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Hayashi S, Kojima J, Sasaki T, Yamamoto A, Kato K, Nishi H. Robot-assisted Surgery with Para-aortic Lymphadenectomy for Endometrial Cancer: A Preliminary Report. Gynecol Minim Invasive Ther 2024; 13:95-100. [PMID: 38911311 PMCID: PMC11192276 DOI: 10.4103/gmit.gmit_29_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 06/03/2023] [Accepted: 06/09/2023] [Indexed: 06/25/2024] Open
Abstract
Objectives There are few reported cases of robot-assisted surgery for endometrial cancer with para-aortic lymphadenectomy (PAL) in Japan. Therefore, this study aimed to examine the clinical outcomes of robot-assisted surgery with PAL for endometrial cancer. Materials and Methods This retrospective cohort study was analyzed 13 endometrial cancer patients who underwent robotic surgery with PAL between January 2011 and October 2018 at our hospital. We examined their perioperative complications and oncological outcomes. Results The median follow-up period, median overall survival, and disease-free interval were 80 months, 79 months (61-120), and 79 months (5-120), respectively. There were two (15.3%) cases of perioperative complications of Clavien-Dindo Class II or higher and three (23.0%) cases of recurrence. Conclusion Our results showed that the surgical and oncological outcomes of robot-assisted surgery for endometrial cancer with PAL were comparable with those of other developed countries.
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Affiliation(s)
- Shigehiro Hayashi
- Department of Obstetrics and Gynecology, Tokyo Medical University, Tokyo
| | - Junya Kojima
- Department of Obstetrics and Gynecology, Tokyo Medical University, Tokyo
| | - Toru Sasaki
- Department of Obstetrics and Gynecology, Tokyo Medical University, Tokyo
| | - Akiko Yamamoto
- Department of Obstetrics and Gynecology, Tokyo Medical University, Tokyo
| | - Kazuyoshi Kato
- Department of Obstetrics and Gynecology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Hirotaka Nishi
- Department of Obstetrics and Gynecology, Tokyo Medical University, Tokyo
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2
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Ponce J, Fernández S, Barahona M, Martínez JM, Ortega C, Martí L. Robotic-assisted para-aortic lymphadenectomy: Technique and indications in gynecological oncology. Best Pract Res Clin Obstet Gynaecol 2023; 91:102401. [PMID: 37678062 DOI: 10.1016/j.bpobgyn.2023.102401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 06/21/2023] [Accepted: 07/27/2023] [Indexed: 09/09/2023]
Abstract
The benefits of minimally-invasive surgeries have been documented, and they have been established as the preferred approach for gynecological surgeries. With the development of robotic surgery, many highly complex surgeries can benefit from these advantages. Due to the complexity of aortocaval lymphadenectomy, surgical technique protocols have been described to reduce risks by maximizing benefits. We describe the technique using five ports (4 robotic arms and an assistant) to work the upper abdominal field, and different instruments recommended in each of their positions to reduce errors and optimize surgical time. After the "step by step" description, we summarize indications of aortocaval lymphadenectomy for every gynecological cancer in different stages.
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Affiliation(s)
- Jordi Ponce
- Gynecologic Department, University Hospital of Bellvitge (IDIBELL), University of Barcelona, Spain.
| | - Sergi Fernández
- Gynecologic Department, University Hospital of Bellvitge (IDIBELL), University of Barcelona, Spain.
| | - Marc Barahona
- Gynecologic Department, University Hospital of Bellvitge (IDIBELL), University of Barcelona, Spain.
| | - José Manuel Martínez
- Gynecologic Department, University Hospital of Bellvitge (IDIBELL), University of Barcelona, Spain.
| | - Carlos Ortega
- Gynecologic Department, University Hospital of Bellvitge (IDIBELL), University of Barcelona, Spain.
| | - Lola Martí
- Gynecologic Department, University Hospital of Bellvitge (IDIBELL), University of Barcelona, Spain.
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3
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Yim NH, McCarter J, Haykal T, Aral AM, Yu JZ, Reece E, Winocour S. Robotic Surgery and Hospital Reimbursement. Semin Plast Surg 2023; 37:223-228. [PMID: 38444958 PMCID: PMC10911894 DOI: 10.1055/s-0043-1771234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
The field of plastic surgery remains at the forefront of technological and surgical innovation. However, the promising applications of robotics in plastic surgery must be thoughtfully balanced with hospital finances and reimbursements. Robotic systems have been studied extensively across multiple surgical disciplines and across diverse health care systems. The results show that there may be equal or better patient outcomes than alternatives. In an era where fiscal responsibility in health care is a top priority, thoughtful budgeting and spending must be considered and revisited frequently to attain sustainable organizational models that ensure appropriate use of robotic technology.
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Affiliation(s)
- Nicholas H. Yim
- Michael E. DeBakey Department of Surgery, Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas
- Division of Plastic Surgery, Texas Children's Hospital, Houston, Texas
| | - Jacob McCarter
- Michael E. DeBakey Department of Surgery, Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas
- Division of Plastic Surgery, Texas Children's Hospital, Houston, Texas
| | - Tareck Haykal
- Michael E. DeBakey Department of Surgery, Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas
- Division of Plastic Surgery, Texas Children's Hospital, Houston, Texas
| | - Ali M. Aral
- Michael E. DeBakey Department of Surgery, Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas
- Division of Plastic Surgery, Texas Children's Hospital, Houston, Texas
| | - Jessie Z. Yu
- Department of Plastic Surgery at The University of Texas, MD Anderson, Houston, Texas
| | - Edward Reece
- Division of Plastic and Reconstructive Surgery at Mayo Clinic in Arizona, Phoenix, Arizona
| | - Sebastian Winocour
- Department of Plastic Surgery at The University of Texas, MD Anderson, Houston, Texas
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4
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Chuang YC, Chen YC, Huang JH, Chiu KM. Robotic management of severe hemorrhage during para-aortic lymph node dissection. Asian J Surg 2023; 46:1526. [PMID: 36357281 DOI: 10.1016/j.asjsur.2022.09.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 09/14/2022] [Indexed: 11/09/2022] Open
Affiliation(s)
- Yi-Chen Chuang
- Department of Obstetrics and Gynecology, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Yen-Cheng Chen
- Department of Obstetrics and Gynecology, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Jih-Hsin Huang
- Division of Cardiovascular Surgery, Cardiovascular Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Kuan-Ming Chiu
- Division of Cardiovascular Surgery, Cardiovascular Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
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5
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Zhou Z, Ge J, Ye K, Zhang Y, Hu Q, Wang L, Chen Y. Comparison of Robotic-Assisted vs. Conventional Laparoscopy for Para-aortic Lymphadenectomy in Gynecological Malignancies: A Systematic Review and Meta-Analysis. Front Surg 2023; 9:843517. [PMID: 36684197 PMCID: PMC9845261 DOI: 10.3389/fsurg.2022.843517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 03/02/2022] [Indexed: 01/05/2023] Open
Abstract
Background Robotic-assisted surgery is one of the novel minimally invasive surgical techniques for the treatment of gynecological malignancies. The aim of this systematic review and meta-analysis was to compare the outcomes of robot-assisted vs. conventional laparoscopy for para-aortic lymphadenectomy (PAL) in patients with gynecological malignancies. Methods An electronic search in PubMed, Scopus, Cochrane Central Register of Controlled Trials (CENTRAL), and Google Scholar databases was performed for articles, published up to 01st November 2021. Outcomes including operating time (OT), total blood loss (TBL), length of stay (LOS), and complication rate (CR) in robot-assisted vs. conventional laparoscopy were investigated. Results A total of nine studies (7 non-RCTs and 2 RCTs) involving 914 participants were included. Of them, 332 patients underwent robotic laparoscopy (robotic group) and 582-conventional laparoscopy (conventional laparoscopy group). A significant decrease in TBL (MD = -149.1; 95% CI: -218.4 to -79.91) [ml] was observed in the robotic group as compared to the conventional laparoscopy group. However, no significant difference was noted for OT, CR, and LOS in the overall findings. Further subgroup analysis showed that the robotic group had a lower OT in mixed histological populations and studies reporting on the extraperitoneal approach. The lower chance of TBL was observed in mixed histological populations and studies involving extraperitoneal approach, Caucasian population, and non-RCTs design. Conclusions Robotic laparoscopy has a significant advantage over the conventional laparoscopy approach for PAL in gynecological malignancies. Further prospective observational studies embedded with a large sample size are needed to validate our findings.
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Gracia Segovia M, Coronado Martín P, Herraiz M. Cirugía ginecológica en la paciente obesa. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2021. [DOI: 10.1016/j.gine.2020.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Gracia M, García-Santos J, Ramirez M, Bellón M, Herraiz MA, Coronado PJ. Value of robotic surgery in endometrial cancer by body mass index. Int J Gynaecol Obstet 2020; 150:398-405. [PMID: 32506474 DOI: 10.1002/ijgo.13258] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 04/07/2020] [Accepted: 06/02/2020] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To compare perioperative outcomes and complications in robotically assisted laparoscopy (RAL) and standard laparoscopy (SLP) approaches in the treatment of endometrial cancer by body mass index (BMI, calculated as weight in kilograms divided by the square of height in meters). METHODS A comparative study was carried out of women treated for endometrial cancer at the Hospital Clinico San Carlos from January 2012 to December 2016: 133 patients were operated by RAL and 101 by SLP. Demographic characteristics of the patients, perioperative outcomes and complications were compared in both approaches. RESULTS Hospital stay was significantly lower in patients with BMI ≤30 operated with RAL (2 days RAL vs 4 days SLP; P=0.002). Estimated blood loss was significantly lower in the group with BMI<25 (60 mL RAL vs 100 mL SLP; P=0.004) and in the group with BMI ≥30 (87.5 mL RAL vs 180 SLP; P=0.003) operated with RAL. RAL significantly reduced the conversion rate in patients with BMI ≥30 (2 [3.4%] patients RAL vs 6 [27.3%] patients SLP; P=0.004). CONCLUSIONS RAL has demonstrated advantages in treating obese women with endometrial cancer by reducing blood loss and conversion to laparotomy.
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Affiliation(s)
- Myriam Gracia
- José Botella Llusiá Institute of Women's Health, Sanitary Research Institute of the San Carlos Clinical Hospital (IdISSC), Complutense University of Madrid, Madrid, Spain
| | - Javier García-Santos
- José Botella Llusiá Institute of Women's Health, Sanitary Research Institute of the San Carlos Clinical Hospital (IdISSC), Complutense University of Madrid, Madrid, Spain
| | - Mar Ramirez
- José Botella Llusiá Institute of Women's Health, Sanitary Research Institute of the San Carlos Clinical Hospital (IdISSC), Complutense University of Madrid, Madrid, Spain
| | - Mónica Bellón
- José Botella Llusiá Institute of Women's Health, Sanitary Research Institute of the San Carlos Clinical Hospital (IdISSC), Complutense University of Madrid, Madrid, Spain
| | - Miguel A Herraiz
- José Botella Llusiá Institute of Women's Health, Sanitary Research Institute of the San Carlos Clinical Hospital (IdISSC), Complutense University of Madrid, Madrid, Spain
| | - Pluvio J Coronado
- José Botella Llusiá Institute of Women's Health, Sanitary Research Institute of the San Carlos Clinical Hospital (IdISSC), Complutense University of Madrid, Madrid, Spain
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Miura JT, Dossett LA, Thapa R, Kim Y, Potdar A, Daou H, Sun J, Sarnaik AA, Zager JS. Robotic-Assisted Pelvic Lymphadenectomy for Metastatic Melanoma Results in Durable Oncologic Outcomes. Ann Surg Oncol 2019; 27:196-202. [PMID: 30949862 DOI: 10.1245/s10434-019-07333-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Indexed: 01/29/2023]
Abstract
BACKGROUND Robotic pelvic lymphadenectomy (rPLND) has been demonstrated to be a safe and effective minimally invasive approach for patients with metastatic melanoma to the iliac nodes. However, the long-term oncologic benefit of this procedure remains poorly defined. METHODS A single-institutional study comparing perioperative outcomes and survival [recurrence-free (RFS) and overall survival (OS)] between rPLND and open PLND (oPLND) for metastatic melanoma was conducted. RESULTS From 2006 to 2018, a total of 63 PLND cases were identified: 22 rPLND and 41 oPLND. Evidence of isolated pelvic metastasis was the most common indication for PLND in both groups (rPLND: 64%, oPLND: 85%). There was no difference in median pelvic lymph node yield (11 vs. 9 nodes, p = 0.65). Neither treatment group experienced a Clavien-Dindo complication ≥ 3. rPLND was associated with a shorter length of stay compared with oPLND (2 vs. 4 days, p < 0.001). With a median follow-up of 37 months, there was no difference in RFS (14.4 vs. 9.6 months, p = 0.47) and OS (43 vs. 50 months, p = 0.58) between rPLND and oPLND, respectively. In basin recurrence was low with 1 (4.5%) and 3 (7.3%) patients in the rPLND and oPLND cohorts, respectively, experiencing an event (p = 0.9). CONCLUSIONS rPLND for metastatic melanoma is a safe, minimally invasive treatment strategy that appears to result in similar intermediate term recurrence and survival rates as oPLND but shorter hospital stays.
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Affiliation(s)
- John T Miura
- Department of Cutaneous Oncology, Moffitt Cancer Center and Research Institute, University of South Florida School of Medicine, 10920 N. McKinley Drive, Room 4123, Tampa, FL, 33612, USA
| | - Lesly A Dossett
- Department of Surgery, Rogel Cancer Center University of Michigan, Ann Arbor, MI, USA
| | - Ram Thapa
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Youngchul Kim
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Aishwarya Potdar
- Department of Cutaneous Oncology, Moffitt Cancer Center and Research Institute, University of South Florida School of Medicine, 10920 N. McKinley Drive, Room 4123, Tampa, FL, 33612, USA
| | - Hala Daou
- Department of Cutaneous Oncology, Moffitt Cancer Center and Research Institute, University of South Florida School of Medicine, 10920 N. McKinley Drive, Room 4123, Tampa, FL, 33612, USA
| | - James Sun
- Department of Cutaneous Oncology, Moffitt Cancer Center and Research Institute, University of South Florida School of Medicine, 10920 N. McKinley Drive, Room 4123, Tampa, FL, 33612, USA
| | - Amod A Sarnaik
- Department of Cutaneous Oncology, Moffitt Cancer Center and Research Institute, University of South Florida School of Medicine, 10920 N. McKinley Drive, Room 4123, Tampa, FL, 33612, USA
| | - Jonathan S Zager
- Department of Cutaneous Oncology, Moffitt Cancer Center and Research Institute, University of South Florida School of Medicine, 10920 N. McKinley Drive, Room 4123, Tampa, FL, 33612, USA.
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Gallotta V, Federico A, Gaballa K, D'Indinosante M, Conte C, Giudice MT, Naldini A, Lodoli C, Rotolo S, Gallucci V, Tortorella L, Romanò B, Scambia G, Ferrandina G. The role of robotic aortic lymphadenectomy in gynecological cancer: surgical and oncological outcome in a single institution experience. J Surg Oncol 2018; 119:355-360. [PMID: 30554410 DOI: 10.1002/jso.25335] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 11/25/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND OBJECTIVE This study aims to investigate the surgical outcomes observed in robotic transperitoneal aortic lymphadenectomy (AL) in gynecological cancer patients. METHODS Retrospective data were collected and analyzed on 71 patients undergoing robotic surgical procedures for gynecological cancers, including transperitoneal AL, between December 2014 and February 2018 at the Catholic University of the Sacred Heart, Rome, Italy. RESULTS Median age of the sample population was 50 years (range, 26-76 years). The median operative time was 210 minutes (range, 75-480 minutes), the median estimated blood loss was 50 ml (range, 20-300 ml). The number of para-aortic nodes removed was 12 (range, 7-43). In the whole series, 13 patients (18.3%) had at least one metastatic node. Overall, 10 patients (14.1%) experienced any grade early postoperative complications. Three patients experienced more than one complication. Three intraoperative complications occurred with two cases of vascular injury. Conversion to laparotomy was necessary for one patient (1.4%). CONCLUSIONS The present study shows the safety and adequacy of robotic transperitoneal AL as surgical staging step for gynecological cancers in terms of perioperative and postoperative outcomes.
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Affiliation(s)
- Valerio Gallotta
- Division of Gynecologic Oncology, Department of Women's and Children's Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Alex Federico
- Istituto di Ginecologia e Ostetricia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Khaled Gaballa
- Division of Surgical Oncology, Oncology Center Mansoura University, Mansoura, Egypt
| | - Marco D'Indinosante
- Istituto di Ginecologia e Ostetricia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Carmine Conte
- Division of Gynecologic Oncology, Department of Women's and Children's Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Maria Teresa Giudice
- Istituto di Ginecologia e Ostetricia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Angelica Naldini
- Division of Gynecologic Oncology, Department of Women's and Children's Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Claudio Lodoli
- Division of General Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Stefano Rotolo
- Division of General Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Valeria Gallucci
- Division of Gynecologic Oncology, Department of Women's and Children's Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Lucia Tortorella
- Division of Gynecologic Oncology, Department of Women's and Children's Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Bruno Romanò
- Institute of Intensive Care Medicine and Anesthesiology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giovanni Scambia
- Division of Gynecologic Oncology, Department of Women's and Children's Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Istituto di Ginecologia e Ostetricia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gabriella Ferrandina
- Division of Gynecologic Oncology, Department of Women's and Children's Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Istituto di Ginecologia e Ostetricia, Università Cattolica del Sacro Cuore, Rome, Italy
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Minimally Invasive Surgery to Treat Gynecological Cancer: Conventional Laparoscopy and/or Robot-Assisted Surgery. Int J Gynecol Cancer 2018; 27:562-574. [PMID: 28187093 DOI: 10.1097/igc.0000000000000925] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Robotic-assisted surgery is a technological advancement derived from conventional laparoscopy, which facilitates the application of minimally invasive techniques for complex operations in the field of gynecological oncology. However, its introduction in gynecological cancer has been scarce in most hospitals worldwide. Most publications on robotic surgery are still retrospective or descriptive in nature. Some studies compare robotic-assisted laparoscopy with open procedures, which is a questionable analysis, because the advantages of minimally invasive surgery have been already well established. Robotic surgery should be directly compared with conventional laparoscopy to determine whether its additional direct and indirect costs are in accordance with some improvements within patient clinical outcomes. On the other hand, the role of robotic-assisted surgery in allowing more patients to receive the benefits of the minimally invasive approach should also be considered. The objective of this article was, therefore, to review the literature regarding the role of conventional and robotic-assisted laparoscopy to treat women with gynecologic cancer.
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11
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Lee HJ, Lee YH, Chong GO, Hong DG, Lee YS. Comparison of robotic-assisted versus laparoscopy for transperitoneal infrarenal para-aortic lymphadenectomy in patients with endometrial cancer. J Obstet Gynaecol Res 2017; 44:547-555. [DOI: 10.1111/jog.13535] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 09/27/2017] [Indexed: 12/01/2022]
Affiliation(s)
- Hyun Jung Lee
- Department of Obstetrics and Gynecology; School of Medicine, Kyungpook National University; Daegu Republic of Korea
| | - Yoon Hee Lee
- Department of Obstetrics and Gynecology; School of Medicine, Kyungpook National University; Daegu Republic of Korea
| | - Gun Oh Chong
- Department of Obstetrics and Gynecology; School of Medicine, Kyungpook National University; Daegu Republic of Korea
| | - Dae Gy Hong
- Department of Obstetrics and Gynecology; School of Medicine, Kyungpook National University; Daegu Republic of Korea
| | - Yoon Soon Lee
- Department of Obstetrics and Gynecology; School of Medicine, Kyungpook National University; Daegu Republic of Korea
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12
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Cost–benefit analysis of robotic surgery in gynaecological oncology. Best Pract Res Clin Obstet Gynaecol 2017; 45:7-18. [DOI: 10.1016/j.bpobgyn.2017.03.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Revised: 03/21/2017] [Accepted: 03/21/2017] [Indexed: 10/19/2022]
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13
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Jayne D, Pigazzi A, Marshall H, Croft J, Corrigan N, Copeland J, Quirke P, West N, Rautio T, Thomassen N, Tilney H, Gudgeon M, Bianchi PP, Edlin R, Hulme C, Brown J. Effect of Robotic-Assisted vs Conventional Laparoscopic Surgery on Risk of Conversion to Open Laparotomy Among Patients Undergoing Resection for Rectal Cancer: The ROLARR Randomized Clinical Trial. JAMA 2017; 318:1569-1580. [PMID: 29067426 PMCID: PMC5818805 DOI: 10.1001/jama.2017.7219] [Citation(s) in RCA: 775] [Impact Index Per Article: 110.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
IMPORTANCE Robotic rectal cancer surgery is gaining popularity, but limited data are available regarding safety and efficacy. OBJECTIVE To compare robotic-assisted vs conventional laparoscopic surgery for risk of conversion to open laparotomy among patients undergoing resection for rectal cancer. DESIGN, SETTING, AND PARTICIPANTS Randomized clinical trial comparing robotic-assisted vs conventional laparoscopic surgery among 471 patients with rectal adenocarcinoma suitable for curative resection conducted at 29 sites across 10 countries, including 40 surgeons. Recruitment of patients was from January 7, 2011, to September 30, 2014, follow-up was conducted at 30 days and 6 months, and final follow-up was on June 16, 2015. INTERVENTIONS Patients were randomized to robotic-assisted (n = 237) or conventional (n = 234) laparoscopic rectal cancer resection, performed by either high (upper rectum) or low (total rectum) anterior resection or abdominoperineal resection (rectum and perineum). MAIN OUTCOMES AND MEASURES The primary outcome was conversion to open laparotomy. Secondary end points included intraoperative and postoperative complications, circumferential resection margin positivity (CRM+) and other pathological outcomes, quality of life (36-Item Short Form Survey and 20-item Multidimensional Fatigue Inventory), bladder and sexual dysfunction (International Prostate Symptom Score, International Index of Erectile Function, and Female Sexual Function Index), and oncological outcomes. RESULTS Among 471 randomized patients (mean [SD] age, 64.9 [11.0] years; 320 [67.9%] men), 466 (98.9%) completed the study. The overall rate of conversion to open laparotomy was 10.1%: 19 of 236 patients (8.1%) in the robotic-assisted laparoscopic group and 28 of 230 patients (12.2%) in the conventional laparoscopic group (unadjusted risk difference = 4.1% [95% CI, -1.4% to 9.6%]; adjusted odds ratio = 0.61 [95% CI, 0.31 to 1.21]; P = .16). The overall CRM+ rate was 5.7%; CRM+ occurred in 14 (6.3%) of 224 patients in the conventional laparoscopic group and 12 (5.1%) of 235 patients in the robotic-assisted laparoscopic group (unadjusted risk difference = 1.1% [95% CI, -3.1% to 5.4%]; adjusted odds ratio = 0.78 [95% CI, 0.35 to 1.76]; P = .56). Of the other 8 reported prespecified secondary end points, including intraoperative complications, postoperative complications, plane of surgery, 30-day mortality, bladder dysfunction, and sexual dysfunction, none showed a statistically significant difference between groups. CONCLUSIONS AND RELEVANCE Among patients with rectal adenocarcinoma suitable for curative resection, robotic-assisted laparoscopic surgery, as compared with conventional laparoscopic surgery, did not significantly reduce the risk of conversion to open laparotomy. These findings suggest that robotic-assisted laparoscopic surgery, when performed by surgeons with varying experience with robotic surgery, does not confer an advantage in rectal cancer resection. TRIAL REGISTRATION isrctn.org Identifier: ISRCTN80500123.
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Affiliation(s)
- David Jayne
- Department of Academic Surgery, Leeds Institute of Biological and Clinical Sciences, University of Leeds, Leeds, United Kingdom
| | | | - Helen Marshall
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, United Kingdom
| | - Julie Croft
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, United Kingdom
| | - Neil Corrigan
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, United Kingdom
| | - Joanne Copeland
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, United Kingdom
| | - Phil Quirke
- Section of Pathology and Tumour Biology, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, United Kingdom
| | - Nick West
- Section of Pathology and Tumour Biology, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, United Kingdom
| | - Tero Rautio
- Division of Gastroenterology, Department of Surgery, Oulu University Hospital, Oulu, Finland
| | | | | | | | | | - Richard Edlin
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Claire Hulme
- Academic Unit of Health Economics, University of Leeds, Leeds, United Kingdom
| | - Julia Brown
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, United Kingdom
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14
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Manciu S, Dragomir M, Curea F, Vasilescu C. Robotic Surgery: A Solution in Search of a Problem—A Bayesian Analysis of 343 Robotic Procedures Performed by a Single Surgical Team. J Laparoendosc Adv Surg Tech A 2017; 27:363-374. [DOI: 10.1089/lap.2016.0323] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Simona Manciu
- Department of General Surgery and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania
| | - Mihnea Dragomir
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Fabiana Curea
- Department of Oncology, Institute of Oncology “Prof. Dr. Al. Trestioreanu,” Bucharest, Romania
| | - Catalin Vasilescu
- Department of General Surgery and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
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Gucer F, Misirlioglu S, Ceydeli N, Taskiran C. Robot-assisted laparoscopic transperitoneal infrarenal lymphadenectomy in patients with locally advanced cervical cancer by single docking: Do we need a backup procedure? J Robot Surg 2017; 12:49-58. [DOI: 10.1007/s11701-017-0685-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 02/12/2017] [Indexed: 10/20/2022]
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Lara-Domínguez MD, López-Jiménez A, Grabowski JP, Arjona-Berral JE, Zapardiel I. Prospective observational study comparing traditional laparoscopy and three-dimensional laparoscopy in gynecologic surgery. Int J Gynaecol Obstet 2017; 136:320-324. [DOI: 10.1002/ijgo.12078] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Revised: 10/24/2016] [Accepted: 12/07/2016] [Indexed: 11/06/2022]
Affiliation(s)
| | | | - Jacek P. Grabowski
- Department of Gynecology; European Competence Center for Ovarian Cancer; Charité-University Medicine of Berlin; Berlin Germany
| | | | - Ignacio Zapardiel
- Gynecologic Oncology Unit; La Paz University Hospital; IdiPAZ; Madrid Spain
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Díaz-Feijoo B, Correa-Paris A, Pérez-Benavente A, Franco-Camps S, Sánchez-Iglesias JL, Cabrera S, de la Torre J, Centeno C, Puig OP, Gil-Ibañez B, Colas E, Magrina J, Gil-Moreno A. Prospective Randomized Trial Comparing Transperitoneal Versus Extraperitoneal Laparoscopic Aortic Lymphadenectomy for Surgical Staging of Endometrial and Ovarian Cancer: The STELLA Trial. Ann Surg Oncol 2016; 23:2966-74. [DOI: 10.1245/s10434-016-5229-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Indexed: 11/18/2022]
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Geppert B, Persson J. Robotic infrarenal paraaortic and pelvic nodal staging for endometrial cancer: feasibility and lymphatic complications. Acta Obstet Gynecol Scand 2015. [DOI: 10.1111/aogs.12712] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Barbara Geppert
- Department of Obstetrics and Gynecology; Skane University Hospital; Lund University; Lund Sweden
| | - Jan Persson
- Department of Obstetrics and Gynecology; Skane University Hospital; Lund University; Lund Sweden
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19
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Iavazzo C, Gkegkes ID. Robotic retroperitoneal lymph node dissection in gynaecological neoplasms: comparison of extraperitoneal and transperitoneal lymphadenectomy. Arch Gynecol Obstet 2015; 293:11-28. [PMID: 26188777 DOI: 10.1007/s00404-015-3814-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 07/03/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The main aim of our study is to review the till now available literature data on the role of robotic retroperitoneal lymph node dissection in gynaecological cancers by comparing the extraperitoneal versus the transperitoneal approach. METHODS A thorough and systematic search was performed in electronic databases of PubMed and Scopus. RESULTS The extraperitoneal approach is described in 148 patients. The age of the patients ranged from 26 to 78 years. The indications included cervical, endometrial and ovarian carcinoma in 113, 22 and 12 patients, respectively. The operative time ranged between 45 and 410 min. The number of dissected lymph nodes ranged from 3 to 25, while only 13 of them were found to be positive. The mean estimated blood loss during the operation was 77 ml (range <50-200 ml). Seven cases were converted to open. The duration of hospital stay ranged from 2 to 14 days. The transperitoneal approach is described in 898 patients. The age of the patients ranged from 15 to 89 years. Cervical, endometrial and ovarian carcinomas were the principal neoplasias present in 248, 449 and 164 patients, respectively. The operative time ranged from 19 to 633 min. The number of dissected lymph nodes ranged from 1 to 54, while the total number of patients with positive lymph nodes dissected was 56 patients. The estimated blood loss during the operation varied between 20 and 1800 ml. Only 9 out of 898 patients were converted to open. The duration of hospital stay ranged from 1 to 40 days. CONCLUSION A reliable definition of the "kind" of lymphadenectomy used in each study is the first step in order to reach safe conclusions. The lack of comparative studies, especially the randomized ones, cannot help us draw any safe conclusion regarding both the clinical outcomes and the possibility of any superiority of these different approaches (extraperitoneal and transperitoneal).
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Affiliation(s)
- Christos Iavazzo
- Gynaecological Oncology Department, Christie Hospital, Manchester, UK. .,, 38, Seizani Str., Nea Ionia, 14231, Athens, Greece.
| | - Ioannis D Gkegkes
- First Department of Surgery, General Hospital of Attica "KAT", Athens, Greece
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