Robotic-assisted Radical Hysterectomy Research Articles

Cervical cancer staging, pretreatment planning, and surgical treatment in the Nordic countries—Survey from the Surgical Subcommittee of the Nordic Society of Gynecological Oncology

Women with cervical cancer in the Nordic countries are increasingly undergoing pretreatment imaging by ultrasound, magnetic resonance imaging (MRI), positron emission tomography-computed tomography (PET-CT) or computed tomography, or sentinel lymph node procedure. The present survey reports the influence of pretreatment imaging findings on the recorded clinical International Federation of Gynecology and Obstetrics (FIGO) stage in Nordic countries and its impact on treatment planning and preferred surgical approach in cervical cancer. The Nordic Society of Gynecological Oncology Surgical Subcommittee developed a questionnaire-based survey that was conducted from 1 January to 31 March 2017. All the 22 Nordic Gynecological Oncology Centers (Denmark 5, Finland 5, Iceland 1, Norway 4, and Sweden 7) were invited to participate. The questionnaires were returned by 19 of 22 (86.3%) centers. The median number (range) of women with cervical cancer treated at each center annually was 32 (15-120). In 58% (11/19) of the centers, imaging findings were reported to influence the clinical staging. MRI in combination with PET-CT was the preferred imaging method and the results influenced treatment planning. Robotic-assisted radical hysterectomy was the preferred surgical method in 72% (13/18) of the centers. Sentinel lymph node procedure was not routinely implemented in the majority of the Nordic centers. More than half of the Nordic Gynecological Oncology Centers already report a clinical FIGO stage influenced by pretreatment imaging findings. The trend in preferred treatment is robotic-assisted radical hysterectomy and the sentinel lymph node procedure is gradually being introduced.

Robot-Assisted Radical Hysterectomy for Early-Stage Cervical Cancers: A Feasibility and Safety Study

Robot-Assisted Radical Hysterectomy for Early-Stage Cervical Cancers: A Feasibility and Safety Study

Robotic-Assisted Radical Hysterectomy Results in Better Surgical Outcomes Compared With the Traditional Laparoscopic Radical Hysterectomy for the Treatment of Cervical Cancer.

ObjectiveThe aim of this study was to compare the surgical outcomes of robotic-assisted radical hysterectomy (RRH) with traditional laparoscopic radical hysterectomy (TLRH) for the treatment of early-stage cervical cancer in a large retrospective cohort of a total of 933 patients.MethodsWe have enrolled 100 patients into the RRH and 833 patients into the TLRH group. The surgical outcomes include operating time, blood loss, transfusion rate, pelvic lymph node yield, hospitalization days, duration of bowel function recovery, catheter removal before and after 3 weeks, conversion to laparotomy, and intraoperative and postoperative complications. Follow-up results were also analyzed for all patients.ResultsBoth groups have similar patient and tumor characteristics but patients with a larger lesion size were preferably enrolled in the TLRH treatment group. The treatment with RRH was generally superior to TLRH with respect to operating time, blood loss, length of hospitalization, duration of bowel function recovery, and postoperative complications. On follow-up of patients, there were no relapses reported in the RRH group compared with 4% of relapse cases and 2.9% of deaths because of metastasis in the TLRH group. No conversion of laparotomy occurred in the RRH group. No significant difference was found with respect to intraoperative complications and blood transfusion between both groups.ConclusionsThe results from this study suggest that RRH is superior to TLRH with regard to surgical outcome and may pose a safe and feasible alternative to TLRH. The operating time and lymph node yield is acceptable. Our study is one of the largest single-center studies of surgical outcomes comparing RRH with TLRH during cervical cancer treatment and will significantly contribute to the safety of alternative treatment options for patients. Furthermore, the difference detected between TLRH and RRH group is further strengthened by the great expertise of the surgeon performing laparoscopic surgeries.

70 - Robotic-Assisted Radical Hysterectomy Results in Better Surgical Outcomes Compared to the Traditional Laparoscopic Radical Hysterectomy for the Treatment of Cervical Cancer

70 - Robotic-Assisted Radical Hysterectomy Results in Better Surgical Outcomes Compared to the Traditional Laparoscopic Radical Hysterectomy for the Treatment of Cervical Cancer

Ogilvie's Syndrome after Robotic-Assisted Radical Hysterectomy for Cervical Cancer

Acute colonic pseudo-obstruction (ACPO), also known as Ogilvie's syndrome, is defined by poor peristaltic activity of the colon that mimics mechanical obstruction in the absence of any mechanical occlusive gut lesion. This case report is the first to be published on ACPO occurring after robotic-assisted radical hysterectomy. Given that robotic-assisted laparoscopic surgery has become the next major stage of advancement for a range of operations, especially in gynecologic oncology surgery, this report emphasizes the importance of recognizing precipitating factors associated with this syndrome, including minimally invasive surgery.

Introduction of robot-assisted radical hysterectomy for early stage cervical cancer: impact on complications, costs and oncologic outcome.

The objective was to assess the impact of robot-assisted radical hysterectomy (RRH) on surgical and oncologic outcome and costs compared with open radical hysterectomy (ORH) at a tertiary referral center in Sweden. In this retrospective analysis all patients treated with radical hysterectomy and pelvic lymphadenectomy for early stage uterine cervical cancer during 2006-2015 were included (n = 304). The patients were divided into two groups, ORH (n = 155) and RRH (n = 149). Patient characteristics, FIGO stage, histology, adjuvant therapy, operation time, length of stay (LOS), lymph node yield, recurrence rate and survival were retrieved from medical records. Complications were graded according to the Clavien-Dindo classification. In addition, costs related to the surgical treatments were calculated. Blood loss, LOS and intraoperative complications were significantly lower as well as lymph node yield after RRH. No differences in postoperative complications or costs were observed between the two groups. Recurrence of disease was detected in 13.4 and 10.3% after RRH and ORH, respectively. Regression analysis demonstrated that histology, tumor size, positive lymph nodes and type of operation (RRH) were significantly associated with recurrence. The introduction of RRH was accompanied by similar postoperative complication rates and costs but lower LOS compared with ORH. An initial learning curve may account for the higher recurrence rate observed after RRH. These data reinforce the need for structured training and monitoring of outcomes when novel treatment modalities are introduced.

Primary Carcinosarcoma of the Uterine Cervix: Report of a Case and Review of the Literature

Abstract Background: Cervical carcinosarcoma is extremely rare. A case of cervical carcinosarcoma is presented and the literature is reviewed. Case: A multiparous woman in her mid-40s, with multiple medical comorbidities, including a body mass index of 48, had an adenocarcinoma identified on routine cervical cytology testing. The cytology was human papilloma virus p16/18–negative, raising suspicion of a primary endometrial rather than a cervical carcinoma but a cervical mass was detected. This patient underwent a robotic-assisted radical hysterectomy and pelvic lymph-node dissection for stage IB1 cervical carcinosarcoma. Results: This patient's postoperative course was complicated by ileus, which resolved spontaneously. Conclusions: Because of the rarity of this lesion, there are no specific treatment protocols. Spread from a uterine primary needs to be ruled out. (J GYNECOL SURG 32:354)

Robot-Assisted Nerve Sparing Radical Hysterectomy in Japan

The aim of this study was to compare robot-assisted nerve sparing radical hysterectomy (RA-NSRH) to abdominal nerve sparing radical hysterectomy (NSRH) in the treatment of cervical cancer.

Sentinel lymph node detection rates using indocyanine green in women with early-stage cervical cancer

ObjectiveOur study objective was to determine feasibility and mapping rates using indocyanine green (ICG) for sentinel lymph node (SLN) mapping in early-stage cervical cancer. MethodsWe performed a retrospective review of all women who underwent SLN mapping with ICG during primary surgical management of early-stage cervical cancer by robotic-assisted radical hysterectomy (RA-RH) or fertility-sparing surgery. Patients were treated at two high-volume centers from 10/2012 to 02/2016. Completion pelvic lymphadenectomy was performed after SLN biopsy; additionally, removal of clinically enlarged/suspicious nodes was part of the SLN treatment algorithm. ResultsThirty women with a median age of 42.5 and BMI of 26.5 were included. Most (90%) had stage IB disease, and 67% had squamous histology. RA-RH was performed in 86.7% of cases. One patient underwent fertility-sparing surgery. Median cervical tumor size was 2.0cm. At least one SLN was detected in all cases (100%), with bilateral mapping achieved in 87%. SLN detection was not impacted by tumor size and was most commonly identified in the hypogastric (40.3%), obturator (26.0%), and external iliac (20.8%) regions. Five cases of lymphatic metastasis were identified (16.7%): three in clinically enlarged SLNs, one in a clinically enlarged non-SLN, and one case with cytokeratin positive cells in an SLN. All metastatic disease would have been detected even if full lymphadenectomy had been omitted from our treatment algorithm, ConclusionsSLN mapping with ICG is feasible and results in high detection rates in women with early-stage cervical cancer. Prospective studies are needed to determine if SLN mapping can replace lymphadenectomy in this setting.

Robot-assisted versus open radical hysterectomy: A multi-institutional experience for early-stage cervical cancer

ObjectiveTo compare perioperative and clinico-pathological outcomes of patients with early-stage cervical cancer who underwent robot-assisted radical hysterectomy (RRH) and open radical hysterectomy (ORH). MethodsThis retrospective multi-center study abstracted demographic, clinico-pathological and perioperative outcomes data from medical records of 491 cervical cancer patients treated with RRH (n = 259) ORH (n = 232) between 2005 and 2011 at two American and one Norwegian University Cancer Centres. ResultsMean estimated blood loss (EBL) and transfusion rates were less for RRH than for ORH (97 vs. 49 mL, p < 0.001, and 3% vs. 7%, p = 0.018, respectively). Mean length of hospital stay (LOS) was significantly shorter in RRH versus ORH (1.8 vs. 5.1 days, p < 0.001). Mean operative time was longer for RRH than ORH (220 vs. 156 min, p < 0.001). Although overall complications were similar (p = 0.49), intra-operative complications were less common in the RRH group than ORH (4% vs. 10%, p = 0.004). In multivariate regression analyses longer operative time, less EBL and intra-operative complications, shorter LOS, and more pre-operative cone were significantly associated with RRH versus ORH. Recurrence and death rates were not statistically different for the two groups at a mean follow-up time of 39 months (p = 1.00 and p = 0.48, respectively). ConclusionsRRH had improved clinical outcomes compared to ORH in the treatment of early-stage cervical cancer in terms of EBL, intra-operative complications, transfusion rates, LOS, and pre-operative cone. Disease recurrence and survival were comparable for the two procedures.

Robotic surgery for early stage cervical cancer: Evolution and current trends.

The management of early stage cervical cancer often includes surgery in the form of radical hysterectomy, radical trachelectomy, or radical parametrectomy. Surgical techniques have evolved to include minimal invasive approaches, and more recently, to include robotic assisted techniques. This review highlights the evolution of surgical management of early cervical cancer and specifically explores robotic assisted radical hysterectomy, radical trachelectomy, radical parametrectomy, and the role of neoadjuvant chemotherapy.

Robot-Assisted Radical Hysterectomy in Cervical Carcinoma: The Belgian Experience.

The purpose of this study was to report the experience and oncological outcome of robot-assisted radical hysterectomies (RRHs) for cervical cancer performed in Belgium. Patients undergoing RRH for cervical cancer (n = 109) were prospectively collected between July 2007 and April 2014 in the 5 Belgian centers performing RRH for cervical cancer. The median age of the patients was 46 years (range, 31-80 years). Histological types included squamous cell carcinoma in 61 patients, adenocarcinoma in 22 patients, adenosquamous in 8 patients, endometrioid carcinoma in 2 patients, and other types (n = 16). The International Federation of Gynecology and Obstetrics stage distribution was IA (n = 9), stage IB1 (n = 71), stage IB2 (n = 4), stage II (n = 24), and unknown (n = 1). Twenty-four patients received adjuvant therapy, 17 patients underwent radiochemotherapy, and 7 underwent adjuvant radiation. Eighteen patients relapsed, and 5 died of disease. The median follow-up was 27.5 months (range, 3-82 months). The 2- and 5-year overall survivals were 96% and 89%, respectively. The 2- and 5-year disease-free survivals (DFSs) were 88% and 72%, respectively. The 2-year DFS per stage was 100% for IA, 88% for IB1, 100% for IB2, and 83% for II. The 5-year DFS per stage was 100% for stage IA and 75% for IB1. The complications were as expected for radical hysterectomy. This series confirms the feasibility and safety of RRH not only in cervical cancer stage IA to IB1, but also after neoadjuvant chemotherapy in stage IB2 to IIB.

A Comparison Between Laparotomy, Laparoscopy and Robotic-Assisted Radical Hysterectomy in Surgical Treatment of Early Stage Cervical Cancer.

A Comparison Between Laparotomy, Laparoscopy and Robotic-Assisted Radical Hysterectomy in Surgical Treatment of Early Stage Cervical Cancer.

Renal Calyceal Rupture in a Patient With Early Stage Cervical Carcinoma Treated by Robot-Assisted Radical Hysterectomy and Pelvic Node Dissection

Renal Calyceal Rupture in a Patient With Early Stage Cervical Carcinoma Treated by Robot-Assisted Radical Hysterectomy and Pelvic Node Dissection

Feasibility and Perioperative Outcomes of Robotic-Assisted Radical Hysterectomy After Neoadjuvant Chemotherapy for Locally Advanced Cervical Cancer.

Feasibility and Perioperative Outcomes of Robotic-Assisted Radical Hysterectomy After Neoadjuvant Chemotherapy for Locally Advanced Cervical Cancer.

A Detailed Analysis of the Learning Curve: Da Vinci Robot-Assisted Radical Hysterectomy in Cervical Cancer

A Detailed Analysis of the Learning Curve: Da Vinci Robot-Assisted Radical Hysterectomy in Cervical Cancer

Combined robotic and vaginal approach in radical hysterectomy for the patient with bulky cervical cancer

Objectives: Robotic surgery is gradually being incorporated into gynecologic oncology. Robotic radical hysterectomy offers some advantages over other surgical approaches with respect to operative time, blood loss, and hospital stay. Due to the necessary location of the robot docking system, however, there is not enough space to enable the performance of vaginal procedures. Therefore, robotic-assisted total radical hysterectomy is in the mainstream for early-stage cervical cancer treatment. In bulky cervical cancer, however, intrauterine manipulation is difficult to install and increases the risk of intra-abdominal tumor seeding. Especially difficult is determination of the level of vaginal cutting. For this reason, the vaginal approach is preferred for robot-assisted radical hysterectomy in bulky cervical cancer.

Robot-Assisted Radical Hysterectomy Combined with Vaginal Approach for the Patients with Bulky Cervical Cancer: Feasibility and Operative Results

Robot-Assisted Radical Hysterectomy Combined with Vaginal Approach for the Patients with Bulky Cervical Cancer: Feasibility and Operative Results

Cerebral oedema following robotic surgery: a rare complication.

We present an unusual complication following robotic assisted radical hysterectomy. A 51-year-old female with stage 1B1 cervical cancer underwent a robotic assisted radical hysterectomy. The procedure was prolonged with difficulties dissecting the left parametrium and vaginal fornix with persistent bleeding from the left vaginal vault. Post-operatively the patient was electively sedated and ventilated. Extubation was difficult due to patient agitation but achieved on day 2. Agitation persisted and a head CT scan was performed and a diagnosis of cerebral oedema was made. Factors contributing to this case include prolonged operating time, prolonged Trendelenburg position with high pressures of CO2 pneumoperitoneum and excessive blood loss. These factors may contribute to poor cerebral venous outflow, increasing intracranial pressure leading to increased risk of cerebral oedema. The mechanics of robotic assistance may be used to reduce these risks by significantly reducing intra-abdominal pressure improving venous return. The use of robotics in surgery has been increasing over the last 10 years, and the benefits have been well documented. We present an unusual complication following robotic assisted radical hysterectomy performed for cervical cancer.

Robotic-Assisted and Laparoscopic Radical Hysterectomy with Pelvic Lymph Node Dissection in the Treatment of Early Stage Cervical Cancer: A Case-Control Study

Robotic-Assisted and Laparoscopic Radical Hysterectomy with Pelvic Lymph Node Dissection in the Treatment of Early Stage Cervical Cancer: A Case-Control Study