Elsevier

Gynecologic Oncology

Volume 108, Issue 2, February 2008, Pages 312-316
Gynecologic Oncology

Robotic radical hysterectomy with pelvic lymphadenectomy for cervical carcinoma: A pilot study

https://doi.org/10.1016/j.ygyno.2007.10.015Get rights and content

Abstract

Objectives

The purpose of this study was to evaluate the feasibility and surgical outcome of robotic radical hysterectomy with pelvic lymphadenectomy for stage I cervical carcinoma using the da Vinci surgical system.

Methods

A retrospective clinical review was performed of ten patients with FIGO stage IA2–IB1 cervical carcinoma who underwent a total robotic approach for definitive surgical treatment. Patient status was estimated in terms of operative morbidity, length of surgery, docking time, estimated blood loss, yield of pelvic lymph node and hospital stay.

Results

All operations were completed robotically with no conversions to laparotomy. Mean operative time was 207 min (range 120 to 240 min). Mean docking time was 26 min (range 10 to 45 min). Mean estimated blood loss was 355 mL. The average number of pelvic lymph nodes resected was 27.6 (range 12 to 52). There were no ureteral injuries or fistula complications.

Conclusions

Robotic radical hysterectomy with pelvic lymphadenectomy for selected patients with stage IB1 cervical cancer is feasible, promising and related with a low morbidity in this pilot study. Only prospective randomized trials will permit the evaluation of potential benefits associated with this surgical technique.

Introduction

Laparoscopic surgery has become an acceptable alternative among selected women with gynecologic malignancies over the last decades. Patient acceptance of surgical procedures increases with the development of minimally invasive endoscopic techniques, even in the absence of randomized clinical trials showing substantial advantages to these approaches. Complete staging procedures including abdominal exploration, hysterectomy, pelvic lymphadenectomy, omentectomy and peritoneal biopsies can be performed with laparoscopy [1], [2], [3]. Radical hysterectomy performed entirely by laparoscopy has been also described. However, this operation was initially time consuming and of questionable radicality [4], [5]. During the past decade, some reports have shown the feasibility of radical hysterectomy by laparoscopic surgery with an equivalent number of pelvic nodes harvested and without compromising patient survival [6], [7], [8].

Nevertheless, laparoscopic procedures for gynecologic surgery including radical hysterectomy have been received with caution. There is uncertainty over the equivalency of surgical yields, complications during the initial phase of the learning curve, effects on patient recovery and overall oncologic outcome. Moreover, the disadvantages of conventional laparoscopy, including an unstable camera platform, the limited mobility of straight laparoscopic instruments, two-dimensional imaging, a poor ergonomic position for the surgeon and a lengthy training interval are the possible explanations for the slow acceptance of minimally invasive options in the field of gynecologic oncology.

In numerous studies, robotic surgical systems have been shown to be safe and effective alternative to conventional laparoscopic surgery in a variety of surgical disciplines. Especially, in the last few years, a number of articles have been published on the performance of surgical procedures using the da Vinci telerobotic laparoscopic system (Intuitive Surgical, Inc. Sunnyvale, CA) in the gynecologic field [9], [10], [11]. The robotic surgical system is an innovative technology that addresses the many of the current limitations of conventional laparoscopy, including development of the a three-dimensional vision system for the surgeon and laparoscopic instruments with a wrist-like mechanism, allowing full replication of the range of motion of the surgeon's hand. Several reports have described robotic laparoscopic hysterectomy as both feasible and promising technique by enhancing the precision of anatomic dissection [11], [12], [13].

As yet, only a few publications in the current literature describe the technique and outcomes of gynecologic oncology staging procedures using a robotic laparoscopic system [14], [15]. Previously, we reported our initial experience with robot-assisted total laparoscopic hysterectomy [16]. The present study elaborated on our preliminary experience and technique of radical hysterectomy with pelvic lymphadenectomy for cervical cancer using a robotic surgical system.

Section snippets

Materials and methods

Between June 2006 and May 2007, 10 patients underwent robotic laparoscopic radical hysterectomy with pelvic lymphadenectomy. All patients consented to undergo laparoscopic surgery using the da Vinci robotic surgical system at Yonsei University Medical Center. The consent included the patient's acknowledgment that the procedure involved a new surgical technique. Inclusion criteria were women with newly diagnosed untreated invasive cervical cancer, FIGO stage IB1 or less disease, no evidence of

Results

All operations were completed robotically with no conversions to laparotomy. Mean docking time was 26 min (range 10 to 45 min). Docking time was counted from the beginning of the examination under anesthesia until the complete docking of the robotic arms to the trocars. The docking time per case showed a decreasing tendency with increased experience. The average operative time was 207 min (range 120 to 240 min). Operative time was measured from the beginning of the complete docking of the

Discussion

The use of robotic surgical systems to facilitate laparoscopic surgeries has increased over the past decade. In numerous studies, it has been shown to be a safe and effective alternative to conventional laparoscopic surgery in a variety of surgical disciplines such as cardiac, urologic and general surgery [17]. In the gynecology literature, there have been several reports of robotic laparoscopic hysterectomy and tubal anastomosis [9], [10], [11], [12], [13], [14]. A significant advantage of the

Acknowledgments

This study was supported by the Brain Korea (BK) 21 Project for Medical Sciences, Yonsei University and a grant of the Korean Health 21 R&D Project, Ministry of Health & Welfare, Republic of Korea (0412-CR01-0704-0001).

References (19)

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