Total Laparoscopic Radical Hysterectomy Versus Abdominal Radical Hysterectomy with Lymphadenectomy in Patients with Early Cervical Cancer: Our Experience

Background  The aim of this study was to retrospectively compare, in a series of 127 consecutive women, the safety, morbidity, and recurrence rate of total laparoscopic radical hysterectomy (TLRH) with lymphadenectomy and abdominal radical hysterectomy with lymphadenectomy (ARH) for early cervical carcinoma. Methods  A total of 127 consecutive patients with International Federation of Gynecology and Obstetrics stage Ia1 (lymphvascular space involvement), Ia2, and Ib1 early cervical cancer, 65 of whom underwent TLRH and 62 of whom underwent ARH with pelvic lymph node dissection, comprised the study population. The para-aortic lymphadenectomy with the superior border of the dissection being the inferior mesenteric artery was performed in all cases with positive pelvic lymph nodes discovered at frozen section evaluation. Results  The median blood loss in the ARH group (145 ml; range, 60–225 ml) was significantly greater than TLRH group (55 ml; range, 30–80 ml) (P < .01). The median length of hospital stay was significantly greater in the ARH group (7 days; range, 5–9 days) than TLRH group (4 days; range, 3–7 days) (P < .01). The median operating time was 196 min in the TLRH group (range, 182–240 min) compared with 152 min in the ARH group (range, 161–240 min) (P < .01). No statistically significant difference was found between the two groups when the recurrence rate was compared. Conclusions   Total laparoscopic radical hysterectomy is a safe and effective therapeutic procedure for management of early-stage cervical cancer with a far lower morbidity than reported for the open approach and is characterized by far less blood loss and shorter postoperative hospitalization time, although multicenter randomized clinical trials with longer follow-up are necessary to evaluate the overall oncologic outcomes of this procedure.     

Robotic radical hysterectomy: applying principles of the laparoscopic Pune technique

Minimal access surgery is an accepted treatment modality in cervical cancer. Despite the advantages of laparoscopy, the surgical technique of laparoscopic radical hysterectomy is not very commonly performed. Robotic surgery is an emerging field with rapid acceptance because of the 3-dimensional image, dexterity of instruments and autonomy of camera control. We report here our technique of performing robotic radical hysterectomy using the Da Vinci surgical system. Twenty patients with cervical cancer stage 1a1–1b2 underwent robotic radical hysterectomy since December 2009. The median duration of surgery was 122 min, and the average blood loss was 100 ml. Postoperative ureteric fistulas occurred in two patients and were managed by ureteric stenting. The median lymph node retrieval was 30 nodes (range 18–38). We compared our robotic results with our published data on laparoscopic radical hysterectomy (Pune technique). We were able to complete all 20 cases robotically with minimal morbidity, and could duplicate our laparoscopic steps in robotic radical hysterectomy.     

Robotic radical hysterectomy versus total laparoscopic radical hysterectomy with pelvic lymphadenectomy for treatment of early cervical cancer

BACKGROUND AND OBJECTIVES: To compare intraoperative, pathologic and postoperative outcomes of robotic radical hysterectomy (RRH) to total laparoscopic radical hysterectomy (TLRH) in patients with early stage cervical carcinoma. METHODS: We prospectively analyzed cases of TLRH or RRH with pelvic lymphadenectomy performed for treatment of early cervical cancer between 2000 and 2008. RESULTS: Thirty patients underwent TLRH and pelvic lymphadenectomy for cervical cancer from August 2000 to June 2006. Thirteen patients underwent RRH and pelvic lymphadenectomy for cervical cancer from April 2006 to January 2008. There were no differences between groups for age, tumor histology, stage, lymphovascular space involvement or nodal status. No statistical differences were observed regarding operative time (323 vs 318 min), estimated blood loss (157 vs 200 mL), or hospital stay (2.7 vs 3.8 days). Mean pelvic lymph node count was similar in the two groups (25 vs 31). None of the robotic or laparoscopic procedures required conversion to laparotomy. The differences in major operative and postoperative complications between the two groups were not significant. All patients in both groups are alive and free of disease at the time of last follow up. CONCLUSION: Based on our experience, robotic radical hysterectomy appears to be equivalent to total laparoscopic radical hysterectomy with respect to operative time, blood loss, hospital stay, and oncological outcome. We feel the intuitive nature of the robotic approach, magnification, dexterity, and flexibility combined with significant reduction in surgeon's fatigue offered by the robotic system will allow more surgeons to use a minimally invasive approach to radical hysterectomy.     

Robotics Versus Laparoscopic Radical Hysterectomy with Lymphadenectomy in Patients with Early Cervical Cancer: A Multicenter Study

Background  

The aim of this study was to retrospectively compare the safety, morbidity, and recurrence rate of total laparoscopic radical hysterectomy (TLRH) with lymphadenectomy and total robotic radical hysterectomy (RRH) with lymphadenectomy for early cervical carcinoma in a series of 99 consecutive women.     

Robot-assisted laparoscopy in gynecologic oncology

Objectives  The aim of this prospective study was to evaluate the feasibility and the outcome of gynaecological cancer surgery with the Da Vinci S surgical system (Intuitive Surgical). Methods  From February 2007 to September 2007, 28 patients underwent 32 gynaecological procedures in a single centre. Surgical procedures consisted of total hysterectomy, bilateral oophorectomy, and pelvic and/or lombo-aortic lymphadenectomy. In all cases, surgery was performed using both laparoscopic and robot-assisted laparoscopic techniques. In this heterogeneous series, a subgroup of 12 patients treated for advanced cervical cancer was compared with a retrospective series of 20 patients who underwent the same surgical procedure by laparotomy. Results  Mean age of the entire population was 52.5 years (range 25–72 years) and mean body mass index (BMI) was 25 kg/m² (range 18–40 kg/m²). Indications for surgery were cervical cancer in 21 cases, endometrial cancer in 7 cases, ovarian cancer in 1 case and cervical dysplasia in 3 cases. Median operating time was 180 min (mean 175.25 min, range 80–360 min) and median estimated blood loss was 110 cc (range 0–400 cc); no transfusions were necessary. No perioperative complications were observed and median time of hospitalisation was 3 days (mean 3.9 days, range 2–8 days). In the subgroup of 12 advanced cervical cancer a significant difference was observed in terms of hospital stay compared with laparotomy; no difference was observed concerning operative time. Fewer complications were observed with laparotomy (33% versus 25%) but more serious complications than with robot-assisted laparoscopy. Conclusion  As suggested in the literature, the use of robot-assisted laparoscopy leads to less intraoperative blood loss, less post operative pain and shorter hospital stays compared with those treated by more traditional surgical approaches. Despite the need for more extensive studies, robot-assisted surgery seems to represent a similar technological evolution as the laparoscopic approach 50 years ago.     

Retroperitoneal laparoscopic radical nephrectomy: Intermediate oncological results

Objectives  To report the intermediate oncological results of laparoscopic radical nephrectomy by retroperitoneal approach. Methods  From 1995 to 2006, 146 consecutive patients with removal of a malignant kidney tumor by laparoscopic retroperitoneal radical nephrectomy were analysed retrospectively. The patients were followed clinically, biologically and radiologically every 6 months. Disease-free survival and specific survival were determined among patients free of metastasis at surgery. Results  Patient’s average age was 61.1 years (25–85). The pathology of these cancers were: 108 clear cell carcinomas, 26 papillary carcinomas, 10 chromophobe carcinomas, and 2 miscellaneous. The T stage were: 105 pT1, 12 pT2, and 29 pT3 (TNM 2002). The Fuhrman grade were: I in 23 cases, II in 70 cases, III in 40 cases, and IV in 9 cases. The surgical margins were positive in 2. No port site recurrence occurred. The average follow-up was 35.4 months (1–137). Five patients had metastatic disease at presentation. Tumor progression was observed among 19 patients, in the form of a local (1) or remote recurrence (18). Fourteen patients died, including 7 because of their tumor. The disease-free survival at 5 and 10 years, were respectively 87.3 and 73.2%, and the cancer-specific survival were 96.2 and 92.0%, respectively. Conclusions  The laparoscopic retroperitoneal radical nephrectomy offers intermediate oncological results compatible with appropriate carcinological efficacy.     

Complications of laparoscopic radical hysterectomy and lymphadenectomy for invasive cervical cancer: experience based on 317 procedures

Background This report presents the incidence of complications and conversions during laparoscopic radical hysterectomy and lymphadenectomy performed for invasive cervical carcinoma. The data are analyzed, and strategies to help prevent future complications are discussed. Methods From July 2000 to December 2005 at the authors’ institution, 317 laparoscopic radical hysterectomy and lymphadenectomy procedures for invasive cervical carcinoma were performed. The authors reviewed the database of patients who underwent laparoscopic radical hysterectomy and lymphadenectomy to examine complications and analyze factors associated with conversion to an open surgical procedure. Results All but four surgical procedures were laparoscopically completed. Pelvic lymphadenectomy was performed for all the remaining 313 patients, 143 of whom underwent paraaortic lymphadenectomy. Major and minor intraoperative complications occurred for 4.4% (n = 14) of the patients. The overall conversion rate was 1.3% (n = 4), including 3 emergencies and 1 elective conversion. Seven patients had vessel injuries, five of which were repaired or treated laparoscopically. One left external iliac vein required laparotomy, and one patient underwent laparotomy to control bleeding sites. Operative cystotomies occurred in five patients, which were repaired laparoscopically. Two patients underwent laparotomy because of hypercapnia and ascending colon injury. Postoperative surgery complications occurred in 5.1% (n = 16) of the patients, including 5 patients with ureterovaginal fistula, 4 with vesicovaginal fistula requiring reoperation, 1 with ureterostenosis treated by placement of a double-J ureteral stent, and 6 with bladder dysfunctions (retention) that exhibited complete resolution within 3 to 6 months by intermittent training and catheterization. Conclusions Laparoscopic radical hysterectomy and lymphadenectomy is becoming a routine procedure in the armamentarium of many gynecologists. Complications unique to laparoscopy do exist, but they decrease with repeated training of the procedure and gradually enriched experiences.     

PK刀在腹腔镜下早期子宫恶性肿瘤手术中的应用

目的探讨等离子刀(PK刀)在腹腔镜下广泛子宫切除术和盆腔淋巴结切除术治疗子宫恶性肿瘤中的应用价值。方法2003年1月~2006年12月,应用PK刀行腹腔镜下广泛子宫切除术和盆腔淋巴结切除术治疗30例经活检证实的早期子宫恶性肿瘤,其中子宫颈癌19例,子宫内膜癌11例。结果30例均在腹腔镜下完成手术,无一例中转开腹手术。手术时间(253.2±55.3)min,术中出血量(310.0±147.7)ml,淋巴结切除时间(73.5±23.6)min,淋巴结切除(17.0±6.2)枚,术后肛门排气时间(32.3±11.2)h,术后应用抗生素时间(5.5±1.5)d,术后住院(12±5)d。术中损伤膀胱1例,术后最高体温≥38.5℃3例,尿潴留4例,淋巴囊肿1例。结论PK刀作为兼备切割和止血的腹腔镜手术器械,其止血效果好,创伤小,具有较高的安全性,在子宫恶性肿瘤腹腔镜下行广泛子宫切除术和盆腔淋巴结切除术是安全、可行的。     

腹腔镜在子宫颈癌治疗中的应用--附37例分析

目的　探讨腹腔镜下广泛子宫切除和盆腹腔淋巴结切除治疗子宫颈癌的可行性及价值。　方法　采用腹腔镜下广泛子宫切除和盆腔及腹主动脉周围淋巴结切除治疗 37例子宫颈癌。其中有2 5例选择性腹主动脉周围内淋巴结切除。　结果　腹腔镜下手术时间平均 182min ,术中出血平均16 8ml,切除淋巴结数平均 16个 ,术后住院平均 10 2天。术中发生膀胱损伤 1例、静脉损伤 2例 ,均于镜下修补成功 ;1例损伤大肠中转开腹 ;2例出现尿潴留。　结论　腹腔镜下施行广泛子宫切除和盆腹腔淋巴结切除术安全可行 ,且手术创伤小 ,并发症少 ,术后恢复快。     

Comparison of a novel surgical approach for radical hysterectomy: robotic assistance versus open surgery

To report the learning curve and perioperative outcomes for robotic radical hysterectomy using a unilateral surgical approach transferred directly from one surgeon’s open radical hysterectomy experience, thirty-two consecutive robotic radical hysterectomy cases (10/2006–1/2009) were contrasted to a cohort of 20 consecutive open radical hysterectomies (2/2005–2/2008). Perioperative characteristics compared included operative time, number of nodes, estimated blood loss, length of hospital stay, and complications. Robotic operative times were significantly longer than for open (122.1 ± 33.0 versus 67.5 ± 16.2 min, P < 0.0001), but decreased with experience, going from 156.0 min for the first eight robotic cases to 95.0 min for the last eight cases (P < 0.05). Blood loss (99.2 ± 46.2 mL versus 275.0 ± 206.0 mL, P < 0.0001) and length of hospital stay (1.7 versus 5.2 days, P < 0.001) were significantly lower for the robotic cohort. Lymph node yield in the robotic cohort was equivalent to that for the open cohort (11.5 versus 9.2, P = 0.1446), and complication rates were 21.9% for robotic and 30.0% for open radical hysterectomy. Implementing a unilateral approach to maximize surgical efficiency greatly reduced surgical times without compromising patient morbidity, bringing robotic operative times while still within the learning curve close to those for open radical hysterectomy. Thus, robotic radical hysterectomy may soon be considered the preferred standard front-line therapy for cervical cancer.