Robotic Radical Hysterectomy for Early-Stage Cervical Cancer

Abstract

Cervical cancers represent 3.5% of all gynaecological malignancies with a 55% overall 5-year survival. In the United Kingdom, around 3500 cases are diagnosed every year (~9.5–10.5/100,000). This disease results in 1000 deaths annually. The incidence and mortality dropped dramatically in the 1990s due to the impact of the introduction of cervical screening programme. Radical hysterectomy remained the preferred method of treatment for patients with early-stage disease. The operation compromises two components: central resection of the cervix and its surroundings as well as complete removal of the draining regional lymph nodes. In 2006, Sert and Abeler described the first reported robotic-assisted radical hysterectomy (Piver Type III) and bilateral pelvic lymph node dissection for Stage IB1 cervical carcinoma. The operation lasted 7 h and 20 min with an estimated blood loss of 200 mL [1]. The patient was discharged home 4 days later without major complications. Several reports/statements were published in literature supporting the robotic technique and demonstrating its oncological safety [2]. The surgical technique of the robotic radical hysterectomy described in this chapter follows the principles of those originally reported by Okabayashi in 1921 [3], which were designed to minimise the transection of the pelvic autonomic nerves.