Robotic-Assisted Pelvic and High Para-aortic Lymphadenectomy (RPLND) for Endometrial Cancer and Learning Curve

Abstract

The present prospective non-randomized observational study was designed to analyse the learning curve for robotic-assisted pelvic and high para-aortic lymphadenectomy for endometrial cancer patients. Between 2011 and 2013, 131 consecutive endometrial cancer patients underwent type-1 extrafascial pan hysterectomy with pelvic and high para-aortic lymphadenectomy using the daVinci® robotic surgical procedures at single quaternary care Indian cancer institution. For lymph nodes retrieval data, the point at which as per AJCC-TNM staging, time taken to reach, recommended minimum number of lymph nodes at each segment of pelvic and para-aortic lymphadenectomy was plotted and analysed. Data were analysed for the number of lymph nodes retrieved in pelvic and high para-aortic lymphadenectomy specimen. The surgery was performed by the same surgeon in all cases. Target number of pelvic lymph nodes 12 was achieved by ninth case, and consistently, more number of pelvic nodes were removed. Target number of para-aortic lymph nodes 10 was achieved at eighteenth case. In our study, adequate number of pelvic lymph nodes retrieval of 12 was achieved by ninth case, and consistently, more number of pelvic nodes were removed and para-aortic lymph nodes retrieval of 10 was after eighteenth case. Our study confirms the proficiency and efficiency of robotic surgical approach in treatment of endometrial cancer, with adequate lymph node retrieval, and offers a safe and useful alternative to conventional surgical techniques with shorter learning curve.