Obstet Gynecol Sci.  2018 Jul;61(4):468-476. 10.5468/ogs.2018.61.4.468.

The comparison of surgical outcomes and learning curves of radical hysterectomy by laparoscopy and robotic system for cervical cancer: an experience of a single surgeon

• Heo YJ
• Kim S
• Min KJ
• Lee S
• Hong JH
• Lee JK
• Lee NW
• Song JY

• KMID: 2439720
• DOI: http://doi.org/10.5468/ogs.2018.61.4.468

Abstract

OBJECTIVE
The aim of this study was to compare and determine the feasibility, surgical outcomes, learning curves of robotic radical hysterectomy with lymph node dissection (RRHND) to conventional laparoscopic radical hysterectomy with lymph node dissection (LRHND) performed by a single surgeon, in patients with cervical cancer.
METHODS
Between April 2009 and March 2013, 22 patients underwent LRHND and 19 patients underwent RRHND. Variables such as age, body mass index, International Federation of Gynecology and Obstetrics stage, histological results, number of dissected lymph nodes, operative time, estimated blood loss, days of hospitalization and complications were reviewed. Learning curves of operation time was obtained using cumulative sum (CUSUM) method.
RESULTS
Both groups showed similar patient and tumor characteristics. In surgical outcome analysis, RRHND (51.8±10.4 minutes) showed longer preparing time than LRHND (42.5±14.1 minutes). In the LRHND group, 8 patients experienced postoperative complications (5 void difficulty, 1 postoperative bleeding, 1 right basal ganglia infarction, 1 fever). On the other hand, in the RRHND group, 4 patients experienced a postoperative complication (2 bleeding, 1 peritonitis, 1 dehiscence of trocar site). Using CUSUM method, the learning curves were obtained by plotting the cumulative sequential differences between each data point and the average operation time, and showed two distinct phases in both type of operations.
CONCLUSION
RRHND would be appropriate surgical approach in patients with cervical cancer with favorable outcome of less voiding difficulty. A minimum of 13 cases of robotic radical hysterectomies are required to achieve surgical improvement in the treatment of cervical cancer.

Keyword

Hysterectomy; Minimally invasive surgical procedures; Learning curve

MeSH Terms

Basal Ganglia
Body Mass Index
Gynecology
Hand
Hemorrhage
Hospitalization
Humans
Hysterectomy*
Infarction
Laparoscopy*
Learning Curve*
Learning*
Lymph Node Excision
Lymph Nodes
Methods
Minimally Invasive Surgical Procedures
Obstetrics
Operative Time
Peritonitis
Postoperative Complications
Surgical Instruments
Uterine Cervical Neoplasms*

Figure

• 

  Fig. 1 Overall survival and progression free survival. (A) Overall survival. (B) Progression free survival. LRH, laparoscopic radical hysterectomy; RRH, robotic radical hysterectomy.

• 

  Fig. 2 Learning curves using cumulative sum of operation time. (A) Laparoscopic radical hysterectomy. (B) Robotic radical hysterectomy. CUSUM-OT, cumulative sum of operation time.

• 

  Fig. 3 Two phases in cumulative sum of operation time in robotic radical hysterectomy. (A) Phase 1. (B) Phase 2. CUSUM-OT, cumulative sum of operation time.

• 

  Fig. 4 Learning curves using cumulative sum of console time and docking time in robotic radical hysterectomy. (A) Console time. (B) Docking time. CUSUM-CT, cumulative sum of console time; CUSUM-DT, cumulative sum of docking time.

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