Robotic Surgery For Endometrial Cancer Research Articles

Robotic surgery in endometrial cancer: first Polish experience.

In Poland, robotic surgery is nowadays perceived as a new method of surgical treatment in endometrial cancer patients. We aim to present the first Polish group of endometrial cancer patients treated using robotic surgery. The analysis was based on 79 patients with mean age of 59.72 ± 11.709 (range 27-83) years and endometrial cancer scheduled for surgical treatment. Mean BMI was 31.38 ± 8.78 (range 19.03-65.97)kg/m2. The data were collected based on a questionnaire consisting of 19 questions concerning the patient's perception of robotic surgery before the procedure. Patients with a family history of neoplastic diseases indicate precision of movements as the most important reason for choosing robotic surgery (p = 0.0035). Patients after surgery procedures in the past named shorter hospitalization as a major benefit (p = 0.0037). Patients who chose robotic surgery for financial reasons stressed the cosmetic effect as a priority (p = 0.0319). Shorter length of hospital stay, less blood loss, enlarged view, and good visualization were statistically significant reasons for choosing robotic surgery (p < 0.05). Women who consider work, good material status, and well-being as the most important aspects of their lives cited the cosmetic effect as a benefit of robotic surgery (p = 0.0029 vs. p = 0.0074 vs. p = 0.01745, respectively). In the follow-up after operations, no patients regretted choosing robotic surgery. Good visualization, precise movements, less blood loss, and cosmetic effects are the most frequent reasons for choosing robotic surgery. Even patients after other types of surgery in the past decided on robot-assisted radical hysterectomy because of the clear benefits of this approach.

Retracted: A Meta-Analysis of Robotic Surgery in Endometrial Cancer: Comparison with Laparoscopy and Laparotomy.

[This retracts the article DOI: 10.1155/2020/2503753.].

Malignant peritoneal cytologic contamination with robotic hysterectomy for endometrial cancer

BackgroundMalignant peritoneal cytology in endometrial cancer (EC) is not considered an independent adverse prognostic factor for uterine-confined disease and is not a determinant factor in the International Federation of Gynecology and Obstetrics (FIGO) staging system. NCCN Guidelines still recommend obtaining cytologies. The aim of this study was to determine the prevalence of peritoneal cytologic contamination following robotic hysterectomy for EC. MethodsPeritoneal cytology from the pelvis and diaphragm were obtained at the initiation of surgery, and from the pelvis only at the completion of robotic hysterectomy with sentinel lymph node mapping (SLNM). Cytology specimens were evaluated for the presence of malignant cells. Pre- and post-hysterectomy cytology results were compared, and pelvic contamination was defined as conversion from negative to positive cytology following surgery. Results244 patients underwent robotic hysterectomy with SLNM for EC. Pelvic contamination was identified in 32 (13.1%) cases. In multivariate analysis, pelvic contamination was associated with >50% myometrial invasion, tumor size >2 cm, lymphovascular space invasion (LVSI), and lymph node metastasis. There was no association with FIGO stage or histology subtypes. ConclusionsMalignant peritoneal contamination occurred during robotic surgery for EC. Large lesions (>2 cm), deep invasion (>50%), LVSI, and lymph node metastasis were each independently associated with peritoneal contamination. Whether or not peritoneal contamination increases risk for disease recurrence should be studied in larger series, including an evaluation of patterns of recurrence and the potential impact of adjuvant therapies. Until the clinical impact of peritoneal contamination during hysterectomy for EC is better understood, methods to reduce peritoneal contamination are warranted.

Health-related quality of life after robotic surgery for endometrial cancer: a prospective longitudinal one-year follow-up study

PurposeThis study aimed to explore how patients treated for endometrial cancer (EC) with robotic surgery are affected in symptoms of anxiety and depression and HRQoL in the long term.MethodsWomen scheduled for primary robotic surgery for EC were included (n = 64), in this single-center study. Socioeconomic variables were obtained at baseline. The European Organization for Research and Treatment of Cancers Quality of Life Questionnaire Core 30 (QLQ-C30), its module for EC (EN24), the Generalized Anxiety Disorder Scale (GAD-7), and the Patient Health Questionnaire Depression Scale (PHQ-9) were followed prospectively from baseline to 2 weeks, 3 months and 1 year postoperatively.ResultsThe number of patients scoring above the clinical threshold for anxiety decreased from 17 (27.0%) at baseline to 4 (7.0%) at 2 weeks (p = 0.012). Depressive symptoms were reported in 20% of patients at baseline and did not change significantly during the one-year follow-up (p = 0.58). A significant decrease in Global health status was seen at 2 weeks (from 69.8 to 62.7; p = 0.048), with return to baseline levels after 3 months (68.5; p = 0.32) and stable at 1 year. Unemployment, low income, and adjuvant therapy correlated with lower Global health status at 3 months.ConclusionThe significant proportion of patients with anxiety symptoms preoperatively reduced prompt after surgery, while the proportion with depression remained constant, indicating that the primary treatment has no long-term negative effect on patients’ mental health. At 3 months, there is no obvious remaining negative impact on patients’ HRQoL, and these results are consistent after 1 year.

Robotic Surgery for Endometrial Cancer Increases Intraocular Pressure: A Pilot Study [A314

INTRODUCTION: To evaluate changes in intraocular pressure (IOP) during robotic surgery for endometrial cancer. METHODS: A prospective study in which IOP was measured in the left and right eyes before surgery (PACU), before induction head of bed 30°, after induction 0°, after pneumoperitoneum at 14-mm Hg at 0°, after robot docking at 30° Trendelenburg, after undocking at 30°, and on supine position before extubation. IOP for each patient was averaged between the left and right eyes. Wilcoxon signed-rank tests were performed to evaluate whether IOP changed significantly between baseline (PACU) and the other time points. RESULTS: A total of 15 patients were included. The average IOP before surgery was 15.4±5.45 mm Hg (mean±standard deviation). The intraocular pressure increased significantly after docking the robot (average IOP increase of 9.43 mm Hg; P=.001091), after undocking (average IOP increase of 11.5 mm Hg; P=.0001; Age was 64.27 years old; BMI 38.98 Kg/m2. Tumor grade 1 (60%). Stage IA 67%. Operative time 149.53 minutes. EBL 68.3 mL. There were no intraoperative complications or readmission. CONCLUSION: The intraocular pressure significantly increased during robotic surgery. Caution should be exercised during surgery on patients with glaucoma or increased intracranial pressure as baseline.

The current status of robotic surgery for endometrial cancer in Japan.

The da Vinci® surgical system (Intuitive Surgical Inc., Sunnyvale, CA, USA) was approved in 2009 by the Japanese Ministry of Health, Labor, and Welfare. In gynecology, robotic surgery for hysterectomy for benign indications and early-stage endometrial cancer has been covered by National Health Insurance since 2018. In a context where the da Vinci surgical system has prevailed in urology departments in Japan, gynecological robotic surgery has spread rapidly once it was covered by insurance. Although minimally invasive gynecologic surgery (minimally invasive surgery, or MIS) in Japan has a specific context, there are several problems with its safety, surgeon education, and cost in Japan. To maximize the many advantages of robotic surgery, its effectiveness needs to be carefully evaluated and this new technology needs to be safely incorporated in practice.

Incidence of Venous Thromboembolic Events with Long Term Enoxaparin in Patients Undergoing Robotic Surgery for Endometrial Cancer

<h3>Study Objective</h3> To determine the incidence of venous thromboembolic (VTE) events in patients undergoing robotic surgery for endometrial cancer who receive postoperative enoxaparin for 28 days starting before surgery versus those receiving only a single dose of preoperative prophylaxis with enoxaparin. <h3>Design</h3> Retrospective cohort study. <h3>Setting</h3> University hospital. <h3>Patients or Participants</h3> All patients undergoing robotic assisted surgical staging between 1/2017 to 8/2020 for endometrial intraepithelial neoplasia (EIN), endometrial adenocarcinoma (EAC), uterine serous carcinoma (USC), and uterine carcinosarcoma (MMMT). Exclusion criteria included a history of a prior thromboembolic event prior to surgery (i.e., DVT, PE), thrombophilia, history of a prior CVA, or use of anti-coagulant therapy prior to surgery. <h3>Interventions</h3> N/A. <h3>Measurements and Main Results</h3> A total of 190 patients had robotic assisted surgical staging for endometrial cancer by two attending surgeons at a single gynecologic oncology practice during the study period. One hundred fifty-nine patients met inclusion criteria. In this cohort, 35 (22%) patients received 28-days of prophylactic enoxaparin postoperatively and 124 (78%) patients did not receive postoperative enoxaparin. There was no significant difference between the 2 groups with respect to age, BMI, tobacco use, aspirin use, and ASA classification. There was no significant difference between the 2 groups with respect to postoperative diagnosis, tumor grade, and stage. There was no significant difference between length of stay and postoperative complications. The rate of clinical VTE diagnosed within 30 days postoperatively was 0 (0%) in the group receiving 28-days of enoxaparin postoperative and 1 (0.81%) in the group receiving no prophylactic enoxaparin (p= 1.0). <h3>Conclusion</h3> In our patient population, no significant increase in rate of clinical VTE was observed in patients who did not receive 28-days of postoperative enoxaparin compared to those receiving one dose of preoperative enoxaparin who were undergoing robotic surgery for endometrial cancer.

Effectiveness of robotic surgery for endometrial cancer: a systematic review and meta-analysis.

Our current study was performed aimed at determining the efficacy and safety profile of robotic surgery (RS) compared to laparoscopic surgery (LPS) and laparotomy (LT) in the treatment of endometrial cancer on the basis of relevant studies. A systematic literature search was conducted based on appropriate keywords, using the Embase, Cochrane library, as well as PubMed. Our studiers also reviewed the key pertinent sources among the publications and included associated literatures published by June 2021. Odds ratios (ORs), mean difference (MD), as well as 95% confidence interval (95% CI) for each study were measured for further assessment and synthesis of outcomes. Thirty studies involving a total of 12,025 patients were eventually included in the current meta-analysis. Compared with LPS, RS could significantly decrease the estimated blood loss, the incidence of intraoperative complications, the length of hospital stay, and the rate of conversion, and increased the rate of readmission. Compared with LT, RS significantly decreased the estimated blood loss, blood transfusion volume, the length of hospital stay, the rate of total, intraoperative and postoperative complications, and the rate of readmission and re-operation, and increased the operative time. Considering the effects and safety profile of RS in terms of treating endometrial cancer, our study suggest that RS exerts superior outcomes than that of LPS and LT.

Same-day discharge after robotic surgery for endometrial cancer.

To assess the safety of same-day discharge (SDD) following robotic-assisted endometrial cancer staging and identify risk factors for postoperative admission in a diverse population. A review of patients who underwent robotic-assisted endometrial cancer staging from April 1, 2017 to April 1, 2019 was performed. Patients were evaluated for SDD if they met the following criteria: tolerating oral intake, voiding spontaneously, ambulating, negative orthostatic vitals, postoperative hemoglobin ≤ 2g/dL from baseline, pain controlled on oral medications, and desire to be discharged. Risk factors for admission were identified. One hundred eighty-seven patients were identified. SDD criteria were met in 158, of which 132 (83.5%) were discharged same day. Median length of stay was 4.5h. Reasons for admission despite meeting criteria were late surgery time (n = 15), abnormal vitals (n = 9), and personal concerns (n = 2), with risk factors being age ≥ 68years (OR 2.72; 95% CI, 1.13-6.59), start time 1400 or later (OR = 11.25; 95% CI, 4.35-29.10), ASA ≥ 4 (OR 23.82; 95% CI, 2.54-223.15), history of CVA/MI (OR 5.61; 95% CI, 1.07-29.52), and operative time ≥ 120min (OR = 3.83; 95% CI 1.36-10.77). Of the SDD cohort, 2 patients (1.3%) presented to the emergency room within 30days (postoperative day 5 and 23). SDD following robotic-assisted endometrial cancer staging is safe and feasible. Age ≥ 68years, surgery start time after 1400, ASA ≥ 4, history of CVA/MI, and operative time ≥ 120min appear predictive of inpatient admission despite meeting SDD criteria.

Perioperative Recovery and Narcotic Use in Laparoscopic versus Robotic Surgery for Endometrial Cancer

To compare intraoperative and perioperative narcotic use, recovery room time, and total hospital stay for patients treated with robotic vs laparoscopic surgery for endometrial cancer. Retrospective cohort. Teaching hospital. All patients having minimally invasive surgery in the division of gynecologic oncology during a 20-month period. Laparoscopic cases were compared with robot-assisted cases with respect to perioperative outcome. Hospital billing records were used to identify all patients with endometrial cancer treated from January 1, 2018 through July 31, 2019 undergoing either laparoscopic or robotic surgery. Data were collected including total narcotic use converted to intravenous morphine milligram equivalent (MME), total amount of time in recovery, and length of hospital stay. A total of 139 laparoscopic and 101 robotic surgeries were eligible for analysis. There was no difference between the groups with respect to blood loss, alcohol use, or smoking. Patients undergoing laparoscopy had a significantly lower body mass index compared with patients undergoing robotic surgery (32.9 vs 38.0 kg/m2; p <.001). Univariate analysis showed no difference between the 2 groups with respect to narcotic use in surgery (21.7 vs 21.1 MME; p=.64), recovery (4.3 vs 4.5 MME; p=.70), or total dose (26.0 vs 25.6 MME; p=.78). However, patients who underwent a robotic approach had a longer recovery room time (128 minutes vs 163 minutes; p <.001 and a longer surgical time (288 minutes vs 204 minutes; p=.001). Patients in the robotic group were also more likely to undergo full lymphadenectomy than patients in the laparoscopy group (38.0% vs 20.8% p <.001). In a multivariate analysis, the only significant factors for predicting total narcotic dose were age, use of a preoperative enhanced recovery after surgery program, and surgical time. Patients who had laparoscopy were more likely to achieve same-day discharge (39.3% vs 17.8%; p<.001), but in the multivariate analysis, the type of surgery did not predict same-day discharge. There was no difference in narcotic use in the perioperative period with robotic surgery compared with laparoscopy. Recovery time was longer for robotic surgery, but this was not significant in multivariate analysis. Same-day discharges were less frequent with robotics, which may be more related to the physician's choice rather than the procedure.

The current evidence for the use of minimally-invasive surgery in endometrial cancer

The aim of the present study is to review the current available data regarding the use of minimally-invasive surgery in endometrial cancer patients and investigate the feasibility and safety of it for cancer control. We also reviewed the current understanding of sentinel lymph node mapping and the use of robotic surgery in endometrial cancer. Studies have consistently demonstrated better short-term outcomes of minimally-invasive surgery in endometrial cancer compared to laparotomy such as less blood loss, shorter hospital stay, and fewer wound complications. Large randomized clinical trials and meta-analyses also suggest the feasibility and safety of minimally-invasive surgery in terms of oncologic outcomes especially in patients with early stage disease. Although evidence for advanced stage disease and patients with high risk for recurrence are still lacking, the current available data seem to support the use of minimally-invasive surgery for those patient groups as well. A large body of literature supports the role of sentinel lymph node mapping in endometrial cancer with a high sensitivity and a low false negative rate, as well as a favorable negative predictive value. Studies also show that robotic surgery is a safe and effective alternative to conventional laparoscopic surgery for endometrial cancer staging but further long-term data are required. Further prospective studies with long-term follow-up are warranted to evaluate the feasibility and safety of minimally-invasive surgery especially in patients with advanced stage disease and high risk for recurrence. However, the current available data support the use of minimally-invasive surgery in all patient groups of endometrial cancer.

Robotic vs. open surgery in obese women with low-grade endometrial cancer: comparison of costs and quality of life measures

BackgroundThis retrospective study compared perioperative measures, costs, quality of life and survival after open vs. robotic surgery, among obese women diagnosed with low-grade endometrial cancer.MethodsObese women (body mass index (BMI) ≥ 30) who underwent open or robotic surgery for endometrial cancer, in one of two tertiary medical centers in the center of Israel, 2013–2016, postoperative grade 1–2, were included. Costs per patient, including 30-days post-surgery were calculated. Quality of life was evaluated by Physical and Mental Components of the SF-36 and a recovery from surgery questionnaire. Overall survival outcomes were obtained from patients’ files. Surgical outcomes, including operating and anesthesia times, length of hospital stay, and intraoperative and postoperative complications according to the Clavien-Dindo classification scale were reviewed.ResultsIn all, 138 women with BMI ≥30 underwent open (n = 61) or robotic surgery (n = 77) during the study period. The groups had similar BMI, comorbidities, demographics and tumor characteristics. Robotic surgery was associated with shorter hospital stays (mean 1.7 vs. 4.8 days; P < .0001) and fewer postoperative complications (Clavien-Dindo > 2, 5.2% vs. 19.7%; P = .0008), but longer operating theater time (3.8 vs. 2.8 h; P < .001). Costs are equivalent when at least 350 robotic surgeries are performed annually, not including the initial system costs. Quality of life measures were better after robotic surgery. SF-36 showed better measures for robotic surgery (Physical 56 vs. 39 and Mental 73 vs. 56; P < .01). After robotic surgery, patients tended to recover quicker when compared to open surgery, as they returned to normal activities earlier, with less need for family and governmental assistance (mean recovery time, 23 vs. 70 days; P < 0.006 and mean change in preoperative total functioning score, − 1.5 vs. -3.9: P < 0.05, respectively). Overall, 5-year survival was 89.8% for the open surgery group vs. 94% for the robotic surgery group (log rank, P = 0.330).ConclusionsObese women with low-grade endometrial cancer had better quality of life after robotic vs. open surgery. They also had shorter hospital stays and fewer postoperative complications. Centers with high volumes of robotic surgery can achieve similar costs when comparing both methods. These results were achieved without jeopardizing survival. Our results further emphasize the need for the Israeli healthcare system to include specific reimbursement for robotic procedures in the population we studied.

Using Regression Models to Predict Surgery Duration for Robotic-Assisted Total Laparoscopic Hysterectomy in Endometrial Cancer

Study Objective To develop regression models using preoperative variables that can accurately predict the operating room time of robotic surgery for endometrial cancer. Design A retrospective review using preoperative variables including age, BMI, ASA score, surgery start time, preoperative diagnosis, number of previous abdominal surgeries, parity, and uterine volume were used to develop regression models. These regression models were compared to institutional models that used preoperative estimations of operating room times based on historical averages. Setting An urban, academic hospital. Patients or Participants 348 patients undergoing robotic-assisted total laparoscopic hysterectomy with staging for endometrial cancer between 2016-2020 by six surgeons. Interventions N/A Measurements and Main Results The mean operating room time was 234 minutes (range: 130 – 484). The mean preoperative estimated operating room time was 223 minutes (range: 120 – 390). Linear, ridge, lasso, and elastic net models had relatively similar performance measures, and all models outperformed preoperative estimated operating room duration. Ultimately, the elastic net model performed the best. Elastic net had the smallest median root mean square error (RMSE) 57.97 (CI of 54.44-61.72) and greatest median R-squared 0.22 (CI 0.18-0.26). Surgery start time and preoperative diagnosis were found to be most influential variables in predicting operating room time followed by BMI, uterine volume, and number of prior surgeries. Age, ASA, parity and surgery type were not important in predicting operating room time. Conclusion Regression modeling more accurately predicted operating room time than the institutional standard that used historical averages for robotic-assisted hysterectomy with staging for endometrial cancers. This study is novel in its application to the field of robotic surgery in gynecologic oncology as it builds off of previous work from other disciplines demonstrating improved OR time predictions with regression models. Further studies are needed with expanded databases and more robust variable sets to refine the models ability to account for variance.

Same day discharge after robotic surgery for endometrial cancer

Same day discharge after robotic surgery for endometrial cancer

Perioperative recovery from laparoscopic versus robotic surgery for endometrial cancer

Perioperative recovery from laparoscopic versus robotic surgery for endometrial cancer

Regression modeling improves or scheduling for robotic surgery on endometrial cancer

Objective: Our objective was to develop a tool that can accurately predict operating room time for robotic surgery for endometrial cancer using quantifiable and qualifiable preoperative variables.

Introduction of robotic surgery for endometrial cancer is associated with lower bill sizes: The experience of a tertiary oncological centre in Singapore

Introduction of robotic surgery for endometrial cancer is associated with lower bill sizes: The experience of a tertiary oncological centre in Singapore

Clinical Outcomes of Robotic Surgery Compared to Conventional Surgical Approaches (Laparoscopic or Open): A Systematic Overview of Reviews.

Describe clinical outcomes (eg, postoperative complications, survival) after robotic surgery compared to open or laparoscopic surgery. Robotic surgery utilization has increased over the years across a wide range of surgical procedures. However, evidence supporting improved clinical outcomes after robotic surgery is limited. We systematically searched MEDLINE, EMBASE, and the Cochrane Central Register of systematic reviews from inception to January 2019 for systematic reviews describing postoperative outcomes after robotic surgery. We qualitatively described patient outcomes of commonly performed robotic procedures: radical prostatectomy, hysterectomy, lobectomy, thymectomy, rectal resection, partial nephrectomy, distal gastrectomy, Roux-en-Y gastric bypass, hepatectomy, distal pancreatectomy, and cholecystectomy. One hundred fifty-four systematic reviews included 336 studies and 18 randomized controlled trials reporting on patient outcomes after robotic compared to laparoscopic or open procedures. Data from the randomized controlled trials demonstrate that robotic-assisted radical prostatectomy offered fewer biochemical recurrence and improvement in quality of recovery and pain scores only up to 6 weeks postoperatively compared to open radical prostatectomy. When compared to laparoscopic prostatectomy, robotic surgery offered improved urinary and sexual functions. Robotic surgery for endometrial cancer had fewer conversion to open compared to laparoscopic. Otherwise, robotic surgery outcomes were similar to conventional surgical approaches for other procedures except for radical hysterectomy where minimally invasive approaches may result in patient harm compared to open approach. Robotic surgery has been widely incorporated into practise despite limited supporting evidence. More rigorous research focused on patient-important benefits is needed before further expansion of robotic surgery.

Quality of Life After Robotic Surgery for Endometrial Cancer

Quality of Life After Robotic Surgery for Endometrial Cancer

A Meta-Analysis of Robotic Surgery in Endometrial Cancer: Comparison with Laparoscopy and Laparotomy.

Background The safety and effectiveness of robotic surgery are evaluated by comparing perioperative outcomes with laparoscopy and laparotomy in endometrial cancer. Method PubMed, MEDLINE, Embase, Cochrane, and other databases were searched for eligible studies up to April 2019. Studies that compared robotic surgery with laparoscopy or laparotomy in surgical staging of endometrial cancer were included. The pooled odds ratio and weighted mean difference were calculated using a random-effects or a fixed-effects model to summarize the results. Results Twenty-seven articles were ultimately included, with one randomized controlled trial and 26 observational studies. A total of 6568 patients were included. Meta-analysis showed that robotic surgery had less estimated blood loss (P < 0.001), blood transfusion (P = 0.04), intraoperative complications (P = 0.001), and conversion to open surgery (P = 0.001), and a shorter hospital stay (P = 0.001), but had a longer operation time (P = 0.04) in surgical staging of endometrial cancer compared with laparoscopy. There were no significant differences in postoperative complications, the total number of lymph nodes harvested, the number of pelvic lymph nodes harvested, and the number of para-aortic lymph nodes harvested between techniques. Robotic surgery had a longer operation time (P = 0.008), less estimated blood loss (P < 0.001), blood transfusion (P < 0.001), and postoperative complications (P < 0.001), and a shorter hospital stay (P < 0.001) compared with laparotomy. There were no significant differences in other variables between techniques. Conclusion Robotic surgery is a safer surgical approach than laparoscopy and laparotomy in surgical staging of endometrial cancer, with less estimated blood loss, blood transfusion, and conversion, and the same number of lymph nodes harvested.