Introducing robotic radical hysterectomy for stage 1bi cervical cancer—A prospective evaluation of clinical and economic outcomes in a single UK institution

Abstract

Background We have assessed the impact of introducing robotics for a stage 1b cervical cancer service on laparotomy rates, complications, and costs. Methods Data were collected prospectively from 90 consecutive patients who had a radical hysterectomy between 1 April 2010 and 31 December 2017. Results There were 37 women before the first robotic procedure and 53 after. The laparotomy rate reduced from 75% (9/12) in 2010 to 0% (0/18) in 2017. The length of stay reduced from 6 days (range 3‐39) to 3 days (range 1‐15) (P < 0.0001). The complication rate before robotics was 68% (25/37) compared with 45% (24/53) afterwards (P = 0.0493). The blood transfusion rate reduced from 43% (16/37) to 11% (6/53) (P = 0.0007). There were no differences between the total costs before and after the introduction of robotics or between each route. Conclusions In this series, introducing robotics for cervical carcinoma reduced hospital stay and complications. No cost differences were demonstrated.

Robotic surgery in gynaecology

“…A meta‐analysis 78 assessing RAL for radical hysterectomy in cervical cancer concluded there were fewer complications for RAL compared with open surgery. One study 79 has demonstrated that the introduction of robotics in the UK resulted in a reduced number of open radical hysterectomies. As a result, the introduction of robotics for cervical cancer surgery has become widely accepted, not just for hysterectomy but also for trachelectomy with a large meta‐analysis 80 reporting from nine studies.…”

Comparison of survival outcomes between robotic and laparoscopic radical hysterectomies for early-stage cervical cancer: a systemic review and meta-analysis

“…Of these articles, 59 did not meet the selection criteria and were excluded. After reviewing the full texts of the remaining 36 articles, we found 20 relevant studies [ 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 ], published between 2008 and 2019, suitable for inclusion in the meta-analysis. Eleven out of the 16 studies excluded from the final review had insufficient data regarding survival outcomes.…”

“…Table 1 presents the main characteristics of the 20 studies included in the final analysis. Their study design types were retrospective (n=12) [ 17 18 19 20 22 24 25 26 27 30 31 33 ], matched retrospective (n=2) [ 21 29 ], and prospective (n=6) [ 14 15 16 23 28 32 ]. The locations of these studies were Asia (n=8) [ 20 21 22 25 27 28 31 33 ], Europe (n=8) [ 17 18 19 23 26 29 30 32 ], and the USA (n=4) [ 14 15 16 24 ].…”

Robotic Radical Hysterectomy Is Not Superior to Laparoscopic Radical Hysterectomy in Perioperative Urologic Complications: A Meta-Analysis of 23 Studies

“…No significant between-study heterogeneity was detected. [20,22,28], 5 prospective cohort studies [12,13,23,32,34], and 1 randomized controlled trial [30]. Five studies were conducted in North America [12,13,16,24,34], 10 in Europe [14,15,17,18,22,23,27,28,32,33], and 8 in Asia [19−21,25,26,29−31].…”

“…[20,22,28], 5 prospective cohort studies [12,13,23,32,34], and 1 randomized controlled trial [30]. Five studies were conducted in North America [12,13,16,24,34], 10 in Europe [14,15,17,18,22,23,27,28,32,33], and 8 in Asia [19−21,25,26,29−31]. The countries with the largest representation in this meta-analysis were Italy (n = 6, 26.1%) [17,22,23,27,28,33], the United States (n = 5, 21.7%) [12,13,16,24,34], and South Korea (n = 4, 17.4%) Fig.…”