Original Article

Gynecological Surgery

, Volume 7, Issue 3, pp 253-258

First online:

Open Access This content is freely available online to anyone, anywhere at any time.

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

  • H. W. R. SchreuderAffiliated withDivision of Woman and Baby, Department of Surgical and Oncological Gynaecology, University Medical Centre Utrecht Email author 
  • , R. P. ZweemerAffiliated withDivision of Woman and Baby, Department of Surgical and Oncological Gynaecology, University Medical Centre UtrechtDepartment of Obstetrics and Gynaecology, VU University Medical Centre
  • , W. M. van BaalAffiliated withDepartment of Obstetrics and Gynaecology, VU University Medical Centre
  • , J. van de LandeAffiliated withDepartment of Obstetrics and Gynaecology, VU University Medical Centre
  • , J. C. DijkstraAffiliated withDepartment of Obstetrics and Gynaecology, VU University Medical Centre
  • , R. H. M. VerheijenAffiliated withDivision of Woman and Baby, Department of Surgical and Oncological Gynaecology, University Medical Centre UtrechtDepartment of Obstetrics and Gynaecology, VU University Medical Centre

Abstract

We analysed the introduction of the robot-assisted laparoscopic radical hysterectomy in patients with early-stage cervical cancer with respect to patient benefits and surgeon-related aspects of a surgical learning curve. A retrospective review of the first 14 robot-assisted laparoscopic radical hysterectomies and the last 14 open radical hysterectomies in a similar clinical setting with the same surgical team was conducted. Patients were candidates for a laparoscopic sentinel node procedure, pelvic lymph node dissection and open radical hysterectomy (RH) before August 2006 and were candidates for a laparoscopic sentinel node procedure, pelvic lymph node dissection and robot-assisted laparoscopic radical hysterectomy (RALRH) after August 2006. Overall, blood loss in the open cases was significantly more compared with the robot cases. Median hospital stay after RALRH was 5 days less than after RH. The median theatre time in the learning period for the robot procedure was reduced from 9 h to less that 4 h and compared well to the 3 h and 45 min for an open procedure. Three complications occurred in the open group and one in the robot group. RALRH is feasible and of benefit to the patient with early stage cervical cancer by a reduction of blood loss and reduced hospital stay. Introduction of this new technique requires a learning curve of less than 15 cases that will reduce the operating time to a level comparable to open surgery.

Keywords

Robotic surgery da Vinci Radical hysterectomy Learning curve