Abstract
The purpose was to compare robotic assisted total laparoscopic hysterectomy (TRH), laparoscopic assisted hysterectomy (TLH) and total abdominal hysterectomy (TAH) with surgical staging +/- lymphadenectomy for the management of uterine cancer. Institutional review board approval was obtained and patient characteristics, pathologic data, and data related to the surgical procedure were collected from chart review. Data were analyzed with SAS statistical software. A total of 102 TRHs were compared to 115 TLHs and 79 TAHs. There were more grade I and endometrial intraepithelial (EIN) lesions in the preoperative pathology of TLHs (P < 0.01). Pelvic lymphadenectomy was performed in 71 (70%) TRH, 46 (58%) TAH, and 28 (24%) TLH cases (P < 0.01). Mean surgical time was 203, 133 and 132 minutes for TRHs, TLHs, and TAHs (P < 0.05). Estimated blood loss was 69, 86, and 215 ml for TRH, TLH, and TAH (P < 0.05). Blood transfusions were 19% in TAHs versus 3% and 2% in TLHs and TRHs (P < 0.01). There were fewer wound infections (2% vs. 10%) in TRHs versus TAHs (P < 0.01). Length of stay was shorter for the TRH and TLH groups (P < 0.05). Despite longer surgical times, benefits of minimally invasive technology included shortened length of stay, decreased wound infections, transfusions, and blood loss. In our population, procedure selection for TLH versus TRH may have been influenced by lower preoperative grade, with reservation of robotic technology for cases anticipated to be more complex, and therefore justifying increased technology costs and operating times.
Highlights
Endometrial cancer has been reported to be the most common gynecologic cancer in the United States, with over 40,000 cases diagnosed annually, and over 7000 deaths [1]
Three hundred and thirteen patients treated for suspected uterine cancer: 110 patients with primary surgical resection attempted by total laparoscopic hysterectomy (TRH) from the inception of our robotics program (August 2006 to January 2009), 123 with primary surgical resection attempted by TLH from the inception of our program for laparoscopic staging for endometrial cancer (June 2005 to January 2009), and 79 patients with primary surgical resection by total abdominal hysterectomy (TAH) before minimally invasive techniques were utilized for staging of endometrial cancer at our institution
Of 110 cases attempted by TRH, eight were converted to open laparotomy, and of 124 cases attempted by TLH, nine cases were converted to open laparotomy
Summary
Endometrial cancer has been reported to be the most common gynecologic cancer in the United States, with over 40,000 cases diagnosed annually, and over 7000 deaths [1]. The majority of these cancers are diagnosed at early stages with corresponding survival rates of approximately 95%. In 2006, GOG-LAP2 presented randomized clinical data that laparoscopy was feasible for surgical staging of women with stage I-IIA uterine cancer [3]. Advocates of this approach cite decreased morbidity without compromise of disease modifying treatment. Laparoscopic hysterectomy has been associated with improved quality of life, decreased complications, and decreased recovery time when compared to total abdominal hysterectomy [4,5,6]
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