Robotic radical hysterectomy is superior to laparoscopic radical hysterectomy and open radical hysterectomy in the treatment of cervical cancer

Jin, Yishuai; Liu, Shanshan; Chen, Jun; Chen, Yan‐Nan; Ren, Chen

doi:10.1371/journal.pone.0193033

Cited by 49 publications

(43 citation statements)

References 37 publications

(41 reference statements)

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“…There is a high prevalence (20–100 per cent) of musculoskeletal pain among surgeons which may affect multiple sites. In addition to having putative benefits for the patient, robotic‐assisted laparoscopic surgery (RALS) is thought to be less physically demanding for the surgeon than conventional laparoscopy (LAP). The greatest muscle strain may be in the neck and shoulders for LAP and the lower back in RALS, but others reported that the shoulders and forearm flexors took the strain in RALS.…”

Section: Introductionmentioning

confidence: 99%

Surgeons' posture and muscle strain during laparoscopic and robotic surgery

Dalager

Jensen

Eriksen

et al. 2020

British Journal of Surgery

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Background: It is assumed that conventional laparoscopy (LAP) and robotic-assisted laparoscopic surgery (RALS) differ in terms of the surgeon's comfort. This study compared muscle workload, work posture and perceived physical exertion of surgeons performing LAP or RALS.Methods: Colorectal surgeons with experience in advanced LAP and RALS performed one of each operation. Bipolar surface electromyography (EMG) recordings were made from forearm, shoulder and neck muscles, and expressed relative to EMG maximum (%EMG max ). The static, median and peak levels of muscle activity were calculated, and an exposure variation analysis undertaken. Postural observations were carried out every 10 min, and ratings of perceived physical exertion before and after surgery were recorded.Results: The study included 13 surgeons. Surgeons performing LAP showed higher static, median, and peak forearm muscle activity than those undertaking RALS. Muscle activity at peak level was higher during RALS than LAP. Exposure variation analysis demonstrated long-lasting periods of low-level intensity muscle activity in the shoulders for LAP, in the forearms for RALS, and in the neck for both procedures. Postural observations revealed a greater need for a change in work posture when performing LAP compared with RALS. Perceived physical exertion was no different between the surgical modalities.Conclusion: Minimally invasive surgery requires long-term static muscle activity with a high physical workload for surgeons. RALS is less demanding on posture. MethodsColorectal surgeons from two Danish hospitals participated. The surgeons were eligible if certified in both surgical modalities, had performed LAP and RALS almost equally, and had a high weekly caseload. The surgeons gave written informed consent to participate, and the Danish Data Protection Agency approved the study (record number 2015-57-0008). Approval from the regional ethics committee was sought, but the present study was exempted. Measurements were conducted on site during normal work procedures. Each surgeon performed two operations -one with LAP and one with RALS. Each of the procedures

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Section: Introductionmentioning

confidence: 99%

Surgeons' posture and muscle strain during laparoscopic and robotic surgery

Dalager

Jensen

Eriksen

et al. 2020

British Journal of Surgery

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“…Numerous observational studies and meta-analyses report superior results in blood loss, hospital stay and complication rates compared with the laparotomic approach. [1][2][3][4] In addition, equal survival rates of robot-assisted laparoscopy and laparotomy were suggested. [5][6][7][8] However, a recent trial by Ramirez et al, 9 which randomised between minimally invasive surgery (MIS) and laparotomy, showed a significantly increased recurrence rate and reduced overall survival in patients receiving MIS for International Federation of Obstetrics and Gynecology (FIGO) stage Ia1-Ib1 cervical cancer.…”

Section: Introductionmentioning

confidence: 99%

The influence of learning curve of robot‐assisted laparoscopy on oncological outcomes in early‐stage cervical cancer: an observational cohort study

Baeten

Hoogendam

Schreuder

et al. 2020

BJOG

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Objective To investigate the learning curve of robot-assisted laparoscopy in early-stage cervical cancer and quantify impact on oncological outcomes. Design Observational cohort study. Setting Tertiary referral centre with one surgical team. Population All women with early-stage cervical cancer treated consecutively with robot-assisted laparoscopy between 2007 and 2017. Methods With multivariate risk-adjusted cumulative sum analysis (RA-CUSUM), we assessed the learning curve of robot-assisted laparoscopy of a single surgical team based on cervical cancer recurrence. Subsequently, a survival analysis was conducted comparing oncological outcomes of women treated during different phases of the learning curve. Main outcome measures Surgical proficiency based on recurrence, survival rates in the different learning phases. Results One hundred and sixty-five women with cervical cancer underwent robot-assisted laparoscopy, with a median follow up of 57 months (range 3-132 months). The RA-CUSUM analysis demonstrated two phases of the learning curve: a learning phase of 61 procedures (group 1) and an experienced phase representing the 104 procedures thereafter (group 2). The 5-year disease-free survival was 80.2% in group 1 and 91.1% in group 2 (P = 0.040). Both the 5-year disease-specific survival and overall survival significantly increased after the learning phase. Conclusion The learning phase of robot-assisted laparoscopy in early-stage cervical cancer in this institutional cohort is at least 61 procedures, with higher survival rates in the women treated thereafter. The learning curve of robot-assisted laparoscopy affects oncological outcomes and warrants more attention in the design of future studies.

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“…In 2006, Sert et al[13] first published the results of robotic radical hysterectomy (RRH) with lymphadenectomy. To date, there have been relatively more studies of RRH for cervical cancer in foreign countries[14-19]. Our center started to provide a service to perform RRH for cervical cancer relatively early in China, and it has also accumulated rich clinical experience.…”

Section: Introductionmentioning

confidence: 99%

Comparative analysis of robotic vs laparoscopic radical hysterectomy for cervical cancer

Chen¹,

Liu²,

Xiao³

et al. 2019

WJCC

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BACKGROUNDCervical cancer is the most common gynecological malignancy, ranking first in female reproductive malignancies with more than 500000 new cases and 275000 deaths each year. Traditionally, open radical hysterectomy is considered the standard surgical procedure for the treatment of resectable cervical cancer. The latest guidelines from the National Comprehensive Cancer Network and the European Society of Gynecological Oncology suggest that open surgery and laparoscopic surgery (using traditional laparoscopic or robotic techniques) are the main surgical approaches for radical hysterectomy for patients with stage IA2-IIA cervical cancer. Robotic surgery has been increasingly used in abdominal surgery and has shown more beneficial effects.AIMTo analyse the perioperative conditions, complications, and short-term and long-term effects in patients undergoing robotic radical hysterectomy (RRH) and laparoscopic radical hysterectomy (LRH) to compare their clinical efficacy, safety, and feasibility.METHODSThe perioperative data of patients undergoing RRH and LRH were extracted and collected from the database of surgical treatments for cervical cancer for statistical analysis.RESULTSOf the patients, 342 underwent LRH for cervical cancer, and 216 underwent RRH. The total complication rate was 9.65% (20 patients) in the RRH group and 17.59% (60 patients) in the LRH group. The complication rate was significantly lower in the RRH group than in the LRH group. There was no significant difference in the follow-up period (P = 0.658). The total recurrence rates were 15.7% and 12% in the RRH and LRH groups, respectively. The progression-free survival time was 28.91 ± 15.68 mo and 28.34 ± 15.13 mo in the RRH and LRH groups, respectively (P = 0.669). The overall survival (OS) rates were 92.13% and 94.45% in the RRH and LRH groups, respectively (P = 0.292). The OS time was 29.87 ± 15.92 mo and 29.41 ± 15.14 mo in the RRH and LRH groups, respectively (P = 0.732). The survival curves and the progression-free survival curves were not statistically significantly different between the two groups (P = 0.407 and 0.28, respectively).CONCLUSIONRRH is associated with significantly less operative time and blood loss than LRH. The two procedures have similar complication rates, OS, and progression-free survival time.

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Robotic radical hysterectomy is superior to laparoscopic radical hysterectomy and open radical hysterectomy in the treatment of cervical cancer

Cited by 49 publications

References 37 publications

Surgeons' posture and muscle strain during laparoscopic and robotic surgery

Surgeons' posture and muscle strain during laparoscopic and robotic surgery

The influence of learning curve of robot‐assisted laparoscopy on oncological outcomes in early‐stage cervical cancer: an observational cohort study

Comparative analysis of robotic vs laparoscopic radical hysterectomy for cervical cancer

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