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Comparative Study
. 2008 Jul-Sep;12(3):227-37.

Robotic radical hysterectomy versus total laparoscopic radical hysterectomy with pelvic lymphadenectomy for treatment of early cervical cancer

Farr R Nezhat  1 , M Shoma Datta, Connie Liu, Linus Chuang, Konstantin Zakashansky
Affiliations
Comparative Study

Robotic radical hysterectomy versus total laparoscopic radical hysterectomy with pelvic lymphadenectomy for treatment of early cervical cancer

Farr R Nezhat et al. JSLS. 2008 Jul-Sep.

Abstract

Background and objectives: To compare intraoperative, pathologic and postoperative outcomes of robotic radical hysterectomy (RRH) to total laparoscopic radical hysterectomy (TLRH) in patients with early stage cervical carcinoma.

Methods: We prospectively analyzed cases of TLRH or RRH with pelvic lymphadenectomy performed for treatment of early cervical cancer between 2000 and 2008.

Results: Thirty patients underwent TLRH and pelvic lymphadenectomy for cervical cancer from August 2000 to June 2006. Thirteen patients underwent RRH and pelvic lymphadenectomy for cervical cancer from April 2006 to January 2008. There were no differences between groups for age, tumor histology, stage, lymphovascular space involvement or nodal status. No statistical differences were observed regarding operative time (323 vs 318 min), estimated blood loss (157 vs 200 mL), or hospital stay (2.7 vs 3.8 days). Mean pelvic lymph node count was similar in the two groups (25 vs 31). None of the robotic or laparoscopic procedures required conversion to laparotomy. The differences in major operative and postoperative complications between the two groups were not significant. All patients in both groups are alive and free of disease at the time of last follow up.

Conclusion: Based on our experience, robotic radical hysterectomy appears to be equivalent to total laparoscopic radical hysterectomy with respect to operative time, blood loss, hospital stay, and oncological outcome. We feel the intuitive nature of the robotic approach, magnification, dexterity, and flexibility combined with significant reduction in surgeon's fatigue offered by the robotic system will allow more surgeons to use a minimally invasive approach to radical hysterectomy.

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Figures

Figure 1.
Figure 1.
Trocar placement for robotic radical hysterectomy and bilateral pelvic lymphadenectomy. The arrows mark the locations of the trocars. A 12-mm camera trocar is placed at the umbilicus, 2 working robotic arms are attached to 8-mm reusable trocars placed bilaterally, and additional ancillary 5-mm to 10-mm trocars are placed in the suprapubic region and the left upper quadrant. The camera port and each working robotic port are placed in a way that allows for optimal robot arm movement and minimizes risk of collisions.
Figure 2.
Figure 2.
Development of the rectovaginal space (A). The posterior vaginal fornix is placed on tension (marked by the arrow), and a moistened sponge on sponge-forceps is placed in the vagina to facilitate delineation of the tissue planes.
Figure 3.
Figure 3.
Development of the vesicovaginal space (A). The uterus (B) is pushed cephalad into the abdominal cavity to facilitate visualization.
Figure 4.
Figure 4.
Left pelvic lymphadenectomy. Lymph node packets (F) are removed from the left common external iliac artery (A) and vein (B). The left obturator nerve (C), the left obliterated umbilical artery (D), and the left ureter (E) are identified. The obturator fossa nodes and the hypogastric nodes are completely removed.
Figure 5.
Figure 5.
The uterine artery (A) is identified and dissected from the point of its origin at the hypogastric artery (B) traversing over the ureter (C).
Figure 6.
Figure 6.
The right uterine artery (A) is coagulated and divided at its origin by using bipolar forceps and monopolar scissors. The right pararectal (B) and paravesical (C) spaces are fully developed; and the right ureter (D), right umbilical (E), and right external iliac artery (F) are visible.
Figure 7.
Figure 7.
Unroofing of the right ureter (A) using monopolar scissors. The paravesical space (B) and right obliterated umbilical artery (C) are identified.
Figure 8.
Figure 8.
Resection of the right parametrium (A). The right ureter (B), right obliterated umbilical (C), and right external iliac arteries (D) are seen.
Figure 9.
Figure 9.
Using monopolar scissors, a circumferential incision is made into the vagina assuring adequate margin.
Figure 10.
Figure 10.
Vaginal cuff closure with intracorporeal tying.
Figure 11.
Figure 11.
Panoramic view of the pelvis after removal of the specimen and vaginal closure. Both ureters (A and B) have been dissected to the level of the bladder.
Figure 12.
Figure 12.
Duration of surgery.
Figure 13.
Figure 13.
Robot docking time.
See this image and copyright information in PMC

References

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