Yonsei Med J.  2008 Dec;49(6):879-885. 10.3349/ymj.2008.49.6.879.

Robotic Surgery for Cervical Cancer

• Magrina JF
• Zanagnolo

• KMID: 1782933
• DOI: http://doi.org/10.3349/ymj.2008.49.6.879

Abstract

The development of robotic technology has facilitated the application of minimally invasive techniques for the treatment and evaluation of patients with early, advanced, and recurrent cervical cancer. The application of robotic technology for selected patients with cervical cancer and the data available in the literature are addressed in the present review paper. The robotic radical hysterectomy technique developed at the Mayo Clinic Arizona is presented with data comparing 27 patients who underwent the robotic procedure with 2 matched groups of patients treated by laparoscopic (N = 31), and laparotomic radical hysterectomy (N = 35). A few other studies confirmed the feasibility and safety of robotic radical hysterectomy and comparisons to either to the laparoscopic or open approach were discussed. Based on data from the literature, minimally invasive techniques including laparoscopy and robotics are preferable to laparotomy for patients requiring radical hysterectomy, with some advantages noted for robotics over laparoscopy. A prospective randomised trial is currently being perfomred under the auspices of the American Association of Gyneoclogic Laparoscopists comparing minimally invasive radical hysterectomy (laparoscopy or robotics) with laparotomy. For early cervical cancer radical parametrectomy and fertility preserving trachelectomy have been performed using robotic technology and been shown to be feasible, safe, and easier to perform when compared to the laparoscopic approach. Similar benefits have been noted in the treatment of advanced and recurrent cervical cancer where complex procedures such as extraperitoneal paraortic lymphadenectomy and pelvic exenteration have been required. CONCLUSION: Robotic technology better facilitates the surgical approach as compared to laparoscopy for technically challenging operations performed to treat primary, early or advanced, and recurrent cervical cancer. Although patient advantages are similar or slightly improved with robotics, there are multiple advantages for surgeons.

Keyword

Cervical cancer; treatment; minimally invasive surgery; robotic surgery

MeSH Terms

Female
Gynecologic Surgical Procedures/*methods
Humans
Hysterectomy/methods
Lymph Node Excision/methods
Pelvic Exenteration/methods
Robotics/*methods
Surgical Procedures, Minimally Invasive/methods
Uterine Cervical Neoplasms/*surgery

Reference

1. Magrina JF. Robotic surgery in gynecology. Eur J Gynaecol Oncol. 2007. 28:77–82.

2. Frumovitz M, dos Reis R, Sun CC, Milam MR, Bevers MW, Brown J, et al. Comparison of total laparoscopic and abdominal radical hysterectomy for patients with early-stage cervical cancer. Obstet Gynecol. 2007. 110:96–102.

3. Puntambekar SP, Palep RJ, Puntambekar SS, Wagh GN, Patil AM, Rayate NV, et al. Laparoscopic total radical hysterectomy by the Pune technique: our experience of 248 cases. J Minim Invasive Gynecol. 2007. 14:682–689.

4. Holloway RW, Finkler NJ, Pikaart DP, Bigsby GE 4th, DeNardis SA, Ahmad S. Comparison of total laparoscopic and abdominal radical hysterectomy for patients with early-stage cervical cancer. Obstet Gynecol. 2007. 110:1174. author reply 1174-5.

5. Zakashansky K, Lerner DL. Total laparoscopic radical hysterectomy for the treatment of cervical cancer. J Minim Invasive Gynecol. 2008. 15:387–388. author reply 388.

6. Obermair A, Gebski V, Frumovitz M, Soliman PT, Schmeler KM, Levenback C, et al. A phase III randomized clinical trial comparing laparoscopic or robotic radical hysterectomy with abdominal radical hysterectomy in patients with early stage cervical cancer. J Minim Invasive Gynecol. 2008. 15:584–588.

7. Magrina JF. Robotic radical hysterectomy: technical aspects. Gynecol Oncol;In press 2008.

8. Symmonds RE. Some surgical aspects of gynecologic cancer. Cancer. 1975. 36:649–660.

9. Sert BM, Abeler VM. Robotic-assisted laparoscopic radical hysterectomy (Piver type III) with pelvic node dissection-case report. Eur J Gynaecol Oncol. 2006. 27:531–533.

10. 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. 3:224–228.

11. 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.

12. Fanning J, Fenton B, Purohit M. Robotic radical hysterectomy. Am J Obstet Gynecol. 2008. 198:649. e1-4.

13. Nezhat FR, Datta MS, Liu C, Chuang L, Zakashansky K. Robotic radical hysterectomy versus total laparoscopic radical hysterectomy with pelvic lymphadenectomy for treatment of early cervical cancer. JSLS. 2008. 12:227–237.

14. Boggess JF, Gehrig PA, Cantrell L, Shafer A, Ridgway M, Skinner EN, 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. 199:357. e1-7.

15. Magrina JF, Kho RM, Weaver AL, Montero RP, Magtibay PM. Robotic radical hysterectomy: comparison with laparoscopy and laparotomy. Gynecol Oncol. 2008. 109:86–91.

16. Magrina JF, Mutone NF, Weaver AL, Magtibay PM, Fowler RS, Cornella JL. Laparoscopic lymphadenectomy and vaginal or laparoscopic hysterectomy with bilateral salpingo-oophorectomy for endometrial cancer: morbidity and survival. Am J Obstet Gynecol. 1999. 181:376–381.

17. Magrina JF. Outcomes of laparoscopic treatment for endometrial cancer. Curr Opin Obstet Gynecol. 2005. 17:343–346.

18. Magrina JF, Weaver AL. Laparoscopic treatment of endometrial cancer: five-year recurrence and survival rates. Eur J Gynaecol Oncol. 2004. 25:439–441.

19. Nezhat F, Yadav J, Rahaman J, Gretz H, Cohen C. Analysis of survival after laparoscopic management of endometrial cancer. J Minim Invasive Gynecol. 2008. 15:181–187.

20. Kehoe SM, Ramirez PT, Abu-Rustum NR. Innovative laparoscopic surgery in gynecologic oncology. Curr Oncol Rep. 2007. 9:472–477.

21. Holloway RW, Finkler NJ, Pikaart DP, Bigsby GE 4th, DeNardis SA, Ahmad S. Comparison of total laparoscopic and abdominal radical hysterectomy for patients with early-stage cervical cancer. Obstet Gynecol. 2007. 110:1174. author reply 1174-5.

22. Hewett PJ, Allardyce RA, Bagshaw PF, Frampton CM, Frizelle FA, Rieger NA, et al. Short-term outcomes of the Australasian randomized clinical study comparing laparoscopic and conventional open surgical treatments for colon cancer: the ALCCaS trial. Ann Surg. 2008. 248:728–738.

23. Nezhat F, Prasad Hayes M, Peiretti M, Rahaman J. Laparoscopic radical parametrectomy and partial vaginectomy for recurrent endometrial cancer. Gynecol Oncol. 2007. 104:494–496.

24. Liang Z, Xu H, Chen Y, Li Y, Chang Q, Shi C. Laparoscopic radical trachelectomy or parametrectomy and pelvic and para-aortic lymphadenectomy for cervical or vaginal stump carcinoma: report of six cases. Int J Gynecol Cancer. 2006. 16:1713–1716.

25. Lee CL, Huang KG. Total laparoscopic radical parametrectomy. J Minim Invasive Gynecol. 2005. 12:168–170.

26. Ramirez PT, Schmeler KM, Wolf JK, Brown J, Soliman PT. Robotic radical parametrectomy and pelvic lymphadenectomy in patients with invasive cervical cancer. Gynecol Oncol. 2008. 111:18–21.

27. Shepherd JH, Spencer C, Herod J, Ind TE. Radical vaginal trachelectomy as a fertility-sparing procedure in women with early-stage cervical cancer-cumulative pregnancy rate in a series of 123 women. BJOG. 2006. 113:719–724.

28. Diaz JP, Sonoda Y, Leitao MM, Zivanovic O, Brown CL, Chi DS, et al. Oncologic outcome of fertility-sparing radical trachelectomy versus radical hysterectomy for stage IB1 cervical carcinoma. Gynecol Oncol. 2008. 111:255–260.

29. Einstein MH, Park KJ, Sonoda Y, Carter J, Chi DS, Barakat RR, et al. Radical vaginal versus abdominal trachelectomy for stage IB1 cervical cancer: A comparison of surgical and pathologic outcomes. Gynecol Oncol;In press 2008.

30. Beiner ME, Hauspy J, Rosen B, Murphy J, Laframboise S, Nofech-Mozes S, et al. Radical vaginal trachelectomy vs. radical hysterectomy for small early stage cervical cancer: a matched case-control study. Gynecol Oncol. 2008. 110:168–171.

31. Gorchev G, Tomov S. [Laparoscopically assisted radical vaginal trachelectomy-first attempt]. Akush Ginekol (Sofiia). 2005. 44:56–60.

32. Marchiole P, Benchaib M, Buenerd A, Lazlo E, Dargent D, Mathevet P. Oncological safety of laparoscopic-assisted vaginal radical trachelectomy (LARVT or Dargent's operation): a comparative study with laparoscopic-assisted vaginal radical hysterectomy (LARVH). Gynecol Oncol. 2007. 106:132–141.

33. Chen Y, Xu H, Zhang Q, Li Y, Wang D, Liang Z. A fertility-preserving option in early cervical carcinoma: laparoscopy-assisted vaginal radical trachelectomy and pelvic lymphadenectomy. Eur J Obstet Gynecol Reprod Biol. 2008. 136:90–93.

34. Díaz-Feijoo B, Gil-Moreno A, Puig O, Martínez-Palones JM, Xercavins J. Total laparoscopic radical trachelectomy with intraoperative sentinel node identification for early cervical stump cancer. J Minim Invasive Gynecol. 2005. 12:522–524.

35. Persson J, Kannisto P, Bossmar T. Robot-assisted abdominal laparoscopic radical trachelectomy. Gynecol Oncol;In press 2008.

36. Geisler JP, Orr CJ, Manahan KJ. Robotically assisted total laparoscopic radical trachelectomy for fertility sparing in stage IB1 adenosarcoma of the cervix. J Laparoendosc Adv Surg Tech A. 2008. 18:727–729.

37. Kehoe SM, Abu-Rustum NR. Transperitoneal laparoscopic pelvic and paraaortic lymphadenectomy in gynecologic cancers. Curr Treat Options Oncol. 2006. 7:93–101.

38. Marnitz S, Köhler C, Roth C, Füller J, Hinkelbein W, Schneider A. Is there a benefit of pretreatment laparoscopic transperitoneal surgical staging in patients with advanced cervical cancer? Gynecol Oncol. 2005. 99:536–544.

39. Papadia A, Remorgida V, Salom EM, Ragni N. Laparoscopic pelvic and paraaortic lymphadenectomy in gynecologic oncology. J Am Assoc Gynecol Laparosc. 2004. 11:297–306.

40. DeNardis SA, Holloway RW, Bigsby GE 4th, Pikaart DP, Ahmad S, Finkler NJ. Robotically assisted laparoscopic hysterectomy versus total abdominal hysterectomy and lymphadenectomy for endometrial cancer. Gynecol Oncol. 2008. 111:412–417.

41. Querleu D, Dargent D, Ansquer Y, Leblanc E, Narducci F. Extraperitoneal endosurgical aortic and common iliac dissection in the staging of bulky or advanced cervical carcinomas. Cancer. 2000. 88:1883–1891.

42. Burnett AF, O'Meara AT, Bahador A, Roman LD, Morrow CP. Extraperitoneal laparoscopic lymph node staging: the University of Southern California experience. Gynecol Oncol. 2004. 95:189–192.

43. Tillmanns T, Lowe MP. Safety, feasibility, and costs of outpatient laparoscopic extraperitoneal aortic nodal dissection for locally advanced cervical carcinoma. Gynecol Oncol. 2007. 106:370–374.

44. Gil-Moreno A, Franco-Camps S, Díaz-Feijoo B, Pérez-Benavente A, Martínez-Palones JM, Del Campo JM, et al. Usefulness of extraperitoneal laparoscopic paraaortic lymphadenectomy for lymph node recurrence in gynecologic malignancy. Acta Obstet Gynecol Scand. 2008. 87:723–730.

45. Vergote I, Pouseele B, Van Gorp T, Vanacker B, Leunen K, Cadron I, et al. Robotic retroperitoneal lower paraaortic lymphadenectomy in cervical carcinoma: first report on the technique used in 5 patients. Acta Obstet Gynecol Scand. 2008. 87:783–787.

46. Magrina JF. Extraperitoneal infrarenal aortic lymphadenectomy: development of a technique. Gynecol Oncol;In press 2008.

47. Chiva LM, Lapuente F, González-Cortijo L, González-Martín A, Rojo A, García JF, et al. Surgical treatment of recurrent cervical cancer: state of the art and new achievements. Gynecol Oncol. 2008. 110:3 Suppl 2. S60–S66.

48. Pectasides D, Kamposioras K, Papaxoinis G, Pectasides E. Chemotherapy for recurrent cervical cancer. Cancer Treat Rev. 2008. 34:603–613.

49. Elst P, Ahankour F, Tjalma W. Management of recurrent cervical cancer. Review of the literature and case report. Eur J Gynaecol Oncol. 2007. 28:435–441.

50. Leblanc F, Narducci F, Chevalier A, Taieb S, Castelain B, Querleu D. Pretherapeutic laparoscopic staging of locally advanced cervical carcinomas: technique and results. Gynecol Oncol. 2005. 99:3 Suppl 1. S157–S158.

51. Pruthi RS, Stefaniak H, Hubbard JS, Wallen EM. Robotic-assisted Laparoscopic anterior pelvic exenteration for bladder cancer in the female patient. J Endourol. 2008. 22:2397–2402. discussion 2402.