Yonsei Med J.  2014 Sep;55(5):1222-1230. 10.3349/ymj.2014.55.5.1222.

Surgical Outcomes of Robotic Radical Hysterectomy Using Three Robotic Arms versus Conventional Multiport Laparoscopy in Patients with Cervical Cancer

• Yim GW
• Kim SW
• Nam EJ
• Kim S
• Kim HJ
• Kim YT

• KMID: 1799484
• DOI: http://doi.org/10.3349/ymj.2014.55.5.1222

Abstract

PURPOSE
To compare surgical outcomes of robotic radical hysterectomy (RRH) using 3 robotic arms with those of conventional laparoscopy in patients with early cervical cancer.
MATERIALS AND METHODS
A retrospective cohort study included 102 patients with stage 1A1-IIA2 cervical carcinoma, of whom 60 underwent robotic and 42 underwent laparoscopic radical hysterectomy (LRH) with pelvic lymph node dissection performed between December 2009 and May 2013. Perioperative outcomes were compared between two surgical groups.
RESULTS
Robotic approach consisted of 3 robotic arms including the camera arm and 1 conventional assistant port. Laparoscopic approach consisted of four trocar insertions with conventional instruments. There were no conversions to laparotomy. Mean age, body mass index, tumor size, cell type, and clinical stage were not significantly different between two cohorts. RRH showed favorable outcomes over LRH in terms of estimated blood loss (100 mL vs. 145 mL, p=0.037), early postoperative complication rates (16.7% vs. 30.9%, p=0.028), and postoperative complications necessitating intervention by Clavien-Dindo classification. Total operative time (200.5+/-61.1 minutes vs. 215.6+/-83.1 minutes, p=0.319), mean number of lymph node yield (23.3+/-9.3 vs. 21.7+/-9.8, p=0.248), and median length of postoperative hospital stay (11 days vs. 10 days, p=0.129) were comparable between robotic and laparoscopic group, respectively. The median follow-up time was 44 months with 2 recurrences in the robotic and 3 in the laparoscopic cohort.
CONCLUSION
Surgical outcomes of RRH and pelvic lymphadenectomy were comparable to that of laparoscopic approach, with significantly less blood loss and early postoperative complications.

Keyword

Cervical cancer; laparoscopy; robotics

MeSH Terms

Adult
Blood Loss, Surgical
Female
Humans
Hysterectomy/*adverse effects/methods
Laparoscopy/*adverse effects
Length of Stay
Middle Aged
Postoperative Complications/*epidemiology
Retrospective Studies
Robotic Surgical Procedures/*adverse effects
Treatment Outcome
Uterine Cervical Neoplasms/*surgery

Figure

• 

  Fig. 1 Port placement. (A) Robotic radical hysterectomy. (B) Laparoscopic radical hysterectomy.

Reference

1. Medeiros LR, Rosa DD, Bozzetti MC, Fachel JM, Furness S, Garry R, et al. Laparoscopy versus laparotomy for benign ovarian tumour. Cochrane Database Syst Rev. 2009; CD004751.

2. Nieboer TE, Johnson N, Lethaby A, Tavender E, Curr E, Garry R, et al. Surgical approach to hysterectomy for benign gynaecological disease. Cochrane Database Syst Rev. 2009; CD003677.

3. Advincula AP, Wang K. Evolving role and current state of robotics in minimally invasive gynecologic surgery. J Minim Invasive Gynecol. 2009; 16:291–301.

4. Lin PS, Wakabayashi MT, Han ES. Role of robotic surgery in endometrial cancer. Curr Treat Options Oncol. 2009; 10:33–43.

5. Mendivil A, Holloway RW, Boggess JF. Emergence of robotic assisted surgery in gynecologic oncology: American perspective. Gynecol Oncol. 2009; 114:2 Suppl. S24–S31.

6. Chen CC, Falcone T. Robotic gynecologic surgery: past, present, and future. Clin Obstet Gynecol. 2009; 52:335–343.

7. Nezhat C, Lavie O, Lemyre M, Unal E, Nezhat CH, Nezhat F. Robot-assisted laparoscopic surgery in gynecology: scientific dream or reality? Fertil Steril. 2009; 91:2620–2622.

8. Lee TY, Jeung YJ, Lee CJ, Kim HY, Kim SH, Kim WG. Promising treatment results of adjuvant chemotherapy following radical hysterectomy for intermediate risk stage 1B cervical cancer. Obstet Gynecol Sci. 2013; 56:15–21.

9. Park JY, Kim DY, Kim JH, Kim YM, Kim YT, Kim YS, et al. Comparison of outcomes between radical hysterectomy followed by tailored adjuvant therapy versus primary chemoradiation therapy in IB2 and IIA2 cervical cancer. J Gynecol Oncol. 2012; 23:226–234.

10. Geisler JP, Orr CJ, Khurshid N, Phibbs G, Manahan KJ. Robotically assisted laparoscopic radical hysterectomy compared with open radical hysterectomy. Int J Gynecol Cancer. 2010; 20:438–442.

11. Nezhat CR, Nezhat FR, Burrell MO, Ramirez CE, Welander C, Carrodeguas J, et al. Laparoscopic radical hysterectomy and laparoscopically assisted vaginal radical hysterectomy with pelvic and paraaortic node dissection. J Gynecol Surg. 1993; 9:105–120.

12. Ramirez PT, Soliman PT, Schmeler KM, dos Reis R, Frumovitz M. Laparoscopic and robotic techniques for radical hysterectomy in patients with early-stage cervical cancer. Gynecol Oncol. 2008; 110(3):Suppl 2. S21–S24.

13. Soliman PT, Frumovitz M, Sun CC, Dos Reis R, Schmeler KM, Nick AM, et al. Radical hysterectomy: a comparison of surgical approaches after adoption of robotic surgery in gynecologic oncology. Gynecol Oncol. 2011; 123:333–336.

14. Spirtos NM, Eisenkop SM, Schlaerth JB, Ballon SC. 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. 2002; 187:340–348.

15. Yim GW, Kim SW, Nam EJ, Kim YT. Role of robot-assisted surgery in cervical cancer. Int J Gynecol Cancer. 2011; 21:173–181.

16. Kruijdenberg CB, van den Einden LC, Hendriks JC, Zusterzeel PL, Bekkers RL. Robot-assisted versus total laparoscopic radical hysterectomy in early cervical cancer, a review. Gynecol Oncol. 2011; 120:334–339.

17. Jung YW, Lee DW, Kim SW, Nam EJ, Kim JH, Kim JW, et al. Robot-assisted staging using three robotic arms for endometrial cancer: comparison to laparoscopy and laparotomy at a single institution. J Surg Oncol. 2010; 101:116–121.

18. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004; 240:205–213.

19. Kim YT, Kim SW, Hyung WJ, Lee SJ, Nam EJ, Lee WJ. Robotic radical hysterectomy with pelvic lymphadenectomy for cervical carcinoma: a pilot study. Gynecol Oncol. 2008; 108:312–316.

20. Querleu D, Morrow CP. Classification of radical hysterectomy. Lancet Oncol. 2008; 9:297–303.

21. Ramirez PT, Adams S, Boggess JF, Burke WM, Frumovitz MM, Gardner GJ, et al. Robotic-assisted surgery in gynecologic oncology: a Society of Gynecologic Oncology consensus statement. Developed by the Society of Gynecologic Oncology's Clinical Practice Robotics Task Force. Gynecol Oncol. 2012; 124:180–184.

22. Sarlos D, Kots L, Stevanovic N, Schaer G. Robotic hysterectomy versus conventional laparoscopic hysterectomy: outcome and cost analyses of a matched case-control study. Eur J Obstet Gynecol Reprod Biol. 2010; 150:92–96.

23. Hoekstra AV, Morgan JM, Lurain JR, Buttin BM, Singh DK, Schink JC, et al. Robotic surgery in gynecologic oncology: impact on fellowship training. Gynecol Oncol. 2009; 114:168–172.

24. O'Neill M, Moran PS, Teljeur C, O'Sullivan OE, O'Reilly BA, Hewitt M, et al. Robot-assisted hysterectomy compared to open and laparoscopic approaches: systematic review and meta-analysis. Arch Gynecol Obstet. 2013; 287:907–918.

25. Thiel DD, Lannen A, Richie E, Dove J, Gajarawala NM, Igel TC. Simulation-based training for bedside assistants can benefit experienced robotic prostatectomy teams. J Endourol. 2013; 27:230–237.

26. Reynisson P, Persson J. Hospital costs for robot-assisted laparoscopic radical hysterectomy and pelvic lymphadenectomy. Gynecol Oncol. 2013; 130:95–99.

27. Vizza E, Patrizi L, Saltari M, Sindico S, Cimino M, Corrado G. Robotic radical hysterectomy after neoadjuvant chemotherapy in locally advanced cervical cancer. Minim Invasive Ther Allied Technol. 2012; 21:206–209.

28. Cantrell LA, Mendivil A, Gehrig PA, Boggess JF. Survival outcomes for women undergoing type III robotic radical hysterectomy for cervical cancer: a 3-year experience. Gynecol Oncol. 2010; 117:260–265.

29. Tinelli R, Malzoni M, Cosentino F, Perone C, Fusco A, Cicinelli E, et al. Robotics versus laparoscopic radical hysterectomy with lymphadenectomy in patients with early cervical cancer: a multicenter study. Ann Surg Oncol. 2011; 18:2622–2628.

30. Brockbank EC, Evans J, Singh N, Shepherd JH, Jeyarajah AR. Ovarian recurrence from a Stage 1b1 cervical adenocarcinoma previously treated with radical vaginal trachelectomy: a case report. Gynecol Oncol Case Rep. 2012; 2:51–53.

31. Shimada M, Kigawa J, Nishimura R, Yamaguchi S, Kuzuya K, Nakanishi T, et al. Ovarian metastasis in carcinoma of the uterine cervix. Gynecol Oncol. 2006; 101:234–237.

32. Gizzo S, Ancona E, Patrelli TS, Saccardi C, Anis O, Donato D, et al. Fertility preservation in young women with cervical cancer: an oncologic dilemma or a new conception of fertility sparing surgery? Cancer Invest. 2013; 31:189.

33. Sicam RV, Huang KG, Lee CL, Chen CY, Ueng SH. Treatment of fallopian tube metastasis in cervical cancer after laparoscopic ovarian transposition. J Minim Invasive Gynecol. 2012; 19:262–265.