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Comparison of a novel surgical approach for radical hysterectomy: robotic assistance versus open surgery

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Abstract

To report the learning curve and perioperative outcomes for robotic radical hysterectomy using a unilateral surgical approach transferred directly from one surgeon’s open radical hysterectomy experience, thirty-two consecutive robotic radical hysterectomy cases (10/2006–1/2009) were contrasted to a cohort of 20 consecutive open radical hysterectomies (2/2005–2/2008). Perioperative characteristics compared included operative time, number of nodes, estimated blood loss, length of hospital stay, and complications. Robotic operative times were significantly longer than for open (122.1 ± 33.0 versus 67.5 ± 16.2 min, P < 0.0001), but decreased with experience, going from 156.0 min for the first eight robotic cases to 95.0 min for the last eight cases (P < 0.05). Blood loss (99.2 ± 46.2 mL versus 275.0 ± 206.0 mL, P < 0.0001) and length of hospital stay (1.7 versus 5.2 days, P < 0.001) were significantly lower for the robotic cohort. Lymph node yield in the robotic cohort was equivalent to that for the open cohort (11.5 versus 9.2, P = 0.1446), and complication rates were 21.9% for robotic and 30.0% for open radical hysterectomy. Implementing a unilateral approach to maximize surgical efficiency greatly reduced surgical times without compromising patient morbidity, bringing robotic operative times while still within the learning curve close to those for open radical hysterectomy. Thus, robotic radical hysterectomy may soon be considered the preferred standard front-line therapy for cervical cancer.

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References

  1. Ramirez PT, Soliman PT, Schmeler KM, dos Reis R, Frumovitz M (2008) Laparoscopic and robotic techniques for radical hysterectomy in patients with early-stage cervical cancer. Gynecol Oncol 110:S21–S24. doi:10.1016/j.ygyno.2008.03.013

    Article  PubMed  Google Scholar 

  2. Renaud MC, Plante M, Roy M (2000) Combined laparoscopic and vaginal radical surgery in cervical cancer. Gynecol Oncol 79:59–63. doi:10.1006/gyno.2000.5912

    Article  CAS  PubMed  Google Scholar 

  3. Malur S, Possover M, Schneider A (2001) Laparoscopically assisted radical vaginal versus radical abdominal hysterectomy type II in patients with cervical cancer. Surg Endosc 15:289–292. doi:10.1007/s004640000306

    Article  CAS  PubMed  Google Scholar 

  4. Spirtos NM, Eisenkop SM, Schlaerth JB, Ballon SC (2002) Laparoscopic radical hysterectomy (type III) with aortic and pelvic lymphadenectomy in patients with stage I cervical cancer: surgical morbidity and intermediate follow-up. Am J Obstet Gynecol 187:340–348. doi:S000293780200131X

    Article  PubMed  Google Scholar 

  5. Querleu D, Narducci F, Poulard V, Lacaze S, Occelli B, Leblanc E, Cosson M (2002) Modified radical vaginal hysterectomy with or without laparoscopic nerve-sparing dissection: a comparative study. Gynecol Oncol 85:154–158. doi:10.1006/gyno.2002.6588

    Article  PubMed  Google Scholar 

  6. Abu-Rustum NR, Gemignani ML, Moore K, Sonoda Y, Venkatraman E, Brown C, Poynor E, Chi DS, Barakat RR (2003) Total laparoscopic radical hysterectomy with pelvic lymphadenectomy using the argon-beam coagulator: pilot data and comparison to laparotomy. Gynecol Oncol 91:402–409. doi:S0090825803005183

    Article  PubMed  Google Scholar 

  7. Hertel H, Kohler C, Michels W, Possover M, Tozzi R, Schneider A (2003) Laparoscopic-assisted radical vaginal hysterectomy (LARVH): prospective evaluation of 200 patients with cervical cancer. Gynecol Oncol 90:505–511. doi:S0090825803003780

    Article  PubMed  Google Scholar 

  8. Steed H, Rosen B, Murphy J, Laframboise S, De Petrillo D, Covens A (2004) A comparison of laparascopic-assisted radical vaginal hysterectomy and radical abdominal hysterectomy in the treatment of cervical cancer. Gynecol Oncol 93:588–593. doi:10.1016/j.ygyno.2004.04.003

    Article  CAS  PubMed  Google Scholar 

  9. Gil-Moreno A, Puig O, Perez-Benavente MA, Diaz B, Verges R, De la Torre J, Martinez-Palones JM, Xercavins J (2005) Total laparoscopic radical hysterectomy (type II–III) with pelvic lymphadenectomy in early invasive cervical cancer. J Minim Invasive Gynecol 12:113–120. doi:10.1016/j.jmig.2005.01.016

    Article  PubMed  Google Scholar 

  10. Ramirez PT, Slomovitz BM, Soliman PT, Coleman RL, Levenback C (2006) Total laparoscopic radical hysterectomy and lymphadenectomy: the M. D. Anderson Cancer Center experience. Gynecol Oncol 102:252–255. doi:10.1016/j.ygyno.2005.12.013

    Article  PubMed  Google Scholar 

  11. Reynolds RK, Advincula AP (2006) Robot-assisted laparoscopic hysterectomy: technique and initial experience. Am J Surg 191:555–560. doi:10.1016/j.amjsurg.2006.01.011

    Article  PubMed  Google Scholar 

  12. Marchal F, Rauch P, Vandromme J, Laurent I, Lobontiu A, Ahcel B, Verhaeghe JL, Meistelman C, Degueldre M, Villemot JP, Guillemin F (2005) Telerobotic-assisted laparoscopic hysterectomy for benign and oncologic pathologies: initial clinical experience with 30 patients. Surg Endosc 19:826–831. doi:10.1007/s00464-004-9122-4

    Article  CAS  PubMed  Google Scholar 

  13. Sert B, Abeler V (2007) Robotic radical hysterectomy in early-stage cervical carcinoma patients, comparing results with total laparoscopic radical hysterectomy cases. The future is now? Int J Med Robot 3:224–228. doi:10.1002/rcs.152

    CAS  PubMed  Google Scholar 

  14. Sert BM, Abeler VM (2006) Robotic-assisted laparoscopic radical hysterectomy (Piver type III) with pelvic node dissection—case report. Eur J Gynaecol Oncol 27:531–533

    CAS  PubMed  Google Scholar 

  15. Kowalski LD (2007) Incorporation of robotics into a gynecologic oncology practice: the first 100 cases. Poster presented at SGO 2007

  16. Kim YT, Kim SW, Hyung WJ, Lee SJ, Nam EJ, Lee WJ (2008) Robotic radical hysterectomy with pelvic lymphadenectomy for cervical carcinoma: a pilot study. Gynecol Oncol 108:312–316. doi:10.1016/j.ygyno.2007.10.015

    Article  PubMed  Google Scholar 

  17. Fanning J, Fenton B, Purohit M (2008) Robotic radical hysterectomy. Am J Obstet Gynecol 198:649 e1–649 e4. doi:10.1016/j.ajog.2007.11.002

    Article  Google Scholar 

  18. Nezhat FR, Datta MS, Liu C, Chuang L, Zakashansky K (2008) Robotic radical hysterectomy versus total laparoscopic radical hysterectomy with pelvic lymphadenectomy for treatment of early cervical cancer. JSLS 12:227–237

    PubMed  Google Scholar 

  19. Ko EM, Muto MG, Berkowitz RS, Feltmate CM (2008) Robotic versus open radical hysterectomy: a comparative study at a single institution. Gynecol Oncol 111:425–430. doi:10.1016/j.y.gyno.2008.08.016

    Article  PubMed  Google Scholar 

  20. Boggess JF (2008) A case–control study of robotic assisted type III radical hysterectomy with pelvic lymph-node dissection compared to open radical hysterectomy. Am J Obstet Gynecol 199:357.e1–357.e7. doi:10.1016/j.ajog.2008.06.058

    Article  Google Scholar 

  21. Magrina JF, Kho RM, Weaver AL, Montero RP, Magtibay PM (2008) Robotic radical hysterectomy: comparison with laparoscopy and laparotomy. Gynecol Oncol 109:86–91. doi:10.1016/j.ygyno.2008.01.011

    Article  PubMed  Google Scholar 

  22. Lowe MP, Chamberlain DH, Kamelle SA, Johnson PR, Tillmanns TD (2009) A multi-institutional experience with robotic-assisted radical hysterectomy for early stage cervical cancer. Gynecol Oncol 113:191–194. doi:10.1016/j.ygyno.2009.01.018

    Article  PubMed  Google Scholar 

  23. Lowe MP, Hoekstra AV, Jairam-Thodla A, Singh DK, Buttin BM, Lurain JR, Schink JC (2009) A comparison of robot-assisted and traditional radical hysterectomy for early-stage cervical cancer. J Robotic Surg 3:19–23. doi:10.1007/s11701-009-0131-0

    Article  Google Scholar 

  24. Yap OWS, Mathews RP, Feuer GA (2006) Radical hysterectomy using a polymer ligation clip and surgical stapling system. American College of Surgeons 92nd Annual Clinical Congress. Working together toward humanitarian ideals. Oct 8–12, Chicago, IL. Abstract #SE-247

  25. Mirhashemi R, Averette HE, Deepika K, Estape R, Angioli R, Martin J, Rodriguez M, Penalver MA (1999) The impact of intraoperative autologous blood transfusion during type III radical hysterectomy for early-stage cervical cancer. Am J Obstet Gynecol 181:1310–1315. doi:S0002937899007589 (discussion 1315–1316)

    Article  CAS  PubMed  Google Scholar 

  26. Pikaart DP, Holloway RW, Ahmad S, Finkler NJ, Bigsby GE, Ortiz BH, Denardis SA (2007) Clinical-pathologic and morbidity analyses of Types 2 and 3 abdominal radical hysterectomy for cervical cancer. Gynecol Oncol 107:205–210. doi:10.1016/j.ygyno.2007.06.015

    Article  PubMed  Google Scholar 

  27. Fanning J, Nanavati PJ, Hilgers RD (1996) Surgical staging and high dose rate brachytherapy for endometrial cancer: limiting external radiotherapy to node-positive tumors. Obstet Gynecol 87:1041–1044. doi:0029784496000555

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

The authors wish to thank April Hebert, Ph.D. for her research assistance in writing this paper and Usha Kreaden for statistical assistance, both of whom are affiliated with the manufacture of the da Vinci Surgical System (Intuitive Surgical).

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  1. Southeastern Gynecologic Oncology, 980 Johnson Ferry Road North East Suite 900, Atlanta, GA, 30342, USA

    Gerald Feuer, Benedict Benigno, Lindal Krige & Patricia Alvarez

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  1. Gerald Feuer
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  2. Benedict Benigno
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  3. Lindal Krige
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  4. Patricia Alvarez
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Correspondence to Gerald Feuer.

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Feuer, G., Benigno, B., Krige, L. et al. Comparison of a novel surgical approach for radical hysterectomy: robotic assistance versus open surgery. J Robotic Surg 3, 179–186 (2009). https://doi.org/10.1007/s11701-009-0159-1

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  • DOI: https://doi.org/10.1007/s11701-009-0159-1

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