Robotic Nerve Sparing Radical Hysterectomy with Cerclage Evolving Technique Post LACC Trial Era

Abstract

Study Objective To evaluate the feasibility of the novel technique of robotic assisted radical hysterectomy with cerclage. Design Prospective patients who underwent robotic assisted radical hysterectomy with cerclage (RARHC) were evaluated for intraoperative outcomes such as operative time, blood loss, conversion, and complications. The pathological specimen outcomes such as parametria length, vaginal cuff margin, number of lymph nodes retrieved, grade, histology, LVSI and cytology was assessed. Length of hospital stay, readmissions, and postoperative complications were determined. Setting A tertiary academic affiliation hospital. Patients or Participants Clinical Stage I cervical cancers were enrolled after appropriate consent forms were obtained. Interventions Robotic Xi platform was utilized to perform all the procedures. Measurements and Main Results 10 patients underwent RARHC from 10/2018 to 04/2020. The demographics characteristics are: Age 46.9, BMI 30, clinical tumor size 1.6 cm. The pathological outcomes: 7/10 had squamous cell carcinoma, 2/10 adenocarcinoma, 1/10 adenosqaumous carcinoma histology. The grade of the tumor 5/10 grade 1, 4/10 grade 2, 1/10 grade 3. The average parametria obtained were 4.5 × 1.3 × 0.65 cm and 4.53 × 1.45 × 0.63 cm on the right and left parametrium respectively, the number of lymph nodes obtained 19.9 and vagina length margin was 2.2 cm. The average operative time was 214 minutes with estimated blood loss of 112 cc. The average length of hospitalizations was 21 hours. There was no conversion, complications and readmission. Conclusion Robotic assisted radical hysterectomy with Cerclage is feasible and safe. Long term outcomes compared to other surgical modalities will be reported in the future.