and this study showed that robot assisted laparoscopic radical hysterectomy is superior to open radical hysterectomy with regard to blood loss, operative time, hospital stay, and lymph 10 Magrina et al 14 Boggess et al 16 Fanning et al 15 Estape et al 13 Persson et al 11 Lowe et al 12 Maggioni et al 18 Boggess et al 19 DeNardis et al 20 Seamon et al 24 Veljovich et al 25 Peiretti et al 22 Lowe et al As many researchers demonstrated the feasibility of robotic radical hysterectomy in cervical cancer, several authors showed that the robot assisted staging surgery in endometrial cancer is comparable to conventional laparoscopic and laparotomic approach in terms of surgical outcomes. [19][20][21][22][23][24][25][26] In addition, length of hospital stay, blood loss and peri-operative complication rates are significantly lower in patients who received robotic surgery than those who underwent laparotomic staging surgery.…”

Section: Robot Assisted Laparoscopic Surgery In Gynecologic Cancermentioning

confidence: 99%

Recent advances of robotic surgery and single port laparoscopy in gynecologic oncology

Jung

Kim

2009

J Gynecol Oncol

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Two innovative approaches in minimally invasive surgery that have been introduced recently are the da Vinci robotic platform and single port laparoscopic surgery (SPLS). Robotic surgery has many advantages such as 3-dimensional view, the wrist like motion of the robotic arm and ergonomically comfortable position for the surgeon. Numerous literatures have demonstrated the feasibility of robotic surgery in gynecologic oncology. However, further research should be performed to demonstrate the superiority of robotic surgery compared to conventional laparoscopy. Additionally, cost reduction of robotic surgery is needed to adopt robotic surgery into gynecologic oncology worldwide. SPLS has several possible benefits including reduced operative complications, reduced postoperative pain, and better cosmetic results compared to conventional laparoscopy. Although several authors have indicated that SPLS is a feasible approach for gynecologic surgery, there have been few reports demonstrating the potential advantages over conventional laparoscopy. Moreover, technical difficulties of SPLS still exist. Therefore, the advantages of a single port approach compared to conventional laparoscope should be evaluated with comparative study, and further technologic development for SPLS is also needed. These two progressive technologies take the lead in the development of MIS and further studies should be performed to evaluate the benefits of robot surgery and SPLS.

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A case matched analysis of robotic radical hysterectomy with lymphadenectomy compared with laparoscopy and laparotomy

Cited by 151 publications

References 18 publications

Robotic-Assisted Radical Hysterectomy Results in Better Surgical Outcomes Compared to the Traditional Laparoscopic Radical Hysterectomy for the Treatment of Cervical Cancer

Robotic-Assisted Radical Hysterectomy Results in Better Surgical Outcomes Compared to the Traditional Laparoscopic Radical Hysterectomy for the Treatment of Cervical Cancer

Minimally Invasive Surgery: A New Approach for Uterine Cervical Cancer

Recent advances of robotic surgery and single port laparoscopy in gynecologic oncology

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