Robotic-Assisted Hysterectomy for Endometrial Cancer Compared With Traditional Laparoscopic and Laparotomy Approaches (original) (raw)
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Robotic versus laparoscopic hysterectomy; comparison of early surgical outcomes
Journal of the Turkish German Gynecological Association, 2020
Objective: To compare early surgical outcomes of robotic assisted laparoscopic hysterectomy with laparoscopic hysterectomy for benign diseases, in terms of operation time, estimated blood loss (EBL), perioperative complications, hospital stay and first gas discharge. Material and Methods: Medical records of 146 patients who either underwent laparoscopic (n=84) or robotic assisted laparoscopic hysterectomy (n=62) for benign diseases were extracted from records. Demographic characteristics and operation time, EBL, length of hospital stay and first gas discharge were compared between the groups. Results: Mean age and mean body mass index of both groups were comparable. The difference in the mean EBL was not statistically significant between laparoscopic (91±65 mL) and robotic group (80±37 mL, p=0.43). The difference in the mean first gas discharge time was not statistically different between laparoscopic (15±5 hours) and robotic group (17±6 hours, p=0.33). The length of hospital stay w...
Total laparoscopic hysterectomy versus da Vinci robotic hysterectomy: is using the robot beneficial?
Journal of Gynecologic Oncology, 2011
To compare the outcomes of total laparoscopic to robotic approach for hysterectomy and all indicated procedures after controlling for surgeon and other confounding factors. Methods: Retrospective chart review of all consecutive cases of total laparoscopic and da Vinci robotic hysterectomies between August 2007 and July 2009 by two gynecologic oncology surgeons. Our primary outcome measure was operative procedure time. Secondary measures included complications, conversion to laparotomy, estimated blood loss and length of hospital stay. A mixed model with a random intercept was applied to control for surgeon and other confounders. Wilcoxon rank-sum, chisquare and Fisher's exact tests were used for the statistical analysis. Results: The 124 patients included in the study consisted of 77 total laparoscopic hysterectomies and 47 robotic hysterectomies. Both groups had similar baseline characteristics, indications for surgery and additional procedures performed. The difference between the mean operative procedure time for the total laparoscopic hysterectomy group (111.4 minutes) and the robotic hysterectomy group (150.8 minutes) was statistically significant (p=0.0001) despite the fact that the specimens obtained in the total laparoscopic hysterectomy group were significantly larger (125 g vs. 94 g, p=0.002). The robotic hysterectomy group had statistically less estimated blood loss than the total laparoscopic hysterectomy group (131.5 mL vs. 207.7 mL, p=0.0105) however no patients required a blood transfusion in either group. Both groups had a comparable rate of conversion to laparotomy, intraoperative complications, and length of hospital stay. Conclusion: Total laparoscopic hysterectomy can be performed safely and in less operative time compared to robotic hysterectomy when performed by trained surgeons.
Pilot study assessing robotic laparoscopic hysterectomy and patient outcomes
Journal of Minimally Invasive Gynecology, 2006
STUDY OBJECTIVE: To examine the operative variables and complications associated with roboticassisted total laparoscopic hysterectomy. DESIGN: Canadian Task Force classification II-1. SETTING: Gynecology service affiliated with a major cancer center in Southern California. PATIENTS: Twenty women with a benign gynecologic condition. INTERVENTION: Robotic-assisted total laparoscopic hysterectomy. Patient status was evaluated in terms of operative morbidity, length of surgery, anesthesia time, estimated blood loss, and hospital stay. MEASUREMENTS AND MAIN RESULTS: Mean operative time was 3.2 hours, and anesthesia time was 4 hours. Mean estimated blood loss was 81 mL, and patient postoperative hospital stay was 2 days. The complication rate in this study was low. The surgical procedure was converted to a laparotomy and abdominal hysterectomy in two patients because of poor visualization during robotic-assisted surgery. CONCLUSIONS: While the number of patients and nonrandomized nature of this single-institution experience are insufficient to draw any definitive conclusions regarding potential treatment efficacy, the patient postoperative stay and low complication rates suggest that this procedure is feasible and promising. Additional study comparing the efficacy and cost of robotic laparoscopic hysterectomy with standard laparoscopic hysterectomy with a larger patient population is warranted.
Journal of Robotic Surgery, 2011
Objectives: To compare patient characteristics, operative variables, and outcomes of 24 patients who underwent robotic-assisted total laparoscopic hysterectomy (TLH) with 44 patients who underwent conventional TLH. We retrospectively reviewed the charts of 44 patients with TLH and 24 patients with robotic TLH. Results: Robotic TLH was associated with a shorter hospital stay (1.0 vs 1.4 days, Pϭ0.011) and a significant decrease in narcotic use (1.2 vs 5.0 units, Pϭ0.002). EBL and drop in hemoglobin were not significantly different. The operative time was significantly longer in patients undergoing robotic TLH (142.2 vs 122.1 minutes, Pϭ0.027). However, only need for laparoscopic morcellation, BMI, and uterine weight, not robotic use, were independently associated with increased operative times. Conclusions: Robotic hysterectomy can be performed safely with comparable operative times to those of conventional laparoscopic hysterectomy. Postoperative measures were improved over measures for conventional laparoscopy.
Current Role of Robotic Hysterectomy
Journal of Gynecologic Surgery, 2013
Background: While robotic surgery for gynecologic indications received U.S. government approval in 2005, and has been rapidly and widely adopted, it is currently unclear how often this approach to hysterectomy is utilized. Objective: The aim of this research was to assess length of stay (LOS), mortality, indications, and current use of robotic hysterectomy, compared to other types of hysterectomy. Methods: A retrospective study of hysterectomies performed in New York State (NYS) in 2011 was performed. Data, including indication for surgery, age, procedure, LOS, and discharge status were obtained from the NYS Department of Health Statewide Planning and Research Cooperative System (SPARCS). Outcome Measures: LOS and mortality rate, were calculated according to institution, procedure, and indication for surgery. Results: For 22073 hysterectomies performed in NYS, the mean LOS was 2.9 days, and there were 29 (0.13%) deaths. The mean LOS for abdominal (12774 cases, 3.9 days) hysterectomies was longer than for laparoscopic (3927 cases, 1.6 days), robotic (2814 cases, 1.6 days), or vaginal (2558 cases, 1.7 days) hysterectomies ( p < 0.05). The adjusted mortality rates for abdominal (0.20%), laparoscopic (0.03%), robotic (0.07%), and vaginal (0.04%) hysterectomies were not significantly different. Overall, robotic surgery was performed in 29% of hospitals, by 11% of physicians and in 13% of cases. A robotic approach was utilized in 35% of patients with uterine cancer, 13% with endometriosis, 11% with excessive bleeding, 8% with leiomyomata, and 8% with pelvic relaxation. Conclusions: Despite the advantages in reduced LOS for robotic and other minimally invasive types of hysterectomies, the abdominal route is still predominant in most institutions. ( J GYNECOL SURG 29:174)
The International Journal of Medical Robotics and Computer Assisted Surgery, 2012
Background The objective of the study was to compare the short-term outcomes of robot-assisted hysterectomy with laparoscopic hysterectomy. Methods This study compared 60 patients who underwent robot-assisted hysterectomy (RAH) with 60 patients who underwent laparoscopic hysterectomy (LH). Results The mean ages of the patients in the RAH and LH groups were 51.52 AE 6.97 and 50.68 AE 8.92 years, respectively. The mean operative times for the RAH and LH groups were 108.12 AE 34.65 and 90.67 AE 25.20 min, respectively (p = 0.002). None of the cases in the RAH group required conversion to laparotomy; the rate of conversion to open laparotomy in the LH group was 1.6%. The complication rate among patients who underwent RAH was 8.3% compared with 6.6% in the laparoscopic cohort. Conclusions Robot-assisted hysterectomy is feasible and safe, resulting in similar surgical results when compared with traditional laparoscopic hysterectomy. It appears that, in the hands of a skilled laparoscopic surgeon, robotassisted hysterectomy is not superior to the laparoscopic approach. Copyright
Gynecologic Oncology, 2009
Objective: To evaluate feasibility and morbidity of robot assisted laparoscopic radical hysterectomy. Methods: From December 2005 to September 2008 robot assisted laparoscopic radical hysterectomy and pelvic lymphadenectomy was performed on 80 women. Using a prospective protocol, and an active investigation policy for defined adverse events, perioperative, short and long term data were obtained. Results: Time for surgery (skin to skin) reached 176 and 132 minutes after 9 and 34 procedures respectively. All tumours were radically removed. Median number of retrieved lymph nodes was 26 (range 15-55). All women had an early follow up (1-3 months) and 43 of eligible 46 women (93%) had a long term follow up (> 12 months). In 33 of 80 women (41%) the peri/postoperative period was uneventful. The remainder had one or more mainly mild adverse events, most commonly from the vaginal cuff (n=17, 21%) or the lymphatic system (n=16, 20%). The proportion of uneventful cases increased significantly over time. Five women were resutured for dehiscence of the vaginal cuff, two women were reoperated for trocar site hernias and one woman had a ureter stricture that resolved following stent treatment. Eight women (14 %) needed 60 days or more to resume spontaneous voiding. One 72-year old woman with disseminated endometrial cancer on autopsy died of pulmonary embolism 31 days after surgery. Conclusions: Robot assisted laparoscopic radical hysterectomy is a feasible alternative to conventional laparoscopy and open surgery. Effort should be made to ensure proper closure of the vaginal cuff, trocar sites and to develop nerve sparing techniques.
Comparative Effectiveness of Robotic Versus Laparoscopic Hysterectomy for Endometrial Cancer
Journal of Clinical Oncology, 2012
Purpose Use of robotics in oncologic surgery is increasing; however, reports of safety and efficacy are from highly experienced surgeons and centers. We performed a population-based analysis to compare laparoscopic hysterectomy and robotic hysterectomy for endometrial cancer. Patients and Methods The Perspective database was used to identify women who underwent a minimally invasive hysterectomy for endometrial cancer from 2008 to 2010. Morbidity, mortality, and cost were evaluated using multivariable logistic and linear regression models. Results We identified 2,464 women, including 1,027 (41.7%) who underwent laparoscopic hysterectomy and 1,437 (58.3%) who underwent robotic hysterectomy. Women treated at larger hospitals, nonteaching hospitals, and centers outside of the northeast were more likely to undergo a robotic hysterectomy procedure, whereas black women, those without insurance, and women in rural areas were less likely to undergo a robotic hysterectomy procedure (P < .0...