Performing surgeries laparoscopically offers patients faster recovery, decreased blood loss and transfusion rates, and less postoperative pain, but laparoscopic procedures in gynecologic oncology can be very challenging and requires significant technical expertise and experience. It is believed that the integration of robotics into these surgeries might offer a significant advantage in the learning curve, thus allowing more surgeons to offer this procedure to their patients. . . but is this an effective and safe alternative?
Dr Raffaele Tinelli from the department of obstetrics and gynecology at Vito Fazzi Hospital in Lecce, Italy, and colleagues sought to explore the safety, morbidity, and recurrence rate associated with total robotic radical hysterectomy with lymphadenectomy for early cervical carcinoma as compared with the total laparoscopic radical hysterectomy with lymphadenectomy. The researchers followed 99 consecutive patients with FIGO stage Ia1 (LVSI), Ia2, Ib1, Ib2, and IIa cervical cancer; 76 of the patients underwent conventional laparoscopic radical hysterectomy and 23 of the patients received the robotic procedure with pelvic lymph node dissection.
Although the difference was not significant, Tinelli and associates found greater blood loss in the robotics group as compared with the group receiving conventional laparoscopy procedure (157 ml versus 95 ml). However, they did see a reduction in hospital stay in the robotic group, with a median hospital stay for patients receiving the robotic procedure of 3 days versus a median of 4 days in the other group. Mean operating time was also higher in the robotics group; mean operating time was 323 minutes in the robotics group versus 255 min for the traditional laparoscopy group. The researchers did not find a significant difference in the recurrence rate.
“Robotic radical hysterectomy can be considered a safe and effective therapeutic procedure for managing early-stage cervical cancer without significant differences if compared with laparoscopic radical hysterectomy, in terms of the recurrence rate and intraoperative and postoperative complications, although multicenter randomized clinical trials with longer follow-up are necessary to evaluate the overall oncologic outcomes of this procedure,” concluded Tinelli and colleagues.
Tinelli R, Malzoni M, Cosentino F et al. Robotics versus laparoscopic radical hysterectomy with lymphadenectomy in patients with early cervical cancer: a multicenter study. Ann Surg Oncol. 2011 Mar 11.