Learning curve in concurrent application of laparoscopic and robotic-assisted hysterectomy with lymphadenectomy in endometrial cancer

Torng, Pao-Ling; Pan, Song-Po; Hwang, Jing-Shiang; Shih, Ho-Jun; Chen, Chi‐Ling

doi:10.1016/j.tjog.2017.10.014

Cited by 14 publications

(19 citation statements)

References 34 publications

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“…Our study did not confirm previous reports [17,21,23,24] concerning higher operative time when robotic assistance was used. In this study, similar operative times were observed in all groups.…”

Section: Discussioncontrasting

confidence: 99%

Robot-assisted Extraperitoneal Para-aortic Lymphadenectomy Is Associated with Fewer Surgical Complications: A Post Hoc Analysis of the STELLA-2 Randomized Trial

Bebia

Hernández

Gilabert-Estellés

et al. 2021

Journal of Minimally Invasive Gynecology

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Study Objective: To evaluate if extraperitoneal para-aortic lymphadenectomy (PALND) using a robot-assisted approach was associated with fewer complications than all other approaches (conventional laparoscopic transperitoneal or extraperitoneal and robot-assisted transperitoneal) without compromising lymph node yield, operative time, or length of stay. Design: Post hoc analysis of the prospective randomized open-label multicenter trial (STELLA-2). Setting: Three academic referral hospitals. Patients: Two hundred and three eligible patients from the STELLA-2 trial were included. Interventions: The patients were randomized to extraperitoneal or transperitoneal PALND using a minimally invasive approach (either laparoscopic or robot-assisted) for surgical staging of endometrial or ovarian cancer. The minimally invasive approaches were not subjected to randomization. Measurements and Main Results: The primary end point was evaluated through a composite variable that included at least 1 of the following events: blood loss ≥500 mL during PALND, any intraoperative complication related to PALND, severe postoperative complication (Clavien-Dindo ≥grade IIIA), impossibility of completing the procedure, or conversion to laparotomy. Of the 203 patients analyzed, 68 were assigned to the extraperitoneal laparoscopic group (X-L), 62 to the transperitoneal laparoscopic group (T-L), 35 to the extraperitoneal robotic group (X-R), and 38 to the transperitoneal robotic group (T-R).

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Section: Discussioncontrasting

confidence: 99%

Robot-assisted Extraperitoneal Para-aortic Lymphadenectomy Is Associated with Fewer Surgical Complications: A Post Hoc Analysis of the STELLA-2 Randomized Trial

Bebia

Hernández

Gilabert-Estellés

et al. 2021

Journal of Minimally Invasive Gynecology

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“…In a study, in the learning curve of laparoscopic hysterectomy, the first 10 procedures were done in a mean time of 180 minutes and decreased to 75 minutes in the 90-100th patients. 21 In the medical center of the present study, the nursing staff, equipment, and engineering were also in training period (learning curve), and the effect of these factors was also evident in the operative time. For instance, unchecked instruments, camera, and monitoring system exhibited problems during operation which took time to solve each of them.…”

Section: Operation Timementioning

confidence: 66%

Follow-up Study Comparing Open Hysterectomy of Expert Surgeon and Laparoscopic Approach (Learning Curve) of the Same Surgeon

Arab¹,

Chowhan²,

Ardebili³

et al. 2019

World Journal of Laparoscopic Surgery With DVD

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Introduction:The goal of minimal access surgery is to minimize damage to the patient without impairment of immunity and the effect of treatment compared to traditional open surgical techniques. Laparoscopic hysterectomy requires more surgical skills and the learning curve is steep. The goal of this study is to compare hysterectomy in learning curve (including about 50 first surgeries) with open hysterectomy of the same surgeon, expert in open surgery, for complications, hospital stay duration, transfusion, operative time, and readmission. Materials and methods: In a prospective cohort study, patients undergoing hysterectomy at an academic medical center located in Tehran were randomly assigned into laparoscopic (in learning curve) and laparotomy groups from 2016 to 2018. Study cases data were recorded regarding complications, hospital stay, operative time, and blood transfusion. Results: There was no significant difference regarding intra-and postoperative transfusion, hospital stay duration, postoperative complications, and readmission in laparoscopy and laparotomy groups of hysterectomy. However, operative time was significantly different in laparoscopy and laparotomy subgroups of hysterectomy and longer in the laparoscopic group (277 minutes in laparoscopy vs 196 minutes in laparotomy). Conclusion:This study encourages starting laparoscopy method instead of open surgery, even in the setting of expert open surgeons, and even in the advanced (level 4) surgery such as hysterectomy.

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“…Minimally invasive surgery using laparoscopy is the preferred approach, when feasible, for the management of painful DIE [ 4 ]. Robotic laparoscopy (RL) has proven its feasibility in DIE, permitting better dexterity and having a shorter learning curve in comparison with conventional laparoscopy [ 11 , 12 ]. There are no differences to date in terms of complications, bleeding, or efficiency between RL and classic laparoscopy (CL), apart from the duration of surgery, which tends to be longer in RL [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

Improvement of Post-Operative Quality of Life in Patients 2 Years after Minimally Invasive Surgery for Pain and Deep Infiltrating Endometriosis

Legendri

Carbonnel

Féki

et al. 2022

JCM

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This study addressed the improvement in the quality of life of patients 2 years after minimally invasive surgery for painful deep infiltrating endometriosis (DIE), evaluated with EHP-5 (Endometriosis Health Profile-5) scores and the intensity of dysmenorrhea and dyspareunia. This was a retrospective study, performed in a referral centre for endometriosis, between January 2010 and January 2019. EHP-5 scores were complete for 54 patients, and two subgroups were analysed: classic laparoscopy (CL) vs. robotic laparoscopy (RL), and conservative surgery (ConservS) vs. total surgery (TS). There was an important decrease in 2-year post-operative EHP-5 scores in the global population (pre-op: 61.36 (42.18–68.75) and 2-year post-op: 20.45 (0–38.06); p < 0.001). The Visual Analogic Scale (VAS) was also lower for dysmenorrhea (pre-op: 8 (7–9.75) vs. 2-year post-op: 3 (2–5.25); p < 0.001) and dyspareunia (pre-op: 6 (3.1–8.9) vs. 2-year post-op: 3 (0–6); p < 0.001). In the subgroup analysis, EHP-5 scores were improved in the RL group (pre-op: 65.9 (59.09–71.02) vs. 2-year post-op: 11.4 (0–38.06); p < 0.001) and the CL group (pre-op: 50 (34.65–68.18) vs. 2-year post-op: 27.27 (14.20–40.90); p < 0.001), with a slight advantage for RL (p = 0.04), and the same improvements were found for ConservS (pre-op: 61.4 (38.06–71.59) vs. 2-year post-op: 22.7 (11.93–38.07); p < 0.001) and TS groups (pre-op: 61.59 (51.70–68.75) vs. 2-year post-op: 13.63 (0–44.30); p < 0.001). Minimally invasive surgery improved the quality of life for DIE patients 2 years after surgery, and conservative surgery showed comparable results to total surgery.

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Learning curve in concurrent application of laparoscopic and robotic-assisted hysterectomy with lymphadenectomy in endometrial cancer

Cited by 14 publications

References 34 publications

Robot-assisted Extraperitoneal Para-aortic Lymphadenectomy Is Associated with Fewer Surgical Complications: A Post Hoc Analysis of the STELLA-2 Randomized Trial

Robot-assisted Extraperitoneal Para-aortic Lymphadenectomy Is Associated with Fewer Surgical Complications: A Post Hoc Analysis of the STELLA-2 Randomized Trial

Follow-up Study Comparing Open Hysterectomy of Expert Surgeon and Laparoscopic Approach (Learning Curve) of the Same Surgeon

Improvement of Post-Operative Quality of Life in Patients 2 Years after Minimally Invasive Surgery for Pain and Deep Infiltrating Endometriosis

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