Robotic-Assisted vs Conventional Laparoscopic Hysterectomy for Endometrial Cancer

Abstract

Introduction The adoption of robotic surgery by Australian gynecologists has increased in the past seven years but remains dominated by the private sector. Robotic assisted laparoscopic hysterectomy (RALH) is associated with improved outcomes when compared with open surgery in women with endometrial cancer. However, the comparison of RALH with conventional laparoscopic hysterectomy (TLH) is met with conflicting data. Study Objective To evaluate the short-term operative outcomes of patients with endometrial cancer who underwent RALH and to compare these outcomes with those of a historical cohort who underwent TLH. Design Retrospective observational study. Setting Tertiary public hospital in New South Wales, Australia. Patients or Participants Outcomes of patients who underwent RALH for endometrial cancer by a single surgeon from June 2017 to November 2018 were compared with cases of TLH for endometrial cancer performed by the same surgeon from June 2013 to September 2018. Interventions N/A Measurements and Main Results Thirty-nine cases of RALH and 41 cases of TLH were performed for endometrial cancer. The cohorts were well-matched in age but women who underwent RALH were higher in BMI. RALH was associated with a longer total operative time (mean 132 minutes) than TLH (mean 107 minutes). There were no intra-operative complications and no conversions to laparotomy. Three minor post-operative complications occurred in each group. The average length of stay was significantly higher in the TLH group (1.78 days vs 1.26 days) than the RALH group. Six patients (15.4%) in the RALH group were discharged on the day of surgery. Majority of cases of RALH reported Conclusion The establishment of a robotic gynecological surgery program at our institution is safe and feasible. Complication rate and blood loss are low and patient recovery is excellent. Length of stay is reduced, and same-day discharge is achievable, allowing significant reductions in health care costs.