From open radical hysterectomy to robot-assisted laparoscopic radical hysterectomy for early stage cervical cancer: aspects of a single institution learning curve

Schreuder, Henk W.R.; Zweemer, Ronald P.; Baal, W.M. van; Lande, Jonas van de; Dijkstra, Jan; Verheijen, René H.M.

doi:10.1007/s10397-010-0572-5

Cited by 53 publications

(38 citation statements)

References 32 publications

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“…The comparison of the first and last 10 operations showed that the mean number of lymph nodes removed increased from 15.0 and 4.7 to 21.0 and 8.0 in the pelvic and para-aortic areas. This finding obviously indicates growing operative limits set by the surgeon as he or she gains more experience [12]. In another study, the effect of robotic surgery was evaluated in 77 endometrial cancer patients who underwent extrafascial (n = 75) or radical (n = 2) hysterectomy with unilateral or bilateral salpingooophorectomy, with staging.…”

Section: Discussionmentioning

confidence: 97%

“…The daVinci Ò System (Intuitive Surgical Inc., Sunnyvale, CA, USA) is robotic-assisted laparoscopic procedure that overcomes the drawbacks of traditional laparoscopy due to the advantages like robotic assistance with the 3D view, more precise visibility of the operative field, the fatigueresistant properties of robot hands, improved dexterity due to 6 degrees of freedom [11,12]. Robot-assisted laparoscopic surgery has been used in gynaecology for benign hysterectomy, myomectomy, tubal reanastomoses, radical surgery, lymph node dissections, sacrocolpopexias and cervical cancer [13][14][15].…”

Section: Introductionmentioning

confidence: 99%

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Robotic-Assisted Pelvic and High Para-aortic Lymphadenectomy (RPLND) for Endometrial Cancer and Learning Curve

Jacob

Somashekhar

Jaka

et al. 2016

Indian J Gynecol Oncolog

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Purpose and Objectives The present prospective non-randomized observational study was designed to analyse the learning curve for robotic-assisted pelvic and high paraaortic lymphadenectomy for endometrial cancer patients. Materials and Methods Between 2011 and 2013, 131 consecutive endometrial cancer patients underwent type-1 extrafascial pan hysterectomy with pelvic and high paraaortic lymphadenectomy using the daVinci Ò robotic surgical procedures at single quaternary care Indian cancer institution. For lymph nodes retrieval data, the point at which as per AJCC-TNM staging, time taken to reach, recommended minimum number of lymph nodes at each segment of pelvic and para-aortic lymphadenectomy was plotted and analysed. Data were analysed for the number of lymph nodes retrieved in pelvic and high para-aortic lymphadenectomy specimen. The surgery was performed by the same surgeon in all cases. Results Target number of pelvic lymph nodes 12 was achieved by ninth case, and consistently, more number of pelvic nodes were removed. Target number of para-aortic lymph nodes 10 was achieved at eighteenth case. Conclusion In our study, adequate number of pelvic lymph nodes retrieval of 12 was achieved by ninth case, and consistently, more number of pelvic nodes were removed and para-aortic lymph nodes retrieval of 10 was after eighteenth case. Our study confirms the proficiency and efficiency of robotic surgical approach in treatment of endometrial cancer, with adequate lymph node retrieval, and offers a safe and useful alternative to conventional surgical techniques with shorter learning curve.

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Section: Discussionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

Robotic-Assisted Pelvic and High Para-aortic Lymphadenectomy (RPLND) for Endometrial Cancer and Learning Curve

Jacob

Somashekhar

Jaka

et al. 2016

Indian J Gynecol Oncolog

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“…For laparoscopic hysterectomy and pelvic-paraaortic lymphadenectomy, competence of the surgeon may be achieved after 49 cases (Lim et al, 2011). A minimum 9 to 24 case was required to achieve proficiency for robotic hysterectomy and pelvic-paraaortic lymphadenectomy (Lowe et al, 2009, Seamon et al, 2009, Lim et al, 2011, and 24 to 28 cases for robotic radical hysterectomy (Schreuder et al, 2010, Yim et al, 2013. Proficiency is achieved after a larger number of procedures and continues to improve over time.…”

Section: Discussionmentioning

confidence: 99%

Feasibility and Safety of Robotic Surgery for Gynecologic Cancers

Manchana

Sirisabya²,

Vasuratna³

et al. 2014

Asian Pacific Journal of Cancer Prevention

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Background: To determine surgical outcomes, perioperative complications, and patient outcomes in gynecologic cancer patients undergoing robotic surgery. Materials and Methods: Surgical outcomes, including docking time, total operative time, console time, estimated blood loss (EBL), conversion rate and perioperative complications were retrospectively reviewed in 30 gynecologic cancer patients undergoing robotic surgery. Patient outcomes included recovery time and patient satisfaction, as scored by a visual analogue scale (VAS) from 0-10. Results: The operations included 24 hysterectomies with pelvic lymphadenectomy (PLD) and/or para-aortic lymphadenectomy, four radical hysterectomies with PLD, and two radical trachelectomies with PLD. Mean docking time was 12.8±9.7 min, total operative time was 345.5±85.0 min, and console time was 281.9±78.6 min. These times were decreased in the second half of the cases. There was no conversion rate. Three intraoperative complications, including one external iliac artery injury, one bladder injury, and one massive bleeding requiring blood transfusion were reported. Postoperative complications occurred in eight patients, most were minor. Only one patient had port herniation that required reoperation. Mean hospital stay was 3.5±1.7 days, and recovery time was 14.2±8.1 days. Two-thirds of patients felt very satisfied and one-third felt satisfied; the mean satisfaction score was 9.4 +0.9. Two patients with stage III endometrial cancer developed isolated port site metastasis at five and 13 months postoperatively. Conclusions: Robotic surgery for gynecologic cancer appears to be feasible, with acceptable perioperative complication rate, fast recovery time and high patient satisfaction.

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“…Operative time was lower after the first 28 interventions with improved track parameters authors: reduce the bleeding, low rate of postoperative complications [20]. However, Schreuder et al suggest that the 14 cases is sufficient to reduce the operating time with 48% [21].…”

Section: Laparoscopic and Robotic Learning Curve Technique In Gynecolmentioning

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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From open radical hysterectomy to robot-assisted laparoscopic radical hysterectomy for early stage cervical cancer: aspects of a single institution learning curve

Cited by 53 publications

References 32 publications

Robotic-Assisted Pelvic and High Para-aortic Lymphadenectomy (RPLND) for Endometrial Cancer and Learning Curve

Robotic-Assisted Pelvic and High Para-aortic Lymphadenectomy (RPLND) for Endometrial Cancer and Learning Curve

Feasibility and Safety of Robotic Surgery for Gynecologic Cancers

Minimally Invasive Surgery: A New Approach for Uterine Cervical Cancer

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