“Learning curve” robotic radical hysterectomycompared to standardized laparoscopy assisted radical vaginal and open radical hysterectomy
Authors:
R. Pilka; R. Marek; P. Dzvinčuk; Milan Kudela; D. Neubert
Authors‘ workplace:
Porodnicko-gynekologická klinika FN a LF UP, Olomouc, přednosta prof. MUDr. R. Pilka, Ph. D.
Published in:
Ceska Gynekol 2013; 78(1): 20-27
Overview
Objective:
To compare intraoperative, pathologic and postoperative outcomes of „learning curve“ robotic radical hysterectomy (RRH) with laparoscopy assisted radical vaginal hysterectomy (LARVH) and abdominal radical hysterectomy (ARH) in patients with early stage cervical carcinoma.
Design:
Comparative study.
Setting:
Department of Obstetrics and Gynecology, University Hospital, Olomouc.
Methods:
The first twenty patients with cervical cancer stages IA2-IIA underwent RRH and were compared with previous twenty LARVH and ARH cases. The procedures were performed at University Hospital Olomouc, Czech Republic between 2004 and 2011.
Results:
There were no differences between groups for age, body mass index, tumor histology, number of nodes removed or preoperative hemoglobin levels. The median theatre time in the learning period for the robot procedure was reduced from 400 min to less than 223 min and compared well to the 215 min for an open procedure. We found differences between the pre- and postoperative hemoglobin levels (RRH, 14.9 ±7 .6; LARVH, 23.0 ± 8.5; ARH, 28.0 ± 12.4). This difference was statistically significant in favor of RRH group ( p= 0.0012). Mean length of stay was significantly shorter for the RRH group (7.2 versus 8.8 days,p = 0.0005). Mean pelvic lymph node count was similar in the three groups. None of the robotic or laparoscopic procedures required conversion to laparotomy. The differences in major operative complications between the two groups were not significant.
Conclusion:
Based on our experience, robotic radical hysterectomy showed better results than traditional laparoscopically assisted radical vaginal hysterectomy in early stage cervical carcinoma cases. Introduction of this new technique requires a learning curve of less than 20 cases that will reduce the operating time to a level comparable to open surger.
Keywords:
cervical cancer – robotic surgery – radical hysterectomy – laparoscopy
Sources
1. Akl, MN., Long, JB., Giles, DL., et al. Robotic-assisted sacrocolpopexy: technique and learning curve. Surg Endosc, 2009, 23(10), p. 2390–2394.
2. Artibani, W., Fracalanza, S., Cavalleri, S., et al. Learning curve and preliminary experience with da Vinci-assisted laparoscopic radical prostatectomy. Urol Int, 2008, 80(3), p. 237–244.
3. Association F. a. D. www fda gov/fdac/features/2005/405_computer html. Accessed 2009.
4. Baltayian, S. A brief review: anesthesia for robotic prostatectomy.J Robotic Surg 2008, 2(2), p. 59–61.
5. Blavier, A., Gaudissart, Q., Cadiere, GB., et al. Comparison of learning curves and skill transfer between classical and robotic laparoscopy according to the viewing conditions: implications for training. Am J Surg, 2007, 194(1), p. 115–121.
6. Boggess, JF., Gehrig, PA., Cantrell, L., et al. A case-control study of robot-assisted type III radical hysterectomy with pelvic lymph node dissection compared with open radical hysterectomy. Am J Obstet Gynecol, 2008, 199(4), p. 357 e1–7.
7. Camarillo, DB., Krummel, TM., Salisbury, JK., Jr. Robotic technology in surgery: past, present, and future. Am J Surg, 2004, 188(4A Suppl), p. 2S–15S.
8. Canis, M., Mage, G., Wattiez, A., et al. Does endoscopic surgery have a role in radical surgery of cancer of the cervix uteri?J Gynecol Obstet Biol Reprod, 1990, 19(7), p. 921.
9. Estape, R., Lambrou, N., Diaz, R., et al. A case matched analysis of robotic radical hysterectomy with lymphadenectomy compared with laparoscopy and laparotomy. Gynecol Oncol, 2009, 113(3), p. 357–361.
10. Fanning, J., Fenton, B., Purohit, M. Robotic radical hysterectomy. Am J Obstet Gynecol, 2008, 198(6), p. 649 e1–4.
11. Feuer, G., Benigno, B., Krige, L., Alvarez, P. Comparison of a novel surgical approach for radical hysterectomy: robotic assistance versus open surgery. J Robot Surg, 2009(3), p. 179–186.
12. Ficarra, V., Cavalleri, S., Novara, G., et al. Evidence from robot-assisted laparoscopic radical prostatectomy: a systematic review. Eur Urol, 2007, 51(1), p. 45–55; discussion p. 56.
13. Kim, YT., Kim, SW., Hyung, WJ., et al. Robotic radical hysterectomy with pelvic lymphadenectomy for cervical carcinoma: a pilot study. Gynecol Oncol, 2008, 108(2), p. 312–316.
14. Ko, EM., Muto, MG., Berkowitz, RS., et al. Robotic versus open radical hysterectomy: a comparative study at a single institution. Gynecol Oncol, 2008, 111(3), p. 425–430.
15. Koehler, C., Possover, M., Klemm, P., et al. Renaissance der Operation nach Schauta. Gynaekologe, 2002, 35, p. 132–145.
16. Lowe, MP., Chamberlain, DH., Kamelle, SA., et al. A multi-institutional experience with robotic-assisted radical hysterectomy for early stage cervical cancer. Gynecol Oncol, 2009, 113(2), p. 191–194.
17. Maggioni, A., Minig, L., Zanagnolo, V., et al. Robotic approach for cervical cancer: comparison with laparotomy: a case control study. Gynecol Oncol, 2009, 115(1), p. 60–64.
18. Magrina, JF., Kho, RM., Weaver, AL., et al. Robotic radical hysterectomy: comparison with laparoscopy and laparotomy. Gynecol Oncol, 2008, 109(1), p. 86–91.
19. Meigs, J. The Wertheim operation for carcinoma of the cervix. Am J Obstet Gynecol, 1945, 40, p. 542–543.
20. Nezhat, CR., Burrell, MO., Nezhat, FR., et al. Laparoscopic radical hysterectomy with paraaortic and pelvic node dissection. Am J Obstet Gynecol, 1992, 166(3), p. 864–865.
21. Nezhat, FR., Datta, MS., Liu, C., et al. Robotic radical hysterectomy versus total laparoscopic radical hysterectomy with pelvic lymphadenectomy for treatment of early cervical cancer. JSLS, 2008, 12(3), p. 227–237.
22. Persson, J., Reynisson, P., Borgfeldt, C., et al. Robot assisted laparoscopic radical hysterectomy and pelvic lymphadenectomy with short and long term morbidity data. Gynecol Oncol, 2009, 113(2), p. 185–190.
23. Pilka, R. Robotická chirurgie v gynekologii. Endoskopie, 2011, 20(1), p. 13–17.
24. Pitter, MC., Anderson, P., Blissett, A., et al. Robotic-assisted gynaecological surgery-establishing training criteria; minimizing operative time and blood loss. Int J Med Robot, 2008, 4(2), p. 114–120.
25. Piver, MS., Rutledge, F., Smith, JP. Five classes of extended hysterectomy for women with cervical cancer. Obstet Gynecol, 1974, 44, p. 265–272.
26. Sert, B., Abeler, V. 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 2007, 3(3), p. 224–228.
27. Schreuder, HW., Verheijen, RH. Robotic surgery. BJOG, 2009, 116(2), p. 198–213.
28. Visco, AG., Advincula, AP. Robotic gynecologic surgery. Obstet Gynecol, 2008, 112(6), p. 1369–1384.
29. Wertheim, E. The extended abdominal operation for carcinoma uteri. Am J Obstet Gynecol, 1912, p. 169–232.
30. Zakashansky, K., Bradley, WH., Nezhat, FR. New techniques in radical hysterectomy. Curr Opin Obstet Gynecol, 2008, 20(1), p. 14–19.
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Paediatric gynaecology Gynaecology and obstetrics Reproduction medicineArticle was published in
Czech Gynaecology
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