Robotic Laparoscopy Research Articles

Development of a Robotic Laparoscope for Laparoscopic Surgery and its Control

[abstFig src='/00290003/13.jpg' width='300' text='Robotic laparoscope' ] In this work, a control method for a robotic laparoscope using a motion sensor, namely Kinect for Windows, is proposed so that the surgeon can operate the laparoscope with his/her head motions. In the control system of the robotic laparoscope, four types of head motion (up, down, left, and right), as well as the open-and-close motion of the mouth, are distinguished via a Kinect sensor. The tip of the robotic laparoscope is controlled in order to follow the head direction that is desired by the surgeon. In addition, the surgeon can change the tip speed of the robotic laparoscope through the open-and-close motion of the mouth, in accordance with the operational situation. For validation purposes, the proposed control system was applied to a robotic laparoscope of three degrees of freedom, which was built for the surgical robot for single-port surgery (SPS) that was developed in our previous study, and verification experiments were conducted. It was verified that the operator can control the tip of the robotic laparoscope intuitively, and the tip position of the robotic laparoscope can track the target position quickly and accurately.

Choice of the mode of laparoscopic right hemicolectomy

Laparoscopy has become the standard surgery mode of right hemicolectomy, including conventional laparoscopy, hand-assisted laparoscopic surgery (HALS), single-port laparoscopic surgery (SPLS), natural orifices translumenal endoscopic surgery (NOTES) and robotic laparoscopy. How to select reasonable laparoscopic mode could be confusing sometimes. For patients, safety, cost-effectiveness and radical cure of the surgery are very important. For doctors, advance and convenience of the surgery must be considered as well. How do we choose a win-win operation method Conventional laparoscopic surgery is the basis of all the minimally invasive surgeries, and total mesocolon resection with D3 lymphadenectomy is an important technical foundation of right hemicolectomy. HALS has some advantages in patients with obesity, abdominal surgery history, intestinal adhesion or intestinal obstruction. SPLS and NOTES have minimized abdominal trauma leading to faster recovery, but have certain technical difficulties, especially NOTES. Although robotic laparoscopic surgery is advanced, but its high cost limits its popularization. Surgeons should integrate their technical levels, hospital equipment, and conditions of patients, then choose reasonable operation mode of right hemicolectomy.

How badly did it hit? Self-assessed emotional shock upon prostate cancer diagnosis and psychological well-being: a follow-up at 3, 12, and 24 months after surgery

Background: We were interested in examining if there was a link between self-assessed emotional shock by prostate cancer diagnosis and psychological well-being at 3, 12, and 24 months after surgery.Material and methods: Information was derived from patients participating in the LAPAroscopic Prostatectomy Robot Open (LAPPRO) trial, Sweden. We analyzed the association between self-assessed emotional shock upon diagnosis and psychological well-being by calculating odds ratios (ORs).Results: A total of 2426 patients (75%) reported self-assessed emotional shock by the prostate cancer diagnosis. Median age of study participants was 63. There was an association between emotional shock and low psychological well-being after surgery: adjusted OR 1.7: (95% confidence interval [CI]), 1.4–2.1 at 3 months; adjusted OR 1.3: CI, 1.1–1.7 at 12 months, and adjusted OR 1.4: CI, 1.1–1.8 at 24 months. Among self-assessed emotionally shocked patients, low self-esteem, anxiety, and having no one to confide in were factors more strongly related with low psychological well-being over time.Conclusion: Experiencing self-assessed emotional shock by prostate cancer diagnosis may be associated with low psychological well-being for up to two years after surgery. Future research may address this high rate of self-assessed emotional shock after diagnosis with the aim to intervene to avoid this negative experience to become drawn out.

Performance of Kymerax© precision-drive articulating surgical system compared to conventional laparoscopic instruments in a pelvitrainer model.

The Kymerax© Precision-Drive Articulating Surgical System by Terumo© is a handheld laparoscopic robot which permits motion in two additional degrees of freedom (deflection and rotation in the instrument tip). In a pelvitrainer model, we compared the performance of participants with different laparoscopic experiences and compared Kymerax© to conventional laparoscopic instruments. 20 expert surgeons, performing more than 50 laparoscopic procedures per year, and 25 medical students without any experience in surgery at all were selected. Each participant was randomized into two groups: Group TK performed the tasks using the traditional laparoscopic Instruments (TLI) first and Kymerax© thereafter, group KT vice versa. Six standardized tasks were used: Two instructional exercises and four tasks where time, number of mistakes, and overall precision were measured. Finally, a questionnaire had to be answered. All four tasks were performed significantly more slowly with the Kymerax© device. Improved needle control in stitches towards the surgeon, significantly less deviation while cutting along different lines as well as a significantly reduced fraying of the cutting edge were found when participants were using Kymerax©. By questionnaire more than 90% of the participants indicated clear advantages using Kymerax©. However, participants needed more training time and had an earlier loss of concentration with Kymerax©. Further complaints about Kymerax© were its limitations in rotation and deflection, the impaired view as well as the non-ergonomic instrument handle. Rotation force, instrument weight, digital instrument-tip control, and needle fixation were rated as accurate. This study shows that more time is needed to solve tasks with Kymerax© compared to conventional laparoscopic instruments. Kymerax© is superior to conventional laparoscopy for suturing at difficult angles and cutting along complex structures. Kymerax© can potentially bring benefits for certain laparoscopic tasks, but as seen in this study, further developments are necessary. Terumo© meanwhile closed down its Kymerax

OP91 Health Technology Assessment On The Da Vinci Surgical System Using Real World Data In China

INTRODUCTION:The Da Vinci surgical system is classified as a type “A” medical device in China; the procurement plan of which is regulated by the National Health and Family Planning Commission (NHFP). Between 2010 to 2015, there were thirty-four Da Vinci surgical robots purchased, and installed in thirty tertiary public hospitals across the country. In order to generate context-specific evidence and support further capital funding decisions, the NHFP commissioned a Health Technology Assessment (HTA) of Da Vinci surgical robots, with a focus on real use of the technology in those tertiary public hospitals.METHODS:Nine hospitals were selected to collect real word data between 2013 to 2015. Using a cross-sectional survey, data of all robotic surgical cases were collected and described. The unit costs of the robotic surgery were estimated from activity based costing. We also collected cases of prostatectomy (427 versus 421) and hysterectomy (247 versus 105) using the robotic system and laparoscope respectively, and then compared hospital fees and effectiveness during hospitalization. Simulation of the budget impact on health insurance in Shanghai City over the next 5 years was also performed.RESULTS:A full HTA was conducted based on real data from nine public hospitals in the central and eastern region. Based on a systematic review methodology, we appraised evidence on safety, effectiveness and cost-effectiveness of the Da Vinci surgical robot. Data on technology use, clinical management, and pricing and payment were collected through a cross-sectional survey and interviews of hospital managers, surgeons and nurses. We designed a cohort study on cost-effectiveness of Da Vinci-assisted prostatectomy and hysterectomy, comparing Da Vinci-assisted and laparoscopic prostatectomy (427 vs 421) and Da Vinci-assisted and laparoscopic hysterectomy (247 versus 105). Ethics and inequity issues were discussed based on patient interviews. A budget impact analysis was performed based on scenario mapping of promoting Da Vinci-assisted prostatectomy in Shanghai City over a 5-year timeline.CONCLUSIONS:Due to a lack of evidence on long-term clinical effectiveness and high impact on public finances, the Da Vinci robotic robot should not be procured in large numbers in China. For equipment purchasing the government should strengthen regulations and require the public hospitals to collect more evidence.

Fertility Outcomes after Laparoscopic Reversal of Tubal Sterilization

Objective: To know pregnancy outcome in the tubal reversal of sterilized women.
 
 Method: Literature review.
 
 Results: Sterilization is considered the most common contraception methods in United States of America, approximately 39% women in reproductive age (15 - 44 years) used this method. However, approximately 15% of these patients deplored this decision due to the influence of their own environment and some factors, such as: young age, the death of a child, the disability of child, and change of partner/ remarried. Tubal reanastomosis or tubal reversal is a surgical procedure that attempts to restore the fallopian tube patency following sterilization. To date, the modern procedure is performed by doing an excision of the tubal segment and reanastomosis by transabdominal laparoscopy. Recently, the laparoscopic technology has developed and evolved rapidly as the robotic assisted laparoscopy was invented. There is alternative method for restoring the fertility in sterilized women who regretted the decision of being sterilized.
 Unlike the tubal reversal which is conducted in order to restore the tubal function, the IVF is performed to bypass the function of tubes in fertility. The major advantage for laparoscopic surgery is short postoperative stay duration with minimal tissue handling, less postoperative
 adhesions, and diminish morbidity rate. Despite of its
 major drawback, high-cost of robotic machine and machine maintenance; there are advantages of robotic laparoscopy compared to the conventional laparoscopy, such as improved dexterity, more precise and accurate articulation, reduced tremor, and better visualization
 of the operating field. In vitro fertilization (IVF) is the hallmark in the era of assisted reproductive technology and became an alternative option to regain the fertility in sterilized women.
 
 Conclusion: The pregnancy rate and live birth rate in laparoscopy, robotic and open surgery were relatively similar. Surgical reversal to women younger than 40 is recommended and laparoscopic reversal should be performed if the expertise is available. It is reasonable to
 counsel IVF to over 40 women.
 [Indones J Obstet Gynecol 2012; 36-3: 154-60]
 
 Keywords: gynecology, IVF, pregnancy outcomes, reanastomosis, robotic laparoscopy, tubal reversal

Automatic guidance of laparoscope based on the region of interest for robot assisted laparoscopic surgery

Background: Minimally invasive surgeries rely on laparoscopic camera views to guide the procedure. Traditionally, an expert surgical assistant operates laparoscopic camera. This process is distracting, and the camera is not always placed in an ideal location. To mitigate these problems, we have developed a laparoscopic automatic navigation method.Methods: In this article, a way to determining surgery status based on the distance of surgical instruments is presented. Combining with the surgery status, the region of interest (ROI) in laparoscopic image is defined, and related parameters are given in detail. Comprehensive the above content, the method of laparoscopic automatic navigation based on the ROI is proposed.Results: Finally, introducing the method into a kind of typical minimally invasive laparoscopic surgery robot system (MLSRS), and the method is simulated by using some typical surgical tasks.Conclusion: The results show that this method is feasible.

Rate of skill acquisition in the use of a robotic laparoscope holder (FreeHand®)

Background: Robotic equipment can greatly add to the ergonomics of a surgical procedure and pre-operative simulation can provide risk-free training of the surgeon leading to precision surgery and less trauma to the patient. Freehand® is a second-generation robotic camera-holding device, which has recently become available to laparoscopic surgeons. It is controlled by the operator selecting a direction using head movement followed by activation with a foot pedal. The purpose of this study was to assess the rate of skill acquisition in the use of the FreeHand® robotic laparoscope holder by a group of laparoscopic surgeons by enrolling them into a programme of training modules at The ICENI Centre, Colchester Hospital University, UK.Material and methods: Twenty surgical registrars performed a series of exercises, escalating in difficulty, to test their skill in controlling the FreeHand® robot. Subjective and objective assessments were evaluated by an observer and by tracking analysis software created for this trial.Results: The observed number of head movements showed a Percentage Performance Score (PPS) of 98% by the end of the third repetition of all exercises, the mean Total Head Movements Score (HMS) reached a plateau of performance at 72%. Fifty per cent of the participants selected ‘Effective control of movements without difficulty’ in the subjective evaluation by the end of the third repetition of exercises, while 35% selected ‘competent intuitive movements’.Conclusion: The FreeHand® robotic laparoscope holder is a useful device, which is easy to operate and requires a very short course of training to achieve competence in its use.

Robots for minimally invasive diagnosis and intervention

Minimally invasive diagnosis and interventions provide many benefits such as higher efficiency, safer, minimum pain, quick recovery etc. over conventional way for many procedures. Large robots such as da-Vinci are being used in this purpose, whereas research of miniature robots for laparoscopic and endoscopic use, is growing in the recent years. A comprehensive literature search is performed using keywords' laparoscopic robot, capsule endoscope, surgical medical robot etc. primarily for the time period of 2000-2015. The articles relevant to the theme of the paper are reviewed and included in the paper. This paper concentrates medical robots for minimally invasive diagnosis and intervention in general and propulsions of miniature robots in particular. Robots are classified and compared using critical characteristics and summarized in Tables 1-6. Large robots such as da-Vinci are successfully used in many procedures e.g. neurosurgery, cardiothoracic surgery etc. However there are needs for more functionality which might lead to flexible robots. For miniature robots, each propulsion mechanism has some advantages and disadvantages. While external magnetic propulsions have potential to provide propulsion without increasing the robot size, they lack precise position control and may require expensive and bulky equipment. On the other hand internal propulsions have the capability of precise position control but require mechanisms which need substantial amount of power to drive. Hybrid propulsion which combines best features of both internal and external propulsions could be a solution for this. Robots have improved the healthcare services for many medical procedures. However, still there are challenges to address to enable use of medical robots universally inside and outside hospitals for diagnosis and interventions.

Accurate prediction tools in prostate cancer require consistent assessment of included variables

Objective: The aim of this study was to create a preoperative prediction model predicting extraprostatic tumour growth in men with clinically organ-confined disease from a prospectively collected Swedish cohort. Materials and methods: The study used data from 3386 men in the prospective multi-centre Laparoscopic Prostatectomy Robot Open (LAPPRO) trial, with 14 participating urological departments. External validation was performed using a cohort of 634 men from the largest study centre with patients who underwent surgery before and after the inclusion period of the LAPPRO study. External validation of the updated Partin table was used for comparison. The prediction models were created by multivariable logistic regression. Nomogram prediction performance, internal, internal–external and external validation are presented as the area under the receiver operating characteristic curve (AUC). Results: The nomogram reached a prediction performance with an AUC of 0.741, with internal and external validation of 0.738 and 0.698, respectively. Internal–external validation showed great divergence between centres, with AUCs ranging from 0.476 to 0.892, indicating inconsistencies in pathological staging or one or more of the included variables in the regression model. When including centre as a variable in the multivariable model it was significantly associated with the outcome of pT3 (p < 0.001). AUC for external validation of the Partin table was 0.694. Conclusions: Accurate prediction tools in prostate cancer require consistent assessment of included variables, and local validation is needed before the use of such tools in clinical practice.

Evaluation of Dehydrated Human Amnion/Chorion Membrane as an Adhesion Barrier in Women Undergoing Robotic Laparoscopy

Introduction: Amniotic membrane contains collagen, cytokines and growth factors, is immune privileged, and has been shown to modulate inflammation and reduce scarring. Dehydrated human amnion/chorion membrane (dHACM) allografts have been used in many clinical and surgical applications to facilitate healing. We describe our experience of using commercially available dHACM allograft as an adhesion barrier in women undergoing da Vinci robot laparoscopy at an outpatient surgery center. Methods: With IRB permission, we conducted a retrospective evaluation of medical records from 16 consecutive patients that had undergone robotic laparoscopy for pelvic pain due to endometriosis and adhesions. All patients had resection of endometriosis and adhesiolysis with application of dHACM. As per our routine practice, all had been scheduled for a second surgery to inspect for reformation of adhesions, and to lyse any additional adhesions found. Results: We found handling characteristics of dHACM to be suitable for the microsurgery environment, although care needed to be taken to avoid fraying or breaking the material as it was introduced through the trocar. Fifteen of 16 patients receiving dHACM had a second procedure 1-2 weeks later. In 14 of the 15 cases, no new adhesions were observed in areas where dHACM was placed. No adverse events or major complications had been recorded in the medical record. Discussion: The biologic properties of dHACM give rise to its use in a wide variety of clinical applications. Our experience demonstrates that using dHACM as an adhesion barrier is feasible in women undergoing da Vinci robot laparoscopy.

Ultrasound-guided transversus abdominis plane block for control of postoperative pain after laparoscopy-assisted robotic abdominal cancer surgery

Background and objective Transversus abdominis plane (TAP) block is a recently developed method for analgesia that is now widely used in a variety of abdominal surgeries. Robotic laparoscopy is being increasingly adopted for surgical resection of abdominal cancers. We studied the efficacy and safety of TAP block to control pain after robot-assisted laparoscopic abdominal cancer surgery. Methods Totally, 30 patients scheduled for robot-assisted laparoscopic abdominal cancer surgery (hysterectomy, colorectal cancer resection, or cystectomy) received general anesthesia. Before extubation the patients were randomized into two equal groups: group T, in which TAP block was performed by means of an ultrasound-guided subcostal approach, and group C (control group), in which no TAP block was performed or other regional anesthesia was induced. We measured visual analog scale (VAS) both at rest and during episodes of coughing at 1, 2, 6, 12, and 24 h postoperatively. We measured total 24 h morphine consumption, in addition to complications and postoperative nausea and vomiting. Results VAS both at rest and during coughing was lower in the T group at all time intervals until 12 h (P Conclusion Ultrasound-guided TAP block by subcostal approach is an effective and safe method for providing analgesia that markedly reduces morphine consumption after robot-assisted laparoscopic abdominal cancer surgery

Évaluation médico-économique de la chirurgie et des autres primo-traitements du cancer de la prostate non métastatique

Prostate cancer is the most frequent cancer and the third leading cause of cancer death in men in France. The development of treatment for prostate cancer is fast and sometimes relies on costly innovations. Medico-economic studies are however rare in this area. This literature review aims to summarize available medico-economic data on the initial management of localized prostate cancer and discuss the quality and usability of existing economic studies on the subject. Literature review was done using PubMed and Cochrane databases. Studies and articles were selected based on several criteria: population with initial treatment for localized prostate cancer (without metastasis), comparative studies with surgery as control treatment, studies in countries members of the OECD, articles in English or French published between 2004 and 2014. The surgical robot, one of the newest innovations, is more expensive than conventional open surgery or no robotic laparoscopy, even if it is associated with a reduction of the original period of stay. Radiation therapy seems more expensive than surgery as initial therapy of localized prostate cancer. Conclusions remain limited because of the rarity of reliable health economic studies on the subject.

Attention-Aware Robotic Laparoscope Based on Fuzzy Interpretation of Eye-Gaze Patterns

Laparoscopic robots have been widely adopted in modern medical practice. However, explicitly interacting with these robots may increase the physical and cognitive load on the surgeon. An attention-aware robotic laparoscope system has been developed to free the surgeon from the technical limitations of visualization through the laparoscope. This system can implicitly recognize the surgeon's visual attention by interpreting the surgeon's natural eye movements using fuzzy logic and then automatically steer the laparoscope to focus on that viewing target. Experimental results show that this system can make the surgeon–robot interaction more effective, intuitive, and has the potential to make the execution of the surgery smoother and faster.

Concurrent use of a robotic uterine manipulator and a robotic laparoscope holder to achieve assistant-less solo laparoscopy: the double ViKY.

Three patients requiring gynecological surgery had uterine manipulation using a VCare(®) controlled by a ViKY(®) at the same time as having a ViKY(®) robotic arm controlling the laparoscope. The setup time for each varied from 6-9 min for the uterine manipulator and 3-5 min for the laparoscope holder. In all cases (one endometriosis and two dermoid cysts) the operative field was good. Two patients were discharged within 24h of surgery. One patient required an extra day in hospital after she went into acute urinary retention once the catheter was removed. This work demonstrated that assistant-less solo gynecological surgery is feasible using two ViKY robotic arms for both uterine manipulation and laparoscope holding.

Initial results of robotic esophagectomy for esophageal cancer

IntroductionThere is scant experience with robot-assisted esophagectomy in cases of esophageal and gastro-esophageal junction cancer. Our aim is to report our current experience. Patients and methodsObservational cohort study of the first 32 patients who underwent minimally invasive esophagectomy for esophageal cancer from September 2011 to June 2014. The gastric tube was created laparoscopically. In the thoracic field, a robot-assisted thoracoscopic approach was performed in the prone position with intrathoracic robotic hand-sewn anastomosis. Patient and tumour characteristics, surgical technique, short-term outcomes (morbidity and mortality) and oncological results (radicality and number of removed nodes) were evaluated. ResultsThirty-two patients, with a mean age of 58 years (34–74), were treated by a totally minimally invasive esophagectomy: robotic laparoscopy and thoracoscopy (11 McKeown and 21 Ivor-Lewis). Twenty-nine received neoadjuvant chemoradiotherapy. There were no conversions to open surgery. Console time was 218min (190–285). Blood loss was 170ml (40–255). One patient died from cardiac disease. Nine patients had a major complication (Dindo-Clavien grade II or higher). There was no case of respiratory complication or recurrent laryngeal nerve palsy. Five patients had intrathoracic fistula, 4 radiological and one clinical. Three had chylothorax, 2 cervical fistula and one gastric tube necrosis. The median hospital stay was 12 days (8–50). All the resections were R0 and the median of removed lymph nodes was 16 (2–23). ConclusionsOur results suggest that minimally invasive esophagectomy with robot-assisted thoracoscopy is safe and achieves oncological standards.

Short-term efficacy of da Vinci robotic and laparoscopic radical gastrectomy for gastric cancer: a Meta analysis

Objective To compare the short-term efficacy between da Vinci robotic and laparoscopic radical gastrectomy for gastric cancer. Methods Database including PubMed, EMBASE, the Cochrane Library, Medline, the China National Knowledge Infrastructure (CNKI) , Wanfang Database, VIP and China Biomedicine were searched with the key words of gastric cancer, gastrectomy, da Vinci surgical system, laparoscopic, laparoscopy，胃癌，胃切除术，达芬奇机器人手术系统and腹腔镜. Literatures published between May 2002 and March 2014 were retrieved. Related controlled trials containing the clinical efficacy of da Vinci robotic and laparoscopic radical gastrectomy for gastric cancer were enrolled in the study, and then the literatures were screened and the data were extracted by 2 independent reviewers. The quality of the literatures was assessed, and the data were analyzed using the RevMan 5.2 software. Patients receiving da Vinci robotic surgery and laparoscopic surgery were allocated into the robotic group and laparoscopy group, respectively. The count data were analyzed using the relative risk (RR) and 95% confidence interval (95% CI) , and the measurement data were analyzed using weighted mean difference (WMD) and 95% CI. The heterogeneity of the data was analyzed using the I2 test. Results Eleven literatures including 3 698 cases were enrolled in the study. There were 953 patients in the robotic group and 2 745 patients in the laparoscopic group. There were significant differences in the operation time, volume of intraoperative blood loss, time of postoperative flatus, time of first oral intake and duration of postoperative hospital stay between the 2 groups (WMD =51.23, -36.96, -0.24, -0.26, -1.11, 95% CI: 28.01-74.46, -61.28--12.65, -0.42- -0.06, -0.39- -0.14, -1.92- -0.29, P 0.05). Conclusion Da Vinci robotic radical gastrectomy for gastric cancer is safe and feasible, with the advantages of minimal invasion and rapid postoperative recovery. Key words: Gastric neoplasms; Da Vinci robotic surgical system; Laparoscopy; Radical gastrectomy; Meta analysis

Resultados iniciales de la esofaguectomía robótica en el cáncer de esófago

IntroductionThere is scant experience with robot-assisted esophagectomy in cases of esophageal and gastro-esophageal junction cancer. Our aim is to report our current experience. Patients and methodsObservational cohort study of the first 32 patients who underwent minimally invasive esophagectomy for esophageal cancer from September 2011 to June 2014. The gastric tube was created laparoscopically. In the thoracic field, a robot-assisted thoracoscopic approach was performed in the prone position with intrathoracic robotic hand-sewn anastomosis. Patient and tumour characteristics, surgical technique, short-term outcomes (morbidity and mortality) and oncological results (radicality and number of removed nodes) were evaluated. ResultsThirty-two patients, with a mean age of 58 years (34-74) were treated by a totally minimally invasive esophagectomy: robotic laparoscopy and thoracoscopy (11 McKeown and 21 Ivor-Lewis). Twenty-nine received neoadjuvant chemoradiotherapy. There were no conversions to open surgery. Console time was 218minutes (190-285). Blood loss was 170ml (40-255). One patient died from cardiac disease. Nine patients had a major complication (Dindo-Clavien grade II or higher). There was no case of respiratory complication or recurrent laryngeal nerve palsy. Five patients had intrathoracic fistula, 4 radiological and one clinical. Three had chylothorax, 2 cervical fistula and one gastric tube necrosis. The median hospital stay was 12 days (8-50). All the resections were R0 and the median of removed lymph nodes was 16 (2-23). ConclusionsOur results suggest that minimally invasive esophagectomy with robot-assisted thoracoscopy is safe and achieves oncological standards.

Comparison of surgical outcome and survival for obese women with endometrial cancer following three surgical approaches: Conventional laparoscopy, robotic laparoscopy and laparotomy

Objectives: Adjuvant chemotherapy is often considered following surgery for uterine leiomyosarcoma. However, due to the rarity of this malignancy, few trials exist documenting active cytotoxic agents in the adjuvant setting. A Phase III trial conducted by the GOG failed to show improved progression-free (PFS) or overall survival (OS) in patients randomized to doxorubicin or observation. The role of gemcitabine and docetaxel was evaluated in a prospective study; however, that trial lacked a control arm. Our objective was to compare survival outcomes among patients with uterine leiomyosarcoma who received adjuvant gemcitabine and docetaxel versus other chemotherapy regimens. Methods: This was a retrospective cohort study including 145 patients diagnosed with leiomyosarcoma from 1981 to 2013 at two tertiary care centers. Data collected included age, BMI, race, tumor grade, stage, residual disease, adjuvant treatment, PFS and OS. Variables were compared by Fisher's exact test or Wilcoxon rank-sum test. Kaplan– Meier curves were used to plot time to progression/recurrence or death. Cox proportional hazards regression was used to estimate hazard ratios for progression/recurrence or death by patient characteristics. Results: Among the cohort, 55 received adjuvant chemotherapy. Of these, 29 received gemcitabine/docetaxel and 26 received other chemotherapy. There were no significant differences in age, BMI, stage at diagnosis, or presence of residual disease between the two groups. However, patients receiving gemcitabine/docetaxel were significantly more likely to be Caucasian (85.7% vs. 61.5%, p = 0.008) and have a high grade tumor (96.6% vs. 61.5%, p = 0.02). Median PFS was 5.5 months in the gemcitabine/docetaxel group compared to 13 months in the other chemotherapy group (p= 0.30). The corresponding median OS was 23 months in the gemcitabine/docetaxel group compared to 39 months in the other chemotherapy group (p= 0.27). Conclusions: There was no significant difference in PFS or OS in patients with uterine leiomyosarcoma treated with adjuvant gemcitabine/docetaxel versus other chemotherapy regimens. Further evidence is needed to determine the role and best therapeutic regimens in the adjuvant setting.

Robotic surgery vs conventional laparoscopy for the treatment of rectal cancer: Review of the literature

Robotic surgery vs conventional laparoscopy for the treatment of rectal cancer: Review of the literature