J Gynecol Oncol.  2013 Jan;24(1):21-28. 10.3802/jgo.2013.24.1.21.

Integration of robotics into two established programs of minimally invasive surgery for endometrial cancer appears to decrease surgical complications

• Cardenas-Goicoechea J
• Soto E
• Chuang L
• Gretz H
• Randall TC

• KMID: 2288557
• DOI: http://doi.org/10.3802/jgo.2013.24.1.21

Abstract

OBJECTIVE
To compare peri- and postoperative outcomes and complications of laparoscopic vs. robotic-assisted surgical staging for women with endometrial cancer at two established academic institutions.
METHODS
Retrospective chart review of all women that underwent total hysterectomy with pelvic and para-aortic lymphadenectomy by robotic-assisted or laparoscopic approach over a four-year period by three surgeons at two academic institutions. Intraoperative and postoperative complications were measured. Secondary outcomes included operative time, blood loss, transfusion rate, number of lymph nodes retrieved, length of hospital stay and need for re-operation or re-admission.
RESULTS
Four hundred and thirty-two cases were identified: 187 patients with robotic-assisted and 245 with laparoscopic staging. Both groups were statistically comparable in baseline characteristics. The overall rate of intraoperative complications was similar in both groups (1.6% vs. 2.9%, p=0.525) but the rate of urinary tract injuries was statistically higher in the laparoscopic group (2.9% vs. 0%, p=0.020). Patients in the robotic group had shorter hospital stay (1.96 days vs. 2.45 days, p=0.016) but an average 57 minutes longer surgery than the laparoscopic group (218 vs. 161 minutes, p=0.0001). There was less conversion rate (0.5% vs. 4.1%; relative risk, 0.21; 95% confidence interval, 0.03 to 1.34; p=0.027) and estimated blood loss in the robotic than in the laparoscopic group (187 mL vs. 110 mL, p=0.0001). There were no significant differences in blood transfusion rate, number of lymph nodes retrieved, re-operation or re-admission between the two groups.
CONCLUSION
Robotic-assisted surgery is an acceptable alternative to laparoscopy for staging of endometrial cancer and, in selected patients, it appears to have lower risk of urinary tract injury.

Keyword

Endometrial neoplasms; Laparoscopic surgery; Robotics

MeSH Terms

Blood Transfusion
Endometrial Neoplasms
Female
Humans
Hysterectomy
Intraoperative Complications
Laparoscopy
Length of Stay
Lymph Node Excision
Lymph Nodes
Operative Time
Postoperative Complications
Retrospective Studies
Robotics
Urinary Tract

Reference

1. Jemal A, Siegel R, Xu J, Ward E. Cancer statistics, 2010. CA Cancer J Clin. 2010. 60:277–300.

2. Childers JM, Brzechffa PR, Hatch KD, Surwit EA. Laparoscopically assisted surgical staging (LASS) of endometrial cancer. Gynecol Oncol. 1993. 51:33–38.

3. Pasic RP, Rizzo JA, Fang H, Ross S, Moore M, Gunnarsson C. Comparing robot-assisted with conventional laparoscopic hysterectomy: impact on cost and clinical outcomes. J Minim Invasive Gynecol. 2010. 17:730–738.

4. Lim PC, Kang E, Park DH. Learning curve and surgical outcome for robotic-assisted hysterectomy with lymphadenectomy: case-matched controlled comparison with laparoscopy and laparotomy for treatment of endometrial cancer. J Minim Invasive Gynecol. 2010. 17:739–748.

5. 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.

6. Seamon LG, Cohn DE, Henretta MS, Kim KH, Carlson MJ, Phillips GS, et al. Minimally invasive comprehensive surgical staging for endometrial cancer: robotics or laparoscopy? Gynecol Oncol. 2009. 113:36–41.

7. Hoekstra AV, Jairam-Thodla A, Rademaker A, Singh DK, Buttin BM, Lurain JR, et al. The impact of robotics on practice management of endometrial cancer: transitioning from traditional surgery. Int J Med Robot. 2009. 5:392–397.

8. Bell MC, Torgerson J, Seshadri-Kreaden U, Suttle AW, Hunt S. Comparison of outcomes and cost for endometrial cancer staging via traditional laparotomy, standard laparoscopy and robotic techniques. Gynecol Oncol. 2008. 111:407–411.

9. Boggess JF, Gehrig PA, Cantrell L, Shafer A, Ridgway M, Skinner EN, et al. A comparative study of 3 surgical methods for hysterectomy with staging for endometrial cancer: robotic assistance, laparoscopy, laparotomy. Am J Obstet Gynecol. 2008. 199:360.e1–360.e9.

10. Veljovich DS, Paley PJ, Drescher CW, Everett EN, Shah C, Peters WA 3rd. Robotic surgery in gynecologic oncology: program initiation and outcomes after the first year with comparison with laparotomy for endometrial cancer staging. Am J Obstet Gynecol. 2008. 198:679.e1–679.e9.

11. Cardenas-Goicoechea J, Adams S, Bhat SB, Randall TC. Surgical outcomes of robotic-assisted surgical staging for endometrial cancer are equivalent to traditional laparoscopic staging at a minimally invasive surgical center. Gynecol Oncol. 2010. 117:224–228.

12. Vaknin Z, Perri T, Lau S, Deland C, Drummond N, Rosberger Z, et al. Outcome and quality of life in a prospective cohort of the first 100 robotic surgeries for endometrial cancer, with focus on elderly patients. Int J Gynecol Cancer. 2010. 20:1367–1373.

13. Lee CL, Han CM, Su H, Wu KY, Wang CJ, Yen CF. Robot-assisted laparoscopic staging surgery for endometrial cancer: a preliminary report. Taiwan J Obstet Gynecol. 2010. 49:401–406.

14. Gocmen A, Sanlikan F, Ucar MG. Comparison of robotic-assisted surgery outcomes with laparotomy for endometrial cancer staging in Turkey. Arch Gynecol Obstet. 2010. 282:539–545.

15. duPont NC, Guru KA, Iskander GB, Odunsi K, Lele SB, Rodabaugh KJ. Instituting a robot-assisted surgery programme at a tertiary care cancer centre. Int J Med Robot. 2010. 6:330–333.

16. duPont NC, Chandrasekhar R, Wilding G, Guru KA. Current trends in robot assisted surgery: a survey of gynecologic oncologists. Int J Med Robot. 2010. 6:468–472.

17. Holtz DO, Miroshnichenko G, Finnegan MO, Chernick M, Dunton CJ. Endometrial cancer surgery costs: robot vs laparoscopy. J Minim Invasive Gynecol. 2010. 17:500–503.

18. Barnett JC, Judd JP, Wu JM, Scales CD Jr, Myers ER, Havrilesky LJ. Cost comparison among robotic, laparoscopic, and open hysterectomy for endometrial cancer. Obstet Gynecol. 2010. 116:685–693.

19. Seamon LG, Fowler JM, Richardson DL, Carlson MJ, Valmadre S, Phillips GS, et al. A detailed analysis of the learning curve: robotic hysterectomy and pelvic-aortic lymphadenectomy for endometrial cancer. Gynecol Oncol. 2009. 114:162–167.

20. Reza M, Maeso S, Blasco JA, Andradas E. Meta-analysis of observational studies on the safety and effectiveness of robotic gynaecological surgery. Br J Surg. 2010. 97:1772–1783.

21. Gaia G, Holloway RW, Santoro L, Ahmad S, Di Silverio E, Spinillo A. Robotic-assisted hysterectomy for endometrial cancer compared with traditional laparoscopic and laparotomy approaches: a systematic review. Obstet Gynecol. 2010. 116:1422–1431.

22. Walker JL, Piedmonte MR, Spirtos NM, Eisenkop SM, Schlaerth JB, Mannel RS, et al. Laparoscopy compared with laparotomy for comprehensive surgical staging of uterine cancer: Gynecologic Oncology Group Study LAP2. J Clin Oncol. 2009. 27:5331–5336.

23. Seamon LG, Cohn DE, Richardson DL, Valmadre S, Carlson MJ, Phillips GS, et al. Robotic hysterectomy and pelvic-aortic lymphadenectomy for endometrial cancer. Obstet Gynecol. 2008. 112:1207–1213.

24. Lowe MP, Johnson PR, Kamelle SA, Kumar S, Chamberlain DH, Tillmanns TD. A multiinstitutional experience with robotic-assisted hysterectomy with staging for endometrial cancer. Obstet Gynecol. 2009. 114:236–243.